Pharma Goes Online; Feds Fail to Follow

While the fiercest opposition to direct-to-consumer (DTC) advertisements has been to television advertisements, pharmaceutical companies have increasingly turned their attention to online marketing and social media, such as Facebook and YouTube with very little opposition or regulation by the Food and Drug Administration. In this report, CHW explores the reasons for this increased use of online marketing and social media, profiles a few recent examples where online DTC advertisements have raised concerns, and suggest possible future directions for consumer advocates.

Since the Food and Drug Administration (FDA) first relaxed guidelines governing direct-to-consumer (DTC) pharmaceutical advertising in 1997, DTC advertising has increased dramatically, from approximately $1 billion per year in 19971 to $5.4 billion in 2006.2 As a result, physician and advocacy groups and some elected officials have begun to raise questions about the ethics of DTC advertising.3 While the fiercest opposition to DTC advertisements has been to television advertisements, with less opposition, pharmaceutical companies have increasingly turned their attention to online marketing and social media, such as Facebook, YouTube, Sermo (for physicians), and iVillage (for women’s health).4 A recent article in Advertising Age notes that “what might be considered a yawn-worthy move into new and social media is nothing short of a revolution” for the pharmaceutical industry.5 In this report, Corporations and Health Watch explores the reasons for this increased use of online marketing and social media, profiles a few recent examples where online DTC advertisements have raised concerns, and suggest possible future directions for consumer advocates.

Online advertisements and social media challenge our conceptions of DTC advertisements

Some of the largest pharmaceutical companies have challenged common conceptions of DTC communication through the launch of popular blogs, YouTube channels and other forms of online media. For example, Johnson & Johnson’s McNeil Pediatrics unit sponsors an attention-deficit hyperactivity disorder group called “ADHD Moms” on the social media site Facebook,6 where the number of participants has grown to more than 8,200 without any expenditure by the company.1 Johnson & Johnson also hosts a popular blog called “JNJ BTW” where the company seeks to create a space for a “three-dimensional view” of the company and a “conversation” with consumers. Novartis, Boehringer Ingelheim and AstraZeneca all use Twitter to deliver news about their companies, and several firms have launched controversial channels on YouTube to promote their drugs. Pharmaceutical companies also bid for key words such as “cholesterol” in Google and other search engines so that advertisements for their drugs will appear in the sponsored search results, for which the search engine company collects a fee each time someone clicks on the advertisement.7 In addition, contextual advertising on websites offers pharmaceutical companies the opportunity to place banners on websites targeted to visitors to certain websites or to visitors in certain geographic locations.7

Reasons for industry’s increased use of social media and online advertisements

At a time when print advertisements for pharmaceuticals are down 18% and television advertisements are down 4% to $4.4 billion in 2008 (compared to the $4.8 billion spent in 2007),1 online marketing efforts have soared.1, 5 One reason drug makers have turned to online advertising is because it is a relatively inexpensive way to reach targeted audiences. But in addition to being cost-effective, online media communications are less likely to mobilize patient advocates who are critical of DTC advertising.4, 7

Some observers have suggested that the “lower profile” yet highly effective online DTC advertisements might be “simply smart politics” on the part of pharmaceutical companies wishing to avoid attention by members of congress who wish to regulate DTC advertisements.2 Pharmaceutical marketers have taken advantage of the fact that greater numbers of Americans are now seeking health information and support online instead of consulting their physicians.4, 5, 8 Patients are now seeking more interactive communications, and, in an interview with Advertising Age, a relationship-marketing agency CEO said that social media offers the pharmaceutical industry an opportunity to rebuild trust between the consumer and an industry that is often unpopular.5

Recent DTC “success stories”

Several pharmaceutical companies have launched highly successful online marketing communications, and in some ways these companies serve as industry forerunners.5 Here are some examples:

MULTIPLE SCLEROSIS: Patients with chronic conditions often turn to the internet for the support of others with similar concerns and for help in managing chronic conditions.4 Acorda Therapeutics, working with a division of global advertising agency Saatchi & Saatchi launched a community website called iwalkbecause.org in advance of the release of its drug for multiple sclerosis which will not be available until next year.5 According to a Saatchi executive, the community of people with multiple sclerosis is a group that searches for online information “ferociously.” 5

AMBIEN CR: Saatchi also worked on an integrated TV-web campaign for Sanofi-Aventis’ sleep drug Ambien CR.5 The 15-second commercial directed viewers to go to a “microsite” called silenceyourrooster.com with games, videos, and other social-media elements.5 In the first three days, the site received 1 million “hits” and a 2% “clickthrough rate” to the branded site www.ambiencr.com.5

ASTHMA: AstraZeneca launched a YouTube channel called “My Asthma Story” for its asthma drug Symbicort where they invite patients to submit videos about their positive experiences with Symbicort to their website, where consumers “essentially create their own advertisements for the drug.”5

RESTLESS LEGS: In late 2006, GlaxoSmithKline introduced an unbranded and very creative video on YouTube that received over 200,000 views, which led the company to establish its own YouTube channel, GSK Vision.5

Future Issues for advocates and regulators to consider

Overall, the FDA has, until recently, been weak in its response to pharmaceutical companies’ online DTC advertisements. In fact, there are no published guidelines for online pharmaceutical advertising by the FDA Division of Drug Marketing, Advertising, and Communications Research, the organization typically responsible for providing such oversight.5 As noted by a senior VP at the public relations and marketing communications firm Fleishman Hillard, “People are still figuring out how we employ new media, whish is such a completely new paradigm. What [pharmaceutical companies] are doing now is experimenting.” 5 Similarly, Symbicort brand manager for AstraZeneca notes, “The social-media space is still very much a gray area.” 5 Without oversight, controversy has begun to erupt as it did this past January, when a banner ad went online for the emergency contraceptive Plan B. Plan B is marketed by Duramed, a subsidiary of Barr Pharmaceuticals, which was recently acquired by Teva Pharmaceuticals USA.9 The company advertised on the MTV website which is very popular among girls 17 and younger, directing viewers to go to the Plan B website with the tagline “Because the unexpected happens.” 9

Last April, the FDA began to take action with regard to DTC advertising in new media by sending major pharmaceutical companies untitled letters in April asking them to not place misleading ads on search engines such as Google and Yahoo,5 as well as taking action regarding several YouTube videos with misleading pharmaceutical advertising content. For example, the FDA requested that UK drugmaker Shire Pharmaceuticals remove its YouTube video for Adderall XR, which the agency argued was overstating the hyperactivity drug’s effectiveness while omitting relevant information about risks.10 The FDA also began requiring pharmaceutical companies to embed safety and risk information in the videos themselves, rather than providing a link alongside the video advertisements they post.10

As pharmaceutical companies increasingly turn to online media and social marketing to reach consumers, regulatory guidance from the FDA on this “gray area” will be increasingly necessary, as will increased vigilance on the part of consumer advocates and Congressional leaders.

References

1 US DTC Rx advertising falls 8% to $4.4 billion. Pharma Marketletter. April 21, 2009.

2 US Pharma DTC “recession” started in 2006. Pharma Marketletter. December 5, 2008.

3 Douglas J. Wood Reed Smith LLP. Legal issues to watch in 2009. Advertising Age. December 15, 2009.

4 US drugmakers switch marketing approach. Pharma Marketletter. April 25, 2008.

5 Miley M, Thomaselli R. Big Pharma finally taking steps to reach patients with digital media: highly regulated industry slowly mobilizes with blogs, Twitter, YouTube. Advertising Age. May 11, 2009.

6 McNeil Pediatrics, ADHD Moms A Place for Moms of Children with ADHD. Press Release dated July 9, 2008. Available at: http://www.mcneilpediatrics.net/mcneilpediatrics/assets/
60CON08453A_ADHD_Moms_Press_Release_FINAL_FOR_DIST.pdf

7 US drug DTC cuts in 1st half 2008: TV ad effectiveness low, regulatory risk high? Pharma Marketletter. October 17, 2008.

8 California HealthCare Foundation. Social Media’s Challenge to Traditional Health Care Patients, Providers, Researchers, and Advocates Forge Online Connections. April 22, 2008. Accessed June 7, 2009 at: http://www.chcf.org/press/view.cfm?itemID=133633.

9 Thomaselli R. “Morning-After Pill” catches flak for MTV.com ad: site’s under-18 visitors will see banner for emergency contraceptive Plan B. Advertising Age. January 8, 2009.

10 US FDA swoops on YouTube “DTC Abuse.” Pharma Marketletter. December 4, 2008.

Image Credit:

1. tomsaint

Reader Response: “New York State’s Tax on Sugar Sweetened Beverages Goes Down the Drain: Lessons from Nutrition Advocates”

Last month Corporations and Health Watch posted a story “New York State’s Tax on Sugar Sweetened Beverages Goes Down the Drain: Lessons from Nutrition Advocates.” The following letter was written in response to this posting.

To Corporations and Health Watch:

I am writing to respectfully respond to the “New York State’s Tax on Sugar Sweetened Beverages Goes Down the Drain: Lessons from Nutrition Advocates” article by Ms. Dinour (posted in May 2009). Contrary to what the article implies, Citizens’ Committee for Children (CCC) has at no point wavered in its support and preference for the establishment of an excise tax on sugar-sweetened beverages. To educate elected officials, health care colleagues and the media on the advantages and strengths of an excise tax, we commissioned a public opinion poll on the proposal and provided poll results and detailed analysis of consumption and revenue to the Governor, the entire New York State Legislature, local and regional media outlets, as well as health care colleagues and advocates. In addition, we mobilized over 4,000 New Yorkers to connect to their state representatives electronically in support of the excise tax facilitating hundreds of e-letters. We traveled to Albany with volunteers and met repeatedly with elected officials to advance the excise tax proposal. We were in constant contact with the Governor’s Office, the Senate and Assembly, providing fiscal impact assessments, projections on consumption and revenue, and encouraging alterations to the sales tax proposal. We held press conferences, background sessions with journalists and media, and testified at hearings on the State Budget and tax options. In every instance we advanced the concept of an excise tax on sugar-sweetened beverages, not simply an innovative way to raise revenue, but as an effective way to improve public health and save lives by reducing consumption of unhealthy beverages. We remained focused on the targeted use of excise tax revenue as well and believed that resources needed to be dedicated to obesity prevention – something the proposal to increase sales taxes on beverages did not do.

The article also suggests that child advocates and health advocates had not gone far enough in their advocacy methods; stating by comparison that the “New Yorkers Against Unfair Taxes created a website, blog, cell phone texting service…” What is missing in this comparison is the open acknowledgement that New Yorkers Against Unfair Taxes is a coalition supported by local and regional business interests, industry organizations and corporations in food retail, bottling, beverage, and distribution. Also absent from the discussion is the fact that the resources, contributions and influence at the coalition’s disposal, were not only disportionate but that several corporations actually threatened to move thousands of jobs out of New York, should the sugar-sweetened beverage tax proposal pass. Conversely, the excise tax was supported by small non-profit advocacy organizations and health care providers focused on the health of the State’s citizens but without the vast resources and without the financial leverage and overwhelming monetary stake in the outcome.

CCC agrees with the article’s conclusion: that a key lesson for advocacy is the need for a “strong policy introduction and legislative champion and effective messaging throughout a campaign.” In fact, our poll clearly documented an increase in public support for the excise tax on sugar-sweetened beverages when participants are told of the public health, rather than gap closing, benefits. Health and child advocates did not waiver in their advocacy or messaging on that point. Unfortunately the media coined and hung on to the “fat tax” terminology, which not only demonized overweight people but also deflected attention from public health benefits of taxing unhealthy products. The catchy phrase helped to dumb down the public discussion and allowed for the lumping of this proposal in with regressive fees, fines and taxes. Faced with multiple and enormous tax policy and budgetary battles, the sugar sweetened beverage tax proposal eventually lost its greatest political champion: the Governor.

On this point, although the article states that advocates should understand “the historical, social and political environments in order to identify windows of opportunity,” it completely fails to acknowledge the historical, social and political environments that advocates faced when the Governor proposed a sales tax on sugar sweetened beverage tax. The debate, on the best method of taxing unhealthy beverages, took place at a time when New York State faced the most profound recession in decades and needed to close a $16 billion dollar budget gap. A time when there was profound concern about protecting hundreds of millions of dollars in investments in basic supports for children and families. In tandem with our efforts to advance a sugar sweetened beverage excise tax proposal, CCC and others were also leveraging significant political and organizational capacity to achieve a progressive increase in personal income tax to raise nearly $6 billion in revenue and ensure that the budget would not be balanced on the backs of the poorest constituents. Thankfully, we achieved both even though the political and social climate seemed against us from the outset, thereby proving the theory that you can lose the battle and still win the war.

We remain committed to advocating for the excise tax on sugar sweetened beverages because we believe that children will ultimately benefit. In fact, the United State’s Senate Finance Committee is now contemplating instituting such a tax as a means to raise revenue to support health care reform and combat obesity on a national scale. It is clear that the rigorous debate in New York has informed this national proposal. CCC continues to educate lawmakers, now on the federal level, and is hopeful that Congress can pass the tax and in doing so place the needs and interests of children and families ahead of those of the bottling and beverage industry.

Jennifer March-Joly, Ph.D.
Executive Director
Citizens’ Committee for Children of New York

Book Reviews: Global Politics & Pharmaceutical Industry Practices

Two books on the ethics, politics and practices of the global pharmaceutical trade. Reviewed are: The Global Politics of Pharmaceutical Monopoly, Power, Drug Patents, Access, Innovation and the application of the WTO Doha Declaration on TRIPS and Public Health by Ellen F.M. ‘t Hoen (AMB Diemen, 2009) and Global Pharmaceuticals: Ethics, Markets, Practices, edited by Adriana Petryna, Andrew Lakoff, & Arthur Kleinman (Duke University Press, 2006).

The Global Politics of Pharmaceutical Monopoly, Power, Drug Patents, Access, Innovation and the application of the WTO Doha Declaration on TRIPS and Public Health by Ellen F.M. ‘t Hoen (AMB Diemen, 2009. ISBN 97890-79700-06-6)

In her new book, The Global Politics of Pharmaceutical Monopoly, Power, Drug Patents, Access, Innovation and the application of the WTO Doha Declaration on TRIPS and Public Health, Ellen ‘t Hoen, former Director of Policy Advocacy for the Medecins Sans Frontieres (Doctors Without Borders) Access Campaign, outlines progress made in increasing access to medication and medical innovation. She also identifies critical unresolved issues in development and distribution of new medical technologies for the treatment and prevention of disease in the developing world. Specifically, this book describes how access to medication in the developing world is affected by the current global rules for pharmaceutical patents. The book highlights recent alternative mechanisms to encourage medical research and development in a way that also ensures access to the product—by separating the cost of research and development from the price of diagnostics, medicines, and vaccines.

Link to reviews of this book:

Knowledge Ecology Studies
European AIDS Treatment Group

Link to this book:

AMB Press (where you will find link to an on-line version of this book)

 

Global Pharmaceuticals: Ethics, Markets, Practices by Adriana Petryna, Andrew Lakoff, & Arthur Kleinman (eds.) (Duke University Press, 2006. 312pp. ISBN 082233741X)

This edited volume, a collection of ethnographies, tackles a timely topic- the inequalities produced by the current global pharmaceutical system that of the anthropologist. This collection provides insights into the burgeoning international pharmaceutical trade and the global inequalities reinforced by market-driven medicine. From an examination of how popular and professional understandings of psychiatric illness in the Western world to the experience of African families faced with the financial burden of AIDS treatment for its members, this book brings together experiences of individuals and communities and the roles they play along with organizations, corporations, and governments in the market-driven game of global pharma. This work is an important step in bringing the moral and ethical issues inherent in every phase of pharmaceutical production to the forefront of the social science research agenda.

Link to review of this book:

British Journal of Psychiatry

Link to this book:

Amazon.com

Commentary: Driving change: the global health impact of the restructured auto industry

In the last several months, the global auto industry has undergone a transformation as profound as any in its history. Despite a $50 billion taxpayer bailout, two of the three biggest US automakers, General Motors and Chrysler, have filed for bankruptcy. As the auto industry plans for its new smaller future, public health advocates need to consider how this restructuring will affect health. In this Commentary, CHW briefly describes some of the recent changes in the global auto industry, examines the possible health impact of these changes, and suggests possible directions for public health research and policy advocacy.

In the last several months, the global auto industry has undergone a transformation as profound as any in its history.  Despite a $50 billion taxpayer bailout, two of the three biggest US automakers, General Motors (GM) and Chrysler, have filed for bankruptcy. Almost 300,000 auto workers have been laid off and more than 2,000 auto showrooms closed.  While every sector of the industry has been hurt by the economic crisis, foreign car makers like Honda, Toyota and Hyundai continue to gain market share and Fiat, an Italian car maker, is expected to soon complete its purchase of Chrysler. After decades of government stalling, in May, President Obama announced tougher new federal fuel emission and mileage standards for US autos, creating new pressure for change.1 As the auto industry plans for its new smaller future, public health advocates need to consider how this restructuring will affect health.  In this Commentary, Corporations and Health Watch briefly describes some of the recent changes in the global auto industry, examines the possible health impact of these changes, and suggests possible directions for public health research and policy advocacy. Our goal in this preliminary report is to raise questions   for more systematic analysis in the months and years ahead.

Downsizing Detroit

In the last 18 months, 289,000 workers in the US auto industry lost their jobs, about half were auto assemblers and the other half worked in the auto supply networks.2 Between September 2008 and March 2009, these two sectors of the auto industry accounted for nearly 20% of the decline in the nation’s gross domestic product.  In Spring 2009, US car makers were producing 423,000 vehicles a month, down from 600,000 late last year.2 Some industry analysts predict that by the end of 2009, a total of 3,800 auto dealerships will be closed, almost double the number closed to date.  The auto industry’s troubles predate the economic crisis –rising oil prices, a collapsing market for SUVs, and intense competition from European and Asian car makers all contributed to the industry’s meltdown.

Globally, the auto industry is also running off the road.  The London-based HIS Global Insight Automotive Group estimates that total 2009 passenger car and light truck production will fall to 59.8 million units in 2009, a 16% drop from 2007.3 In the last year, car sales have declined in Japan, Europe and elsewhere.  In 2008, auto sales in China hit a ten year low, although the Chinese stimulus plan, which provides subsidies for car purchases, has helped to lift sales more recently.  As Michel Freyssnet observed in Le Monde, what is striking about the current crisis in the automobile industry is that “there is not any major market nor any manufacturer that is not in decline.” 4

In January 2009, people in China bought 748,000 cars, a 4.6% reduction from the year before while in the U.S., people bought 657,000 cars in January, a 37.1% reduction.4 This statistic highlights the changing face of the global auto industry.  In the coming decade, most analysts agree that European, Japanese, and Chinese car makers will outpace the US industry, with Brazil, South Korea and India not far behind.

In China, for example, the high cost of gasoline is pushing even tougher fuel emission mandates than those announced by President Obama.  In a plan released in May, China will require car makers to improve fuel economy an additional 18% by 2015, creating new pressures for more fuel efficient and smaller cars.5 Already China imposes a sales tax of 1% on fuel-efficient cars and 40% on gas-guzzling SUVs and sports cars.  Since most multinational auto companies are vigorously competing for a share of the Chinese auto market, China has the potential to play a leading role in setting global environmental and production standards. As Dieter Zetsche, the chairman of Daimler, said at the opening day of the Shanghai auto show in April, “The center of gravity is moving eastward. This has, if anything, only accelerated through the crisis.”6

Auto industry analysts, from the  World Watch Institute7 to KPMG8 to the US Department of Commerce9, seem to agree that if the auto industry is to survive, it must make fewer, smaller and better cars, with an emphasis on more environmentally friendly  and fuel efficient vehicles.  It also seems likely that carmakers in other countries, especially China, will continue to grow in influence.  While the emerging auto markets in the global South are likely to demand smaller and more fuel-efficient cars, if their goal is to achieve developed nation levels of car ownership the overall adverse impact of cars on health and the environment may continue to grow.  In the coming decade, this tension between equity in ownership levels and sustainable patterns of automobile production will dominate the debates among the global automobile industry, policy makers and environmentalists.  On the one hand, the developed nations have no right to tell Asians, Africans and Latin Americans that they can’t have cars. On the other hand, a continued rise in automobile use will inevitably choke our cities, pollute our air, injure and maim growing numbers of people, and exacerbate human-induced climate change, all trends that will hurt the global south more.  Only by reframing the issues can we escape this dilemma.

In the coming decade, this tension between equity in ownership levels and sustainable patterns of automobile production will dominate the debates among the global automobile industry, policy makers and environmentalists.

One important influence on how much Americans will drive and what kinds of cars they will buy is the price of gasoline.  In the United States, oil demand has dropped without interruption for more than 15 months. Globally, the International Energy Agency estimated that daily average oil consumption would decline by 3% in 2009. 10 A rapid economic recovery, new oil production and consumer optimism could lead to more driving and fewer incentives to buy small cars.  Conversely, a long recession, high gas prices, or continued political conflict in Nigeria, Iraq, Russia, Venezuela or other major oil-producing countries could accelerate the trends to less driving and smaller, more fuel-efficient vehicles.

How does the auto industry influence health?

For the last century, the auto industry has been a major influence on health.  It has changed the air we breathe, the form of our cities and suburbs, and contributed to rising rates of obesity by encouraging sedentary behavior.  An extensive literature documents the profound social and environmental impact of the automobile.11, 12, 13 At the individual level, automobile ownership has been associated with various health benefits.  As Macintyre et al. note, car ownership can increase access to employment, shops selling healthy affordable food, leisure facilities, social support networks, health services and open space and help owners to avoid crime.14

At the population health level, more attention has been focused on the adverse impact of the density of automobile ownership.  Here we consider its impact in four separate domains: air pollution, climate change, automobile accidents and injuries, and physical inactivity.  Also of vital importance but considered only briefly below is the industry’s impact on the well-being of its workers and the communities in which its factories are located.

Air pollution Outdoor air pollution causes an estimated 800,000 deaths around the world  each year and motor vehicles are a major source of  such pollutants as nitrogen oxides (NOx) and volatile organic compounds (VOCs)—which interact to form ground level ozone—and of microscopic particulate matter (PM10).  It is estimated that 1.4 billion people are exposed to urban air pollution above World Health Organization (WHO) limits. Deaths from air pollution are only the tip of the iceberg. For example,  for every death caused by PM10  there will be 34 emergency admissions, 407 asthma days, 6,085 reduced activity days, and 18,864 acute respiratory symptom days.15

Climate change In April 2009, the US EPA issued a proposed finding that carbon dioxide (CO2) poses a danger to health and welfare, opening the door to federal regulation of CO2 from all sources.16 According to Environmental Defense, the United States has 5% of the world’s population and 30% of the world’s automobiles, but it contributes 45% of the world’s automotive CO2 emissions.17 Thus, reducing car use and increasing fuel efficiency of cars are essential steps in reversing human-induced climate change.  According to Dan Becker, the Director of the Safe Climate Campaign, the improvements in fuel efficiency standards that President Obama announced last month are, “the biggest single step to curbing global warming.  It’s a major step forward in cutting auto emissions.” 18

Accidents In the last century or so, cars have killed at least 30 million people, perhaps many more—each year cars kill 1.2 million and injure 50 million.19 According to the World Health Organization, traffic deaths and injuries are rising worldwide, likely to double by 2020 and automobile accidents are the leading cause of death for 10 to 24 years old.19 Children in less developed countries (LDCs), especially those in densely populated cities, experience the highest burden of automobile injuries, dying at six times the rate of children in higher income countries and accounting for 96% of all children killed in traffic collisions.13 The US automobile industry has a long record of opposing public health measures to improve car safety including seat belts, air bags and auto-locking brakes.  Over the 20th century, as consumer and government pressure forced the US auto industry to add safety devices, auto deaths and injuries fell dramatically.  Still, in the 1990s, automaker decisions to promote SUVs at the expense of sedans contributed to thousands of preventable deaths in the US from rollovers, crashes and collisions with pedestrians.20

Obesity/physical inactivity More recently, automobiles and the cities and suburbs designed to accommodate them have been implicated as one factor contributing to rising rates of obesity.  As cars have become more central in many transport systems, people are less likely to walk to shops or work and fewer children walk to school. One study found that each additional hour spent in the car was associated with a 6% increase in the likelihood of obesity.21

How will the restructuring of the auto industry influence its impact on these and other health outcomes?

Box 1 lists possible implications of some of the previously described trends.  Future research will need to test these possible associations across time and place, seeking to gain insights into the pathways by which changes in auto industry practices lead to changes in health and health behavior.  In addition, changes in the automobile industry are likely to be associated with other changes in the global economy, trends which may interact to produce positive or negative health consequences.

Box 1. Possible Health Consequences of Changes in the Auto Industry

Trend

Possible Health Effects

Fewer automobiles produced

Less driving, less air pollution including C02 emissions, fewer accidents and injuries, more walking and less obesity

Higher proportion of smaller more fuel efficient cars

Less air pollution including less carbon dioxide emissions and less global warming

Fewer miles driven

Less air pollution, fewer accidents and injuries, more walking and less obesity

Higher rates of automobile ownership  in Asia, Africa and Latin America

More air pollution, more accidents and injuries, and less physical activity, exacerbating North-South health inequities

Finally, any review of the health consequences of the auto industry restructuring must acknowledge the profound adverse impact on workers in the automobile industry and on the communities where the auto industry has been centered.  Hundreds of thousands of auto workers have and will lose their jobs and often their health insurance, putting them at risk of prolonged unemployment, home foreclosure, and high levels of stress.  In addition, these catastrophic losses are concentrated in a few cities and regions, most notably Detroit and its suburbs, in the US, where they further jeopardize the well-being of populations already suffering from more than two decades of deindustrialization.

Future policy and research for a healthier auto industry

In the US, as in the rest of the world, the goal is not simply to restore the auto industry to a health that has often sickened the world by producing unsafe, polluting and environmentally damaging cars.  To avoid this future, auto makers, government policy makers, public health and environmental professionals, labor unions, and advocates will need to engage in an ongoing dialogue.  Here, Corporations and Health Watch suggests some proposals that may help to spark this dialogue.

1. Move from state to federal regulation for automobile safety and environmental standards.

In the past many years, public health and environmental activists have often emphasized state rather than federal regulation because of the business friendly environment in Washington. The recent economic crisis and the 2008 election may provide a window of opportunity to move the action back to Washington where decisions can benefit the population as a whole and pressure industry to meet consistent standards.   Industry may now be willing to support such a move, at least in those cases where federal regulation doesn’t threaten profits. As the Alliance of Auto Manufacturers noted in May, a national program for regulating CO2 “avoids conflicting standards from different regulatory agencies, and it gives automakers much needed certainty for long-term product planning.”22

2. Reinvigorate the National Highway Safety and Transport Administration and the Environmental Protection Agency.

For the federal government to play a positive role in reducing the health and environmental consequences of the automobile industry, it will need a vigorous and science-based regulatory infrastructure, much of which was decimated under the Bush Administration.  Rebuilding these agencies will provide the means to implement new policies.

3.  Consider the quid that tax payers can expect for the quo of the auto industry bailout.

Bailouts are not, by themselves, a solution to the auto industry’s problem.  As Joseph Romm, a former US Energy Department staffer, wrote recently in Salon, “when you bail someone out of jail, there is no guarantee that he won’t jump bail, and even less of a guaranteed that he won’t ultimately end up in jail anyway.”23 So continued government support has to be contingent on auto makers acting in the public interest.  Among the auto industry practices US tax payers ought not to subsidize are: deceptive advertising that implies big cars are safe, design of cars that are environmentally damaging, or lobbying to thwart public health protections.

Film maker Michael Moore, who 20 years ago showed the seamy side of GM in his film “Roger and Me,” recently suggested that President Obama24 follow the example President Roosevelt set after the attack on Pearl Harbor.  Then, FDR ordered GM to halt car production and begin to produce planes, tanks and machine guns. Now, Moore urged Obama to convert our auto factories into ones capable of building mass transit vehicles and alternative energy devices.

4. Construct clear, compelling narratives and frames to present the issues facing the American auto industry to the American public.

For decades the US auto industry has opposed reforms that will reduce the public health and environmental harms its products cause, and, for decades, the American public has had difficulty contesting the industry’s self-serving arguments. Now the American public is much less likely to trust auto industry executives to decide what’s best for America. To realize this opportunity, public health and environmental advocates will need to find new language and narratives to help Americans consider their options.  Recently, the psychologist Drew Westen and the pollster Celina Lake suggested some frameworks for discussions about auto industry reform, illustrated in the diagram below, in which the words in blue suggest future directions and those in red the policies we want to escape.25

In the coming years, the auto industry will continue to change. Whether public health and environmental advocates will be able to influence those changes for the better depends on our success in engaging a wide variety of constituencies in policy debates about the future of the car.  By understanding the health and environmental consequences of these changes and communicating them clearly, we have an opportunity to join the discussion.

By Nicholas Freudenberg, Distinguished Professor and Founder and Director of Corporations and Health Watch.

References

1 Broder JM. Obama to Toughen Rules on Emissions and Mileage. New York Times, May 18,2009. Available at:http://www.nytimes.com/2009/05/19/business/19emissions.html?_r=2

2 Uchitelle L. Once a key to recovery, Detroit adds to the pain.  New York Times, June 1, 2009, p. B1, 3.

3 Cited in Rennert M. Global auto industry in crisis.  Worldwatch Institute, May 18,2009. Available at:http://www.worldwatch.org/node/6113.

4 Freyssenet.A Major Battle Is Joined Over the Transition to the Clean Car. Tuesday 03 March 2009. Truthout. Originally Published in Le Monde  Available at http://www.truthout.org/030509G

5 Bradsher K.  Miles to go in China.  Thursday, May 28, 2009, p. B1.

6 Bradsher K. China influence grows with car sales. New York Times, April 20, 2009.

7 Rennert M. Global auto industry in crisis.  Worldwatch Institute, May 18,2009. Available at: http://www.worldwatch.org/node/6113

8 KPMG International.  Momentum: KPMG’s Global Auto Executive Survey 2009.  Available at:http://www.kpmg.com/SiteCollectionDocuments/Momentum-KPMG-Auto-Executive-Survey-2009.pdf

9 International Trade Administration.  The Road Ahead for the U.S. Auto Market.  U.S. Department of Commerce, Washington, D.C., 2008.

10 Mouawad J. Gas is up; drivers may not cut back.  New York Times, May 21, 2009.

11 Ladd B.  Autophobia Love and hate in the Automotive Age.  Chicago: University of Chicago Press, 2008.

12 Woodcock J, Aldred R. Cars, corporations, and commodities: Consequences for the social determinants of health. Emerg Themes Epidemiol. 2008 ;21;5:4.

13 Dauvernge, P. 2008. The Shadows of Consumption  Consequences for the Global Environment. Cambridge, MA: MIT Press, 2008.

14 Macintyre S, Ellaway A, Der G, Ford G, Hunt K. Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study. J Epidemiol Community Health. 1998;52(10):657-64.

15 “Urban Transport.” Encyclopedia of Public Health. Ed. Lester Breslow. Gale Cengage, 2002. eNotes.com. 2006. 23 Jun, 2009 http://www.enotes.com/public-health-encyclopedia/urban-transport

16 Broder JM. EPA clears way for greenhouse gas rules. New York Times, April 18,2009. Available at:http://www.nytimes.com/2009/04/18/science/earth/18endanger.html

18 Tankerley R, Simon R. US to limit greenhouse gas emissions from autos.  Los Angeles Times, May 19th, 2009. Available athttp://articles.latimes.com/2009/may/19/nation/na-emissions19.

19 World Health Organization and World Bank. World Report on Road Traffic Injury and Prevention. Geneva, Switzerland, 2004.

20 Bradsher K. High and Mighty SUVs: The World’s most Dangerous Vehicles and how they Got that Way. New York, NY: Public Affairs; 2002.

21 Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med. 2004 Aug;27(2):87-96.

22 Alliance of Automobile Manufacturers,. Automakers support President in development of national program for autos. Press Release, May 18, 2009. Available at:  http://www.autoalliance.org/index.cfm?objectid=55B4BAFF-1D09-317F-BBB0DA0B7783C956

23 Romm, J. Is Detroit Worth Saving? Salon.  November 12, 2008. Available at:http://www.salon.com/env/feature/2008/11/12/barack_obama_detroit/

24 Moore, M. Goodbye GM. June 1, 2009. Available at: http://michaelmoore.com/words/message/index.php

Photo Credits:
1. trashd 
2. thomashawk
3. httpdcmaster

 

Is the Food Industry Playing with our Brains? New book by former FDA commissioner David Kessler examines neuroscience of overeating

In his new best-selling book titled The End of Overeating: Taking Control of the Insatiable American Appetite, David Kessler, M.D., former U.S. Food and Drug Administration Commissioner, presents research on the newest discoveries of neuroscience related to appetite and eating, as well as the insights he learned from top food industry executives that resulted in his theory on overeating.

It’s no longer news to point out that Americans are gaining weight and most public health folks have heard the alarming projection that if current trends continue, by 2015, 75% of American adults will be overweight and 41% will be obese1 And it’s also no news that many Americans are trying to lose weight. We  spend nearly $60 billion annually on weight loss products and diets 2. This year Weight Watchers stands to earn a $1.58 billion in revenue (excluding sales of food products), and Jenny Craig will earn nearly $610 million 2. Unfortunately, most dieters return to their initial weight within three to five years 3, suggesting that more dieting isn’t going to solve America’s obesity problem.

In his new book The End of Overeating: Taking Control of the Insatiable American Appetite David A. Kessler, M.D., a physician and lawyer who served as Commissioner of the U.S. Food and Drug Administration (FDA) from November 1990 until March 1997, brings a fresh perspective to the obesity problem.  He argues that it is not faulty metabolism or lack of will power that causes people to eat too much or fail at dieting but rather complex brain functions that lead to “conditioned hypereating.” Acording to Kessler, environmental cues trigger biological drives for foods high in fat, sugar and salt  and eventually overwhelm the mechanisms that controlled overeating in earlier eras when unhealthy food was less promoted and less available.

Having spent many years at the FDA synthesizing research on the addictive powers of tobacco, Kessler turned his attention to high fat, salt and sugar foods, which,  after tobacco, are the second leading killer of Americans.   His new book is the result of seven years of research, and last month it emerged on the top-ten bestsellers list for non-fiction in the New York Times Book Review. In his book, Dr. Kessler presents research on the newest discoveries of neuroscience related to appetite and eating, as well as the insights he learned from his interviews with food industry executives.

Hyperpalatable foods engineered by industrial chefs and conditioned overeating

In essence, Dr. Kessler maintains that foods high in fat, salt and sugar alter brain chemistry in a way that compels people to overeat.  While these foods have always been “salient” to humans, the modern food industry has taken advantage of this phenomenon.  Kessler describes how industrial chefs have engineered “hyperpalatable” foods that are layered in fat, sugar and salt to trigger a release of the neurotransmitter dopamine, resulting in “conditioned hypereating.” He profiles engineered foods from some of the most popular brand manufacturers, chain restaurants, and fast food restaurants, including the Cinnamon Crunch Bagel at Panera (430 calories, 8g fat, 430mg sodium), and the Sowthwestern Eggrolls (910 calories, 57g fat, 1960mg sodium) and Boneless Shanghai Wings (1260 calories, 71g fat, 3030mg sodium) from the nation’s second-largest restaurant chain Chili’s Grill and Bar. Dr. Kessler said he estimates that approximately 70 million Americans are affected by hypereating4, and he maintains that  what “the food the industry is selling is much more powerful than we realized.” 5

Advertising: “The emotional gloss”

When  hyperpalatable foods are combined with modern-day marketing and advertising (“the emotional gloss,” as Dr. Kessler puts it), the result is changed social norms that make it acceptable for Americans to eat foods daily that used to be considered occasional treats.  According to Dr. Kessler, “We took down all these barriers; now you can eat anytime, anywhere.  It’s socially acceptable.  We have this constant stimulation, and we’re no longer eating for nutrition.  We took fat, sugar, and salt, made it very appealing, put it on every corner, and made it socially acceptable.” 6 While some have argued that advertising serves an important function in informing consumers about products, Dr. Kessler’s research reveals that food advertisements in fact serve as cues to induce people to eat these engineered, unhealthy foods4. Constant bombarding by advertisements that link these foods to fun and good times makes it more difficult for people to address their overeating.5

Dr. Kessler’s inspiration for the book

In interviews, Dr. Kessler describes his inspiration for the book as well as his own struggles with overeating.  Before he wrote the book, he said that he didn’t know the causes of overeating, but that he knew it “wasn’t just a matter of diet and exercise.” 6 Kessler says his inspiration came seven years ago when he was watching a woman on The Oprah Winfrey Show 5, 6 who in tears, described how she could not control her eating.  He said, “I was sitting there trying to listen as a doctor, but I could also relate to what she was talking about from my own experience.  I needed to understand what was driving her behavior.6

Solutions to the overeating epidemic

This book promises to be highly influential in changing the way that Americans view the practices of the food industry as well as the epidemic of overeating. In an interview with a Huffington Post reporter, Kessler summarized the basic premise of his theory, “Now, we know that highly palatable foods – sugar, fat, salt – are highly reinforcing and can activate the reward center of the brain.  For many people that activation is sustained when they’re cued.  They have such a hard time controlling their eating because they’re constantly being bombarded …For decades the food industry was able to argue, ‘We’re just giving consumers what they want.’ Now we know that giving them highly salient stimuli is activating their brains.” 4

Dr. Kessler says that his book is not meant to be a policy prescription.  Instead, he wants to explain why people  have such a difficult time with overeating. 6 Based on his tobacco experience at the FDA, Dr. Kessler has noted that there are many parallels between problems associated with food and tobacco  industry practices. Both industries manipulate consumer behavior to sell products that are harmful to health.5 He maintains that while government has a role to play, many of the great public health successes have come from changes in the way people perceive the product.4 He states, “We did this with cigarettes. It used to be sexy and glamorous but now people look at it and say, ‘That’s not my friend, that’s not something I want.’ We need to make a cognitive shift as a country and change the way we look at food.” 5

References

1 Wang Y, Beydoun MA. The obesity epidemic in the United States – gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiologic Reviews. 2007;29:6-28. Available at: http://epirev.oxfordjournals.org/cgi/content/abstract/29/1/6

2 Miley M. New Year, new round of diet programs. Advertising Age. January 12, 2009.

3 Wadden TA, Phelan S. Behavioral assessment of the obese patient.  In: Wadden Ta, Stunkard AJ, eds.  Handbook of Obesity Treatment. New York: Guilford Press, 2002:186-226.

4 McCready L. Interview with Dr. David Kessler, author of The End of Overeating, on why we can’t stop eating. The Huffington Post. May 6, 2009. Available at: http://www.huffingtonpost.com/louise-mccready/d-kessler-author-of-emthe_b_195676.html.

5 Layton L. Crave man: David Kessler know that some foods are hard to resist; now he knows why. The Washington Post. April 27, 2009. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2009/04/26/AR2009042602711.html.

6 Hobson K. David Kessler on why we’re prone to eating too much. U.S. News & World Report. May 4, 2009. http://health.usnews.com/blogs/on-fitness/2009/05/04/david-kessler-on-why-were-prone-to-eating-too-much.html.

 

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1. publiccitizen

Researching for Advocacy: The Industry Trade Press as a Resource for Activists

A recent report put out by the Berkeley Media Group, entitled, Navigating the Trade Press: What are the food and beverage industries discussing?, recommends public health advocates concerned with obesity regularly monitor various publications, including trade journals and magazines, to stay on top of the latest developments in the food and beverage industries. This review of the report features links to the report and key trade publications recommended for tracking.

To plan effective advocacy campaigns to change health-damaging corporate practices, activists need to understand what company managers are thinking and what business and political strategies they are planning.  Unlike big corporations and trade associations, few advocacy groups or independent researchers have the resources to hire investigators to gather this intelligence.  One practical and inexpensive alternative is to monitor business and trade press coverage of the industry in question.

A few years ago, the Berkely Media Stduies Group released a useful guide called Navigating the Trade Press: What are the food and beverage industries discussing? [pdf] It provides a starting point not only for activists seeking to change the food industry but also for other corporate campaigners who need an overview of the world of trade presses, business publications geared towards industry insiders.  In the report, author Lori Dorfman and Elena Lingas argue that “reading these sources makes it easier to articulate the divergent goals of public health and the food, beverage, and advertising industries,” enabling advocates, who often go up against companies with many times more resources, to more effectively and efficiently contest the practices of these industries that harm heath.

A web link to a 200-item annotated bibliography of key sources for tracking activities of these industries is a main highlight of Navigating the Trade Press. Separating the sources into business and science- focused categories, and then into tiers according to their direct proximity to issues of interest to most obesity prevention advocates, the report highlights the most relevant sources (including websites) for all public health advocates whose work is affected by these industries.  In addition to these sources, the report recommends that advocates choose specialty journals from the bibliography, in addition to the more general sources listed below, in order to stay on top of  industry practices that affect the issues they work on.   Dorfman and Lingas note that most sources offer an opportunity to sign up for periodic newsletters and news alerts via email, making it easy to monitor issues of interest.

Key sources for tracking food and beverage industry activities:

New York Times Business section (see especially the Advertising column)
Wall Street Journal Marketplace section
LA Times
Washington Post
Ad Age
Ad Week
Grocery Manufacturers of America
Food Institute
Food Chemical News
Obesity Policy Report

Some of these publications may require a subscription for viewing full contents on line. Most large public or university libraries have such electronic subscriptions, making these institutions a useful resource for activist researchers.

Future Corporations and Health Watch postings will examine how policy advocates can use the trade press of other industries (e.g., pharmaceutical, firearms, alcohol, tobacco, etc.) in their work. We invite readers to send suggestions to responses@corporationsandhealth.org

To read the full Navigating the Trade Press report and download the excel spreadsheet of food industry sources, please visit:

Mapping the Debate on Food

Marin Institute Releases New Alcohol Tax Calculator Tool

Read about and link to the new tool developed by the Marin Institute designed to assist states in raising revenue through alcohol taxation.

Online Feature Helps States Charge for Harm to Raise Revenue

Marin Institute has released the country’s first online alcohol tax and fee calculator to assist lawmakers looking for new revenue. The user-friendly tool is available at www.MarinInstitute.org.

The powerful program works for every state, as well as nationally and the District of Columbia. You just enter the amount of new tax (nickel or dime a drink, for example) for beer, wine or spirits (or any combination). Then the program instantly estimates additional annual revenues, based on a variety of factors specific to that particular jurisdiction.

Marin Institute developed the tool in response to inquiries from states looking for new revenues sources while holding Big Alcohol accountable for the enormous harm its products cause. Many states have not raised alcohol taxes or fees in decades. States with pending legislation to raise alcohol taxes or fees include: California, Illinois, Massachusetts, Minnesota, New York, Oregon, South Carolina, Tennessee, Wisconsin, Arizona, and Hawaii.

Visit the Tax / Fee Revenue Calculator on Marin Institute’s website to quickly estimate how much your state can raise in new alcohol taxes and fees.