Spotlight on the Food Industry: Coke, PepsiCo, and McDonald’s Pledge Healthier Ads for Kids; Critics question impact

In April 2007, 15 food companies, including McDonald’s, Coca-Cola, and PepsiCo, announced that beginning in 2008, they will devote at least half of their ads directed to children under 12 toward promoting “healthy dietary choices” and/or physical activity. Does this new pledge represent a change in direction or is it simply an effort to avoid stronger public oversight?

At least some companies worry about the growing public focus on obesity. In a recent talk at the Venice Festival of Media, Coca-Cola Company Chief Creative Officer, Esther Lee admitted, “Our achilles heel is the discussion about obesity. It’s gone from a small, manageable U.S. issue to a huge global issue. It dilutes our marketing and works against it. It’s a huge, huge issue.”

A recent study of television advertising for children conducted by the Kaiser Family Foundation found that for children under the age of eight , only one ad out of 26 promotes fitness or a healthy diet and for children 8 to 12, it’s even worse, one ad out of 48. Furthermore, the food and beverage ads directed towards children overwhelmingly promote high fat and sugary snacks or fast food. The study looked at 8,854 commercials aimed at children, none of which promoted fruits or vegetables.

Do these ads affect eating behavior? A recent study at the University of Liverpool found that children who had been exposed to food advertisements on television were more likely to overeat than children who had not been so exposed. In the study, 59 nine to eleven year old children of varying weights were exposed to 10 food or 10 toy ads. The children were then allowed to eat a range of snacks at will – from fruit to potato chips and candy. Results showed that total calorie intake was significantly higher after the children were exposed to the food ads. Children of normal weight increased consumption by 84 percent, overweight children by 101 percent, and obese children by 134 percent even though the foods that the children were allowed to eat were not the ones that were advertised.

According to Dr. Jason Halford, Director of the University of Liverpool’s Kissileff Human Ingestive Behavior Laboratory and an investigator in this study, “That’s important because what we’re showing goes beyond branding effects. Advertisers have always argued that food ads do nothing but get kids to change from one brand to another for the same thing – the same argument tobacco companies used. This study shows that that’s completely incorrect. It doesn’t matter if the ad is for a specific product. It produces consumption. Kids consume after they see them.”

These studies suggest that to reduce over consumption and obesity, children may need to see fewer ads, not different ones. According to Marion Nestle, Professor at the Department of Nutrition and Food Studies at New York University, the main nutrition message Americans need to hear is “Eat less” yet the food industry consistently encourages Americans to eat more, the necessary message for healthy profits if not healthy children.

Several recent and current government investigations have scrutinized food advertising to children. For example, this summer, the Federal Trade Commission will be issuing compulsory requests for information from 44 food, beverage, and quick-service restaurant chains. The FTC is especially interested in marketing practices of in-store promotions, events, packaging, internet marketing and product placement in video games, movies, and TV programs. According to the Institute of Medicine, annual sales of food and beverages to American children was more that $27 billion in 2002. Some researchers have calculated that children are exposed to 27 food ads a day and that most promote foods high in fat, sugar, and calories. As a result, children begin to make their first request for a product by two years of age, and 75 percent of those requests are for sugary cereals.

School foods have also become a new battleground. In an effort to lower the rates of childhood obesity, in April, the Institute of Medicine (IOM) recommended strict standards to cut calories, fat, and sugar in all snacks and beverages sold in school vending machines, at fundraisers, and as a la carte items in school cafeterias. In school systems around the country, parents, teachers and food activists are struggling to clear schools of unhealthy food.

Many food industry executives resent government involvement and dread the close attention. One executive told Advertising Age, “It’s clearly a witch hunt.” He said if anyone is to be picked as the scapegoat it’s likely to be the fast food outlets that buy as much media for the 6-to-11-year-old set as other marketers spend on their entire annual budget.

The April announcement is in part a response to this growing government attention. Food industry leaders hope that their voluntary measures will stave off further oversight. Yet, research evidence suggests that voluntary guidelines developed by industry often fail to achieve their objectives. Recently two nutritionists reviewed changes in portion sizes of sodas, hamburgers and French fries at McDonald’s, Burger King and Wendy’s and found few changes despite pledges by these companies to improve their offerings. The authors concluded that “voluntary efforts by fast-food companies to reduce portion sizes are unlikely to be effective, and that policy approaches are needed to reduce energy intake from fast food.”1

Historically the food and beverage industry have shown their capacity to respond quickly to public concerns about health. In 1991 the industry was called to introduce 5,000 new reduced fat food products by the year 2000 to support the Healthy People 2000 initiative – a goal they met by 1995. Yet as these new products came on the shelf, obesity rates continued to grow.

The Coca-Cola Company has been particularly adept in responding to new market forces. The Company’s global beverage portfolio now includes 400 brands that include soft drinks, diet soft drinks, juices, juice drinks, sports beverages, waters, teas, coffees, milk-based drinks and fortified beverages. However, no advertiser has yet promoted reduced consumption of such beverages or encouraged use of tap water, two messages that nutritionists support.

In fact, soft drink companies have been especially eager to promote physical activity, another avenue to weight reduction, rather than reduced consumption. For example, in its Get Active/Stay Active program, Pepsi Cola encourages young people to engage in sports and other physical activities while it still signs pouring rights contracts that require high schools to serve only Pepsi. The effort to divert blame for obesity to physical inactivity is reminiscent of the tobacco industry’s attempt to point the finger at air pollution as the main cause of lung cancer. Both air pollution and physical inactivity warrant attention but the self-serving goal of the focus makes the message suspect.

Some countries have chosen alternatives to voluntary guidelines. In November 2006, the British food regulator agency banned advertising of high fat, salt and sugar foods in television programs made for children or of particular appeal to children under age 16. In announcing the new regulations, outgoing Prime Minister Tony Blair said, “Particularly where children are concerned, I have come to the conclusion we need to be tougher, more active in setting standards and enforcing them.” The British regulatory agency also decided to prohibit the use of licensed characters, celebrities, promotional offers and health claims in food advertising to children. Whether the United States is ready for such a step could make an important issue for the 2008 election.

 

1 Young LR, Nestle M. Portion sizes and obesity: responses of fast-food companies. J Public Health Policy. 2007;28(2):238-48.

Towards a Global Tobacco Control Agenda: The WHO’s Framework Convention for Tobacco Control

Each month Corporations and Health Watch examines global perspectives on corporations and health. We post coverage of campaigns to change corporate practices in other developed and developing countries; present news and analysis on new global trade and other agreements among corporations and their supporters and among international alliances of advocacy groups working to modify health-damaging practices. We invite readers to send us suggestions for campaigns, reports and issues to analyze for our Global Perspectives section. Send suggestions to us.

On May 31, 2007 tobacco control advocates and activists around the world recognized World No Tobacco Day. Through their actions, they drew attention to the fact that globally, tobacco products claim nearly 5 million lives per year and secondhand smoke has been proven to cause death and disease, and they challenged Big Tobacco’s continuing attempts to weaken national and international tobacco control measures.

Tobacco control is a global issue for several reasons. First, as Western nations implement stricter laws curbing secondhand smoke and tobacco industry practices, Big Tobacco increasingly looks to the global south – where there are often weaker tobacco control laws in place – to market its products. Second, in an era of globalized media, Big Tobacco’s marketing efforts reach beyond their country of origin and influence individuals, particularly youth, worldwide. Third, if current trends continue, by 2030 tobacco products will cause more than 10 million deaths per year with 70% of such deaths taking place in the global south. Thus, controlling tobacco has the potential to improve population health around the world. Finally, smuggling of tobacco products is an international issue and this practice is often coordinated by the tobacco industry itself.

As part of a global effort to fight Big Tobacco, 168 countries have signed the Framework Convention for Tobacco Control (FCTC) created by the World Health Organization. Of these, 147 have become Parties – members of the regulating body of the FCTC. More than 250 organizations from 90 countries have also joined the Framework Convention Alliance for Tobacco Control – an international group created to support the FCTC.

The FCTC is considered the world’s first public health treaty. The treaty is designed to address the growing crisis of tobacco-related death and disease and to reduce the health, social, environmental and economic impact of tobacco and secondhand smoke. It was adopted unanimously by the World Health Assembly (the governing body of the World Health Organization) in May 2003. In November 2004, Peru became the 40th country to ratify the treaty, thus meeting the minimum number of ratifications needed to enter the FCTC into force, an event that took place in February 2005. The FCTC is legally binding for those countries that ratify it. However, it is up to national governments to implement the agreement.

The main provisions of the FCTC require signatories to: 1) Ban the use of misleading tobacco advertising; 2) Enact and enforce comprehensive bans on tobacco marketing and sponsorship within five years of ratifying the treaty; 3) Increase tobacco taxes; 4) Require health warnings on tobacco packaging that cover a minimum of 30% of the display area but ideally cover 50% and 5) Implement comprehensive measures to protect citizens from the health hazards of secondhand smoke.

The FCTC also promotes research and the sharing of such research internationally, encourages legal action against the tobacco industry, suggests signatories support cessation services, and requires action against tobacco smuggling and for regulation and labeling of all ingredients in tobacco products. Countries that sign and ratify the FCTC are encouraged to look to these provisions as minimum measures and are encouraged to take a stronger stand against the tobacco industry practices that harm health.

The United States has been an international leader in tobacco control, particularly since the 1998 1998 Master Settlement Agreement, the provisions of which helped reduced already declining smoking rates in the United States. However, the Bush Administration has not been supportive of the FCTC. For more than a year the U.S. refused to sign the treaty and attempted to undermine it. In particular, the Bush Administration fought the provision which mandated a comprehensive ban on tobacco advertising, sponsorship and promotion, claiming that this would be unconstitutional in the United States as corporations are granted First Amendment rights to freedom of speech, which protects their right to advertise. The Bush Administration continued to fight this provision even when language was proposed that would have called for a ban of advertising “within constitutional limits.” The U.S. also fought the funding provisions within the treaty. Finally, in May 2004 the United States signed the FCTC but as of yet it has neither been ratified by Congress nor have its legislative mandates been passed . “Unfortunately,” Kathryn Mulvey of the advocacy group Infact told The Washington Post, “our government has a history of signing treaties, leveraging its power to weaken the treaties, and then never ratifying them. This is a stunning PR maneuver. We are not holding our breath for the U.S. to ratify the treaty.”

By July 2006, 131 countries representing more than 75% of the world’s population had ratified the FCTC. Thus, as other countries sign, ratify and implements its mandates, the United States is falling behind.

From June 30 to July 6, 2007, the Framework Convention for Tobacco Control’s “Conference of the Parties”, a group of countries that lead the effort to monitor implementation, will meet in Bangkok, Thailand. Their agenda is to develop guidelines to:

  • provide protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.
  • eliminate of illicit trade in tobacco products.
  • move towards a comprehensive ban on tobacco advertising, promotion and sponsorship, covering both its within-country and cross-border elements.
  • establish standards for packaging and labeling of tobacco products.

The Framework Convention and its nongovernmental partners have the potential to match the global tobacco industry in advancing an international agenda on tobacco, an agenda that protects rather than harms health. Whether the decisions made in Bangkok can realize this potential remains to be seen.

Campaign Profile: Licensed to Kill

Last month youth activists from around the world working with Essential Action’s Global Partnerships for Tobacco Control held a rally in front of the Altria/Philip Morris’ New York City headquarters one day after the company’s 2007 shareholder meeting. The youth staged an action Altria and handing out information to passersby. While youth activists have been taking on Big Tobacco internationally for some time, what made this action particularly interesting was that the activists were joined by rival tobacco company Licensed to Kill (LTK). At the rally, LTK representatives attempted to deliver the “Profiting off of Poison Award–Golden Coffin Award 2007″ to Altria representatives who declined to receive it.

Lest you think that tobacco industry representatives have finally come clean about the fact that their product, when used as directed, causes cancer, emphysema, heart disease and death, it is important to know that LTK is the creation of former corporate lawyer and now activist Robert Hinkley of Essential Action. However LTK is more than just a spoof; it is an actual tobacco company incorporated in the state of Virginia with the stated purpose of engaging in the “manufacture and marketing of tobacco products in a way that each year kills over 400,000 Americans and 4.5 million other persons worldwide.” Hinkley formed the company in order to make a point about both the tobacco industry and the protected status of corporations in American society, particularly those that operate at the expense of public health and safety. While LTK’s application raised eyebrows at the State Corporation Commission, as long as the name isn’t already registered and the applicant pays the filing fee, the application meets basic requirements, and the state has little choice but to grant a corporate charter. Thus, on March 19, 2003, Licensed to Kill was born.

One month later, anti-tobacco activists, including 200 youth, staged a protest at the Virginia State Capital to condemn the company, to call for stricter tobacco control and to stand in solidarity with tobacco control activists around the world. The activists were not alone. Licensed to Kill CEO “Rich Fromdeth” and other Senior VPs were at the state capital celebrating the founding of their new company. Company director Gray Vastone stated, “If a person was to ask the state for authorization to go on a serial killing rampage, he would surely be locked up in jail or a mental institution. Luckily, such moral standards do not apply to corporations.” As LTK executives attempted to introduce their new cigarette brands “Serial Killer,” “Genocide,” and “Global Massacre,” the youth activists booed and attempted to drown out their speeches. In an imaginative alliance, LTK and Essential Action work together to educate the media and the general public about the health hazards of tobacco, the tobacco industry, and the nature of corporations that profit at the expense of human health. In these staged confrontations, LTK “representatives” spoof Big Tobacco and Essential Action youth protest them and the tobacco industry at large.

Licensed to Kill’s website is a humorous critique of Big Tobacco. In the “about our company” section, LTK defines the five attributes that define their business as “a strong commitment to profits over people; excellence in marketing death; financial pay-offs; innovation in public relation spin, and an undying dedication to making a killing.” Their motto is “We’re Rich. You’re Dead!” Licensed to Kill separates itself out from other Big Tobacco companies through their dedication to transparency. They openly admit their products cause death and disease (and that they don’t care); they don’t attempt to improve their public image through a company name change, and they don’t state one thing publicly and another privately. Instead, LTK admits that they market to young people (“Duh! It’s plain common business sense!”) through brands like “Chain™”, a chocolate flavored cigarette. The company also admits it markets to African Americans and specifically designed the product “Slave” to celebrate the historical linkages between Africans and the tobacco industry.

While other tobacco industry representatives try to downplay the health hazards of smoking and secondhand smoke, (“The solution is really quite simple: just don’t breathe!”), LTK boasts that the death and disease caused by smoking is good for the economy: “When our customers eventually succumb to emphysema and cancer, they spend billions of dollars on oxygen tanks, chemotherapy, and medical operations. Every cigarette smoked represents money earned and a stronger American economy.” Big Tobacco is also good for the global economy, states LTK, and applauds weaker tobacco control regulations in countries around the world which allow them to market their products to larger numbers of youth and adults. Finally, Licensed to Kill representatives also laud the U.S. government for its granting corporations Bill of Rights protections such as the right to advertise a deadly product is protected under the guise of “free speech.”

Through mock documents on their website, press releases, and events staged throughout the world, LTK specifically critiques Philip Morris/Altria. For example, shortly after LTK’s incorporation, former Virginia Governor Mark Warner announced that Philip Morris would create 450 jobs in the Richmond area in return for a $25 million performance-based grant from the Virginia Investment Program. LTK responded that it would also seek a relocation incentive package from the state of Virginia. In order to increase its chances, company executives announced that they would invest $1 million in local Richmond area charities: “It’s a tried and true way of showing that, despite our company’s intent to kill 4.9 million people annually, we’re really a good corporation citizen – every dollar we donate buys us the freedom to continue business as usual,” stated Senior VP Corrie Prutspin.

In 2004 the company issued a press release stating LTK executives were in Thailand to attend the ASEAN Art Awards and to “lend Philip Morris support in defending their industry’s right to use art to cover up the 5 million lives it kills worldwide and every year – including more than 40,000 in Thailand alone.” Company spokesperson Virginia Slime also announced LTK’s support for efforts to prevent the ratification and implementation of the Framework Convention on Tobacco Control. The company had previously praised the Bush Administration for its efforts to gut the treaty. Rich Fromdeth declared, “A ban on tobacco advertising, promotion and sponsorship would eliminate one of our industry’s most effective avenues for hooking kids and young adults to our addictive product line. It’s heartening to have a president who stands up for the Big Guys, however unpopular or detrimental to public health it may be.”

In June of 2005, LTK issued a press release announcing that executives would be in Washington, DC to lobby DC city council member Jim Graham against supporting smokefree workplace legislation. CEO Rich Fromdeth argued, “If he cares at all about the health of the tobacco industry, he will take a stand for maintaining the smoky status quo.” Senior VP Virginia Slime continued, “Unlike our industry rival, Altria, which gave the Metropolitan Restaurant Association of Washington $10,000 for its awards ceremony last week, Licensed to Kill believes in direct lobbying.”

Essential Action’s humorous and over-the-top approach both provides information about Big Tobacco and also generates media and public interest in tobacco control, especially among young people. It demonstrates that small organizations can contribute to the changes in public consciousness that will be needed to reduce the harm from tobacco and other lethal but legal products.

Scientists, the Food Industry, and Heart Health: An Interview with Dr. Jeremiah Stamler

Dr. Jeremiah Stamler is one of the founders of preventive cardiology, a speciality that focuses on preventing heart disease.. He is now professor emeritus and was founding chairman of the department of preventive medicine at Northwestern University’s medical school in Chicago. He has published more than a thousand articles, monographs and reports and now in his mid-80s, he continues to write, publish, and advise younger researchers around the world. During his career, he has had numerous encounters with the food industry and government agencies concerning the policy implications of his research. In Fall 2006, Corporation and Health Watch founder Nicholas Freudenberg interviewed Stamler in New York City and Sag Harbor, New York. Here we present excerpts of Dr. Stamler’s descriptions of some of his interactions with the food industry and government as well as his advice for young scientists.

CHW: Dr. Stamler, tell me how your research on heart disease first brought you into contact with industry groups.

STAMLER: As you know, I am a cardiovascular researcher primarily focused on atherosclerotic disease as it affected the coronary arteries. I began as an animal experimentalist, got interested in that in medical school, and spent my first ten years focused on animal experimental work, although I soon branched out into clinical trials and epidemiological issues. Early on I became convinced that the animal experimental knowledge was applicable not just to individual men and women, but to whole populations. It became clear to me that the growing epidemic of cardiovascular and, particularly, coronary heart disease, including sudden death, was related to lifestyle.

From the start, we found ourselves involved in hassles with industry. I had one limited personal encounter — an interesting experience. I got a grant from the National Dairy Council, a one year grant, for experiments on feeding cholesterol to chickens. A knowledgeable and decent colleague was the Scientific Director of the Dairy Council, and we dealt with her. We got that grant with the usual rules, which I had learned from my chief, Louis Katz, the Director of Cardiovascular Research at Michael Reese Hospital in Chicago. Dr Katz taught me that if you take money from an industry or an agency related to an industry, the ground rules have got to be very clear.

CHW: And what were Dr. Katz’s rules?

STAMLER: Rule Number 1. The protocol is our responsibility. We’re pleased to show it to you (the funder), but we will not modify it at your request unless we agree the modifications are useful.

Rule Number 2. We make the decision as to the duration of the study. There are no restrictions on the duration of the study. If we think at the end of a given period, spelled out in the protocol, we need to do further work, repeating or modifying or extending the given study, we extend it. You can give us money, enough to support six months, or a year, or whatever; but if we find that we are not well off at that point and we think more work should be done, it’s our right to continue to do so.

Rule Number 3. With regard to publication, we elect to publish or not to publish. If we do not publish, we will give the data to you for your confidential information. It can not be used in the public arena. If we do publish, we will show you copies of the manuscript, but we have complete control of the manuscript.

And Rule 4. Any money you give us is an unrestricted gift. There are no strings whatsoever, even if it may be for a very specific piece of research. It comes as a check for all, so to speak, a deposit in the bank, and that’s it. We use it as we wish. No strings attached. Those are very good rules. Many young people don’t even know about such rules, when they get involved with drug companies.

CHW: Tell me more about what happened with the Dairy Council.

STAMLER: Well, The Dairy Council agreed to these terms and we got a grant. It was a modest sum, $10,000 for one year. In the middle of the grant year, I got a call from the Scientific Director at the Council.

”Jerry, I’d like you to help us with something,” she said.

“Anything, I can do to help. Tell me what you want.” I replied.

“We’d like you to testify.”

“Where would you like me to testify?”

“State Legislature.”

I said “Well, what would you like me to testify about?”

“Margarine.”

“What about margarine?”

“Coloring of margarine.”

I said, “Oh, you’re in favor of it.” (Which I knew, of course, was not the case.) [The Dairy

Council opposed coloring of margarine that made it look more like butter.]

There was a pause on the other end, and she said “No, we’re against it.”

I said to her, “Look, they say every man has his price. Far be it for me to be Jesus, Moses,

Mohammed, Sir Gallahad, Sir Lancelot — maybe I’ve got a price, too. Maybe if you said a one million dollar deposit in a numbered account in Switzerland, I might think twice. But for one miserable $10,000 grant for which I get nothing in my personal pocket, no way.” The next year I didn’t get renewed.

CHW: Tell me about some of your interactions with government agencies on these questions.

STAMLER: Norman Jolliffe was a distinguished national and international nutritionist who was the Director of the Nutrition Bureau at the New York City Department of Health from 1949 to 1961. As a good public health officer, Norman wrote letters to the Food and Drug Administration, which a number of us co-signed, expressing profound concern with the failure of the FDA to do anything about what came to be known as the diet-heart question. He requested that the FDA go officially on record supporting diets lower in saturated fats and cholesterol, as part of healthy nutrition. You have to understand that prior to the USDA/DHHS dietary guidelines there were only nutritional recommendations for health, focusing mainly on undernutrition. Also, one of the problems was that the dairy industry had a — what is the wrestling term? — a grip lock on nutritional recommendations. The dairy industry, through the National Dairy Council, was the dominant source of nutrition information in elementary schools, high schools, colleges, and rural areas.

Well, the FDA never replied to any of Jolliffe’s letters. No replies at all. None. But finally one day Norman was at FDA headquarters, and he saw the Commissioner of the FDA and said, “Look, what’s going on? We write you letters. You don’t reply. You don’t say no, you don’t say yes, you don’t say anything. You file it, get rid of it. What’s the problem?”

The guy says, “Look, Jolliffe, you get meat, egg, and dairy off my back and I’ll reply.” Just that simple. And for years, the National Heart, Lung, and Blood Institute also avoided making a statement on diet and heart disease for similar reasons. In 1960, the American Heart Association issued its first statement on diet. I was a co-author. We went through seven revisions of a very careful statement on the possibility of preventing coronary disease. It was the first American Heart statement. A year or two before, there was a statement on risk factors for heart disease that Mary Lasker helped to publish through the National Health Education Committee, a private group. But the NIH Heart Institute was silent. The Public Health Service, FDA — for years — silent. Bob Levy, then Director of the National Heart, Lung, and Blood Institute, once had a Congressional staff person say to him, “You organize the Heart Institute to go on record on the diet-heart question, and we’ll cut the balls off your budget.” Simple.

CHW: Let’s turn to salt. The American Medical Association estimates that 150,000 lives could be saved annually if sodium levels in packaged and restaurant foods were cut in half. I understand you spent many decades studying the impact of salt on cardiovascular health. Tell me something about your interactions with Campbell’s Soups and with the Salt Institute, the industry trade group, on this issue.

STAMLER: Well, in the late 1980s, Campbell’s presented soups on the shelves called “Heart Healthy” on the basis that they were low in fat. But as you know by looking at any label of usual Campbell soups, they were then and they are today (except for a few “salt-modified” or “lowsalt” products), very high in salt. So people who were concerned with salt and heart health said “How can you make a claim for heart healthiness when you have a soup that’s so loaded with salt?”

So several advocacy groups went to the Federal Trade Commission and said that this was false and misleading advertising and should be stopped. In January 1989, the Federal Trade Commission cited Campbell’s for making misleading health claims and temporarily enjoined Campbell’s from making such claims, pending a hearing.

CHW: How did the Federal Trade Commission get to you?

STAMLER: A young FTC lawyer came to me and said the Commissioners are saying, “What are the data that refute the argument that salt sensitivity is a minority phenomenon prevalent only among some hypertensives, not a population wide phenomena? Will you come and talk to the Commissioners?” she asked. Before the FTC lawyers could go into the courtroom to get an injunction, they needed approval from the Commissioners. And I went and delivered a talk and then the lawyers got permission to go ahead.

In the court proceeding, I was asked to be an expert witness for the Federal Trade Commission on the question, “Is salt really a public health concern?” The argument repeatedly used by food processors whose products have a lot of salt and the salt industry is “No. If salt relates at all to blood pressure, first of all it’s one of many variables; second, it relates only to people who have high blood pressure, and, third, it relates only to a proportion of them who are ‘salt-sensitive’. Therefore, it is a clinical issue, not a public health issue. There is no reason to say that a soup that claims heart healthiness because of its low fat content can’t make that claim because of public health concern with salt.” By the way, these same syllogisms were used in the past by the food industry special interests that defended high fat food, until they finally more or less gave up on the fat question.

CHW: So what happened at the FTC hearing?

STAMLER: FTC proceedings allow a period of discovery so I was deposed by a distinguished, able, straightforward, calm, businesslike Washington attorney. In a day and a half or two of detailed depositions, his main objective was to try to undermine my scientific foundation for the statement that the problem with the so called salt sensitivity response of the blood pressure to dietary salt is not idiosyncratic, not only a clinical problem ; and does not affect only a small percent of population. Rather, we argued it’s fundamentally a population-wide issue.

Our Intersalt Study has shown that it is a problem throughout the population with, at most, only a small percent of people escaping the consequences with no rise in blood pressure with age. In that study, we found a consistent relationship between salt and blood pressure and concluded that high salt intake is a major preventable risk factor for epidemic cardiovascular disease.

CHW: When you were being questioned by this lawyer, did he know the science? Was he up on the science?

STAMLER: Oh, yes, he was very well prepared to represent his client. But I and my colleagues who were expert witnesses for the Government held our own. It wasn’t readily possible to shake the foundation of our conclusions. This, of course, is supported by the fact that such conclusions have been stated, and restated time and again by independent research groups.

CHW: So what happened next?

STAMLER: Soon after the depositions, Campbell’s Soups threw in the towel and dropped their objection to the FTC finding. I’m sure one of the reasons was that the legal action was costing a fortune. You can imagine what a good Washington law firm was costing them. Even for a relatively rich corporation, they are in the food industry where profit margins are not like in the drug industry.

CHW: Did Campbell’s change their products?

STAMLER: Well, they began to put out more soups that were modified salt, but most of these are still too high. There are three levels with Campbell’s Soup and salt. The first is the usual, which is almost like drinking sea water. The second is a modified version, which is somewhat lower but still too high in salt content. And then there are a few low salt, or really low salt soups. Their problem is that many people are attuned to soups that are high in salt, and there is no good salt substitute that gives the equivalent flavor. They’ve been wrestling with trying to get a substitute; they used potassium, they used other things, but it has been very hard. There are ways you can make soup that’s very tasty without salt. We know a wonderful cook who makes lentil soup for us, and we make tomato soups. Tomato’s a good way to go for taste without salt.

CHW: So what’s happening now on salt?

STAMLER: A new committee created through the Department of Agriculture and the Department of Health and Human Services is reviewing the dietary guidelines for Americans, one of the seven being on salt. The Salt Institute launches a big campaign to get rid of that one, and intensified its harassments and its objections and its criticisms of the latest scientific work on salt. But nonetheless, repeatedly that body has reiterated the salt recommendation. Recently, the World Health Organization had a huge conference in Paris reviewing the whole situation, it’s purpose being not to review the facts but, taking the facts as given, what can be done to reduce the population’s intake in salt. In addition, the American Medical Association joined the effort to reduce salt in processed food and the new USDA/DHHS guidelines reiterated the importance of reducing salt.

CHW: Even though you are a prominent scientist with a long track record of scientific publications, you have never hesitated to step into the policy arena or to take on the special interests that defend health damaging policies. What kind of advice can you give young researchers who want to look at the relationship between the food industry and patterns of illness? What advice would you give for how to study those things or for how to frame the questions in the context of the current biomedical framework?

STAMLER: Well, first of all, unfortunately, too few people have an interest of that kind. There is still prevalent in the scientific community a rejection of what I call the classic Baconian creed on what science is all about. You know, Bacon helped to create the foundations of modern scientific approaches, and struggled against scholasticism — medieval, church-based scholasticism of the kind of “How many angels are dancing on the head of the pin?” His idea was that the task of scientists is to collect information for human welfare, to improve the lot of mankind. And that became the creed of science. To this day there are big hassles in our country on the conflict between basic and applied research. Influenced by Bacon, Pasteur formulated the simple concept “There is no such thing as basic and applied science. There is only science and its application.” Very simple. Very clear. But to this day, throughout the scientific community in America, the good science, the real science, the quality science is still considered basic science.

But how do you define basic science? Do you mean you work at a bench? Do you mean you work on the sub cellular level, the cellular level, the tissue level, the organ level? Is it a level? Is it a place of work? Is it a scientific tool? What’s basic research? When Einstein formulated his famous equation, that was pretty basic research, and when it was made into a bomb, that was a pretty definitive application. Similarly with Fleming and penicillin. So what’s the dialectic there?

CHW: So bring this back to your advice to young scientists.

STAMLER: Yes, let me go back to your question — that was a long diversion. My fundamental viewpoint is that everything having to do with medicine, at every level has to do with a practical, applied branch of human life. Therefore, everybody working in medicine must ask himself/herself the question: “What are the possible applications?” And in fact, when you write a research grant you have to put it in. That’s kind of ironic. There’s no such thing as a research grant — at least not for the National Institutes of Health — where the researcher can say, “I’m doing basic research. I don’t have even a remote idea—a hypothesis– about the application.” By the way, the only real definition of basic research is, research whose application is not currently apparent.

So every scientist working in medical research, wherever, has to be conscious of possible applications. Any scientist who has any application that is in the public health arena at all, and nowadays that covers anything related to treatment because all treatment relates to pharmaceutical and other industries. So as soon as you get to treatment, you’re up to your eyeballs in commercial interests. Therefore, you have to be aware that what you are working on not only may have applications, but may relate to special interests that have an axe to grind in relation to those applications. Sometimes a very nasty axe of downright vicious opposition. C. E. Winslow, the great public health leader the of the early twentieth century, said all progress in public health in the United States is going to be very difficult from now on because every step proposed will be in conflict with special interests. So every scientist must be aware of this. And every scientist who is worth his weight in anything should be prepared to struggle for the integrity of the application, of the sound knowledge that he collects. He or she cannot be indifferent.

Now, this business of indifference is a whole ideology: “ I’m a scientist. I collect the data. I make them available to the policy makers to do with it what they see fit. What is done with these data is not my responsibility.” That’s a whole ideology. Some researchers say “Well, I’ve got to remain objective. If I espouse a cause, I become committed and, therefore, biased.” That’s not true. To espouse the truth is not biased. To fail to espouse the truth is to betray the Baconian tradition.

CHW: So what are the implications for training scientists?

STAMLER: Well, I have certain ideas. If you’re going to espouse the proper application of your findings and other findings, then you have to do it skillfully, carefully, not just a gesture. And that means first and foremost, you have to work with organizations. So if you’re in the cardiovascular field you have to be active in the Heart Association, if you’re concerned with public health, the American Public Health Association. You may even be active in electoral politics at one level or another, you have to respond with articles on policy, not just articles on your scientific findings, etc. Do it well. Do it well. Don’t just give it a lick, a promise, a gesture.

And the final thing is, of course, you cannot allow yourself to be intimidated by special interests who deliberately try to intimidate you. I’ve had my experience with the salt industry and others as well. I received a letter from The Salt Institute’s lawyers challenging our data and demanding the whole data file so that further and “proper” analyses could be done. That could be very intimidating, you know.

In fact, many people prefer not to get involved in the public arena because they don’t want all those hassles, including the time it consumes. It consumes a lot of time. So I think good preceptors need to make all young scientists aware of this set of issues. What is the right tradition of science? Does advocacy mean loss of objectivity? Advocacy for valid, true, clearly established, sound data –so defined by the scientific community? What does that signify? Is such advocacy bias that reflects loss of objectivity? Is commitment biased? Is that a valid line of thinking? Unfortunately, many young scientists are never confronted with these issues.

Spotlight on the Alcohol Industry: Anheuser-Busch Pulls “Spykes” Amid Criticism

Anheuser-Busch, the manufacturer of Spykes, a two-ounce flavored malt beverage, decided to pull the product from the market after receiving a written warning on May 10th from 27 state Attorneys General accusing the company of violating the Beer Institute Advertising and Marketing Code. According to the Attorneys General, Spykes the drink, as well as its promotions and advertising, appeared to be especially designed to attract youth, particularly young girls.

Spykes was a two-ounce flavored malt beverage containing caffeine, ginger, guarana –and 12% alcohol. The product was available in such flavors as chocolate, mango, watermelon, and lime and was marketed as a flavor additive to beer. According to Anheuser Busch, Spykes was created for adults as a lower alcohol alternative to hard liquors. They pointed out that the market contains more than 50 products in this category in all colors and flavors, most of which are hard-liquor beverages that have a greater concentration of alcohol by volume than Spykes. However, according to one critic, Bruce Livingston, the Executive Director of The Marin Institute, “Spykes was a 12 percent alcohol depth charge – clearly designed to appeal to teenage girls in brightly colored 2 ounce containers that look like nail polish.” Richard L. Keller, MD, a coroner from Chicago added that “my concern is that they fit easily into a tuxedo jacket pocket, or purse for prom night ‘fun’.”

The Attorneys General pointed out that the product was marketed primarily on the Internet with no effective means of preventing underage visitors from entering the site. In addition, they noted that the product website included wallpapers, screensavers, instant messaging icons and ringtones that were highly attractive to teenagers. Finally, they stated that Spykes Internet ads offered “vivid” descriptions of the flavors available, but no mention that the product contained alcohol. They concluded that “The labeling for Spykes is inadequate and the content of its advertising is irresponsible, reflecting a basic disregard for consumer safety and welfare.”

In defense, Francine Katz, a spokesperson for Anheuser-Busch stated, “Those who criticize Spykes fundamentally misunderstand the behavior of many illegal underage drinkers. They drink for instant impact. The fact that Spykes are sold in two-ounce bottles and have a total alcohol content equivalent to only one-third of glass of wine makes it much less likely that illegal underage drinkers will choose Spykes as opposed to similarly-colored and similarly-flavored products that are 70 to 80 proof hard liquor.”

However, according to a statement from the Connecticut Attorney General, Richard Blumenthal, “Spykes is double trouble – alcohol and caffeine combined in large doses to create a high energy rush with the illusion of alertness when drinkers are impaired. With Spykes marketing and promotion, Anheuser-Busch belies the fight against underage drinking and its own public pitch to ‘drink responsibly.’”

The May 10th letter was signed by Attorneys General from Alaska, Arizona, California, Connecticut, Colorado, Florida, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Nevada, New Mexico, New York, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, West Virginia, and Wyoming.

Alcohol Producer Voluntarily Adopts Stricter Rules in an Effort to Reduce Underage Drinking

While state attorneys general mount a high-profile campaign to curb under-age drinking, Beam Global Spirits and Wine, manufacturers of such brands as Jim Beam, Maker’s Mark bourbon and Canadian Club whiskey, announced earlier this month that they would voluntarily adopt stricter rules to keep messages away from young people.

Beam elaborated that it would purchase print and broadcast advertisements only in outlets where at least 75 percent of the audience is above the legal drinking age. This is a more stringent standard than the current, self-imposed industry standard of 70 percent.

However, the move may be largely symbolic. Beam Global Spirits and Wine does not produce beer or flavored malt liquors – the target of most of the objections to alcohol advertising. Critics argue that beer and flavored malt beverages – often referred to as alcopops – appeal to under-age drinkers, particularly young girls, while Beam’s products appeal to primarily an older, adult audience. According to George Hacker, Director of the Alcohol Policies Project at the Center for Science in the Public Interest, “If Beam takes a good look at their target audience, they are not sacrificing a lot.” Mr. Hacker added that he would prefer to see Anheuser-Busch and Diageo, maker of Smirnoff-Ice, adopt the higher standard. “Their products are more deliberately targeted to young people.”

While Beam Global Spirits and Wine is volunteering to curb its advertising, it maintains that advertising does not contribute to under-age drinking. But Steven Rowe, the attorney general of Maine argued, “To say there’s no causal connection is to have your head in the sand. It’s to not recognize reality.” He told The New York Times that he and other attorneys general were “calling on industry members to follow Beam’s lead and join the effort to reduce under-age drinking.”

Two Schoolgirls Force GlaxoSmithKline to Apologize for Deceptive Food Advertising and to Pay Fine

Two recent studies have noted that alcohol industry advertising has a strong effect on youth and contributes to underage drinking. In January of 2006, the American Medical Association’s Archives of Pediatrics and Adolescent Medicine published a study by Snyder et al which found that the number of alcohol ads viewed was positively associated with the amount of alcohol consumed by youth. Each advertisement viewed raised the number of drinks consumed by 1%.

In 2004, two 14 year old New Zealand school girls, Anna Devathasan and Jenny Suo, tested the Vitamin C levels of their favorite drinks for a school science project. One product, Ribena, made by GlaxoSmithKline(GSK), the world’s second largest drug manufacturer, tested much lower than advertised. GSK had claimed that blackcurrants, Ribena’s main ingredient, had four times the Vitamin C of oranges but according to the girls’ science experiment the beverage had much lower levels.

The girls wrote a letter to the company reporting their findings but got no response. According to Jenny Suo, a telephone call to GSK was equally frustrating. “They didn’t even really answer our questions,” she told a reporter for Aukland’s Weekend Herald. “They just said it’s the blackcurrants that have it, then hung up.” Undeterred, the students contacted business watchdog groups, a television consumer affairs program, and, finally the New Zealand Commerce Commission.

On March 27, 2007, three years later, the company appeared in court in Aukland to plead guilty to 15 charges of making misleading claims about Ribena and breaching the Fair Trading Act. The Commerce Commission fined GSK US $168,000 The commission said that although blackcurrants did have more Vitamin C than oranges the same was not true of Ribena . The commission found that ready-to-drink Ribena had no detectable level of Vitamin C. Paula Rebstock, the commission chair, said thousands of New Zealanders had been duped by the company and described the company’s behavior as “a massive breach of trust with the New Zealand public.”

Before the New Zealand decision, GlaxoSmithKline, which has a worldwide turnover of more than $40 billion year, reported itself to the Australian Competition and Consumer Commission. GSK agreed to the Australian Commission’s suggestion that it correct its labeling, cease making claims about Vitamin C, and publish an article in an industry magazine on the importance of accuracy in advertising.

At the Aukland court hearing, Anna Devathasan expressed concern and satisfaction about the outcome. “They’re a multi-billion dollar company,” she told the Sydney(Australia) Morning Herald, “so it’s a bit disappointing, but I think their reputation has been damaged enough to have an effect.”

Interview with John Johnson, Executive Director, Iowans for the Prevention of Gun Violence on the Campaign to Close the Newspaper Loophole

In March 2007, Cho Seung-Hui, a Virginia Technical University student, walked into a gun store in Roanoke, VA., and paid $571 for a Glock 9-millimeter handgun and a box of ammunition. A few weeks earlier he had purchased a Walther .22-caliber semiautomatic pistol at a pawnshop. On April 16th, the student used these weapons to kill 32 people and then himself, leaving the highest death toll of any such shooting episode in U.S. history.

The massacre in Blacksburg, Virginia, again focused media and public attention on the practices of the U.S. gun industry and its allies. One continuing issue has been the retail practices of gun sellers and the degree to which the gun industry monitors the sales of its products. In this report, we excerpt an interview, conducted in August 2006 (before the Virginia shooting) by Corporate Health Watch staff member Sarah Bradley with John Johnson, Executive Director of Iowans for the Prevention of Gun Violence, a founder of the national Campaign to Close the Newspaper Gun Loophole. This Campaign seeks to persuade newspapers around the country to refuse gun advertisements from unlicensed dealers.

CHW: Gun control advocates have used several strategies to restrict access to lethal weapons and reduce the harm from gun violence. What made you decide to focus on newspaper advertising of guns? After all, newspaper ads aren’t the biggest source of guns, are they?

JJ: No, newspapers are probably not the biggest source of guns. And we can see that, yes, there are probably more sales through gun shows and the internet, but the reason we focused on newspapers — I think this is important — is that it doesn’t require legislation. To close the “internet loophole” would require legislation. Closing the newspaper loophole doesn’t take an act of Congress. All it takes is a management decision. And gun ads are probably a very small source of the total income for the newspaper. That’s another factor that helps. Whereas if you went to people who do internet sales that’s their whole business. So you’re trying to get them to change their whole business. When we go to newspapers, we’re trying to get them just to change a tiny part of their business. So that’s why we focused on newspapers. Not that they’re the biggest source, but it’s an area where we thought we could have some success, and we have had some success. This sends an important message when newspaper publishers do make a change.

As a small group with two and a half staff and not a lot of money, the Campaign to Close the Newspaper Loophole made a decision not to focus on state and federal legislation, but to work on what we called non-legislative initiatives. When we get a newspaper to change, to us that means, “Okay, that’ll be 100 gun ads that won’t be sold through the newspaper this year.” We look at it as more than just the 100 guns that won’t be sold through the newspaper. We look at it as here’s a business that has made a responsible decision on the way they conduct their policies. The Campaign to Close Newspaper Loopholes shows that these businesses recognize the concern and have taken appropriate action, setting a good example for other newspapers and other businesses.

As I said before, I think the legislative strategy can change with the legislature. Right now, the legislatures are not friendly, throughout. And, therefore, I’d say at this point, it’s just a pragmatic decision. We just don’t think we could accomplish anything legislatively. You know that could change. We hope it will change. To pass a law in Iowa with the legislature, I have to get 100 people to vote. And they’re worried that if they vote this way, they’ll lose their job or something like that. Whereas to get 30 newspapers to change, all I have to do is go to 30 newspapers. So in my mind, it’s just a pragmatic decision. To use a football analogy, you “take what the defense gives you.” You know if they put ten men on the line of scrimmage, then you’re going to have to pass. Whereas, if they drop everybody off the line to cover the pass, then you need to run. So the strategy to go to the publisher is really an opportunity that we see is out there. These other opportunities don’t seem to be as realistic.

CHW: Can you give me some examples of how you approach newspaper publishers? What do you say and how do the publishers respond?

JJ: During the summer of 2002, I learned about a series of articles in the Detroit Free Press about the high number of homicides among teenagers in the city, mostly from firearms. From our previous survey, we knew this was a newspaper that took classified ads for all guns…shotguns, even hand guns from unlicensed dealers. Since the Detroit Free Press is a progressive newspaper in a large metropolitan city that generally has higher rates of crime than smaller cities and rural areas, and a paper that brought this issue to the attention of their readers, we thought it was a good candidate to change their policies. We always felt that the reason newspapers took gun ads was because they just hadn’t given it a lot of thought.

I contacted the President of the Detroit Million Mom March chapter. They’re a gun control organization, part of the Brady Campaign. And I explained to her about what our campaign to close the newspaper loophole was, asking newspapers to voluntarily refuse classified ads for guns, and to see if she would work with me to try to bring this issue to the attention of the management of the newspaper. She agreed to do that, and more than that, she put together a coalition of local activists ….

Ms. Hamilton sent a letter to the publisher of the Detroit Free Press, making the case for closing the loophole and asking for a meeting. We had a meeting with the management of the newspaper where all these local organizations went in and made the case. The next day the paper called up and said they’re going to change their policy.

CHW: That’s a great story — is it always that easy?

JJ: Another example comes from Florida, the Sarasota Herald Tribune. You couldn’t ask for an example that better shows the danger from these ads. A man was involved in a contentious divorce and child custody dispute with his spouse, purchased a semi-automatic hand gun from an unlicensed seller through a classified ad in the Sarasota Herald Tribune. On the same day that he bought the gun, which was a Sunday morning, he went to the home where his estranged wife was living and shot and killed her in front of their nine-year old daughter.

What made this incident interesting for us was that the murder was recorded in the newspaper; but the newspaper story never really reported how he got his gun. A person in Sarasota, Florida, read in the newspaper that after the shooting, the police executed a search warrant of the man’s house where they recovered newspaper ads and a gun receipt. But the article never said that he bought the gun from an ad in our newspaper. So this person in Sarasota sent me an email saying we might be interested in this. So we started working on this on our own. We called the sheriff’s office to see if they would give us information, and they said, “Well, the guy’s busy” and it was kind of a difficult. We looked at some court records online, and we were able to find out that the person who sold the gun was a man named John Spearman. We tried to find him through Internet searches and telephone books but that didn’t work. But I happen to have a cousin who lives in Bradenton, Florida, where this shooting happened. And I called her and said, “You know we think that somebody bought a gun through an ad in a local newspaper” and I asked her to go to the library and make copies of the ads for that weekend. I figured if he bought the gun it was probably an ad that weekend. So my cousin went to the library and sent me ads from the two local papers and we also finally got a hold of the Sherriff’s office, and they told us what kind of a gun was used; and we were able to match them up and confirmed that it was an ad from the Sarasota Herald Tribune. So I called this John Spearman and asked him if he sold the gun to the shooter. And he said, “Yea, I did. And you know what? That stupid idiot went and shot and killed somebody with it.”

So then we wrote a letter to the Editor/Publisher of the Sarasota Herald Tribune. We said, “An ad in your newspaper was the source of this gun,” and we made the request to close this loophole. We also wrote letters to about twenty other newspapers in Florida saying “An ad in the Sarasota Herald Tribune was the source of the gun used in a murder. You ought to consider changing your policies.” After sending that letter we started calling editors and set a date for a press conference. We were going to hold a press conference to increase public awareness of this concern. And when we called the Sarasota Herald Tribune, they said, “We have decided to change our policy.” In fact, they ran a front page story before our press conference telling their readers that they were changing their policy.

CHW: Did you get any other papers in Florida?

JJ: Yes, we got four or five other Florida newspapers out of those twenty.

CHW: I noticed that over the years your campaign changed its focus from asking newspapers to end all advertising for guns to asking them just to drop classified advertisements by unlicensed gun dealers. Can you explain that change?

JJ: Originally we did ask people just not to take ads for guns. Then we discovered a few newspapers that actually had the restrictive policy of taking ads from licensed dealers only. And we thought that was a better position to adopt. And so since we started our 50 state campaign — to reach newspapers all around the country — our position has been to ask publishers not to take classified ads for guns from unlicensed sellers.

We thought this approach would have broader appeal for a couple of reasons. One, I think it’s an easier position for us to argue. We come across less as anti-gun. And I’ve always felt it’s an easier position to advocate. Second, newspapers find it easier for them to implement. They could say, “Well, we have nothing against guns. It just that we’re concerned about the way they’re sold.” However, when the Sarasota Herald Tribune changed their policy, it was just “We won’t take ads for guns, period.” That’s even better.

CHW: Do a lot of licensed dealers advertise in newspaper classifieds?

JJ: No. Licensed dealers don’t typically advertise in the classifieds. They run retail ads. So by taking this position, not only is it an easier sell but it virtually eliminates all classified gun ads. I think it’s easier to frame the issue. And it’s a much more definitive issue. If a newspaper says “I’m not taking ads for guns”, then they’ve made a moral decision to not take ads for guns. But most people in business don’t want to be against guns because they want business from gun people.

CHW: So what do you think makes it so hard to make progress on developing stricter gun control laws?

JJ: To me, what makes this issue so hard is that everybody is against gun violence. I don’t think anybody is advocating for more violence. Even your most right wing NRA is not advocating for violence. We all agree we would like to have fewer gun deaths and injuries. But where we disagree is “How do you get there?” We have policies we support like a ban on assault weapons and background checks on gun purchases. But there are people in the NRA who believe the way to have lower gun violence is to have everybody carry a gun, and then we’d all be safer because criminals wouldn’t dare rob a store because everybody in the store would be armed even though there’s not much empirical evidence for that kind of perspective.

On this issue, I‘ve always tried to be fact-based. So look at the policy. Is there any reasoned analysis, data or studies that would indicate that it would work? The NRA and other people, they just have things that sound good to them. You know, “more guns, less crime.” It’s been so hard to counter these arguments that have no factual basis.

Tracking the Effects of Corporate Practices on Health