Citation needed — government excise tax on sweeteners extremely proper?

When an article gets published in a major medical journal that wouldn’t even past muster for a Wikipedia article, you know something’s up. And it’s a pretty good bet that it’s not sound science.

There were other clues, too. It was published online and the entire article offered for free to the public, with the journal’s standard $10 per article fee waived*. It wasn’t that the article was reporting major clinical trial findings of critical importance for medicine, either. It was an opinion piece. Its release was also coordinated to appear simultaneously with other opinion pieces in major media outlets — from ABC News to the Wall Street Journal — by the same authors. That’s marketing.

It was written for consumers and given the patina of medical authority by appearing in the New England Journal of Medicine. The authors were the health commissioner for New York City and the director of the Rudd Center for Food Policy and Obesity.

Citing alarming rates of childhood obesity, the authors called for large taxes on sugary drinks, claiming they “may be the single largest driver of the obesity epidemic.”

Citation needed

“Excess consumption of unhealthful foods underlies many leading causes of death,” their article began.

[Citation needed]

While this argument may have played well with lay readers and reporters, it didn’t with scientists or medical professionals.

There is no crisis of ill health and deaths necessitating the urgent implementation of government intervention for the sake of public health. The leading causes of death in the United States are diseases primarily of aging: heart disease, cancers and stroke — which have seen significant declines this past half century. In fact, age-adjusted mortality has been cut nearly in half since 1950. Nearly nine out of ten Americans report being in good to excellent health and the CDC’s National Center for Health Statistics reports that our life expectancy continues to reach record highs. In fact, according to government statistics, age-adjusted death rates for 11 of the 15 leading causes of death — heart disease, cancers, strokes, chronic lower respiratory diseases, accidents (unintentional injuries), diabetes mellitus, influenza and pneumonia, septicemia, intentional self-harm (suicide), chronic liver disease and cirrhosis, and hypertension — have all dropped significantly.

Clearly, our diets are not the death of us, even if we were eating as dreadfully as the special interests want us to believe, which we’re not. But there’s not even a link between “excess consumption of unhealthy foods” and the leading causes of death.

[That’s not to say that plenty of “healthy” plant foods — from apples, cassava, cherries, lima beans, potatoes to rhubarb — can’t be toxic if they’re not processed and you eat enough of them. And no one would argue with defining green, rotted, feces-covered foods as unhealthy — but that’s not what they’re talking about, of course.]

There is no credible science to support claims that foods underlie the leading causes of death. Despite the intense marketing of lifestyle medicine, even the world’s largest epidemiological studies have been unable to find tenable links (greater than chance) between Western diets, fats or sugars and 17 cancers, heart disease or diabetes.

Nor have any randomized controlled clinical trials of healthy eating and lifestyles (regardless of how that’s defined) — among nearly 9,000 studies examined in two Cochrane Collaborative systematic reviews, for instance — been shown to reduce or prevent type 2 diabetes. In fact, the results of every major randomized, controlled clinical trial of healthy eating and lifestyles — including the largest, longest and most expensive one in the history of our country — has failed to demonstrate any significant benefits for preventing chronic diseases of old age, such as diabetes, heart disease or cancers or improving cancer outcomes, or in helping people live longer. Nor has any healthy eating intervention been shown to give everyone a government-approved BMI.

“Enter the science,” the NEJM article authors, Kelly Brownell, Ph.D., and Dr. Thomas Frieden, M.D., MPH, wrote. “ Sugared beverages, more than any other category of food, have been shown time and again to be linked with poor diet overall and to risk for obesity and diabetes,” they said.

[Citation needed]

Repeating these popular myths gave away that this article was written for reporters, politicians and a lay public, not medical professionals.

The popular belief that eating sugar or eating bad foods cause “sugar” diabetes is one medical science long ago dismissed. “In this day and age, I still get patients who believe that they developed diabetes from eating too much sugar,” said Dr. Gerald Bernstein, M.D., of New York City and former director of the Beth Israel Health Care Systems Diabetes Management Program. “Bad eating habits such as too much refined sugars, empty carbohydrates and fructose do not cause diabetes.”

Medical research for more than half a century has continued to find no correlation between added sugars, regardless of their form, and obesity or age-related chronic diseases like diabetes or cancers. And those findings are not from the food industry, but the conclusions reached by every expert entity that has examined the evidence. As reviewed in the Science of sweets , for instance, governmental agencies such as the FDA’s expert Sugar Task Force had been commissioned to conduct a comprehensive review of epidemiological, clinical and animal studies on sugars in response to repeated scares raised by special interest groups. It specifically examined and rejected hypotheses that sweeteners play a causal role in “glucose tolerance, diabetes mellitus, lipidemias, cardiovascular diseases (hypertension and atherosclerotic coronary artery disease), behavior, obesity, malabsorption syndromes, food allergies, calciuria-induced renal disease, gallstones, nutrient deficiencies, and carcinogenicity.

The Joint Report prepared by the World Health Organization and the United Nations Food and Agriculture Organization also found no evidence that sugar consumption is a causative factor in any disease, including diabetes and coronary heart disease, or obesity.

One of the largest and most in-depth dietary research studies in the world on growing children from infancy to adulthood specifically examined refined added sugars and carbohydrates and the development of body fat. Researchers with the Dortmund Nutritional Anthropometric Longitudinally Designed (DONALD) Study found no relationship between the added sugars, dietary fiber, glycemic index or glycemic loads, the children consumed while toddlers at age two or throughout early childhood, and their percentage of body fat or BMIs at age seven. These null findings held regardless of how they analyzed the data (cross sectional, prospective, and changing each dietary variable). Without even a link, then scientists know that it's without merit to consider them as possible causes.

After reviewing the evidence, the 1996 American Heart Association Scientific Statement for healthcare professionals concluded: “Studies of diet composition in children do not identify the cause of obesity in youth.”

The bottom line is that regardless of their diets or physical activity, children naturally grow up to be a wide range of heights and body weights. The strongest body of both clinical and epidemiological research has continued to show that fat children as a group normally eat no differently than their thinner counterparts. An earlier DONALD study had clinically followed children, weighing them and recording their diets at least ten times a year and followed them thusly for 17 years. It found that no matter what the children ate during childhood or adolescence, they naturally grew up to be a wide range of weights. While there were great differences in the children’s diets, these differences weren’t at all related to their weights.

Sweeteners have been studied more than any other food ingredient in history and the exact same scares surface over and over again, given more elaborate spins with every decade, while the science re-examines the fears over and over again. Sadly, the evidence on sweeteners (here, here, here, here, here, and here) rarely breaks through popular discourse.

Fears of sweeteners and beliefs that sweets are empty calories or mean poor diets, for instance, defy a poor understanding of biological science. In the real world setting, there is no evidence of micro-nutrient deficiencies due to excessive sweets, as Dr. David Benton, BSc, Ph.D., at the University of Wales Swansea in the UK explained. “Added sugars have little or no association with the diet quality of individuals over the age of two years, children or adults,” he said. The effects of sugar on micro-nutrients are “always so small as to be of no clinical significance.” There are simply “few grounds for concern,” he outlined. “After considering obesity, behavior, and a range of other disorders, an American expert report found that there was insufficient evidence to set a tolerable upper limit for the intake of total or added sugars (Food and Nutrition Board, 2005).”

“The strongest science exist on soda and sweetened beverages,” said Brownell and Frieden. “For each extra can or glass of sugared beverage consumed per day, the likelihood of a child's becoming obese increases by 60%,” they wrote.

Here, they gave a citation.

This is the strongest science for soda’s role in childhood obesity. It’s also the most often cited study in support for soda’s role. Yet, no reporter or peer-reviewer at the NEJM ever bothered to it look up and read it. As JFS readers know, it had actually disproved a link between soda and obesity! It was published in 2004 and had found no difference in the BMIs of children consuming the most and the least amounts of sugar or sugary drinks after 18 months. In the discussion section of the study, the researchers had even noted “there is no clear evidence that consumption of sugar per se affects food intake in a unique manner or causes obesity.”

Clearly, this NEJM opinion piece wasn’t about science or health, even though it appeared in a medical journal and was given wide media coverage. Based on the belief that sugary drinks were bad, they argued that government officials needed to take drastic action to penalize its consumption to coerce people to eat “healthier” and that taxation was the best way to accomplish that. It would be “a grand slam,” said Brownell, generating money for government and prevent obesity and diabetes.

They didn’t want a sales tax, though, but “an excise tax of a penny per ounce would be better.” Quoting Adam Smith, they said sugar, like rum and tobacco, is not a necessity of life and is universally consumed, making sugary drinks “extremely proper subjects of taxation.” Their argument paralleled that of the New York Department of Health and Mental Hygiene a few months ago when New York Governor, David Paterson, proposed an 18% obesity tax on sugar-sweetened drinks.

That one didn’t hold up to scrutiny, either.

© 2009 Sandy Szwarc

* This is the same journal that had not too long ago booted out its editor-in-chief who’d objected to the medical journal name being sold for brand marketing.