Copyright ©1997-2005 American Society of Exercise Physiologists   All Rights Reserved.


        Professionalization of Exercise Physiologyonline        


         ISSN 1099-5862   Vol 8 No 11 November 2005 
 

 

Editor-in-Chief:   Tommy Boone, PhD, MPH, FASEP EPC
 
Addressing Conflicts of Interest in Exercise Physiology
Tommy Boone, PhD, MPH, FASEP, EPC
Professor and Chair
Director, Exercise Physiology Laboratories
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811

“In 2000, the drug industry sponsored more than 314,000 events for physicians – everything from luncheons to getaway weekends – at a cost of almost $2 billion.  On top of that, many doctors accept speaking and consulting fees that link them to drug companies.” – John McKenzie [1]

The editors of the New England Journal of Medicine and other scientific and medical journals are wrestling with what they believe is an important conflict of interest.  In short, they are uncomfortable with authors who are unduly influenced by secondary financial interest.  The decision to disclose consulting and other relationships with commercial sponsors is not easy for many authors.  Questioning a researcher, professor, or a physician about consulting fees is never popular.  Many say they have the right to make the money, which raises the question: “Why do you have the right to say anything about what I make in consulting fees?”  Of course the reason behind the question is obvious.  A person who promotes a product may not be able to discuss or represent the facts fairly and accurately.

“If you can’t beat‘em, join’em” is a common attitude [1] among researchers and healthcare professionals prevail.  Part of the reason is that the “…drug companies’ reach is just too deep.”  And, if that is the case with physicians, what is the use of exercise physiologists trying to avoid conflict of interest?  After all, the medical profession is well established and the exercise physiology profession is just beginning its profession path.  If any profession has the power to avoid the bias introduced by drug companies, physicians should have it.  But, some are unwilling to separate the their medical practice from consulting deals.  More medical journals are publishing articles by authors who are consultants for drug companies [2].

Conflict of interest is a problem is medicine.  This is partly the reason George Soros [3] concluded that, “…the integrity of the medical profession is…endangered today….”  When this comment was discussed in a graduate class, a student said, “This is really hard to believe.  Everyone knows that the medical profession is at the top of the career ladder.  All my biology friends are applying to medical school.”  Then, she said, “Isn’t the medical profession guided by ethical and professional values?”  That is the crux of the problem.  If the work of physicians is guided by professional values and ethics, then physicians should be held accountable to the practice of medicine?  Is medicine for sale?  Maybe professional values, honesty, and integrity are not more important than money!  Clearly, the business element [3] of medicine is alive and well.   

It may come as a surprise that business element is also alive and well in exercise physiology.  Today, it is not enough to be a professor.  Highly individualized market plans in the pursuit of financial success [4, 5] are evident on the Internet.  No wonder exercise physiologists are confused, especially when they realize the potential for conflict of interest.  Exercise physiologists who do research in sports nutrition more so than exercise physiologists with an interest in cardiovascular physiology or cardiac rehabilitation are especially vulnerable.  The potential for conflict is greater because the supplement companies are literally no different from the drug companies who want to promote their products.  And, frankly, after reading hundreds of scientific journals, magazines, newspapers, and articles on the Internet, it is clear that most of it is little more than an advertisement for different products. 

Recently, a student in a professional development class said, “Dr. Boone, I’ve read that the true test of any ergogenic aid is whether it works.  Since creatine is reported to improve exercise capacity in the majority of studies, it must be ethical to ingest it.  If it didn’t improve performance, it would be unethical.  This way of thinking seems all wrong since it doesn’t allow for the consideration of whether it is ethical to use creatine in the first place.”  Mike knew that athletes have used sports supplement strategies since time immemorial.  But, he was concerned about the athlete’s reliance on supplements, the impact on the credibility of exercise physiology, the fact that the industry is unregulated, and that the products are potentially dangerous untested ingredients.  Clearly, the business side of sports nutrition and the role of the exercise physiologists as paid consultants must be addressed.  The sports supplement industry is aided by exercise physiologists who have written dozens of books specifically to explore, perhaps encourage, and market supplements [6] others performance-enhancers [7]. 

  • Sports Supplements: A Complete Guide to Physique and Athletic Enhancement 
  • Sports Supplement Encyclopedia 
  • Supplements for Endurance Athletes
  • Supplements for Strength-Power Athletes
  • Fit Kids-for-Life: A Parents Guide to Optimal Nutrition and Training for Young Athletes
  • Fast Track:  Training and Nutrition Secrets from America’s Top Female Runner
  • Sustaining the Caffeine Advantage
  • Javalution - Fitness and Weight Loss Through Functional Coffee
  • Essentials of Sports Nutrition and Supplements
  •  Double Play - Training and Nutrition Advice from the World's Experts in Baseball
  • Essentials of Creatine in Sports
  • Essentials of Protein and Amino Acids in Sports
  • Creatine –The Power Supplement

This means that sports nutrition is no longer just a course in the exercise physiology curriculum.  It has taken on a business life of its own.  The “new view” of sports nutrition as a business is not in the best interest of exercise physiology.  Rather than sports nutrition serving exercise physiologists, there is the real possibility that the emphasis on sports supplements is a disservice to the profession.  With the financial enticements as they are, sports nutrition has become a business much like the pharmaceutical business that has its grip on the medical profession.  Forget the shared professional values of right and wrong that should guide professionals and the teaching of sports nutrition, it is increasingly dominated by the for-profit sports supplement businesses.  Occasionally, as bad as it sounds, I’ve heard from several colleagues who believe that some exercise physiologists put their financial goals above the interests of athletes and often disregard their ethical responsibilities to the public sector.   

What is obvious is this:  The sports supplement industry is in the business of making money.  The CEOs and consultants are interested in making a profit.  They are not interested in providing healthcare, which is the business of exercise physiologists.  This raises the question:  “Why are exercise physiologists giving sports nutrition away to the supplement industry?”  Obviously, sports supplements do not constitute sports nutrition.  Why, then, has the power of sports nutrition shifted from exercise physiology to the sports supplement industry?  The answer is money and misdirected thinking.  Some may say it is about the science of athletics and high performance competition.  And since some exercise physiologists are engaged in very lucrative sports supplement businesses, what are the professional implications? 

  • Could professionalism suffer at the hands of making money?
  • Are exercise physiologists more ethical than physicians? 
  • Could consulting fees, grants, and sport supplement company purchased equipment and supplies influence the future of sports nutrition? 
  • Are exercise physiologists immune to ethical problems?
  • Is the presence of the sports supplement industry in the sports nutrition course or the exercise nutrition curriculum good for students?
  • Is it logical not to believe that the supplement industry is buying something for their financial investment?

For the record, my answers to the six questions are: “yes, no, yes, no, no, and no.”  What are your answers?  It seems certain that it is almost impossible to rule out the increased opportunities to benefit financially.  Understandably, not every university has tons of money to spend on laboratory equipment for research.  But, the question is:  “Should the exercise physiologist’s laboratory be funded by the supplement industry?”  Also, should graduate students be encouraged to research supplements to run faster, jump higher, or get bigger muscles (i.e., if they actually work)?  This topic raises more questions than answers, such as:  Why isn’t there a conflict of interest with exercise physiologists who are paid consultants of the sports supplement industry?  One view is that it certainly can be a conflict of interest.  This concern for violating professional ethics has led me to re-visit the exercise physiologist’s code of ethics [8] on numerous occasions.  Is it possible for exercise physiologists to be recognized as healthcare professionals with credibility if they do not honor their own code of ethics?       

Aside from the ethical issues that professionals think that exercise physiologists face when they promote sports supplements, there is good evidence that much of the supplement advertising isn’t just misleading but legally questionable as well.  The promotional statements made in nearly all the advertisements are not supported by actual research data, despite the claims otherwise.  Much of the research is dubious at best.  College teachers should be more vigilant in passing on correct information to their students.  And, perhaps, it isn’t too extreme to believe that college teachers should be encouraged to “say no to sports supplements” when speaking to their students.  They should also think seriously about keeping their distance from the supplement industry-backed research.  By agreeing not to accept money or gifts from the supplement industry, they significantly decrease the likelihood of a conflict of interest in their teaching, research, and education.  After all, this is exactly the same concerned faced by the medical profession.

There is not any reason to believe exercise physiologists are more ethical than physicians.  If the medical profession recognizes this concern, then the exercise physiology profession must do the same.  And, yet it is apparent that exercise physiologists have a lot to learn about being professional and being part of a new profession.  Most still believe that it is okay to engage in research driven by the supplement industry.  Even the idea that it is wrong or could be a conflict of interest has not been discussed among exercise physiologists with an interest in sports nutrition.  For certain, it is not the role of educators to promote commercial products.  As a parallel in thought, think about this [9] for a moment:  “At the University of California in San Francisco, a special committee convened by the dean of the medical school has just recommended an end to free lunches for doctors and a move away from direct company sponsorship of educational events.” 

Exercise physiologists must keep the concerns about conflicts of interest at the top of their lists of professional responsibilities.  The fact that there is such a strong link between exercise physiologists and the supplement industry is a relationship that needs redefining.  Contrary to the belief of some colleagues who promote sports supplement research, others believe that there is simply no good reason to do so.  Sure, even if the products should work, there are the ethical concerns.  If the products should enhance physical performance, there is the concern of whether they are illegal for athletes to use in certain countries.  But, who among us is teaching about the undue influence of the supplement industry and the paid consultants?  If you are an exercise physiologist, do you teach that nurturing the relationship with the supplement industry is good for athletics and the profession?  Have you considered that your views, if you are a consultant to the industry, are shaped and/or influenced by the industry?  Have you taken the time to determine the influence of the industry on your research and/or findings?  How can exercise physiologists avoid compromising their credibility as researchers?  Sports nutrition, more so than any other area of exercise physiology, is critically susceptible to influence by the supplement industry.  Yet, when some colleagues are asked the question: “Do you think the industry is having an impact on education and research decision-making?”  They say, “No.”  They deny that they could be influenced by the supplement industry.  And, unfortunately, they are frequently the same colleagues who are influencing the increased use of supplements in sports and athletics. 

It is important that the exercise physiology community has confidence in the integrity of those who teach sports nutrition.  As in other examples, especially medicine, it is not a given that this is the case by any means.  For example, an American study showed that physicians who meet with pharmaceutical representatives are 13 times more likely to recommend the use of their products, and the physicians who accept money to speak at symposiums are 21 times more likely to recommend use of their products [10].  There is all the reason in the world to expect exercise physiologists to respond like the medical profession.  It is evident in the sponsorship of conferences.  Have you noticed that the research leads to a bias in favor of a company’s supplement?  The bias is most easily observed with the frequent use of words like “should help” or “may” or “it appears” [11].  How can students learn the truth in college when everything about sports supplements is all about “it appears” or “it should” just after the author(s) outlined the scientific rationale for the use of the supplement?

While the feeling that drug companies have had a negative influence on the practice of medicine is not new, it is new to think in terms of the sports supplement industry engaged in the same thirst for profit and ambition.  To look at this point, I typed in the words “drug companies influence on medicine” in Google.  Within .21 seconds, about 1,820,000 hits were generated.  Many of the key hits included phases such as: 

  • Drug companies have emerged as the primary financial backers of clinical research.
  • The truth about the drug companies, how they deceive us, and what to do about them.
  • Facts and research about the influence of drug companies of medicine.
  • Free drug samples influence doctors’ choices.
  • Efforts by drug companies to suppress, spin, and obfuscate findings.
  • The giving of gifts by drug companies to medical students is wrong.
  • When drug companies make gifts to doctors, are such gifts really free?
  • Drug companies fly private practitioners to nice place, why?
  • New England Journal of Medicine raises alarm about how pharmaceutical companies influence clinical trials in order to increase drug sales.
  • Seeking to curb the growing influence of drug firms on research is important.

Then, I typed in the words “sport supplement companies influence on sports nutrition” in Google.  In .28 seconds, 159,000 hits were generated.  The conclusions are three-fold.  First, the 159,000 hits versus the 1,820,000 hits indicate that the role of the sports supplement companies is not yet recognized as having a negative influence on sports nutrition.  Second, in the first 50 hits, only three sports nutrition articles were listed that discussed the concerns associated with supplement use in athletics.  The titles of the articles published in the Professionalization of Exercise Physiologyonline and the Journal of Professional Exercise Physiology are:  (a) Is Sports Nutrition For Sale? [12]; (b) Cheating in Sports: What Should Exercise Physiologists Think? [13]; and (c) The Anatomy of Complicit Behaviors:  An Essay for Exercise Physiologists. [14]

What this indicates is that exercise physiologists are either not aware of the influence of sports supplement use in athletics or they do not think there is a problem.  They could also be in denial.  None of this speaks well for the profession of exercise physiology.  Third, what is different between the generated web pages for the two different searches is very important.  While the drug company search generated only two sponsored links (Pfizer Inc., and Business List & Directory for Drug Companies) during the first 50 hits (6 pages of listings), the sports supplement search generated 10 sponsored links, which are: 

In addition to the sponsored links, it is instructive to acknowledge the following list of 10 of the first 50 hits: 

The time has come that exercise physiologists must ask the question, “What can be done about the conflict of interest before it gets worse?”  Athletics is already infected with the supplement craze.  It can only get worse, particularly since no one in exercise physiology is writing about the problem.  Obviously, the use of sports supplement isn’t going away.  The pattern is clear.  All one can do now is imagine what it will be like in 10 years?  But, why wait for 10 or 20 years since it is obvious that the influence of the supplement industry on exercise physiology can only get worse?  Now is the time to give direction to sports nutrition as part of the academic foundation of exercise physiologists.  Those of us who care enough to talk about the problem know that it can only get worse.  Imagine just decades from now, every 10-12 year old baseball player will be on some kind of muscle booster!  All college athletes will have bottles of supplements in their athletic bag.  It will then be next to impossible to get rid of the supplements, as it is presently difficult to get rid of the drug companies from controlling the practice of medicine.  This is why exercise physiologists must deal with the root cause (i.e., the exercise physiology link to the sports supplement industry influence) if they are to be recognized as credible professionals. 

This raises the question, “Where is the soul-searching and future thinking in exercise physiology?”  There is a significant volume of soul-searching in medicine and its specialties.  Just recently (June 16, 2005), the president of the American Society of Hypertension, Dr. Thomas Giles, a professor of Medicine at Louisiana State University, said that, “…about $1.5 million of its $4.4 million annual budget is met by ‘unrestricted educational grants’ by drug companies.”  Among the sponsors of this year’s annual meeting in San Francisco were Novartis AG, AsraZeneca Pharmaceuticals LP, and Pfizer Inc [15].  To be sure, others are asking questions about the sponsors to various sports nutrition societies.  One nutrition organization has a string of sponsors (such as www.EAS.com/ www.amino-vital.com/ www.powerbar.com/ ) and the likes of JavaFit, Ross Nutrition, Champion Nutrition, and so forth.  This is an interesting twist.  Rather than journals per se servicing the industry through their published articles and advertisements, organizations have now devolved into industry advertisements.  Some web sites with an assumed educational component are actually 100% advertisements for supplements.  The problem here lies with students who click on these sites.  Without knowing how to think critically about the sites, they are likely to end up being impressed by them.  Could it be possible that different sports nutrition organizations are in a “collaborative relationship” with the supplement companies?

Similarly, just as the sponsored clinical trials rarely produce unfavorable results with a financial tie to drug companies, it is common knowledge that exercise physiologists teach sports supplements without discussing the negative implications or ethical concerns.  Students are not aware that they are subject to views that may be biased towards the use of specific supplements.  Most are not aware that much of the sports supplement information is based on propaganda and pseudo-scientific thinking.  The supplement industry is all about marketing not science.  It is about money, not professionalism.  The supplement research is a biased sample of what the industry wants exercise physiologists to see and to give to their students, many of whom are athletes.  The CEOs of the supplement industry do not care about the health and safety of the athletes and non-athletes who buy into their culture of biased research and marketing strategies?  It is all about the bottom line.  And, it is also about executives pocketing huge financial compensations and stock options.  The emerging partnership between the supplement industry and academia is likely to continue with devastating consequences.   

The teaching of sports nutrition is therefore problematic, especially when the instructor is a paid consultant of the supplement industry.  Some would say the bottom has fallen out from under the course, and it is in need of serious repair.  The emphasis on supplements, competition, and winning is one of the main reasons to change sports nutrition.  Another reason is that industry leaders have identified sports nutrition more so than other exercise physiology courses as the way to promote their products.   And, since anyone can become a sports nutritionist by getting an Internet certification [16], the concern doesn’t stop at the college level.  Just imagine, following the completion of a home study sports nutritionist course, a person can call himself a sports-nutrition professional!  Does this make sense?  Of course it doesn’t make sense.  If you are 18 years of age, regardless of your education, you can become a fitness professional.  You are not required to have a college degree.  This is absolute nonsense; all for $225.  But, once you are certified, you can become part of the effort to push discounted bodybuilding supplements within your own fitness business and/or on the Internet.  It may seem like this is a lot of good thinking, but it isn’t.  The outcome can be very dangerous, especially when bad advice is given to the wrong client.  In plain and simple words, it is just chaos.  Unfortunately, there isn’t much that can be done to stop the unqualified person from getting away with pretty much anything.

“Because sports nutrition is so integral to sports conditioning, it is imperative that the teaching and practice of exercise physiologists must be monitored.  At the very least, exercise physiologists should honor their own code of ethics.  In addition they should have an agreed upon sports nutrition philosophy based on moral reasoning...” [17].  Embracing this thinking is an important key to professional development of exercise physiology.  Think about why sports nutrition is important to exercise physiology and, therefore, how it can be used to its advantage.  Credibility is important.  Appearing directionless, that is, without having an understanding of professional development is not the way to succeed.  Promoting sports supplements to feed the “win-at-all-cost” mentality is never good for athletics.  It has been and will continue to be a widely recognized problem in athletics. 

However, the “winning-at-all-costs” attitude in academics isn’t that well understood.  But, nonetheless, it is a problem.  If only exercise physiologists could decide to stop over-emphasize winning.  In the words of Keith Yamashita and Sandra Spataro [18], remember that,  “A decision today is often twice as worthy as a decision tomorrow.  There is a deep opportunity cost of not deciding.”  Exercise physiologists must get involved in the shared context of change and responsibility for the profession.  And, they must do it today not tomorrow.  Now is the time for recognizing conflicts of interest.  To help with the commitment to make it happen, the following steps may prove useful in clarifying feelings about a conflict of interest: 

  • Write down your thoughts about being a professional exercise physiologist, such as what is credibility and why professionalism is important.
  • Talk with colleagues about the negative effects on exercise physiology that result from a conflict of interest.
  • Publish a paper about the importance of the exercise physiologists’ code of ethics and standards of practice.
  • Form an exercise physiology group to discuss strategies for building professionalism and what is required for professional development.
  • Compose a speech about the role of professional development and present it at a national meeting or local conference.

Not surprisingly, dealing with the sports supplement conflict of interest is a major challenge for exercise physiologists.  Probably, at the present time, few exercise physiologists have the perspective to understand the significance of a conflict of interest.  And, yet even among those who rarely speak out, it is clear that everyone must get involved in strengthening the core values of exercise physiology.  The corrupting influence of sports supplements on the profession of exercise physiology must be critically analyzed by all of us.  It is simply no longer reasonable to allow exercise physiologists to publish articles without questioning the science that underpins them.  And, while an occasional use of words like it “appears” or “may” benefit performance are acceptable, a flood of such usage in a given paper should alert the reader to the true intentions of the author.  What is also important is if the supplement does work, there is the question of whether it crosses the line with fair play and character development.  This brings up ethical concerns worth discussion and analysis far beyond where the profession is today.  By comparison, in 2001, the editors of 13 leading medical journals published a joint editorial about the commercialization of medical research.  In short, they concluded [19] that the,  “The potential for conflict of interest can exist whether or not an individual believes that the relationship affects his or her scientific judgment.”     

If fees, gifts, and grant money for equipment from the sports supplement industry cannot corrupt exercise physiologists, they must know something that the medical community does not know.  What could that be?  Are they more ethical?  What is it that upsets the exercise physiologists when someone brings to light the unsettling assessment of their involvement with the industry?  If papers have not be distorted by conflict of interest, then is a person left to conclude, oddly enough, that their win-win mentality is incredibly ethical?  If so, why is that?  How are the exercise physiologists able to keep at a distant the hard-nosed marketers?  How is an exercise physiologist likely to think about a sports supplement product after receiving thousands or even millions of dollars from the business itself?  What is clear is this:  They have no rights as such that exempts them from critical analysis.  Their work, how they think, and what they publish is everyone’s business.  They are not exempt from criticism, financial conflict of interest, and adverse influence on students, athletes, teaching, and research?  Self-delusion or denial is not the answer or the equivalent to integrity.  If exercise physiologists believe they are not influenced by the power of money, they are either intentionally stubborn or arrogant.  Either is wrong when the after math of their consequences has such high stakes.

Far too long very little attention has been paid to this concern.  This inattention needs analysis to better understand the self-interested behavior.  How many exercise physiologists just a few months ago or years ago were promoting androstenedione (andro) and ephedra products?  Interestingly, the League of Fans [20, p. 2] concluded, “Andro and ephedra products were previously available to everyone, regardless of age, with no guarantees of safety, effectiveness or even ingredients.  But even with the ban, it is typical industry practice to replace one untested chemical with another.  To be sure, other substances are already available with similar characteristics, and with the lack of testing, potentially comparable and dangerous side effects.”  The League of Fans [20] also concluded the following:  “…supplement use is widespread from the professional level all the way down to the junior high school athletes who easily purchase and fill their lockers with unregulated substances.  These athletes are guinea pigs for the sports supplement industry….” 

Exercise physiologists should take such statements to heart.  There are more professionals and adults against the use of sports supplements than some colleagues would have the reader to believe.  As an example, the “American Academy of Pediatrics strongly condemns the use of performance-enhancing substances and vigorously endorses efforts to eliminate their use among children and adolescents” [21, p. 2].  Why is it exercise physiologists do not get this point?  The Academy concludes that, “…the intentional use of any substance for performance enhancement is unfair and, therefore, morally and ethically indefensible [p. 4].  Clearly, pediatricians are against the use of performance-enhancing substance.  The Academy has 11 recommendations [21].  Here are four: 

  1. Use of performance-enhancing substances for athletic or other purposes should be strongly discouraged.
  2. Parents should take a strong stand against the use of performance-enhancing substances and, whenever possible, demand that coaches be educated about the adverse health effects of performance-enhancing substances.
  3. Schools and other sports organizations should be proactive in discouraging the use of performance-enhancing substances….
  4. Coaches at all levels…should encourage wholesome and fair competition by emphasizing healthy nutrition and training practices, taking a strong stand against cheating, and avoiding the “win-at-all-costs” philosophy.

The gross denial by some of our colleagues that there is an issue is ethically and professionally problematic.  It is unfortunate that the sports supplement issue and the industry’s influence on exercise physiology and sports nutrition have only rarely been discussed in the exercise physiology literature.  It is my opinion that members of the exercise physiology profession must be aware of this influence and act accordingly.  College teachers, in particular, must be aware of the slick marketing by supplement companies.  Aside from holding oneself accountable to a professional code of ethics, department chairs and exercise physiologists who are responsible for exercise physiology and sports nutrition courses should develop a set of guidelines for conflict of interest.  Clearly, the ethical issues that lurk in the interface between athletics and exercise physiology are huge.  In short, exercise physiologists should: 

  1. Make sure that they do not exploit their students and/or athletes for any reason.
  2. Exercise extreme caution when endorsing supplements.
  3. Provide full disclosure of pecuniary interest in the sale of supplement products.
These are rather standard recommendations across professional disciplines.  Why exercise physiologists do not understand this point is part of their denial process.  In the end, however, it is clear that exercise physiologists will have to address this issue.  There are simply too many problems that result from partnership with supplement companies, not the least of which is the influence on decisions to push for the use of certain supplement products.  That is one of the reasons for the Canadian Centre for Ethics in Sport’s (CCES) current position [22, p. 4] of,  “…discouraging their use both on scientific and ethical grounds.”  In addition, the World Anti-Doping Agency (WADA) and the International Olympic Committee (IOC) strenuously urge athletes to stay away from supplements. 

Contrary to the views of some exercise physiologists, the CCES states [22, p. 5] that, “Most supplement products have undergone little scientific research.”  The Centre [22, p. 5] also states that,  “The premise of usefulness for supplement products is based largely on biochemical theory of chemical reactions within the body.  The peer reviewed clinical studies providing evidence of the biochemical theory has, up to this point, been lacking.”  It is disappointing that some colleagues are in denial about these points.  My criticism is the naïveté of exercise physiologists and/or their unwillingness to accept and/or consider the evidence that the sports nutrition course is increasingly becoming a sports supplements course.  It seems to me that the problem lies in part, perhaps, even significantly so with our colleagues conduct more so than the supplement industry.  At least some discussion should prevail in this regard, along with the interactions between the two and the need to stay transparent in financial dealings.

The ethical issues at stake for exercise physiologists as healthcare professionals are high.  It is not to our collective advantage to believe we can willfully or ignorantly deny the evidence that the supplement industry has on exercise physiology and will continue to have on the behavior of exercise physiologists who teach sports nutrition.  No one is immune to such influences, even when they believe 100% that they are acting in the best interest of the profession through their research and/or teaching activities.  The exercise physiology profession needs to take the lead on these issues before a concerned public force the profession to do so.  If exercise physiologists could agree on this point (and especially that there are significant ethical issues that must be confronted), then what could they do to build and/or keep the trust of other healthcare professionals and the public sector at large?  Several steps might include: 

  1. Critically review the exercise physiologists’ code of ethics and take whatever steps are considered necessary to enforce the code [23].
  2. Agree that it is time to open their eyes to the influence of the supplement industry on exercise physiology.
  3. Fund directly laboratory research from department and/or other resources other than the supplement industry.
  4. Develop a Guideline for Conflict of Interest document to decrease financial reliance on the supplement industry.
  5. Identify and deal with conflict of interest, especially in regards to the use of sports supplements.

It is well documented that other healthcare professions have already taken major steps to maintain the trust of the scientific and public community.  Healthy skepticism is not a bad thing.  Its aim is to improve the professional status of exercise physiology by agreeing that the profession is vulnerable to advertising and subtle messages that underpin financial arrangements.  It is also important to stress the need for openness and transparency in research and/or contractual dealings with the supplement companies.  Disclosure of financial or other arrangements to institutions is important.  Disclosure per se does not imply a conflict of interest.  However, it does help to ensure that such conflicts do not exist.  This is an important step towards taking professional responsibility.  It is also a powerful statement to other healthcare professionals, which says in effect: “The buck stops here.”  It is also a matter of logic that in order to “make exercise physiologists accountable” no exercise physiologist is released from maximum responsibility and accountability.  Compassion for exercise physiology as a healthcare profession is one motive for taking responsibility.  The choice is clear.  Will exercise physiologists be closed off from professionalism or choose to live it.  


References

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