Here is the online version of my commentary in New Scientist, March 14, 2015:24-25.

I submitted an illustration with it, which the editors did not use.  It’s from the Ontario Medical Association.

Cigarettes get plain packets – will junk food be next?

The tobacco industry is fighting moves to sell cigarettes in plain packs by claiming food manufacturers will be hit next. Will they?

ANTI-SMOKING advocates will be delighted. MPs have today voted in favour of introducing uniform packaging for cigarettes in the UK. That plain wrappers will undoubtedly further reduce smoking, especially among young people, is best confirmed by the tobacco industry’s vast opposition to this government measure and positive evidence from Australia, the first country to adopt it.

Along with lobbying and appeals to the World Trade Organization, the tobacco industry, when under attack, inevitably wheels out well-worn arguments about the nanny state, personal freedom, lack of scientific substantiation, and losses in jobs and tax revenues.

So to perk up its tired and thoroughly discredited campaign, the tobacco folks have added a new argument. Requiring plain wrappers on cigarettes, they say, is a slippery slope: next will be alcohol, sugary drinks and fast food. This argument immediately raises questions. Is it serious or just a red herring? Should the public health community lobby for plain wrappers to promote healthier food choices, or just dismiss it as another tobacco industry scare tactic?

Let me state from the outset that foods cannot be subject to the same level of regulatory intervention as cigarettes. The public health objective for tobacco is to end its use. So for cigarettes the rationale for plain wrappers is well established. Company logos, attractive images, descriptive statements, package colours and key words all promote purchases. Plain wrappers discourage buying, especially along with other measures such as bans on advertising, smoke-free policies, taxes and health warnings.

Australia’s pioneering law specified precise details of pack design, warning images and statements. The result: cigarette brands all look much alike. Most reports say plain packaging boosts negative perceptions of cigarettes among smokers and increases their desire to quit. Australia expects plain packaging to further reduce its smoking rate, which, at 12.8 per cent, is already among the world’s lowest. Along with the UK, New Zealand and Ireland are well on the way to adding plain packaging to their anti-smoking arsenal. More nations are considering it.

Which is all bad news for the tobacco industry. So it ramps up the slippery slope argument, hoping the food industry will support its fight against plain wrappers. It cites examples such as the regulation of infant formula in South Africa, where pictures of babies on labels are forbidden; that’s a big problem for the Gerber food brand – Gerber’s company logo is a smiling baby.

But those peddling the slippery slope idea ignore the fact that the health message for tobacco is simple: stop smoking. But beyond tobacco, it is more complex. For alcohol it is a little more nuanced: drink moderately, if at all. For food it is much more nuanced. Food is not optional; we must eat to live. Nutritional quality varies widely. Foods are spread across a spectrum from unhealthy to healthy, from soft drinks (no nutrients) to carrots or fish (many nutrients). Most fall somewhere in between. What’s more, an occasional soft drink is fine; daily guzzling is not. So the advice is to choose the healthy and avoid or eat less junk, both in the context of calorie intake and expenditure.

Is there any evidence that plain packaging for unhealthy foods would reduce demand? Research has focused on marketing’s effect on children’s food preferences, demands and consumption. Brands and packages sell foods and drinks, and even very young children recognise and desire popular brands. When researchers compare the responses of children to the same foods wrapped in plain paper or in wrappers with company logos, bright colours or cartoon characters, kids invariably prefer the more exciting packaging.

But the problem is deciding which foods and beverages might call for plain wrappers. For anything but soft drinks and confectionery, the decisions look too vexing. Rather than having to deal with such difficulties, health advocates prefer to focus on interventions that are easier to justify – scientifically and politically.

We know that some regulations and market interventions –analogous to, if not the same as those aimed at smoking cessation – are essential for reducing the damage from harmful products. If not plain packaging, then what? Studies suggest small benefits from a long list of interventions such as taxes, caps on portion size, front-of-package traffic-light labels, nutrition standards for school meals, advertising restrictions, and elimination of toys from fast food meals and cartoons from packaging. Rather than dealing with the impossible politics of plain wrappers on foods, health advocates increasingly favour warning labels.

These first appeared on cigarette packs in the 1960s and have been considered for food products since the early 1990s. Heart disease researchers suggested that foods high in calories and fat should display labels such as: “The fat content of this food may contribute to heart disease.” More recently, health advocates in California and New York proposed warning labels on sugary drinks. The Ontario Medical Association takes a similar view: “To stop the obesity crisis, governments must apply the lessons learned from successful anti-tobacco campaigns.” It has mocked up examples of warnings on foods.

Although no warning label law has passed so far, such messages are the logical next step in promoting healthy food choices, in the same way that plain wrappers are the next logical step for all cigarette packages. Health advocates should recognise the slippery slope argument for the typical tobacco ploy that it is.

A new study in PLoS Medicine provides documentary evidence of sugar industry manipulation of research on dental caries in the 1960s and 1970s.

The paper is a formal presentation of an article in Mother Jones (which I wrote about in a previous post).

The researchers are at UCSF, which sent out a press release:

A newly discovered cache of industry documents reveals that the sugar industry worked closely with the National Institutes of Health in the 1960s and ‘70s to develop a federal research program focused on approaches other than sugar reduction to prevent tooth decay in American children.

The archive of 319 industry documents, which were uncovered in a public collection at the University of Illinois, revealed that a sugar industry trade organization representing 30 international members had accepted the fact that sugar caused tooth decay as early as 1950, and adopted a strategy aimed at identifying alternative approaches to reducing tooth decay.

These approaches, as the article explains, involved encouraging the NIH to do research on mitigating or preventing tooth decay, which is fine in theory, but in practice distracted the dental research community from trying to discourage sugar consumption.

The analysis showed that in the late 1960s and early 1970s, the sugar industry funded research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay. It also shows they cultivated relationships with the NIDR and that a sugar industry expert panel overlapped by all but one member with the NIDR panel that influenced the priorities for the NIH tooth decay program. The majority of the research priorities and initial projects largely failed to produce results on a large scale, the authors found.

Understandably, the Sugar Association is not pleased.  Here is what the Sugar Association told Time Magazine:

It is challenging for the current Sugar Association staff to comment directly on documents and events that allegedly occurred before and during Richard Nixon’s presidency, given the staff has changed entirely since the 1970s. However, we are confused as to the relevance of attempts to dredge up history when decades of modern science has provided answers regarding the role of diet in the pathogenesis of dental caries… A combined approach of reducing the amount of time sugars and starches are in the mouth, drinking fluoridated water, and brushing and flossing teeth, is the most effective way to reduce dental caries.

As Stan Glantz pointed out in his blog post, “This sounds similar to the statement from Brown and Williamson Tobacco put out in 1995 in response to our first papers based on tobacco industry documents.”

Distracting researchers from focusing on underlying causes is a strategy perfected by the tobacco industry and copied widely by other industries making potentially harmful products, as shown clearly in the just released film, Merchants of Doubt (a must-see).

The World Health Organization (WHO) has finally officially released its recommendations for sugar intake.  I say “officially,” because I posted an earlier version these guidelines late in January.

The new—and official—WHO guideline, “Sugar intake for adult and children,” makes these recommendations for adults and children:

• For general health, Reduce daily intake of free sugars to less than 10% of total energy intake.
• For additional health benefits: Reduce daily intake to below 5% or roughly 25 grams (6 teaspoons) per day.

This recommendation is based on a scientific review as well as comments by groups such as Center for Science in the Public Interest.

The British advocacy group, Action on Sugar, is disappointed in the recommendations, thinks they don’t go far enough, and suspects that heavy food industry lobbying was at work.

There is absolutely NO nutritional requirement for free sugars in our diets, therefore AoS is disappointed that the 5% recommendation is conditional. The WHO used the GRADE[Grading of Recommendations Assessment, Development and Evaluation] system for evaluating the evidence which is useful for drug trials, but is not appropriate for the links between diet and health. This has allowed the food industry to sow the seeds of doubt amongst the WHO, who have failed to come up with the strong recommendation that is so vitally needed, especially for children.

On the other hand, the food industry says the recommendations are misleading and based on weak evidence.

The US Sugar Association [said]…Such a claim is serious, and requires high-quality data, particularly given the potential for consumer confusion and the likelihood that the economic impact to developing countries will be severe. There was a need for extensive debate, especially before the 5% value was included in official recommendations, said the European Committee of Sugar Manufacturers (CEFS). “Especially because the data this value is based on was deemed to be of very low quality by both WHO and the dental health review authors,” it said…. The sugar industry said that sugar in isolation could not be blamed for obesity and asked people to focus on what the WHO defined as the primary cause of obesity: an imbalance between calories and activity.

The WHO recommendations are similar to those issued for decades by national health agencies.  The last time WHO tried to issue the 10% of calories advice in 2003, it got clobbered by lobbyists.

This time, lobbyists didn’t succeed.  This is progress.

Tomorrow: more on sugar lobbying.

The School Nutrition Association’s bizarre opposition to the USDA’s nutrition standards for school meals has stimulated research.

Three studies show the benefits of healthier school meals.

1.  From The Rudd Center, now at U. Conn: A press release announces publication of its new study in Childhood Obesity demonstrating that the rules have led to an increase in fruit consumption without increasing plate waste.

USDA, understandably pleased with this result, quotes Secretary Tom Vilsack in a press release:

For Congress to meddle with doctors’ recommendations and go back to less healthy meals now would not be in the best interest of our children.

2.  From the Harvard School of Public Health: It also sends a press release to announce its study demonstrating that an increase in consumption of fruits and vegetables is a direct result of the new USDA standards, and that these also do not increase plate waste.

3.  From the Union of Concerned Scientists: UCS announces a new position paper, “Lessons from the Lunchroom: Childhood Obesity, School Lunch, and the Way to a Healthier Future,” also documenting why school meals are so important to kids’ health. This report comes with an explanatory Infographic.

All of these aim to head off congressional opposition to the new standards and keep them in place.

Let’s hope this science-based strategy does some good.

Postscript:  Dana Woldow argues that the school food scene would be much easier if schools actually got enough money to pay for what they serve and for decent wages to school food service workers.  

Kate Pine, a reader of this blog, sends this winter scene from Cedar Rapids, Iowa:

Her poignant comment:

I thought you might like to see this billboard…Note the snow on the street since I took this photo a couple days ago. This is part of why the public is so ill-informed about where and how food is produced.

Postscript: Daniel Bowman Simon writes: “This appears to be an ad for Bushel Boy, a year-round greenhouse tomato growing operation in MN.”  He also sends this link to a story in Crain’s about how Bushel Boy is financed.

Last week the Mexican Supreme Court passed down its judgment on a writ of unconstitutionality (amparo) filed against the soda tax that went into effect in January 2014.

This unanimous judgment:

• Confirms the constitutionality of the tax
• Validates its rationale as a public health measure to discourage soda consumption

Documents (in Spanish):

• The Supreme Court’s press release
• El Financiero account
• El Universal account

I was invited by CNN to comment on the announcement by Nestlé that it is removing artificial colors from its chocolates.

Here’s what I said:

(CNN) When food giant Nestle USA (to which I am, alas, not related) last month announced plans to remove all artificial flavors and colors from its chocolate candies, it understandably made headlines. According to the company, by the end of 2015, none of a group of 250 chocolate products including Butterfinger and Baby Ruth will contain artificial flavors or colors such as Red #40 or Yellow #5.

With the expectation that these chemicals will also disappear from the company’s other candies, it looks like the end of the use of artificial flavors and colors in anything but the cheapest food products. If that proves to be the case, it will be a welcome shift.

Nestle USA intends to advertise the reformulated products with a “No artificial flavors or colors” claim on package labels. If sales of the “no artificial” candies grow as expected, the company will surely extend the removal to all of its other colored and flavored food products. After all, Nestle’s international parent company — and the company’s competitors — will have to take notice and find ways to remove these chemicals from all their product lines.

Nestle USA has undeniable clout. It accounts for a quarter of the $100 billion in annual revenues of the more than century-old, privately held parent corporation, which itself is the largest food company in the world. This move surely will not only reverberate through the candy industry, but also affect every other major food company.

In substituting natural for artificial flavors and colors, Nestle USA is responding to what its customers are saying. The company’s own research indicates that Americans prefer their beloved candy brands to be free of artificial flavors and colors, while other surveys find majorities of respondents saying that artificial chemical additives negatively influence their buying decisions.

Nestle is also responding to decades of complaints from consumer advocates about the potential health risks of these chemicals, especially the dyes. Studies in experimental animals have linked high doses of food dyes to health problems, among them organ damage, cancer, birth defects, and allergic reactions. In humans, studies link food dyes to hyperactivity and other behavioral problems in young children.

The credibility of these studies and their implications for human health remain hotly debated. In the 1970s, for example, Ben Feingold, a physician in California, suggested that food additives caused children to become hyperactive. Much of the evidence for the “Feingold hypothesis” rested on anecdotal reports by parents, whereas double-blind, controlled clinical trials produced contradictory results.

On the basis of current evidence, some artificial food dyes have been banned, while others remain in use despite suggestions that they too might be harmful. But the makers and users of food dyes argue that the chemicals are safe at current levels of usage. As a result of all this, and in the absence of convincing evidence of their safety, the advocacy group Center for Science in the Public Interest has campaigned since the 1970s to remove food dyes and other chemicals from foods, and has continued to petition the Food and Drug Administration to ban them.

The opposing views complicate the regulatory status of food dyes. But after one clinical trial reported that dyes induce hyperactivity in half the children studied, the British government asked companies to stop using most food colors; the European Union requires a warning notice on many foods made with them.

In the United States, the FDA does not permit artificial food dyes to be used unless the manufacturers can meet safety requirements. But the amounts of these substances in the country’s food supply have greatly increased in recent years — soft drinks, breakfast cereals, frozen desserts and even salad dressings all contain artificial coloring agents. True, the FDA considers a dye to be safe if there is a reasonable certainty that no harm will result from its intended use. But that standard is vague enough to cause concern.

Given the unresolved scientific questions, it is reasonable to ask why artificial colors have to be in foods at all. From the standpoint of manufacturers, such additives are essential for covering up and hiding unattractive colors in processed foods. To the public, red candy seems to taste better than the drab variety. And while natural colors exist, they are less stable or more expensive to produce. But for Nestle to have taken the action that it has, the company must have found substitutes it can live with. And appealing to consumers’ preference for “natural” makes good business sense.

The truth is that whether artificial colors do or do not cause health problems in adults or children, they are there strictly for cosmetic purposes. For that reason alone, getting rid of them is a good idea.