DR CHRIS VAN TULLEKEN: There is a catastrophe of suffering and death caused by ultra-processed foods… and the experts who are supposed to protect us are paid to turn a blind eye

When I was in medical school in the 90s, it was common for our lunches to be paid for by pharmaceutical company reps. We ate their sandwiches and they gave us branded pens and mugs.

None of us thought it affected our prescribing, but of course there is no such thing as a free lunch. The evidence shows that their gifts made us preferentially prescribe their drugs, leading to inferior and more expensive prescribing.

The pharmaceutical industry still pays around £40 million a year to British healthcare professionals, but at least the agency that decides whether the drugs themselves are safe, the MHRA, is free from this kind of conflict of interest. People who regulate drugs should not be taking money from drug companies, of course.

You would expect the situation to be similar to eating. But it isn’t.

There are a number of government agencies that regulate various aspects of our diet, but the final decision on what is healthy or unhealthy lies with the Scientific Advisory Committee on Nutrition (SACN), which was established in 2000.

It is one of the most important government agencies regulating food, literally defining what a healthy diet is and advising on policy. It has produced dozens of reports on every aspect of diet, nutrition and health.

Over the lifetime of the SACN, there has been an explosion in suffering and death from diet-related diseases such as obesity and type 2 diabetes. Our statistics are among the worst in the world.

This pandemic is caused by our diet consisting mainly of ready-made packaged foods that are high in calories, fat, sugar and/or salt; also known as ultra-processed foods or UPF.

In other words, the problem is caused by the industries that sell and market our harmful food. This is not up for debate. No one who is serious thinks that we cook worse food at home.

Any reasonable person would expect the SACN experts to be independent of the financial influence of the food industry. Shockingly, the opposite is true.

An analysis in The BMJ this month found that more than half of the SACN’s experts have conflicts of interest with companies that produce ultra-processed foods, such as Nestlé, Unilever (the world’s largest ice cream maker), Coca-Cola and PepsiCo.

One member alone holds more than £5,000 worth of Unilever shares, and also does consultancy work for Tate and Lyle and Coca-Cola’s Israel franchise. Another SACN member chairs an expert group at the International Life Sciences Institute Europe, which is funded by PepsiCo and Cadbury’s US owner Mondelez, among others.

It is important to say that these members have not broken any rules. And that is the problem. Despite the universal acceptance that the pharmaceutical regulator must be free from industry influence, these conflicts are still allowed and considered acceptable in the SACN.

A spokesperson for the Department of Health and Social Care told The BMJ: ‘No member of the committee is directly employed by the food and drink industry. They all have a duty to act in the public interest and to be independent and impartial.’

Why should we be concerned? Because a huge body of evidence on financial conflicts of interest suggests that this is simply not possible and, in my view, these financial relationships influence the reports that the SACN produces in subtle ways that benefit the industry. And I am not alone.

Rob Percival, head of policy at the Soil Association, told The BMJ: ‘There is now really good evidence that conflicts of interest at the intersection of science and policy can influence specific policies or public narratives in favour of the food industry, in ways that undermine public health.’

And in a private conversation with me, a committee member who has no conflict of interest indicated that he also believes that these conflicts of interest do indeed influence the committee’s reports.

The most striking consequence is that the SACN reports say nothing about the role of the food industry in causing health damage. The fact is that our increased intake of calories, salt, fat and sugar comes from industrially processed, packaged products. However, the report on sugar does not emphasise where the increase in our diet comes from.

It is astonishing that in its more than twenty years of existence it has never published a report on the cause of obesity in the population.

A telling example is last year’s report, ‘SACN Statement on Processed Foods and Health’. The government’s Office for Health Improvement & Disparities called this document an ‘independent report’, but the reality is very different.

The report investigated whether UPFs are harmful to health. UPFs make up more than half the calories in our British diet. They are typically high in calories, salt, fat and sugar and are made using processes and additives that are only used by the industry.

Some of it is clearly junk, but many of our staples contain UPF: supermarket bread, most breakfast cereals, ready meals, and so on.

Our country is suffering from a dietary catastrophe – one that many doctors and scientists, like me, believe is largely caused by the constant marketing of UPFs by the food industry. The SACN report did not entirely dispel concerns about UPFs, but it seemed to me that it reflected many of the views of the food industry and the scientists they pay.

According to the SACN, virtually all of the research is “observational” and the evidence to date “should be treated with caution”.

It suggested that consumption of ultra-processed foods can be an indicator of other unhealthy diets and lifestyle behaviors. This is almost certainly true, but the studies are clear that this is not the only problem.

Describing all the studies showing that UPF is harmful would be beyond even a large academic study.

There are over 80 studies linking smoking to cancer, and in addition there are hundreds of experimental studies on the additives and properties of these food products and the way they are marketed.

The association between a diet high in UPF and harm to human health is strong and consistent across studies in different populations and countries.

When a country switches from its traditional diet to a UPF-based diet, rates of diet-related disease and premature death skyrocket. Importantly, there is no other good explanation for the disease rates we see in the UK. Indeed, the SACN’s cautious position differs from that of many experts worldwide who are clear that a diet high in UPFs is detrimental to human health.

This does not mean that all UPFs are equally harmful or that they should all be banned or taxed. It does mean that a diet like ours, where 60 percent of calories come from UPFs, is harmful.

Until the SACN says this clearly, it will be impossible for policymakers to take action. Many other countries around the world are taking strong action, including France, Brazil, Israel, Mexico, Argentina and Canada. Even the US is considering warning against UPF intake.

But even if the money had no influence on the SACN’s advice, these conflicts of interest damage the commission’s reputation and credibility.

We are rightly concerned when politicians of any persuasion accept money or favours. How can the public trust a commission that has ties to companies like Coca-Cola, PepsiCo, Nestlé or Unilever?

Perhaps most importantly, these conflicts enhance the reputations of the food companies causing the problem: an association with the SACN creates much-needed respectability.

It may take several years for the SACN to resolve the conflicts, but we can start now: no new people with conflicts should be appointed and people with conflicts should consider stepping down.

This sets an example for the food charities and academic departments currently paid by the food industry to consider ending these relationships as well.

While the SACN is full of good, decent people – even those who take industry money undoubtedly do so in good faith – and much of the advice is scientifically sound, I think these conflicts have prevented the SACN from framing the problem of obesity and diet-related disease as a problem caused by commercial incentives.

Until the fact that our obesity pandemic is caused by a small number of very powerful corporations is clear in the minds of all policymakers and the public, we will not see an improvement in our health – nor an end to so much needless suffering.