Hand the kids a ciggy

Back when Kevin was an MP rather than a PM, he made an inconvenient election promise that might be interpreted to mean he would fix the health system. So (being keen to be seen to be a man of his word), after he got the gig, he formed a Commission. The Commission was to gather submissions from anyone who cares and come up with recommendations on how to fix the health system.

The Commission duly performed as expected and (a year and half later) came up with sleep inducing statement of stuff-we-already-knew (in 123 parts). Unfortunately (and rather inconveniently) the Commission also suggested an actual structural change. They wanted to add basic dentistry to Medicare. Even more unfortunately, the Commission (clearly getting carried away with its own importance) suggested raising taxes to pay for the actual structural change.

Kev knew the media would eventually read the report and discover the tax-bomb. So he cut them off at the pass by announcing plans to have a ‘conversation’ (yep, another one) with the Australian people before anyone did anything. The plan was to punt the issue well beyond the next election. The nit-picky media (you know who you are) chose to focus on the tax rise rather than all the excellent stuff-we-already-knew (obviously being manipulated by the opposition’s friends in high places), causing a bit of a pickle for our hero ...

No, this isn’t the plot for an episode of The Hollowmen. It’s very (and, all too sadly) real. But stepping aside from the political reality (that gradual change will most likely occur in due season), its worth looking at some of the concentrated wisdom of the health hierarchy so painstakingly collected throughout the report.

An overwhelming theme is that prevention is better than cure. So it’s a bit odd that the single biggest cost in the whole thing (and the only item with a specific funding proposal) is actually 100% cure and 0% prevention. The National Health and Hospitals Reform Commission want to spend $3.6 billion per year on basic dental services. The money will come from a 50% increase in the Medicare levy paid by every ‘working family’.

Dental services are primarily consumed fixing damage done by tooth decay. And the cause of tooth decay is established beyond any shadow of a doubt. There aren’t many occasions when Nestle, Coca-Cola and the World Health Organisation find themselves in complete agreement on a health issue, but this is one of them. Tooth decay is caused by the consumption of sugar.

Preventing a disease is rarely as easy or as obvious as halting the consumption of a single consumer substance. It’s even rarer to have everybody (even the people who make a fortune from selling it) agree that it does in fact cause the disease. The only other example I can think of is tobacco (yes, Big Tobacco did eventually agree). All of which makes me wonder why the medical and political responses to lung cancer and tooth decay are so very different.

We actively try to prevent people commencing consumption of tobacco. If they are foolish enough to do it anyway, we tax them into submission instead. The taxes raised vastly exceed the health costs of treatment and go to benefiting the whole community. Imagine our response to tobacco if it was the same as the proposed response to sugar. We’d be handing our kids a ciggy, resigning ourselves to the inevitability of them eventually needing extensive treatment for lung diseases and jacking the medicare levy up to cover the costs.

Since everyone is in wild agreement that the cause of tooth decay is sugar, why are we not acting to restrict its consumption? Why are we not doing anything to convince people to think twice before shoving it in their gob? Why are we prepared to mutely accept the damage it does and raise taxes to pay for it?

There are many reasons to be worried about sugar consumption. It causes heart disease, stroke, diabetes, obesity and helps cancer grow. But none of these are as black and white as tooth decay. We can’t even muster the political will to do something about preventing a disease that everybody knows is caused by sugar. We’d rather just jack up taxes than attempt any kind of prevention. So we have no hope of doing something about short circuiting the real drivers of the health cost explosion (obesity, heart disease and diabetes).

We’ve got our faces so firmly pressed against his large grey buttocks, that we no longer have any chance of seeing the giant sugary elephant sitting in the room. Before we race to slap a tax band-aid on the most obvious sugar disease, let’s really do something about prevention rather than simply making agreeable noises and having more ‘conversations’ with the Australian people.

Also published in Crikey.

Are you getting enough sugar?

Don’t tell the neighbours, but I don’t often venture northwards enough on the telly’s dial to make contact with SBS. However, last week some alert promo watchers warned me to tune in to Food Investigators on Wednesday night.

Food Investigators is in English and doesn’t contain any nudity (as far as I can tell from limited exposure) so I’m not quite sure why Aunty’s little sister funds it. Maybe it’s got something to do with SBS’s need to attract advertisers in these days of Master Runway Decorator Chefs?

Last week’s edition was a revelation. In hard hitting style, the show’s host(ess), ‘hospital doctor, actor and healthy eating enthusiast’ Dr Renee Lim was on the trail of some big news. She revealed that ‘recent studies’ show that we are all eating 20 percent less sugar than 30 years ago. This information seemed to come from Dr Alan Barclay who also pointed out that over the same period ‘rates of overweight and obesity have gone through the roof’.

That was enough for Renee, who pronounced that ‘too much sugar isn’t the major cause of obesity’. Having dropped her bombshell (or Dr Barclay’s bombshell, it wasn’t clear which), Dr Lim crossed to the show’s built in dietician, Hanan Saleh to find out how much sugar we all should be eating.

Hanan recommends ’15-20% of your daily energy intake should come from sugar’. She helpfully explains that translates to up to 32 teaspoons for men and up to 25 teaspoons for woman and children. Concerned that you, gentle viewer, will be freaking out about having to add another 30 teaspoons of sugar to your coffee (just to get your recommended dose), she helpfully explains that 80% of that has already been added to your food by your friendly neighbourhood food and beverage conglomerate (or words to that effect).

I stayed glued to the Box in the hope that Renee or Alan might pop back in and reference the world changing research they had unceremoniously dropped on the floor without so much as a ‘how’s your father?’. No such luck though. I had to know more, but hours spent hunched over a hot browser left me none the wiser, so I emailed Dr Barclay.

The good doctor got straight back to me with a clarification that wasn’t in the show. His research has not yet been published. He will reveal all at the Australian Diabetes Society’s annual conference in Adelaide next month. He was stumm as to any further detail, so I guess I’ll just have to sit and wait.

In all my searching, I couldn’t find Dr Barclay’s research (or even anything that it might be based on), but I did find out quite a bit about him. SBS described him with the brief under-title, ‘Diabetes Australia’, but there is so much more they could (and should) have told us.

Alan Barclay has a PhD to top up his undergraduate studies in nutrition and dietetics. He is the human nutrition manager at Diabetes Australia-NSW. He’s also a media spokesperson for the Dieticians Association of Australia (having recently completed a media training course at NIDA). So I’m guessing he knows a thing or two about human nutrition (and how to talk to journalists).

So far so good, but then things get a little murky. Alan is also the CSO (I think that means Chief Science Officer) and occasionally Acting-CEO at Glycemic Index Ltd (GIL). GIL is a ‘not-for-profit company formed by the University of Sydney, the Juvenile Diabetes Research Foundation, and Diabetes Australia’. It exists to dispense GI Symbols to worthy recipients.

The GI Symbol is the poor relation of the heart foundation’s tick. Prospective supplicants submit their fare for testing, pay the ‘testing fee’ and, if adjudged worthy, receive a little blue G that they can display on their labels.

Just like the tick, the GI program is designed to ‘help consumers choose healthy foods’. And just like the tick, consumer research shows it actually works. But there is one place you’ll find a GI Symbol that not even the heart foundation has (so far) dared to go. CSR have managed to get one slapped proudly on the front of a packet of sugar. Yep, sugar. The very same stuff that Alan helped SBS point out is no longer a threat to our waistlines.

This is, of course, not news to Alan. He was right there at the launch of the new GI Approved Sugar in March and his boss, board member, Professor Jennie Brand-Miller was widely quoted in support of CSR’s announcement.

At this stage, it seems that only SBS have been privy to Dr Barclay’s paradigm smashing research on sugar, so I can’t comment on that. I do however think it would have been a nice touch to mention his association with a sugar producer. This is particularly important given the program did much more than break the news on the ‘research’ front. It suggested that people should be getting up to a fifth of their calories from sugar (which is more than even Nestle recommends).

How long would a doctor keep his practising certificate if he prescribed a medication in which he had an undisclosed financial interest? Exactly how many minutes would a lawyer spend in the wild, if he counselled clients to invest in a scheme from which he took an undisclosed fee?

Human nutrition is no longer a soft science or an almost-profession. People base life decisions on the information dispensed by shows like The Food Investigators. The standard ‘this advice does not take account of your circumstances’ disclaimer doesn’t cut it when the advice affects everyone. The science says there isn’t a category of person who won’t be harmed by sugar consumption. Telling people to eat it in quantity, is like recommending daily arsenic supplements.

Also published in Crikey

Cake and Bindi Irwin? There are bigger gummi bears to fry.

Boy, am I glad my free thepunch.com.au subscription is up to date. I had barely pulled the digital cling wrap off yesterday’s copy before I noticed sugar was being hotly debated by none other than the big kahuna of News Limited’s foray into online journalism, David Penberthy.

Dave was taking the big stick to that icon of the Australian nutrition, Rosemary Stanton, for taking the big stick to that icon of, well, ah, crocodile stuff, Bindi Irwin. Rosemary was upset by an ad that Bindi had done which promoted a packet chocolate cake for Green’s. She didn’t think it was appropriate for a child to push unhealthy food to other kids.

Penbo came out flailing in defence of Big Sugar. Slamming Rosemary for delivering a ‘pretty out there tirade’, he went on to accuse her of being in ‘cloud cuckoo land’ and suffering from ‘bad taste’ while she was about it.

Rosemary, you have a point. High profile kids shouldn’t advertise high sugar (the cake mix is 37% sugar) foods to kids. They will want to buy it (otherwise, Green’s ‘significant’ contribution towards wildlife conservation will have been a waste of money). But it is cake mix. No-one is suggesting it is healthy, no-one is giving it a heart tick and no nutritionist is advertising it as a replacement for fruit or anything else. It’s a treat, we know it’s a treat and no-one is being duped.

David, you have a point – it’s just cake – but get a grip. Rosemary just said she was saddened by an inappropriate use of a child in advertising. No nuclear devices were detonated. Australia didn’t lose the Ashes. And no advertisers were harmed.

Don’t get me wrong, I am loving seeing the glitterati of the food debate (a little artistic license with that, I know) slugging it out in the broadsheets of the nation. But seriously people, there are bigger gummi bears to fry.

Streets want every child to get their ‘afternoon calcium’ from their new Paddle Pop Moos. They proudly proclaim every single ice-block has the calcium of ‘1 Glass of Milk’ but leave the fact that it is 20% sugar to the small print. Nestle would rather the kids get their daily calcium from Milo Duo ‘nutritious energy cereal’ (30% sugar) or a nice (Australian Heart Foundation approved) chocolate Billabong (19% sugar). Really health conscious kids are encouraged to go for some Uncle Toby’s Oats, So Tasty for Kids (30% sugar).

For that after breakfast snack, Kellogg’s wants you to feed your young iron-men Nutrigrain Bars and perhaps give the other kids some nice (heart foundation ticked) K-Time Twists (both 37% sugar – the same as the cake mix). And don’t even get me started on LCM’s (30% sugar) and their schoolyard commercials.

The problem is not that Bindi (or anyone else) is advertising cake mix. No-one is in danger of being fooled into believing chocolate cake is health food. The real problem is that food that should be clearly labelled as ‘high sugar confectionary – use extreme discretion when feeding to children’ is being marketed as the equivalent of broccoli ‘but fun’.

Why aren’t the hard questions being asked by the people who have the kind of firepower that gets column inches about chocolate cake? Why are nutritionists silent or complicit? These are the questions that need answering. Let’s leave spats about whether Bindi should have plaits or a pony tail to the school yard where it belongs.

Also published in Crikey

Taxing Sin

Good news! Kevin and Nicola (you know, brown hair, answers to ‘health minister’) are thinking about raising tobacco taxes again. Baccy tax is a politician’s dream tax. It drags in wads of money and everyone (well according to a recent Newspoll, 88 percent of everyone) thinks you’re a legend for doing it. If only they could convince us to feel that way about income tax. Then they could hand out stimulus packages every second Tuesday and even afford to buy their own utes.

The latest proposal from the think tank over at the National Preventative Health Taskforce should rake in $1.97 billion (with a B!) in extra taxes every year. That’s a lot of mullah just by whacking an extra 67c on a pack of ciggies. They’d better hope not too many people give up.

The extra two billion will be added to the six billion or so they already take from the tobacco industry every year. Eight billion will be quite a nice little earner when you consider that the direct health costs of treating smokers is just $318 million (with an M) a year (mostly because smokers have the good grace to die before they cost real money).

But don’t start picking out next year’s plasma TV just yet, if another paper from the National Health and Hospitals Reform Commission (all these government Taskforces and Commissions are starting to blur together into one steaming, committee coloured pile) is to be believed, we’re going to need every last cent of that (and a whole lot more).

The research underlying the report says that by 2033, the Australian health system will be costing up to $295 billion every year (up from the $94 billion it currently costs). To put that in perspective, last year the total income tax take for the entire country was a mere $209 billion which was topped up with $76 billion in GST. The biggest cost increases are directly related to chronic diseases caused by sugar consumption such as Type II Diabetes. There will be almost four times as many of us with the disease by then.

Depending on how things track between now and then, the health system may cost up to 15% of our GDP. Our friends in the US already have a health system which costs 15% of GDP and they’re finding it a bit tricky to keep delivering the essentials. Kevin’s mate, Barack says "When it comes to health-care spending, we are on an unsustainable course that threatens the financial stability of families, businesses and government itself." Oh ok, so no big deal then?

But, as they say, necessity is the mother of taking science seriously. So our friends over the pond are seriously considering slapping a sin tax on soft drinks (or soda, as they insist on calling it), fruit drinks, energy drinks, sports drinks and ready-to-drink teas.

They reckon if they add 10c per litre to the price, everyone will win. The government will pocket an extra $6 billion a year (to go towards the health system) and the tax would ‘lower consumption, reduce health problems and save medical costs.’ Gosh that sounds familiar. Except this time they’re not talking about ciggies, they’re talking about a substance that Nestle advertises to Australian kids as a healthy and nutritious snack (ah c’mon, you knew I couldn’t leave that alone).

Michael Jacobson, executive director of the Center for Science in the Public Interest says "Soda is clearly one of the most harmful products in the food supply, and it's something government should discourage the consumption of." I don’t think Mike’s worried about the water, so that leaves the other ingredient in soft drink, sugar. That’s right, sugar. And it would appear that he has good reason to be worried.

The evidence on sugar is enough to have the US Senate seriously considering the imposition of tobacco-like sin taxes. Clearly Americans have a very different metabolism, because in Australia, we’re not in the least concerned. Just last week (in response to one of my earlier rants) Susan Anderson, National Director, Healthy Weight at the Australian Heart Foundation told Cardiology Update “Although associated with tooth decay... eating sugar itself is not clearly associated with other health problems.”

Susan isn’t on her John Malone. The House of Representatives Inquiry into Obesity (which handed down its report in June) was more worried about ensuring the taxpayer (that means you and me) footed the bill for gastric banding surgery than doing anything about sugar consumption. And the Preventative Health Taskforce wants to increase cigarette taxes and educate us to eat less fat and exercise more (because that’s worked so well to date).

A sin tax on sugar may not be the ideal approach. But at least it acknowledges the real cause of the obesity crisis and (much like a tobacco tax) ensures some of the real costs associated with its consumption are built into the price paid by the consumer. It’s time for Australian ‘experts’ to extract their heads from the sand and start acting on sugar. At the very least, let’s stop pushing it to our kids as ‘health food’.

Residents of Melbourne might like to know I’ll be giving a free public lecture next Tuesday. People who can’t (or wont) go to Melbourne (even to hear me) can tune into Ockham’s Razor this Sunday instead.

Also published in Crikey