Search results: the corporation not me

The American Journal of Public Health has just published a first look—ahead of its print in June—at my most recent article, Regulating the Food Industry: An Aspirational Agenda [if you are not a member of the American Public Health Association, this will be behind a paywall, alas].

It begins:

I end it with policy recommendations for:

• Dietary guidelines
• Mass media campaigns
• Taxes
• Warning labels
• Marketing restrictions
• Portion size restrictions
• Farm subsidies

Hence, aspirational.

And, I say,

While we are thinking in aspirational terms, let us not forget root causes. We must also demand policies that link agriculture to public health, keep corporate money out of politics, reduce corporate concentration, and require Wall Street evaluate corporations on the basis of social as well as fiscal responsibility.  In comparison with those challenges, takin gon the food industry should be easy.

Let’s get to work.

As the WHO/UNICEF report I posted yesterday makes clear, the marketing of infant formula—impossible for new mothers to avoid—interferes with breast feeding and, therefore, is a public health concern.

I posted about the Abbott Labs infant formula recall last week.

Here are some additional items I’ve collected on this topic.

I.  What the marketing looks like.

II.  Study finds no benefit of enriched infant formula on later academic performance: Children who are given nutrient or supplement enriched formula milk as babies do not appear to have higher exam scores as adolescents than those fed with standard formula, suggests a study published by The BMJ, leading researchers to argue renewed regulation is needed to better control infant formula promotional claims…. Read more

III.  IBFAN, the International Baby Foods Action Network, writes that it is:

launching a PETITION calling for an immediate halt to a new study  –  funded by the Gates Foundation and led by researchers from the University of California – that is randomly allocating infant formula to breastfeed in low-birth-weight babies in Uganda and Guinea-Bissau on assumption that this might prevent wasting and stunting.

The study, which has been cleared by ethics committees in the USA, Uganda and Guinea -Bissau – uses purchased ready-to-use infant formula made by Abbott, a US pharmaceutical corporation operating in 160 countries.  Abbott is a major violator of the International Code and is currently at the centre of a media storm in the USA because of contamination in its powdered formula. (NB. The formula used in the trial is liquid Ready-to-Feed).

IV.  IBFAN issued an earlier statement: The baby food industry’s destruction of an irreplaceable natural resource.

The International Code of Marketing of Breastmilk Substitutes was adopted forty years ago by the World Health Assembly, the world’s highest health policy setting body…Today 70% of countries have adopted laws based on the Code, however far too many are limited in scope and full of loopholes as a result of industry interference. As a consequence predatory marketing of baby food products continues throughout the world.  and the global Baby Food Drink Market is forecast to rise more than 30% in 5 years (from $68bn in 2020 to $91.5bn by 2026)….Aside from its crucial role in child survival (more than 800,000 children die each year because they are not breastfed and many more do not reach their full potential, ­­ breastfeeding is the most environmentally friendly way to feed an infant, resulting in zero waste, minimal greenhouse gases, and negligible water footprint. As a renewable natural food resource, mother’s milk makes an important contribution to local food and water security.…the baby food industry lost no time in exploiting the fear and confusion during the pandemic: falsely claiming their products build immunity; that their  ‘donations’ are humanitarian; encouraging the needless separation of mothers and babies and pretending that they are essential ‘partners’ who are genuinely working to address the problems.

V.  The Access to Nutrition Initiative (ATNI) assesses nine formula companies’ adherence to WHO recommendations.  Its report is here.

According to its press release,

Despite the World Health Assembly (WHA) adopting ‘The International Code of Marketing of Breast-milk Substitutes’ forty years ago and passing 18 associated resolutions since (collectively referred to as ‘The Code’), the BMS/CF Marketing Index 2021 found that none of the companies it assessed fully abides by The Code’s recommendations and most fall well short.

The summary: 

• Danone retained first place with a score of 68%, up from its 2018 score of 46%
• Nestlé, the market leader in sales value, retained its second place with a score of 57% – also a substantial improvement on its score of 45% in 2018
• KraftHeinz achieved the greatest improvement, ranking third, with a score of 38% compared to in 2018 when it didn’t score at all
• Reckitt (previously RB) substantially improved its BMS Marketing policies which led to a big jump in its score from 10% in 2018 to 32% in 2021 and climbing one place to fourth in the ranking.

VI.  A study: Conflicts of interest are harming maternal and child health: time for scientific journals to end relationships with manufacturers of breast-milk substitutes.  Pereira-Kotze C, et al.  BMJ Global Health. 2022 Feb;7(2):e008002. doi: 10.1136/bmjgh-2021-008002

The promotion and support of breastfeeding globally is thwarted by the USD $57 billion (and growing) formula industry that engages in overt and covert advertising and promotion as well as extensive political activity to foster policy environments conducive to market growth. This includes health professional financing and engagement through courses, e-learning platforms, sponsorship of conferences and health professional associations and advertising in medical/health journals…journal publishers may consciously, or unconsciously, favour corporations in ways that undermine scientific integrity and editorial independence—even perceived conflicts of interest may tarnish the reputation of scientists, organisations or corporations.  Such conflicts have plagued infant and young child nutrition science for decades.

Comment: As I mentioned yesterday, we now have more than enough evidence to put a stop to this.

I learned about this one from an article—no, it’s an ad really—in NutraIngredients.com.

Its headline: “Large new study validates krill oil’s heart health benefits.”

Heading the page is this note:

CONTENT PROVIDED BY AKER BIOMARINE SUPERBAKrill Learn More

I clicked on Learn More and got a disclaimer, the first time I have seen something like this:

The following content is provided by an advertiser or created on behalf of an advertiser. It is not written by the NutraIngredients.com editorial team, nor does it necessarily reflect the opinions of NutraIngredients.com.

OK.  Now we know that the entire article is an ad paid for by the maker of the product under discussion.

What about the research?

The study: Effectiveness of a Novel ω-3 Krill Oil Agent in Patients With Severe HypertriglyceridemiaA Randomized Clinical Trial.  Dariush Mozaffarian, MD, DrPH¹; Kevin C. Maki, PhD^2,3; Harold E. Bays, MD⁴; et alFernando Aguilera, MD⁵; Glenn Gould, MD⁶; Robert A. Hegele, MD⁷; Patrick M. Moriarty, MD⁸; Jennifer G. Robinson, MD, MPH⁹; Peilin Shi, PhD¹; Josefina F. Tur, MD¹⁰; Jean-François Lapointe, PhD¹¹; Sarya Aziz, PhD¹¹; Pierre Lemieux, PhD¹¹; for the TRILOGY (Study of CaPre in Lowering Very High Triglycerides) investigators.  JAMA Netw Open. 2022;5(1):e2141898. doi:10.1001/jamanetworkopen.2021.41898

Method: The investigators pooled data from two previous trials of people given Krill oil or a cornstarch placebo for 26 weeks.

Results: “This study found that ω-3 –PL/FFA, a novel krill oil–derived ω-3 formulation, reduced TG levels and was safe and well tolerated in patients with severe hypertriglyceridemia.”

Funding/Support:The study was sponsored by Acasti Pharma Inc. [Acasti partners with Aker to make Krill oil]

Role of the Funder/Sponsor: The sponsor collaborated with the academic principal investigator (Dr Mozaffarian) in the design and conduct of the study, interpretation of the data, and review and suggestions for editing of the manuscript. The sponsor collaborated with the academic principal investigator and an independent contract research organization (IQVIA) in study implementation, data collection, and management. The sponsor had no role in the analysis of the data or the decision to submit the manuscript for publication.

Conflict of Interest Disclosures: Dr Mozaffarian reported serving as a consultant for Acasti Pharma Inc as principal investigator of this trial; receiving research funding from the National Institutes of Health, the Gates Foundation, and the Rockefeller Foundation; personal fees from Barilla, Cleveland Clinic Foundation, Danone SA, and Motif FoodWorks; chapter royalties from UpToDate; serving on the scientific advisory board of Beren Therapeutics PBC, Brightseed, Calibrate, DayTwo (ended June 2020), Elysium Health, Filtricine Inc, Foodome Inc, HumanCo, January, Perfect Day Inc, Season, and Tiny Organics; and holding stock ownership in Calibrate and HumanCo outside the submitted work. Dr Maki reported receiving research grants from and consulting for Acasti Pharma Inc and Matinas BioPharma Holdings Inc, and receiving research funding from Indiana University Foundation, Pharmavite, Novo Nordisk A/S, General Mills Inc, The Kellogg Company, and PepsiCo Inc, and consulting for 89bio Inc, and NewAmsterdam Pharma outside the submitted work. Dr Bays reported receiving research grants from Acasti Pharma Inc. Dr Aguilera reported receiving research grants from Acasti Pharma Inc. Dr Gould reported receiving research grants from Acasti Pharma Inc. Dr Hegele reported receiving research grants from Acasti Pharma Inc and personal fees from Akcea-Ionis, Amgen Inc, Arrowhead Pharmaceuticals, HLS Therapeutics Inc, Novartis International AG, and Pfizer Inc outside the submitted work. Dr Moriarty reported receiving research grants from Acasti Pharma Inc. Dr Robinson reported receiving research grants to the institution from Acasti Pharma Inc, Amarin Corporation, Amgen Inc, Astra-Zeneca, Eli Lilly & Co, Esperion Therapeutics Inc, The Medicines Company, Merck & Co Inc, Novartis International AG, Novo Nordisk A/S, and Regeneron Pharmaceuticals Inc, and consulting fees from COR2ED, Getz Pharma Limited, The Medicines Company, and Novartis International AG. Dr Shi reported consulting for Acasti Pharma Inc for performing statistical analyses on this trial. Dr Tur reported receiving research grants from Acasti Pharma Inc. Dr Lapointe reported owning stock or stock options in Acasti Pharma Inc. Dr Aziz reported owning stock or stock options in Acasti Pharma Inc. Dr Lemieux reported serving chief operating officer/chief strategy officer of Acasti Pharma Inc during the conduct of the study and outside the submitted work and holding a patent for CaPre. No other disclosures were reported. [My emphasis]

Comment: You can’t make this stuff up.

Reference: For research on why and how industry sponsorship can influence study outcome, see Unsavory Truth: How Food Companies Skew the Science of What We Eat.

As if we don’t have enough trouble with alcohol in this country, it’s now being added to sodas.  In states that allow such things, expect to see them taking up more and more room in supermarket aisles.

The business press is interested in this trend; there is much money to be made on drinks of any kind.

See, for example, Bud Light to Launch Hard Soda.

Bud Light Seltzer Hard Soda will have no sugar or caffeine. Anheuser-Busch describes it as ‘light like a seltzer and bold like soda pop.’ Each can will contain 100 calories and 5% alcohol.

This comes in cola, cherry cola, orange and lemon-lime flavors.

Consumer demand has soared over the past few years for nonalcoholic seltzers such as LaCroix and alcoholic ones such as White Claw that are low on calories and offer just a hint of flavor. Now some consumers are migrating toward stronger flavors, industry experts say, and brewers are trying out new fizzy drinks.

This, then, is about market share.

Lots of other companies are getting into this act.

• From Beer to Hard Seltzer: A Cultural Pivot Finds a New Market:  Boston Beer Co., owner of popular brands like Sam Adams and Dogfish Head, launched its hard seltzer Truly in 2016. CEO Dave Burwick explains the company’s cultural pivot that made it No. 2 in the rapidly growing category.
• No- and low-alcohol category value in key global markets nears $10bn.  Monster enters alcohol category with CANarchy Craft Brewery Collective acquisition:  Monster Beverage Corporation will acquire CANarchy Craft Brewery Collective LLC, a craft beer and hard seltzer company for $330m, providing a springboard for the energy drink giant into the alcoholic beverage category…. Read more
• Coca-Cola, Molson Coors to partner on Simply Spiked Lemonade.  The RTD alcoholic beverage, which is set to hit shelves this summer, is the second drink to be developed by the two companies, following the launch of Topo Chico Hard Seltzer in 2021.
• Dry January movement grows presenting opportunity for non-alcoholic beverage brands:  Many consumers are reporting to take part in Dry January by either abstaining completely or significantly cutting down (‘Damp January’) on their alcohol consumption for the month, presenting year-long opportunities for the non-alcoholic beverage brands, says Morning Consult…. Read more

Given all that, what are we to make of this piece of news?

• Alcohol and COVID-19: Good news for red wine drinkers, but blow for beer boozers?  People who consume red wine between one to more than five glasses a week had a 10 to 17% lower risk in contracting COVID-19, but beer drinkers had a heightened risk, according to a recent study…. Read more
• Here’s the study: COVID-19 Risk Appears to Vary Across Different Alcoholic Beverages.
• Here’s the caveat: Association does not equal causation.  Drinkers of red wine have different lifestyles than beer drinkers, perhaps?
• And here are the study’s sensible conclusions:  The COVID-19 risk appears to vary across different alcoholic beverage subtypes, frequency, and amount…Consumption of beer and cider and spirits and heavy drinking are not recommended during the epidemics. Public health guidance should focus on reducing the risk of COVID-19 by advocating healthy lifestyle habits and preferential policies among consumers of beer and cider and spirits.

Amen.

Priya Fielding-Singh.  How the Other Half Eats: The Untold Story of Food and Inequality in America.  Little, Brown Spark, 2021.

I did a blurb for this book (some of it ended up on the cover)

How the Other Half Eats is a must-read for anyone who has ever wondered why Americans don’t eat more healthfully. Fielding-Singh achieved something remarkable in gaining the trust of families who then let her observe their daily food choices. Her book is a thoughtful, riveting, compassionate, and utterly compelling account of why eating healthfully is so difficult, especially for the poor. What’s more, she offers a superb example of why on-the-ground field research is invaluable for gaining a deep and nuanced understanding of the ways that our industry-driven and highly inequitable food environment affects real people on a daily basis.

What I found so amazing about this book was that Fielding-Singh actually talked to people about how they feel about their diets—and listened.  Her analysis is exceptionally thoughtful.  Some examples:

From page 253

It is one thing to be able to find and afford a head of cauliflower.  But it is another to want to buy that cauliflower, to choose to spend one’s money on that cauliflower (at the expense of other purchases), to have the time and tradition to cook that cauliflower, and to possess the patience to weather one’d child’s complaints and pleas for macaroni and cheese and soldier on to feed that cauliflower to one’s child.  Only a handful of parents I met had all of these things.

From page 255

Personal responsibility has never solved a public health problem or remedied an inequity.  Food is no exception…Many of the families I met had either done so or were trying to figure out how to eat more nutritiously with the resources they had.  But, largely due to the structures implemented by the food industry and federal government, most felt like they were fighting an uphill battle—and losing.

Page 259

Banning marketing to kids would give moms a fighting chance of being able to feed their kids what they want rather than what corporations push on them.  Currently, only those families with the most money, time, and bandwidth have a shot at prevailing against the industry—and even those families often struggle and even fail.  Protection from the food industry should be right granted to all families, not a privilege reserved for the few.

Digital marketing, especially when targeted to children, is a rising source of concern and for well-documented reasons.

Two reports provide the data.  The big issue?  Digital marketing promotes unhealthful eating.

I.  From the World Health Organization’s Regional Office in Europe: Digital Food Environments Factsheet

Digital technologies are becoming integrated to varying degrees into everyday life across the 53 countries of the WHO European Region. The increase in digital technologies can increase the convenience of food and prepared meals. A recent unrepresentative survey of 10 European countries found that every fifth meal was consumed outside of the home, with 80% from commercial outlets. The influence of digitalization on dietary behaviour, however, is not well understood, raising questions about its influence on the health and nutrition of adults and children.

II.  From the U.S. Center for Digital Democracy comes Big Food, Big Tech, and the Global Childhood Obesity Pandemic

The full report

Some of the largest food and beverage corporations—including Coca-Cola, McDonald’s, and Pepsi—have, in effect, transformed themselves into Big Data businesses, acquiring specialist firms, establishing large in-house operations, and hiring teams of data scientists and technology experts to direct these systems. With these enhanced capabilities, they can more effectively engage in ad targeting—whether on the leading platforms or through their own mobile apps.

The Executive Summary

A growing body of academic research has documented the increasing presence of unhealthy food promotion in digital media, as well as clear patterns of youth engagement with major brands, and influences on health behaviors.

The Press Release

Tech platforms especially popular with young people—including Facebook’s Instagram, Amazon’s Twitch, ByteDance’s TikTok, and Google’s YouTube – are working with giant food and beverage companies, such as Coca Cola, KFC, Pepsi and McDonald’s, to promote sugar-sweetened soda, energy drinks, candy, fast food, and other unhealthy products across social media, gaming, and streaming video. The report offers fresh new analysis and insight into the most recent industry practices.

Comment: All this calls for regulation, of course.  Any chance of that coming our way?

Two articles on similar themes have come out recently.

Is It Time to Break Up Big Ag? — The New Yorker

Nationally, the four largest dairy co-ops now control more than fifty per cent of the market. They’ve been able to grow so big, in part, because of a 1922 law called the Capper-Volstead Act, which provides significant exemptions from antitrust laws for farmer-owned agricultural coöperatives. “The agricultural industry is different than other industries because Capper-Volstead allows them to combine in ways that other individuals would go to jail for,” Allee A. Ramadhan, a former Justice Department antitrust attorney who led an investigation into the dairy industry, told me.

The law’s protections were intended to give small, independent farmers the right to collectively bargain prices for processing and selling their goods, but many large co-ops, such as D.F.A., have increasingly come to resemble corporations.

Break Up Big Chicken — The New York Times

Most chicken that Americans eat is processed by a handful of big companies because, in recent decades, the government gave its blessing to the consolidation of poultry processing, along with a wide range of other industries. The unsurprising result: In recent years, the surviving companies took advantage of their market power to prop up the price of chicken, overcharging Americans by as much as 30 percent.

Evidence of the industry’s misconduct became so blatant — thanks in part to lawsuits filed by wholesale poultry buyers — that regulators were roused from complacency. Beginning in 2019, the government has filed a series of charges against the companies and their executives.

And while we are at it, let’s not forget Philip Howard’s work, which I’ve written about previously.

I am a co-author on a paper published recently by BMJ Global Health 2021;6:e006885.  The need to reshape global food processing: a call to the United Nations Food Systems Summit.  Authors: Carlos Augusto Monteiro, Mark Lawrence, Christopher Millett, Marion Nestle, Barry M Popkin, Gyorgy Scrinis, Boyd Swinburn.

Because this paper is open access, I reproduce its text below.  The link is to the pdf.