Dr. Kelsey also became a scientist and a medical doctor (she earned both a Ph.D. in pharmacology and an M.D. from the University of Chicago) at a time when few women entered STEM professions. Her legacy, in ways not often fully appreciated, also speaks to science and social justice—and to why diverse perspectives matter in science as in society.
As a newly hired medical officer at the U.S. Food and Drug Administration (FDA) in 1960, Dr. Kelsey was responsible for reviewing drug manufacturer Richardson-Merrell’s application for thalidomide approval in the U.S. Thalidomide was to be sold as a sedative specifically recommended for pregnant women to ease morning sickness. Although doctors had already begun prescribing it in Canada, Europe, and Africa, Dr. Kelsey had questions that she believed the company had not adequately answered, and she refused to approve it without stronger evidence for its efficacy and safety.
At the time, drug companies had to submit applications for approval of new drugs to the FDA, but if the agency didn’t act within 60 days to deny the application, approval was automatic. Under constant pressure from the drug manufacturer, Dr. Kelsey remained steadfast—even as company executives complained to her supervisors. Every 60 days, she returned the company’s application with a request for more evidence, which the company failed to provide. As reports began emerging of babies born without arms or legs—or with flipper-like appendages and deformed internal organs—linked to thalidomide in countries where the drug was legal, the company abruptly withdrew its FDA application in 1961.
A year later, following a story in the Washington Post hailing Dr. Kelsey as a “heroine,” Congress unanimously passed the Kefauver Harris Amendment, a law which updated and greatly strengthened the 1938 Federal Food, Drug, and Cosmetic Act. Among other improvements, the Kefauver Harris Amendment required new drugs to pass more rigorous trials and gave the FDA full authority to approve or deny new drug applications. President John F. Kennedy awarded Dr. Kelsey the Medal for Distinguished Federal Civilian Service for her role in improving drug safety.
Of the estimated 10,000 “thalidomide babies” born outside the U.S., only around 40 percent survived. In the U.S., some physicians had received supplies of thalidomide with its approval still pending; fortunately, only 17 births were affected. Now in their fifties, thalidomide survivors have struggled with life altering disabilities, as well as major health problems now being exacerbated by age.
Once the dangers of thalidomide became public, pregnant women who had taken the drug faced the difficult decision of whether knowingly to bring children into the world that would face a lifetime of suffering. The burden of deciding what to do and then living with the consequences of their decisions disproportionately fell to women. While ethical considerations were complex—and painful and private and deeply personal for any woman—a complicating factor in the U.S. was that abortion was still illegal in 1961.
What that meant is that women who wanted to end affected pregnancies faced extraordinary obstacles. In a well-publicized case, Sherri Chessen (a.k.a. Sherri Finkbine)—a mother of four in Phoenix, Arizona, pregnant with her fifth child—took thalidomide her husband had obtained during a trip to England. An abortion was quietly arranged by her doctor at a local hospital. Hoping to alert other women who might have unknowingly taken the drug, Sherri—the Phoenix area host of the popular children’s TV show Romper Room—told her story to the press before the procedure was performed. Fearing negative publicity and potential litigation, the hospital withdrew its permission, a judge denied an appeal, and Sherri ended up travelling to Sweden to have the abortion. The aborted fetus was missing both arms and both legs.
Had thalidomide been more widely distributed in this country, other white, financially secure women like Sherri Chessen likely would have made similar trips. As painful as their decisions would have been, it is difficult to speculate on the even greater consequences for poor women—especially poor women of color—who were already disproportionately affected by anti-abortion laws.
By preventing approval of thalidomide in the U.S., Frances Oldham Kelsey not only spared countless children from birth defects or death, she also spared their mothers.
Although Dr. Kelsey rarely spoke about how gender had affected her own career, she did offer a few clues in her “Autobiographical Reflections.” Of her decision to get an M.D. after already earning a Ph.D., she said, “[As] a woman, I needed the extra credentials. Let us face it, I needed all the help I could get.”
When Dr. Kelsey was offered a job as a research assistant at the University of Chicago—a job that paved the way for her to attend graduate and medical school there—the offer letter was addressed to “Mr. Oldham.” Instead of correcting the mistake and informing her would-be employer she was a woman, she simply signed the letter and showed up. Of that experience in 1936, she said, “to this day, I do not know if my name had been Elizabeth or Mary Jane, whether I would have gotten that first big step up. My professor at Chicago to his dying day would never admit one way or the other.”
Nor will we ever know how much her life experiences as a woman influenced her decisions around thalidomide, but she did reflect, “I was very cautious about using drugs during my own pregnancies.”What we do know, from new research, is that gender bias continues to afflict women in science more than half a century after Dr. Kelsey earned her credentials. A 2014 study found scientists of both genders less likely to mentor, offer jobs, or recommend equal salaries if the name on identical resumes is Jennifer rather than John.
Dr. Kelsey’s legacy teaches us that this must change. The point of diversity in science, as elsewhere in our society, is not only to create opportunities for underrepresented groups but also to expand our collective understanding by including and embracing a multitude of experiences and perspectives. Only in doing so can we ever hope to progress toward the democratic ideals of equality, freedom, and justice for all.]]>
But how does anyone really “choose” Coke? While the company removed cocaine from the product more than 100 years ago, the amount of sugar remains staggering. A 20 oz. bottle—just one serving according to its Nutrition Facts label—contains 65 grams of sugar. That’s about 16 teaspoons and far exceeds what the American Heart Association, the World Health Organization, and the U.S. Dietary Guidelines Advisory Committee all recommend that people consume in an entire day. Moreover, recent brain research has shown that sugar “can not only substitute to addictive drugs, like cocaine, but can even be more rewarding and attractive.”
All that science on sugar is important because it contradicts the message the company would like us to hear—that is, that we should “choose” to drink more of their product. Coca-Cola spends hundreds of millions of dollars on annual advertising to persuade us that its choice of what we should be drinking is “our” choice. But the company’s tactics to control consumer “choice” don’t stop with catchy ad slogans. Coca-Cola, like other sugar interests, also pours money into misinformation campaigns aimed at casting doubt on the growing body of scientific evidence showing that excessive sugar consumption is harmful to our health.
When we wrote about this phenomenon in our 2014 report Added Sugar, Subtracted Science, we noted that many companies have their own research institutes and initiatives and pay scientific experts to conduct seemingly independent studies to promote their sugary products. We found that “Coca-Cola’s Beverage Institute for Health and Wellness features misleading content on its website. The site confuses the science around sugar consumption and ill-health by focusing on the role of sugar-sweetened beverages in ‘hydration’ and ‘energy balance’ while ignoring the negative impacts of sugar-sweetened beverages, including their role in obesity and metabolic diseases.”
Just recently, the company established a new “research” institute called the Global Energy Balance Network. Its purpose is to persuade people that they’re focusing too much on calories and portion size and not enough on exercise. The Network claims to provide “a forum for scientists around the globe to come together and generate the knowledge and evidence-based pathways needed to end obesity.” But it doesn’t take much scratching under the surface to see that the scientists contributing to this forum can hardly claim to be independent of food industry conflicts of interest. At the top of their list of scientists is James O. Hill. A quick search of the Integrity in Science database, maintained by the Center for Science in the Public Interest, shows that Dr. Hill has ties to PepsiCo, McDonald’s, and the Sugar Association. He has also previously received consulting fees from Coca-Cola and other food companies.
Sure, “You can’t beat the feeling” of a Coke, as a 1987 ad put it. Why? It’s the sugar, of course! And, given what we now know is the toxic truth, Coca-Cola and other food companies have a lot at stake in persuading us to “choose” their sugary products over the science that tells us otherwise.
Journalists play a key role in communicating to the public the scientific information generated and used by the government. Earlier this year, UCS partnered with the Society of Professional Journalists to conduct a survey of science, health, and environment reporters. We wanted to know about their experiences trying to obtain information and speak with scientific experts at government agencies.
In a new report released today, we highlight survey findings and contextualize them through in-depth interviews with journalists and agency public information officers (PIOs) that we conducted following the survey. In our report, we discuss four key barriers journalists identified in their efforts to interview agency scientists:
Journalists expressed particular frustration with interview preapproval and monitoring. These practices, unlike denying interviews or avoiding tough questions, are explicitly written into policies at many agencies, and journalists rightfully worry that agencies can misuse monitoring and preapproval requirements to chill speech, spin the science, and hide wrongdoing. When PIOs utilize preapproval and monitoring to curtail what journalists can ask and how interviewees can answer, they exert a form of control over how reporters understand an issue and what they write—and hence the information the public receives.
Journalists say they need agency scientists to be able to speak candidly, especially when the data or experts’ interpretation of the data differ from official reports. Such discrepancies can signal inappropriate political or corporate influence or interference and indicate the need for further inquiry. Journalists strongly support whistleblower protections as a vital mechanism for shielding agency experts from retribution when they publicly expose wrongdoing. However, they worry that agency employees may only be willing to risk alienating their employers by taking advantage of whistleblower provisions under the most egregious circumstances, as the act of whistleblowing can significantly damage or end a career.
The degree of control PIOs can exercise over journalists’ interactions with agency employees through preapproval and monitoring—even when that control is exercised responsibly—is a cause of concern within the journalism community.
We spoke to PIOs at NASA, NIH, EPA, and FWS and asked them what they thought of the barriers journalists had identified. All of the PIOs said that they strive to facilitate, and not inhibit, conversations between scientists and reporters. At some agencies, it’s easier to do that than at others. At NASA, for example, the 1958 Space Act mandates the dissemination of the agency’s scientific findings to the widest possible public. Correspondingly, survey respondents and journalists we interviewed spoke generally favorably about NASA’s openness. A survey respondent noted that “scientists at NASA are the easiest to interview” and that this agency, in contrast to others, has improved in recent years: “Nowadays, I can directly contact scientists at NASA and ask them questions. About a decade ago, this was not the case.”
However, in contrast to the barriers identified by reporters, PIOs at all four agencies cited three issues that they wished reporters were more cognizant of: staff capacity, bureaucracy, and litigation. The latter was emphasized as a particular concern at agencies that perform both research and regulatory functions, like the EPA and the FWS. PIOs have the added challenge of designating clear boundaries between communicating science and communicating policy. Those boundaries can be complex, and lines are not always easy to draw. In responding to a reporter’s inquiries, a PIO must make decisions about separating and clarifying where the responsibilities of scientists end and those of policy makers begin.
Ultimately, when PIOs, scientists, and journalists work together, everyone benefits. Journalists have their questions answered; write accurate, fact-based stories; and meet their deadlines. Scientists get to share their knowledge with the public. Agencies and policy makers gain credibility and trust. And the public obtains information about issues that affect their lives and communities. That’s why journalists, scientists, agencies, policy makers, and the public all have a stake in overcoming the above barriers to communicating government science.
Read our report to learn about the concrete steps agencies, journalists, and scientists can take to achieve that goal.]]>
Following recommendations in the Scientific Report of the U.S. Dietary Guidelines Advisory Committee (DGAC), which UCS supported, the FDA’s decision to update its proposed labeling rule to reflect the scientific evidence on added sugar is a positive and welcome next step. Here are three reasons why.
Experts are finding increasing evidence that excessive sugar consumption—whether from sugar cane, sugar beets, or corn—has been implicated in a myriad of health problems. Sugar, in the amounts and frequency Americans are consuming it, causes tooth decay. It is also associated with weight gain and with the rise in the incidence of diabetes, cardiovascular disease, high triglycerides, and hypertension. The association between sugar and these chronic metabolic diseases is separate from sugar’s effect on total caloric intake and exclusive of its effect on obesity.
Sugar can also activate the brain’s reward and craving centers, and high sugar consumption can stimulate addiction-like behaviors. In addition, added sugar, particularly from sugar-sweetened beverages, is a source of empty calories—harmful because they displace calories in more nutritious foods.
Like experts at the World Health Organization and the American Heart Association, the DGAC recommended in its Scientific Report that people consume no more than 10 percent of their daily calories from added sugar. In order to follow that science-based recommendation, people need to see the %DV for added sugar on packaged foods and beverages, as the FDA is proposing.
It’s hardly a secret that the food industry will oppose the FDA’s new proposal. Food and beverage manufacturers and their trade associations overwhelmingly opposed the original proposed rule to simply include a separate line for added sugar.
As UCS documented in two 2014 reports—Added Sugar, Subtracted Science and Sugar-coating Science—the food industry has gone out of its way to persuade the public to eat more sugar. They’ve attacked the science, lobbied policy makers, and spent billions on advertising and high-powered PR firms. Along the way, they’ve to make sugar-laden products appear healthy and have even pushed sugar on diabetics and children under the guise of social responsibility. We only celebrate Halloween once a year, but thanks to Big Sugar too many Americans are overdosing every day on the added sugar equivalent of a Halloween haul.
The FDA’s proposed changes to the Nutrition Facts label won’t magically stop food industry misinformation campaigns but will provide one more tool to empower the public.
Simply put, we have the right to know what’s in our food, and the current Nutrition Facts label doesn’t provide enough information about added sugar. Most people aren’t familiar with the 61 names for sugar and therefore cannot recognize them in the ingredients list. And without a %DV for added sugar, a separate line for the amount, whether it lists grams or the more familiar teaspoons, doesn’t tell people how much is too much.
Ultimately, the ubiquity of added sugar in our food and beverages means eating healthy foods is not just a matter of consumer choice, as the food industry would like us to believe. It’s hard to avoid added sugar even when we want to, and we need all the information we can get just to understand the scope of the problem.
The FDA’s updated proposed rule to the Nutrition Facts label to include %DV for added sugar is a welcome step in the right direction and would be a victory for science-informed policy if and when the rule is finalized. Tell the FDA you support their proposed changes by submitting a comment on the proposed rule. And tweet your opposition to food industry misinformation and efforts to block science informed policy on added sugar at the hashtag #bullsugar.
While not entirely surprising on its own (we’ve written about it here — and here and here and here and here and here), food industry denial of the science on added sugar stands out starkly in comments to the FDA from major companies and their trade groups. The Grocery Manufacturers Association said, for example, “there is scant evidence to support the idea that added sugar contributes to ill health” and therefore “providing this information in a nutrition label will not help aid consumers in maintaining a healthy diet.”
What is an ordinary person to do when both the food industry disagrees with independent scientists and public health experts so much yet both claim to have the facts on their side? The key is understanding motivations.
Perhaps the food industry believes that if they deny the science on added sugars often enough, loud enough, and to the right people—policymakers with the power to change labels and make dietary recommendations to the public—it will just go away.
The same trend we found in comments to the FDA appeared in food industry comments to the Dietary Guidelines Advisory Committee as these experts reviewed the evidence—and in comments on the DGAC’s final report to the U.S. Departments of Agriculture and Health and Human Services, in which the committee found moderate to strong evidence of a link between excessive added sugar consumption and a host of health problems, from type 2 diabetes to heart disease.
Laugh as we may, this tactic has worked in the past for Big Tobacco and for the Merchants of Doubt hawking climate change skepticism for fossil fuel interests. Following the close of the public comment period on the DGAC report on May 8 (Submit your comments today!), the USDA and HHS will develop the 2015 Dietary Guidelines for Americans, a document that will inform what Americans eat for the next five years.
Marion Nestle, a professor of nutrition, food studies, and public health at New York University and author of Food Politics, whom we spoke with about corporate interference in food policy, said, “Attacking the science is the first line of industry defense against recommendations that suggest eating less of their products. Food companies are following the lead of cigarette companies in that regard.”
The flip side of denying facts is claiming things to be facts that are not facts. This seems to be the latest trick the food industry is playing. In the website snippet below, the American Beverage Association, a trade group that represents companies like Coca Cola and PepsiCo, says on a page claiming to provide “the facts on added sugars labeling” that “sugar is sugar, regardless of its source.”
The science says otherwise.
Other trade groups, like the International Food Information Council tout their own “research” that finds, of course, that labeling added sugar is misleading and confusing because the public doesn’t know how to read food labels. Yet along with the independent experts serving on the 2015 Dietary Guidelines Advisory Committee, preeminent public health organizations, such as the American Heart Association, support limiting and labeling added sugar. How does the average person make sense of this disagreement over evidence and policy?
Dr. Robert Lustig, a pediatric endocrinologist, expert on the science of sugar, and author of the bestselling book Fat Chance, explained it to us succinctly when we spoke with him by phone. “The only ones opposed to limiting and labeling added sugar,” he said, “are the ones putting it in our food.”]]>
Even at agencies that received high scores for their polices, anecdotal reports and earlier research indicate that, in practice, obstacles to clear communications between agency scientists and the media still exist. For example, a 2011 survey conducted by the Columbia Journalism Review and ProPublica found that the free flow of information between agency scientists and the press was not what journalists had hoped for, given the Obama administration’s promises of transparency.
That’s why—in an effort to shed further light on the issue of policy versus practice—UCS partnered with the Society of Professional Journalists to conduct a new survey of science, health, and environment reporters. We wanted to know about their more recent experiences trying to obtain information and speak with experts at government agencies at all levels.
What did we find? Things haven’t changed all that much since 2011:
Ultimately, suppressing information challenges our democracy. Suppressing information and ideas in the ways this survey indicates harms the public understanding necessary to solve problems our nation’s most pressing problems. It allows for manipulation of the public for political or other reasons that may not be in the public interest. And it permits problems and malfeasance to go on unchecked.
Scientists and journalists have a shared stake in addressing these problems. At a release event at the National Press Club today, Carolyn Carlson, a former SPJ president, and UCS’s Michael Halpern are discussing the survey findings. Stay tuned for updates on this event and an expanded report on the survey’s findings, supplemented with interviews and recommendations, to be released in June.
“Thank you for this opportunity to speak. My name is Deborah Bailin, and I am an analyst in the Center for Science and Democracy at the Union of Concerned Scientists. I join my colleagues Lindsey Haynes-Maslow and Doug Boucher who are also speaking today, respectively, on healthy food systems and sustainability. I will be speaking on added sugars.
The Center for Science and Democracy works to expose misinformation campaigns, protect scientists from harassment, defend our nation’s science-based public health and environmental laws, and ensure public access to independent scientific information.
We strongly support the DGAC’s recommendation that Americans should limit added sugar consumption to a maximum of 10% of their daily calories. We also support the Nutrition Facts panel listing added sugars on a separate line from total sugars in both grams and teaspoons.
Studies increasingly point to sugar overconsumption as a major contributing factor in rising risks for metabolic syndrome, including type-2 diabetes and cardiovascular disease. These risks are disproportionately affecting our youth and low income and minority communities, and our nation is bearing the burden of the increasing healthcare costs associated with treating these diet-related chronic diseases.
Broad support exists in the public health community and among concerned citizens for limiting and labeling added sugar. This spring, the Center generated more than 26,600 signatures on a petition which we will deliver as a public comment to the agencies. These signatures represent the public’s approval of the DGAC’s recommendations on sugar. Additionally, we prompted more than 760 public comments from health professionals and food and nutrition scientists, representing support for the DGAC’s scientific-process and urging HHS and USDA to uphold the same standards.
Two reports the Center released in 2014—“Added Sugar, Subtracted Science” and “Sugar-coating Science”—document how food companies and trade associations attempt to influence food policy and to manipulate consumer choice. We found that sugar interests within the food industry have a consistent record of attempting to cast doubt on the body of scientific evidence linking sugar overconsumption to health problems. We also found that sugar interests often prioritize profits over public health in their efforts to influence consumer choice by marketing sugar-laden products as healthy—including products like bread, cereal, and yogurt that often contain surprisingly large amounts of added sugar.
In this regard, voluntary labeling efforts are insufficient. Such efforts are not uniformly implemented, have been shown to confuse consumers, and do not list added sugars. They highlight what food companies want us to know, not necessarily what we need to know.
I urge you to utilize the science on sugar’s health impacts and include strong language in the 2015 Dietary Guidelines encouraging Americans to limit sugar in their diets by restricting their daily intake of added sugars to a maximum of 10% of daily calories. To follow such advice, the public also needs an added sugars declaration on the Nutrition Facts panel. Such guidance would be consistent with the science on sugar and health, allow the public to make more informed choices, and help to promote health for all Americans. Thank you.”]]>
While companies like General Mills and PepsiCo—responsible for the ubiquity of products with excessive added sugar in our grocery stores—may hide behind the veneer of socially responsible messaging, their trade associations are aggressively pushing contrarian views.
In comments to the Dietary Guidelines Advisory Committee (DGAC), the independent scientific body tasked with making recommendations to the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) as these agencies develop the 2015 Dietary Guidelines for Americans, the Grocery Manufacturers Association (GMA), the American Beverage Association (ABA), and the Sugar Association have taken a page from Big Tobacco’s playbook. These and other food industry trade groups are striving to influence agency rulemaking by casting doubt on the mounting scientific evidence linking added sugar to obesity, diabetes, heart disease, and, yes, even tooth decay.
Members of the DGAC are distinguished scientists and have done their work with a very systematic, comprehensive and evidence-based approach. Their conclusions represent the scientific consensus. However, by creating the illusion of uncertainty, food industry comments to the DGAC attempt to discredit the committee’s scientific authority in order to undermine its recommendation to label and limit added sugar.
The ABA, for example, asserts that the DGAC is acting improperly by “making recommendations that are more appropriately the responsibility of other authoritative bodies” and “providing recommendations on topics that clearly fall outside of their purview and that fail to reflect the relevant body of scientific evidence.” The GMA disputes the DGAC’s thoroughness, insinuating that the committee’s recommendations are not “based on the totality of available scientific evidence” because they do not align with member companies’ views. A 14-page letter from the Sugar Association expresses “concerns” with the rigor of the DGAC’s research. In the letter, the trade group accuses the DGAC of following flawed methodology, claiming falsely that the findings in meta-analyses the committee relied on “contradict the positions and advice of U.S. professional organizations.”
“Doublethink” is the term George Orwell coined in his novel 1984 for “tell[ing] deliberate lies while genuinely believing in them.”
In just one of many displays, the Sugar Association contends in its letter that the American Heart Association is one of the professional organizations disagreeing with the DGAC, citing an irrelevant paper on stroke prevention. To the contrary, the American Heart Association has expressly and publicly endorsed exactly what the DGAC is recommending—namely, limiting added sugar to 10 percent of daily calories. The letter says the same thing about the American Diabetes Association and the American Dental Association—and links to papers that similarly contradict the sugar group’s assertions.
In its own letter, the GMA, like the Sugar Association and the ABA, tries to downplay what every gum-smacking eight-year-old learns after visiting the dentist. In the letter, the trade group writes, “the frequency of sugar consumption, the stickiness of the food, and the length of time between sugar intake and tooth brushing plays a bigger role in the development of tooth decay than the quantity of sugar.” That statement is then referenced with a study that finds exactly the reverse: “The evidence that dietary sugars are the main cause of dental caries is extensive …. Without sugar, caries would be negligible.”
Another common tactic of sugar interests—when the only studies they can find unambiguously refute their own assertions—is to deploy their own scientists to dispute mainstream science and repeat industry talking points. In another letter to the DGAC, the GMA chides the committee for an incomplete review of the available science and proffers a list of scientists with whom the committee should consult.
All five scientists named have food industry conflicts of interest on sugar [links to form page; enter scientist’s name in the form to see conflicts]. Theresa A. Nicklas received support from the Sugar Association; Joanne L. Slavin was funded by General Mills; and G. Harvey Anderson received support from General Mills, Archer Daniels Midland, and unrestricted funding from the Sugar Association and the Canadian Sugar Institute. In 2014, the other two, John Sievenpiper and Roger Clemens, appeared on an industry “sponsored satellite program” organized at a biology conference by James Rippe, an infamous figure paid $41,000 a month—among other conflicts of interest—by the Corn Refiners Association to produce and publish research that aligns with the trade group’s position on high fructose corn syrup and health.
Ultimately, the goal of all this sophistry is to forestall policies aimed at protecting Americans’ health. And there’s nothing new in the tactics outlined here. As we’ve written, the Sugar Association went so far as to threaten the World Health Organization in 2003 when it released a report recommending a 10 percent daily limit on calorie intake from sugar. Those familiar with WHO history described sugar industry pressure as “tantamount to blackmail and worse than any pressure exerted by the tobacco lobby.”
Doublethink, in Orwell’s dystopia, is about denying objective reality at the same time those in power are taking advantage of it. There is no place for doublethink in our democracy. As the USDA and HHS prepare the new dietary guidelines, they should rely not on doublethink but on the best available science.
The DGAC’s recommendations on added sugar recognize the growing body of scientific evidence that over-consumption of sugar is a major contributing factor to the increased risk of developing metabolic syndrome, along with the subsequent and significant health care costs of treating it.
By following the DGAC’s recommendation, the USDA and HHS could have a significant impact on turning the tide against the chronic diseases affecting American families and communities across the nation.
But too many children in Baltimore were not so fortunate. This highly contagious and serious disease sickened around 500 area residents, mostly children, and caused a third of them to wind up in the hospital. Across the nation, thousands of people were afflicted during that outbreak and 41 died.
A majority of victims in Baltimore were poor and African American or Hispanic. Vulnerable to barriers like cost and healthcare access, they were unvaccinated—or under-vaccinated—not by choice but by circumstances.
Today, as the Disneyland measles outbreak continues to unfold, the demographics have changed somewhat. Many white, educated, affluent parents are choosing not to vaccinate their children. However, individuals under-vaccinated by circumstances still tend to be poor and black, placed at greater risk of preventable illness by the decisions of others.
The choice not to vaccinate, often framed in terms of individual liberties, is not just a personal one. It’s infused with privilege and has consequences for those who have less freedom to choose—not only those who have difficulty accessing healthcare but children who are too young to be vaccinated and people with compromised immune systems.
In the wake of the Baltimore outbreak during my college years, both the city and the State of Maryland made important policy changes that improved access to immunizations and empowered residents to protect themselves and their communities through science-driven interventions. Clinics added extra hours; walk-in appointments were permitted; a pre-vaccination physical exam was no longer required; and vaccines were offered free of charge.
But will these measures be enough to keep Baltimore measles free?
Along with public engagement efforts, Baltimore’s policies have paid off over time. As the current Baltimore City health commissioner, Dr. Leana S. Wen, put it in a public statement this week, “For the last ten years, our city has seen zero measles infections. Zero hospitalizations. Zero permanent injuries. Zero deaths.”
Dr. Wen made her remarks at a symposium I attended organized by the Johns Hopkins School of Public Health. Sitting in an auditorium at my alma mater hearing Dr. Wen speak made me proud of my school and the city I once called home, but I also keenly appreciated how much my perspective during that outbreak in my college years had been shaped by social privilege as much as by the success of vaccines. I didn’t worry about measles because, unlike the kids in nearby neighborhoods, my parents—and the parents of my friends and the parents of their friends—had easy access to medical care. They had us vaccinated as children and, in doing so, created a level of protection against disease in our communities that was unprecedented in human history.
Yet it is this unprecedented freedom from diseases once a scourge to humanity that has created a different and dangerous kind of privileged perspective—a distortion of risks that rejects science for sickness and places the personal freedom to chance disease above the public will to stay well.
Balancing individual liberties with safeguards to protect the common good has always been a challenge for our democracy, even as science has advanced and policy has worked hard to keep pace. From the audience, I felt the passion—and compassion—in Dr. Wen’s voice as she tried to navigate this complexity. “Baltimore is not an island,” she cautioned, reminding us of the precariousness of her city’s success:
“Despite consensus among doctors and scientists that vaccines are safe and effective, there have been increasing numbers of parents who have chosen not to vaccinate their children. In 2014, there were 644 cases of measles across 27 states.
“The recent outbreak that began at Disneyland is spreading among unvaccinated children. As a result, parents of children who are not able to be vaccinated, such as those under one year of age and those with weakened immune systems, are fearful of illness and complications. The Disneyland outbreak raises the real risk that measles may come roaring back.
“We have come too far to let that happen …. “
Even as initiatives like Baltimore’s have helped to democratize access to vaccines and reduce racial and ethnic disparities in immunization rates, rising personal belief exemptions across many states mean that we can no longer count on community immunity (the discovery of Arthur Hedrich, another Baltimorean and Johns Hopkins scientist) to safeguard the vulnerable groups Dr. Wen mentioned. To sustain community immunity, localities, states, and the federal government must work together.
Baltimore—its science-based policies and high vaccination rates notwithstanding—cannot maintain its freedom from measles forever, as long as other localities lack stronger safeguards to stop the spread of this preventable disease.
In retrospect, even though I attended college steeped in the culture of Hopkins’ highly regarded achievements in science and medicine, I now recognize that as a student I took my health and my freedom from diseases like measles for granted. Are we not doing the same thing today when we fear vaccines more than the diseases they have prevented so many of us from ever having suffered? Are we not taking both science and democracy for granted if we pretend that privilege equals personal freedom and knowledge carries no responsibility to act on behalf of the public good?]]>
The study examined the salt and sugar content of commercial infant and toddler food in the U.S. Researchers looked at a 2012 dataset of 1074 infant and toddler foods and beverages. Among infant products, they found that 41 of 79 mixed grains and fruits—i.e. healthy seeming items—contained more than one added sugar; in 35 infant items, more than 35 percent of calories came from sugar. Among toddler products, the researchers found that 72 percent of dinners and most cereal bars, breakfast pastries, fruit, snacks, desserts, and juices contained more than one added sugar.
Given the American Heart Association’s recommendations on added sugar, it’s pretty clear from the CDC study that many very young children are getting too much.
The study concludes with advice to pediatricians. Namely, counsel parents to pay attention to labels on the food and drink products they buy for their infants and toddlers and try to limit the added sugar. Unfortunately, this advice—no matter how well parents try to follow it—can only go so far.
Currently, the Nutrition Facts label does not provide parents with enough information to truly make informed decisions. Total sugar is listed in grams—not the more familiar teaspoons—and neither the amount of added sugar nor the percent daily value are provided. So parents, who may be trying diligently to follow their pediatricians’ science-informed advice, cannot know how much sugar has been added to the foods and beverages they are feeding their infants and toddlers—or how much is too much.
As the FDA considers its proposed rule to update the Nutrition Facts label to include added sugar, the U.S. Departments of Agriculture and Health and Human Services are concurrently developing the 2015 Dietary Guidelines for Americans. A forthcoming report from the Dietary Guidelines Advisory Committee—an independent scientific body tasked with providing guidance to the agencies—is expected to contain recommendations on limiting added sugar to a maximum of 10 percent of daily calories and including added sugar and percent daily value on the Nutrition Facts label.
It would be an important, science-based step forward not only for parents of young children but for all Americans if the agencies decide to adopt the DGAC’s recommendations on limiting and labeling added sugar.
One of the important things that will happen if and when more information about added sugar is made available on food labels is that people will better understand not only the amount of it in any one food product but how omnipresent it is across our food supply.
Predictably, the food industry has responded to the CDC’s study on infant and toddler food with skepticism, doubt-mongering, and the old, tobacco-style “free choice” argument. According to the Grocery Manufacturers Association, a trade group representing major food companies like General Mills, the CDC study “does not accurately reflect the wide range of healthy choices available in today’s marketplace” and “could needlessly alarm and confuse busy parents as they strive to develop suitable meal options that their children will enjoy.”
Indeed! Those busy parents would realize that added sugar is everywhere and almost unavoidable in processed food that is marketed to appear healthier than it really is—not only in infant and toddler food but in cereal, bread, yogurt, pasta sauce, and even salad dressing. These aren’t choices in any real sense of the word. If the food industry really cared about healthy choices, it would accept the science linking sugar to a host of health problems and be honest with their customers. Maybe choices and preferences would change—and maybe the food industry would have to change, too, if it wanted to keep those customers.
And that’s a lot more challenging—but a lot better for public health—than doubt-mongering and science denial.]]>