E. Cuyler Hammond and Daniel Horn, two scientists working for the American Cancer Society, published one of the first studies conclusively linking cigarette smoking to lung cancer seventy years ago, adding to a growing scientific consensus that cigarettes were to blame for the disease’s global spread. This may have been the moment when Americans realised the dangers of smoking and quit permanently – but of course, they did not.
Faced with overwhelming evidence that their very valuable product was hurting its consumers’ health, the tobacco industry resisted. That same year, it founded the Tobacco Industry Research Committee to cast doubt on the research. And it worked. Pseudoscience provided by the industry has a greater impact on popular attitudes towards smoking than thoroughly filtered evidence. People continued to smoke, and many physicians remained sceptical of the link between cigarettes and cancer in the 1950s. Cigarette sales in the United States began to drop only in the mid-1960s, after a decade-long lag in public awareness that claimed the lives of countless smokers.
Tobacco’s persistent opposition to public health common sense is an all-too-familiar narrative. Companies that benefit from dangerous or unhealthy products, such as ultra-processed foods, prescription opioids, and social media, frequently use a tried-and-true strategy of deception and denial to keep their sales going as long as possible. Their techniques can be so effective that public perception takes decades to catch up, resulting in public health catastrophes that appear practically impossible to manage. Companies frequently generate uncertainty as successfully as they do hazardous products.
The term “market-driven epidemics” was recently used to characterise the dynamics of these dangerous consumer items. It is estimated that market-driven epidemics kill 23 million people globally each year. They are at the root of some of the world’s most pressing health issues, such as heart disease, obesity, diabetes, drug addiction and overdose, and certain malignancies, and they cost healthcare systems trillions of dollars to treat. However, these astronomical social and economic consequences are not inevitable. Countless lives may be spared if academics did a better job of recognising market-driven epidemic trends earlier and responded more assertively to predicted corporate opposition.
Researchers have recently studied three of the most widespread market-driven epidemics in modern history—cigarettes, prescription opioids, and sugary foods and beverages—to better understand how this is possible. In each of these situations, businesses aggressively pushed goods despite known risks and actively opposed public health initiatives to regulate them. The tobacco industry, for example, supported studies that sought to attribute cancer to other causes, such as particular diets or hormones, rather than smoking. The sugar business followed the tobacco industry’s lead by supporting research that dubiously moved the responsibility for America’s obesity issue to saturated fats, resulting in a surge of low-fat items that neatly increased their sugar level to keep flavour.
In the late 1990s, Purdue Pharma used many of the same strategies to increase demand for their prescription painkiller, OxyContin. They continued to fraudulently state that OxyContin had a misuse rate of less than 1%, even as the opioid crisis spread to rural regions. Many doctors believed these false claims of low usage rates, and it was not until 2011 that the US Centres for Disease Control and Prevention acknowledged the overdose issue in the United States. Eventually, overwhelming proof of these goods’ detrimental consequences, along with repeated messages from public health authorities, was enough to overcome corporate resistance. Cigarette sales in the United States have plunged by 82% since their peak, while prescription opioid use has decreased by 62%.
It is not always clear when a market-driven outbreak begins. Many of the items we now know to be hazardous were once perceived as harmless, if not beneficial. However, there are obvious methods that public health officials may take to detect and stop market-driven epidemics before they cause widespread harm. Emerging market-driven epidemics that require special attention include ultra-processed foods, which have accumulating evidence of harm but have not yet convinced authorities to act, as well as nutraceuticals and dietary supplements.
HOW CAN RESEARCHERS STEP UP?
First, researchers must work more promptly to study the first signs of new health hazards. Governments should also enhance the obligations for firms to investigate and report on the health effects of their goods, as well as hold them accountable when evidence of damage is hidden.
Second, public health officials must recognise their critical role in bending the consumption curve. When the United States Surgeon General issued its first formal warning about smoking in 1964, the bombshell report dominated newspapers and television, becoming the authoritative voice that the public could no longer ignore. It’s hardly surprising that cigarette usage in the United States began to decline in about 1964.
Third, the voices of professional organisations, journalists, and even pop culture icons can have a significant impact on changing the trajectory of a market-driven pandemic. In the case of sugar, for example, the Centre for Science in the Public Interest’s 1999 study “America is Drowning in Sugar” is remembered as one of the focal events that began to reverse the tide of America’s sugar addiction.
According to research, there are methods to intervene to speed the transitions, preventing disease and death before the consumption tipping point occurs.
The larger concern is how we will respond the next time smart observers point out unfavourable health impacts associated with the usage of a popular consumer product. Will we listen? Will we allow the unscrupulous manoeuvres of corporations aiming to maintain their profits to triumph once more? If we improve our ability to recognise early warning signs—and call out the inevitable attempts to divert us from them—the next market-driven epidemic may not be as expensive.
