Jumping on the sugar bandwagon

This had to happen. Stanton Glantz has jumped on the anti-sugar bandwagon with an article that is so bad it made me laugh out loud a couple of times.

Glantz made his name in the 1990s after he was sent thousands of pages of internal tobacco industry documents which he turned into a book called The Cigarette Papers. He's been dining out on them ever since and now he is trying the same routine with the sugar industry. It's a shrewd business move which gives him something to fall back on if his $6.6 million anti-tobacco racket ever fades.

“Sugar Papers” Reveal Industry Role in 1970s NIH Dental Program ... just like Big Tobacco

Big Tobacco was involved in a dental program?

It wasn't, of course. The sugar industry was "just like Big Tobacco" in the sense that it, er, exchanged goods for money.

The archive of 319 industry documents, which were uncovered in a public collection at the University of Illinois, revealed that a sugar industry trade organization representing 30 international members had accepted the fact that sugar caused tooth decay as early as 1950, and adopted a strategy aimed at identifying alternative approaches to reducing tooth decay.

"Uncovered in a public collection", for god's sake.

The first author located these documents in 2010 in an inventory of the papers of Roger Adams housed in the University of Illinois Archives through a Google search using the terms “International Sugar Research Foundation” and “archives”. Roger Adams, Emeritus Professor of Organic Chemistry, served on the SRF [Sugar Research Foundation] and then ISRF [International Sugar Research Foundation] Scientific Advisory Board from 1959 until his death in 1971. Adams’s files contain correspondence with sugar industry executives, meeting minutes, and other relevant reports.

Wow, the sugar industry is really bad at hiding things. They put entire archives in publicly accessible libraries which can be found with a simple Google search. It's almost as if - I dunno - they feel they haven't got anything to hide.

Glantz's schtick in this 'study' is to assume that sugar should have been treated like tobacco as soon as it became apparent that it increased the risk of dental caries (tooth decay). In fact, the government worked with the sugar industry to look at ways of preventing tooth decay, such as tooth-brushing, fluoridation, product modification and research into a possible vaccine. These efforts are ludicrously portrayed by Glantz as tobacco-style 'deflection and delay'.

Jenkins saw fluoridation as “the only thoroughly well-established method of reducing caries which does not require the active (and usually reluctant) participation of the patient”.

Well, perhaps it is. Glantz doesn't seem to understand that it is very difficult to get people to stop eating sugar - even if it was the government's job to force them - and he is dismissive of those who do. People like Richard Greulich of the Nationak Institute of Dental Research, for example, whom he quotes:

One could say, on logical grounds and good evidence, that if we could eliminate the consumption of sucrose, we could eliminate the problem—because we would be denying these pathogens their primary source of nutrient. We are realists, however, and we recognize the value of sucrose to nutrition. So while it is theoretically possible to take this approach to demonstrate it, and it has been demonstrated certainly in animal models, it is not practical as a public health measure. It is like saying the maximum speed of a jet plane is the speed of light. It just is not practical to try and evolve on to that point. And so in smooth surface caries, we have a more practical goal in working on the microorganism. (emphasis added [by Glantz])

To a sane person, this is common sense. Eliminating sugar consumption is not going to happen, but tooth decay can be prevented by other means so let's do those. To Glantz, however, this is "industry deflection of attention away from limiting sugar intake".

The documents show that the sugar industry knew that sugar caused dental caries as early as 1950 and did not attempt to deny the causative role of sucrose in tooth decay. Instead, through trade associations, the sugar industry adopted a strategy to deflect attention to public health interventions that would reduce the harm of sugar consumption, rather than restricting intake.

Reducing harm is what medical science is all about. Banning sexual intercourse is not a realistic way of preventing HIV, so we have condoms. Banning cars is not a realistic way of reducing road fatalities so we have seat belts and air bags. If you want to ban sex and cars, these might look like ways to "deflect attention". To reasonable people, they are sensible, evidence-based responses to risky behaviours that cannot, and should not, be stamped out by the state. Naturally, these goes against Glantz's prohibitionist mindset.

The majority of the research priorities promoted by the sugar industry and those selected for the 1971 NCP RFC failed to lead to widespread application. By 1976, clinical studies of dextranase mouth rinses in humans had failed to duplicate the success of using dextranases to inhibit new dental caries in experimental animals. 

That's the way it goes in scientific research. Not every research avenue leads to a breakthrough. In science, unlike in 'public health', you can't guarantee you're going to get the result you want before you start doing the research.

Glantz, of course, presents the failure of some research projects as another part of the delay and deflection strategy, but even he can't pretend that it was all a waste of time.

The most successful interventions selected for funding following the 1971 NCP RFP were topical fluoride and sealants. While a 1980 prevalence survey found that the burden of dental disease in children had decreased by more than 30% since the last survey in 1971–1973, 64% of children still exhibited dental caries, far short of the NCP’s founding goal of eradicating the disease.

Glantz downplays this, but imagine his delight if his anti-smoking policies led to a 30 per cent reduction in lung cancer in less than a decade.

In fact, as the CDC confirms, the supposed period of inaction on sugar saw a very substantial decline in dental caries.

Glantz continues:

Regulatory science to support sensible and defensible policies to limit added sugar consumption was not pursued in the 1970s because of the alignment of the NIDR’s research priorities with those of the sugar industry.

So what are these "sensible and defensible policies" that would "eradicate" tooth decay? How does Glantz think the USA would have stopped kids eating sweets if it hadn't been for Big Sugar's dirty tactics?

Proposals centered on ways to limit sucrose consumption were just around the corner. In its multi-year review of foods generally recognized as safe initiated in 1969, the FDA deemed sucrose consumption at 1976 levels as unsafe for teeth. In the coming years, the FDA would consider food labels “to warn against the hazards to the teeth of consuming a particular product” and debate whether warning labels should be placed on foods based on the percentage of sugar content, or on some measure of cariogenic potential.

Warning labels. That's it. That is literally the only policy Glantz puts forward as an alternative 'public health' solution to tooth decay.

Comparison to the Tobacco Industry

The sugar industry formed SRF in 1943 to fund research that supported the industry position, 11 years before the creation of the Tobacco Industry Research Committee (TIRC) in 1954 to play a similar role for the tobacco industry. In 1954, the TIRC hired SRF’s first scientific director, Robert Hockett, to serve as the TIRC’s associate scientific director, where he was positioned to help the tobacco industry learn key science manipulation tactics from the sugar industry.

Wait, what? The tobacco industry was working from Big Sugar's playbook? Is that the narrative now? I thought it was the other way round.

Glantz then wibbles on about how the sugar industry looking for cures and vaccines for tooth decay is basically the same as the tobacco industry developing low tar cigarettes. I won't bore you with it. Only an obsessive would see a comparison. His concluding point is that his piss-poor research might help ambulance-chasing lawyers sue the sugar industry.

Litigation against tobacco companies has been a major factor in achieving meaningful policy change. Successful litigation could not have been achieved without industry documents research illuminating the strategies and tactics of tobacco companies. This analysis demonstrates that sugar industry documents research has the potential to define industry strategies and tactics, which may potentially prove useful in future litigation.

It's not going to happen, Stan. Pulling documents out of a library which show that the sugar industry funded research into tooth decay—much of which succeeded in reducing tooth decay—is not going to lead to class action suits, even in America.

Glantz's article does, however, provide a nice illustration of the interaction between science, medicine and 'public health' which I show in the Venn diagram below.
 

There is no interaction. Public health has no relationship with either medicine or science (or, if it does, it is like the relationship between a dog and a lamppost). Medical science is an inquisitive endeavour to find solutions, cures and vaccines to help people lead their life as they wish with the least practical risk. 'Public health' is a dogmatic endeavour to use the cudgel of legislation to make people live in a way that does not accord with their preferences. Medical science makes the world a better place. 'Public health' does not.