by Marion Nestle

Currently browsing posts about: Tobacco

Mar 12 2015

New Scientist: Cigarettes get plain packets – will junk food be next?

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.

OMA

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.

 

 

Mar 11 2015

Study documents sugar industry influence on dental research in the 1960s and 1970s

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).

Apr 17 2014

Is Big Food the new Tobacco?

Thanks to Maggie Hennessy at FoodNavigator-USA for her report on a meeting I wish I’d been able to attend—the Perrin Conference on “Challenges Facing the Food and Beverage Industries in Complex Consumer Litigations.”

Hennessey quotes from a speech by Steven Parrish, of the Steve Parrish Consulting Group describing parallels between tobacco and food litigation.

From the first lawsuit filed against [tobacco] industry member in 1953 to mid-1990s, the industry never lost or settled a smoking and health product liability suit. In the mid ‘90s the eggs hit the fan because the industry for all those decades had smugly thought it had a legal problem. But over time, it came to realize it had a society problem. Litigation was a symptom of the disease, not the disease itself.

…When it came time to resolve the litigation, we couldn’t just sit in a room and say, ‘how much money do you want?…A lot had nothing to do with money. It had to do with reining the industry in…We spent so much time early on talking to ourselves about greedy trial lawyers, out-of-touch regulators, media-addicted elected officials and public health people who didn’t know how to run a business. At the end of the day, it didn’t matter. We would have been much better off recognizing these people had legitimate agendas.”

… Maybe there are some parallels, but I urge people not to succumb to the temptation to say, ‘cigarettes kill you, cigarettes are addictive. But mac and cheese, coffee, and Oscar Meyers wieners don’t. That may be true, but there are still risks for the industry.

The article also quotes Michael Reese, plaintiff’s attorney for Reese Richman LLP, talking about the increasingly accusatory tone of media coverage of Big Food: 

There’s this idea, which has picked up steam in the media, that large food companies are manipulating ingredients to hook people on food. It hasn’t been manifest in litigation yet, but we’re seeing it with legislative initiatives, like Mayor Bloomberg in New York City saying sugar hooks people and causes diabetes. We’ve seen some with GMOs, though most of that legislation is about consumers’ right to know. But there’s this overarching concept that Big Food is somehow manipulating our food supply and as a result, giving us non-food.

Sounds like the message is getting across loud and clear.

Thoughts?

Feb 11 2014

Room for Debate: CVS to stop selling cigarettes

The New York Times Room for Debate blog asked me to comment on What other unhealthy products should CVS stop selling?

Here’s my response: Next, Cut the Soda and Junk Food.

Good for CVS! Cigarettes are in a class by themselves. The evidence that links cigarette smoking to lung cancer and other serious health problems is overwhelming, unambiguous and incontrovertible. So is the evidence that the mere presence of cigarettes is sufficient to create demand, especially among young people.

When the anti-cigarette smoking movement began, the issues were simple: stop people from starting to smoke and get people who smoked to stop — by making it difficult, uncomfortable and expensive for smokers to continue their habit. The ultimate goal? Put cigarette companies out of business. This, of course, has been politically impossible, not least because cigarette companies pay such high taxes.

If CVS wants to promote health, it could increase sales of healthy snacks, and stop selling sugary foods and drinks.

Although there are many parallels in company marketing practices, food is not tobacco. For all tobacco products, the response is simple: stop. Food is more complicated. We must eat to survive. A great number of foods meet nutritional needs. The evidence that links a particular food product to health is often uncertain. This is because each food is only one component of a diet that contains many foods in a lifestyle that might involve other factors that affect health: activity, alcohol, drugs, stress and let’s not forget genetics.

With that said, if CVS really wants to promote health, it could consider increasing its sales of fruits, vegetables and healthy snacks, and stop selling sodas, ice cream, chips and other junk foods. Those foods may not have the same bad effect on health as tobacco, but eating too much of them on a regular basis is associated with weight gain, obesity and the conditions for which obesity is a risk factor, like Type 2 diabetes and heart disease. If CVS wants to counter obesity, dropping soft drinks is a good place to start. They have scads of sugars, and kids who drink them regularly take in more calories, are fatter and have worse diets than kids who do not.

Jul 6 2012

A food politics thought for the weekend: treatment vs. prevention

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

May 12 2011

Robert K. Ross: Speaking truth to power

The Future of Food conference in Washington last week is now pretty much online (although I’m still having trouble with some of the links).  Much of it is well worth a listen, certainly Prince Charles’ thoughtful speech on sustainability, but also the one that I thought the most powerful—comments by Robert K. Ross, head of the California Endowment.

In the first 8 minutes of his talk, Dr. Ross explained that he comes to the issues discussed at the conference from the angle of public health and obesity, yet climate change, soil quality, hunger, and economic development are all wrapped up in the obesity issue.   Here is my paraphrase of what he said (with my emphasis):

If you care about these issues, you have to decide whether you are a group, network, or a movement.

Nothing short of a powerful movement will reverse the trends that are in front of us.

The tobacco battle is the proudest victory of public health, although not yet fully accomplished.

The scientific community first understood that tobacco was bad for health in 1921.  Hundreds of studies followed.  Yet it was not until 1965 that the Surgeon General first got permission for a warning label on cigarettes.  Only in the 1990s did we have policy and practice changes that included environmental incentives to drop the tobacco habit.

In other words, we have had a 100-year war on tobacco.

A side-by-side comparison of food and tobacco indicates that food, health, and sustainability are far more complex issues than tobacco.  We do not have 100 years to deal with these problems.

The tobacco wars were not about lack of scientific data.  They were and are a power issue.

The only way to confront power is to build a movement that wields power.

Science-based, evidence-driven policy wonks and researchers want more science.  But if you think you are in a policy debate and the other side thinks it is in a fight, you are not going to come out too well.

We need to bring as much rigor to the fight as we do to the science.

Food advocates: take careful note.

Jul 28 2010

Obesity vs. Tobacco: a zero-sum game?

Anti-tobacco advocates have been worried for years that concerns about obesity would draw funding away from anti-smoking initiatives (see previous posts).  Their fears are justified, as described in today’s New York Times and in a recent editorial in the New England Journal of Medicine.

Years of experience have taught anti-smoking advocates that countering the marketing efforts of cigarette companies required constant vigilance.  It also taught them that cigarette companies take immediate advantage of any weakening of resistance to their efforts.

Cigarettes remain the leading cause of preventable deaths among Americans.  Cigarette marketing aimed at children remains a national—and international—public health scandal.

Health should not be a zero-sum game.  Anti-obesity advocates have much to learn from anti-smoking advocates.  How about joining forces to improve the health of Americans?

Jul 1 2010

Food is not tobacco, but some analogies are worth attention

I’ve just read an enlightening paper in the July issue of the American Journal of Public Health (see Note below) about the tobacco industry’s role in and funding of “We Card,” a program ostensibly aimed at discouraging smoking among young people by encouraging retail cigarette sellers to “card” underage buyers.

The paper is an analysis of internal food company discussions about this program in cigarette company documents released as part of the 1998 Master Settlement Agreement.  These documents are now publicly available on the University of  California San Francisco (UCSF) website.

This analysis demonstrates that the actual purpose of tobacco industry support for the program was to make the industry look good (public relations) and to convince legislators and health officials that regulation would be unnecessary.

The industry effectively recruited astonishing numbers of private business, retail, and trade groups (expected) and state health, legal, and police agencies (which should have known better) as partners in this program.  The paper lists these groups in tables that take up nearly five pages.

As the paper explains:

Economic theory predicts that industry self-regulation will achieve social benefits far smaller than those gained from government regulation, although governments increasingly view self-regulation as a means to achieve public goals without public spending. However, industries and governments may have competing agendas, suggesting that public health advocates should be wary of self-regulation strategies…. This program’s success in reaching tobacco retailers and attracting independent allies has made We Card one of the tobacco industry’s major public relations achievements. However, despite industry claims that the program is effective, internal industry evidence suggests that We Card has not reduced tobacco sales to minors and that it was not designed to do so. Instead, We Card was explicitly structured to improve the industry’s public image and to thwart regulation and law enforcement activity.

The authors’ conclusion: “Policymakers should be cautious about accepting industry self-regulation at face value, both because it redounds to the industry’s benefit and because it is ineffective.”

Proponents of food industry self-regulation and of partnerships and alliances with food companies should read this study carefully.

Note: Only the Abstract is available to non-subscribers.  The reference is Apollonio DE, Malone RE, The “We Card” Program: Tobacco Industry “Youth Smoking Prevention” as Industry Self Preservation.. Am J Public Health 2010;100:1188-1201.

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