12

Sickeningly Sweet

in december 1953, John W. Hill, founder of the public relations firm Hill & Knowlton, shared with his clients in the tobacco industry a brilliant and nefarious strategy to “manufacture uncertainty” about the link between tobacco and lung cancer. To do so, Hill proposed the launch of something called the Tobacco Industry Research Committee (TIRC), to be housed one floor below Hill’s office in the Empire State Building, which would promise to conduct rigorous scientific research that would get to the bottom of the health effects of smoking. Less than three weeks later, on January 4, 1954, the industry went public with these plans, buying full-page ads in major American newspapers for what it labeled as a “Frank Statement to Cigarette Smokers.” In addition to announcing the formation of TIRC, the industry pledged a commitment to a “research effort into all phases of tobacco use and health,” to be directed by “a scientist of unimpeachable integrity and national repute. There was also to be an advisory board of scientists “disinterested in the cigarette industry.”¹

This announcement stirred the interests of one Robert C. Hockett, who had recently retired as the scientific director of the Sugar Research Foundation (SRF), the science arm of the sugar industry. The same morning that the tobacco industry’s “frank statement” was announced in every important newspaper in the country, Hockett sent off a letter to the tobacco people (not even knowing the name of the most appropriate recipient). He noted that the tobacco industry had established the TIRC and pitched himself aggressively and perceptively:

Ten years ago, a very similar industry association, the Sugar Research Foundation, Inc., was formed to investigate charges that refined sugar is a primary cause of diabetes, tooth decay, polio, B vitamin deficiencies, obesity, mid-morning hypoglycemia, and many other conditions. […]

During a period of nine years, I organized and directed research projects in medical schools, hospitals, universities and colleges which exonerated sugar of most of the charges that had been laid against it. […]

The challenge of the present situation to the cigarette industry is so similar to that which I helped the sugar industry to meet that I am tempted now to suggest that my experience and background may be useful to the new Tobacco Industry Research Committee.²

Hockett’s letter must have reached the right department, because his offer was swiftly accepted. His job was to apply the techniques he had employed with sugar, now on behalf of cigarettes. The goal was simple: make the product look safe, or at least question the evidence that it was killing its users.

That the Sugar Research Foundation’s former chief could transition so seamlessly to defending cigarettes speaks volumes of the work conducted by the SRF. And indeed, the two industries had similar histories. As documents uncovered and published in 2016 by researchers from the University of California, San Francisco (UCSF) revealed, the sugar industry ran a brilliant, secret disinformation campaign on several fronts starting in the 1950s, if not earlier.

As scientific evidence first began to link sugar with increased risk of heart disease in the 1950s, the Sugar Research Foundation reached out to nutrition scientists as part of their efforts to counter “negative attitudes toward sugar.” The industry group provided nutritionists with its own counter-research, which promoted the idea that the primary culprits in heart disease were dietary fats, not sugar. (Conveniently enough, cutting fat intake would also allow everyone to consume more sugar without increasing their caloric consumption.) Although Big Tobacco is now the iconic industry for the dishonest use of science, Big Sugar’s subterfuge actually predates that of the more notorious industry. It can now be plausibly argued that rather than merely imitating Big Tobacco’s game plan, it was in fact Big Sugar that provided the first full-scale model.³

The efforts of Big Sugar also had a profound impact on the American understanding of health across the remainder of the twentieth century. Until contrary research appeared in the 1990s, the widely accepted scientific conclusion was that fats were the primary dietary contributor to cardiovascular disease. In fact, both fat and sugar are culpable, but Big Sugar has spent a fortune going full bore focusing on just one of the two dietary factors. The industry has assured the public that, yes, the sugar in our diet may deliver “empty calories,” but the calories are otherwise benign. Other falsehoods: Sugar doesn’t cause disease; although diabetics need to cut back on sugar, sugar didn’t cause their diabetes. Sugar certainly doesn’t contribute to heart disease. And while sugar’s calories do contribute to weight gain, all you need to do is exercise to burn off those calories. (None of this is true.)

The documents unearthed by Cristin Kearns and a group of UCSF researchers included the text of a speech by Sugar Research Foundation president Henry Hass before the American Society of Sugar Beet Technologists. With the title “What’s New in Sugar Research,” the speech announced the launch of a new public relations campaign, one spurred by the industry’s stance that “(f)ear of obesity is undoubtedly the greatest single deterrent to sugar consumption.” He laid out the forthcoming rebuttal clearly and identified a strategic opportunity for the industry: increase sugar’s market share by getting Americans to understand that fat, not sugar, is their chief dietary enemy:

I am unhappy about advertising which implies that sugar is in some unique sense the cause of obesity. […]

On September 21 [1953] the members of Sugar Association voted unanimously to spend $600,000 [more than $5,500,000 in 2019 dollars] per year for at least three years to tell the story of sugar in the diet… We hope that Leo Burnett [one of the leading advertising firms in the country, who later that year would be awarded the Marlboro account by Philip Morris and would go on to develop the Marlboro Man campaign] can do for sugar what has been done for meat. There will be no bunkum and no ballyhoo, only a process of presenting the facts about sugar in an interesting way. […]

You have seen our first advertisement. Factual, scientifically correct, simple and easy to comprehend, it is the prototype of many more to follow. At last people who never had a course in biochemistry are going to learn that sugar is what keeps every human being alive and with energy to face our daily problems.⁴

More than a dozen years later, in 1967, the fat-blaming initiative achieved its greatest success with a two-part review of the causes of coronary heart disease, published in the prestigious New England Journal of Medicine. Authored by scientists at Harvard School of Public Health, it attributed far more significance to fats than sugars in terms of increasing the risk for heart disease. In the article’s fine print, funding for the study from some industry interests groups (including the Special Dairy Industry Board) was acknowledged, as was funding from some non-industry sources. The Sugar Research Foundation was absent from the list.⁵ (In that not-so-distant era, conflict of interest disclosures were not required by journal editors.) Later, the financial link between the authors and the sugar industry was confirmed by the discovery of the sugar papers by UCSF researchers.³

These claims about the sugar industry’s hidden role in cardiovascular disease research—fingering fats, exonerating sugar—and the parallels with Big Tobacco’s strategy of manufacturing uncertainty made national headlines. There is some debate within the academic community whether it’s fair to ascribe nefarious motives to the scientists involved, especially the high-profile Harvard team. It certainly appears, in the words of one leading nutritional expert, that the “intent of the industry-funded review was to reach a foregone conclusion. The investigators knew what the funder expected, and produced it.”⁶ Or, alternatively, is any accusation against the scientists an overextension of “the analogy of the tobacco industry playbook” and a failure “to assess historical actors by the norms and standards of their times”?⁷

These two views are not mutually exclusive. Big Sugar used some of the same tools as Big Tobacco. However, that does not necessarily mean that the Harvard scientists changed any of their opinions or shaded their findings to appease their sponsor. It may be that sugar’s efforts played only a supporting role in attributing blame for heart disease on dietary fats. But there is little question that this is exactly what the industry tried to do. Big sugar did what tobacco did—funded a secret campaign combining mercenary science and a public relations campaign to raise doubts about the link between sugar and disease. We don’t know all the details, and we don’t know how much sugar learned from tobacco and vice versa. Much of our knowledge about the strategies and actions of the cigarette industry come from the literally millions of pages of documents disclosed in the giant tobacco lawsuits, and we don’t (yet) have those for sugar. But there is little question that the parallels are there.

In addition to its misinformation about fats, Big Sugar has long proffered an idea that all calories are equal, no matter their source in the diet. In other words, as it concerns their impact on one’s weight, 1,000 calories from a bucket of soda has the same impact as 1,000 calories from a meal featuring, say, fish, salad, broccoli, and fresh fruit. That’s the argument. A corollary of this argument holds that increased caloric intake can be balanced by increased caloric expenditures, primarily through increased exercise. So, you can consume as many calories as you want, just as long as you exercise and burn away more calories than you eat.

This “energy balance” theory certainly sounds convincing, which is why Coca-Cola, needing something—anything—to counter the growing concern among public health experts and the public about the obesity and related epidemics, seized on it as the answer to all its PR problems. According to emails and other documents uncovered by the New York Times and US Right to Know (themselves a food industry research group, but funded by the organic food industry), Coca-Cola launched, funded, and provided logistical support to a nonprofit called the Global Energy Balance Network, or GEBN, which operated under the slogan “Healthier living through the science of energy balance.” The uncovered documents show how an industry-sponsored nonprofit tried at great expense to shift the public’s focus from the link between diet and deleterious health outcomes (obesity, diabetes) to increased exercise as the best way to address these diet-related health problems.⁸

Clearly, Coca-Cola recognized that enlisting scientists to front its ideas would be far more credible than dispensing the same claims through its PR department. To this end, Rhona Appelbaum, who in 2014 was Coca-Cola’s chief health and science officer, sent a proposal to a small group of academic scientists describing how GEBN envisioned a concerted campaign to take on “the most extreme public health experts” who advocate “stronger regulation on specific foods.” No doubt referring to her employer, she decried the academics who cast “particular food companies as the villain, even likening them to tobacco companies.” Appelbaum’s solution: throw money at this problem. GEBN’s $20 million endowment would promote new research supporting the hypothesis that reducing caloric input was not necessary to tackle obesity. The campaign’s “consistent message” would emphasize that “an energy balance framework is the only framework that makes sense in addressing obesity.”⁹

To get this slippery ball rolling, Coca-Cola pulled together what appeared to be an impressive group of university professors, but one primarily grounded in the field of exercise science. The front group’s vice president, Steven Blair (then an exercise scientist at the University of South Carolina) said, “Most of the focus on the press is, ‘Oh they’re eating too much, eating too much, eating too much’—blaming fast food, blaming sugary drinks and so on… and there is virtually no compelling evidence that this is the case.” Additional comments in the GEBN press release blamed the media for proliferating stories that focused on nutrition, then described Blair’s approach as “an alternative, data-based theory.”¹⁰

These assertions so lacked in subtlety that they triggered multiple inquiries into the organization’s funding sources. The first questions came from Yoni Freedhoff, an obesity specialist at the University of Ottawa. And indeed, Coca-Cola’s fingerprints were everywhere. Although GEBN’s website, Facebook page, and Twitter feed made no mention of Coca-Cola, the group’s website was registered to the soda manufacturer, which was also listed as the site’s administrator. The New York Times reported that two of GEBN’s founding members, Blair and Gregory Hand (the latter being the dean at West Virginia University School of Public Health) had received $4 million from Coca-Cola since 2008. This included $500,000 to Hand to help launch GEBN, plus another $1 million to the University of Colorado School of Medicine, employer of GEBN’s President James Hill, to fund GEBN activities.¹¹

The universities who employed the GEBN executives didn’t appreciate being identified in one of the country’s largest newspaper as complicit flacks for Coca-Cola. At West Virginia, Hand was demoted from his position as dean. Colorado returned its million dollars. With its cover blown and credibility forfeited, GEBN served little purpose to Coca-Cola. Funding presumably dried up from there, and within a few months its academic beneficiaries folded their tent and announced they were going out of business “due to resource limitations.”¹²

Secretly shoveling money to scientists to claim that drinking gallons of Coke posed no threat to anyone’s long-term health? It looked bad. The GEBN scandal caused significant damage to the iconic brand’s reputation, and Coke committed to greater transparency in future funding. It even released a list of its recent donations, including $3 million to the American Academy of Pediatrics, $3.1 million to the American College of Cardiology, $3.5 million to the American Academy of Family Physicians, $2 million to the American Cancer Society, and $1.7 million to the Academy of Nutrition and Dietetics, the nation’s largest organization of dietitians. The grand total of its giving was $120 million over six years; of that, $29 million was designated to support academic research. According the New York Times, this “won the company allies in anti-soda initiatives, wielded influence over health recommendations about soft drinks, and shifted scientific focus away from soda as a factor in the causes of obesity.”¹³

But was Coke’s itemization complete? Researchers at the University of Oxford and the London School of Hygiene and Tropical Medicine suggested that the company was only acknowledging its funding of do-good organizations, while hiding its stacking of the scientific literature with papers promoting their mercenary “energy balance” theory. The team discovered 151 journal articles, published by 468 authors across approximately 100 different journals, that identified the Coca-Cola Company or the Coca-Cola Foundation as a funder of their research, none of whom were included in the company’s list of donation recipients. Not surprisingly, many of these papers promoted the “energy balance” message, equating the obesity epidemic with lack of physical exercise.¹⁴

From a critical perspective, the evidence supporting the “energy balance” theory is equivocal at best. A letter signed by 36 leading nutrition scientists criticized Coca-Cola and the Global Energy Balance Network for spreading “scientific nonsense.”¹⁵ Certainly there are cross-sectional studies that show thinner people exercise more than fat ones, but you can’t tell from these types of studies which way the causation runs. Does the exercise make people thin or do thin people choose to exercise more? Studies conducted over longer periods of time that attempt to control for this question find little evidence that people who are more physically active gain less excess weight than those who are less active.¹⁶ On the other hand, there is little question that diet change is a powerful mechanism for losing weight or maintaining a healthy weight. The studies proving this point number in the hundreds, at a minimum.

Just as Big Tobacco lost its battle with the truth about cigarettes, Big Sugar is going to lose its battle with the truth about empty, but nevertheless harmful, calories. On this matter, time will most certainly tell.

In recent years, public health experts have focused their overall concerns about dietary sugar on the increase in consumption of the sugar-sweetened beverages (SSBs, as they’re generally labeled). With little uncertainty, the science that shows that the amounts of sugar currently consumed by many Americans and people all over the world is harmful to the point of being dangerous. It is widely accepted that obesity and diabetes, not to mention tooth decay, will be prevented if sugar intake is reduced. And while sugar-sweetened solid, processed foods at least play a useful role in curbing hunger, SSBs have little if any redeeming nutritional value. Yes, they quench thirst, but that goal is accomplished better, or at least as well, by water. In short, SSBs are nothing but sugar-delivery systems—not as addictive as nicotine, but certainly playing to humans’ built-in sweet tooth.

Given the global scale of the obesity epidemic, the importance of understanding the true health impacts of sugar and SSBs cannot be overstated. For its part, the scientific community has launched large numbers of independent studies. And for their part, the manufacturers of these beverages have gone to great lengths to slow the momentum of scientific understanding. Leading this charge is the American Beverage Association, the trade group representing Coca-Cola, PepsiCo, Dr Pepper, and other SSB producers, which has taken what Big Tobacco did for lung cancer and applied the strategy to obesity.

In 2012, the New England Journal of Medicine published three randomized control studies focusing on sugar intake, accompanied by an editorial concluding that the results provide a strong impetus “to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.”¹⁷

In response, the ABA issued long statement, raising criticisms of each the studies—and adding a bold assertion of its own:

Obesity is a serious and complex public health issue facing our nation and the rest of the world, and we all must work together to solve it. We know, and science supports, that obesity is not uniquely caused by any single food or beverage. Thus, studies and opinion pieces that focus solely on sugar-sweetened beverages, or any other single source of calories, do nothing meaningful to help address this serious issue. [emphasis added] … The fact remains: sugar-sweetened beverages are not driving obesity. By every measure, sugar-sweetened beverages play a small and declining role in the American diet.¹⁸

While lacerating the credibility of independent scientific studies, soda manufacturers also sponsored their own studies, ones that offered countervailing science (what we might today call “alternative facts”). A scientific review of these studies prompts the question of whether they were designed by scientists or by public relations firms; they are not good. The methods are weak, and the results are, by definition, highly questionable.

But is anyone else besides scientists looking closely? The results of flawed, industry-backed studies are blasted to the media in glossy, pandering ways, and it works. Outrageous or counterintuitive stories about scientific studies, especially ones that sell an easy path to weight loss, get attention and not all journalists are equipped to assess their rigor. One journalist who is equipped, the Associated Press’s Candace Choi, identified, critiqued, and published a few embarrassing claims by the industry that were guaranteed to grab the attention of dieters and would-be dieters: “Study: Diet Beverages Better for Losing Weight Than Water.” The headline accompanied a story reporting research funded by, of course, the American Beverage Association. “Hot Oatmeal Breakfast Keeps You Fuller for Longer,” described a study paid for by Quaker Oats.¹⁹

Academic journals are filled with sugar studies. Some are funded by the National Institutes of Health or other independent sources; some are funded by the producers of sugary drinks. The types of studies vary greatly, and the devil is in the details. No single study would, by itself, be sufficient to understand the effects of drinking soda or other sweetened beverages. So researchers (and their funders) set out to review and synthesize the accumulated data, often by evaluating the findings and the quality of multiple individual studies. Predictably, studies paid for by SSB producers, or those performed by scientists with links to the industry, reported very different findings from those conducted by nonconflicted scientists. In one analysis of 60 sugar studies, 25 of 26 negative studies (i.e., studies that found no correlation between SSBs and obesity) were industry-funded; only one of the 34 studies that reported a positive relationship between SSB consumption and ill health was paid for by an SSB manufacturer.²⁰ This “funding effect”—finding the result your funder wants—has been true of studies on SSBs, but also for the large-scale reviews of the accumulated studies.

There are now several reviews of the reviews. And what do they show? The first of them was sponsored by a foundation, not the industry, and published in 2007. It found that the reviews funded by industry were seven times more likely to have a favorable conclusion than those with no industry funding.²¹ Over time, the numbers have gotten starker. A more recent analysis of 133 SSB studies published between 2001 and 2013 reported that industry-related papers were 57 times more likely to conclude that the drinks had a weak or no detrimental health effect than did studies by independent scientists.²² Virtually all industry-funded reviews of the reviews found the evidence linking SSBs to ill health was weak and unconvincing.²³

In an effort to write its own narrative, Coca-Cola engaged epidemiologist Douglas Weed to review the reviews that linked SSBs to negative health outcomes. Weed was an excellent choice: a respected scientist who, before launching his own consulting firm, held a high-level post at the National Cancer Institute. After leaving NCI, he has lent his scientific credibility to the defense of corporations accused of making people sick by exposing them to DuPont’s Teflon chemical PFOA²⁴ and the controversial pesticide glyphosate made by Monsanto.²⁵ On behalf of the American Chemistry Council, he produced a review critical of a Consumer Products Safety Commission advisory panel’s report on the effects of phthalates (chemicals used to make plastics softer and more flexible, common in toys and care items) on children’s health.²⁶ These are but a few of his projects. In short, Weed has transitioned to a career as a product defense scientist. And in that role, it is little surprise that his and two colleagues’ review of the SSB reviews concluded that, overall, the quality of earlier reviews was low.²⁷ If you follow the logic in Weed’s analysis, we really can’t be sure that SSBs contribute to the risk of obesity, heart disease, or diabetes. And in the absence of certainty, the beverage industry would be quick to remind us, no action can or should be taken.

But Coca-Cola couldn’t catch a break. When Weed’s paper appeared in the American Journal of Clinical Nutrition, it was accompanied by a scalding editorial by Vasanti Malik and Frank Hu, both of the Harvard School of Public Health. They wrote, “[R]ather than shedding more light on this pressing public health issue, [Weed’s review] obscured important relations between SSB consumption and harmful health consequences.” In short, Malik and Hu said exactly what Coke did not want to hear. The two public health professors argued that the policies the beverage industry is trying to stop, like taxing SSBs, are working and should continue:

Despite attempts from the beverage industry to obfuscate the issue by funding biased analyses and reviews, and by providing misleading information to consumers, many regulatory strategies to reduce intake of SSBs are already in place. Some states are considering taxation as a means of reducing SSB intake and as a method of offsetting some of the high health care costs attributed to regular consumption of these beverages. These measures have a great potential to reduce SSB consumption and their adverse health consequences.”²⁸

In 2016, when the U.S. government’s Dietary Guidelines Advisory Committee recommended a limit or target for “added sugars” of no more than 10 percent of total calories, the sugar industry answered with a long list of challenges. As the tobacco industry did for decades, they focused on the uncertainty of the scientific evidence and the absence of randomized clinical trials—a multi-year study in which some volunteers are assigned to consume large amounts of sugar and others are allowed little or none. Until any such sweeping (very expensive) study is conducted, it is likely that America’s sugary beverage manufacturers will continue to do what they’re doing: publish their own reviews, then complain that the government didn’t pay enough attention to them.²⁹

The pushback on sugar is not restricted to the beverage producers. Producers of many other processed foods—dairy products, eggs, breakfast cereals, pork, beef, soy products, dietary supplements, juices, cranberries, nuts, and chocolate—have gone to great lengths to defend their products in the face of threatened regulation or market contraction. New York University’s Marion Nestle is perhaps the leading academic expert on nutrition and the corporate marketing of food products. (I should note that she is not a renegade member of the Swiss food juggernaut’s founding family, Nestlé; Marion Nestle is American, and her name rhymes with “wrestle.”) Nestle was one of the first to bring attention to the food and beverage industry’s manipulation of data and promotion of questionable science, including the link between industry funding and favorable results.

One notable, often repeated bit of industry treachery relates to chocolate, and it originated in a study funded by Mars Inc. (now known as Mars Wrigley Confectionary), the maker of chocolate candies, including the ubiquitous M&Ms. The subject of the study was the possible benefits of cocoa flavanols on arterial function and blood pressure. As the researchers concluded, plant metabolites “have the potential to maintain cardiovascular health even in low-risk subjects.” This was great news for the people at Mars, who broadcast the findings in a full-page advertisement in the New York Times on September 27, 2015. But as Nestle pointed out, “[n]either the press release nor advertisement explained that cocoa flavanols are largely destroyed during all but the most careful processing of chocolate, nor did they mention chocolate at all. They didn’t have to. Uncritical readers are likely to interpret the statements as evidence that chocolate is good for them and that its sugar and calories can be ignored.”³⁰

Vox’s Julia Belluz identified 100 studies funded or supported by Mars over the past twenty years, all looking at the health effects of cocoa. Is it surprising that nearly every one of them provided findings favorable to this key ingredient in chocolate? And if these were the only studies you read, you might, as Belluz points out, mistakenly believe that “[r]egularly eating cocoa flavanols could boost mood and cognitive performance, dark chocolate improves blood flow, cocoa might be useful for treating immune disorders, and both cocoa powder and dark chocolate can have a ‘favorable effect’ on cardiovascular disease risk.”³¹

Mars walks a line of legality here. For all the liberties taken by food companies in co-opting research, making claims up without having some semblance of scientific support might induce charges of deceptive advertising by the Federal Trade Commission (FTC). That’s exactly what happened to the POM Wonderful company, which asserted in advertisements that its product—pomegranate juice—could cure a host of dreaded diseases, including heart disease, prostate cancer, and erectile dysfunction. In official charges against the juice company in 2010, the FTC asserted that such claims must be supported by at least one clinical trial. Without that justification, the manufacturer must drop its claims. The company disagreed and replied, “We stand behind the vast body of scientific research documenting the healthy properties of Wonderful variety pomegranate. Our research is unprecedented among food and beverage companies, and we take pride in having initiated a program of modern scientific research to investigate the health benefits of this ancient and revered fruit.”³² POM Wonderful took the FTC all the way to the Court of Appeals, losing the legal argument at every level.³³

Food manufacturers are creative. If the sugar in a product is a problem, they change the subject. A product that’s bad for you can suddenly be healthful when viewed in a very specific, narrow way. General Mills, for example, aggressively markets its high-sugar cereals like Lucky Charms and Cinnamon Toast Crunch as “made with whole grains.”³⁴ Yes, whole grains are better than plain white flour. But that matters appreciably less when your toddler is getting walloped with sugar in every serving.

So, should sugar researchers accept funding support from Big Sugar? The question is too narrow. A more important question is, should any food and nutrition researchers accept funding support from industry? There is no question that more (and better) science is needed to improve the diet and nutrition of people across the world. For the most part, the studies from which we learn the most are large, long-term, and expensive. Academic scientists can’t do this work without support, and with government funding decreasing, at least in the United States, these sorts of sweeping studies aren’t coming anytime soon. It would be fair to argue that the food industry firms should pay for the research, because they are the ones who benefit from research that finds new, improved products. Providing data that show a product is safe is the reasonable cost of doing business if they want to exploit it in a free-market economy.

But industry funding brings with it the inherent conflicts of interest. There are too many ways studies can be kneaded and shaped to fit the needs of the sponsors, and there are not enough people with the expertise and platform to officiate such matters. Firms certainly won’t hire scientists whose studies have a track record of finding that food products are unsafe or not particularly nutritious. Industry will commission studies that answer the questions the industry wants answered. More often than not, these questions are posed in ways that produce results more suited to marketing materials than nutritional goals. Scientists who receive industry money are likely, consciously or not, to produce the results their sponsors expect. Research funding is hard to come by, and they want to keep the financial support flowing.

The answer in all this, I believe, is not simply to allow industry to fund nutrition research; food manufacturers should be required to do so. Our system for scientific inquiry needs to move past the current ethical controls, which are applied inconsistently at best and which allow independent researchers to design studies, apply for funding, and publish the results no matter what the outcome of the work. In this model, the industry gets to set the research agenda and select who does the study, with little public disclosure, all but guaranteeing that the firms will get the results they want.

An alternative system could require all components of the food industry to contribute money to a research institute, one with pooled funding and a board of experts stewarding the research agenda and deciding which independent scientists will be funded to conduct the studies. In terms of model, the precedent of requiring producers to contribute to a fund for the collective good of the food industry is already well established. Congress has authorized 22 industry-funded research and promotion (R&P) boards that collect mandatory contributions or fees in a range of industries—beef and pork, dairy and eggs, all sorts of fruits and vegetables—even the firms that produce the paper and packaging for food products have an R&P Board to which they all contribute.³⁵

These R&P boards work, in that they promote the sales of crops and products. The new board or boards would have to be independent of the funders, directed by scientists with no financial conflict of interest. Controversial? Yes. But impossible? No.

In the most remote, poorest village in Latin America or Asia or Africa, you can buy a Coke. It will cost more than pennies, but not much more. Sugary drinks (along with other processed foods, but especially SSBs) are present almost everywhere, which in itself explains why the obesity epidemic is also global.

The price paid in terms of medical and disability costs and lowered workforce productivity is much more than pennies. In considering the toll of sugar-laden products on human health, and especially the ensuing costs saddled on municipalities, states, and national governments, it is important to consider how healthier diets can be encouraged more actively—in other words, how barriers to unhealthy habits can be constructed. The most straightforward is an excise tax in order to raise the price of the product for which decreased consumption is deemed a public good. The reasoning is straightforward: demand is elastic; higher prices mean less consumption. With cigarettes—the most obvious example—the problem is that once addicted, it’s difficult to stop, and smokers end up paying a sizable portion of their income to satisfy their nicotine fix. A key strategy with cigarettes, therefore, is to discourage that first puff, or at least that first pack by raising the price. It has worked. According to the U.S. Centers for Disease Control and Prevention, “increasing the price of tobacco products is the single most effective way to reduce consumption.”³⁶

Today, the most prominent experiment with an excise tax on a food product is the “soda tax” on sugar-sweetened beverages. It’s designed to discourage SSB consumption while generating revenues for public health programs often aimed at the diseases and conditions associated with sugar consumption. Among processed food products that are logical targets of market intervention, the sugar drinks are the low-hanging fruit. They provide little or no nutritional value, and the tax is easy to levy.³⁷ School districts, goaded by PTAs and nutritionists, are going even further, limiting or banning these products from school cafeterias and snack machines. Make it harder to tank up on sugar.³⁸

The opposition has been fierce, predictably, with millions of dollars spent to convince the public and legislators that the science behind the soda taxes is doubtful, that the causation between sugar and obesity has never been proved, that taxes will be woefully ineffective in fighting obesity, and that thousands of jobs will be forfeited in a (failed) experiment in social engineering. Nor, critics argue, does the government have any right to interfere with the workings of the free market. This last salvo can be an effective argument, but it’s a real howler in its hypocrisy. Most consumers probably do not know that many, many food products, with sugar products high on the list, enjoy subsidies and market protections of one sort or another. The producers know this very well, of course. Sugar producers benefit from one of the commodity support programs common across the food industry, and from tariffs on competing exporters (in effect in the United States since 1789, in fact). They are subsidized by the government and protected from their competitors. Now that is a sweet deal.

The tobacco and liquor industries don’t pay the costs of the diseases their products cause; they have shifted much of this cost to the public, especially through safety net programs like Medicaid. The same is true for manufacturers of the sugar drinks and other sugar-added products. They want it both ways: Privatizing profits, socializing risks. This should be stopped. (Only the mammoth lawsuits against Big Tobacco forced the cigarette manufacturers to repay states for a small portion of the money laid out by Medicaid systems for millions of cases of lung cancer, heart disease and a host of other illnesses caused by tobacco. Is this in the future for Big Sugar?)

Despite the unflagging opposition, momentum for these soda taxes is growing. They have been enacted in countries around the globe, including Barbados, Belgium, Chile, Dominica, France, Great Britain, Hungary, Kiribati, Mauritius, Mexico, Portugal, and Tonga. Several U.S. jurisdictions, including a growing number of cities, states, and tribes, have done the same. The World Health Organization has recommended that all governments enact taxes to raise the retail price of SSBs at least 20 percent.³⁹ And the taxes appear to work. After Mexico implemented its one peso per liter tax on SSBs, sales decreased 5 percent the first year and almost 10 percent the second year, with the largest decreases seen where the price increases probably have the biggest impact: low-income neighborhoods.⁴⁰ Decreases in consumption also occurred after soda taxes went into effect in Berkeley (the first American city to embrace this approach)⁴¹ and Philadelphia.⁴² The success in low-income neighborhoods is used to support the argument that soda tax disproportionately impacts the poor. Well, yes. The rich are never going mind paying a few extra cents for every gulp, but the poor may. The two most notorious excise taxes—tobacco and liquor—also impact the poor disproportionately. However, this is only part of the complicated calculus. Lower disease rates associated with healthier diets will benefit these consumers in the long run, both physically and monetarily, and less illness will mean less societal spending on medical costs associated with sugar-related diseases.

Governments are getting smarter in their implementation of the tax. The first ones simply raised the price of all sugary beverages. Newer ones use a sliding scale to reflect the relative amount of sugar in a given product.⁴³ When Great Britain began consideration of a soda tax, industry’s response was predictable. The British Soft Drink Association commissioned a report by a consulting group affiliated with Oxford University that forecast the new tax would have little positive impact (decreasing daily consumption by a mere five calories per person, on average) but would kill 4,000 jobs.⁴⁴ These conclusions were widely promoted, with many in the media mistaking this public relations effort for actual, impartial analysis.⁴⁵ Recognizing the need to maintain their market share, Britain’s leading soft drink manufacturers, including Coca-Cola and Pepsi, reformulated their soda, dramatically decreasing their sugar content. Just the threat of the law had a major impact on sugar consumption.

People who oppose sugar taxes are quick to label the legislation paternalistic. “The government shouldn’t tell people what they should and shouldn’t eat,” cry the soda manufacturers. “Let them choose for themselves!” This sounds good, but the producers’ argument is blatantly hypocritical. The argument is valid only if the associated risks are widely available and publicized—and they aren’t, because Big Sugar spends tremendous sums manufacturing uncertainty about the health impacts of its products. It’s the same old story: sow doubt and confusion in order to slow down or eliminate requirements to provide the better information they claim they want.

I will conclude here with a modest suggestion relating to the U.S. Department of Agriculture, which holds the mandate to protect the nation’s food supply and promote healthy diets. Enforcing that mandate is tricky, however, because the agency is also in the business of promoting the agriculture industry. The USDA is thus tasked with serving two masters, the industry and the public. The resulting danger is “industry capture,” which is an abiding risk within any regulatory structure. The political power and financial influence of a given industry are too powerful, and they overshadow concern for the public good within the oversight agency. The industry ends up in de facto control. In the past, when it has become clear that an agency couldn’t serve both masters, Congress has subdivided the agency into one serving the industry and a second one, presumably independent, whose primary mission is safety. Where this doesn’t happen, the public gets the short shrift as the government goes to great pains to accommodate corporations. In 2010, for example, the Deepwater Horizon explosion and subsequent monumental oil leak illuminated the conflicted mission of the Interior Department’s Minerals Management Service (MMS), whose job was to both promote and regulate offshore drilling. The predictable result was lax oversight of the offshore wells. Less than one month after the explosion, Interior Secretary Ken Salazar split the MMS into three independent agencies. But imposed independence isn’t guaranteed. Soon after taking office, the Trump administration rolled back many restrictions on the deep wells, clearly at the behest of the drillers.

Given that tens of thousands of Americans are killed annually by the diseases related to obesity and eating unhealthy foods, and given that the USDA is given the impossible task of serving Big Sugar and the other Big Food producers while also promoting standards for healthy diets that might not serve the interest of the producers, the imperative is evident: break up the USDA. Create an agency that’s independent of the producers and promotes only healthy eating.