The Disconnect Between Science and Policy

Back in 1912, when hardly anyone smoked cigarettes, lung cancer was like a museum curiosity: extremely rare. In the next few decades, however, it rose dramatically around the world, roughly fifteen-fold. But researchers had already nailed it way back then. By mid-century, the evidence linking lung cancer and tobacco was considered overwhelming. Says who? Says the tobacco industry’s own research scientists in an internal memo. We now know that “senior scientists and executives within the cigarette industry knew about the cancer risks of smoking at least as early as the 1940s.”

Publically, though, they said things like, “Sure there are statistics associating lung cancer and cigarettes. There are statistics associating lung cancer with divorce, and even with lack of sleep. But no scientist has produced clinical or biological proof that cigarettes cause the diseases they are accused of causing.”

What was the government saying? My video American Medical Association Complicity with Big Tobacco includes several real cigarette advertisements, including one in which a leading U.S. Senator advises readers to smoke Lucky Strikes. Who wouldn’t want to “give [their] throat a vacation,” as another ad proclaimed? Others assured “not one single case of throat irritation,” and how could your throat and nose be adversely affected when cigarettes “are just as pure as the water you drink”? What if you do feel irritation from smoking? No problem—your doctor can write you a prescription for cigarettes, according to an ad from the Journal of the American Medical Association. After all, “don’t smoke” is advice hard for patients to swallow, as we’re told in another ad.

This reminds me of the recent survey of doctors that found the number-one reason doctors don’t prescribe heart-healthy diets was their perception that patients fear being deprived of all the junk they’re eating. After all, Philip Morris reminded doctors in an ad that we want to keep our patients happy and to “make a radical change in habit…may do harm.”

The tobacco industry gave medical journals big bucks to run ads like the ones I’m sharing with you. Should we be concerned about a conflict of interest? Not if we listen to Philip Morris, who assured us their “claims come from completely reliable sources” based on studies conducted by “recognized authorities…whose findings have been published in leading medical journals.” They even kindly offered to send free packs of cigarettes to doctors so they can test them out themselves and invited physicians to “make the doctors’ [smoking] lounge your club” at the American Medical Association convention.

What did the AMA have to say for itself? Like most other medical journals, they accepted tobacco ads but asserted that “[p]ostmortem examinations do not reveal lesions in any number of cases that could be definitely traced to the smoking of cigarettes.” So, as far as the AMA was concerned, case closed.

In fact, even after the Surgeon General’s Report on Smoking and Health came out, the American Medical Association, American Cancer Society, and Congress continued to drag their feet. The government was still subsidizing tobacco, just as our tax dollars subsidize the sugar and meat industries today. The AMA actually went on record refusing to endorse the Surgeon General’s report. Could that have been because they had just been handed ten million dollars from the tobacco industry?

Today the money is coming from big food. The American Academy of Family Physicians has accepted large sums of money from Coca-Cola “to fund patient education on obesity prevention.” I wonder what that pamphlet will say.

Who was featured as a top partner on Coca Cola’s website? The American College of Cardiology.

Just as it would have been hazardous to your health to take the medical profession’s advice on your smoking habits in the 1950s, it may be hazardous to your health today to take the medical profession’s advice on your eating habits.


If the balance of scientific evidence favors plant-based eating, why isn’t the medical profession at the forefront of encouraging people to eat healthier? That’s the question this video tries to answer. Looking back to smoking in the 1950s, we can see how all of society, the government, and even the medical profession itself could be in favor of habits that decades of science had already overwhelmingly condemned as harmful.

For more on the influence industry can have on food policy, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Cancer-Causing Caramel Color

Caramel coloring may be the most widely consumed food coloring in the world.  Unfortunately, its manufacture can sometimes lead to the formation of a carcinogen called methylimidazole, which was identified as a cancer-causing chemical in 2007. For the purposes of its Proposition 65 labeling law, California set a daily limit at 29 micrograms a day. So, how much cancer might caramel-colored soft drinks be causing? We didn’t know…until now… My video Which has more Caramel Coloring Carcinogens: Coke or Pepsi? explores these questions and more.

Researchers tested 110 soft drink samples off store shelves in California and around the New York metropolitan area, including Connecticut and New Jersey. None of the carcinogen was found in Sprite, which is what you’d expect since Sprite isn’t caramel-colored brown. Among sodas that are, the highest levels were found in a Goya brand soda, while the lowest levels were in Coke products, which were about 20 times less than Pepsi products. Interestingly, California Pepsi was significantly less carcinogenic than New York Pepsi. “This supports the notion that [labeling laws like] Proposition 65…can incentivize manufacturers to reduce foodborne chemical risks…” To protect consumers around the rest of the country, federal regulations could be a valuable approach to reducing excess cancer risk—but how much cancer are we talking about?

Johns Hopkins researchers calculated the cancer burden, an estimate of the number of lifetime excess cancer cases associated with the consumption of the various beverages. So, at the average U.S. soda intake, with the average levels of carcinogens found, Pepsi may be causing thousands of cancer cases, especially non-California Pepsi products, which appear to be causing 20 times more cancer than Coke. Of course, there’s no need for any of them to have any these carcinogens at all “as caramel colorings serve only a cosmetic purpose [and] could be omitted from foods and beverages…” But we don’t have to wait for government regulation or corporate social responsibility; we can exercise personal responsibility and just stop drinking soda altogether.

Cutting out soda may reduce our risk of becoming obese and getting diabetes, getting fatty liver disease, suffering hip fractures, developing rheumatoid arthritis, developing chronic kidney disease, and maybe developing gout, as well.

In children, daily soda consumption may increase the odds of asthma five-fold and increase the risk of premature puberty in girls, raising the likelihood they start getting their periods before age 11 by as much as 47 percent.

If we look at the back of people’s eyes, we can measure the caliber of the arteries in their retina, and the narrower they are, the higher the risk of high blood pressure, diabetes, and heart disease. Researchers performed these kinds of measurements on thousands of 12-year-olds and asked them about their soda drinking habits. Their findings? Children who consume soft drinks daily have significantly narrower arteries. “The message to patients can no longer remain the simplistic mantra ‘eat less, exercise more.’” It matters what you eat. “[S]pecific dietary advice should be to significantly reduce the consumption of processed food and added sugar and to eat more whole foods.”


Prop 65 is lambasted by vested interests, but, as I mentioned, it may push manufacturers to make their products less carcinogenic. Other Prop 65 videos include:

For more background on caramel coloring, see my video Is Caramel Color Carcinogenic?.

There are other soda additives that are potentially toxic, too. See my three-part series on phosphates:

Other coloring agents are less than healthy. For more on this, see Artificial Food Colors and ADHD and Seeing Red No. 3: Coloring to Dye For.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

From Adequate Nutrition to Optimum Nutrition

Research in human nutrition over the past four decades has led to many discoveries as well as a comprehensive understanding of the exact mechanisms behind how food nutrients affect our bodies. As I discuss in my video Reductionism and the Deficiency Mentality, however, the “prevalence of epidemics of diet-related chronic diseases, especially obesity, type 2 diabetes, osteoporosis, cardiovascular diseases, and cancers, dramatically increases worldwide each year.” Why hasn’t all this intricate knowledge translated into improvements in public health? Perhaps it has to do with our entire philosophy of nutrition called reductionism, where everything is broken down into its constituent parts; food is reduced to a collection of single compounds with supposed single effects. “The reductionist approach has traditionally been and continues today as the dominant approach in nutrition research.” For example, did you know that mechanistically, there’s a chemical in ginger root that down-regulates phorbol myristate acetate-induced phosphorylation of ERK1/2 and JNK MAP kinases? That’s actually pretty cool, but not while millions of people continue to die of diet-related disease.

We already know that three quarters of chronic disease risk––diabetes, heart attacks, stroke, and cancer—can be eliminated if everyone followed four simple practices: not smoking, not being obese, getting a half hour of exercise a day, and eating a healthier diet, defined as more fruits, veggies, and whole grains, and less meat. Think what that could mean in terms of the human costs. We already know enough to save millions of lives. So, shouldn’t our efforts be spent implementing these changes before another dollar is spent on research such as figuring out whether there is some grape skin extract that can lower cholesterol in zebra fish or even trying to find out whether there are whole foods that can do the same? Why spend taxpayer dollars clogging the arteries of striped minnows by feeding them a high cholesterol diet to see whether hawthorn leaves and flowers have the potential to help? Even if they did and even if it worked in people, too, wouldn’t it be better to simply not clog our arteries in the first place? This dramatic drop in risk and increase in healthy life years through preventive nutrition need not involve superfoods or herbal extracts or fancy nutritional supplements—just healthier eating. When Hippocrates supposedly said, “Let food be your medicine and medicine be your food,” he “did not mean that foods are drugs, but rather, that the best way to remain in good health is to maintain a healthy diet.” (Note: Hippocrates probably never actually said that—but it’s a great sentiment anyways!)

The historical attitude of the field of nutrition, however, may be best summed up by the phrase, “Eat what you want after you eat what you should.” In other words, eat whatever you want as long as you get your vitamins and minerals. This mindset is epitomized by breakfast cereals, which often provide double-digit vitamins and minerals. But the road to health is not paved with Coke plus vitamins and minerals. This reductionistic attitude “is good for the food industry but not actually good for human health.” Why not? Well, if food is good only for a few nutrients, then you can get away with selling vitamin-fortified Twinkies.

We need to shift from the concept of merely getting adequate nutrition to getting optimal nutrition. That is, we shouldn’t just aim to avoid scurvy, but we should promote health and minimize our risk of developing degenerative diseases.

Bringing things down to their molecular components works for drug development, for example, discovering all the vitamins and curing deficiency diseases. In the field of nutrition, “[h]owever, the reductionist approach is beginning to reach its limits.” We discovered all the vitamins more than a half-century ago. When is the last time you heard of someone coming down with scurvy, pellagra, or kwashiorkor, the classic deficiency syndromes? What about the diseases of dietary excess: heart disease, diabetes, obesity, and hypertension? Ever heard of anyone with any of those? Of course we have. Yet we continue to have this deficiency mindset when it comes to nutrition.

When someone tries to reduce their consumption of meat, why is “where are you going to get your protein?” the first question they get asked, rather than “if you start eating like that, where are you going to get your heart disease?” The same deficiency mindset led to the emergence of a multibillion-dollar supplement industry. What about a daily multivitamin just “as ‘insurance’ against nutrient deficiency?” Better insurance would be just to eat healthy food.


Professor Emeritus T. Colin Campbell wrote a Whole book about this issue, and I’m looking forward to doing many more videos on the topic.

So, where do plant-eaters get protein? Check out Do Vegetarians Get Enough Protein? to learn more.

The concept of optimal, rather than merely adequate, nutrition is illustrated well in this video about fiber: Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

Other videos on reductionism include

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: