It’s Not the Dough, it’s the Dopamine: The Dangerous Myth of the Responsible Gambling Model
How the gambling industry misleads regulators and imperils the public’s health. . . and what we can do about it
An unprecedented Zoom event during Problem Gambling Awareness Month
March 15, 2023 from 1:00 – 3:00 PM EDT
Presenters:
Dick Daynard, University Distinguished Professor of Law at Northeastern University, has long been at the forefront of an international movement to establish the legal responsibility of the tobacco industry for tobacco-induced death, disease and disability. He is president of the law school’s Public Health Advocacy Institute, chairs its Tobacco Products Liability Project and helped initiate its Center for Public Health Litigation. Recently, he has worked with PHAI on issues involving obesity, gambling, opioids, gun control and e-cigarettes.
Jim Orford is Emeritus Professor of Clinical and Community Psychology at the University of Birmingham. His books on addiction include Excessive Appetites: A Psychological View of Addictions and An Unsafe Bet?: The Dangerous Rise of Gambling and the Debate We Should Be Having, and, most recently, The Gambling Establishment: Challenging the Power of the Modern Gambling Industry and its Allies, published by Routledge in 2019.
Mark Petticrew is director of the National Institute of Health and Care’s Public Health Research Unit and Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine where he heads the Department of Public Health, Environments and Society. His research on commercial determinants of health extends from alcohol, tobacco, firearms, and fast food to gambling.
Matt Gaskell is a consultant psychologist and a clinical lead for addictions for the Leeds and York Partnership NHS Foundation Trust and serves as clinical lead for the National Health Service Northern Gambling Service.
Liz Ritchie, along with her husband Charles, founded Gambling with Lives in 2018 to support bereaved families, raise awareness of the devastating effects of Gambling Disorder, and campaign for change. Will Prochaska is the Strategy Director for the charity.
Harry Levant of Ethos Treatment, LLC is an Internationally Certified Gambling Counselor and policy advocate working with people and families struggling with gambling disorder; also a person with lived-experience in recovery from gambling addiction, and a doctoral student at Northeastern University who researches the impact of gambling on public health.
Mark Gottlieb is the executive director of the Public Health Advocacy Institute at Northeastern University School of Law in Boston where he teaches public health advocacy. His research and advocacy have focused on tobacco litigation as a public health strategy, examining legal and policy approaches to food policy, and considering public health approaches to gambling and gun violence.
On July 9, 2019. the WBUR (Boston NPR affiliate) opinion blog, Cognoscenti, published an opinion piece penned by PHAI’s executive director seeking to leverage any forthcoming settlement of the the more than 2,000 lawsuits pending against opioid pain manufacturers, their distributors, and their retailers to create an independent foundation to help coordinate a national response to the opioid epidemic.
The commentary, along with an amicus brief by PHAI and other public health organizations submitted to the court overseeing the litigation, considers the public health experience with the Master Settlement Agreement between the states and cigarette companies in 1998. It resulted in large payments from the settling defendants to the states that sued them. But those funds have not been adequately invested to develop the public health interventions and infrastructure needed to minimize the addiction, disease, and death caused by tobacco products.
While it is obviously important for the plaintiffs to recover damages as part of a settlement, the commentary urges that a portion of the settlement should be used to create a national foundation to fund local addiction recovery, provide overdose reversal medication, education, and fostering of promising demonstration projects. Such a foundation should also serve as a watchdog for the opioid medication and addiction treatment industries.
In the face of a crisis, no public health opportunity to address it should be squandered.
Five months before Howard A. Willard III presided for the first time over the Altria Group annual shareholders meeting in Richmond, Virginia, the company carried out a business plan that dominated the discussion at the meeting. On December 20, 2018, Altria Group announced it had spent $12.8 billion to purchase a 35% share of San Francisco-based Juul Labs, Inc. While that expenditure was not enough to buy an outright controlling interest in the company, it was more than enough to provide major controversy throughout the one-hour shareholders meeting on the morning of May 16, 2019.
Willard, Altria’s chairman and Chief Executive Officer, called 2018 a “strong year for the core tobacco business” and touted the JUUL investment, couching it as having been done to provide JUUL to adult smokers. 2018 was also a year that saw a dramatic surge in youth use of e-cigarettes, including JUUL. According to the 2018 National Youth Tobacco Survey, current e-cigarette use among middle and high school students rose dramatically between 2017 and 2018, with over 3.6 million young people currently using e-cigarettes in 2018. This marked a stark reversal of downward trends of such use in previous years.
In the shareholder meeting’s question and answer session, this author noted that, since the December purchase, “a federal class action lawsuit has been filed in Sarasota County, Florida, on behalf of a girl and her parents accusing JUUL of intentionally targeting teenagers for addiction and falsely denying doing so. The lawyers are using Florida’s anti-racketeering statute, alleging the company committed fraud, product liability and deceptive trade practices. In late April, the Public Health Advocacy Institute (for which I work) sent a demand letter to JUUL on behalf of three youths in Massachusetts. The three of them have become addicted to nicotine by using JUUL, and allege a violation of the state Consumer Protection Act. Specifically, the allegations involve breach of the implied warranty of merchantability regarding the design of the product to addicting non-smoking minors and also unfair marketing to teenagers.
“And the plaintiffs here are seeking the establishment of a program for the prevention and treatment of nicotine addiction in young people who use JUUL. And then, of course, just yesterday, the North Carolina Attorney General, Josh Stein, sued JUUL, saying that it had misrepresented the potency and danger of nicotine in its products. He is seeking injunctive relief, the disgorgement of profits and limiting some of the flavors used by JUUL. “So my question is, what specific steps will Altria Group take to protect its $12.8 billion investment in JUUL by making JUUL less vulnerable to lawsuits of this type?”
Willard responded by acknowledging that, in December, Altria was aware of litigation against JUUL. Then he gave the standard assurance that “we are very committed to helping address the increase in e-vapor use and to encourage JUUL to make sure that their marketing is only to adult cigarette smokers.”
Another shareholder approached the issue of the $12.8 billion investment in JUUL from a different angle. Dr. Andrew Kramer cited three major criticisms of the deal “One that we paid too much. Two, more often, to me, is that here’s no path to control. And lastly, we’re restricted from distributing any other nicotine vaping systems that limits our – that prohibits our ability to build a diversified portfolio in that space.” Willard rejected Kramer’s analysis, calling the deal a “very attractive investment” for Altria.
Jonathan Chafee of Cattaraugus County, New York, asked why Altria had changed its position on raising the purchase age for tobacco products to 21 from two years earlier, when then-CEO Martin Barrington had said that local laws to raise the age to 21 would not help prevent youth use of tobacco because they would just travel to a community without such a law. Willard justified that switch in position by noting the rapid increase in youth use of e-vapor products in 2018.
Olivia Lang of New York asked what Altria sees as its ethical obligation to help their customers make better informed decisions about using products that harm their health. Willard cited the company’s “significant opportunity with products like IQOS and the new e-vapor products like JUUL to convert adult cigarette smokers down the risk continuum.”
Two shareholder resolutions were presented. The first one, supported by Sister Nora Nash, a sister of St. Francis of Philadelphia, called on Altria Group to disclose publicly the nicotine levels of the company’s cigarette brands. Sr. Nash said that “Altria needs to hear the calls of the thousands of people who will die this year from the horrible effects of smoking cigarettes and other products.”
The second resolution was presented by Cathy Rowan the director of socially responsible investments for Trinity Health and a member of the Interfaith Center for Corporate Responsibility. It called for a report on Altria’s policy and procedures governing direct and indirect lobbying, the company’s payments for such lobbying, Altria’s membership in and payments to any tax-exempt organization that endorses model legislation and a description of Altria’s oversight of this activity.
The first resolution garnered 3.9% YES votes, while the second resolution got 27.9% YES votes.
Young people from New York and Nebraska attended the meeting while many more were outside the Richmond Convention Center, chanting slogans such as “People Over Profits” and holding signs with messages including “We will not be FUULed! 1 Pod = 1 Pack”, “Who do you think these flavors are targeting? Fruit Medley” and ”13 is the average age of a new smoker.” Approximately85 teen leaders came to Richmond to confront Altria Group management over the company’s outrageous conduct. The youth who came to Richmond for this meeting were able to see through the multi-billion dollar corporate smokescreen and returned to their communities with the powerful messages they delivered to the management of Altria Group, Inc.
Today, the Public Health Advocacy Institute (PHAI) took the first step in launching a public health class action lawsuit in Massachusetts against Juul Labs, the makers of the most popular e-cigarette in the United States, for designing and marketing its product to appeal to and addict adolescents. This is the first such case brought against Juul in Massachusetts, and the first such lawsuit asking only one thing: for a court to require the company to fund a statewide clinical program for the treatment of nicotine addiction in young people who used Juul e-cigarettes.
While Juul Labs
maintains that its product is intended to be used by adult smokers, the
product’s design, in fact, caters to adolescents, whose brains are especially
vulnerable to nicotine addiction. . Importantly for teens, Juul is designed to
be used discreetly. To the untrained eye, a Juul e-cigarette may look simply
like a USB drive. The design enables young people to use Juul surreptitiously
without parents, teachers, or other adults even knowing. This product feature
has helped Juul capture a massive teen market. “Kids use Juul everywhere,” said
Matthew Murphy, now 19 years-old and one of the class representatives.
“I knew kids who used Juul during class. I used it in my bedroom and my parents
couldn’t smell it. They had no idea until long after I was hooked.”
Despite Juul’s
claims that its e-cigarettes are intended solely for adult smokers hoping to
switch from conventional cigarettes, the company engineered its sophisticated
e-cigarettes to yield a physiological response and degree of nicotine
‘satisfaction’ which may actually exceed those of traditional cigarettes. Dr. Jonathan Winickoff is a professor of
pediatrics at Harvard Medical School who treats Juul-addicted patients in his
pediatric practice. “First of all, Juul is not a recommended or approved
product for smoking cessation,” said Winickoff. “On the other hand, a teen can
easily inhale a cigarette pack’s worth of nicotine in a Juul pod and, because
the product’s design almost eliminates the body’s natural response to bronchial
irritation caused by high doses of inhaled nicotine, addiction can occur very
quickly”
Juul Labs went
from a startup to being valued at over $30 billion in just over three years.
Its business model depends on the sale of proprietary “pods” of liquid
nicotine, including flavors like
Mint, Mango, Fruit, and Crème that help make their e-cigarettes highly
palatable and attractive to teenagers.
Marianne
Savage is the mother of an addicted teen user of Juul and a class
representative. “It is so hard seeing your child struggle with addiction,” said
Savage. “It affected his grades, his social life, and his health. We have to
fight hard to quit. The ordeal of Juul addiction caused my son a lot of pain
and anxiety.”
Because best practices for treatment have yet to emerge, young people
suffering from nicotine addiction caused by Juul have very few places to turn
for help. “The goal of this lawsuit is to make sure that these kids and their
parents in Massachusetts have a place to go to deal with this addiction,” said Mark
Gottlieb, Executive Director of the Public Health Advocacy Institute. “Our
non-profit law firm is taking on Juul Labs so that the company with the
greatest responsibility for teenage addiction to e-cigarettes pays the cost for
effective treatment for these young people.”
It became clear in the months leading up to the May 17th Annual Shareholders Meeting for Altria Group that 2018 would be a time for change for the company. In January, Chairman, CEO and President Martin Barrington publicly announced his intention to retire due to the approach of his 65th birthday later in the year. At the shareholders meeting in Richmond, VA it was noted that 54-year-old Howard A. Willard III would become the next Chairman and CEO of the company while 47-year-old William F. Gifford, Jr. would become the Vice Chairman of Altria. But, as it was during the Philip Morris/Altria Group regimes of Hamish Maxwell, Geoffrey C. Bible, Michael A. Miles, Louis C. Camilleri and Martin J. Barrington, it is expected to be business as usual.
For this author, completing this annual trip to Virginia’s capital was unlike any of the more than two dozen such trips he has made. As I addressed the meeting on an overcast Thursday morning in Richmond, I noted that this meeting “is the first Altria Group Shareholders Meeting taking place since the death of Father Michael Crosby. He passed away last August, eight months after his diagnosis with cancer. And I just wanted to state and I think this is certainly a very appropriate setting for me to state my enormous admiration and respect for Father Crosby. I met him actually in the early 1990s coming to shareholder meetings when the company was called Philip Morris, and also going to the Reynolds meetings in Winston-Salem. He was just without any flaw in terms of his total dedication to social justice, inspired by his devotion to his Catholic faith and, of course, he was a Capuchin father for many, many years. So, I just wanted to note that most certainly, I could not possibly be here without thinking of and respecting his memory.”
Citing five separate litigation setbacks for the tobacco industry that occurred just within the past three months, I asked Mr. Barrington, “isn’t it true that the value of Altria shares has been diminished by the uncertainties and concern about tobacco litigation?” In response, Mr. Barrington did begin by seconding my comments about Father Crosby and noted that the company had reached out to his family after his death. As to the issue of litigation and stock price, Mr. Barrington denied a link, alleging that Altria’s shareholders “should feel good about the way the company’s handled litigation.”
Before, during and after the meeting at the Greater Richmond Convention Center , dozens of youth from Reality Check of New York and No Limits Nebraska exercised their First Amendment rights by demonstrating forcefully outside the building with the resounding message: People Over Profits. Other slogans included “Say Yes to Life, No to Altria” and “We’ve Seen Enough.”
Austin Ring, a Senior at Olean (NY) High School entered the meeting and asked a question on the company’s advertising and packaging of tobacco products. He noted that the “three most heavily advertised brands in America – Marlboro, Newport and Camel – were the preferred brands of cigarettes smoked by middle school and high school students. So, my question is, what is Philip Morris doing to decrease the appeal of its products to youth?” In response, Mr. Barrington referred the questioner to the company’s website and specifically claimed that the company does “not make our packaging to look like the other products” [such as mint, gum and beef jerky products].
Emma Stewart, a Senior at Plattsburgh (NY) High School, addressed the problem of the 4.5 trillion cigarette filters that are littered worldwide each year. She recommended the adoption of smoke-free policies for outdoor spaces as one way to reduce such litter. Mr. Barrington responded that the fight against litter could be viewed as a totally separate issue from the question of adopting smoke-free policies outdoors, which the company opposes.
Justin Flores, the Vice President of the Farm Labor Organizing Committee (FLOC) and a colleague, Jackie Castillo, addressed the problem of farm conditions having gotten worse for FLOC’s members.
Sister Nora Nash
The one shareholder resolution was sponsored by the Sisters of St. Francis of Philadelphia. The resolution called on the Board of Directors to “take steps to preserve the health of its tobacco-using customers by making available to them information on the nicotine levels for each of our cigarette brands and begin reducing nicotine levels in our brands to a less addictive level.” In support of the resolution, Sister Nora Nash urged the company to “play a more significant role in protecting young Americans against the severe health effects of tobacco.” She also noted that Mr. Barrington in November 2017 had said that “Altria is ready for the introduction of reduced {risk] cigarette products.” Moreover, Mr. Barrington had admitted that Altria has “developed ways of producing reduced nicotine cigarettes and aspire to become the U.S. market leader in non-combustible tobacco products such as the e-cigarettes, ahead of potential federal requirements for tobacco.” She concluded by stating that the Sisters of St. Francis and other supporters of the resolution “are about protecting families and reducing the risk, the FDA and all concerned shareholders are looking at how we can protect the American family and all who have serious issues with nicotine.”
The resolution got 4% voting in favor, with 96% in opposition.
As I left downtown Richmond after the 2018 shareholders meeting, I realized that it was not only Altria Group, Inc. that was undergoing transitions. For I had seen that, in addition to middle-aged adults who were speaking truth to power, there was an energetic and passionate group of youth who were ready, willing and able to do the same. In that regard, even if they had never met him, the dozens of youth were indeed carrying on the legacy of Father Michael Crosby.
This year, PHAI continued moving cases against Philip Morris and R.J. Reynolds to trial, went to court to tell Coca-Cola and the American Beverage Association to be honest about the link between sugar drink consumption and disease, and have been working on a number of other potential lawsuits with a public health impact.
We provided help to communities seeking to adopt and implement tobacco prevention policies, promoted smoke-free housing policies, and are working to disseminate the Tobacco-Free Generation approach to phase out tobacco sales entirely over time.
We created and curate a new web-based database of all of the tobacco prevention secondary literature that allows advocates to quickly find current resources and evidence on a range of tobacco prevention topics vital to policy making.
Most recently, we published a report on state policies to help get drinking water to children in schools and childcare centers.
PHAI administers the Violence Transformed project which uses a variety of trauma-informed approaches to utilize art creation and expression as a means to reduce the impact of violence in the community. We are currently collaborating with others on a project that is exploring the role that this approach might have in the context of housing insecurity in the Dorchester neighborhood of Boston.
We also continue to administer the Beyond OSHA project that works to improve the health and safety of some of the most vulnerable workers in the U.S..
In short, we continue to work our hardest to develop and implement “big ideas for advancing public health and social justice.” We are not afraid to take on the big corporations that profit at a tremendous cost to public health and develop new approaches to make a healthier world.
We do this without the benefit of any huge grants or contracts or gifts. While some of our income derives from fee for service work, much of our work is funded only through donations to PHAI from individuals who are passionate about public health.
Or mail your check to:
The Public Health Advocacy Institute, Inc.
360 Huntington Avenue #117CU
Boston MA 02115-5000
Access to safe and appealing drinking water in child care centers and schools is a key strategy to build healthy habits that children will use for life to maintain a healthy body weight and to support overall health.
This study sought to identify and summarize state-level policies in twenty states for drinking water quality and access in public schools and licensed child care centers. This information was then used to generate individual state profiles and general policy recommendations to achieve increased drinking water consumption by children and to ensure drinking water is safe and appealing.
The guiding principles behind these policy recommendations are to ensure that safe, potable drinking water is made available at no cost to children throughout the day. The state profiles and policy recommendations can be used to assess current policies for drinking water access and quality and to determine which policy recommendations are relevant to the needs of a particular state’s schools and child care centers. The state profiles and policy recommendations also can be used as points of comparison and sources of ideas during the policymaking process.
In 2015, a remarkable program moved to PHAI. Violence Transformed is an annual series of visual and performing arts events that celebrate the power of art, artists and art-making to confront, challenge and mediate violence. Violence Transformed furthers our public health goal of reducing preventable injury.
Project Director, Mary Harvey, recently sent out this request for support:
Dear Friends — Artists, Curators, Donors, Friends and “Friends of Friends”:
Please consider making a tax-deductible donation to Violence Transformed and invite your friends and colleagues to do likewise. To make an online contribution, please visit our website: www.violencetransformed.com and click on DONATE.
I am making this appeal at an exceptional time in the very unique history of Violence Transformed. Now in its Tenth Anniversary Year, Violence Transformed continues to launch an annual (and annually expanding) series of visual and performing arts exhibits and events. In addition, in 2015 Violence Transformed embraced the goal of broadening and deepening its engagement with the health and public health community — supporting artist-led workshops for health care providers who serve individuals and communities affected by and at continuing risk of violence and identifying violence as a public health issue requiring the attention of communities locally, nationally and indeed world wide.
Blessed with a truly remarkable level of collaboration among artists, arts organizations, health and mental health service organizations, and partnering venues throughout Greater Boston, Violence Transformed is growing in ways we never anticipated and is attracting the interest of artists and organizations beyond Boston and indeed beyond our nation’s borders. Please keep visiting our website to keep track of current and upcoming events and to look at the works already brought to Boston this year. There you can also view a digital archive of Violence Transformed activities from 2007 forward.
All in all, Violence Transformed is exhilarating, fulfilling …and daunting! While we continue to seek grant funding where available, none of what we have done could have been done without the tremendous volunteer energy, commitment and passions of participating artists, curators, academics, social activists and sponsors. Nor can it be done without significant financial assistance from donors who believe in Violence Transformed and have stepped up to contribute whatever they can.
We use your donations to: support our curators and our website and social media staff, to award Artist Honorariums if and as we are able to do so, and to publicize the work and cover the growing operational costs of Violence Transformed. We can always use large donations, of course, but we welcome donations of any size. We are proud that at 80% of the funds we bring in do go directly to artists, curators and arts organizations that affiliate with us.
So …. thank you for whatever you are able to contribute and for whatever help you can give us by passing the word of this unique enterprise on to others who might be interested in supporting our work. I hope that you are proud of what we do and of your role in contributing to Violence Transformed.
Thank you.
Mary
Mary R. Harvey, Ph.D. Director, Violence Transformed Public Health Advocacy Institute 360 Huntington Avenue / #117 Cushing Hall Boston, MA 02115 Associate Clinical Professor of Psychology Department of Psychiatry Harvard Medical School Cambridge Health Alliance
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:
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)
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:
Coke ended its role as a corporate sponsor of NHLBI’s Heart Truth Campaign in 2014
After being called out by the New York Times for funding junk science promoted by Coke and researchers it funded that focused on what it calls “energy balance science” (which claims that there is no established link between soda consumption and obesity and promotes exercise as the most effective way of compensating for the extra calories derived from soda consumption), Coke announced in September 2015 that it would no longer fund the American College of Cardiology including the CardioSmart program
ClimbCorps is no longer an active program of BWH
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?
Massachusetts attorney general, Maura Healey, has proposed regulations to protect consumers from deceptive practices of daily fantasy sports operators in Massachusetts. These include provisions to prevent youth access, limit monthly betting, and prevent professional players from using special tools to dramatically improve their chances of winning.
The Public Health Advocacy Institute previously argued to Ms. Healey that daily fantasy sports is illegal under Massachusetts law. At this time, 10 states have taken that position. Rather than take that approach, General Healey has staked out a moderate position of permitting the games while protecting consumers. We argue that some of the most important protections in the proposed regulations may be impossible to effectively enforce. Were it enforced, we argue, the industry’s business model would fail because it is built on practices that are unfair to the consumer.
