Recognizing Industry’s Role in Protecting Public Health

In a recent article in the New England Journal of Medicine, CDC Director Dr. Thomas Frieden extolled the government’s role in protecting and promoting health through population-wide action (Frieden, 2013). He alleged that government may be the only entity capable of promoting the greater good in public health by reconciling social and economic interests. His perspective requires some examination.

Amongst the longstanding nutritional interventions that are considered major triumphs in protecting and promoting public health are milk pasteurization in the 1890s (Hall and Trout, 1968), the iodization of salt in 1924 (International Council for the Control of Iodine Deficiency Disorders, 2013), the addition of niacin to bread in 1938 (Park et al., 2000), the UV irradiation of milk to increase vitamin D levels in the 1930s (Weckel and Jackson, 1939), fluoride supplementation of toothpaste in 1956 (History of Toothpaste), the addition of natural fiber to bread and other products in 1975 (Satin et al., 1978), and the supplementation of baked goods with folic acid in 1977 (Gorman, 1981).

However, contrary to Dr. Frieden’s assertions, these were not the actions of a responsive government; they were the actions of a conscientious private sector, responsive to their clients. It was the open market and the common sense of consumers that allowed these science-based interventions to persist and result in the public health success they continue to enjoy today.

Trans fats, first used in margarines and frying fats in the early 20th century, established a limited market up until the 1980s. At that time concerns were made by some medical researchers that saturated animal fats were related to heart disease. Immediately, the consumer activist groups Center for Science in the Public Interest (CSPI) and the National Heart Savers Association (NHSA) attacked the use of saturated animal fats and forcefully endorsed and lobbied in favor of trans fats as a healthier, alternative (Schleifer, 2012).

In a defensive response to this open public attack, the food industry began replacing animal fats with trans fats. The government stood by and allowed this market shift to take place. It was neither the food industry nor the market that demanded the much wider use of trans fats to replace animal fats; it was the consumer activist movement and a government that was unwilling to evaluate any possible health consequences that might result from this market swing. Years later, when additional evidence indicated possible negative consequences, it was the very same consumer activist group, which instigated the greater use of trans fats, that led the new campaign against them.

The major private sector interventions that resulted in the public health triumphs noted above stemmed from a focus on the dynamic nutritional needs of consumers. The triumphs were the result of the responsive relationship between a supplier and client. They also were based on industry’s profound knowledge of the needs and behavior of consumers in rapidly changing lifestyles.

Over the years, however, a greater degree of the food industry’s attention and research efforts have shifted towards meeting government and consumer activist demands and labeling requirements, many of which are not rooted in sound science or in a knowledge of how consumers perceive information. Some of us believe that this has resulted in negative impacts on the consumers’ understanding of individual foods in the context of whole diets within individual lifestyles.

The competitive nature of free enterprise and the relationship between supplier and consumer has resulted in many major public health achievements. It is time that the government recognizes this fact.

Morton Satin, a member of IFT, is Vice President,
Science and Research, Salt Institute, Alexandria,
Va. ([email protected]).

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