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No More Heart Health Valentines from Coke

Thursday, February 11th, 2016

By Cara Wilking, JD, Consulting Attorney, Public Health Advocacy Institute

[PLEASE NOTE: This blog post was prepared prior to unexplained changes to Coca-Cola’s database of its funding of  organizations in the United States. The information reflects the dollar amounts initially reported by Coca-Cola in the Fall of 2015.]

For years, the month of February has been the kick-off of the Coca-Cola Company’s sponsorship of the National Heart Lung and Blood Institute’s (NHLBI) Heart Truth campaign. Heart Truth began in 2002, with the goal of raising awareness that heart disease is the number one killer of women. The campaign fits within the general mission of NHLBI to collaborate with a range of stakeholders to promote the prevention and treatment of heart, lung, and blood diseases. As part of the Department of Health and Human Services (HHS), NHLBI provides research funding and conducts outreach with the public to improve the public health. As a federal agency, NHLBI is subject to legal limits on its use of funds and HHS’s ethical guidelines for co-sponsorship of events. These guidelines are meant to guard against conflicts of interest that would undermine the primary mission of NHLBI. Coke’s corporate funding disclosures in the Fall of 2015 indicate that as public pressure on NHLBI built, Coke shifted the bulk of its heart health giving to a tight circle of non-governmental heart health organizations consisting of the American College of Cardiology, the Preventive Cardiovascular Nurses Association, the American Dietetic Association, and Brigham and Women’s Hospital in Boston, MA.



Coke’s Heart Health Campaign

From 2008 to 2014, The Coca-Cola Company, under its Diet Coke brand, was the Heart Truth campaign’s most visible co-sponsor: Despite the fact that HHS’s ethical guidelines place a particular emphasis on avoiding the appearance of product endorsement, Heart Truth logos were printed on billions of Diet Coke cans, heart health-themed Diet Coke ads ran during the Olympic Games, Coke enlisted high-profile celebrities like Heidi Klum to appear at Heart Truth events, and Diet Coke beverages were distributed at community heart health screenings.

NHLBI’s partnership with Coke drew ire from the public health community because it seemed untenable to partner with a company that also sells sugary drinks linked to obesity and heart disease. The fact that the partnership focused on Diet Coke was particularly problematic because it closely followed the release of the NHBLI-funded Framingham Heart Study’s findings that consumption of diet soft drinks appeared to be linked to increased risk factors for heart disease.

In 2010, the Center for Science in the Public Interest (“CSPI”) called on the government agency to sever its ties with Coke, but NHLBI publicly refused to do so. The primary rationale NHLBI gave for keeping Coke as a corporate sponsor was that the company allowed the agency to extend its reach to get out the message that heart disease is an important health concern for women. CSPI’s challenge to the program led to a public debate about the role of Coke in NHLBI’s educational activities.

Coke’s Heart Truth Contracts with NHLBI

In 2010, PHAI requested Coke’s contracts with the NHLBI pursuant to the Freedom of Information Act (FOIA) and received copies of contracts the company entered into with Ogilvy Public Relations Worldwide on behalf of the NHLBI from 2007, 2008, 2009 and 2010:

  1. Coke Agreement_December-17-2007
  2. Coke Agreement_Jan-3-2008
  3. Coke Agreement_Oct-21-2008
  4. Coke Agreement_Jan-13-2010-2011

At the time, the dollar amounts in these contracts were redacted as proprietary information.

Coke’s recent funding disclosures date back to 2010, and show that in 2010 the company paid NHLBI $440,000 in support of a fashion show to promote heart health awareness. Through its contracts with NHLBI for the 2010 Heart Truth Fashion Show, Coke was granted:

-Exclusivity as the only carbonated beverage category event sponsor

-Full use of the NHLBI Heart Truth logo in any Coke marketing, advertising and or promotional materials or activities

-Assistance from NHLBI’s agent, Ogilvy, in the “development of heart health content and messages” for its use

-“Access to heart health experts and spokespeople to serve on Coca-Cola’s behalf including at Coca-Cola luncheons, ambassador program, opinion shaper and other customer/VIP events”

-Highlighted attention to Coca-Cola’s partnership activities on the Heart Truth webpage

-Soundbites from NHLBI representatives at Heart Truth events for use by Coca-Cola

-The right to provide free samples of Coca-Cola products at the fashion show

-The right to feature Coca-Cola advertising in essentially all aspects of the event

-Pre-approval of “all [NHLBI] creative materials, press releases, collateral materials, signage and other items using” Coca-Cola’s trademarks

The breadth of the rights granted to Coca-Cola is in keeping with a typical private arrangement for event sponsorship, but seems startling in the context of a government run educational campaign. Ogilvy Public Relations Worldwide was awarded multi-year government contracts from the NHLBI totaling $11.9 million to execute the Heart Truth campaign on its behalf. Organizers of complex, national educational campaigns must work with sponsors to ensure events run smoothly. The contracts Ogilvy entered into on NHLBI’s behalf with Coke, however, reveal a situation where it appears that NHLBI was granting Coke rights to advance the company’s commercial agenda.

Coke Abruptly Shifts Its Heart Health Spending

In March of 2010, PHAI wrote a detailed letter to the Associate General Counsel for Health and Human Services (HHS), asking that it review NHLBI’s relationship with Coke pursuant to the agency’s written ethical guidelines for co-sponsorships of events. In its reply, HHS cited a general provision of the Public Health Service Act granting NHLBI the authority to conduct health promotion campaigns and deferred decision-making about the appropriateness of Coke’s co-sponsorship of the Heart Truth campaign to NHBLI. Despite NHLBI’s public defense of Coke in response to CSPI’s letter and apparent agency inaction after PHAI’s request to review the relationship, after 2011 Coca-Cola shifted its support for Heart Truth and other heart health activities sharply away from the NHLBI.

According to Coke’s initial funding disclosures in the Fall of 2015, between 2010 and 2015, Coke’s total funding of heart health-related organizations and educational activities was approximately $8 million (click here for a detailed description). $7.8 million of these funds went to just five organizations: NHLBI (via Ogilvy and the Foundation for the National Institutes of Health), the American College of Cardiology, the Preventive Cardiovascular Nurses Association, the American Dietetic Association, and Brigham and Women’s Hospital in Boston, MA. NHLBI-related funding of the Heart Truth totaled $1.9 million with Coke’s contributions peaking at $1 mil in 2011. Starting in 2012, Coke sharply reduced its direct NHLBI support and shifted its gifts to private organizations not subject to FOIA requests.

Coke’s Heart Truth Spending to Key Partners (2010-2015)

Coke’s Heart Truth Spending to Key Partners (2010-2015)

Brigham and Women’s Hospital Cardiologists Associated with Millions in Coke Money

Coke’s Heart Truth partnership with NHLBI was created under the leadership of then NHLBI Director Elizabeth (Betsy) Nabel, MD. Dr. Nabel is a cardiologist who left public service in 2010 to become President of Brigham and Women’s Hospital (BWH) in Boston, MA. Dr. Nabel traveled to Canada to be an official 2010 Olympic Games Torchbearer for Coke and spoke glowingly about her relationship with Coke.


It turned out that Dr. Nabel was not the only Coke heart health partner at BWH. She was joined by Dr. JoAnne Foody, MD, the Medical Director of BWH’s Pollin Cardiovascular Wellness Center. Dr. Foody is featured as a heart health expert in continuing education presentations produced by Coca-Cola’s Beverage Institute for Health, and in 2011 was selected to serve as the Editor-In-Chief of the American College of Cardiology’s (ACC) CardioSmart initiative. ACC received $2.6 million in Coke funding for CardioSmart and community screenings between 2010 and 2015. CardioSmart is described as “a patient education site committed to providing accurate, un-biased heart health information in an advertising-free environment.”

Coke clearly valued its relationship with Dr. Foody. As was reported in 2012, she was included in an email sent from Coca-Cola executive Helen Tarleton to a list of “partners” in various health organizations sharing the company’s position on a proposed New York City ordinance to limit soda portions. The email asked Dr. Foody to disseminate a Coke infographic downplaying the role of sugary drinks in the obesity epidemic. Coke’s direct request to advance a policy position potentially at odds with CardioSmart’s mission to educate heart health patients is a striking example of the depth of the relationships it formed with its public health “partners.”


In 2013 and 2014, Dr. Nabel and Dr. Foody leveraged their relationship with Coke into $1.2 million dollars of funding for a BWH cardiovascular health initiative called ClimbCorps to promote stair climbing for heart health and provide heart health education. Dr. Foody served as the ClimbCorps’ Medical Director. In 2013, Coca-Cola executive Helen Tarleton personally attended a ClimbCorps event with Dr. Nabel and Dr. Foody. The program no longer has an active website and all links to ClimbCorps redirect to the BWH general website. The program’s emphasis on physical activity fit well within Coke’s overall obesity strategy to focus on physical activity as opposed to diet.


Coke Exits the Heart Health Picture

Coke’s funding disclosures paint a more complete picture of how it operated and who it turned to when it needed to shift its giving from a highly scrutinized government agency to private organizations. In response to public pressure, Coke has since bowed out of the heart health initiatives it funded over the past five years:

In the process, millions of dollars were spent in ways that Coke itself now admits were not adequately transparent, and were inappropriate given the company’s overwhelming commercial interests in the health issues addressed.

There is no question that funds are desperately needed for programs to address crucial diet-related public health issues like cardiovascular disease in women. Coke spent $8 million on heart health education in five years (not including the in-kind contributions it made via specially printed product packages, Heart Truth dedicated websites and television commercials), while the federal government spent just $17 million on the Heart Truth campaign over ten years. The problem with Coke’s heart health spending is that its primary goal has been to downplay the role of sugary drinks in the obesity epidemic and to position diet beverages as healthy alternatives. Neither of these positions is fully supported by actual evidence and, as such, are in conflict with the mission of truly unbiased cardiovascular health initiatives.

There remain many unanswered questions about Coke’s heart health “partnerships.” To what extent did Coke’s initial participation with NHBLI’s Heart Truth campaign give the company legitimacy through what appeared to have been the government’s imprimatur and grant it access to the private organizations it subsequently partnered with? What other requests for political support did the company make of the heart health organizations it funded? How did Coke’s funding impact the heart health activities of the organizations it funded in terms of dietary recommendations to the public or support for public health policies at odds with Coke’s agenda? The most important question left in the wake of Coke’s co-optation of the Heart Truth campaign is this: Moving forward, how can the United States create and sustain unbiased funding mechanisms for the crucial public health issues of our time?

Coke’s Balancing Act

Tuesday, August 25th, 2015

By Cara Wilking, JD, Consulting Attorney

BalanceDebateCloseupThe Coca-Cola Company’s pouring of millions of dollars into the Global Energy Balance Network (GEBN), a front group focused on exercise as opposed to diet to combat obesity, has crystallized an issue that the public health community has long been concerned about: the role of industry funding to research and develop solutions to public health threats. A New York Times story exposing this funding arrangement has led to a public relations nightmare that finally culminated in a formal statement from Coke’s Chairman and CEO, Muhtar Kent. Mr. Kent stated that the accusation that the company is deceiving the public about its support for scientific research “does not reflect our intent or our values,” and promised more transparency. He promised to make available a list of the funding it supports, and to convene expert panels to assist with future “investments in academic research.”

Coke’s funding of GEBN is part of a well-articulated company strategy it calls “Balancing the Debate.” Coca-Cola’s chief scientific officer, Rhona S. Applebaum , PhD, laid out the Balancing the Debate strategy at a 2012 conference for the sugar industry. (CLICK HERE FOR THE FULL PRESENTATION)  The strategy seeks to discredit what the company calls “detractors” in the scientific community like Kelly Brownell, Dean of the Sanford School of Public Policy at Duke University (formerly of Yale University), and public health organizations like Center for Science in the Public Interest.


At that 2012 industry conference, Ms. Applebaum told participants that she had come with a “plea from Coca-Cola” that “we all have to work together and use science.”


To that end, Ms. Applebaum, shared Coke’s strategy to “Balance the Debate” by using three interdependent steps: “Cultivate Relationships,” “Collaborate Research,” and “Communicate Results.” These steps, if properly taken, will result in a balanced debate that will “Address the Negative” and “Advance the Positive” for the food industry.


Ms. Applebaum, was clear that cultivating relationships and research collaborations comes down to dollars and cents. She outlined how to use research funding for “defensive and offensive science and research” to address the issues faced by the food industry.


The GEBN seems to have been tailor-made for the offensive and defensive research Coke had in mind, and it amplifies and expands  the mission and capabilities of Coke’s Beverage Institute for Health and Wellness, which is run by Ms. Applebaum.  On a slide entitled “What Experts Tell Us,” Ms. Applebaum gave insight into the company’s research agenda to “Shift energy balance,” “Inspire/Motivate consumer behavior change,” and “Bring opportunities (on energy in/out).”


To add a gloss of legitimacy to Coke’s vision for funding science to serve its agenda, its chief scientific officer, Ms. Applebaum, co-authored two papers: one in 2009 with guiding principles for industry funding of food science and nutrition research, and one in 2012 with guiding principles for establishing panels of scientific advisers. With respect to funding food science and nutrition research like that conducted by GEBN, Ms. Applebaum co-wrote the following guiding principles:

In the conduct of public/private research relationships, all relevant parties shall:

1) conduct or sponsor research that is factual, transparent, and designed objectively; according to accepted principles of scientific inquiry, the research design will generate an appropriately phrased hypothesis and the research will answer the appropriate questions, rather than favor a particular outcome;

2) require control of both study design and research itself to remain with scientific investigators;

3) not offer or accept remuneration geared to the outcome of a research project;

4) prior to the commencement of studies, ensure that there is a written agreement that the investigative team has the freedom and obligation to attempt to publish the findings within some specified time frame;

5) require, in publications and conference presentations, fully signed disclosure of all financial interests;

6) not participate in undisclosed paid authorship arrangements in industry-sponsored publications or presentations;

7) guarantee accessibility to all data and control of statistical analysis by investigators and appropriate auditors/reviewers; and

8) require that academic researchers, when they work in contract research organizations or act as contract researchers, make clear statements of their affiliation; require that such researchers publish only under the auspices of the contract research organizations. (emphasis added).

These guiding principles clearly were not adequately followed in the case of Coke’s funding of the GEBN, and it remains to be seen what other research it has been cultivating as part of its effort to “balance the debate.” Moreover, the whole concept of funding “defensive and offensive science and research” is completely at odds with the principles of objective research design contained in the guiding principles.

Coke has had a concerted effort to fund science in its favor pursuant to a specific plan laid out by its chief scientist in 2012, and it failed to adequately follow the ethical guidelines its chief scientist helped to write in 2009. The remedies CEO Kent now promises are to disclose who the company has funded (something, according to their chief scientist, the company should have already been doing), and enlisting more experts to help sort things out. For Coke’s CEO to say that the criticism of actions that were clearly in line with a well-articulated Coca-Cola Company strategic plan and failed to comply with basic ethical principles co-written by its chief scientific officer “does not reflect” the company’s “intent” or “values” is partly right and partly wrong. It clearly reflects Coke’s intent to fund science to serve its interests. It does not, however, reflect the purported values of the company with respect to working with scientific researchers.

Re-Tooling Bottled Water Bans and Healthy Beverage Requirements to Serve Sustainability and Public Health Goals: A Constructive Path Forward

Monday, June 29th, 2015

By Cara Wilking, JD, PHAI Consulting Attorney

Researchers at the University of Vermont in Burlington (UVM) published a paper describing the impact of a campus bottled water ban that was paired with a healthy beverage requirement. The study found that removing bottled water from campus had no impact on the number of plastic bottles shipped to the campus, and resulted in higher consumption of unhealthy beverages. These results do not support the sustainability or public health goals of the bottled water ban: it failed to reduce plastic trash and carbon emissions or improve the nutrition profile of beverages consumed by students, faculty and staff on the UVM campus.

The study puts a fine point on a very practical tension that exists between two highly organized movements: the obesity and oral health prevention movements with a primary focus on shifting the public from caloric beverages to non-caloric beverages like water–for the most part regardless of how they are packaged; and a segment of the sustainability movement that has honed in on bottled water as a unique source of plastic trash, carbon emissions from its transportation, and a burden on communities from where it is extracted for packaging. The public health community regards bottled water as a healthy alternative to other drinks when consumers are choosing a beverage to buy, and the environmental community considers bottled water to be a needless source of pollution. The UVM study findings call out for solutions that meet the goals of both groups, and that combine their forces for a greater collective impact.

A constructive path forward is for both movements to work together to reduce access points for all packaged beverages. A key to the bottled beverage industry’s success has been to insert itself into every aspect of daily life. Vending machines are found in parks, schools, college campuses, recreation centers, etc. And coolers selling bottled beverages are placed at the end-caps of retail check-out lines, and fill the walls of convenience stores all over the country—including in places like college campuses. These access points haven’t always been there. They’ve been inserted via private contracts over time—these are contracts that are not required to be renewed and can be radically altered to support the environment and the public health.

A strategic focus on reducing total access points for packaged beverages benefits the environment through:

And benefits the public health through:

A focus on a total reduction of packaged beverages is timely because demand for sugary drinks is on the decline. This new path will require both movements to expand their thinking on their respective issues and entails political risks on both sides. The obesity prevention movement will have to move beyond efforts to change the product mix in existing vending machines and other retail sales outlets and embrace phase-outs of beverage vending machines and cooler equipment. A focus on an overall total reduction in sales of bottled beverages will not be cost-neutral in terms of revenues from bottled beverage sales. This will undoubtedly raise great opposition from the beverage industry and firms and institutions that profit from packaged beverage sales.

The environmental movement will have to expand its definition of bottled water to include water that has been carbonated, sweetened, flavored or brewed and packaged in plastic. A focus on bottled water alone has strategic benefits, especially on a college campus, because plain water can be accessed via drinking fountains. Moreover, allowing other packaged beverages to remain quells critics by providing choices beyond the drinking fountain. There, however, seem to be few discernible differences between bottled water and other bottled beverages: all have water as the primary ingredient, both may have been bottled at the same factory, both are placed in plastic containers, trucked in a vehicle, refrigerated in a machine, tossed into a trash or recycling receptacle, or not properly disposed of at all.

Both movements have built momentum and achieved many accomplishments. Imagine how much more progress can be made if they join forces.

Copycat Snacks Undermine School Nutrition

Wednesday, June 11th, 2014

Today, the Public Health Advocacy Institute at Northeastern University School of Law, is releasing the issue brief Copycat Snacks in Schools on the food industry’s recent push to market popular junk food brands in schools. As noted in today’s New York Times story by Michael Moss entitled “The Domino’s Smart Slice Goes To School,” PHAI has called upon the USDA to address branded junk food marketing in schools. Starting July 1, 2014, all foods sold outside of the National School Lunch Program, such as food from vending machines and school stores, will have to meet United States Department of Agriculture “Smart Snacks” nutrition criteria. Not wanting to lose an in-school marketing opportunity, major food companies like PepsiCo are producing reformulated versions of popular junk foods like Cheetos® and Doritos® that meet the Smart Snacks criteria, but use the same brand names, logos and spokescharacters as are used to market traditional junk food.

For example, PepsiCo produces and markets to school food service directors a product called Cheetos® Flamin’ Hot Puffs Reduced Fat. This product meets the USDA Smart Snack guidelines, but it is not widely available for retail purchase outside of schools. Instead, PepsiCo offers Cheetos® Flamin’ Hot Puffs to the broader public. As you can see below, the product packaging is almost identical.


Cheetos Combined

Copycat snacks like reduced fat versions of Cheetos® products are not widely available for purchase outside of schools and are clearly designed to co-market traditional junk food to children in school. The issue brief describes copycat snacks, how they undermine nutrition education efforts, and what can be done to stop the sale and marketing of these products in schools.

Plumbing codes an important factor in availability of school water fountains, finds PHAI’s Wilking in CDC study

Wednesday, May 7th, 2014

schoolfountainsIn a study examining availability of water fountains in schools published in the May, 2014 issue of the CDC journal, Preventing Chronic Disease,
PHAI’s senior staff attorney, Cara Wilking, along with CDC researchers, Stephen J. Onufrak and Sohyun Park found that state plumbing codes were a predictor of whether and how many water fountains were available to children.

Because the availability of plain drinking water to schoolchildren is an important strategy to reduce sugary beverage intake of empty calories, understanding the factors that facilitate or frustrate prevalence of water fountains is a key to successful implementation of this strategy.

Citation:  Onufrak SJ, Park S, Wilking C. Student-Reported School Drinking Fountain Availability by Youth Characteristics and State Plumbing Codes. Prev Chronic Dis 2014;11:130314. DOI:

PHAI’s Gottlieb and Wilking Co-author study in JAMA Pediatrics Showing that Fast Food Giants Confuse and Deceive Kids

Monday, March 31st, 2014


Boston –

After much criticism and prodding, Fast food giants McDonald’s and Burger King agreed to depict healthier food options in advertising directed at children.  Researchers at the Norris Cotton Cancer Center at Dartmouth-Hitchcock, along with the Public Health Advocacy Institute (PHAI) at Northeastern University School of Law, found that attempts to honor these pledges by depicting healthier kids’ meals frequently go unnoticed by children ages 3 to 7 years-old.  In research published on March 31, 2014 in JAMA Pediatrics, these researchers found that one-half to one-third of children did not identify milk when shown McDonald’s and Burger King children’s advertising images depicting that product. Sliced apples in Burger King’s ads were identified as apples by only 10 percent of young viewers; instead most believed that the ads were depicting  french fries. 

Children in the study were confused by the images of food.  One typical participant said, “And I see some…are those apples slices?” 

The researcher replied, “I can’t tell you…you just have to say what you think they are.”

“I think they’re french fries,” the child responded.

Video of this and other responses from children participating in the study

“Burger King’s depiction of apple slices as ‘Fresh Apple Fries’ was misleading to children in the target age range,” said principal investigator James Sargent, MD, co-director Cancer Control Research Program at Norris Cotton Cancer Center. “The advertisement would be deceptive by industry standards, yet their self-regulation bodies took no action to address the misleading depiction.”

Mark Gottlieb, Executive Director of PHAI and an author of the study, observed that, “when young children believe they will be getting french fries with their meals because of deceptive or confusing advertising imagery, they may insist that the adult bringing them orders french fries instead of apple slices. Likewise, if advertising leads children to expect a sugary drink rather than milk, they may well end up getting the sugary drink. This has the effect of undermining the self-regulatory pledges that the companies made.”

Study author and PHAI Senior Staff Attorney Cara Wilking said she found it, “troubling that fast food giants would publicly make a self-regulatory pledge, fail to live up to the pledge, and receive no sanction from the relevant self-regulatory body. Such failures suggests that self-regulation is often more about public relations than about fulfilling the role of actual governmental regulation.”

Sargent and his colleagues studied fast food television ads aimed at children from July 2010 through June 2011. In this study researchers extracted “freeze frames” of Kids Meals shown in TV ads that appeared on Cartoon Network, Nickelodeon, and other children’s cable networks. Of the four healthy food depictions studied, only McDonald’s presentation of apple slices was recognized as an apple product by a large majority of the target audience, regardless of age. Researchers found that the other three presentations represented poor communication.

This study follows an earlier investigation conducted by Sargent and his colleagues, which found that McDonald’s and Burger King children’s advertising emphasized giveaways like toys or box office movie tie-ins to develop children’s brand awareness for fast food chains, despite self-imposed guidelines that discourage the practice.

While the Food and Drug Administration and the Federal Trade Commission play important regulatory roles in food labeling and marketing, the Better Business Bureau operates a self-regulatory system for children’s advertising. Two different programs offer guidelines to keep children’s advertising focused on the food, not toys, and, more specifically, on foods with nutritional value.

“The fast food industry spends somewhere between $100 to 200 million dollars a year on advertising to children, ads that aim to develop brand awareness and preferences in children who can’t even read or write, much less think critically about what is being presented.” said Sargent. 


Bernhardt AM, Wilking C, Gottlieb M, Emond J, Sargent JD. Children’s Reaction to Depictions of Healthy Foods in Fast-Food Television Advertisements. JAMA Pediatr.2014;():. doi:10.1001/jamapediatrics.2014.140.

This study was funded by the Robert Wood Johnson Foundation’s Healthy Eating Research program.

PHAI’s Wilking Authors Piece for Update Magazine on Digital Food Marketing targeting Kids

Wednesday, January 29th, 2014

PHAI Senior Staff Attorney Cara Wilking’s article, State Law Approaches to Curtail Digital Food Marketing Tactics Targeting Young Children, has been published in the January/February, 2014 issue of the Food and Drug Law Institute’s Update Magazine.  In the article, Wilking describes why digital marketing, which is inherently deceptive to younger children.  She explains the role of packaging, “advergames,” and digital sweepstakes in digital marketing.

Wilking concludes that these practices may trigger specific consumer protection law provisions and case law precedent around unfair and deceptive trade practices and looks to state attorney generals to take steps to stop these practices.

Download State Law Approaches to Curtail Digital Food Marketing Tactics Targeting Young Children (pdf).

PHAI Releases Major Report on Digital Food Marketing to Youth: Urges State Attorneys General to Act

Thursday, December 19th, 2013

December 19, 2013

The Public Health Advocacy Institute (PHAI) at Northeastern University School of Law, along with our partners at the Center for Digital Democracy and Berkeley Media Studies Group, today releases State Law Approaches to Address Digital Food Marketing to Youth.  It is a first-of-its kind resource that provides an evidence base and action steps grounded in state law.  State attorneys general and other stakeholders in children’s health and privacy can use it to put a stop to troubling digital marketing practices that deceive youth and their parents.

In addition to clear explanations of how digital marketing works and why it poses privacy and health risks to youth, key legal issues for state regulators are explored.  These issues include personal jurisdiction over out-of-state food and beverage marketing and media companies; the interplay of federal and state laws regulating mobile marketing; and the application of state promotions laws to child consumers.

Key findings include:

Senior Staff Attorney, Cara Wilking, who was lead author of the report, noted that, “state attorneys general are in a unique position to leverage state law approaches to stop unfair, deceptive, or otherwise illegal digital marketing of unhealthy foods to our youngest and most vulnerable consumers.”

PHAI’s Executive Director, Mark Gottlieb, added, “there is a general failure to understand the disturbing marketing practices that are becoming commonplace in the digital marketing world. This report goes a long way toward closing the knowledge gap between those using powerful technology to sell junk to kids and those who have the responsibility to protect them.”

State Law Approaches to Address Digital Food Marketing to Youth Report

Support for State Law Approaches to Address Digital Food Marketing to Youth was provided by the Robert Wood Johnson Foundations Healthy Eating Research Program (#69293).



PHAI researchers co-author article in AJPH describing how health advocates battling the food and beverage industry can learn by looking back at the smoking and health crisis of the late 1950s and early 60s

Thursday, November 14th, 2013

Richard Daynard, Lissy Friedman, and Mark Gottlieb have co-authored an article published today in the American Journal of Public Health, along with our research partners from Berkeley Media Studies Group (BMSG). The article is entitled: “Cigarettes Become a Dangerous Product: Tobacco in the Rearview Mirror, 1952–1965.”

BMSG’s press release appears below:

Nutrition advocates may be able to use lessons from tobacco control to help government move faster toward protecting the public from harmful food and beverage company products and marketing practices, say the authors of a new study published today by the American Journal of Public Health.

In a content analysis of public and internal documents, the authors, from Berkeley Media Studies Group and the Public Health Advocacy Institute at Northeastern University School of Law, examined national newspapers, tobacco industry documents and the Congressional Record and Congressional Index between 1952 and 1965 to learn how health harms from cigarettes were framed in the early days of anti-tobacco advocacy.

The study found that news coverage of tobacco focused primarily on its health harms — not who was responsible for addressing them. Much as nutrition advocates often see headlines today about sugary drinks, junk food or other products that fuel disease, pre-1965 conversations about cigarettes were typically disconnected from the industry that produced them.

As such, the personal responsibility rhetoric the tobacco industry became known for in the 1980s and beyond — rhetoric that food and beverage companies have borrowed and are using today to forestall government regulation and shift blame for their products’ health harms onto the consumers who buy them — was all but absent from both news coverage and industry documents. Instead, tobacco companies focused on raising doubts about cigarettes’ links to lung cancer. More than three-quarters of tobacco industry documents denied that cigarettes are harmful to health, with industry spokespeople claiming that the causes of cancer are complex and more research was needed. The industry also discussed cigarettes’ alleged benefits, such as a “feeling of well-being and refreshment.”

What little discussion there was of culpability identified both individuals and industry as sharing blame for the problem and, strikingly given today’s political discourse, called upon government to act.

“The backdrop for early tobacco control was wildly different from today’s political climate,” Lori Dorfman, the study’s lead author and director of the Berkeley Media Studies Group, said. “Profound distrust of the government has made it harder for public health advocates to make the case for protections from harmful products. In the 60s, a belief in government’s duty to act to protect public health was the norm.”

According to the study, government action was contested only in internal industry documents, not public discussion. News coverage and legislative documents questioned not whether the government should act, but how.

Nevertheless, once the dangers of cigarettes were established, actions were individually oriented and related mostly to providing consumers with more education and warnings about smoking’s health harms.

“We now take for granted how effective tobacco taxes and indoor smoking bans are,” study author and Public Health Advocacy Institute Director Mark Gottlieb said. “But moving tobacco control efforts from smoking cessation to industry regulation happened over the long haul.”

The study authors suggest that advocates now pushing for healthier food environments may be able to do the same, shifting attention from unhealthy foods and beverages to the companies that manufacture and market them. However, they will have to do so within a changed, and more challenging, political context.


Article abstract link:

Ciation: Dorfman L, Cheyne A, Gottlieb MA, Mejia P, Nixon L, Friedman LC, Daynard RA. Am J Public Health. Published online ahead of print November 14, 2013. doi:10.2105/AJPH.2013.301475.

About Berkeley Media Studies Group

Berkeley Media Studies Group researches the way public health issues are characterized in the media and helps community groups, journalists and advocates use the media to advance healthy public policy. BMSG is a project of the Public Health Institute.

About Public Health Advocacy Institute

The Public Health Advocacy Institute (PHAI) is a legal research center focused on public health law at Northeastern University School of Law. PHAI’s goal is to support and enhance a commitment to public health in individuals and institutes who shape public policy through law. PHAI is committed to research in public health law, public health policy development; to legal technical assistance; and to collaborative work at the intersection of law and public health. Their current areas of work include tobacco control and childhood obesity.


Heather Gehlert, BMSG
(510) 704-3471,

Verizon Mobile Ad Promotes Distracted Driving

Monday, October 21st, 2013

By Matthew Puder, Legal Intern

The commercial for Verizon’s NFL Mobile app begins with a noisy, crowded stadium and flashing camera lights. The quarterback calls out a play and makes offensive adjustments, and linebacker Clay Matthews counters by calling out his own defensive adjustment. The ball is hiked and handed off to the running back. Players run through a crowd of cheering fans on the field of play and then Clay Matthews lays a crushing tackle on the running back, jumps up, and flexes.

A voiceover comes on and states “Never be far from the game. Download NFL Mobile and watch live NFL games exclusively from Verizon. Never be without football.” During these few sentences the commercial cuts to a quick scene, about one-second in duration, of a man and a woman in a car. She leans from over him, from left to right, and shows him the live action football play that just unfolded on her mobile device.

To most, this one-second visual of the man and woman in the car would not evoke much thought. But when looked at in the context of Verizon’s corporate responsibility pledge to eliminate distracted driving, the innocuous clip becomes somewhat more concerning.

Verizon boasts to have taken the pledge to eliminate distracted driving by partnering with Sprint and  T-Mobile  to promote AT&T’s “It Can Wait” campaign. The essence of the campaign is to raise awareness of the dangers of distracted driving. It also advocates that drivers take the pledge to refrain from texting and driving so as to eliminate distracted driving, making the roadways a safer place for all who use them. Texting and driving is a major public health concern as the combination of the two creates a 23 fold increase in the chance of getting into an automobile accident.

In his blog post describing Verizon’s contribution to the campaign, Jack MaCartney, the Director of Corporate and Community Responsibility, acknowledges “Taking our eyes off the road, our hands off the wheel, to send or read a text, email, comment, post, tweet, is an unnecessary risk.” While Verizon’s efforts to call attention to the dangers of distracted driving are commendable, the commercial described above indicates that Verizon may not be as in touch with its distracted driving campaign as it claims to be.

Although the man and the woman in the one-second scene in the commercial appear to be in the back of a cab or a friend’s car that may not be readily apparent to the audience at first glance. The man is sitting in the position that a driver would normally be, and the woman in the position of the passenger. At a glance, the commercial seems to be advocating watching live football in the car in a way that would take the driver’s eyes off of the road.  But, even assuming that the NFL  live video was confined to the back seat, the temptation for the driver to look back to see a play or replay could also create an unnecessary distraction.  AT&T, for example, has helped helped to vividly describe the consequences of inattention to the road in its commissioned film by noted directed Werner Herzog, “From One Second to the Next.”

The Verizon spot is reminiscent of a Beck’s Beer commercial that was cited and sanctioned by the FTC for violations of the FTC Act involving the combination of beer and sailing. The commercial depicted a number of passengers on the boat with a large bucked of ice containing bottles of Beck’s Beer. Almost all of the passengers held bottles of beer, with one passenger standing dangerously close the bowsprit, others sitting on the edge of the bow, and none of passengers wearing life jackets. The issue the FTC had with the commercial was that the advertisers depicted boating passengers as drinking Beck’s Beer while engaged in activities that require a high degree of alertness and coordination to avoid falling overboard.

In its complaint the FTC stated that as many as one-half of all boating fatalities are alcohol related, including an average of 60 recreational boat fatalities annually from falling overboard while drinking. Also it the its complaint, the FTC acknowledged that the company may be in violation of the Federal Trade Commission Act, the Beer Institute’s own Advertising Marketing Code, and federal and state boating safety laws. The After its investigation, the FTC concluded that Beck’s had violated the FTC Act with this advertisement and were sanctioned with strong oversight by the FTC of future advertisements involving alcoholic beverages and boats.

Verizon’s commercial is arguably similar to the sanctioned conduct of Beck’s Beer. Like the Becks commercial where it was only the passengers drinking while on the boat, the passengers in the car are engaging in activity that poses a public health hazard. The FTC did not make the distinction between passengers and driver in its citation of the Beck’s commercial. Additionally, like the Beck’s commercial, the NFL Mobile commercial promotes activity that is prohibited by law in many states, i.e. using mobile devices while driving. Verizon could have omitted the passengers being in the car and put them somewhere else where the passenger has a further removed from being the driver, such as in a bus or in the subway.

While Verizon most likely did not make the commercial with the intention of promoting unsafe behavior, the company was at best oblivious and at worst careless in its production of the commercial. Verizon should take care to ensure that all forms of media use while driving are eliminated, not just texting, as they all increase the risk of injury and death. The company should be more and aware and sensitive to the messages it promotes in its commercials concerning mobile media and the dangerous implications they may have.

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