Coke’s Opaque “Transparency” Campaign
Coca-Cola has reneged on its promise to fully reveal its health and science funding. A previous article exposed the loopholes that Coke uses to hide the scientists and organizations it funds. And the constant unexplained changes to its database leaves even its current entries in doubt. Nonetheless, Coke has given the public a peek at some of the money it directs towards some scientists and health organizations.
Perhaps the most surprising entries in Coke’s diabetes dollars database were for the foundations associated with the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). Over the past few years, the public has become more aware of the perils of scientific fraud and corruption. Citing the Center for Public Integrity’s Science for Sale series, Senators Elizabeth Warren (D-Massachusetts) and Richard Blumenthal (D-Connecticut) recently wrote a letter to NIH Director Francis Collins asking that PubMed require “disclosure of funding sources or other activities that could present a conflict of interest.”
If conflict of interest is a problem for articles published by NIH, how is it not a problem for the NIH itself? Yet the press has granted these particular “partnerships” between Coke and the NIH and CDC Foundations very little scrutiny.
Is it really appropriate for the CDC and NIH Foundations to be engaged in a long-term “partnership” with Coca-Cola?
The Numbers: Coca-Cola’s NIH and CDC Payments
Coca-Cola has paid the CDC’s Foundation at least $1,072,431 since 2010. Coke recently deleted a million dollars worth of CDC Foundation funding, alleging there were “duplicate entries.” Over 85 percent of Coca-Cola’s CDC funding went towards “NCD prevention.”
NCD stands for non-communicable diseases, also known as chronic diseases. Think of type-2 diabetes and heart disease. According to the CDC,
Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic diseases accounts for 86% of our nation’s health care costs.
One might also refer to NCD’s as “Diseases related to Coca-Cola products.”
As for the NIH Foundation, Coca-Cola has paid it at least $1,750,490 since 2010. Some of Coke’s money went towards “Understanding Nutrition Related Consumer Behavior.” In other words, Coca-Cola paid the NIH to better understand how consumers decide what to eat. Coca-Cola’s interest in this field is easily intuited.
Coca-Cola also directed its NIH funding towards a “US-Russia Collaborative Program in the Biomedical Sciences.”
Thanks to Coca-Cola’s generous gift, those Russian scientists studied “Physical Activity, Energy Balance and Health” at the NIH. It’s worth mentioning that The New York Times has exposed how Coca-Cola uses the “Energy Balance” concept to divert attention away from the health risks of its products.
Through its Diet Coke brand, Coca-Cola has partnered with the National Heart Lung and Blood Institute (NHLBI), an office of the National Institutes of Health, to promote The Heart Truth, the agency’s heart-health campaign for women. Some see this partnership as a Coke attempt to steer attention from the role that its sugar drinks play in promoting heart disease. In February 2013, Diet Coke partnered with NHLBI to feature the group’s Heart Truth logo on six billion cans to raise awareness of American Heart Month.
Technically, Coca-Cola has paid the 501(c)(3) foundations of the NIH and CDC, not the NIH and CDC themselves. It’s unclear if this technical distinction means anything practical, however. For example, the NIH Foundation funds NIH research directly. And the CDC Foundation “raises private funds to support the work of the CDC.” Therefore Coke money funded the NIH and CDC, through their Foundations, in the context of a long-term “partnership.”
Coca-Cola has directed its NIH and CDC funding towards studying the health consequences of its products. How is this different from Big Tobacco funding the CDC’s lung cancer prevention efforts? Or Big Sugar funding NIH tooth decay research?
What Could this Mean for Nutritional Research?
Nutritional research comes in two flavors: industry-funded and independently-funded. Industry-funded research comes with an obvious conflict of interest. See below:
In contrast, independently-funded research is often considered the gold standard of nutritional science. In 2010 it was reported that,
The National Institutes of Health (NIH) holds the majority of US government research spending on nutrition and obesity at roughly 1.4 billion and 700 million, respectively.
Much of the “independent” funding for nutritional and obesity research comes from the NIH and CDC. If the NIH and CDC receive Coca-Cola funding, how much nutritional research truly remains independent of industry influence?
The CDC: From Malaria to Diabetes
Before we examine the implications for nutritional research, let’s take a look at the CDC and NIH. In 1946, the Communicable Diseases Center was founded in Atlanta, Georgia. The CDC developed out of a World War 2 Malaria control program, and from the outset, opaque Coca-Cola funding was crucial.
In 1947, Coca-Cola President Robert Woodruff’s anonymous gift permitted the CDC to buy 15 acres from Emory University to build a headquarters. Coca-Cola reports,
Mr. Woodruff worked behind the scenes … There was rarely a paper trail or a smoking gun behind his good deeds.
To this day, CDC’s HQ remains on the land Coca-Cola’s President purchased. And Coca-Cola has faithfully continued Woodruff’s donation style.
In 1988, the CDC opened its National Center for Chronic Disease Prevention and Health Promotion. And in 1992, the US Congress changed the CDC’s name to the Centers for Disease Control and Prevention. Originally founded to prevent the spread of infectious diseases, the CDC has widened its focus to address a more rapidly-spreading epidemic: chronic diseases.
While a close relationship with Coca-Cola may have made sense when the CDC was fighting to contain malaria, it’s a different situation now that the out-of-control epidemic is type-two diabetes.
The NIH: The World’s Largest Funder of Research
Headquartered in Bethesda, Maryland, the NIH dwarfs the CDC. It is the “single largest source of funding for medical research in the world.” With an annual budget of over $30 billion, it consists of 27 distinct Institutes and Centers, including the aforementioned National Heart Lung and Blood Institute (NHLBI).
While the NIH does conduct its own research at its Intramural Research Laboratories, it mainly funds external research. Its website notes, “80% of the NIH’s budget goes to more than 300,000 research personnel at over 2,500 universities and research institutions.”
As mentioned above, the vast majority of deaths and healthcare spending in the US are related to chronic diseases. NIH’s funding decisions, however, do not yet reflect that reality. As Yach et. al noted in 2010, NIH funding levels for nutrition and obesity research,
fall short of the levels provided for research related to infectious and emerging infectious diseases, bioengineering, and others. Further, the major outcomes of NIH nutrition and obesity research often lead to new medication or surgical solutions as opposed to sustainable food-based solutions. This mismatch between where R&D resources are spent contrasts with recommendations of a global and diverse set of experts who have identified the top 20 policy and research priorities for chronic diseases, a number of which involve food and nutrition policy.
For example, in 2014 NIH spent over five times more on neuroscience research than on diabetes research. And this after the CDC predicted that up to 1/3, or 100 million adult Americans, will suffer from diabetes by 2050.
Can Industry Misdirect the NIH and CDC? History Suggests Yes
One might object that Coca-Cola’s indirect influence on research through the NIH will have different effects than direct Coca-Cola funding might. Theoretically, the NIH could have effective procedures for preventing industry influence.
Unfortunately, the history of the NIH’s National Institute of Dental Research (NIDR) contradicts that hypothesis. Thanks to the University of California, San Francisco’s pioneering research into the sugar industry’s internal documents, it’s possible to delineate when and how Big Sugar influenced the NIH.
Sugar causes cavities. The relationship between sugar and cavities, or caries, has been well-known since at least 1950. That year an industry-linked body, the Sugar Research Foundation, reported,
There is evidence tending to show that carbohydrates, including sugar, and perhaps other food types, are implicated in tooth decay.
One might expect, then, that health policy would look for ways to decrease sugar consumption. And yet, NIH research long focused on ways to reduce the effects of chronic sugar consumption, not to reduce sugar consumption itself. In this regard, NIH’s approach matched the sugar industry’s strategy.
This was not an accident. In 1966, the NIH’s NIDR first announced it was considering a national research program to eliminate dental cavities. The sugar industry responded swiftly. Time reports,
In 1969, an NIDR formed a subcommittee called the Caries Task Force Steering Committee, which started regularly meeting to come up with their research priorities. Simultaneously, another group called the International Sugar Research Foundation (ISRF) started their own series of meetings to identify dental-health priorities. In their investigation, UCSF researchers notices that ISRF’s panel and the NIDR’s steering committee were made up almost entirely of the same people.
Cristin Kearns, Stan Glantz, and Laura Schmidt detail the overlap in personnel between industry and the NIH’s NIDR cavity committee in the graph below:
In March 1971, after receiving President Richard Nixon’s endorsement, the NIDR began its National Caries Program. When the NIDR released “Opportunities for Participation in the National Caries Program” that same year, the content closely matched the ISRF’s suggestions. The UCSF investigative team found that,
78% of a report submitted to the NIDR by the sugar industry was directly incorporated into the NIDR’s first request for research proposals.
The impact was obvious. Roughly 14 percent of the NIDR’s document copied the sugar industry’s document verbatim.
The NIDR assumed that reducing sugar consumption was unfeasible. Instead, it directed funding towards enzymes and vaccines aimed at preventing cavities without the need to cut back on sugar. The NIDR’s strategy achieved mixed results that dramatically fell short of its original goal: to eradicate cavities in the US entirely. Big Sugar won.
The Sugar Association has responded to this UCSF investigation by pointing out the time elapsed. The Association objected that it was, “confused as to the relevance of attempts to dredge up history.”
Much as we’d hope that industry influence of the NIH were a mere historical curiosity, the evidence suggests that little has changed.
Industry-NIH Personnel Overlaps
Take Yang Pan, for example. For the past six years, Pan has worked for the NIH as the Special Review Expert for Small Business Innovation Research Grants. During that period she has also worked for Coca-Cola, and later, PepsiCo (Pang has modified her LinkedIn profile since we noticed her conflict of interest). From 2006-2013 Pan was Coca-Cola’s “Senior Scientist.” In 2014 she moved over to a similar role at PepsiCo: Principal Scientist.
When Pan works as an NIH grant reviewer, does she always recuse herself from subjects related to PepsiCo products? (PepsiCo owns not just soft drink brands but also Frito-Lay and 20 other processed food brands worth at least a billion dollars each). For that matter, what topic in health research is completely separate from food?
Is a Coke-CDC-NIH Partnership a Conflict of Interest?
The NIH mandates a strict conflict of interest policy for scientists. For example, NIH tells reviewers to be sure you have “recused yourself from the review of any application or proposal pending review in the Scientific Review Group where your participation constitutes a real or apparent COI (conflict of interest).”
Why have the CDC and NIH not applied this standard to themselves? Surely partnering with Coca-Cola constitutes an “apparent COI,” at least. The CDC Foundation used a Coca-Cola grant to fund public health research in Mexico. The NIH also funded this research, through Coca-Cola-funded researcher Robert Sallis. Yet somehow, the authors, including Sallis, managed to claim they “have no competing interests.”
How is Coca-Cola funding not a competing interest in public health research?
CDC and NIH’s Strange Collaboration With Another Coke Partner
Unfortunately, we have not been able to ascertain the extent of Coca-Cola’s funding of the CDC and NIH foundations prior to 2010. Nonetheless, there are clues.
The CDC has long maintained a close relationship with the the American College of Sports Medicine, another Coca-Cola partner. In fact, the CDC has been an “official corporate partner of the ACSM, along with Coca-Cola and PepsiCo, according to the ACSM. Why would the CDC sponsor the ACSM, an organization that has made baseless claims about its competitors, and allowed itself to be influenced by its corporate sponsors, Coca-Cola and PepsiCo?
The CDC-ACSM relationship goes back to at least 1995, when they collaborated on physical activity recommendations. The author list includes some of the most discredited Coca-Cola advocates in history. Lead author, Russell Pate, is Coca-Cola’s go-to source for defending Coke advertisements. Another author, Steven Blair, co-founded a Coke proxy called the Global Energy Balance Network. Blair claimed that there’s little evidence that nutrition has anything to do with obesity. He later admitted that this statement did a “disservice” to his fellow researchers. His Global Energy Balance Network shut down after the press revealed the extent to which Coke controlled its operations.
For brevity’s sake, we won’t examine all of the CDC-ACSM authors’ backgrounds. Nonetheless, consider a third author, James Rippe. He has “received consulting fees from ConAgra Foods, Kraft Foods, Florida Department of Citrus, PepsiCo International, The Coca Cola Company, Dr. Pepper/Snapple Group, Corn Refiners Association, and Weight Watchers International.” The Corn Refiner’s Association pays Rippe a $41,000-per-month retainer to defend high fructose corn syrup. We must hand it to Rippe; he may have amassed the most extensive conflict of interest list we’ve ever seen. And yet the CDC selected him to author this statement.
What physical activity recommendations did these Coca-Cola/CDC/ACSM authors come up with? They advised, “Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.” There’s a catch, however. They define “moderate-intensity physical activity” as a category that includes “fishing, standing/casting,” as well as painting, golf, and home repair. Exercise is Medicine incorporates these guidelines a generation later.
To this day, the CDC is still spreading the same misleading hydration guidelines that the ACSM and Gatorade have, despite the fact that they contradict the current scientific consensus, and despite the fact that these commercialized hydration guidelines have led to a rash of hyponatremia deaths. The CDC says, “A sports beverage can replace the salt and minerals you lose in sweat.” In reality, sports drinks have roughly 1/7th the sodium concentration of healthy human blood, so they dilute serum sodium levels, just like water does. The CDC’s misleading message about sports drinks is, however, perfectly in line with the message that the CDC Foundation’s partner Coca-Cola has promoted. We have tried to contact the CDC to correct their potentially fatal guidelines and put them in touch with scientists, but they have not paid attention to our efforts.
Not only has the CDC sponsored the ACSM, but the official CDC website promotes the ACSM and Coca-Cola-founded program Exercise is Medicine. The NY Times, Sydney Morning Herald, and the Guardian have already exposed Exercise is Medicine as a Coke-funded group that advances an industry agenda. Yet the CDC is still promoting it. Why?
In addition, the CDC also refers people to ACSM’s trainer database. Again, one must wonder why the CDC is promoting a fitness trainer-certifying organization long funded by Coca-Cola and PepsiCo?
It gets worse. The CDC consulted Rhona Applebaum, former Coca-Cola Chief Science and Health Officer. Applebaum served on the Centers for Disease Control Foundation’s Corporate/CDC Roundtable on Global Health Threats. Well, as a Coca-Cola Vice President, Applebaum must have been quite familiar with “global health threats.” Last year Applebaum resigned from Coca-Cola after her embarassing internal emails telling the Global Energy Balance Network what to do were leaked
And worse. Take CDC official Michael Pratt. Pratt is “Senior Advisor for Global Health in the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention.” Coca-Cola has funded Pratt’s public health department at Emory University, where he is an assistant professor, with over $2 million.
Pratt is on the Exercise is Medicine advisory board. He often offers lectures with his colleague at Emory and the CDC, Felipe Lobelo, on Exercise is Medicine. EIM chair Robert Sallis, whom Coke directly funds, described Pratt and the CDC itself as some of his “key collaborators.” And Pratt called the CDC a “partner” of Exercise is Medicine.
In 2010, the International Life Science Institute invited Pratt to Singapore to discuss “Exercise is Medicine” (the link was originally available on ILSI’s website but ILSI has since deleted it). ILSI is a well-known Coca-Cola/food industry front group. Who paid for the CDC official’s travel and speaking expenses?
The Coke-ACSM-CDC relationship is not an accident. ACSM notes meeting with NIH and CDC officials as key parts of its lobbying agenda. And the CDC, in turn, does appear to promote Coke-ACSM ideas such as Exercise is Medicine and dangerous, debunked hydration guidelines. The CDC Diabetes Twitter account has never tweeted about reducing sugar consumption, but it has emphasized the role of physical activity in controlling glucose levels. This means the CDC’s messaging on diabetes has fallen perfectly in line with Coke/ACSM talking points: addressing physical activity at the expense of nutrition.
Divergent Goals: Public Health and Soda Profits
An article in the Lancet said it best:
… ultimately, the goals of Coca-Cola and those of medical organisations and health researchers that wish to improve public health are very different. Moreover, medical health professionals must guard against any possible conflict or perceived conflict when working towards the overarching goal of improving public health and preventing non-communicable diseases, such as obesity and type 2 diabetes.
With the CDC and NIH’s combined annual budgets approaching $40 billion, why do their Foundations still maintain Coca-Cola partnerships that directly conflict with public health?
The University of Colorado had the moral courage to return Coca-Cola funding. What’s holding the NIH and CDC Foundations back from doing the right thing?