When I was studying medicine in the 1990s, it was perfectly normal for pharmaceutical company sales reps to buy us lunch. We ate their sandwiches and were given branded pens and mugs.
None of us thought it would affect our prescribing, but of course nothing is free. The evidence shows that their gifts persuaded us to prescribe their drugs preferentially, leading to poorer quality and more expensive prescribing.
The pharmaceutical industry still pays around £40m a year to UK healthcare professionals, but at least the body that determines whether medicines are safe, the MHRA, is free from these conflicts of interest. The people who regulate medicines should obviously not be taking money from pharmaceutical companies.
This pandemic is driven by the fact that our diet consists primarily of prepared packaged foods that are high in calories, fat, sugar and/or salt; also known as ultra-processed foods or UPF.
You might think the situation would be similar with food, but that is not the case.
There are several government bodies that regulate different aspects of our diet, but the final say on what is healthy and unhealthy lies with the Scientific Advisory Committee on Nutrition, or SACN, which was established in 2000.
It is one of the most important government agencies regulating food, literally defining what constitutes a healthy diet and advising on policy. It has produced dozens of reports on all aspects of diet, nutrition and health.
During SACN’s existence there has been an explosion of suffering and death from diet-related diseases such as obesity and type 2 diabetes. Our statistics are among the worst in the world.
This pandemic is driven by the fact that our diet consists primarily of prepared packaged foods that are high in calories, fat, sugar and/or salt; also known as ultra-processed foods or UPF.
In other words, the problem is caused by the industries that sell and market unhealthy foods to us. This is not up for debate. No one seriously thinks that we are cooking worse at home.
Any reasonable person would expect SACN experts to be independent of the financial influence of the food industry. Surprisingly, the opposite is true.
An analysis published in The BMJ this month found that more than half of SACN experts have conflicts of interest with ultra-processed food companies such as Nestlé, Unilever (the world’s largest ice cream producer), Coca-Cola and PepsiCo.
One member alone owns more than £5,000 worth of Unilever shares, as well as doing consultancy work for Tate and Lyle and the Israeli Coca-Cola franchise. Another SACN member chairs a think tank at Europe’s International Life Sciences Institute, which is funded by PepsiCo and Mondelez, the US owner of Cadbury, among others.
It is important to say that these members have not broken any rules. And that is the problem. Despite the universal acceptance that the pharmaceutical regulator must be free from industry influence, these conflicts are still allowed and considered acceptable in the SACN.
A Department of Health and Social Care spokesperson told The BMJ: “No member of the committee is directly employed by the food and drink industry, and all have a duty to act in the public interest and to be independent and impartial.”
“The problem is caused by industries that sell and market unhealthy foods to us. There is no debate about this. No one takes seriously the idea that we are cooking worse at home,” writes Dr. Chris Van Tulleken.
Why should we be concerned? Because there is a large body of evidence about financial conflicts of interest that suggests this is simply not possible, and in my view these financial relationships do affect SACN’s reporting in subtle ways that favour the industry. And I am not alone.
Rob Percival, policy director at the Soil Association, told The BMJ: “There is now really good evidence that conflicts of interest at the interface of science and policy can skew specific policies or public narratives in favour of the food industry in ways that undermine public health.”
And, in a private conversation with me, one committee member who did not have conflicts expressed that he also feels that these conflicts affect the committee’s reports.
The most obvious effect is that the SACN reports fail to mention the role of the food industry in increasing health damage: the fact is that our increased consumption of calories, salt, fat and sugar comes from industrially processed and packaged products, but its report on sugar fails to emphasise where the increase in our diet is coming from.
Surprisingly, in more than 20 years of work, he has never produced a report on the cause of population obesity.
A clear example is last year’s report, “SACN Statement on Processed Foods and Health.” The government’s Office for Health Improvement and Disparities called this document an “independent report,” but the reality is very different.
The report looked at whether UPFs are harmful to health. UPFs account for more than half the calories in our UK diet. They are typically high in calories, salt, fat and sugar, and are made using processes and additives that only industry uses.
Some are obviously rubbish, but many of our staples are UPF: supermarket bread, most breakfast cereals, ready meals, etc.
Our nation is suffering a food catastrophe, which many doctors and scientists like myself believe is largely due to the constant marketing of UPFs by the food industry. The SACN report did not entirely dismiss concerns around UPFs, but it seemed to me to echo many of the views promoted by the food industry and the scientists they pay.
In SACN’s view, almost all research is “observational” and the evidence to date should be “treated with caution”.
She noted that the consumption of ultra-processed foods may be an indicator of other unhealthy eating habits and lifestyles. This is almost certainly the case, but the studies are clear that this is not the only problem.
Detailing the full body of research showing that UPF causes harm goes beyond even a major academic review.
There are more than 80 such studies linking smoking to cancer, as well as hundreds of experimental studies on the additives and properties of these food products and the way they are marketed.
The link between a diet high in UPF and damage to human health is strong and consistent across studies conducted in different populations and countries.
Every time a country switches from a traditional diet to one based on UPF, its rates of diet-related disease and premature death increase accordingly. Importantly, there is no other good explanation for the disease rates we see in the UK. In fact, SACN’s cautious view differs from that of many experts worldwide who are clear that a diet high in UPF is detrimental to human health.
This is not to say that all UPFs are equally harmful or that all should be banned or taxed, but that a diet like ours, in which 60 percent of our calories come from UPFs, is harmful.
Until SACN makes this clear, it will be impossible for policy makers to act. Globally, many other countries are taking strong measures, including France, Brazil, Israel, Mexico, Argentina and Canada. Even the United States is considering warnings about UPF consumption.
But even if money did not affect SACN’s advice, these conflicts of interest damage the committee’s reputation and credibility.
We are rightly concerned that politicians of any stripe accept money or favours. How then can the public trust a committee linked to companies such as Coca-Cola, PepsiCo, Nestlé or Unilever?
Perhaps most importantly, these conflicts enhance the reputation of the food companies driving the problem: an association with SACN creates much-needed respectability.
It may take several years to eliminate conflicts in the SACN, but a start can be made now: no new officers with conflicts should be appointed and those who do should consider resigning.
This will serve as an example for food charities and academic departments that currently receive payments from the food industry to also consider ending these relationships.
While the SACN is full of good and decent people (even those who take industry money, I’m sure, do so in good faith) and much of the advice given is scientifically accurate, I believe these conflicts have meant that the SACN has failed to frame the problem of obesity and diet-related disease as one driven by commercial incentives.
Until it is clear in the minds of all policymakers and the public that our obesity pandemic is being driven by a small number of enormously powerful corporations, we will not see an improvement in our health or an end to so much unnecessary suffering.
