Commentary: Sweet policiesBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h780 (Published 11 February 2015) Cite this as: BMJ 2015;350:h780
- Peter Anderson, professor, Institute of Health and Society, Newcastle University, UK, and Faculty of Health, Maastricht University, Netherlands,
- David Miller, professor of sociology, University of Bath, UK
If we consider harms from addictions and lifestyles in contemporary societies,1 sugar is high on the list of offenders.2 Ecological analyses show that humans have evolved to be active and functional in seeking out sugar from food sources, primarily fruits and honey.3 Indeed, there is an overlap with alcohol, with airborne alcohols from fruit potentially serving in smell driven localisation of sugar-containing food resources.4 5 No wonder then that when sugar is so easily available in such refined and potent form2 we take so much of it—a global average of 50 g per person a day; no wonder that the heavy sustained use of sugar is similar in some respects to that of alcohol and other drugs.2 6 7 And, no wonder because our bodies are not used to taking so much of it,3 sugar causes so many health problems— increasing dental caries,8 cardiometabolic risk,9 overweight and obesity10 (and subsequent effects on cancers), diabetes,6 and liver dysfunction.6
To reduce the harm done by sugar, last year the World Health Organization launched a consultation on revised sugar guidelines, noting that consumption below 5% of total daily energy intake (around 25 g for an adult of normal body mass index) would bring health gain.11 There are calls for effective sugar regulation, similar to those for alcohol,6 12 but initiatives such as taxes on sugar sweetened drinks or regulation of serving sizes are often vetoed because of lobbying by the sugar industry.13 14 This has led some to call for food producers to voluntary reduce sugar content,15 similar to salt reduction initiatives.
The industry engages in a wide range of lobbying and advocacy activities to resist public health regulation of its products. Corporate activities include attempts to influence the scientific evidence base, to fund and influence civil society organisations and pressure groups, manage the media (both traditional and social) and—the ultimate aim—influence policy.16 As in the case of the alcohol industry, the sugar industry invests in a dizzying number of groupings and organisations—from trade associations and elite policy planning groups, lobbying and public relations consultancies, through parliamentary groups, science based lobbies, expert gatherings and committees, and groups that appear to be grass roots organisations.16 By these means policy makers and others are given the impression of a wide rage of opposition to public health measures, when the reality may be that they are simply disguised corporate voices.17
To propose measures to reduce the harms associated with sugar, or indeed alcohol and other drugs, it is necessary to follow industry activities wherever they take place. For example, the advertising industry often works with food and alcohol companies to limit restrictions on advertising. Some of the academics cited by Mars18 as supporting its claims on the response of the young to marketing, have been linked through advertising related bodies such as the Advertising Education Forum to big sugar companies like Coca-Cola, Nestlé,19 and (in the past) Mars subsidiary Masterfoods20—all of which have helped to fund the forum. Some experts advising on, say, children’s responses to advertising may not be fully aware that the groups they advise are in part vehicles for the food industry.21 Subsequent non-declarations of potential conflicts of interest mean that neither ministers nor the public are aware of conflicts in expert reports commissioned by government.22 23
Managing competing interests
Conflict of interest in relation to sugar is an increasingly structural and complex problem, as it is with alcohol and other drugs.23 More needs to be done to monitor and reduce conflicts, especially when those who write in medical journals are less than fully transparent in their disclosures.24
We should also improve the quality of debate on conflict of interest, which some insist on equating with conscious wrongdoing or corruption. Colin Blakemore, former chief executive of the Medical Research Council, is reported as saying: that it is “ridiculous” that scientists with industry links are “automatically tainted” and seen as “evil.”25 Some argue that conflict of interest declarations can stigmatise honest scientists.26 27
Of course, conflict of interest can be innocent in that scientists who produce genuinely good science that happens to fit particular corporate priorities may then receive funding enabling them to do more of the work and to have more impact on the evidence base. Such relations can be useful to industry, especially if the scientist sits on official advisory committees. In such cases the need for enhanced transparency and, indeed, reducing conflicts is very important. Should official advisory positions be open to those with important roles with industry?
As the fight over sugar gets more intense, the need to protect the scientific evidence base from corporate influence will be heightened. Conflict of interest policies need ongoing attention and implementation. Transparency on conflict of interest is no panacea, but it continues to be a key means to defend scientific integrity.23
Because the problems of corporate influence spread beyond the scientific evidence to wider society,28 there is a similar need to enhance scrutiny of the links between the sugar industry and experts, policy groups, civil society actors, the media, and the policy process, as described by Gornall.29
Cite this as: BMJ 2015;350:h780
Competing interests: We have read and understood BMJ policy on declaration of interests and declare PA and DM receive funding from the European Commission for an FP7 project (ALICE RAP) that focuses on rethinking addictions in Europe. DM is also a director of Public Interest Investigations, a non-profit company which is behind two websites: spinwatch.org and powerbase.info. He is a member of the UK Centre for Tobacco and Alcohol Studies.
Provenance and peer review: Commissioned; not externally peer reviewed.