GESTIÓN EN SALUD PÚBLICA: BioEdge: ‘Sugar War’ pits consumer choice against common good

domingo, 27 de mayo de 2018

BioEdge: ‘Sugar War’ pits consumer choice against common good

BioEdge: ‘Sugar War’ pits consumer choice against common good

Bioedge

‘Sugar War’ pits consumer choice against common good

by Michael Cook | 26 May 2018 |

In the 17th Century the Dutch Republic and Portugal fought a forgotten war lasting more than two decades over Brazilian sugar, in a conflict sometimes called the “Sugar War”. Nowadays the weapons in a new sugar war are less sanguinary, but the passions run just as high. At stake is the public health value of reducing obesity versus the freedom of industry to market high-sugar drinks and food.

Experts have been debating the role of sugar in a range of chronic disease since at least the 1960s. In 1972 journalist John Yudkin published a jeremiad against sugar, Pure, White and Deadly. But the demon of the day for chronic disease experts was saturated fats. The US sugar industry managed to smother critical research with industry-funded studies and advertising.

Now that we are in the middle of a world-wide obesity crisis (37.9% of American adults are obese, for instance), critics of sugar are again loading their muskets for an assault on “Big Food”. In February Lawrence O. Gostin, a Georgetown University expert in public health law, called for severe regulation of sugar in foods. In an essay in The Hastings Center Report, he sets out a strategy for tackling the problem. He first outlines the problem:

The real tragedy, of course, is the disability, suffering, and early death that devastates families and communities. But all of society pays, with the annual medical cost estimated at $147 billion. The causal pathways are complex—poor diets and sedentary lifestyles. But if we drill down, sugar is a deeply consequential pathway to obesity (and to dental disease), and the single greatest dietary source is sugar‐sweetened beverages (SSBs)—sodas, fruit drinks, energy drinks, and specialty coffees with added sugar, corn syrup, sucrose, fructose, glucose, or honey. Socioeconomic class drives SSB consumption, exacerbating unconscionable health disparities.

And then he suggests “sensible, effective interventions” to take on “Big Food”, drawn from the battle plans for attacking Big Tobacco.

Tobacco control offers a powerful model, suggesting that success requires a suite of interventions working in concert: labeling, warnings, taxation, portion sizes, product formulation, marketing restrictions, and bans in high‐risk settings such as schools and hospitals

Pushback against restrictions on sugar is strong and a number of initiatives have already sunk. New York banned sugary drink in portions larger than 16 ounces; industry sued, took its case to the state Supreme Court and won. Gostin attributes opposition, ultimately, to American attachment to notions like “personal autonomy, parental responsibility, limited government, low taxation, and free speech” – all of which are used by Big Food in its marketing:

America has placed the value of individualism on a pedestal, and the results mean that more people are coping with chronic diseases and dying prematurely. For the first time in history, the next generation may live shorter lives than their parents. Why not try another way, placing the common good as a high value? A good place to start is to take action against the major harms wrought by the pervasive presence of sugar in the American diet.

A later post on The Hastings Center website argues that Gostin did not go far enough. Theodore Bach, of Bowling Green State University Firelands College, argues that government-imposed restrictions on adult consumption will fail. But if opponents were to focus on harms to children, they would have far more chance of success.

Americans fervently defend individualism and oppose paternalism primarily in relation to adult decision-making rather than child decision-making. For example, even staunch libertarians can balk at legally permitting a 10 year old to get a face tattoo without parental approval or sign up for a tour of military duty.

He argues that food products (especially drinks) above a specific sugar content should be banned for minors – for their own good and for the long-term benefits to society.

Would restrictions work? Americans can look east, across the pond, to the United Kingdom where a Soft Drinks Industry Levy was passed in April. The Public Health Minister declared: “Our teenagers consume nearly a bathtub of sugary drinks each year on average, fuelling a worrying obesity trend in this country. The Soft Drinks Industry Levy is ground-breaking policy that will help to reduce sugar intake, whilst funding sports programmes and nutritious breakfast clubs for children.”

Time will tell if it works

Sunday, May 27, 2018

Ireland, which was once Europe’s most socially conservative nation, has voted to repeal the Eighth Amendment to its constitution in order to permit abortion. The vote was roughly 2 to 1 in favour of change, with nearly the whole country supporting it. Taoiseach (prime minister) Leo Varadkar reassured No voters. “Ireland will still be the same country today as it was before, just a little more tolerant, open and respectful.”

The legalisation of abortion comes hard on the heels of the legalisation of same-sex marriage in 2015. Together they suggest that Ireland is not the same country, at least not compared to 1983, when the Eighth Amendment was passed by a 2 to 1 margin. It is obvious that the country has “changed, changed utterly” in a single generation – although people will differ on whether this signals a “terrible beauty” or a terrible shame.

What is responsible for the turnabout? The decline in the prestige and power of the Catholic Church, which once was synonymous with Irish culture, surely has something to do with it. But there must be other reasons as well, as Ireland is simply treading the well-worn path towards secularisation which has swept across Western Europe. It’s worthwhile trying to understand the dynamics of the change, as the rise of bioethics itself is part of that secularisation. Otherwise we – Ireland and the rest of us – will fail to understand ourselves.

One example of the narrative which is being used to explain the referendum result is the image of Savita Halappanavar, an Indian migrant who died after asking for an abortion in 2012. It was used to show what happens to women who are denied their reproductive rights. However, abortion had nothing to do with her tragic death, a government investigation concluded in 2014. Instead, it was a perfect storm of medical negligence.

“We have voted to look reality in the eye and we did not blink," says Mr Varadkar about the referendum result. If he meant by these self-congratulatory words that Ireland is no longer living in a world of delusion and lies, he has obviously spoken too soon.