In the good old days, the tobacco industry had a strategic marketing playbook script that worked something like this:
- emphasize personal responsibility for choosing to smoke
- pay scientists to deliver research that instills doubt about risks
- criticize the “junk science” that finds harms associated with smoking
- make self-regulatory pledges
- lobby with massive resources to stifle government action
- introduce “safer” products
- simultaneously manipulate and deny both the addictive nature of tobacco products and marketing said products to children
The compelling question asked by researchers Drs. Kelly Brownell and Kenneth Warner is this: How does the script of the modern food industry compare to that tobacco industry script?
Their conclusions, published in The Milbank Quarterly*, pulled no punches. Consider, for example, the paper’s title: “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?”
These two men are uniquely qualified to undertake this particular comparison. Yale University’s Dr. Kelly Brownell won the 2012 American Psychological Association award for Outstanding Lifetime Contributions to Psychology for his work on obesity and food policy. Dr. Kenneth Warner, meanwhile, teaches public health at the University of Michigan, where his research on disease prevention/health promotion has focused specifically on tobacco.
First, B&W recall that when early research began showing the harmful effects of tobacco on health, the tobacco industry paid prominent scientists to conduct studies and to act as advisors and consultants with the intent of countering this potentially damaging scientific evidence – and this practice continues today.
For example, they point to two different studies investigating the tobacco industry’s questionable behaviour in trying to undermine scientific evidence about the dangers of secondhand smoke (McGarity and Wagner 2008; Tong and Glantz 2007).
Medical experts with their greedy fingers in the wallets of big corporations are not a new phenomenon, sadly.
Consider those willing physicians hired by Big Tobacco decades ago to undertake research “proving” that cigarettes were not dangerous to our health.
Back in 1969, Post-Keyes-Gardner, the ad agency for tobacco giant Brown & Williamson, relied on the paid testimony of physicians for a new campaign “to set aside in the minds of millions the false accusations that cigarette smoking causes lung cancer or other diseases.” (Handbook of Public Relations, Heath & Vasquez, 2004). See also: Doctors On The Take: How To Read The Fine Print in Medical Research
Tobacco giant Phillip Morris was also a very active philanthropist, as described in a 2006 Grist interview with Richard Daynard, law professor at Northeastern University School of Law and a veteran of the tobacco wars:
“(Phillip Morris) particularly gave money to minority organizations, and basically bought silence. Meaning that in exchange for donations, recipient groups would not speak critically of industry.
“There have been a number of articles written about how the tobacco companies bought silence, particularly from black organizations. They also would advertise very heavily in minority media – one of the few national companies to do this. It resulted in the black organizations and the black media basically not getting the word out that they were among the principal victims of this industry.”
Can the same high-priced professional help who knowingly assisted Big Tobacco be at work today in other industries, too?
Just consider these other examples of financial conflicts of interest reported from just one prestigious institution – Harvard University – as reported by the Center for Science in the Public Interest and their Integrity In Science conflict-of-interest project:
- a Harvard pediatrician is paid by The Sugar Association to write good things about children and sugar
- a Harvard doc is paid $100,000 cash by a major drug company to testify in court that their recalled drug does not cause deadly heart attacks
- a Harvard astrophysicist banks over $630,000 in payments from ExxonMobil in exchange for co-authoring a report questioning climate change.
Which of these Harvard “experts” would you trust?
Similarly, Drs. Brownell and Warner observed that the major food companies commonly like to:
- stack their advisory boards with of the field’s most visible academics
- pay scientists as consultants
- fund research
The question, say Brownell and Warner, is what industry “buys” with these transactions.
The shopping list is impressive. While B&W acknowledge that it may be possible for some scientists and professional organizations to somehow avoid being affected, they remind us what generally happens for others:
- the conduct or interpretation of science becomes biased
- scientists or professional organizations issue statements and take positions more favourable to industry
- well-placed scientists help industry in key strategic roles (e.g., membership on the Dietary Guidelines Committee)
- industry uses the funding of research as evidence that it’s seeking the “truth” about the dangers of its products.
Speaking of shopping, how about a nice big box of the sugary breakfast cereal Froot Loops (the ones with that now-moribund Smart Choices symbol on the box)? Companies could pay to include this healthy eating recommendation symbol on their products – like junk Froot Loops (50% sugar by weight) – to seduce health-conscious American consumers. At least, until the entire Smart Choices program was finally yanked.
Dr. Eileen Kennedy, the Dean of Tufts University’s Friedman School of Nutrition Science and Policy, in a stupefyingly bizarre statement to the New York Times, defended the Smart Choices logo on Froot Loops at the time because she claimed it was “based on government dietary guidelines and widely accepted nutritional standards”. (Widely accepted on what planet, Dr. Kennedy?)
Now, common sense argues that industry would not be spending the money for endorsements like these if there were no significant financial return, but more important are the data addressing the issue.
One compelling example is the research done on the connection between the consumption of soft drinks and health. B&W cited a meta-analysis of all available research investigating this connection that has shown clear relationships among the consumption of soft drinks, poor nutrition, and negative health outcomes (Vartanian, Schwartz, and Brownell 2007).
First, an important reminder: this research was not funded by industry.
Here’s what that report showed: studies with stronger methods were more likely to show these negative outcomes. And a comparison of studies funded or not funded by industry showed that industry-funded studies were more likely to find results favourable to industry.
An analysis of studies of the health effects of second hand smoke produced similar findings (Misakian and Bero 1998).
The soft drink industry, through the American Beverage Association (ABA), responded swiftly to this meta-analysis report by Vartanian et al. A news release was produced immediately that said:
“You can be a healthy person and enjoy a soft drink. What is important is consuming a variety of foods and beverages in moderation and getting regular physical activity.”
Next, the ABA supported a group of industry-friendly researchers to conduct its own review of the link between soft drinks and body weight. So if you don’t like the results of independent researchers, you simply need to pay your own researchers to counter those results.
Two of these industry-friendly authors, in fact, had already been paid to conduct multiple industry-funded studies in the past, and one was actually employed by the ABA when their study was published – which begs yet another thorny question: why would any editor of any reputable journal accept for publication any paper written by any employee of any industry whose product is being “studied”? (See also: How Are Hockey-Playing Goons the Same as “Puzzled” Medical Journal Editors?)
This industry-funded study, to nobody’s amazement, found that the consumption of soft drinks is not related to negative outcomes (Forshee, Anderson, and Story 2008).
Last year, the American Beverage Association donated $10 million to the Children’s Hospital of Philadelphia. Here’s how the Philadelphia Inquirer explained it:
“When City Council was considering a soda tax last spring, doctors from the Children’s Hospital of Philadelphia testified about the dangers of sugar-sweetened drinks. But on Wednesday, the hospital announced that it would expand its obesity program with the help of $10 million from the very industry that produces them.
“The three-year grant is the inaugural gift from the Foundation for a Healthy America, a nonprofit created by the American Beverage Association.”
The ABA’s defense in response to New York City’s proposed ban on sales of soda servings larger than 16 ounces** has of course focused on Mayor Bloomberg’s assault on “free will”:
“The debate over a soda ban isn’t about a national dialogue on obesity – it’s about a mandate from politicians who believe they are uniquely qualified to determine how much free will citizens should be allowed.”
In the U.S. of A., perceived attacks that undermine this concept of personal free will are interpreted as fighting words.
Drs. Brownell and Warner were originally hopeful that this kind of industry conflict of interest might decline as “sunshine” being trained on the issue by the media may shame conflicted scientists and professional organizations into behaving differently. This refers to so-called “sunshine laws” – regulatory provisions intended to shed light on the financial relationships between the industry and physicians/academics (for example, drug company payments to doctors which have the potential to influence patient care in the company’s favour by increasing prescription of that company’s drugs).
One highly visible scandal did occur, for example, when the press documented that a prominent obesity researcher was paid by the restaurant industry to write a brief in its legal case opposing menu-labeling regulations in New York City (Nichols 2008; Saul 2008; Stark 2008).
But Brownell and Warner also make this interesting observation:
“Improvements also may follow when scientists recognize that the field’s response to conflicts – disclosure – may actually make the situation worse.
“Cain, Loewenstein, and Moore (2005) found that an audience hearing information from a source who discloses a financial conflict of interest discounts what they hear, but only to a small extent.
“The source, however, feels emboldened to present his or her views more strongly, ultimately making the conflicted source more, rather than less, credible.
“This phenomenon may apply to organizations as well as to individuals, and as noted earlier, prominent organizations such as the American Dietetic Association and the Obesity Society receive considerable funding from industry.”
Consider also industry-funded front groups – like the ABA’s ironically-named Foundation for a Healthy America – that provide another parallel between the tobacco and food industries. (See also: How To Set Up Your Own Phony Non-Profit as a Front for Big Business)
The tobacco industry has also created organizations that appear at first glance to be grassroots groups seeking to protect smokers’ rights and to fight off government intrusion (Advocacy Institute 1998; Apollonio and Bero 2007).
Big Pharma is the mother lode of legitimate-sounding front groups set up by industry. For example, even with no payroll, no building and no offices, drug giant Merck’s wholly-owned non-profit, the Bone Measurement Institute, helped Merck boost annual sales of its osteoporosis drug Fosamax as high as $3.2 billion.
What’s become known as marketing-based medicine has in fact prompted some experts, like Dr. Marcia Angell (for over 20 years the Editor-in-Chief at the prestigious New England Journal of Medicine) to call this industry influence:
“… a pervasive conflict of interest that corrupts the medical profession.”
Industry, of course, has the right to promote its positions, Brownell and Warner remind us, but when money flows through such organizations, their nature and intent are not apparent to the general public.
Like the tobacco industry, the food industry also funds groups with names that would not necessarily alert the public to their industry connections. The Center for Consumer Freedom is one example. Such front groups attack and instill doubt in published science and the scientists who do research, in concert with the industry playbook script (McGarity and Wagner 2008; Michaels 2008).
Drs. Brownell and Warner conclude:
On June 19, 2012, the journal Public Library of Science Medicine*** launched a four-part series of reports on Big Food that included an examination of the activities and influence of the food and beverage industry in the health arena. Here are some of their key findings on soda marketing activities:
- Because sugary beverages are implicated in the global obesity crisis, major soda manufacturers have recently employed elaborate, expensive, multinational corporate social responsibility (CSR) campaigns.
- These campaigns echo the tobacco industry’s use of CSR as a means to focus responsibility on consumers rather than on the corporation, bolster the companies’ and their products’ popularity, and to prevent regulation.
- In response to health concerns about their products, soda companies appear to have launched comprehensive CSR initiatives sooner than did tobacco companies.
- Unlike tobacco CSR campaigns, soda company CSR campaigns explicitly aim to increase sales, including among young people.
- As they did with tobacco, public health advocates need to counter industry CSR with strong de-normalization campaigns to educate the public and policymakers about the effects of soda CSR campaigns and the social ills caused by sugary beverages.
* Brownell, K, Warner, K.E. “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?” The Milbank Quarterly, Vol. 87, No. 1, 2009 (pp. 259–294).
*** Dorfman L, Cheyne A, Friedman LC, Wadud A, Gottlieb M (2012) “Soda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?” PLoS Med 9(6): e1001241. doi:10.1371/journal.pmed.1001241