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Thursday, June 28, 2012

Big Gulps + Big Medicine = Big Government?

By James Beckerman, MD, FACC


Last month Mayor Michael Bloomberg re-ignited a national debate about the role of government in regulating what the private individual can do — or drink. His new policy restricting the sale of jumbo sodas responds to frustration that nutrition education has had limited success in promoting healthy intake and more exercise. We have learned through research that limiting choices and creating obstacles to less healthy behaviors (thereby making healthy behaviors more convenient) can steer behaviors in a direction that may turn the tide, however slowly.

Supporters of Mr. Bloomberg herald his decision as brave and many believe his policy is the first of many to domino across the nation as health care costs skyrocket and true health reform (regardless of the recent SCOTUS decision) is nowhere in sight. If we instill policies that make it easier for people to become healthier, they might argue, then everybody wins!

But based upon the controversy surrounding his announcement, many think that the typical American won’t win. Some suggest that thirsty individuals will gladly pay for another medium-sized drink to sate their sweet tooth, and some believe that the law unfairly targets lower-income individuals. Others point to the limited effectiveness of menu labeling and other regulatory measures as a sign that it just won’t work.

Which brings us to regulation. Probably the greatest frustration that people have with Mr. Bloomberg’s plan is that it presents yet another example of Big Government intruding into the lives of ordinary citizens, limiting choices and free will in the form of a 32-ounce Big Gulp.

How dare an organization over which we have limited day-to-day control meddle in our dietary affairs?

These points are fair, but also need to be interpreted in proper context. First, the government provides health care to a booming number of citizens, including lower-income individuals who may be disproportionately impacted by this legislation as well as older individuals who have the highest rates of heart disease, diabetes, and health care costs. Promoting health, even through regulation, can be consistent with providing health care. Second, and perhaps more importantly, regulation is not a new thing.  A regulation is a principle designed to control behavior. It’s just a euphemism for manipulation…and it’s happening all around you.

Have you ever wondered how high fat, high sugar, high salt, and highly processed foods are so cheap? And why soda bottles got so big in the first place? Through a clever combination of government subsidies, lax rules regarding marketing to youths, and extensive research into our palates without consideration for our paunches, the beverage industry has manipulated us into buying its products and consuming more than we need. It has facilitated unhealthy behaviors and — by reducing cost per calorie as compared to healthier options — Big Beverage has created obstacles to eating real, unprocessed food.

How dare an organization over which we have limited day-to-day control meddle in our dietary affairs?

But it doesn’t end there. Our health care system (which is partially propped up by our government) is at a loss for how to improve health outcomes, so organizations like the American Heart Association, the American College of Cardiology, and Canada’s PartipACTION promote healthy behaviors through advocacy, education, and outreach. But it costs a lot of money to make television commercials, run exercise programs, and print pamphlets. Wouldn’t it be great if corporate donations helped to support these lofty goals?

Welcome back to the tent, Big Beverage. Our thirst for your sodas is only exceeded by our thirst for your profits. Corporations that create and promote unhealthy products are some of the greatest donors, supporters, sponsors, and partners of our health organizations. It’s altruism with a bottom line. And as a result, Big Medicine ends up having egg on its face. Or at least some sugary carbonated water.

I understand the skepticism surrounding Mr. Bloomberg’s policy, but I’m struck even more by the extent to which corporations have manipulated — and even regulated — our tastes, our cravings, and our pocketbooks. The proposed policy is a response, but the initial outrage might be directed elsewhere.

Big. Gulp.

Photo: Polka Dot

Posted by: James Beckerman, MD, FACC at 10:55 am


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