It aint over til the fat lady dies

Dearest Australian Big Sugar, the days of uncritical acceptance of sugar as just-another-food are behind us. As you know, the science has made it clear for some time that it is a lethal and addictive element of the food supply.

Unfortunately, that knowledge appears to be filtering into the consumer domain. We, here in the United States, are now repeatedly fending off claims that we are causing all manner of damage. Even worse, the Feds are now talking about special taxes against us and otherwise interfering with our right to sell whatever we damn well like to whoever we damn well please.

We’ve learnt a thing or two about how to distract consumers worried about sugar. So here are some tried and true strategies you can use to ensure your customers remain docile and compliant.

Everything in Moderation – As market awareness about the danger develops, you should respond, that of course you are aware that excessive consumption of sugar is not good, but that foods such as yours should be consumed in moderation.

It’s a tactic that worked exceedingly well for Big Tobacco for many years. In the 1960’s they successfully put a message about that it was fine to smoke in moderation (can you believe they got away with that?!). Eventually this message runs out of steam, but Big Tobacco got a solid 30 years out of it, so it should be good for a while for us.

Point out that your product is natural – In the US, we emphasise that our sugar comes from natural corn. You could do the same with sugar or if the punters are already sceptical of cane sugar, you could start using phrases like ‘made with real fruit’ instead. We know it’s all the same, but it seems to reassure the public and throw them off the scent (for a while at least).

Produce meaningless front of pack labels – If you are a beverage manufacturer, proudly display the number of calories per serving. Of course the damage being done by sugar has nothing to do with calorie content, but it looks like you care about your customer’s health. You can also be cute with the number of servings in a package. Consumers will assume they are holding one serving in their mitts, when in fact there are two (or more).

If you’re a cereal manufacturer, produce a dizzying array of numbers which compare the number of grams of up to 12 ingredients (in a serve slightly larger than an espresso glass) to the hypothetical requirements of an adult male. Make sure you point out meaningless information about the high sugar product on the front of the pack. Things like high in “Fiber” or “Low Fat” seem to work well here.

And of course, fiercely lobby against the introduction of any traffic light nutrition labelling system. Those systems would stop people buying just about everything we sell. You can say you are already providing more than enough information.

Produce a Light Version – Obviously we don’t mean use less sugar. We all know that would mean our products wouldn’t sell. No, the way to go is to produce a smaller container (beverage) or package (confectionary). This has numerous benefits apart from the obvious opportunity for profit. You can pitch “built-in portion control” as part of a “healthy lifestyle”. Clearly you don’t want consumers to reduce their consumption, so remember to sell the smaller cans in 8 packs rather than 6 packs.

Get the experts onside – Nutritionists are more than happy to line up to help us spread the messages about ‘moderation’ and how all that really matters is the ‘number of calories’. Naturally, they won’t do this for free, so be ready to sponsor some conferences and even employ some of them. Obviously it would be even better to get some doctors on board, but they are paid a bit more than Nutritionists so be prepared to part with some serious money for that one.

We very much hope it doesn’t come to this in Australia, but as a last ditch effort, you might have to set up some outfits like the Center for Consumer Freedom or Americans Against Food Taxes. They will help make your lobbying look independent.

If you are forced to do it, you could model your version on the New Zealand Nutrition Foundation (sponsored by Cadbury, Coca-Cola, Nestle, McDonald’s etc). They have come in very handy in the past to independently remind people that there is “no such thing as a bad food or beverage.”

Good Luck and remember it aint over until the fat lady dies.

Warning: there is a possibility that this letter was not written by Big Sugar, your mileage may vary, product may not work as advertised, read the PDS in the accompanying brochure, caveat emptor, etc, etc.

Also published in Crikey.

Why fructose-laden drinks when there’s a healthy option on tap?

When I was a kid, I was able to sit in a classroom for an hour (or even two) without requiring rehydration. Adults were able to go for a walk without toting a drink bottle. And the only reason to carry water in a car was to refill the radiator.

When did we become a nation requiring constant hydration? Somehow we have all come to believe that drinking is a core part of being healthy. Kidney Health Australia helped propagate the message that we should all be drinking eight glasses of water a day. And even the official dietary guidelines chimed in to tell us that we should be getting two litres a day. Unsurprisingly, they got plenty of support from water authorities and bottled water manufacturers.

Unfortunately, there is no scientific basis whatsoever for such a recommendation. Hydration has nothing to do with kidney health. It turns out that high blood pressure and diabetes are the primary risks to our kidney health. And we’re suffering more than ever before. End stage kidney disease (the bit just before you die) in men increased by 31% between 2000 and 2007 (19% for women). And because you can get by on just 10% kidney function without showing symptoms, most kidney disease goes undiagnosed.

But try as they might, Kidney Health Australia are having difficulty stuffing the drink-water-for-kidney-health genie back in the bottle. We love a health message that encourages us to do something we were going to do anyway. We’re even keener to do it if we can convince ourselves its cool.

Ok we weren’t going to drink 2 litres of water a day (well, not after the first day). But we pretty quickly convinced ourselves that any drink counted. As long as we were getting the required fluid volume. Big Sugar was more than happy to help us with our self delusion.

Coca-Cola for example, has a special site dedicated to letting us know that “water* plays many important roles in the body”. The asterisk is there to remind us that “it’s not just plain drinking water that contributes to hydration” (just in case you temporarily forgotten they’ve got some sugary stuff to sell to you).

But there probably aren’t too many people that believe a bottle of coke is really health food (with the possible exception of Kerry Armstrong). It’s much more of a problem when this kind of intentional deception sneaks into the marketing of children’s drinks.

School canteens don’t sell soft drinks these days. And schools certainly don’t encourage children to sip Pepsi throughout the day. They don’t do it because the various state health authorities have declared softdrinks to be too full of sugar to be safely consumed by children. Instead they sell water. No, not plain old boring tap water. Its water, but ‘fun’.

Wacky Water and Play Sports Water have the school canteen market sown up. They’re both made by P&N Beverages and the lead line from the Wacky Water website sums up their approach to the market. It says “Do you find drinking the amount of water that nutritionists recommend difficult?”

Both drinks are targeted firmly at worried parents. They fret that little Hermione and Reginald are dehydrated (and their kidney’s are on the verge of packing it in) but they know they have Buckley’s of getting them to drink ‘enough’ water. Solution: Wacky, Sporty, Water.

These ‘Waters’ are sweetened with pure fructose. Somehow this counts as neither “added sugar” (which it is) nor “artificial sweetener” (which it also is) by the time it gets onto the Fun, Wacky, Sporty labels of these bottles of (what looks like) pure fresh water (they leave the colouring out for some reason). Education departments are happy that everyone is being healthy. Parents feel less guilty. And kids can’t believe they’re actually being encouraged to drink this stuff.

A 500ml bottle of Sports Water delivers 21g of pure fructose to the thirsty child. To get that much fructose from sugar, you’d have to chow down on 10 teaspoons of the white gold.

Inconveniently, it seems that all that ‘natural’ fructose causes chronic kidney disease. So these ‘waters’ are not exactly having the desired effect.

A study released last month confirmed that fructose directly causes high blood pressure. It does this by raising uric acid levels in the blood. High uric acid levels are known to cause kidney disease, as is the high blood pressure itself. Eighty percent of patients with failed kidneys have high blood pressure.

Every day in Australia seven new patients are added to the list of people requiring dialysis or transplantation of failed kidneys and the rate is accelerating. One in ten deaths are now as a result of kidney disease. What are these numbers going to look like by the time the kids we’re stuffing with fructose wear out their kidneys?

Our children will drink water when they are thirsty. So make sure there is water available in the playground. But every day that fructose laden drinks are sold as water adds more kids to the back of the queue for a new kidney.

Fructose is deadly. There is no justification for selling it to our children as health food. Its time our governments (and those they pay to care) pulled the pin on this disgusting display of corporate greed at the expense of children’s health.

Also published in Crikey

Why aren't they studying soft drink consumption?

Here’s a brain teaser for you. What do you do when the people who most need your product can’t afford to buy it? Purveyors of big screen TVs and other electronic knick-knacks have found the answer in buy-now- pay-nothing-til-2037 deals. And that works well where the punters are queuing round the block but just don’t have the readies.

But what to do when your potential customers don’t know they need your product? And even if they did, may not have the wherewithal to drop up to 13 large acquiring it? Give up? Then forget about a career in pharmaceutical PR. You get the government to pay for it, dummy.

The folks at Allergan have exactly this problem. Allergan make a nifty little thing called a lap-band. If you chop open an obese person and whack a lap-band in, they suddenly can’t eat as much and the theory is that should do all sorts of good things for them.

Lap-Band surgery is starting to get very popular. Two years ago, just 8,193 were done in Australia, but last financial year this had grown to 12,247. A whopping 50% increase in the market in just one year. There’s gold in them thar hills.

You don’t need Glenn Stevens to run the numbers to realise that the number of people with the necessary girth AND mullah is not going to last much longer. Solution: get the government (that is, the taxpayer) to step in and start picking up the tab.

Allergan’s done all the right things. Endow a university with some dosh to research how terrific their product is. Smile happily as the researchers go forth and tell the government. Glow contentedly when the government makes a recommendation that consideration be given to ‘boosting access’ to their product. It’s all good stuff, but it’s not exactly moving like a freight train and where’s that government money?

Time for a bit of PR creativity. Time to introduce the new sport of Extreme Lobbying. Professor Dawn DeWitt from the University of Melbourne explained how it works to ABC’s AM program yesterday.

Prof DeWitt is helping the folks at the Monash Centre for Obesity Research and Education (funded by Allergan) with a new “trial” of Allergan’s lap-band product in 30 indigenous Australians in the Goulburn Valley. She wants to see if they have the same success as folks in the “white population”.

This is a product which has been installed in almost 18,500 Australians in the last two years alone. Even basic maths would tell us that over 500 of those could have been of indigenous descent (and some of them may even have been from the Goulburn Valley). So what exactly will this trial tell us that that we don’t already know? Is there some suggestion that people in Goulburn Valley are constructed differently from the rest of us?

Prof DeWitt was ready with the answer to that one. She told AM that “if [the trial] does work then we can go to government and say look there really ought to be a special program to support this in an ongoing way.” Ah, right, so this has nothing to do with the health of indigenous Australians and everything to do with getting taxpayers to pick up the tab for lab-band surgery.

Indigenous Australians suffer 6 times the rate of Type II Diabetes when compared to the rest of the population. Unfortunately for Allergan they also have significantly less purchasing power when it comes to surgical solutions. This latest trial is clearly nothing more than a disingenuous attempt to end-run that problem and open up a brand new government funded gold-mine for Allergan.

Extreme lobbying uses actual surgical intervention in order to make your political point (let’s hope Turnbull doesn’t start doing that – Rudd-ectomy anyone?). This trial is not asking patients to fill in a survey or keep a food diary. This is significant surgery that requires major re-operation in 1 in 5 cases.

In more than half of the recipients, it does not result in significant weight loss. At most, it has only a two in five chance of causing a remission of Type II Diabetes (for up to 9 years). And even according to the lastest research funded by Allergan, patients only gain 1.2 years of life expectancy. To put these trial recipients through all of this for research purposes is questionable. But to do it as part of a lobbying exercise is outrageous.

If Monash’s Centre for Obesity Research is really that concerned about the rate of diabetes in indigenous Australians, how about spending some time and money looking at the fact that they consume twice as much soft drink as the rest of the population? Oh that’s right, silly me. No-one’s going to pay them to do that.

Also published in Crikey

How necessary is lap-banding?

Imagine for a moment that there was a medical benefit to penis enlargement. I can’t imagine what it might be. But you can bet that if there was the slightest chance of one, Big Pharma would be working the PR angles overtime.

There would be submissions to parliamentary enquiries on the virtues of large members. There would be intense lobbying for bigification to be added to the medicare schedules. Universities would be endowed with grants for studies showing that despite the huge costs involved, the community as a whole would be better off.

Successful recipients of the procedure would make regular appearances on current affairs shows. And even the occasional celebrity might become a posterboy for his newly enlarged and much more healthy lifestyle.

Normally this kind of cosmetic surgery misses out on the PR windfall of there being a remote possibility of medical benefit. But there is one kind of beautification which has managed to land smack bang in the middle of the biggest medical concern we have (no not hair regrowth, the other one).

Lap-band surgery promises to blow away years of eating the wrong thing with a simple slice of the scalpel (and large quantities of liquid food). But it’s not cosmetic surgery, oh no, this is about reversing Type II Diabetes.

You need look no further than our own Monash University’s Centre for Obesity Research and Education (CORE) for proof that lap-band surgery is a cost effective way to manage diabetes. I’m sure that the fact that CORE’s ‘principal sponsor’ is Allergan has very little to do with their decision to focus their efforts on the study of lap-band surgery.

Allergan is the little pharmaceutical company that gave the world Botox. It followed up that gift to mankind with the invention of the very first (and still the most popular) device for bariatric surgery. Years of marketing Botox for medical uses (really? It’s also used for cosmetic purposes? Well spank my bottom and call me Anna) has ensured that Allergan knows how to tread the cosmetic-surgery-that’s-healthy path with great skill.

CORE has been having a bit of success on the lobbying front. It submitted to the House of Reps inquiry into obesity that “the barriers to publicly funded access to this surgery need to be addressed as a matter of urgency”, (but forgot to mention that their principal sponsor was a maker of such devices). And voila out pops a key recommendation that governments need to work together to boost access to bariatric surgery.

One of the chaps who has run multiple studies for CORE is a GP by the name of Dr John Dixon. His latest study correctly discloses that he is affiliated with CORE and the Baker IDI Heart and Diabetes Institute, but doesn’t mention that he is also a consultant to Allergan and “the charter member of the board” of, and has an ‘ownership interest in’ Bariatric Advantage.

The recipients of lap-band surgery are put on an Optifast diet before and after surgery. It’s not the surgery that makes them thin, it’s being forced to stick to a very low calorie liquid diet. Optifast is one of those shake diets you can buy at the local pharmacy, but there is a special high end version for those undergoing lap-band surgery.

Bariatric Advantage makes its money flogging optifast liquid diets (and various other bibs and bobs) to lap-band patients, so it’s logical that Dr Dixon might want to have an ‘ownership interest’ in its operations. The primary ingredient in Optifast shakes (besides powdered milk) is fructose, a substance so dangerous to diabetics (remember diabetes is the disease we are ‘curing’ here), that the American Diabetes Association has pronounced “the use of added fructose as a sweetening agent in the diabetic diet is not recommended.”

CORE expects that 14,000 lap-band procedures will be done this year in Australia. But don’t worry, since Nestle make Optifast, they can probably get their hands on the industrial quantities of fructose required for the construction of that many ‘diet shakes’. And Nestle have no problems selling fructose to our kids as health food, so I guess this isn’t much of a leap to push it to diabetics either.

Bariatric surgery is not a simple piece of cosmetic beautification. One in five patients will suffer complications (but don’t worry less than 1 in 100 dies). And all for what? An average of just one decade’s remission from Type II Diabetes (for up to 40% of patients – the rest miss out).

Are we really going to seriously consider publicly funding surgery based on a submission from an outfit funded by the maker of the surgical device? Are we to seriously consider ‘research’ run by a GP who is a paid consultant to that manufacturer? And what are we to make of his side business flogging fructose (on behalf of Nestle) to the recipients of these devices? Is this really how public health policy is put together in this country?

Here’s an idea. How about instead of leaving a publicly funded first aid kit at the bottom of the slippery slide, we give some thought to telling people about the dangers before they climb the ladder? How about instead of blindly accepting that people are obese because they’re lazy or gluttonous (or both), we pay some attention to the more than 3,000 studies which suggest we’re fat because of a dangerous toxin (fructose) in our diet? How about we look a little deeper than the shiny surface that Big Pharma and Big Sugar want us to see?

Also published in Crikey

Wake up Australia

It’s been a rough few weeks for Big Sugar in the United States. First, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, said that soda and sugar-sweetened beverages "play a particular role in the obesity epidemic."

Then the American Heart Association dramatically reduced their recommendation on safe levels of sugar consumption. They suggested an adult male should eat no more added sugar than is contained in a can of soft drink, women may only have two thirds of a can and children a third or less per day.

The New York City Department of Health then jumped on the bandwagon, releasing it’s ‘Are you pouring on the pounds’ campaign in subway stations all over the Big Apple. The posters depict human fat being poured out of a soft drink bottle and end with the slogan ‘Don’t Drink Yourself Fat’.

Then, up pop New York City health commissioner Dr. Thomas Farley, nutritionist Dr. Walter Willett of the Harvard School of Public Health, Kelly Brownell, an obesity expert at Yale University in Connecticut and a bunch of other health experts, demanding that the US tax soft drinks to fund the health effects of their consumption.

And if all that wasn’t enough, some actual science happened as well. Dr Richard Johnson and his team from the University of Colorado reported on a study they had been conducting on the relationship between fructose and high blood pressure. Fructose is a simple sugar which is one half of sucrose (table sugar). They found that if they gave men a 200g daily dose of fructose for two weeks they increased their blood pressure.

At the start of the study, 19% of the participants were diagnosed as suffering metabolic syndrome (a condition made up of several conditions including excess weight around the midriff, high blood pressure, raised blood sugar and raised levels of blood fats known as triglycerides). At the end of the study (just two weeks later), this figure had more than doubled to 44%. In addition to the increase in blood pressure, there were also rises in triglyceride levels, insulin levels and measures of insulin resistance, as well as a lowering in ‘healthy’ HDL cholesterol levels.

You’d need to drink two, 2 Litre bottles of soft drink a day to get 200g of fructose, so it was more than twice the amount the average American consumes. But in just two weeks it had caused considerable harm indeed.

On the same day a joint study by the California Center for Public Health Advocacy and the UCLA Center for Health Policy Research reported that even at the levels currently being consumed, soft drink was doing serious harm. The researchers interviewed 42,000 Californians. They found that 24% of adults drink one or more soft drinks a day, and these adults are 27% more likely to be overweight than their peers who didn’t.

In the face of this constant barrage, Big Sugar has had no choice but to hit back. Today they’ve launched a co-ordinated national newspaper and television campaign putting their side of the story.

Full page advertisements made up to look like news stories declared corn sugar to be innocent of accusation that it makes people fat. And TV ads ran a similar line accusing the consumer of unfairly blaming corn sugar for his weight problem. High Fructose corn sugar is what Americans use to sweeten soda instead of sugar. It’s functionally equivalent to sugar and is about 55% fructose.

Corn refiners are sick of being blamed for the obesity epidemic and the ads point out that HFCS is no worse than sugar or honey. Which is perfectly true, but meaningless when all three contain similar amounts of fructose.

Meanwhile, juice maker Welch's, soft drink maker PepsiCo Inc, the American Beverage Association, the Corn Refiners Association, McDonald's Corp and Burger King Holdings Inc have formed a group called ‘Americans against Food Taxes’ to lobby against the proposed soda tax. It’s clearly panic button time.

Putting aside for a minute the inanity of fighting about whether sugar is worse than HFCS or the pros and cons of sin taxes. The point is that there is a significant public debate going on across the pond. The science is being discussed in daily newspapers, dramatic limitations are being recommended and the politicians and universities are in the debate up to their ying-yangs.

Here in Sugarland exactly none of the above is happening. Our Heart Foundation endorses high sugar snacks for kids. Our national healthy eating guidelines recommend levels of consumption that are at least twice the American recommendations. And our public health messages are stuck in the low fat 1960s with barely a mention of sugar. You won’t see Big Sugar running desperate (and stupid) TV ads here. They don’t need to. There is no public concern. There is no debate. And there is no PR problem.

Wake up Australia.

Also published in Crikey