Most of us in public health are cheering for the ban, but I am sure some of you are rolling your eyes at yet another “nanny state” intrusion.
The effort reminds of a decades-old tale of the rather pernicious collaborations between Big Tobacco and Big Food, which may help narrow this ideological divide. Let’s begin with that slightly sordid story, then segue into considerations of where responsibility lies for what finds its way to our lips- whether for smoldering there, or swallowing.
In 2005-2006, The Chicago Tribune ran a 4-part expose entitled “The Oreo, Obesity, and Us.” The entire series was provocative, but most so the final entry: “Where There’s Smoke, There Might Be Food Research, Too.”
All of you no doubt remember the great “tobacco settlement” of 1998, the largest civil litigation settlement in U.S. history. But the Chicago Tribune told a part of the story that flew under most people’s radar.
The largest U.S. tobacco company, Philip Morris, and the largest food maker in North America, Kraft, were at the time of that settlement siblings of a sort. They were both held by the same parent company, initially under the Philip Morris brand, later- under the name, Altria. This corporate family clearly imbued its “family values” to both siblings.
In the case of the tobacco sibling, this meant using functional MRI machines and studies in animals and people to determine what ingredients in cigarettes would most reliably transition people -young people in particular- from curiosity, to trial, to addiction. But what of Big Food?
The investigative journalists at the Tribune had for their review some 3 million pages of proprietary tobacco industry documents, accessible under subpoena and courtesy of the Freedom of Information Act. That these documents revealed nefarious shenanigans serving uptake of tobacco surprised no one. The food involvement was the surprise. Because Kraft and Philip Morris were siblings, and because they were collaborating- the tobacco documents also spilled Kraft’s beans.
Food scientists and tobacco scientists were sharing the functional MRI machines and research protocols. The tobacco effort was directed as noted. The food effort was all about finding the ingredients, textures, and flavors that most reliably put the human appetite center- in the ventromedial hypothalamus for the neuroanatomically fastidious among you- into overdrive. On fMRI images, a highly stimulated appetite center lit up like a Christmas tree for all to see.
Fans of Pulitzer Prize winner, Michael Moss- I certainly count myself among those- might find this story familiar. He tells it in his books- Salt, Sugar, Fat and Hooked- and in an excerpted New York Times Magazine cover story, The Extraordinary Science of Addictive Junk Food. Back in 2013 when that article ran, I thought: “here is the smoking gun!” Surely widespread outrage would be the result, and food industry reform would follow. But frankly, I thought the same of the Chicago Tribune reporting almost a decade prior. Instead, business as usual perseveres, and prevails.
I know that some among us champion both the hegemony of free markets, and the primacy of personal responsibility. The argument is something along the lines of: free markets can and should respond to consumer desires and demand; and autonomous, adult consumers are fully capable of engaging personal responsibility to direct those demands and desires in suitable directions.
There is a logical deficit in that cascade of rather sizable importance.
Mary Poppins, the quitessenttial nanny
Faith in free markets means that companies will spend their money as best serves the interactions of demand and supply. But anyone paying attention to any brief interval of modern living knows we are awash in marketing and advertisements- and behind that is a whole lot of free market spending. In fact, many large companies, notably those making consumer goods, place marketing and advertising near the top of their expense ledger.
What does that mean? It means the dispassionate calculus of business has determined that advertising works. We are influenced by it, and enough to justify rather massive expenditures. Translated, this means that the supply can shape the demand, rather than vice versa. If demand were native and de novo, we would want what we want, and the supply-side would be duly encouraged to provide it- no marketing required. The reality is, we are told what to want- and then it is sold to us.
One cannot both champion the free market and deny this state of affairs. If marketing does not create demand, then the free market does not work, because all major companies are spending fortunes on boondoggles. If it does work - and it clearly does- then demand is not remotely autonomous. It is at best facilitated, at worst…imposed.
We are manipulated, routinely and rather lavishly. It only begins with the marketing that hides in plain sight. It continues into the realm of chemistry and neuroscience, with insights born of functional MRI images that put the vulnerabilities of human appetite on graphic display.
I fully endorse personal responsibility. At the end of the day, what I do with my feet and my fork is up to me. But it simply isn’t true that where there’s will, there’s way. There may be will, and the way is blocked, elusive, obscured, or willfully concealed. The way may be obstructed by marketing, manipulation, or stated bluntly- a lie. We are all personally responsible for the choices we make, but the choices any of us makes are subordinate to the choices we all have. The choices we have deceive us on a daily basis.
Consider this sequence of psychological subversion: Years are spent emphasizing nutrients rather than foods, and all the while- most packaged foods are being made with variably flavored and colored versions of the same, several, inexpensive, mass-produced ingredients: corn, wheat, and sugar. Then, the cultivated focus on nutrients is exploited by vitamin and mineral-fortifying dubious foods - putting lipstick on a pig, if you will- and letting the tale of nutrients wag the dogma about dietary choices.
The result is on display daily as, to borrow from Supertramp, breakfast in America: so-called cereals made more from sugar than anything else and featuring artificially flavored and colored psychedelic marshmallows peddled as “part of a complete breakfast!” because, after all, they are “fortified with # essential vitamins and minerals…” They are also gluten-free, so, hey- it’s all good. Maybe Joe Jackson said it best: I can sell you anything.
What shall we call this? Fair, free-market influence? Manipulation? Outright brainwashing? Pick your place in the spectrum as you choose, but there is a lot more going on here than supply satisfying demand. Supply is crafting the demand it wants, in ways it reveals, along with ways it conceals.
Personally, I call this predation. Menthol in cigarettes is among the many progeny of such predatory profiteering. It needs to go. No nannies need apply.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.