When I was at medical school in the 1990s, it was totally normal to have our lunch paid for by drug-company sales reps. We’d eat their sandwiches and they’d give us branded pens and mugs.
None of us thought it affected our prescribing but, of course, there’s no such thing as a free lunch. The evidence shows that their gifts swayed us to prescribe their drugs preferentially, leading to inferior and more expensive prescribing.
The pharma industry still pays around £40million per year to UK health professionals, but at least the body that determines whether the drugs themselves are safe, the MHRA, is free of these conflicts of interest. People who regulate drugs obviously shouldn’t take money from drug companies.
This pandemic is driven by the fact our diet is mainly made up of pre-prepared packaged food that’s high in calories, fat, sugar and/or salt; aka ultra-processed food or UPF
You might expect that the situation would be similar with food. But it isn’t.
There are a number of government bodies which regulate different aspects of our food but the last word in what is healthy or unhealthy comes via the Scientific Advisory Committee on Nutrition, or the SACN, which was created in 2000.
It is one of the most important government bodies that regulate food because it literally defines what constitutes a healthy diet and advises on policy. It has produced dozens of reports on every aspect of diet, nutrition and health.
Over the lifetime of the SACN there has been an explosion of suffering and death from diet-related diseases such as obesity and type 2 diabetes. Our statistics are some of the worst in the world.
This pandemic is driven by the fact our diet is mainly made up of pre-prepared packaged food that’s high in calories, fat, sugar and/or salt; aka ultra-processed food or UPF.
In other words, the problem is caused by the industries that sell and market us harmful food. This is not in dispute. No one serious thinks that we’re cooking worse food at home.
Any reasonable person would expect that the SACN’s experts are independent of food-industry financial influence. Shockingly, the opposite is true.
An analysis in The BMJ this month revealed that more than half of the experts on the SACN have conflicts of interest with ultra-processed food companies such as Nestle, Unilever (the world’s largest ice cream producer), Coca-Cola and PepsiCo.
One member alone has Unilever shares worth more than £5,000, as well as doing consultancy work for Tate and Lyle and Coca-Cola’s Israel franchise. Another SACN member chairs an expert group at the International Life Sciences Institute Europe, which is funded by PepsiCo and Cadbury’s US owner Mondelez, among others.
It’s important to say that these members have broken no rules. And this is the problem. Despite universal acceptance that the pharma regulator should be free of industry influence, these conflicts are still allowed and considered acceptable at the SACN.
A spokesperson for the Department of Health and Social Care told The BMJ: ‘No members of the committee are 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 the industries that sell and market us harmful food. This is not in dispute. No one serious thinks that we’re cooking worse food at home,’ writes Dr Chris Van Tulleken
Why should we be concerned? Because a huge body of evidence on financial conflicts of interest suggests that this just isn’t possible and, in my view, these financial relationships do affect the reports that the SACN produces in subtle ways that favour industry. And I’m not the only one.
Rob Percival, head of policy at the Soil Association, told The BMJ: ‘There’s now really good evidence that conflicts of interest at the interface of science and policy can skew either specific policies or public narratives in favour of the food industry in ways which undermine public health.’
And, in a private conversation with me, an unconflicted committee member expressed that they also feel that these conflicts do affect the committee’s reports.
The most obvious effect is that the SACN reports are quiet on the role of the food industry in driving health harms: the fact is that our increased intake of calories, salt, fat and sugar has come from industrially processed, packaged goods, yet its report on sugar fails to emphasise where the increase in our diet has come from.
Staggeringly, in more than 20 years of work it has never produced a report on the cause of population obesity.
A stark example is last year’s report, ‘SACN Statement on Processed Foods and Health’. The government’s Office for Health Improvement & Disparities labelled this document an ‘independent report’, but the reality is very different.
The report looked at whether UPFs harm health. UPFs make up more than half of the calories in our UK diet. They’re typically high in calories, salt, fat and sugar and they’re made using processes and additives only used by industry.
Some is obvious junk, but lots of our staples are UPF – supermarket bread, most breakfast cereals, ready meals and so on.
Our nation is suffering a dietary catastrophe – one which many doctors and scientists like me believe is primarily driven by the food industry’s constant marketing of UPFs. The SACN’s report did not entirely dismiss concerns around UPF, but it seemed to me that it echoed many of the views promoted by the food industry and the scientists they pay.
In the view of the SACN, almost all of the research is ‘observational’ and the evidence to date needs to be ‘treated with caution’.
It pointed out that consumption of ultra-processed foods may be an indicator of other unhealthy dietary patterns and lifestyle behaviours. This is almost certainly true, but the studies are clear that this is not the only problem.
Detailing the full body of research showing that UPF causes harm is beyond even a large academic review.
There are more than 80 of the type of studies that linked smoking to cancer, as well as hundreds of experimental studies on the additives and properties of these food products and the way they’re marketed.
The link between a diet high in UPF and harm to human health is strong and consistent across studies in different populations and countries.
Whenever a country switches from its traditional diet to one based on UPFs, its rates of diet-related diseases and premature deaths subsequently soar. Importantly, there is no other good explanation for the rates of illness we see in the UK. Indeed, the SACN’S cautious view differs from many experts globally who are clear that a diet high in UPFs does harm human health.
This is not saying that all UPF is equally harmful or that it all needs to be banned or taxed, but that a diet such as ours where 60 per cent of our calories come from UPF is harmful.
Until the SACN says this clearly, it will be impossible for policy makers to act. Globally many other countries are taking strong action including France, Brazil, Israel, Mexico, Argentina and Canada. Even the US is considering warning about UPF intake.
But even if the money didn’t affect the SACN’s advice, these conflicts of interest damage the reputation and credibility of the committee.
We are rightly concerned when politicians of any stripe accept money or favours. So how can the public trust a committee with links to companies like Coca-Cola, PepsiCo, Nestle or Unilever?
Perhaps most importantly these conflicts enhance the reputation of the food companies driving the problem – an association with the SACN creates much needed respectability.
It may take several years to deconflict the SACN, but it can start now: no new appointees with conflicts should be made and those with conflicts should consider stepping down.
This will set an example for the food charities and academic departments currently paid by the food industry to consider ending these relationships, too.
While the SACN is full of good, 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 the SACN has been unable to frame the problem of obesity and diet-related disease as being driven by commercial incentives.
Until the fact that our pandemic of obesity is driven by a small number of vastly powerful corporations is clear in the minds of all policy makers and the public, we will not see an improvement in our health – nor an end to so much needless suffering.
