Public health or profit: time to decide

Abstract

For anyone who believes that big business rules the world, reading Nicholas Freudenberg's book Lethal but Legal will provide the information needed to form a convincing argument to challenge any non-believer. As a public health practitioner, researcher, and self-proclaimed activist, Freudenberg's motivation to expose the threat of corporate power and manipulation—framed by the term corporate ideology of consumption—is driven by a public health concern that goes beyond the personal to address the global burden of non-communicable diseases (NCDs), such as cardiovascular and chronic respiratory diseases, cancers, and diabetes. He explores how industry sustains the population that in turn maintains those very same industries that damage health, with profound and fatal consequences.Freudenberg provides the reader with an exceptionally detailed and thought-provoking historical profile of how corporations have risen to power and maintained their influence in the shaping of our societies, predominately in the USA, but with a wider worldwide reach. He focuses on six industries—food, tobacco, alcohol, pharmaceuticals, guns, and automobiles—that seem to override government policy and regulation, sociological and scientific evidence, and ethical practice, seeking only to line their pockets and tighten their grasp on a notional product that Freudenberg calls hyperconsumption; a lifestyle that is directly linked to premature mortality and preventable illness.Tobacco, the leading cause of preventable deaths worldwide, has been at the core of public health debate over the past few decades, yet the industry continues to thrive, despite blatant warnings that scream tobacco kills whenever you pick up a packet of cigarettes. In the first chapter, “Manufacturing disease”, Freudenberg investigates how this contravention has continued to plague an informed population. He looks at the successes of rebranding, promotion of corporate responsibility, and the smart move of openly endorsing the US Food and Drug Administration's (FDA) regulation of tobacco—while behind the scenes tobacco companies shifted their focus onto less well informed emerging markets, such as Russia, China, and South America, where tobacco-related illness due to smoking continues to rise.Margaret Chan, Director General of WHO, spoke at the UN meeting on NCDs in September, 2011, about the pressing need to address the global burden, saying that NCDs “deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year.” Although, as Freudenberg suggests, the modern global consumer economy might be blamed for this crisis, he argues that this blame, attributed to lifestyle, and therefore individual choice, is another weapon brandished by the corporate consumption complex. He believes that this perspective should be recognised for its irresponsible and misleading message that “confuses the symptoms of a changed environment, ie, rises in unhealthy behaviour, for the causes of those changes. In public health as in medicine, treating symptoms rather than causes rarely leads to lasting improvements in health.” This outlook, Freudenberg claims, keeps progress stuck in a cycle of inevitable failure, corporations safe from accountability, and the public distanced from a lifestyle that is safe from harm.Urban smog, a trigger for asthma and other disorders, is linked to motor vehicles in urban environments; cars undoubtedly contribute to human-induced climate change, another worldwide threat to public health. Yet Freudenberg documents the automobile industry's consistent opposition to all regulatory policies to improve safety and minimise risks to respiratory health. Corporations are wealthy and influential. They have the best public relations tactics, the best legal minds, and the best marketing techniques, and they create strong ties with government bodies, not to mention their greatest allies, trade organisations and industry lobbyists who actively promote their interests. They can adopt high-tech strategies, using social media and viral marketing—including so-called neuromarketing, which uses clinical information to understand and influence what happens in consumer's brains as they decide which product to buy. Reading our minds, so that we buy a product that is potentially harmful, is rightly perceived as frightening and invasive.The pharmaceutical industry has undoubtedly saved millions of lives; however, prescription drugs are also a cause of death in high-income countries, with a substantial number of patients experiencing serious adverse reactions, as well as fatal reactions to the drugs, according to the FDA. This increases the burden of healthcare costs, and causes health concerns about the safety of marketed and approved drugs. Freudenberg explores the complex relationship the drug companies have with their consumers, as both a profit-driven industry and providers of health care; the promotion of inadequately tested drugs to physicians and the extortionate costs of patented drugs that deny access to people in low-income countries, harm health, and put profit before human wellbeing.In the USA, excessive alcohol consumption is the third leading cause of death, but, despite positive publicity, responsible drinking campaigns do little to target the real problem and divert and undermine resources that could benefit public health. In response to sanctions, the industry simply identifies new demographics to infiltrate and monopolise.This book offers an enlightening insight into the world of corporate dominance over global health priorities and the seemingly impenetrable power of the corporate ideology of consumption, explained by Freudenberg as consisting of key tenets that appeal to the values of independence, democracy, and free will: you are responsible for your lifestyle choices; we cater for these choices, providing you with what you want; government should not tell you what to do; free trade is good for everyone; consumption helps economic growth; and providing education is the solution. However, a counterattack is possible, Freudenberg asserts in the second part of the book, entitled “Creating solutions”. By fully understanding the history of the corporate, political, and economic dynamic, and the limited, but not limiting, role that individuals can now embrace, the ability to promote and engender change is achievable. He is convinced that we can emulate and learn from roles adopted by those “organizing to protect people's health from corporations that put profit over well-being”, working at “local, regional, national, and global levels”.Using past and recent advocates of health and safety as models of successful reform, such as work safety and child labour laws—and more recently the work of the California Air Resources Board, Brooklyn Food Coalition, and Corporate Accountability International, who launched the Challenge Big Tobacco campaign—he draws on the strength of people and groups working together as a movement, rather than as independent clans with similar goals. Grassroots organisations working with health-care providers, non-governmental organisations, and other interested parties can consolidate their knowledge, influence, and passion to create a workable policy agenda by suggesting alternatives, engaging government, targeting companies, and operating at many levels. The message, although enmeshed in a web of corporate strands of seemingly impenetrable strength, is ultimately one of hope for a healthier future, but only if the global community takes action to cut itself free. For anyone who believes that big business rules the world, reading Nicholas Freudenberg's book Lethal but Legal will provide the information needed to form a convincing argument to challenge any non-believer. As a public health practitioner, researcher, and self-proclaimed activist, Freudenberg's motivation to expose the threat of corporate power and manipulation—framed by the term corporate ideology of consumption—is driven by a public health concern that goes beyond the personal to address the global burden of non-communicable diseases (NCDs), such as cardiovascular and chronic respiratory diseases, cancers, and diabetes. He explores how industry sustains the population that in turn maintains those very same industries that damage health, with profound and fatal consequences. Freudenberg provides the reader with an exceptionally detailed and thought-provoking historical profile of how corporations have risen to power and maintained their influence in the shaping of our societies, predominately in the USA, but with a wider worldwide reach. He focuses on six industries—food, tobacco, alcohol, pharmaceuticals, guns, and automobiles—that seem to override government policy and regulation, sociological and scientific evidence, and ethical practice, seeking only to line their pockets and tighten their grasp on a notional product that Freudenberg calls hyperconsumption; a lifestyle that is directly linked to premature mortality and preventable illness. Tobacco, the leading cause of preventable deaths worldwide, has been at the core of public health debate over the past few decades, yet the industry continues to thrive, despite blatant warnings that scream tobacco kills whenever you pick up a packet of cigarettes. In the first chapter, “Manufacturing disease”, Freudenberg investigates how this contravention has continued to plague an informed population. He looks at the successes of rebranding, promotion of corporate responsibility, and the smart move of openly endorsing the US Food and Drug Administration's (FDA) regulation of tobacco—while behind the scenes tobacco companies shifted their focus onto less well informed emerging markets, such as Russia, China, and South America, where tobacco-related illness due to smoking continues to rise. Margaret Chan, Director General of WHO, spoke at the UN meeting on NCDs in September, 2011, about the pressing need to address the global burden, saying that NCDs “deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year.” Although, as Freudenberg suggests, the modern global consumer economy might be blamed for this crisis, he argues that this blame, attributed to lifestyle, and therefore individual choice, is another weapon brandished by the corporate consumption complex. He believes that this perspective should be recognised for its irresponsible and misleading message that “confuses the symptoms of a changed environment, ie, rises in unhealthy behaviour, for the causes of those changes. In public health as in medicine, treating symptoms rather than causes rarely leads to lasting improvements in health.” This outlook, Freudenberg claims, keeps progress stuck in a cycle of inevitable failure, corporations safe from accountability, and the public distanced from a lifestyle that is safe from harm. Urban smog, a trigger for asthma and other disorders, is linked to motor vehicles in urban environments; cars undoubtedly contribute to human-induced climate change, another worldwide threat to public health. Yet Freudenberg documents the automobile industry's consistent opposition to all regulatory policies to improve safety and minimise risks to respiratory health. Corporations are wealthy and influential. They have the best public relations tactics, the best legal minds, and the best marketing techniques, and they create strong ties with government bodies, not to mention their greatest allies, trade organisations and industry lobbyists who actively promote their interests. They can adopt high-tech strategies, using social media and viral marketing—including so-called neuromarketing, which uses clinical information to understand and influence what happens in consumer's brains as they decide which product to buy. Reading our minds, so that we buy a product that is potentially harmful, is rightly perceived as frightening and invasive. The pharmaceutical industry has undoubtedly saved millions of lives; however, prescription drugs are also a cause of death in high-income countries, with a substantial number of patients experiencing serious adverse reactions, as well as fatal reactions to the drugs, according to the FDA. This increases the burden of healthcare costs, and causes health concerns about the safety of marketed and approved drugs. Freudenberg explores the complex relationship the drug companies have with their consumers, as both a profit-driven industry and providers of health care; the promotion of inadequately tested drugs to physicians and the extortionate costs of patented drugs that deny access to people in low-income countries, harm health, and put profit before human wellbeing. In the USA, excessive alcohol consumption is the third leading cause of death, but, despite positive publicity, responsible drinking campaigns do little to target the real problem and divert and undermine resources that could benefit public health. In response to sanctions, the industry simply identifies new demographics to infiltrate and monopolise. This book offers an enlightening insight into the world of corporate dominance over global health priorities and the seemingly impenetrable power of the corporate ideology of consumption, explained by Freudenberg as consisting of key tenets that appeal to the values of independence, democracy, and free will: you are responsible for your lifestyle choices; we cater for these choices, providing you with what you want; government should not tell you what to do; free trade is good for everyone; consumption helps economic growth; and providing education is the solution. However, a counterattack is possible, Freudenberg asserts in the second part of the book, entitled “Creating solutions”. By fully understanding the history of the corporate, political, and economic dynamic, and the limited, but not limiting, role that individuals can now embrace, the ability to promote and engender change is achievable. He is convinced that we can emulate and learn from roles adopted by those “organizing to protect people's health from corporations that put profit over well-being”, working at “local, regional, national, and global levels”. Using past and recent advocates of health and safety as models of successful reform, such as work safety and child labour laws—and more recently the work of the California Air Resources Board, Brooklyn Food Coalition, and Corporate Accountability International, who launched the Challenge Big Tobacco campaign—he draws on the strength of people and groups working together as a movement, rather than as independent clans with similar goals. Grassroots organisations working with health-care providers, non-governmental organisations, and other interested parties can consolidate their knowledge, influence, and passion to create a workable policy agenda by suggesting alternatives, engaging government, targeting companies, and operating at many levels. The message, although enmeshed in a web of corporate strands of seemingly impenetrable strength, is ultimately one of hope for a healthier future, but only if the global community takes action to cut itself free.