On December 5th the U.S. Senate Committee on Health, Education, Labor and Pensions held a hearing on the question “What is the FDA Doing to Reduce the Diabetes and Obesity Epidemics in America and Take on the Greed of the Food and Beverage Industry?” Health, education, labor and pensions seems like quite a lot of ground for one committee to cover, which perhaps explains why its members didn’t have time to workshop a pithier title. Nevertheless, watching the proceedings provides some unexpected entertainment, and it illuminates this peculiar moment, in which the dysfunction of the food system is becoming a salient national issue.
Because this is politics the whole thing unfolds with a stilted sort of theatricality. Committee chair Bernie Sanders, the ringmaster, has come prepared to take on the food industry. Waving around a 20 oz. bottle of coke like a cudgel, repeatedly mentioning the fifteen teaspoons of sugar it contains, he weaves a compelling narrative of nefarious corporations bent on hooking Americans. Why, he asks, do we allow food companies to advertise products that are as addictive as cigarettes to our children? Unlike Chile and many other developed countries, why don’t we require clearer front of package labels when the FDA claims to have been working on them for over a decade? What has the FDA been doing as Americans have been getting sicker? If you have ever seen Sanders give a speech you can imagine exactly how this sounds. There’s lots of cantankerous bluntness and plenty of high moral dudgeon when he gets his teeth into the big business that is food in America.
Other committee members have different concerns. Tommy Tuberville, doing a good job of exuding folksy common sense, raises the questionable safety of artificial red food coloring; his boys at home (who, one suspects, listen to Joe Rogan) have got him wondering why it’s allowed. “I want to ask you about Red 3 and Red 40 and get your comments on this. It’s not a conservative or a liberal standpoint. I think we all need to understand as a group how we’ve gotten to this point.”
There are more tangents and topics: a new nutrition research center, the differences between plant milks and cow’s milk, mortality rates in comparison to peer countries, the regulation of lab-grown meat, and a long discussion about the seismic implications of weight loss drugs that seem to work with acceptably few side effects.
Giving the FDA’s perspective is Commissioner Robert Califf, MD, Califf’s show-stealing mustache, and Jim Jones, Deputy Commissioner of the Human Foods Program. Califf in particular comes across as well-meaning, but says he is limited by the threat of lawsuits, by a lack of legislative clarity, and by inadequate funding. He insists that he takes the problems seriously, but his agency is limited. “The FDA is trying to do its part within its authorities and budget, but successful change in the trajectory of our health depends on reaching a societal consensus that we will do this together.”
Two points emerge from the grandstanding and ass-covering. First and somewhat heartening is that enough people have begun caring about the relationship between food and health to compel the Senate into putting on a public display of concern. Second and somewhat depressing is that no one involved has a remotely plausible plan for fixing the food system.
Take artificial dyes. I happen to agree that the potential negative health impacts of individual additives deserve greater scrutiny, but positing that such scrutiny will somehow fix the larger problem is counterproductive. Here’s an example from the hearing. At one point Califf mentions the FDA response to evidence that trans fats pose serious health risks. In his telling, a robust effort of education and regulation led to a reduction of consumption by the public and the reformulation of products by the industry. While removing trans fats was doubtless for the good, that word ‘reformulation’ is the devil in the details, since it is industry speak for keeping the eating experience exactly the same while replacing one ingredient with another. Singling out any particular additive invites the makers of processed food to claim they are serving the public interest by trading one substance for another.
Or look at Senator Sanders’ front of package labelling. He is correct that Chile required such a label a decade ago, and he is correct that the FDA’s feckless inability to follow suit is ludicrous. But he leaves unmentioned the fact that Chile’s and similar laws have not done anything to alter the trajectory of obesity. Even a self-identified socialist isn’t advocating for the sorts of draconian regulation that would probably work (say, a 400% tax on any food item with more than two ingredients) because such a proposal would be about as popular as tofu disguised as meat.
A more interesting possibility briefly arises when Sanders and Califf engage in a pointed exchange about the FDA’s relationship to the industries it oversees. Sanders repeatedly tries to get Califf to say something critical of the entities that have flooded the marketplace with comically unhealthy food for decades, sickening the populace in the process. “I’m not going to castigate the people working in the food and beverage industry,” Califf finally says, to which Sanders thunders, “That is your job!”
It’s good theater, but I happen to agree with Sanders. I’ll go further—the only way the dietary trends that have been ascendant for the better part of a century will reverse is if the public perception of food undergoes a truly radical shift. Swapping one emulsifier for another, mono- for diglycerides, powdered beet extract for Red 40 will not move the needle. Neither will prominently displaying the sodium content on the front of every can of soup. Only if the public at large comes to view processed food as poison, to view McDonald’s as more akin to cigarettes than a healthy dinner, will dietary patterns have a chance of shifting dramatically enough to reverse the trends of obesity and related diseases. The government cannot legislate such a change, but public health officials could at least be clear in their messaging.
The other path, which we are far more likely to race down, is drugs. As much as I would love a social response, one in which without coercion or chemical support we collectively undertake the hard work of rediscovering how to make and share and eat real food, I am not holding my breath. I am aware of no country in the world that has brought about such a shift, no matter the government or cultural particularities. But there are early signs that novel weight loss drugs have succeeded at reducing rates of obesity, and I would bet the evidence will become incontrovertible in years to come.
I’m not alone in finding the prospect a food system so unhealthy that a large percentage of the populace requires lifelong prescription drugs simply to avoid a litany of metabolic disorders pretty grim. As Dr. Califf says, in the hearing’s most poignant moment, “I’ve had this nightmare that I was the head of this agency that my great-grandkids read about called the FDA, where a society allowed people to gain essentially a pound of weight every year, and then to fix it they invented a drug at $20,000 per year to try to deal with it. That would be a very bad legacy to leave behind.”
A tragedy for certain, but it would also be a crystalline example of the perils of a society in which technology increasingly shapes each of us, body and soul. The only response we can conceivably muster to an environment designed to manipulate us into ill health comes in the form of drugs designed to manipulate us into resisting it. No one likes this, and perhaps our collective discontent will lead to a ban on a chemical or two and maybe to ominous labels on the front of some foods. But I think everyone knows the real solution, when it arrives, will be injections and pills that allow us to walk through an orchard of poisoned fruits without reaching out our soft hands. There’s little appetite for a response that begins with taking up our axes to clear the land for something better.
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Well done. Thank you.