Transcript
Paper: Gearhardt AN, Brownell KD, Brandt AM. From Tobacco to Ultraprocessed Food: How Industry Engineering Fuels the Epidemic of Preventable Disease. Milbank Q. 2026;104(1):0202.https://doi.org/10.1111/1468-0009.70066
https://www.milbank.org/quarterly/articles/from-tobacco-to-ultraprocessed-food-how-industry-engineering-fuels-the-epidemic-of-preventable-disease/
Ashley, let's talk a little bit about, just set the stage for what this paper was all about, and since it was your brainchild, you approached Allan and me about being involved. Tell us what you set out to do and why you thought these issues were worth digging into.
Ashley - You know, I've just been so struck that when we think of cigarettes, they were something that's so common, so normal that we kind of think, oh, they've always just sort of been there. But truly, they're just taking a natural plant from the ground and through advancements and corporate engineering and technology and knowhow, they took a poisonous plant and made it into the most deadly and addictive drug in human history. And yet that was, you know, just accompanied by tons of debate. It didn't look like other addictive substances. And I just really felt like, man, we're reliving this history right now when it comes to how we've altered our food supply. I wanted to really bring you all together and see if we could really lay that story out of the, the parallels of these two public health crises.
We'll get in a minute into the issue of what you discovered, but tell us what you covered, what the paper was meant to do.
Ashley - The paper really goes back from how you take the tobacco plant in the field, or the corn in the field, and walks essentially through all the kind of levers that are being pulled to transform it in very specific ways. And through specific technologies and corporate practices that are being shared by modern cigarettes and ultra processed foods. These products maybe look harmless on their face initially, or don't look like they're just maybe pleasurable or craveable. But truly, I would argue that they've crossed thresholds into things that are addictive and clearly damaging many people's lives.
Okay, so several decades ago, I don't know who came up with a term, but there was a lot of discussion about similarities between tobacco industry behavior and food industry behavior. And the press started publishing cover pieces that would say food is the next tobacco. And it was a term that the food industry really didn't like, and they don't want that comparison at all. It'll be interesting to see whether they deserve it. You clearly made that connection in this paper.
Allan, let's turn to you. Oh my God. I mean, we could do a 15-hour podcast and not cover the history of the tobacco industry. There's so much to say, enough that you wrote a massive book about it. But give an overall sense, if you will, of the kind of tactics and morality of that industry.
Allan - Well, as Ashley already mentioned, early in the 20th Century we wouldn't really be thinking much of cigarettes, and they were just a very peripheral sales consumer item. And over the course of the 20th Century, we came to a point in the middle of the century of the 1970s, and '80s where about half of all American adults were smoking cigarettes regularly. I wanted to understand that. How do you take something that's at the very margin of the economy and culture and make it a dominant consumer force? And I think in that way, we have certain parallels to ultra processed foods. But then there were the questions, how do you make it so popular? Is it dangerous to use? Is it addictive? Does it cause disease? And how do you resist regulation and other public health approaches to try to keep people smoking? And I found a lot of evidence in each of those areas, both of how the industry acted. And when you say, you know, it's ultra processed food like cigarettes, we're learning a lot about ultra processed foods. But we know a ton about what the industry did to make the 20th Century what I call the Cigarette Century. And we have seen really important declines in smoking in the last 30-40 years. It's a remarkable public health effort. But at the same time, the industry worked incredibly hard and, in some ways brilliantly, to maintain the popularity of their product. And underlying all this is the idea that nicotine is highly addictive. And the industry came to understand that certainly before consumers did. And as a result, they could engineer, manage, manipulate the addictive character of a product that kills. I think looking for parallels, both in terms of how the industry did it and how perhaps public health law regulation can undo it, is the critical aspect of what we've been working on together.
Okay. So, the tobacco industry did more than just take a plant, dry it out, chop it up, and roll it up in some paper. Then people might be driving whatever natural pleasure there would be from that product. But they did more, didn't they?
Allan - Yes.
And you talked about nicotine in particular. So how manipulated was this industrial process and was it designed to create such high levels of addiction?
Allan - Well, for a long time we couldn't be sure about that. And we have learned that the industry had learned sophisticated techniques of industrial production of cigarettes. So, it wasn't like just chopping up tobacco and putting it in paper. You know, they added many additives. They added liquids. They dried it out, they put it in long strips of tobacco for cutting and packaging. And they had innovated the technologies, instead of human beings rolling cigarettes, they were able through machinery and technology to produce hundreds of thousands of cigarettes a day. And then they had to figure out how do we sell this tremendous volume of cigarettes in order to make our industry truly lucrative. So, there were those aspects. And certainly by the middle of the 20th Century, many people realize that - I smoke regularly and I crave my next cigarette and I'm smoking a pack a day, sometimes two packs a day. And people would ask, well, is it a habit? Is it habituating? Is it addictive? And as the science of addiction really grew in the middle of the 20th Century, we began to realize it had all the characteristics of addiction. But we really didn't know exactly what the companies were doing. And what we did learn in the '80s and '90s is that the companies had a precise ability to manage the nicotine in their product. And they did, so that even as they put filters on and they claimed they had safer cigarettes, they were also producing increasingly addictive cigarettes where we have craving, we have withdrawal, we have tolerance. The basic categories, that structure, how we understand addiction.
Okay. We'll dive into some of those in a little more detail, but thanks for that background. Ashley, people kind of get it that drugs can be addictive and they know that alcohol can be addictive. They know that cigarettes can. But what about food?
Ashley - Yes, so I think one of the things that when I take a step back, is that the reward and motivation system that alcoholic beverages, cigarettes can start to hijack and drive towards compulsive problematic use, that was laid down in the brain to make sure we were getting enough food. It's really sensitive to food reward, energy density. But the thing is you actually consume nicotine probably most days. Nicotine is actually in a lot of plants like tomato and eggplant, but nobody's getting addicted to the chemical in that delivery vehicle. I would argue the same thing's happening. When we look at our research nobody's getting addicted to minimally processed foods like bananas and broccoli, and salmon filets. It's when you're able to process and titrate and hedonically engineer food reward in a way that mimics the intensity and the sensory appeal and the spikes and crashes and the craveability of something like cigarettes, that you start to see people losing control. And when I read Allan's book, my husband was watching over my shoulder. And he's like, you know, if you highlight every single sentence, it's not gonna help you because you've highlighted the whole book. And reading what Allan laid out about how each wave of cigarette addiction, it wasn't because we suddenly discovered what nicotine was, it's because the industry got better at manipulating engineering, designing, flooding the market with it. And then health washing it, so people didn't really understand what they were getting into. And to me, that is what we've done to our food supply. And the result of that has been the astronomical increases in diet related disease and health concerns.
Tell us about the concept of ultra processed food and how that fits in.
Ashley - Yes. Yeah, that's a great question. So, ultra processed food is a concept that actually came out at about the same time as the Yale Food Addiction Scale, that Kelly and I published together, about how to operationalize who might be showing signs of addiction and certain foods. Carlos Monteiro from Brazil was noticing that his grocery store was starting to be flooded by foods that you could not make in your home kitchen. I have exactly no idea how to make a double stuffed Oreo or a flaming hot Cheeto, or a Cherry Coca-Cola. And as these products that were industrially created with additives and flavor enhancers that are kind of biologically novel, that's when the disease risk started to go up. And so, these foods are so fundamentally changed in they're kind of most archetypal forms of things, like sodas and, you know, your sweet, savory sort of snacks, that a whole new category had to be created for them. To really distinguish them from, you know, grandma's homemade cookies or, you know, an apple or an orange.
Ashley, you're brilliant at framing things. And one of the things that I learned from you a long time ago, and I've used a thousand times in discussions with people, is thinking about food, like turning the coca plant into cocaine and into crack cocaine. That if you take the coca plant into its natural form, people can live in harmony with it. You don't really have addiction. But when you process it and it becomes cocaine, then things change dramatically. And when you hyper process it, like the hyper palatable foods and the ultra processed foods, then the crack cocaine becomes incredibly addictive. So that same sort of phenomenon I think applies here. And it's a very compelling way to think about this.
Allan, let's get back to the addiction thing and tobacco. One of the most stunning things I remember about the tobacco history. Is the videotape of the seven tobacco company executives testifying before Congress that nicotine wasn't addictive. Swearing, you know, sworn statements about nicotine. Tell us about that and what that kind of meant in history.
Allan - It's a great story and it has a kind of visual linkage to many of us who actually saw those congressional hearings. And it was a brilliant sort of performative politics, if you will. And there had been more and more knowledge that the industry was manipulating nicotine to make cigarettes that they were claiming were safer and not addictive, even more highly addictive. And David Kessler, the head of the FDA under Clinton, had really been a major player in this. And one thing I should say is we were learning more and more about the industry because people were suing them. And they would typically lose the suits, but they would get hundreds, hundreds of thousands of documents. And the industry also had whistleblowers who were coming forward and saying, of course we know it's addictive. So, Henry Waxman, a really fantastic congressman who represented consumers invited all seven of the major tobacco CEOs to a hearing on nicotine. And he went one by one - do you believe nicotine is addictive? And they would say, Congressman, I do not believe that nicotine is addictive. And it's like any great prosecutor, he had figured out how to get them essentially to perjure themselves in front of a congressional, and video news audience. And in fact, the Department of Justice considered for some time whether they should be put on trial and indicted for perjury before Congress. But it was so in congress, with what we had come to know, especially experts, but even, you know, parents and the public and citizens had come to know that it was incredibly difficult to get off of nicotine. It just didn't comport with our existing knowledge. And we're not quite to that point with ultra processed foods yet, but I think we have a good chance to get there because as we understand what they're doing better and we have a sophisticated understanding of the characteristics of addiction, that same question will be put ultimately to CEOs of the food industry. Especially those who are producing these highly addictive products. And there are many people who are involved in this. So, they will tell a story of how we understood we could make our product sell better and be used at a much higher level if we could make it addictive. And regrettably, as we learn more about addictive addiction, we not only learn perhaps how to help people who are addicted. But we often learn how to make certain products even more highly addictive.
Ashley, let's take what Allan said and apply it into the food arena. So, if you think about the criteria for addiction, like Allan had mentioned: cravings, withdrawal, and tolerance, and, tolerance being the need to have more of the substance over time in, in order to produce the same pharmacologic effect. How do those things apply to foods?
Ashley - Yes. There there's very strong parallels there. And I actually have a paper I wrote with Dr. Alex DiFeliceantonio, where we took the 1988 Surgeon General's report on the addictiveness of tobacco and nicotine in particular. And we took what they identified as the necessary and sufficient criteria to prove that it was addictive. It was a watershed moment for tobacco. And the major one is that people consume it compulsively. Meaning, you know, they want to cut down and they can't. They know it's harming them and they can't. Clearly we see that with ultra processed food. That it shifts mood. It increases pleasure. It reduces negative affect through its mechanism on the brain. And I think if you look at any marketing, you know, they're always saying you're craving meet your maker, get your bliss point. You're not you unless you're eating a Snickers. They show that it was highly reinforced. And that is, you know, animals and humans will work really hard to get access to it. With nicotine one of the major points of that is that animals, about 20% of the time, would work to get nicotine over cocaine. And that was quite striking because cocaine is so powerfully addictive. Well in those same models, animals will work for processed sweet taste and choose it 80% of the time over cocaine. It just shows that when we start altering, processing food reward into these unnaturally intensely stimulating packages, our brains were not evolved to protect itself against that. And then the final pieces that's been kind of added over time has been the cravings. I mean, if you think about what is the core of addiction, it's the craveability of it. That they maximize that. So, you can't stop thinking about anything else. And when I read, and we even quote in our paper, spots where, you know, industries, the big food is having webinars and how to turn cravings into corporate wins. And how to take snackers who are consuming, because their cravings feel unmanageable, but here's how you can keep them snacking even though they want to quit. And so, the craving really seems to me, based on my read of what I've seen from the industry, is the core engine of driving and selling ultra processed food.
So, these foods, and I've heard you say this, Ashley, you know, they have less to do with the farm and, you know, these sort of romantic ideas of the farmer growing crops and the crops being harvested and coming to a farmer's market. These are really industrial lab-based, you know, heavy duty factory related products. And there's a real question, isn't there, about what you even should call them food.
Ashley - Yes, absolutely. I actually grew up on a farm and I never ate anything that we grew on the farm because it was all due to Ag policy. Just, corn to go into high fructose corn syrup, soy to go into soybean oil. And I was surrounded by what looked like lots of food, but in reality, it was not. And some of the things that I learned in writing this paper with you all is just to what degree ultra processing allows them to even control the molecular structure and size of the different starch chemicals. That carby kind of access point in food. Allan talks in his book about how you can treat tobacco. So, you break it down and make it molecularly more bioavailable so nicotine gets more rapidly into the body. That's a huge driver of addictive potential. I found in ours that they were actually using enzymes that mimic what's in the saliva in your mouth. And hitting starches with it. Essentially you were predigesting, pre salivating, essentially the starch creating what's called a starch slurry. And that's a base of so many common ultra processed foods like cereals and savory snacks. Many of these products really have far more in common with that cigarette and have almost nothing in common, you know, with the apple or the can of beans anymore.
You know, that image that you said about pre salivating food. I mean, it's in some ways as if the industry is spitting in your food to bypass your own biological mechanisms that occur when the food gets in the mouth and. People get a kind of a yuck response to that, but it deserves that kind of a response. Let's dive into the paper and talk about what you reported, Ashley. You talk a lot about the kind of processes. You just mentioned one of them, but there are a lot more. What are some of the specific techniques to food processing that surprised you when you started digging in. How did you get this information?
Ashley - Yes, so one of the functions that actually didn't surprise me, but it made me look at it in new light, is the work on how we really changed the way we saw cigarettes when we realized they weren't just taking a plant and drying it and rolling it up. But that they were actually curating and titrating these just right doses of nicotine. So, you get stimulated, but not too satisfied and you don't feel overwhelmed by the amount of nicotine. When we realized that was very intentional and designed and titrated, that really changed this from a natural kind of product, it's just a plant to, oh, this is an in industry engineered product. They're controlling so much of this. We all know that they are altering the amount of sweetened refined carbohydrates and fats in our food. I mean, that's just plain knowledge. And at levels that go way beyond what exists in nature. But I think I've become very obsessed with extrusion technology. Extrusion is something where they take really high pressure, high shear mechanical impact, high pH, high temperature. And they can break the corn or the potatoes and things into this slurry that is broken down again into this kind of predigested molecular base that on its own is nasty. No one is like, oh, starch, slurry, yes! They need all the sensory and flavor additives to blitz that and texturize it so it can trick your brain into thinking it's appealing. I realized that actually has such a strong parallel to modern cigarette where, as Allan talks about in his book, one of the major technological advances was creating reconstituted tobacco where they take the tobacco scraps and they do the same sort of process to create what they call a tobacco slurry. That was then very easy to manipulate by putting flavor and preservative additives in it, and that's what makes up a large component of modern cigarette. And so, when we look at these processes and those sensory additives, the flavors, that are put in it, cigarettes have more sugar and flavor additives in them by weight than they do nicotine. And so many of those flavor additives are actually in our ultra processed food supply. Why? Because the flavor and sensory profiles are what you start to become really emotionally attached to. And that starts to drive brand loyalty from a very young age. I could go on and on and on. Oh man, we could be here for a day, so I'm really inhibiting myself. I'll be exhausted. I'll have to go get an ultra processed food from this. But it was stunning to me to see how the goals of the engineering were so shared. And I guess it shouldn't surprise us because, you know, we know that the tobacco companies like Philip Morris and RJ Reynolds actually created, manufactured and sold many of our favorite ultra processed foods that are now in our modern food supply, like Fig Newton's and you know, Hawaiian Punch and things. It really came from the same industrial practices.
So Allan, I want to bring this back to the tobacco industry in a minute, but Ashley, I wanted to ask you first. I'm going to make a characterization. Tell me if I'm off on this. The industry is kind of manipulating every possible characteristic of a product. Its fragrance, its color, its texture, everything in the ways you mentioned. It becomes this industrialized product much more than a food. People consume it. They get immense reward from it because it's delivering a drug, basically, to the brain very quickly in a very efficient way. People then, of course, want more of that sensation. If tolerance exists, then it means they need more of the food over time in order to get the same reward. And then you've got a public health nightmare on your hand because people aren't just eating a little bit of these foods, they're eating a lot of these foods. And they're designed in order to produce that very impact. Does that seem fair?
Ashley - Absolutely. That sums it up quite nicely.
Okay, Allan, back to the tobacco experience. This kind of information that Ashley is talking about in the context of food, and you talked about in the context of tobacco. Manipulation of the product. As this kind of damning information became public knowledge, how did that happen in the tobacco arena? And then what was the consequence? Was it, you mentioned whistleblowers; was it investigative journalism? The hearings you mentioned were important. Scientific research, discovery. It sounds like a whole lot of things happened that made this information available to the public, which in turn changed public opinion against the industry.
Allan - Yes, I think that's exactly right. It changed public opinion and it changed public policy and it took a long time. So, these are aspects that I think we have to, you know, acknowledge in thinking about public health and especially these powerful commercial interests that spend a lot of money on lobbying. They spend a lot of money on advertising. They know how to get to kids. These are very challenging. I do think, you know, early in the anti-tobacco campaigns, there were a few lawyers who said, well, we're going to sue them because they have misled, deceived, and in some instances probably acted criminally to build their addictive and extremely harmful life-threatening product. And people said, well, you know, it's everybody's decision whether they want to smoke and people quit all the time, so you're not going to do very well. And I think as a young academic type, I was very skeptical of the suits against the companies. But one thing that happened that I think was unanticipated, the lawyers asked for the company's records and their research reports and what people were doing. And they took depositions and the lawyers often lost the case, but they won an incredible archive that was incredibly self-incriminating of what the industry knew. When they knew it and how they continued to act to sell a harmful product. And I think that began to change things. So once you have documents, you know you're going to be more successful in court. Once you have some documents, you can call the CEOs in and say is it addictive? When they say no, you have documentation to challenge them about their own industry. Obviously, education is important. Investigative journalism. A lot of the documents not only came from the court suits, but from whistleblowers who snuck them out of law firms. Some of the whistleblowers came directly from the industry where they said, here's what my bosses told me. They need to know can you make this cigarette even more addictive? And they knew, for example, that taking nicotine out of cigarettes, which is not that difficult to do given the extent of manipulation, had to be something that was resisted. We could end the tobacco pandemic by just removing nicotine. Even if we did, you know, 10% a year. Many people would be able to stop smoking who cannot. But we had to array a kind of knowledge and practice and advocacy that really hadn't existed till the second half of the 20th Century.
Ashley, when Allan mentioned these archives that exist on tobacco industry behavior, there's some food things in there, aren't there? Tell us about that connection between tobacco and food companies.
Ashley - Yes, so you know, actually, Dr. Laura Schmidt at University of California - San Francisco, has done this just stunning work by using those same tobacco archives. Because they owned alcoholic beverage and ultra processed food and beverage companies she's been able to show really how much these industries kind of spoke back and forth. The different sectors of Philip Morris and RJ Reynolds, you know, they're big conglomerates. They were pulling scientists working on the cigarettes, or the marketers working on marketing cigarettes to kids, and putting them on and intentionally using that playbook to sell their ultra processed foods and beverages. That's very clear and very intentional. They might not say as blatantly. I feel like they learned their lesson a little bit. Oh, we're going to make this more addictive. They use synonyms even out in the public. Some of it that we report in this paper is not hidden. It's industry trade newsletters. It's interviews on 60 minutes with labor scientists where they're saying, yeah, we design these products, so you get a big flavor burst. And then it fades really rapidly because that makes you want to keep coming back for more and more and more. And yeah, addictive is a good word for that. And so there is this moment where it just becomes so implausible that they don't know that they have crossed the Rubicon into something that is hooking people. That plausible deniability that we're just, you know, giving consumers what they want, not actually engineering their desires to override what they know they should have to nourish themselves. It just feels beyond the pale to me to believe that's the case.
Allan, look, you mentioned delay. And I'd like to talk about that a little bit more. There's a point in time when the science on something becomes robust. And you're very certain say that tobacco is causing lung cancer and heart disease. And then you can't change things the next day or the next week. So, a little bit of delay is probably acceptable and to be understood. But the delay in this case between that knowledge and significant public health action policy action wasn't measured in days, weeks, months, or even years. It was decades. And you can count the number of attributable deaths to that delay in the millions. What did the industry do to make that delay as long as possible in terms of planting doubt, conflicts of interest with science and things like that?
Allan - This is highly relevant to our moment because I make a few claims in the book. One is that the industry invented disinformation and misinformation. And there's always this way that says, well, I know that study appeared, but we need more information. And this was very clever on the part of the tobacco companies because they said, well, you know, that science shows this, but that science is unreliable. And we need to use different methods. And lung cancer is not a result of cigarette smoking, it's actually genetic. And maybe there are a few people that shouldn't be smoking cigarettes. We should be able to identify what's different about them. They kept finding strategies of delay, manipulation, building uncertainty. There's one of the tobacco documents in this phase that says, from now on, our product is doubt. And what they really needed to do to sell the product was to create doubt about a science that was highly robust and really important to consumers. On the other hand, I think consumers are sensitive to being manipulated. They don't like that. They don't like being tricked. They know these industries, especially tobacco industry, you know, is disreputable. And as that became the case, what did they know and what are they selling. We began to see some slow shifts in public awareness. And, you know, it's so interesting presenting the cigarette problem to a jury in 1970 became radically different than presenting the case against the tobacco companies in the 1990s. And a lot had changed, A lot had been documented and, you know, we never even thought of the idea that a company would scientifically mislead us probably until in any consequential way till the middle of the 20th Century. And now we're incredibly skeptical and I think taking advantage of the public skepticism, both politically and culturally is going to be one of the important issues of pushing back against what I've called rogue industries. They're operating unethically; in many cases, unlawfully. They're misrepresenting what they produce. And they have the idea that having addicted customers is the best customer. And Warren Buffet once said, you know the tobacco industry, that's crazy. It cost a dime to make it. You sell it for a dollar and its addictive. He said, what industry could be more, you know, lucrative than tobacco?
Ashley, how do those things apply into the food area now?
Ashley - Oh, my brain is just exploding with all the things I want to say. But I think I have an answer to Warren Buffett, which is if you've pulled all those same levers and pretend to people that it's food, and it's because we all have to eat, you know? And I walk around a grocery store and I, in my head, I'm like, if I waved a magic wand, and all the products in here that are masquerading as food but are actually ultra processed, chemically adulterated starch, slurries essentially disappeared. There is so little food in my grocery store. Real food. And it's also expensive. We would be rioting in the streets if we really saw the degree that we're not being adequately nourished or supported in our current environment. And it's the mirage of abundance that is totally hooking us. You know, taking us hook, line, and sinker. And so, you know, I'll have people often say to me, you know, it's food. Like can't really be addictive. We all need to eat. And to me that is absolutely true. Just like we all need pain management. And there used to be a belief, a myth, that if you were in pain, you couldn't get addicted to painkillers like opiates which we now know is incredibly wrong. That just because we need calories to survive doesn't mean that if you manipulate and hedonically engineer those products, that it won't impact the brain in a way that can drive it in compulsive problematic ways. It's so essential for us to carve out, yes, you need real nourishing food. This is real nourishing food and these other things. I'd love it if the grocery store, it's like you're walking around this spot, you know you're getting real food. Sure, you want to go get those Cheetos, go for it. But it's in a very clear designated area that you're not being tricked into thinking that you're eating something that's nourishing you when it's really addicting you.
So, people have very strong affective attachments to foods. Particular foods that they like. Some of it is kind of what you grew up with, what your parents gave you, but a lot of it's marketing as well. And you mentioned a Cheeto or Coca-Cola, or a Dorito or a Twinkie or whatever it is. People don't want that taken away from them. Tell me if this is correct, the problem isn't so much that people eat Cheetos. It's that they overeat Cheetos, and then you add to that all the other thing, not just that food. But then you've got a real problem. Could it be a matter of just removing some of the especially troublesome ingredients from that. If you look at the list of ingredients on these foods, there could be 25 or 30 different ingredients. Well, what if, what if 12 of them got taken out or 13 or 15 of them got taken out? You'd still have the food; it would still have its taste. People could enjoy it, but it's not hijacking your biology.
Ashley - Yes, I'm very skeptical of that as the response, because as Allan lays out in his book, we were like, okay, if we just get the tar out of the cigarette. You know, it's all fine, Vapes, right? Oh, you're vaping. It's fine. It will be harmless because our reward system is so porous to different levers that signal food reward. We see it with the non-sugar sweeteners. Look, we took all the sugar out, we gave you Diet Coke, we gave you non-sugar sweeteners. It's a get out of jail free card. And now we're realizing how much that messes up our gut microbiome, could potentially lead to earlier brain aging and so, you know, abstinence, clearly making this stuff illegal, that's never the goal. But I think that sense of saying, oh, we can just engineer our way out of this is unlikely. And we have the alternative. You know, for what should be the majority of what we're eating. I love a Reese's Cup, right? I will have an ultra processed food, but it shouldn't be 60% of the food supply, or 70% of what my kids are getting for their calories. And so again, that clear understanding that this is something that's fundamentally different from the food that nourishes us. We have the answer which is real food. If we poured even a tiny amount of the investment, even closing the tax loopholes on things like ultra processed food marketing to kids that they get tax breaks on and invested that into technology to make real food in its original food matrix affordable, accessible, convenient. That stuff is tasty. Have a fresh apple. It's just everything's been wired for that to be the minority of our food supply. That's often unaffordable and we all feel really time poor. These are solvable problems. We've just been shoving all our money towards how we make new flavor additives to sell high fructose corn syrup, starch, slurries. So, we just need to have the right in incentives in mind.
Your point is very well taken that government trying to say, okay, let take out this ingredient or that ingredient is stepping into a trap. It makes all the sense to me in the world that that is a trap because. Using that philosophy requires a trust in the industry that if you ask them to take out these 12 things, they're not going to put in 12 new things that might even make things worse. And both of these industries, tobacco and the food industry have done everything but earn our trust so that's a very good cautionary note that you raised.
I would say in the tobacco area, the idea of that we think that, you know, vaping will be harm reduction. And there's been a strong political notion that we should be, you know, doing harm reduction. And of course, in many instances, harm reduction can be helpful. But I found in tobacco, that I can't trust the industry to make a harm reduction product that's not going to get kids addicted. That's going to, you know, make sure that we're not using both tobacco and nicotine in the form of vape or other products. And so while many people who I admire in the public health world have said, yes, harm reduction is the way to go. I don't think that's true with tobacco. We have a lot of children and adolescents today who are profoundly addicted to nicotine.
So, this discussion has led to lots of, oh my God, kind of observations from both of you. Paints a pretty scary picture of the food supply. How much manipulation there is. And how much harm gets caused by it. I'm hoping we might end on a bit of a positive note if there is one here. I'd like to ask each of you, is there a reason to be hopeful about the future? Allan, let me start with you. You're looking in on this with a unique perspective because of your years and years of working on tobacco. As you look in on the food space and see what's happening, what do you think?
Allan - Well, I tend to be an optimist. I believe public policies can make a difference. I believe the courts can be used to serve consumers who have been harmed in the market. So, I have seen those things work to a really significant degree around the cigarette. Especially in countries where we have resources for education, where we can make policies that sometimes work or mostly work. I don't think I ever would've thought when I started this work in like the 1980s that we would've gotten so far. I once said to my son when he was seven, he was taking a flight with me. And I said, you know, people used to smoke on airplanes. And he said, no, that's impossible. And he just couldn't believe the idea that we had let people smoke on airplanes. And I've been collecting cigarette packages that were given out by the big airlines. Of course, you and I, Kelly, remember probably, when they start to put smokers in the back of the plane. But the smoke was wafting throughout it. And a lot of things that seem almost impossible now, were actually reduced through regulation and politics and public health. I'm very hopeful that we can use what we've learned about how to get smoking from 50% of the population down to 15 or 12, as bad as that is. And apply it to other gigantic risks like ultra processed foods.
All right, thanks for that positive note. Ashley, what do you think are there grounds for being positive?
Ashley - Yes, I'm also a huge optimist. I feel wildly optimistic. I just, from listening to consumer sentiment right now, the degree to which corporations are able to hack our limbic systems, I mean, you see it right now with social media and sports betting. I think in our bones as a society, we're starting to just get fed up. And to me there is nothing that is more clear cut of how industries can manipulate us than taking food, the thing we most evolved to care about and to find rewarding and nourishing, and somehow jacking it up into an addictive, harmful substance. And I have two little kids. I have a five and 7-year-old and I am just as a mom full of rage every time I go grocery shopping because they've just shoved protein in a Pop-Tart, now they're trying to tell me it's a health food. I think we're catching onto them, and I think that there is no way to go but up. And again, we already have the solution. In opiates, we are still struggling to find non-addictive pain management. We have non-addictive food and it's called, you know, minimally processed real foods. So, it's just about putting the incentives in the right place.
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Ashley Gearhardt, Ph.D., is a Professor of Psychology in the Clinical Science area at the University of Michigan. She also earned her B.A. in psychology from The University of Michigan as an undergraduate. While working on her doctorate in clinical psychology at Yale University, Dr. Gearhardt became interested in the possibility that certain foods may be capable of triggering an addictive process. To explore this further, she developed the Yale Food Addiction Scale (YFAS) to operationalize addictive eating behaviors, which has been linked with more frequent binge eating episodes, an increased prevalence of obesity and patterns of neural activation implicated in other addictive behaviors. It has been cited over 800 times and translated into over ten foreign languages. Her areas of research also include investigating how food advertising activates reward systems to drive eating behavior and the development of food preferences and eating patterns in infants. She has published over 100 academic publications and her research has been featured on media outlets, such as ABC News, Good Morning America, the Today Show, the Wall Street Journal, and NPR.
Allan M. Brandt is the Amalie Moses Kass Professor of the History of Medicine and Professor of the History of Science at Harvard University, where he holds a joint appointment between the Faculty of Arts and Sciences and Harvard Medical School. Brandt served as Dean of the Graduate School of Arts and Sciences from 2008 to 2012. He earned his undergraduate degree at Brandeis University and a Ph.D. in American History from Columbia University. His work focuses on social and ethical aspects of health, disease, medical practices, and global health in the twentieth century. Brandt is the author of No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (paperback, 1987; 35th Anniversary Edition, 2020); and co-editor of Morality and Health (1997). He has written on the social history of epidemic disease, the history of public health and health policy, and the history of human experimentation, among other topics. His book on the social and cultural history of cigarette smoking in the U.S., The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America, was published by Basic Books in 2007 (paperback, 2009). It received the Bancroft Prize from Columbia University in 2008 and the Welch Medal from the American Association for the History of Medicine in 2011, among other awards. Brandt has been elected to the National Academy of Medicine and the American Academy of Arts and Sciences. In 2015, he was awarded the Everett Mendelsohn Excellence in Mentoring Award by the Harvard Graduate School of Arts and Sciences. In 2019-20, Brandt was a recipient of fellowships from the American Council of Learned Societies and the Radcliffe Institute for Advanced Study. He recently served as the interim chair of the Department of Global Health and Social Medicine at Harvard Medical School. Brandt is currently writing about the history and ethics of stigma and its impact on patients and health outcomes.
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