Recently the academic community has been charged with nutrition malpractice for allegedly spending billions of dollars in international nutrition research and failing to make a difference. Looking at this issue from a field perspective one would conclude that notable progress has been made and is being made on a daily basis. The analysis presented is based on my experience as a clinical nutritionist in Chile, a developing country in transition. It points out the issues and some of the answers by using selected examples of what can be accomplished by integrated health, nutrition, and educational interventions. The results have been a dramatic decline in infant and childhood malnutrition and mortality rates and the emergence of a pattern of mortality that closely resembles that of developed countries. The specific nutritional problems of hospitalized patients are discussed and the benefits of enteral nutritional support are presented. Preventive strategies are emphasized; they require wide coverage of basic human needs and community participation. Nutritional improvement is a prerequisite for economic development and is only possible if individuals and institutions are committed to making this happen. Critical dilemmas facing clinical nutritionists in developing countries are addressed.