It offers specific solutions to curb a primary contributor to the problem – the overconsumption of fast food and the ubiquitous marketing of fast food to children.
“Parents and policymakers have long felt at a disadvantage to counter the ubiquity of junk food and its marketing,” said Dr. Freudenberg. “This guide will empower families and communities to create healthier food environments for current and future generations.” Slowing Down Fast Food focuses on four local policy approaches: school policy, “healthy” zoning, curbing kid-focused marketing, and redirecting subsidies to healthier businesses.
As case studies in the report demonstrate, dedicated grassroots initiatives can overcome the food industry’s staunch opposition and build the political will sufficient for the passage of strong public health policies. For example, in San Francisco, the groundbreaking Healthy Meals Incentive Ordinance set basic nutritional standards for kids’ meals that are accompanied by toy giveaways. It was the power of grassroots initiatives involving parents, health professionals, and community leaders that helped secure the passage of this ordinance.
“What we can take from the city’s action is that all cities and towns could pursue and institute like-minded policies,” said San Francisco City Supervisor Eric Mar, the sponsor of the measure. “While no single community or organization can match the political and economic might of the fast food industry, we can make change on the community level that effectively challenges the fast food industry’s negative impact on public health.”
Such policies have positive and direct effects, but also have helped provoke critical changes across the food industry at large. While McDonald’s and its trade association attempted to block the ordinance, ultimately the burger giant and its competitors altered their practices internationally. For example, shortly after the San Francisco ordinance passed, Jack in the Box, the nation’s fifth largest burger chain, pulled the toy giveaways from its kids’ meals.
National media coverage of the San Francisco ordinance also helped foster public discourse and a deeper understanding of the harmful impact of marketing fast food to children. A growing number of studies have found that ending junk food marketing directed at kids could spare the health of millions of children. In June, the American Academy of Pediatrics even urged a ban on junk food advertising to children as part of a new research review published in the Pediatrics journal.
The report also identifies the obstacles to the passage of policies addressing fast food, namely industry opposition, interference, cooption and avoidance of regulation. It documents how fast food corporations use their political and financial clout to advance their interests, even when their products or practices jeopardize health. While this type of pervasive corporate interference has translated into inaction in Congress, local policy solutions have proven an effective means of countering special interests and protecting public health.
“Corporate influence may be drowning out the will of the people in our nation’s capital right now, but it cannot be allowed to remain this way,” said Kelle Louaillier, executive director of Corporate Accountability International. “Change needs to and can start at the local level, and the policies in this report are a critical place to start.”
The report and its companion Action Guide offer specific, practical guidance for putting policy concepts into motion, offering additional resources from a wide range of organizations engaged in protecting our health from the abuses of fast food corporations.
Corporate Accountability International (formerly Infact) is a membership organization that, for the last 35 years, has successfully advanced campaigns protecting health, the environment and human rights. Value [the] Meal is Corporate Accountability International’s campaign dedicated to reversing the global epidemic of diet-related disease by challenging the fast food industry to curb a range of its practices.
“What is the difference between a doctor and a pilot?” Dr. David Healy asked during a recent talk at the CUNY Graduate Center. The answer? A doctor isn’t going to go down with you.
Healy, a psychiatrist, psychopharmacologist and scientist, is the author, most recently, of Pharmageddon, a book about the “hijacking” of American healthcare by the pharmaceutical industry and what can be done about it. During his talk, Healy observed that doctors, not patients, are the consumers of medicine. And because doctors, unlike pilots, are not going to be personally affected by every professional decision they make, they may be less critical of “evidence” put forth by pharmaceutical companies, and more willing to overlook potential risks associated with the drugs they prescribe.
Healy argues that we have become too comfortable with the randomized control trial as our only source of drug evaluation. Evidence from clinical trials now trumps the values of patients and the expertise of doctors, despite the fact that, in Healy’s opinion, these trials have become mechanical and thoughtless. Because of dependence on control trials, prescription drugs are seen as innocent until proven guilty, and the pharmaceutical industry, rather than doctors, is playing an increasingly large part in curing disease.
In Pharmageddon, Healy cites examples of clinical trials that showed significantly different evidence of a drug’s effects than were actually published. “The unpublished trials primarily are negative,” he said in his talk, but pharmaceutical companies have strategies for turning negative trials into positive reports. Healy pointed to Eli Lilly’s Prozac trials from 1986. Data on suicides and suicidal acts while on Prozac were compared to the same events on placebo, no drug, or older drugs. For U.S. trials, Eli Lilly listed four suicides on Prozac and one on placebo, as well as 26 suicide attempts on Prozac and nine on other treatments. The corporation took this data and discounted seven of the nine suicide attempts on Prozac as non-genuine, while none of the placebo attempts were discounted. Four of the nine suicide attempts on placebo were in patients who had recently discontinued fluoxetine treatment (fluoxetine is the generic name for Prozac). Ultimately, the data that ended up in a 1991 BMJ article that reported on these trials looked quite different from the original 1986 data. Healy goes into further detail on this and other examples in Pharmageddon and on his blog.
“When the range of ways the suicide data were handled by Eli Lilly in this case or other companies in other cases do come up,” he writes, “companies tend to portray themselves as not statistically sophisticated. The implication is that if things went wrong, they did so by accident.” Accident or not, there is a lack of consistency between what the literature says and the trial results. Healy calls this the greatest divide in all of medicine.
Because of our dependence on randomized control trials and resulting uncritical acceptance of new drugs, we are suffering, according to Healy, from a new disease he calls “Pharmacosis.” One thing we can do to prevent the spread of this disease is to shift from evidence-based medicine to data-based medicine. We can do this by providing access to the data from randomized control trials, not just to the published reports.
We also need to give greater weight to anecdotal evidence. Currently, doctor and patient observations of drug effects are disregarded, despite the fact that most of these observations turn out to be correct. Though reports of adverse events from taking a drug may be anecdotal, Healy believes that it is still important for the system to pay heed and change as a result. This is why Healy has started www.RxISK.org, a patient adverse event reporting system. Through this website, patients can enter side effects they are experiencing from a particular drug, learn more about that drug, and view how many other people in their area are experiencing similar effects. People experiencing adverse events from a particular drug may believe that they are isolated, but this system will allow them to see whether others are having similar problems, and ideally mobilize them to do something about it.
In a video clip on Rxisk.org, Maria Bradshaw, whose son died by suicide 15 days after taking Prozac and experiencing a range of adverse reactions, discusses how sharing these reactions is important. She says that the trial populations pharmaceutical companies use to test their drugs are not representative of people who actually take them. “The only way that we’re actually going to learn about how these drugs work on people in the general population is for people like me and everyone else out there who’s using these drugs to file adverse reaction reports,” she urges. Healy’s hope is that people will use Rxisk.org to do just that, giving us a mechanism besides control trial reports through which to judge drugs, ideally reversing the effects of Pharmacosis.
On February 15, Marion Nestle, a public health professor at New York University, spoke on corporate influences on food policy at a meeting of the NGO Working Group on Food and Hunger. Nestle proposed food insecurity as one of the main issues around corporations and food policy for 2012, arguing that the main thing we can do to combat food insecurity is address its root causes. “There’s plenty that can be done at the local level if not at the international level, but work on the root causes, all you public health people,” she urged.
Nestle referred to UNICEF’s conceptual framework for the causes of malnutrition in society (Figure 1) to emphasize that food insecurity stems from social issues, not just from a lack of food. Lack of food is the end problem, but dealing only with that lack does not solve the root causes of food insecurity. According to Nestle, in order for everyone on the planet to be adequately nourished, we must create income equity and political stability, invest in sustainable agriculture and education, empower women, ensure access to clean water and safe food, and promote breastfeeding.
Some food and beverage corporations seek to position themselves as part of the solution to the problem of global food insecurity, marketing fortified food products in developing countries to target under-nutrition.
For example, European consumer-goods corporation Unilever produces food and beverages, among other products. Under “Sustainability” on the Unilever website, you can read about how the corporation’s “brands can play a role in tackling under-nutrition and many of [its] products already make an important contribution to the micronutrient intakes of hundreds of millions of people worldwide.” These products include fortified margarines, instant porridges, powdered drinks and snacks, and instant hot school meals. American food processing company H.J. Heinz is also investing in micronutrients in the name of sustainability. According to its website, Heinz has been a pioneer in supporting the development of micronutrient powders, provided in convenient, “single-serve sachets.”
While such products do indeed address nutrient deficiencies, according to Nestle, “these efforts are about products, not food.” And in the words of Dr. Alfred Sommer, dean emeritus of the Johns Hopkins Bloomberg School of Public Health, “Nutrition can only be sustainable if people ultimately pay for it. Nutrition could stop being a program when governments change priorities.” So, while fortified foods are important suppliers of emergency nutrients, they come at a price. Rather than addressing root causes of food insecurity, fortified foods are marketable products that must be purchased. People suffering from food insecurity will have to rely on government programs or charitable donations to access fortified foods, instead of benefitting from sustainable solutions to undernourishment.
In a 2010 article in the American Journal of Public Health entitled, “Can the Food Industry Help Tackle the Growing Global Burden of Undernutrition?” Derek Yach et al argue that, yes, food and beverage corporations are ideally positioned to address under-nutrition. According to the authors, corporate business expertise, distribution capacity, and product development capabilities are all vital components of successfully combating problems of food insecurity. (It is, perhaps, important to note that Yach, a former WHO health official, is now a senior vice president at PepsiCo.) True, corporations have resources and expertise that could have a huge impact on food insecurity, but would they be able to use this expertise to address the root causes?
In his 2010 Wall St. Journal article, “The Case Against Corporate Social Responsibility,” business professor Aneel Kanmani corroborates Nestle’s argument: “The fact is that while companies sometimes can do well by doing good, more often they can’t. Because in most cases, doing what’s best for society means sacrificing profits.” In our economic system, a corporation’s end goal is always to make a profit, and profit comes from products. And products, no matter how healthy, can never address the inequality that is the root cause of food insecurity.”The goal of the company is to make a profit. It’s really that simple,” Nestle said in her presentation. And, as she argued with co-author David Ludwig in a 2008 Lancet article, “In a Western-style capitalistic economy, food corporations, like all corporations, must make the financial return to stockholders their first priority. Wall Street places corporations under great pressure not only to be profitable, but also to meet quarterly growth targets… Far greater profits come from highly processed, commodity-derived products.” Nestle sees an irreconcilable conflict between highly processed products and public health, even if these products contain essential nutrients. Image Credits:
CHW: Your previous book, The Corporation, focused on the behavior of corporations more generally. What inspired you to look specifically at corporate targeting of children in Childhood Under Siege?
JB: In The Corporation, I saw that the way that corporations targeted children was a really important topic, but I was only able to look at it as part of this larger project. As I was out on the road with both the book and the film, this seemed to be an issue that people were really concerned about. I’m also a father of two teenagers who were then around six or seven, so I was starting to see some of the effects of the corporate world on their lives and on my life as a parent. So that all came together and got me back into the writing chair to write this book.
CHW: In your new book, you write about the “new curriculum of childhood.” What do you mean by this?
JB: I found the term the “new curriculum of childhood” in another source, and it really hit me at the time. I had just finished reading a study by the Kaiser Family Foundation, which showed that children spend, on average, 8-10 hours a day engaged with commercial media. That is twice the amount of time they spend in school, and so it really seemed a propos to call this the “new curriculum of childhood.” What kids are learning from commercial media is the dominant influence in terms of their intellectual formation and their value formation. Increasingly, family influence and the influence of teachers have really subsided in relation to the influence of corporate marketers, advertisers and companies that are producing products. To me that is a quite radical shift.
CHW: You write that parents can be powerless to protect children from this harmful corporate influence. Why is this case?
JB: I think parents are the first line of defense for children, but the issues have become much larger than what parents can handle. As a society we can create conditions that are either hostile or facilitative of parents being able to do their job of protecting kids’ interests, and currently we’re creating conditions that are disempowering parents. I did an interview with a children’s environmental health expert, Dr. Bruce Lanphear, about the effect of industrial chemicals on children’s developing biological systems. I said, “How do you deal with this as a father?” and he said, “I can’t.” Parents shouldn’t be expected to be chemists. They simply don’t have the knowledge or the ability, and this is something that government regulators can and should do but are not dealing with.
Look at marketing targeted to children. When I was young, all my mother and father had to worry about was a television set in the living room and three channels. Now kids are out in the world with mobile devices, interacting with media. So how do parents control their children’s use of media in this context? How do you do it when your kids’ very social life depends on their being on Facebook, which is a marketing platform?
I look at pharmaceuticals as well. I tell the story of the tragic suicide of a girl while she was on Zoloft. The doctors and her parents thought Zoloft was a good drug. It turned out the company that produces it, Pfizer, had actually done studies that showed that when kids or teens took that antidepressant, the risk of suicide increased substantially. How is a parent supposed to protect his or her child without access to information that the company has failed to disclose, but that has crucial relevance for making decisions about their child? The problem is too big and the information too inaccessible. Parents don’t have 24 hours a day to become researchers in all of these areas. What we need to do as a society is deal with these issues in a way that makes it possible for parents to make good decisions that protect their children.
CHW: What are some of the implications of these corporate actions for public health?
JB: One of the public health issues I describe in the book is marketing. The American Psychological Association has just come out with a report that summarizes a review of a year’s literature on the effects of sexualized media on girls, and finds that there are links to low self-esteem, eating disorders and inappropriate sexual behavior. All of these things as companies are targeting younger and younger girls with more and more sexualized material. That’s a public health issue.
It’s a public health issue that many kids are becoming compulsive game players and social network participants. Currently, gaming and social network addiction are not recognized as true addictions, but I think any parent can tell you that their kids’ use of this media sometimes reaches unhealthy levels of compulsion, taking them away from interactions with family, from their school work and from sports. In the book, I look very closely at how game designers specifically rely upon behaviorists and psychological research to try to create games that are addicting.
Another issue I deal with is children’s unique vulnerability to environmental toxins. You have research showing that even very small quantities of industrial chemicals can have profound effects on developing biological systems. Industry continues to lobby for the most minimal constraints on production, distribution and emission of these chemical toxins, to the point where right now there are 90,000 industrial chemicals in the environment, and only 200 of those have been sufficiently tested for health effects. We’ve been taking this approach that chemicals are effectively innocent until proven guilty, and as a result, we’re creating an environment that is likely very toxic for children. One of the people I interviewed, an expert on children’s environmental health, Dr. Leo Trasande, said, “We are the humans in a dangerous and unnatural experiment, and it’s unconscionable.”
CHW: How have corporations responded to your criticisms?
JB: People who work in corporations really wear two hats. Yes, they make decisions that lead to actions that cause harm, but at the same time they’re human beings. They’re parents too. They live in this world too, and they’re as concerned as any other audience. I think I have, with this book, hit a nerve, because if you’re a parent there’s really nothing you care about more than your kids’ health and wellbeing. But there is a powerful feeling of disempowerment among parents today. What I suggest in the book is we have to perform our responsibilities as parents and do the best we can to protect our kids from all of this, but we also have a responsibility as citizens to try to change the conditions in which we’re parenting, to try to create a better society from the perspective of our kids.
CHW: One of the five ways corporations harm kids that you detail in your book is through pharmaceuticals. This is also one of the issues we examine at CHW. Can you give an example of how the pharmaceutical industry harms children?
JB: Over the last 30 years, pharmaceutical companies have ramped up their efforts to get kids on psychotropic drugs. In 1980, it was almost unheard of for a child to be diagnosed with a mental disorder and prescribed drugs to treat it. Now it’s as common as giving out antibiotics for strep throat. What has happened over the last 30 years? Have kids become so much more mentally ill? Is it a result of us becoming better at diagnosing mental illness? Or is there a third factor — pharmaceutical companies’ relentless marketing campaigns to doctors, to parents and children to sell the idea that certain behavioral difficulties are, in fact, psychiatric disorders that require treatment with drugs. The pharmaceutical industry has also managed, through various legal changes that took place in the early 1980s, to effectively take over medical research. The process of conducting clinical trials and publishing studies is much more driven now by corporate money than it ever was. This creates a systemic bias in favor of drug treatments that, I argue in the book, is likely leading to more kids being put on more psychotropic drugs for more disorders than is scientifically justified.
CHW: In your opinion, why is there not more governmental regulation of these issues?
JB: We’re currently going through a period where the notion of governments playing an active role in protecting public interest and promoting public good has been thoroughly undermined, and where the notion that markets and corporations should be free of any government restrictions seems to be in play. What I’m saying in this book is that as governments have pulled out of the task of trying to protect children, whether from chemical toxins or from mental toxins in the marketing context, or from undue prescriptions of psychotropic drugs, we’ve seen mounting harms to children.
CHW: Is government regulation the best solution?Are there other solutions?
JB: Government is definitely not sufficient. You can’t run childhood simply through government regulation. But, while it’s not sufficient, I do believe it’s necessary, because I don’t believe parents have the ability to protect their children from many of the harms that I outline. We need governments to step in and actually stop industry from throwing certain kinds of harms at our kids. In a democracy, that’s how it’s supposed to work. Governments are supposed to represent the people and defend the people’s interests, and somehow we’ve gone all askew on that. The main people whose interests are being protected in our current order are corporate persons. The rest of us have been told that it’s no longer the job of government to protect us.
CHW: What have you found in your research that gives you hope that corporations’ effect on children can be reversed? What can health advocates do to help?
JB: In all the areas I look at, there are real champions at all levels of government, in various non-governmental organizations and in parents’ groups. The problem, at the moment, is really a political problem. It’s that somehow the political will isn’t strong enough to address these issues in the way that they need to be addressed. There are lots of reasons for that, not the least of which that the industries involved have both feet in the door of the political process. Democracy is messy, difficult, complicated, and the only way we’re going to turn these things around is if we as citizens become active and do what we can in relation to these issues.
Want to learn more about who-knows-who at the heights of business and government? For those interested in knowing where a certain politician is getting his or her funding, finding out what individuals sit on which corporate boards, or learning more about the networks that connect the most powerful people in the world, the website LittleSis is a helpful tool. The site is a self-proclaimed, “‘involuntary Facebook’ of powerful people and organizations,” aiming to bring “transparency to networks of influence, tracking the key relationships between politicians, corporate executives, lobbyists, financiers, and their affiliated organizations.”
LittleSis, the name a play on “Big Brother,” was developed by the Public Accountability Initiative(PAI), founded in 2008 by Kevin Conner and Matthew Skomarovsky. According to its website, PAI is a “nonprofit, non-partisan research and educational organization focused on corporate and government accountability,” whose mission is “to facilitate and produce investigative research that empowers citizens to hold their leaders accountable.” To further its mission, PAI set up LittleSis so that citizens can better understand the relationships and financial actions of powerful people and their networks. LittleSis is a free database of who knows who in the top positions of business and government.LittleSis supports the work of journalists, watchdogs and grassroots activists by documenting where individuals in positions of power work, who they know, and who they donate to. This information is already publicly available, but the goal of LittleSis is to bring it all together in one place so that it can be a useful tool for revealing the social networks that have the greatest influence over U.S. public policy. In addition to being a searchable database, LittleSis also has a blog, called Eyes on the Ties, that helps readers keep up with the shifting networks in the database.
To explore how LittleSis can be used, I decided to see what I could find out about James Skinner, the CEO of the McDonald’s Corporation. Here’s what I learned:
James A. Skinner, who has been CEO of McDonald’s since 2004, is also on the Board of Directors of two other corporations, Illinois Toolworks and the Walgreens drug store chain. He has contributed money to the Illinois Republican Party, John McCain, the Republican National Committee, Mitt Romney, the National Republican Congressional Committee, and McDonalds Corporation Political Action Committee, among others. Skinner is also on the Board of Catalyst, a leading nonprofit membership organization that defines its mission as expanding opportunities for women and business.
Skinner sits on boards of other organizations with 229 other people, including:
Judith Dimon, the wife of JPMorgan Chase CEO Jamie Dimon;
William F. Aldinger III, who is President, Chief Executive Officer and Director of Capmark Financial Group Inc., a commercial real estate finance company, and also serves on the boards of AT&T Inc., KKR Financial Corp. and The Charles Schwab Corporation;
William M. Goodyear, Past Chairman and Chief Executive Officer of Bank of America,
Barbara Paul Robinson, a partner at Debevoise & Plimpton LLP;
Enrique Hernandez Jr, President & CEO of Inter-Con Security Systems and a director at Wells Fargo.
Following a link to McDonald’s Corporation, we learn that McDonald’s has hired Michael Tiner as a lobbyist, paying him $390,000 between 1999 and 2008. Tiner has also served as lobbyist for the agribusiness company Amgen. We learn that James Simons, a former mathematician whose quantitative hedge fund returned 73 percent net of fees – as high as 5 percent of assets and 40 percent of profits – in 2007, owns 8,165,300 shares of McDonalds. These random factbits illustrate the world in which McDonald’s operates and show its multiple connections to the financial sector, responsible for many of the nation’s current economic woes.
Anyone can contribute to the LittleSis database by signing up on the website. Users can add to the database, fill in gaps, and correct errors. In addition to the online community of researchers, LittleSis gets its information from government filings, news articles and other sources. Because the database is so participant-driven, there is no guarantee that all of the information will be completely accurate all of the time.
“LittleSis is an experiment – an ambitious one – in the world of crowd-sourcing of transparency and accountability efforts,” says Ellen Miller, co-founder and executive director of the Sunlight Foundation, one of the original funders of LittleSis. “It empowers us all to be our own best watchdogs and collectively develop an unprecedented, authoritative database of information on the powers that be.”
An Interview with Anna Lappé, Author of Diet for a Hot Planet.
Anna Lappé is a food writer and activist whose most recent book Diet for a Hot Planetexamines the role of our food system in human-induced climate change. A few weeks ago, Corporations and Health Watch writer Monica Gagnon interviewed Lappé about her book and her work. An edited version follows.
CHW: What drew you to researching and writing this book about the food and climate connection?
AL: I’ve been thinking about food and food systems for many years, and I was drawn to write this book because I have become aware of the impact of our global food system on our lives.
For instance, agriculture uses 70% of all fresh water on the planet and it is the single largest land user – about 40% of all land is either in ranching or farming. Agriculture is also the driving force behind the more than 400 dead zones in oceans around the world – places that become so polluted every year, mainly from agricultural runoff, that the aquatic life at the ocean floor is killed off by lack of oxygen.I was also starting to hear concern that our food yields would be affected by climate change. But what I wasn’t hearing was how agriculture is not just a victim but also a perpetrator of climate change: Our food system indirectly and directly is responsible for about one third of all greenhouse gas emissions. These facts were largely missing from the public conversation. So the book is my exploration of why it is that we haven’t heard more about the food system’s role in contributing to this crisis and how can our food system actually be transformed to become part of the solution to the climate crisis.
CHW: How is the climate crisis affecting public health?
AL: We typically don’t think about climate change as a public health problem, and yet we should. We know for instance that there are an increasing number of deaths around the world every year that can be tied, indirectly and directly, to the climate crisis, whether because of more extreme weather, more flooding, more drought, or the impact of climate change on food supply.
Farmers certainly are seeing that as our climate and weather patterns change, pests spread into regions where they were not as abundant, or were never found, before. As climates warm, more pests are able to survive through the winter and we’re seeing more pest pressures on farms.
CHW: What is the general response of food corporations to climate concerns?
AL: One of the things I found most interesting was exploring the corporate response to this crisis. I found a lot of parallels with the response from Big Oil and other industries that historically have been at the center of the crisis. I ultimately found myself frustrated that the responses weren’t more substantive. What we are seeing is that a lot of food companies are pushing to be their own police, not to have government regulation of the industry. For instance, in this country the livestock industry has been very successful in allowing producers who are raising livestock in concentrated animal feeding operations or CAFOs not to be regulated the way a factory would be around air emissions.
If we look at what companies are doing to reduce their carbon footprint, many aren’t taking the significant steps that they should. Instead, companies exaggerate how much they have transformed the bottom line, exaggerate how much of a difference they’re making, and underplay the real impact that they have.
In the book, I give the example of Tyson, one of the largest poultry producers in the country. In a recent sustainability report, Tyson devotes a whole section to boasting about how the company is providing resources for biodiversity conservation. They point to a 35-acre conservation area in Tennessee where Tyson protected ten bluebird nests. 35 acres? Ten bluebird nests? Counter that with the fact that Tyson, as a company, has had an enormous negative impact on biodiversity, whether it’s from the genetic uniformity of the birds raised in its factories, or the fact that the company has been found responsible for pollution from its poultry operations, paying millions of dollars in damages in various states. That’s just one example of what I saw throughout the food industry: exaggerating their environmental strides to deflect public outrage that would otherwise lead to stricter government regulation.
CHW: Do you think it’s accurate to say that, rather than denying there’s a problem, the industry is positioning itself as part of the solution?
AL: When we talk about the food industry we have to recognize it’s multi-faceted. Not every sector of the food industry has the same self-interest when it comes to addressing its environmental impact. For when we say “food industry,” we really mean the entire food chain: agribusiness companies that produce commodities, the building blocks of processed foods that end up in our supermarkets; livestock producers, say Tyson that’s involved with the poultry factory farming; companies like Coca Cola or PepsiCo; and food retailers, including one of the fastest growing food in this country: Walmart.
These players don’t always have the same self-interest and use different strategies of denying or acknowledging their impact on climate. For instance, initially, the American Meat Institute, a trade association, did not publicly address climate change concerns at all; there was a policy of silence. After I released my book, I noticed AMI released a statement on meat and climate change, denying that there was a significant connection and trying to minimize the impact of industrial meat production on the climate and the environment. In other words, AMI shifted from a strategy of silence to a strategy of denial. Others have taken a strategy of, “Hey if we’re part of the problem that means we can get compensated for being part of the solution, even if our solutions are on paper only.”
CHW: How does corporate advertising exacerbate the problem?
AL: Like other sectors,the food sector has used “green advertising”. I give an example in the book of going to an advertising industry conference sponsored by Advertising Age that had signs posted around the conference center with different taglines, and one I thought was very telling was “Low-carbon is the new fat-free.” Companies are getting it that more and more people are concerned about climate change and trying to spin their message in a way that resonates.
At this conference, Mary Dillon, an executive at McDonalds, described how the company is presenting this image of social responsibility. She gave the example of a recent Happy Meal initiative in Europe whose theme was protecting endangered species. Customers could collect each of five endangered species. The concept was that kids would buy not one but five Happy Meals in order to collect all these endangered species, and then would go online to take eco-actions on the McDonalds website. Of course. of the ways you could reduced your environmental footprint, I’m sure none said, “Please do not buy heavily processed food at McDonalds that is helping to contribute to environmental crises around the world.” That they would claim that somehow by purchasing this Happy Meal they you’re helping protect endangered species was beyond ironic.
And just two years earlier McDonalds had a very different Happy Meal campaign in the United States when they partnered with General Motors to sell Hummer-themed happy meals. They ended up selling 42 million of these Hummer-themed meals, each one with a different style and color. I suppose two years later McDonalds decided that it would be better for the public image not to align itself with the Hummer, a vehicle that had become the symbol of consumer excess and environmental destruction, and instead align itself with this image of protecting the environment.
CHW: What do you think is the corporate social responsibility to climate change, and do you think it’s ever going to happen?
AL: There’s a school of thought that says that companies’ entire “social responsibility” is to make profit – to return the highest return to shareholders. I adhere to a different school of thought, one that believes all corporations have an inherent responsibility to community and the environment. What, after all, does every company need to make profit? Use, and often abuse, our common resources. These shared commons no one company owns; no one company should be able to either use free of charge or abuse without remediating or paying for the damage. In order to run factory farms, for instance, Tyson pollutes the water, land, and air where its factories are located, whether it’s through leaching from waste cesspits or through noxious emissions from its operations.
”Social responsibility” is not adding an extra burden onto the shoulders of companies and asking them to do us all a favor by being more socially or environmentally responsible. It’s simply asking companies to operate in line with our collective values, including the belief that polluters should pay for polluting, that companies should give back to communities for those resources they use.
To me, the social-environmental responsibility question is just common sense; it’s expecting companies to simply do the bare minimum of what they should be doing.
CHW: How can consumers tell the difference between true corporate social responsibility and marketing ploys?
AL: Unfortunately, because we don’t have terribly strict regulations about claims that companies can and can’t make, it’s sometimes hard to know when you’re hearing the real deal. In the book I give examples of some green claims food companies are making and how to make sense of them. One of the resources I find very helpful is the Consumers Union program that evaluates green claims. It’s called greenerchoices.org and it helps you parse out, among all these claims, which are the ones you can trust.
If you are looking to reduce the carbon footprint of the food you eat, finding food that’s grown locally can be a choice that’s good for the climate. Also look for the USDA organic seal. Organic agriculture practices tend to reduce on-farm emissions, in some cases by as much as half. Organic production practices also for the most part don’t use synthetic chemicals.
So those are some of the things you can do, but since we live in a regulatory context where it’s easy for companies to greenwash their story and hard for consumers to detect misleading claims, a healthy dose of skepticism is always good.
CHW: What else can health advocates do to help change destructive corporate behavior?
AL: One of the things that health advocates can do is find ways to make their voices heard by coming together. A positive example of that kind of action has been the recent work by Corporate Accountability International and health advocates in every single state calling on McDonalds to discontinue the use of its Ronald McDonald character to lure children to their stores to consume foods that we know are highly problematic for public health.
CHW: What is the role of the EPA in providing information about food’s effect on climate change?
AL: In the book, I talk about how the meat industry quotes the EPA on food agriculture-related emissions to defend its claims that the food system isn’t a really big player in the crisis. It’s not that the data on this subject from the EPA is wrong, it’s that the data doesn’t describe the full spectrum of the food chain and the food system, so it doesn’t account for all the emissions associated with the food that we eat in this country. Food trade associations have taken those government statistics and misrepresented them as telling the full story of food to downplay the food-related emissions in the United States. In the book, for instance, I quote the National Cattlemen’s Beef Association using that EPA data to say that its producers are not really impacting the environment here and that environmentalists are exaggerating the impact.
CHW: What gives you hope that these unhealthy climate trends can be reversed?
AL: What gives me most hope is that there’s so much evidence now that sustainable or organic farming techniques, ways of growing food without relying on toxic chemicals or synthetic fertilizer or intensive animal operations, can produce high yields in some of the countries that are most hard hit by hunger. These production practices can also be relatively inexpensive to implement – they just require knowledge and training, not seeds, chemicals, or fertilizer. And these farming practices are showing that, on the farms that are implementing these practices, there’s higher carbon content in the soil. In other words we’re able to sequester carbon out of the atmosphere and into our farm soils if we implement these sustainable techniques. We’re finding that these farming practices greatly reduce on-farm energy use and overall on-farm emissions. And so we have this incredible potential for farming to help us mitigate the crisis, help us really reduce emissions in food production.
The other thing that gives me hope is we’re finding that these farming practices create more resilient farms that can handle droughts and floods better. I visited one organic farm in Wisconsin the summer the region was hit by floods that had devastated the many farmers there. But at New Forest Farms, the farmer Mark Shepard had lost only four percent of his crops; the rest were thriving because his soil was so healthy it acted as a sponge able to absorb the water. The biodiversity on his farm was a boon too: trees and shrubs lessened the impact of the pounding rain on the crops below. .
As I stood on his land, having just heard about the devastation of so many of the region’s farmers, I thought: “If more farms could look like this we would be in a much better place to feed the world in a climate unstable future.”
CHW: How can environment and health advocates work together on this issue? Are you seeing any of this happen in your travels and your research?
AL: We’re starting to see people make these connections. Environmental and health advocates are beginning to see themselves as being in the same boat, not working across purposes. They’re also really seeing how their other big allies are farmers. The source of public health is good food, clean water, and clean air. Farms run well, farms run sustainably, can help to preserve pristine groundwater. Whereas farms run as industrial operations where synthetic fertilizer is overused and leaches into the groundwater, industrial animal operations that end up housing massive manure cesspits that have very little protection to ensure that it doesn’t affect the groundwater. So farmers need to be brought into the conversation. As stewards of the land, sustainable farmers are at the forefront of helping us adapt to climate change, mitigate emissions, and bringing us the healthy food that is the cornerstone of public health.
Roberto Abadie is an anthropologist who has studied the experiences of people who get paid by pharmaceutical companies to take drugs in clinical trials. For the past two years, he has been a visiting scholar at the public health program at the Graduate Center of the City University of New York. His book, The Professional Guinea Pig: Big Pharma and the Risky World of Human Subjects, was published by Duke University Press last year. Monica Gagnon interviewed Abadie by email for CHW. An edited transcript follows.
CHW: What inspired you to launch an investigation into the ethics of clinical trials?
RA: In 2001, Ellen Roche, an employee at Johns Hopkins University, volunteered in a clinical trial for asthma. She suffered an adverse event (as adverse drug reactions are usually referred to) fell into a coma, and died at a local hospital a month later. She had received a few hundred dollars for her participation in the trial that resulted in her death. I realized then that while bioethicists have been debating the ethics of paying volunteers participating in the first phase of clinical trials where drug safety is assessed, no empirical studies documenting the volunteers’ experiences and motivations to volunteer had been conducted. I was especially concerned about those volunteers who earn a living by selling their bodies to test drug safety. Some professional guinea pigs (as they refer to themselves) I met have done 80 or more trials in the course of a few years. I wanted to know how much they knew about the risks they face as trial subjects but also how the prospect of monetary compensation affects their perception and disposition to volunteer.
CHW: What challenges did you face during your research into Big Pharma? Did they attempt to shield their practices (or their human trial subjects) from you?
RA: Big Pharma is not a very open industry and they try very hard to shield information about their practices. Of course, they won’t say they don’t want the public to know. Their argument is that everything related to the drug production process is proprietary information. By being secretive they are protecting their products and their shareholders. It was very hard for me to gain access to the industry side. I wanted to ask them questions about how they deal with the issue of risk during the first phase of clinical trials and what they do to ensure that research subjects are adequately protected. Unfortunately, I didn’t manage to reach them. One of the public sources of information about Big Pharma’s practices regarding Phase I trials, or any aspect of drug development for that matter, are the lawsuits that are brought against them. For example, the Vioxx case went to court and its records provided a great deal of information about how the industry thinks about risks, public health and profits. Unfortunately, few cases go to court; most are settled out of court, leaving valuable information hidden from the public view. Professional healthy research subjects I met with feared retaliation from the industry if exposed, but anonymity protected them well.
CHW: How do the participants in the trials you studied now think about the pharmaceutical industry?
RA: I studied a very particular subgroup of the ample universe of subjects that earn a living as professional guinea pigs in America. I focused on a group of white, male anarchists living in Philadelphia, a hotbed of clinical trials activity. While all professional research subjects share similar interests (make money from participating in the trials) and experiences of dehumanization and alienation, this group of anarchist guinea pigs has particular strong views against Big Pharma and also, not surprisingly, about the role of the government and the FDA (the agency in charge of overseeing the drug production process). These volunteers feel that the industry lies, not only because they enroll volunteers when they know they don’t meet all their admission criteria, but more importantly, they lie to the consumers by producing drugs that are not safe and effective, as the industry claims.
But despite their hostility towards the industry, they feel the trials they participate in are in general only moderately risky. First, they reason, they are scientific, controlled experiments where there is a lot of oversight. Second, adverse events are very rare in their experience and most of them had not experienced them. And finally, they believe that ethical regulations and the fear of lawsuits are enough to deter the industry from bad practices.
CHW: How are the health risks of clinical trials underplayed by Big Pharma?
RA: I think that the most important risk overlooked by the industry is the risk derived from the fact that trials depend on a group of professional guinea pigs, paid to test drug safety. These subjects consider their trial participation to be their job, a particular kind of trade where boredom, pain and dehumanization are exchanged for money. They do seven or eight trials a year, deriving a total estimated income of $20,000 in a good year. The problem is that the industry does not have a registry that tracks trial participation and might not be aware of the extent of the professionalization.
My concern is that continuous participation in the trial economy might expose trial subjects to unknown or unforeseen risks, some of which might show up 20, 30 or even more years later. The industry is under a lot of pressure to recruit and retain trial subjects and has no incentive to create a registry or implement any measure that would limit their ability to recruit trial subjects for the first phase of clinical trials.
CHW: What are the economic forces that drive pharmaceutical companies to use risky test strategies?
RA: In particular, considering Phase I clinical trials where drugs are assessed for toxicity and not therapeutic benefit, Big Pharma depends on a group of professional subjects to run the trials smoothly. Until the 1970s, drugs were first tested on prisoners. Willing, compliant and readily available, they represented the perfect captive research subject. But ethical concerns brought the practice to a halt. The industry had to find a replacement population for an increasing number of trials and started paying prospective subjects. Some started volunteering and become dependent on the income and habituated to the trial routines.
Market recruitment of trial subjects created a new economic category: the professional guinea pig. It works well for poor, vulnerable research subjects because it provides a flexible schedule with reasonable pay, and it is great for the industry because it offers a steady supply of bodies to test drug safety quickly and effectively. The underside is that this professionalization might expose these workers to occupational risks, something that other workers in mining or agriculture have also experienced and where risks are better documented.
CHW: To what extent has the FDA addressed these problems? What has limited their effectiveness as a regulator of testing practices?
RA: The FDA only audits one percent of Phase I trials in America. And it is a paper trail kind of process, looking for protocol inconsistencies and especially missing cases where subjects unexpectedly are dropped from the research protocol. Of course they also pay attention to the reporting of adverse events. But this monitoring has severe limitations. First, they review a very small number of trials. Second, they never do on site inspections, going to the trial sites, looking at the working conditions, talking to research subjects, etc. Part of the explanation for this lack of enforcement is that the FDA does not have enough resources and manpower to do this kind of job.
But the main cause is that the FDA increasingly, since the 1980s, has taken the view that what is good for the pharmaceutical industry is good for the public and that speeding the drug development process would be a good thing because first, it would bring valuable drugs to consumers, but also would help American companies compete better in a global pharmaceutical landscape.
CHW: What is the crux of the relationship between risk and monetary compensation? Do you find that volunteers typically fully understand the risks of participating in these clinical trials?
RA: The research subjects I studied are well informed about risks but this does not mean that they make good decisions about whether they should enter a trial or not. For example, they know that psychotropic drug trials are risky and they try not to volunteer for them. But this is one of the fastest growing sectors in drug development and a big producer of blockbuster drugs for the industry. Big Pharma needs to test the safety of these drugs, and knows that subjects are reluctant to mess up their mind, as they have told me, taking them. What would the industry do then? Simple, they just offer the highest pay, from $5,000 to $10,000 for a few weeks as a trial subject. Most subjects I interviewed admitted that they thought these trials presented a high risk but were tempted by the money and had done at least one.
CHW: Do professional guinea pigs often rely on money from test trials as their primary income? If so, why is this particularly problematic?
RA: They do. For most of them, trials are their main, and in many cases only, source of income. They can earn around $20,000 a year and sometimes even more. I find this practice extremely problematic because Big Pharma uses money strategically to recruit and retain research subjects who otherwise would have no interest in participating in the trial economy. Research subjects are vulnerable because they depend on the income generated from the trial and that leads them to accept poor working conditions or risks they would not accept otherwise. Of course, the industry knows this and that’s why they use money to lure people and to keep them participating.
CHW: In what ways are the rights of human test subjects protected (or not)?
RA: Ethical regulations regarding the participation of human subjects in research have evolved a great deal since the horrors of the WWII. We have now a number of regulations that protect subjects like the requirement of informed consent before a subject enrolls in a trial. And civil law also affords protections against any wrongdoing or harm that occurs during the trial. Still, the consent form requirement is seen by professional guinea pigs as a formality, a paper to be signed among others in order to enter the trial. In most cases they make their decision about entering a trial before they get to sign the consent form. And legal recourse is expensive and might be out of reach for most subjects, unless they die or experience devastating adverse events, in which case the prospects of financial gain can lead skilled lawyers to volunteer in the case
CHW: Have you come across any particularly unique stories of people who have had negative (or positive) health effects from these trials? Please describe.
RA: There are no positive health effects from healthy research subjects testing drug safety in the first phase of drug development. These tests are designed to assess the toxicity of a drug, not its efficacy and thus no health benefits are expected. Negative health effects or adverse events are rare. While most of the subjects I encountered had experienced some discomfort, fainting, nausea or other symptoms, they had not faced serious adverse events. In 2006, a trial sponsored by Parexel in England left research subjects with very serious injuries and opened a public debate about the professionalization of Phase I trial research in Europe and the need to create a centralized registry to track participants involvement in this trial economy.
CHW: How do you suggest that Big Pharma change its practices and policies regarding human subjects?
RA: Since there is no centralized record tracking the participation of research subjects in Phase I trials in America, nobody knows for example if a subject is doing two trials at the same time, or if a subject is not complying with the mandatory 30-day wash-out period in between trials. As I mentioned in the previous question, such a registry was recently implemented in Europe when it was found that trial subjects in drug safety trials were trial hopping, doing for example a trial in Ireland, then another one in England, one immediately after in Germany and a subsequent one in France. A centralized registry would prevent this from happening in the US as well. Such control would slow the recruitment rate of research subjects, delaying the completion of Phase I trials, and that’s why Big Pharma has been opposed to its implementation.
CHW: What are the broader public health implications of this practice of the pharmaceutical industry, and what can be done about it?
RA: The lack of a centralized registry tracking the participation of professional research subjects in Phase I trials endangers the research subjects because it exposes them to dangerous drug interactions. But it also challenges the validity of the trial itself because its findings become compromised if researchers cannot tell with certainty that their results are not contaminated by a different drug that is being surreptitiously taken by the research subject, enrolled simultaneously in two different trials. This is a very serious development because it compromises the quality and efficacy of drugs millions of people depend on for their health care.
The lack of a centralized registry, but also of adequate FDA control regarding the first phase of clinical trials speeds up drug production and contributes to making Big Pharma one of the most profitable industries in America. But increasingly we find new evidence that the pharmaceutical industry’s continuous search for profits and public health interests are not on the same page. We need to step up the oversight on this industry, from government, of course, but also from citizens and consumer groups. In particular, journalistic exposes have contributed to documenting outrageous cases of abuse and exploitation of research subjects in Phase I trials, like the case of undocumented Latino immigrants being recruited in a facility in Florida a few years ago, or poor, African-American homeless men with alcohol and drug related issues recruited at a site in the Midwest. Such cases, when exposed through the press, generate a public relations nightmare for these companies. When they are touched in their pocket books, these companies have shown they can do the right thing.
Michael Schwalbe is author of the recently published book Smoke Damage: Voices from the Front Lines of America’s Tobacco Wars (Madison, WI: Borderland Books, 2011). He is a professor in the Department of Sociology and Anthropology at North Carolina State University in Raleigh. Recently, Corporation and Health Watch editor Monica Gagnon interviewed Schwalbe about his new book. An edited version of the transcript is presented here.
CHW: Why did you want to write a book about the people affected by the tobacco industry?
MS: The initial impetus was watching my mother care for my father as he was dying of lung cancer caused by smoking. The experiences of caregivers under those conditions are not well documented.
We know a lot about how many people die, but we don’t know a lot about how the dying and the decline affect people around them. Watching what my mother went through for a year and a half—between the first diagnosis, treatments, and my father’s death—made me think that this was something that really needed to be documented.
CHW: How did you end up expanding from tobacco widows to all of the faces we see in your book now?
MS: As I thought more about it, it occurred to me that there are many categories of people in our society whose lives are changed in dramatic ways because of the health damage caused by tobacco use. I thought the book would be more compelling if I could document a wider range of the experiences related to tobacco-related disease.
CHW: Your book has a lot of images and seems like it’s really about giving the tobacco industry’s victims a human face. What did you hope to accomplish by that?
MS: I wanted to make the magnitude of the problem have more emotional weight. We can look at the statistics and say that 443,000 die every year [in the United States] of tobacco-related disease. We can say that 3.6 million suffer from some kind of chronic disease related to tobacco use. But those figures are overwhelming, so it’s hard to feel what they mean. If people don’t feel what those figures mean, as well as grasp them intellectually, I don’t think it motivates much action. That’s why I did the photographs and the interviews—to try to put the experience in people’s own words. In the book there’s a brief descriptive paragraph about each person and then a 500-word excerpt from the interview in which the person talks about his or her experience as related to tobacco and tobacco-related disease.
CHW: What was it like taking photographs of these people—meeting them and hearing their stories?
MS: Some of the stories were familiar to me from my own family, but I learned a lot about how people experience the problem in different ways, especially struggling with addiction. Some of the people I interviewed were still struggling to quit smoking. Talking to the litigators was new for me. I found it interesting to get their perspective on the industry and on efforts to use the courts to bring the industry to heel. Legislators were a new group too, and it was interesting to get their perspective on what they hoped to accomplish. It took me ten months to find three ex-tobacco farmers. These are people who the industry portrays as absolutely dependent on tobacco to make a living. Certainly there’s an economic dependency on the part of some farmers, but the ones I interviewed had decided that they didn’t want to be in it anymore, [not just] for market reasons [but also] for moral reasons. And they were doing fine as farmers. So this idea that farmers can’t get out of the industry is simply not true. I had never talked to farmers in that situation before, so that was new to me. In general, people in every category were cooperative and helpful.
CHW: How did you feel the experience was for them, to talk about their interaction with tobacco in this context?
MS: Part of what makes the material in the book powerful is that people spoke honestly about some very difficult experiences in their lives. I think it comes through in the text.
CHW: Talk about the economic and political interests that keep tobacco so widely available to the public.
MS: Most people know that the tobacco corporations have a clear interest in profits and in continuing to profit from selling an addictive and disease-causing product. Many government units also have a stake in deriving revenues from tobacco taxes and the Master Settlement Agreement. So I don’t think we’re going to see the government move any time soon to put the tobacco corporations out of business. And of course there are a host of secondary industries dependent on tobacco—advertising, marketing, retailing. It’s an industry that has its tentacles spread deeply throughout our society, throughout our economy and into government, so it’s a difficult industry to combat.
The tobacco industry has its tentacles spread deeply throughout our society, throughout our economy and into government, so it’s a difficult industry to combat.
CHW: What concerns should readers have about workers in the tobacco industry?
MS: Certainly we want to look for solutions that aren’t going to deprive ordinary folks of their livelihood. On the other hand, we don’t want to hold that out as a reason for protecting industries that do more harm than good. This is what the tobacco industry has done for a long time. We see it clearly in North Carolina. I say we should weigh tobacco industry jobs against the economic costs of the 12,000 North Carolinians who die every year from tobacco-related disease. In this state, it doesn’t take long for tobacco to kill more people than it employs. We also pay about $2.5 billion a year in health care costs because of tobacco—again, that’s just in North Carolina. So, while we need to be concerned with how people can make a living, we also need to be concerned with how people can live. In the long run, this is an industry that has to go by the wayside.
In North Carolina, it doesn’t take very long for tobacco to kill more people than it employs.
CHW: How have the tobacco companies changed to adapt to the new environment they face?
MS: They’re amazing in their ability to adapt to new marketing restrictions. They can’t use terms like “light” and “mild” anymore to suggest that some cigarettes are safer than others, so they’ve started to color-code the packs to convey the same message. Now that more people can’t smoke in the workplace and in some public spaces, they’ve put money behind smokeless products that can be used anywhere. Tobacco products that can be used without giving off smoke are partly a way to keep people addicted. In fact, if you look at the advertising for some of these products, you’ll see that these aren’t offered as paths to quitting, but as alternatives to smoking if people can’t smoke in a particular situation.
In other parts of the world, tobacco industry marketing operates pretty much as it did in the U.S. thirty or forty years ago. In some parts of the world there’s also a considerable amount of illegal activity. In Africa in particular, cigarette giveaways and breaking up packs to sell one or two at a time are ways to get kids addicted. This is why comprehensive marketing bans are so important.
CHW: What do you think is the role of the tobacco industry in exacerbating health disparities?
MS: The industry is adept at targeted marketing. They know what kinds of messages appeal to which groups. Some of this developed over time; the classic example is probably the marketing of menthol cigarettes to African-Americans. Once that market began to take shape, it became something the industry could continue to exploit with its marketing imagery, selling Newports and Kools and other menthol cigarettes to African-Americans. What the industry cares about is selling its product, and it will find ways to sell product to different demographic groups based on the kinds of messages that are likely to be appealing to those groups. Marketing is a craft in that sense—a craft of figuring out how best to tap into the manufactured desires and insecurities of different groups of people and sell them a product that they’re led to believe will resolve their insecurities and satisfy their needs. In the larger sense, we’re seeing patterns develop today where it’s clear that the more education people have, the less likely they are to smoke; it’s almost a linear relationship. So we see much higher rates of smoking among high school dropouts and less-educated people in general. Rates are also higher among people in poverty. The industry takes advantage of the fact that these vulnerable populations exist. Marketing messages are tailored to these demographics, especially to young people, who are the industry’s main concern – “replacement smokers,” to use their language.
CHW: On the individual level, what can people do to influence this face of tobacco that you’ve portrayed in your book?
MS: When people ask this, I always tell them to look for a group to join so that they can benefit from other people’s experience and from the power of collective action. But whether you’re part of a group or speaking as an individual, there are certain kinds of policies that we know work and need to be lobbied for. This means bringing pressure to bear on legislators. I also tell people that a good way to pull resources away from the industry, if only in a small way, is to quit smoking. Every pack of cigarettes bought gives the industry money to continue to promote its products, and so it’s a small act of individual resistance to withdraw support from the industry, even at that level of not buying its products. Most CHW readers probably aren’t smokers, but still they can use these kinds of arguments to encourage others not just to quit smoking, but to quit giving the industry money to carry on its destructive behavior.
CHW: What about the role of the tobacco survivors in helping to mobilize people?
MS: I think it can be effective, but it’s a small effort in the face of a still-powerful industry. Education is important, and that’s one of the roles survivors can play. But policy is important too. We need policies and laws that restrict the industry’s behavior. That’s what’s crucial. So my hope is that when the survivors take their message out, they’re not just saying, “You shouldn’t smoke,” but rather, “Not only should you not smoke but you need to press your representatives for policies that will, in the long run, keep other people from becoming addicted.” We especially need policies that give people additional incentive to quit. Smoke-free air laws and higher taxes on tobacco products have this effect.
CHW: What about a grassroots movement against tobacco? Do you think that public interest on this issue has given way to newer issues or is there still a vibrant movement against the tobacco industry? If not, how would you suggest we re-mobilize the grassroots movement?
MS: The movement has taken different forms over the years. Originally there was a lot of mobilization around control of advertising and passing smoke-free air laws. We’ve still got a ways to go on the smoke-free air laws. About half the states do not have comprehensive indoor smoke-free air laws, so there’s clearly work to be done in those states—and people are doing it. There’s also been an institutionalization of the movement, which has meant less energy at the grassroots level and more professionalization. Most states have tobacco-control agencies and branches that work on the issue. And so yes, in places where smoke-free air laws have been won there has been a predictable easing-up of effort. Now it seems like, “OK we’ve won, we’ve got smoke-free air laws. We can relax.”
On the other hand, there are strengths to institutionalization. Thousands of people have full-time professional careers in tobacco control, and they’re tremendously knowledgeable. They understand tobacco industry strategies and how to counter those strategies, and that’s a good thing. The institutionalization of the movement is a two-edged sword. Yes, some of the grassroots energy has been dissipated, but at the same time we’ve developed a stable base of expertise and personnel. In general, grassroots groups working with tobacco-control professionals have been extremely effective in promoting smoke-free air laws and other practices that have helped reduce tobacco-related disease.
Another problem is that movement organizations can get caught up in the issue of the day, so I think lately there’s been some displacement of public health energy from tobacco to obesity, for instance. Obesity is a serious problem, of course, and needs citizen energy as much as tobacco. But I think people have to remember that the tobacco problem is not behind us. That’s part of what I wanted Smoke Damage to do—keep public awareness of the issue alive and help people understand that there’s much more that needs to be done. We can’t be complacent. If politicians are going to do the right thing, grassroots groups need to bring pressure to bear. As far as reigniting the movement, people have to understand that corporations act in the interest of profit-making, not public health, and that if we’re going to protect health, we’re going to have to confront corporate power. Maybe what we’ll see is a kind of an enfolding of grassroots tobacco-control efforts into a larger anti-corporate power movement directed against corporate interests that promote obesity, tobacco use, and other kinds of unhealthy behaviors.
I wanted Smoke Damage to keep public awareness of the issue alive and help people understand that there’s much more that needs to be done.
CHW: Where do you think there is potential for bringing health advocates together across these issues?
MS: Some of this is going on already. Maybe the uniting vision needs to be one that looks at all the determinants of public health and asks, “What needs to be challenged?” If people understand the threat that corporate power poses, that could be an umbrella under which people come together. Industry, whether fast food or tobacco, wants to define public health problems as stemming from individual choice. They benefit from promoting the notion that this is all about individual choice. They don’t want us to see our national health problems as consequences of how corporations engage in marketing, lobbying, buying political influence through campaign contributions, and shaping public opinion. So maybe that awareness would help people come together. It’s work that needs to be done, and sometimes you have to rise above your particular issue to see what the issues have in common, whether it’s obesity, alcoholism, or tobacco-related disease.
On Tuesday, March 1, a panel of activists, writers, and organizers spoke on the struggle over control of the food system. The event, titled “Food Fight! Countering Corporate Control of Our Food Supply” and held at CUNY Law School, was presented by the CUNY Law Review and the CUNY Law Green Coalition Food Fighters. Speakers called for grassroots, locally based activism to pressure the US government to support its citizens rather than corporations.
The panel, moderated by Anna Lappé, author of Diet for a Hot Planet and co-founder of the Small Planet Institute, included attorney-activist (and CHW contributing writer) Michele Simon, New York City food and garden organizer and community activist Karen Washington, and Food and Water Watch Executive Director Wenonah Hauter. New York City Council MemberMelissa Mark Viverito responded to the panelists’ remarks, emphasizing the recent food-related activities undertaken by the New York City Council.
Lappé began by asking the panelists to explain the historical context of today’s food system. “We have enormous consolidation in our food system,” responded Hauter, “and we’ve seen more and more over the past 20 years.” “We need to strengthen antitrust laws and we need to have the laws followed,” she continued. “I think the message is we can’t just vote with our fork; we can’t buy our way out of this problem, we can’t shop our way out of this problem, we have to organize our way out of it.”
Washington elaborated on the theme of organizing, placing the responsibility on the shoulders of communities. “Allowing these companies to control our food system has to say something about our society,” she said. “When are we going to get together to say enough is enough?” Simon agreed that there are things we can do locally, but pointed out that the subsidies that make the wrong kinds of food cheap can’t be fixed at the local level. As a lawyer, she also noted, “When you can’t get where you want to go with legislation and regulation, often litigation is a last resort.”
The conversation then shifted to the one-year anniversary of Michelle Obama’s “Let’s Move” campaign, and her recent support of Walmart. Hauter said that Obama is not in a position to take on the food industry, the real obesity culprit, so in her view, “Let’s Move” will lack follow-through. She called Obama’s free publicity for Walmart “offensive,” “hypocritical,” and “problematic.” “When you look at WalMart’s track record, it’s pretty scary that they’re getting into food,” said Hauter. She warned that they are forcing the price of organics down, and the quality will soon follow. Hauter also pointed out that Walmart’s promises to promote healthy food are shaky since they are essentially just making unhealthy food a little less unhealthy. Washington agreed that “Walmart is like the Monsanto of supermarkets,” but gave the Obama administration credit for bringing school food issues into the public eye. She promoted existing bodegas as establishments that can easily fill the role that Walmart claims is needed in New York City neighborhoods, noting that bodegas are already more integrated with the community than Walmart could ever be.
“Industry’s game is twofold,” added Simon. She explained that first, they begin calling their virtually unchanged products “natural” in order to keep people buying them, and second, they ensure that policy makers stay away by fooling everyone into thinking they are voluntarily self-regulating. “Basically”, she said, “the government is handing over the reins of our food supply to Corporate America.” “We want government policies to be in favor of people, not corporations,” concluded Simon, stressing that Walmart and McDonalds can never be the solution to the problem. “Just get out of the way and let the community fill the void.”
Council Member Viverito began her response saying, “I know this was not supposed to be an anti-Walmart forum, but I will jump on that bandwagon any day,” much to the delight of the audience. She also spoke about the New York City Council’s efforts to address access to healthy food. She discussed the Food Works report released by City Council Speaker Christine Quinn in November of last year, and also mentioned supporting bodegas and the FRESH initiative to bring more supermarkets into underserved neighborhoods.