Wednesday, July 21, 2010

What soft drinks and cigarettes have in common

Judging by the outrage sparked by the American Academy of Family Physicians' agreement with Coca-Cola to produce patient education materials about obesity, and the respected ScienceBlogs website's brief flirtation with a nutrition blog sponsored by PepsiCo, many health professionals consider soda to be nothing less than the "new tobacco." There are many good reasons to think so. The average American consumes approximately 50 gallons of soda each year, which is thought to be a major contributor to our current epidemic of obesity, the details of which I discussed in a previous post. In 2004, the Centers for Disease Control estimated that obesity killed almost as many people in the U.S. per year (about 400,000) as tobacco did, and predicted that it would soon surpass it as the number one cause of death.

Taxes on cigarettes have proven to be very effective at discouraging their use, and early versions of the U.S. health reform bill sought to do the same by taxing sugar-sweetened beverages. In addition to reducing soda consumption, the penny-per-ounce tax would have raised billions of dollars to expand coverage for the uninsured and fund public health campaigns targeting other lifestyle behaviors that lead to obesity, such as physical inactivity.

Using time-tested tactics borrowed from Big Tobacco a generation ago (when Phillip Morris and other tobacco companies openly attacked and distorted the science linking smoking to lung cancer, heart disease, and other causes of death), the beverage industry quickly flooded Washington, DC with lobbyists and challenged research linking soda consumption to obesity. As reported in the Los Angeles Times, an industry-funded coalition calling itself "Americans Against Food Taxes" spent millions of dollars in key states to discourage Congress from including the tax in the bill - and won. State governments lost, too. Earlier this year in New York State and in Washington, DC, websites and airwaves were blanketed with "anti-tax" messages that were so effective at generating political opposition that neither of these proposals even came to a vote.

I admit that connecting soft drinks with obesity and premature death isn't quite as instinctive as knowing that inhaling a burning carcinogen-delivery system is bad for you. After all, the beverage industry argues, extra calories can come from many sources other than what people drink. But sugar-sweetened beverages are unique among junk foods in that their calories don't make us feel "full." We just keep on drinking, adding empty calories in 40-ounce Big Gulp containers or going back to the dispenser for free refills.

The president of the American Academy of Family Physicians recently wrote in the Annals of Family Medicine that there was nothing unethical about the organization taking hundreds of thousands of dollars from Coca-Cola in order to produce apparently unbiased educational content. She is wrong, and I would say this if a candy or fast-food company stepped forward with a fistful (okay, a briefcase-full) of cash next year. No one expects an organization of family doctors to say that soft drinks are good for you, but in taking Coca-Cola's money, what the AAFP is effectively telling patients (few of whom will ever visit the website) that soft drinks aren't really bad for you. That's the message that smokers were hearing a few decades ago, and most of them aren't alive today to wish that they had been told otherwise.