What Is Going on at the CDC? Health Agency Ethics Need Scrutiny

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Officials at the Centers for Disease Control and Prevention have their hands full these days. An epidemic of obesity has hit Americans hard, raising the risks for heart disease, stroke, type 2 diabetes and certain types of cancer. Childhood obesity is a particular prevalent problem.

Last year, World Health Organization (WHO) Director General Margaret Chan said the marketing of full-sugar soft drinks was a key contributor to rising obesity rates among children, suggesting restrictions on sugar-rich beverage consumption.

Though the beverage industry has strongly objected, several U.S. cities have been passing, or trying to pass, taxes on sugary sodas to discourage consumption. Since Berkeley, California became the first U.S. city to levy a soda tax in 2014, consumption dropped more than 20 percent in some areas of the city, according to a report published August 23 by the American Journal of Public Health. A Mexican soda tax correlated with a similar drop in soda purchases, according to research published earlier this year. One would expect the efforts would be heartily applauded by the CDC. And indeed, earlier this year a CDC research report said more aggressive measures were needed to convince Americans to cut back on sugary drinks.

But behind the scenes, mounting evidence suggests that rather than cracking down on the soda industry, high-ranking officials within the CDC’s National Center for Chronic Disease Prevention and Health Promotion are instead cozying up to beverage giant Coca-Cola and its industry allies, even in some cases aiding the industry as it argues that sodas are not to blame.

At least one internal ethics complaint over industry influence was lodged this month, according to a source inside the CDC. And more may be coming as a group of scientists within the CDC reportedly are attempting to push back against a culture cultivating close ties with corporate interests.

One recent focus of scrutiny has been the ties between Michael Pratt, Senior Advisor for Global Health in the CDC’s disease prevention unit, and Coca-Cola’s brainchild — the nonprofit corporate interest group called the International Life Sciences Institute (ILSI.) ISLI was founded by Coca-Cola scientific and regulatory affairs leader Alex Malaspina in 1978, and continues to advocate for the agenda of beverage and food industries. Some in the scientific community see ILSI as little more than a front group aimed at advancing the interests of those industries with little regard for public well-being.

Still, ILSI’s money and influence are well known at the CDC, and Pratt’s work with ILSI is a prime example. Documents show that Pratt has a long history of promoting and helping lead research backed by Coca-Cola and ILSI.

One item at the top of the agenda for Coca-Cola and ILSI is gaining acceptance for the concept of energy balance. Rather than focusing on reducing consumption of sugar-laden foods and beverages to help control obesity and other health problems, policy makers should be focusing on a lack of exercise as the primary culprit, the industry says. That type of strategic spin is expected from companies that make money off those sugary foods and drinks. They’re protecting their profits.

But it’s harder to understand how the CDC can sign off on Pratt’s involvement in the industry effort. This public employee, presumably drawing a taxpayer-funded paycheck, has spent the last few years working in a range of roles near and dear to the industry: He co-authored a Latin America health and nutrition study and related papers funded in part by Coca-Cola and ILSI; he has been acting as a scientific “advisor” to ILSI North America, serving on an ILSI committee on “energy balance and active lifestyle.”

Until his activities came under scrutiny, he was listed as a member of the ILSI Research Foundation Board of Trustees (his bio was removed from the website earlier this month). Pratt also served as an advisor to an international study of childhood obesity funded by Coca-Cola. And for roughly the last year or more he has held a position as a professor at Emory University, a private research university in Atlanta that has received millions of dollars from Coca-Cola entities.

The CDC says Pratt’s temporary assignment at Emory has ended. But now Pratt is headed to the University of San Diego (UCSD) to take the role of Director of the UCSD Institute for Public Health. And coincidentally — or not — ISLI is partnering with the UCSD on a “unique forum” related to “energy balance behavior” planned for November 30 to December 1 of this year. One of the moderators is another CDC scientist, Janet Fulton, Chief of the CDC’s Physical Activity and Health Branch.

When asked about Pratt’s work for these other outside interests, and asked if he had received approval and ethics clearance for the activities, CDC spokeswoman Kathy Harben said only that Pratt will be doing his work at UCSD while on annual leave from the CDC. If the public wants to know if Pratt has properly disclosed conflicts of interest and received approvals for his outside work, we have to file a Freedom of Information request, Harben said.

That is not an especially promising suggestion given that documents recently supplied by the CDC related to employee ties to Coca-Cola were only turned over after large swaths of communications were blacked out. Those emails pertained to former Pratt colleague Dr. Barbara Bowman, who was director of the CDC’s Division for Heart Disease and Stroke Prevention until departing the agency this summer amid scrutiny of her ties to Coca-Cola. Bowman was instrumental in helping direct CDC funds to a pet project that ILSI is working on with the U.S. Department of Agriculture to develop a “branded foods database.”

Email communications obtained that were not redacted showed that Bowman, a former Coca-Cola nutritionist, maintained a close connection with the company and ILSI as she rose in rank at the CDC. The emails show that Bowman was happy to help the beverage industry cultivate political sway with the World Health Organization (WHO) as it tried to beat back regulation on sugary soft drinks. The emails showed ongoing communications regarding ILSI and beverage industry interests. Bowman “retired” in late June after those emails became public.

ILSI has a history of working to infiltrate public health organizations. A report by a consultant to WHO found that ILSI was infiltrating the organization with scientists, money and research to garner favor for industry products and strategies. ILSI was also accused of attempting to undermine WHO tobacco control efforts on behalf of the tobacco industry.

So should the public be concerned? The CDC says no. But we at the consumer group U.S. Right to Know believe the answer is an emphatic yes. The mission of the CDC is to protect public health, and it is problematic for agency officials to collaborate with a corporate interest that has a track record of downplaying the health risks of its products. Questions about the alliances and the actions of some CDC officials are growing, and it is time the public received some answers.

(This article first appeared in The Hillhttp://www.thehill.com/blogs/pundits-blog/healthcare/293482-what-is-going-on-at-the-cdc-health-agency-ethics-need-scrutiny)

More Coca-Cola Ties Seen Inside U.S. Centers For Disease Control

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In June, Dr. Barbara Bowman, a high-ranking official within the Centers for Disease Control and Prevention, unexpectedly departed the agency, two days after information came to light indicating that she had been communicating regularly with – and offering guidance to – a leading Coca-Cola advocate seeking to influence world health authorities on sugar and beverage policy matters.

Now, more emails suggest that another veteran CDC official has similarly close ties to the global soft drink giant. Michael Pratt, Senior Advisor for Global Health in the National Center for Chronic Disease Prevention and Health Promotion at the CDC, has a history of promoting and helping lead research funded by Coca-Cola. Pratt also works closely with the nonprofit corporate interest group set up by Coca-Cola called the International Life Sciences Institute (ILSI), emails obtained through Freedom of Information requests show.

Pratt did not respond to questions about his work, which includes a position as a professor at Emory University, a private research university in Atlanta that has received millions of dollars from the Coca-Cola Foundation and more than $100 million from famed longtime Coca-Cola leader Robert W. Woodruff and Woodruff’s brother George. Indeed, Coca-Cola’s financial support for Emory is so strong that the university states on its website that “it’s unofficially considered poor school spirit to drink other soda brands on campus.”

CDC spokeswoman Kathy Harben said Pratt had been on a “temporary assignment” to Emory University but his work at Emory “is completed and he is now back on staff at CDC.” Emory University websites still show Pratt as currently assigned as a professor there, however.

Regardless, research by consumer advocacy group U.S. Right to Know shows Pratt is another high-ranking CDC official with close ties to Coca-Cola. And experts in the nutrition arena said that because the mission of the CDC is protecting public health, it is problematic for agency officials to collaborate with a corporate interest that has a track record of downplaying the health risks of its products.

“These alignments are worrisome because they help provide legitimacy to industry-friendly spin,” said Andy Bellatti, a dietitian and founder of Dietitians for Professional Integrity.

One key message Coca-Cola has been pushing is “Energy Balance.”Consumption of sugar-laden foods and beverages is not to blame for obesity or other health problems; a lack of exercise is the primary culprit, the theory goes. “There is increasing concern about overweight and obesity worldwide, and while there are many factors involved, the fundamental cause in most cases is an imbalance between calories consumed and calories expended,” Coca-Cola states on its website.

“The soda industry is keen on deflecting the conversation away from the well-documented negative health effects of sugar-sweetened beverages and onto physical activity,” said Bellatti.

The messaging comes at a time when leading global health authorities are urging a crack-down on consumption of sugary food and beverages, and some cities are implementing added taxes on sodas to try to discourage consumption. Coca-Cola has been fighting back in part by providing funding for scientists and organizations who back up the company with research and academic presentations.

Pratt’s work with the industry appears to fit into that messaging effort. Last year he co-authored a Latin America health and nutrition studyand related papers funded in part by Coca-Cola and ILSI to investigate the diets of individuals in Latin American countries and to establish a database for studying the “complex relationship existing between energy imbalance, obesity and associated chronic diseases…” Pratt also has been acting as a scientific “advisor” to ILSI North America, serving on an ILSI committee on “energy balance and active lifestyle.” And he is a member of the ILSI Research Foundation Board of Trustees. He also served as an advisor to an international study of childhood obesity funded by Coca-Cola.

ILSI’s North American branch, whose members include Coca-Cola, PepsiCo Inc., Dr Pepper Snapple Group and more than two dozen other food industry players, states as its mission the advancement of the “understanding and application of science related to the nutritional quality and safety of the food supply.” But some independent scientists and food industry activists consider ILSI to be a front group aimed at advancing the interests of the food industry. It was founded by Coca-Cola scientific and regulatory affairs leader Alex Malaspina in 1978. ILSI has had a long and checkered relationship with the World Health Organization, working at one time closely with its Food and Agricultural Organization (FAO) and with WHO’s International Agency for Research on Cancer and the International Programme on Chemical Safety.

But a report by a consultant to WHO found that ILSI was infiltrating WHO and FAO with scientists, money and research to garner favor for industry products and strategies. ILSI was also accused of attempting to undermine WHO tobacco control efforts on behalf of the tobacco industry.

One April 2012 email exchange obtained through a Freedom of Information request shows Pratt as part of a circle of professors communicating with Rhona Applebaum, then Coca-Cola’s chief scientific and regulatory officer, about difficulties getting cooperation on a study in Mexico from that country’s National Institute of Public Health. The Institute would not “play ball because of who was sponsoring the study,” according to an email Peter Katzmarzyk, a professor of exercise science at the Pennington Biomedical Research Center at Louisiana State University, sent to the group. Appelbaum defended the integrity of the research and expressed anger at the situation, writing “So if good scientists take $$$ from Coke – what? – they’re corrupted? Despite the fact they’re advancing public good?” In the email exchange Pratt offered to assist “especially if these issues continue to arise.”

Emails show Pratt’s communication with Applebaum, who also served a term as ILSI’s president, continued through at least 2014, including discussion of work for “Exercise is Medicine,” an initiative launched in 2007 by Coca-Cola and for which Pratt serves as an advisory board member.

Applebaum left the company in 2015 after the Global Energy Balance Network that she helped establish came under public scrutiny amid allegations that it was little more than a Coca-Cola propaganda group. Coca-Cola poured roughly $1.5 million into the establishment of the group, including a $1 million grant to the University of Colorado. But after Coca-Cola’s ties to the organization were made public in an article in The New York Times, and after several scientists and public health authorities accused the network of “peddling scientific nonsense,” the university returned the money to Coca-Cola. The network disbanded in late 2015 after emails surfaced that detailed Coca-Cola’s efforts to use the network to influence scientific research on sugary drinks.

Coca-Cola has been particularly zealous in recent years in working to counter concerns about consumption of beverages with high sugar content and links between sugary beverages and obesity and other diseases. The New York Times reported last year that Coke’s chief executive, Muhtar Kent, admitted that the company had spent almost $120 million since 2010 to pay for academic health research and for partnerships with major medical and community groups involved in curbing the obesity epidemic.

Marion Nestle, a professor of nutrition, food studies and public health at New York University and the author of “Soda Politics,” said that when CDC officials work so closely with industry, there is a conflict of interest risk the CDC should consider.

“Officials of public health agencies run the risk of cooptation, capture, or conflict of interest when they have close professional ties with companies whose job it is to sell food products, regardless of the effects of those products on health,” said Nestle.

Pratt’s ties to Coca-Cola and ILSI are similar to those seen with Bowman. Bowman, who directed the CDC’s Division for Heart Disease and Stroke Prevention, worked early in her career as a senior nutritionist for Coca-Cola and later while at the CDC co-authored an edition of a book called Present Knowledge in Nutrition as “a publication of the International Life Sciences Institute.“ The emails between Bowman and Malaspina showed ongoing communications regarding ILSI and beverage industry interests.

During Bowman’s tenure, in May 2013, ILSI and other organizers invited Bowman and the CDC to participate in a project ILSI was engaged in with the U.S. Department of Agriculture to develop a “branded foods database.” Travel costs for Bowman would be paid by ILSI, the invitation stated. Bowman did agree to participate and the CDC provided funding, at least $25,000, Harben confirmed, to support the database project. The 15-member steering committee for the project held six ILSI representatives, documents show.

Both Bowman and Pratt have worked under the direction of Ursula Bauer, director of the National Center for Chronic Disease Prevention and Health Promotion. After U.S. Right to Know publicized emails about Bowman’s ties to ILSI and Coca-Cola, Bauer defended the relationship in an email to her employees, saying “it’s not unusual for Barbara – or any of us- to correspond with others who have similar interests in our areas of work…”

Still, Bowman announced an unexpected retirement from CDC two days after the emails were made public. CDC initially denied she had departed the agency, but Harben said this week that was only because it took some time to “process” Bowman’s transition to retirement.

The relationships raise fundamental questions about how close is too close when public officials collaborate with industry interests that can conflict with public interests.

Yoni Freedhoff, MD, an assistant professor of family medicine at the University of Ottawa and founder of the Bariatric Medical Institute, said there is a real danger to when public health officials become too close with corporate players.

“Until we recognize the inherent risks of conflicts of interest with the food industry and public health, there is near certainty that these conflicts will influence the nature and strength of recommendations and programs in ways that will be friendly to industries whose products contribute to the burden of illness those same recommendations and programs are meant to address,” Freedhoff said.

(Post first appeared in The Huffington Post )

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