E249: History fact check - Impact of Corporate Influence on Research

Study after study has shown that consumption of sugar sweetened beverages poses clear health risk. So how have the big soda companies, Coke and Pepsi in particular, reacted to this news and to public health policies that have aimed to restrict their business dealings like marketing, labeling, and even taxes? A fascinating and important part of this history has been told in a new book by Dr. Susan Greenhalgh called Soda Science: Making the World Safe for Coca Cola. Dr. Greenhalgh is the John King and Wilma Cannon Fairbank Professor of Chinese Society Emerita at Harvard University. But hold on, what in the heck does China have to do all this? Well, we're about to find out. This will be a very interesting discussion.

Interview Summary

Let's begin by setting the context for your book, again, on soda science. Back in 2015, the New York Times published a major expose, written by Anahat O'Connor, and a critique of what was called the Global Energy Balance Network (GEBN), that was funded by Coca Cola. Could you explain what this network was?

Sure. The GEBN was an international network of researchers that argued that the energy balance framework is the best approach for addressing the obesity epidemic. So that simple framework calls for balancing the energy in - the number of calories consumed through eating with a number of calories burned - through moving to achieve a healthy weight. While that sounds neutral in practice, in the early 2000s, Coke and the food industry at large, adopted energy balance as their motto. It had several advantages. One is under the banner of "energy balance," the industry and the scientists working with it could say that people could eat whatever they wanted and then exercise it off. Unfortunately, that doesn't work for most people. Second, in practice, the energy balance slogan was used to promote exercise as the priority solution. What the research shows about energy is that exercise helps, but the primary answer to the obesity issue is to eat fewer unhealthy foods. Now the third advantage to the energy balance framework is that talking about energy balance meant the companies and the GEBN didn't need to mention soda taxes, or other legislative and regulatory measures, that worked but that might hurt the industry.

So, in my book, I call this body of ideas adopted by the GEBN and the food industry “Soda Science.” That's short for Soda Defense Science - a science created not so much to understand obesity, as to defend the profits of the soda industry.

Okay, that all makes sense, and I totally agree with your interpretation of the science that food intake is much more important in the obesity epidemic, in particular, than physical activity. It's not that activity is unimportant, but to divert attention away from the dietary part of it is really a public health misdeed. But one can obviously see the benefit to the industry for making that diversion. So, in that 2015 article, it was highly critical of the conflicts of interest that had been created by the soda industry paying prominent scientists. What benefits did the company reap from making these payments and what happened after that article got published?

The GEBN was the product of the 15 years that came before it, of gradually building up this soda science. The GEBN itself lasted only about a year, but during that 15-year period, the industry benefited by having fewer people, fewer specialists, fewer countries talking about soda taxes. But what happened after the GEBN was outed in the New York Times in late 2015 was Coca Cola was absolutely mortified. The revelation that the company had paid for industry-friendly science was just incredibly embarrassing. So, under absolutely withering criticism from scientists and the public, Coke stopped funding the GEBN, which of course led to its collapse. The company also took a major turn in its approach to obesity. Vowing to no longer single-handedly fund scientific research, and by publishing a long so-called transparency list of all the individuals and organizations it had funded over the last 5 years.

So, those things helped, but Coke's reputation remains tarnished to this day. But meanwhile, as for the academic scientists behind the GEBN, they saw things differently. They continued to maintain that their science had not been affected by the 20 million dollars that Coke had promised to support their network. Of the four researchers who led the GEBN effort, two stepped down and found wonderful jobs elsewhere. They both have leadership positions in different universities. One retired and the fourth continues to work in his previous position. So, there was no single, discernible impact on these debates within the academy.

I know some of the individuals involved. And by the way, I know a good bit of information available to understand what this network was doing came from Freedom of Information requests that various parties made. And your book contains transcripts from emails and things like that, that these various scientists were sharing with the industry. The content of those is extremely interesting and very telling. And the result, it's sort of this good-old-boy-back-slapping-network of people who were kind of winking - let's go get the people that don't like us. It's just interesting. My impression is that some pretty negative consequences befell at least two of those academics afterwards. You know, there was a lot of embarrassment. One basically, I think, had to leave the job he had. Another, suffered some real penalties in his academic life. And so, it wasn't outcome free, or it wasn't penalty free for these scientists at the end of the day. But I do think that your basic point is well made. That lots of people take lots of money from lots of industries on lots of topics. Not just on food, but you know energy and environment and all kinds of things. And very rarely do they pay any kind of a penalty. It only took this investigative report by the New York Times to shed special light on how pernicious this particular one was. But let me ask you a question, and then I kind of have my own thoughts about it. Why don't you think anything more happened to the people that got caught? I don't know if caught is the right word. But at least that they're taking industry money and their favorable science for industry got exposed. Why don't you think more happened about that?

The scientists themselves were deeply convinced that they hadn't done anything wrong. They were convinced that their science was not affected by all the money that they had taken from Coke, and the scientific nonprofit working for the industry, over all those years. I think there's a significant fraction of folks in the public health field, or at least in the obesity research field, who think the same thing. There's just a lot of support for them. As I see it, the two people who lost their original jobs have bounced back. I haven't done a survey of the field to ask people what they feel about these researchers, but they did pretty well given what they did.

The reason I think that they're convinced that they didn't do anything wrong is they have these practices, I call them “doing ethics,” to assure the world and themselves that their scientific integrity is intact. And one of the practices that these guys used was to constantly say, "This problem of obesity epidemic, it's huge. We have to include the food industry as our partner." And then when you go there, food industry begins to have a huge voice and there's very little you can do to effectively restrain it.

You know, it's an interesting way to think about it and consistent with the way I've thought about it over the years. I've done some writing on this topic and it seems to me that scientists have, not all scientists by all means, but a few select ones, get sought out by industry. And then this blind spot ensues where if you ask these scientists sort of, in general, does research get tainted or affected by industry money? They'll say yes. But if you ask does YOUR research get tainted by it? They'll say no. ‘Oh, no, I'm above that. I can be objective We have to change from within.’ There's a whole series of rationalizations for taking the money. But do they ever stop and ask, why is industry investing this money? And industry is not stupid. They wouldn't be paying you $50,000 as a consultant, or putting you on boards, or flying you around the world, or funding your research if there was no return from it. And the research on it is absolutely clear. Industry-funded research typically finds industry favorable results. So, all that's been documented. But the scientists who want to get involved with industry and take the money don't kind of interpret it that way. Like ‘I can take money but be free of the temptations to bias the work I do.’

May I just interject something here? I think that they believe it's a win-win prospect. Of course, Coke wants to emphasize exercise to make people forget about their sugar. But I've just dug long and hard into those emails, which none of the scientists ever thought would be read and used in scholarly accounts. But in the emails, the leader of the GEBN wanted to fund a major research project that he was promoting, and he's arguing all the reasons that Soda Science was good for Coca Cola. I suspect that he thought that Coke wasn't influencing him. Instead, he was influencing Coke. And in fact he was, but it doesn't matter where the influence comes from because in the end the science is affected.

You know, I've often asked myself, if there are negative consequences from this, the question is isn't there a police force out there looking after this kind of thing? And it's hard to know who that would be, because the scientists themselves have shown that enough of them are willing to take the money. And so the scientists aren't policing themselves sufficiently. Their institutions, the universities, tend not to do it because they're taking money from industry, too, in some way, generally. And their university's response to that is you have to disclose that you're taking money from industry. But there's research on disclosure, and that seems to make things worse rather than better. The journals that people publish their work in do the same thing. They make people disclose, but that doesn't have much impact. And professional associations have been investigated every which way by one of the same people who wrote that article in 2015, showing that they take money from industry. So, how can they police their members? So, it seems to me that the police have to be the press and people that do investigative scholarly work like you've done in this book. The book is pretty new. So, it's a little early to say what its impact is going to be. But let's hope that a lot of people read this book. And get more insight into how this works, how people feel when they're involved in this money taking, and what the ultimate impact might be.

So let's turn to one particular area of expertise you have. Let's talk about China. So almost all the criticism on industry-funded efforts like the Global Energy Balance Network have been focused on the U.S. But you follow the soda trail to China. So why did you do that and what's the significance of this inquiry?

Really significant. The GEBN was part of a much larger corporate project that was absolutely global in scope. So, from the vantage point of the industry, the U.S. has long been a declining market for soda. The important markets for sugary drinks are the large rapidly developing countries in the Global South. So that's where the industry is focusing its efforts to sell product, that is junk food and drinks. And to promote a corporate science and corporate policy that stresses exercise over dietary change in soda taxes.

China has 1.4 billion people these days. One billion back in 1980 when Coke set up shop in China. China was the single biggest market for the soda companies. Coke was so keen to get into the China market that it started lobbying early. Actually the mid 1970s, when Mao Zedong was still alive. And in 1978, Coke became the very first Western company to set up shop in China as the country opened up for the first time in 30 years to the market, into the global economy.

And another advantage of the Global South, from the point of view of the food industries, is an attitude toward Western firms that's less critical than what you find in the U.S. In the U.S., huge companies are always under suspicion that they will promote corporate interests over socially valued goals. So those attitudes are much less prevalent in many countries in the Global South where big companies are often seen as agents of development, essential agents. In China, big Western companies were celebrated as sources of capital and advanced interests. So, nobody would suspect they were hurting the country. And the industry has lots of ways of dressing this up in a self-serving, positive way, by talking about developing emerging markets, investments in the developing world, and things like this. But it strikes me also as being stunningly similar to what the tobacco companies did when they got hammered in the United States. They simply moved outside the United States and tried to sell as many cigarettes as beyond our borders as they could. And a lot of these same sort of phenomenon take place. Does that seem true to you?

Absolutely. So let me ask what actually occurred in China. So, Coke sets its sights on China. It has this kind of process established that's trying to affect policy through connections with scientists. So, what actually took place in China? What was the impact on policies?

Well, to understand that, we need to know that the food industry had a magic weapon way back in the late 1970s. The food industry created an industry-funded scientific nonprofit based in DC that was global in scope. And whose job was to sponsor science that served industry needs. Its name was ILSI (International Life Sciences Institute). So, in China, the local branch of ILSI organized a series of major conferences and other activities designed to combat obesity. Over time, the proportion of these anti-obesity activities focusing on exercise rose dramatically, while the proportion focusing on diet sank.What this shows is that the food industry had tilted China's approach to obesity. ILSI China also played a major role in creating China's first and most important policies on obesity. The most important was the National Campaign for Healthy Lifestyles, ironically modeled after the patriotic health campaigns that Mao used to promote in his day. So, that healthy lifestyle campaign drew heavily on the Soda Science created by Coke, ILSI, and their academic friends. So, that ‘healthy lifestyle’ campaign prioritized exercise in a number of ways. Said nothing about sugar and soda. And it made the individual, not the government or industry, responsible for fixing the obesity problem. So, with this campaign, ILSI China had smuggled the policy favored by the food industry into China's policies.

That's an amazing history that you've documented. And it occurs to me that in the United States, we can celebrate public health victories, like the huge decline in cigarette smoking that occurred. And, the big decline that's occurred in sugared beverage consumption too. And those things are all good. But if this is like a balloon and you're just squeezing the end of it here, but it expands elsewhere in the world, the overall public health impact could be even worse than when you started, not better. And it sounds like the industry-funded front groups have been pretty responsible for making that happen.

Yes, they're incredibly effective. In my view, I really took apart ILSI, looking at it as an organizational sociologist. And I think it's just brilliantly designed to make academic-looking science that benefits industry. And to keep everything hidden from sight under that label nonprofit. It's really quite brilliant. They're not very happy with this project.

And the work that you've done, and the investigative journalists have done in the U. S., to expose these industry ties can have traction in the U. S. much more so in a country like China. So, it sounds like there's probably not much to put the brakes on this kind of thing in China. Is that right?

To tell the truth, there's a younger group of obesity experts, trained in the U.S., who now are based in China and have written major articles. There was a three-part series in The Lancet in 2021 on obesity in China. And they are on board with a critique of the food industry and working in every way they can to bring that to the attention of officials. But the government has a vested interest in the success of Coca Cola. I have to say that Coca Cola, and there's a huge state-owned enterprise called COFCo, they now have a partnership called COFCo Coca Cola, that runs the bottlers in 19 provinces, representing something like 60-70 percent of the Chinese population. So, the government has a vested interest in making sure Coca Cola remains happy.

Let's talk about that just a bit more. So, Susan, you'd think that the Chinese government would be in a conflicted position with this. On one hand, they want to financially benefit from Coca Cola prospering in their country. And I'm sure officials are benefiting individually from that kind of thing. But the country doesn't benefit because they certainly don't want high rates of diabetes and heart disease and obesity and other things that come from consumption of these products. How do you think that that plays out? Is it just that the short-term financial benefits are prevailing over the longer-term health consequences?

I think the government is highly conflicted. It has a number of policy, overarching policy themes, that it has been promoting ever since opening up in the late 70s and early 80s. One of those themes is marketization, growing the economy, advancing the technology in high end industries. And nothing can interfere with the achievement of that goal. China is known around the world for having very sophisticated environmental policies. But when push comes to shove, market goals prevail over environmental goals. I think the very same thing happens with health. It's just astonishing to see how market forces and market logics pervade the health sector. I did a separate piece of research, it's not in this book. But it shows that the major western food companies have been partnering with the Chinese government to carry out China's policies on chronic disease. And that means they're teaching the Chinese people basic notions of good nutrition. And what they're teaching them is not that soda is bad, is that, you know, it's that you can drink soda as long as you go ahead and exercise at all. I think there are major fundamental conflicts here at the level of profound party policy. I think this is going to be very hard to address.

I was going to say that's just a stunning observation. That part of the food nutrition education has been turned over to the food industry.

Absolutely. And you can, you can read about it in the Chinese media every year. They have, it's called Food Week or Nutrition Week, that's sponsored by the Chinese Nutrition Society, which is nominally independent. And they invite Western food companies to come in and sponsor a big project within that week. And of course they're very happy to do it.

Unbelievable. So, a chapter of your book is entitled Doing Ethics, the Silent Scream. What do you mean by that?

Let me start with just a little bit of background. So, in China, the head of the ILSI branch operated as a virtual health ministry official. Kind of a de facto part of the government. So, no one could question what she did, part of the government, no questioning the government. As I just mentioned, most of the scientists I interviewed believed that Coke and other food and beverage companies were positive forces in China. They loved Coke's corporate social responsibility programs and had them all in their head and regaled me with these stories of schools in the rural areas supported by Coke. They thought everything was above board. They thought that ILSI's science was objective or disinterested. They couldn't imagine that Coke was supporting policies that benefited the corporate bottom line while harming the health of the Chinese people. Now, getting to that chapter, some very senior scientists, folks who had worked in the field before money came to dominate everything in China, they knew in their hearts that the food industry was corrupting China's science and policy. But it was very dangerous for them to talk about it. They certainly didn't volunteer those feelings to me. But when I began to ask really probing questions, they quietly acknowledged that yes, of course, corporate funding shapes the science. But the whole subject caused them just incredible angst. They couldn't talk about it. They certainly couldn't talk about it in public, and they couldn't do anything about it. And so, they issued a silent scream. And this is a really important part of the story of China. There really are voices of resistance, voices that see through the official line that everything's being done correctly. The readers of this book can hear that silent scream in that last chapter.

That's a pretty, pretty amazing story. Well, you know, it's heartening in a way that in a country like China, where the government controls so much of what day to day life is like, that there is some activity. At least some pushback, some resistance. So, let's hope ultimately that the objective science prevails. That the industry influence wanes, and the public health will be protected. So, speaking of chapters in your book, the last two chapters are titled, Soda Science Lives On. And then the final chapter, So What and What Now. Tell us more.

Oh sure, I'd love to. Soda Science Lives On: that's like the conclusion to the China part. I show how, even to this day, the provisions of Soda Science continue to shape China's policies on obesity and chronic disease more generally. In the last decade, President Xi Jinping has stressed the importance of including health in all policies, which is good. But a close look suggests that his signature policy package, that's called Healthy China 2030, bears the imprint of the Coca Cola company and -promotes ILSI's trademark exercise programs that omit soda taxes. And have a strong market orientation that makes individuals, again, not companies, not even the government, fundamentally responsible for maintaining a healthy weight through their healthy lifestyle choices. This, of course, neglects the importance of China's obesogenic environment and the impact of that environment on the choices available to individuals. So, this part of the book also introduces a group of next generation Chinese scientists who understand the threat posed by big food constantly lobbying the government to introduce policies to restrict its power.

I've talked about the impact on China, but I'm also very interested in the impact on America, especially American fitness culture. In the book's conclusion, what I do is I take the short history of Soda Science. And I place that in the context of the much larger history of the post-World War II history of American fitness culture. What I suggest is that Soda Science was instrumental in creating today's Fitbit wearing, step counting, exercise and obesity-obsessed culture that assumes that exercise by itself can take off pounds. That 10,000 steps a day is going to solve all my problems. It won't, but the idea is very much part of our everyday thinking about obesity. There's a lot of work to do.

As we all know, those big food companies are some of the wealthiest and most powerful forces in the world. Way richer than any of any fields of science in America. For critical scientists and social scientists, the effort to chip away at their power through the power of expose and documenting the truth often feels quite futile, time consuming and useless. But in fact, our work can make a difference. And I document this in the book. In the last few years, Coca Cola cut its ties with ILSI. That is big because Coca Cola was the founding company behind ILSI. Two other companies have also dropped ILSI. ILSI itself has also undergone a major reorganization and this is big - ILSI China has dissolved. It is no longer.

I'd like to think that the in-depth research of the social sciences has exposed what is really going on and left these corporate science organizations little choice but to close shop, or fundamentally change how they work. That's my secret dream. So this, this is progress, yes, but the food industry is still at it, for sure. Especially in the Global South. The industry is focusing its energies on defending junk food and drinks by opposing regulatory measures that have proven successful. You know, taxes, front of package warning labels, marketing restrictions and so on. So even in countries that have developed, often with the assistance of American researchers, really impressive chronic disease prevention programs, the industry has been moving aggressively to weaken, delay, or block them. Our work has just begun. And I really hope some listeners will be, will be encouraged to join the force of all of us working to expose and change how things are happening.

BIO

Susan Greenhalgh is John King and Wilma Cannon Fairbank Professor of Chinese Society Emerita in the Anthropology Department and Fairbank Center for Chinese Studies at Harvard University. A former Guggenheim fellow, she is a specialist in the social study of science, technology, and medicine, especially as these intersect with questions of policy, governance, and the state.

Her latest book, Soda Science: Making the World Safe for Coca-Cola (2024), uncovers the secret strategies by which Big Food, working with allies in academia, created an industry-friendly, “soda-defense” science of obesity that argued that the priority solution to the obesity epidemic is exercise, not dietary restraint, and that soda taxes are not necessary – views few experts accept. For 15 years the “soda scientists” were highly successful in promoting these ideas, eventually getting them built into Chinese policy, where they remain today. An earlier study of the American obesity epidemic, Fat-Talk Nation: The Human Costs of America’s War on Fat (2015), illuminates some of the unexpected consequences of the national panic over obesity for the bodies, lives, and selves of vulnerable young people. Under the Medical Gaze: Facts and Fictions of Chronic Pain (2001) presents a case study of iatrogenic injury, illustrating medicine’s power to define disease and the self, and manage relationships and lives, and sometime induce suffering.