Michael F. Jacobson, executive director of the Center for Science in the Public Interest (@CSPI), comments on a research article appearing in PLOS Medicine last week that describes the sugar industry’s continuing efforts to subvert public health policies.
Forty or 50 years ago, at least in the United States, tooth decay was seen as the major health problem associated with consumption of refined sugars. Back then, many dentists (probably unsuccessfully) warned patients away from sugar, and public health researchers sought ways to reduce the toll of caries, the most prevalent chronic disease in children and adolescents. Few, if any, were looking into the relationship between refined sugars and obesity or diabetes or heart disease. Now, in a remarkable piece of dental-political forensics, researchers at the University of California San Francisco have brought to light the forces that shaped oral-health policy in that era.
In a research article appearing in PLOS Medicine this week, Cristin E. Kearns, Stanton A. Glantz, and Laura A. Schmidt mined an archive of industry papers long buried in the library of the University of Illinois, Urbana, as well as ancient documents at the National Institute of Dental Research (NIDR). They skillfully wove a public health whodunit that we didn’t even know had been done to us, showing how sugar-industry executives and the International Sugar Research Foundation (ISRF, which later became the Sugar Association) sought, successfully, to influence NIDR policy.
The documents reveal a virtual capture of the NIDR by an affected industry. In the late 1960s NIDR began planning a National Caries Program (NCP) to fund research on the prevention of caries. The cane and beet sugar industry, understandably, was concerned that the committee might recommend measures to reduce sugar consumption, which even it had recognized as contributing to caries. Hence, the industry mounted a campaign to ensure that research focused not on the public health goal of reducing sugar consumption, but instead on prophylactic measures like vaccines, dextranases, and other approaches to reducing caries.
To achieve their goal, the industry formed a task force to influence NIDR. The membership of the industry committee was almost identical to that of NIDR’s; nine of 11 members of NIDR’s Caries Task Force Steering Committee also served on the ISRF’s Panel of Dental Caries Task Force. Remarkably, several high officials of NIDR served on the industry committee. The revolving door was also swinging. Dr. Philip Ross, who had been chief of the NIDR/NIH Research Grants Section from 1963–1965, was elected president of the ISRF in 1968. He went on to coordinate meetings with NIDR.
Kearns, Glantz, and Schmidt found that 78 percent of the industry’s 1969 submission to NIDR was directly incorporated into NIDR’s 1971 request for contracts. And industry prevailed: NIDR’s 1971 invitation for research proposals did not request proposals for research on the cariogenicity of foods or reducing sugar consumption. Out of hundreds of grants rewarded, only one or two grants related to the cariogenicity of foods.
Between 1970–1999, consumption of caloric sweeteners (mostly sugar and high-fructose corn syrup [HFCS]) increased by 25 percent in the US (USDA data here). Whether more research on the cariogenicity of foods would have tempered or even reversed that trend—and reduced the prevalence of caries, obesity, and other diseases—is impossible to know.
Fast-forward now to recent years. Fuelled in part by the doubling of childhood and quadrupling of adolescent obesity rates in the last 30 years, research on the health effects of refined sugars has increased greatly, with the focus shifting from tooth decay to more lethal diseases. Studies have strongly implicated refined sugars, especially in beverage form, in the causation of obesity, diabetes, and heart disease. The strongest evidence fingers fructose (half of the sucrose molecule and about half of HFCS) as the major culprit.
That research has spurred campaigns by consumer groups, the American Heart Association, the Centers for Disease Control and Prevention, and local and state health departments to rein in sugar and sugar-drink consumption. Strategies have included getting sugar drinks out of schools, levying excise taxes on sugar drinks, requiring warning notices on sugar-drink containers, restricting levels of sugar in beverages, and mounting publicity campaigns. Those efforts (and increased sales of bottled water) have reduced per-capita consumption of carbonated sugar drinks by 25 percent and of caloric sweeteners by 15 percent since 1998.[*]
In response to those campaigns, industry has ratcheted up its political efforts. Most prominently, the soft-drink industry has spent over $125 million opposing local, state, and federal soda-tax proposals, prevailing everywhere but in Berkeley, CA. A tax of one cent per ounce would reduce sales by about 10 percent.
The industry is also fighting two upcoming federal actions. The US Departments of Agriculture and Health and Human Services are now doing their five-year updating of the Dietary Guidelines for Americans. The government’s advisory committee of academic experts recommended that sugar consumption, especially from beverages, be limited to 10 percent of calories (current consumption is about 15 percent). It also recommended exploring the use of “pricing” (i.e., tax) approaches to reduce consumption of sugar drinks.
If those recommendations are included in the 2015 Dietary Guidelines for Americans they will strengthen the Food and Drug Administration’s proposal to include an “added sugars” line on the Nutrition Facts label. A Dietary Guidelines recommendation of a 10 percent limit on refined sugars would also provide a basis for the FDA to set a Daily Value for refined sugars and include a “%DV” on food labels. That could make high-sugar foods, especially beverages, look like poor nutritional choices.
The sugar and soft-drink industries are already opposing these federal actions. The Sugar Association and American Beverage Association filed voluminous comments with the Dietary Guidelines Advisory Committee challenging the tentative finding about sugars’ and sugar drinks’ contributions to chronic diseases. The sugar group charged, for instance, that the committee’s conclusions were “opinion-based” and not “science-based.” Industry lawyers have even contended that including “added sugars” on nutrition labels would be unconstitutional. If those tactics are more visible than those chronicled by Kearns, et al., rest assured that industry will also be working behind-the-scenes inside the halls of government just as hard as 40 years ago.
[*] Calculations based on annual volumes of carbonated drinks reported by Beverage Digest (pdf here), estimates of non-caloric drinks, and U.S. population.
Michael F. Jacobson, Ph.D., is the executive director of the non-profit Center for Science in the Public Interest. He reports not having any conflict of interest other than many years’ efforts to reduce the consumption of sugar and soft drinks. He can be reached at mjacobson@cspinet.org.
