All posts by blackfriar

facts & data points, healthy habits, nutrition, policy, politics

WHO leaks sugar report – industry will be displeased

  • WHO will recommend sugar be limited to 5 teaspoons per day or 5% of total calories (current AU consumption around 35-45 teaspoons)

Source: http://www.raisin-hell.com/2014/01/the-world-health-organisation-has-taken.html

Sunday, January 5, 2014

The World Health Organisation has taken a tough stand on sugar. It’s about time we listened.

Last week the WHO (World Health Organization) leaked a draft report about sugar. The report will tell the world’s health authorities that they should be severely limiting the amount of sugar we all eat. It will recommend that we consume no more than 5 teaspoons of sugar a day. Given the average Australian is putting away somewhere closer to 35-45 teaspoons a day, it’s a very big call indeed.
The WHO is the health policy unit of the United Nations. Its aim is provide evidence based leadership on health research. It is well funded, free from corporate influence and motivated entirely by a desire to ensure that the 92 UN member countries get the best possible, evidence based, health advice. The WHO doesn’t run a Tick program or receive sponsorship from the processed food industry. Indeed it has even recently taken the extraordinary step of banning one ‘research’ group sponsored by industry from participating in its decision making processes.
Shrinath Reddy, a cardiologist and member of the WHO panel of experts, told the Sunday Times the WHO is moving on sugar because “There is overwhelming evidence coming out about sugar-sweetened beverages and other sugar consumption links to obesity, diabetes and even cardiovascular disease.”
The worldwide burden for those diseases is accelerating very quickly. According to a new report out this week the number of overweight and obese in the developing world has quadrupled since 1980.
A billion people in the developing world are now on the chronic disease express. But don’t worry, we still win. Less than a third of the population in China and India is overweight compared to our two thirds or more. They are just starting to get the hang of this Western Diet Thingy, so expect very big rises in the very near future.
The WHO have looked dispassionately at the evidence and have seen the tsunami of human misery caused by sugar coming for more than a decade They publicly warned that sugar was strongly implicated in obesity, type II diabetes, hypertension and heart disease in 2003.
They then took the extraordinary step of telling member governments that they should ensure their populations limited sugar consumption to a maximum of 10% of total calories (around 10 teaspoons of sugar a day – the same amount you would find in a Coke or a large Apple Juice). They did this despite an overt and vicious public campaign conducted by the Food industry.
The US sugar lobby demanded that the US Congress end its $406 million funding of the WHO. This is the same WHO that co-ordinates global action against epidemics like HIV, Bird Flu and SARS. But the US food industry wanted it destroyed because it dared to suggest we eat less sugar.
The lobbying behind the scenes was even more ruthless. Derek Yach, the WHO Executive Director who drove the sugar reduction policy work told a British documentary crew in 2004, that millions were spent trying to torpedo the policy. US Senators wrote directly to the WHO threatening its very existence. They also threatened the Food and Agriculture Organisation (a sister UN department concerned with food production) with a cut in funding.
In the end the food industry campaign paid off. The WHO removed its 10% recommendation from the final text of its recommendation. It was watered down to a suggestion that people ‘cut the amount of sugar in the diet’.
As one of the people involved at the time, Professor Phillip James, Chairman of the International Obesity Taskforce, predicted “we’ll end up with nice little policies telling [us] to have ‘just a bit less sugar and a little more balanced diet’ the nonsense that’s gone on since the Second World War during which time we’ve had this vast epidemic of heart disease, diabetes and obesity.”
Even the briefest glance at the official dietary guidance on sugar in Australia or the UK will tell you Professor James wasn’t too far from the mark with his prediction. Our guidelines are stuffed with words like ‘moderation’ and ‘balanced diet’ when it comes to sugar.
But the thing about evidence is, it doesn’t go away. And in the 10 years since the WHO last tried to save us from sugar, the evidence has become overwhelming (to quote Dr Reddy).
The WHO got a serious kicking when they tried to suggest a 10 teaspoon upper limit on sugar consumption, so you can imagine that the evidence they have reviewed must be truly overpowering to have them step up to the plate again. But this time they want the limit to be 5% (5 teaspoons) or less. I hope they’re wearing their flak jackets because I suspect a whole heap of blood money from the processed food industry is pouring into ‘lobbyists’ pockets as we speak.
The WHO is not running down sugar because it hates sugar farmers. It is not doing it because it likes getting mauled by the US Government (and its sponsors). It’s doing it because we will all suffer immensely if we don’t act on its advice.
I don’t know if the WHO can withstand the punishment they are about to receive. And I have no confidence that their recommended limit will make it through the firestorm of food industry sponsored ‘science’ which will suddenly surface. But I do know that when good people decide the evidence is so powerful that they should say it anyway, then the rest of us better be bloody listening.
data saving lives

Handler: Big data without the entry

  • the inconvenience of data entry stops tools being used by doctors
  • computer-assisted physician documentation (CAPD) can alleviate the problem
  • natural language understanding (NLU) converts sentences into codes
  • One of the most exciting promises of Big Data combined with advanced technologies like NLU is its ability to “bootstrap” — to identify important missing data and either grab it from another source, infer it from existing data, or prompt the clinician to add it during the normal course of documentation.

Source: http://www.wired.com/insights/2013/12/big-data-insights-without-big-data-entry/

Big Data Insights Without Big Data Entry

  • BY DR. JONATHAN HANDLER, M*MODAL
  • 12.23.13
  • 2:03 PM

Image: openexhibits/Flickr

Image: openexhibits/Flickr

My brand new Xbox One has a new feature — its Kinect camera recognizes users’ faces and automatically logs them in. The new feature saves me nine clicks and 45 seconds compared to my old Xbox 360. Microsoft correctly recognized that people are too busy for their videogames to turn them into data entry clerks.

It’s the same thing for doctors. Doctors can use Big Data algorithms to help provide better patient care, but those algorithms are very data hungry. Who will enter all that data? Patients already wait weeks to be seen and then sit in the waiting room despite an appointment. The last thing we want is doctors doing even more data entry that further delays care. At the same time, we want computers to provide great decision support to doctors.

Can we realize the benefits of Big Data without suffering the pain of Big Data entry? Using modern technologies, this may be possible.

In 1998, my colleagues and I had built some of the earliest online decision support tools, and within a few years more than 50 were freely available. Although very useful, I used those tools only occasionally in my clinical practice because most required me to enter lots of data before providing any help in return. For example, one score for predicting the likelihood a patient will die requires the user to enter 17 pieces of data, two of which are formulas that must be calculated. Big Data can speed up the development of decision support tools and create more accurate algorithms.

However, those algorithms require lots of data. For example, an algorithm for diagnosing heart attacks was developed using 156 data elements, and the final model used 40 data elements. Entering all that data is a lot to ask from physicians trying to manage an already overcrowded emergency department.

Over the last decade, it has been well documented that tools demanding significant data entry were felt to make doctors less efficient and were seen as less useful. Not surprisingly, tools requiring doctors to do lots of data entry were used less often. Although automatically populating these tools with existing data from the Electronic Health Record (EHR) seems the obvious answer, it has real challenges.

Sometimes it is not clear which data to enter. For example, there may be multiple blood pressures documented and it may not be obvious to the computer which one should be used. In other cases, the needed inputs might not be recorded exactly in the right format or with the right details, or the inputs may be completely missing.

New technologies might alleviate the problem. Computer-assisted physician documentation (CAPD) uses real-time natural language understanding (NLU) to convert the clinician’s sentences into computer-readable codes.

Those codes automatically populate decision support algorithms executed by rules engines, and seamlessly display the result. Caregivers are no longer forced to re-document the same information in checkboxes and manually run the tools. The rules engines automatically identify when a required input is missing, and can immediately prompt the clinician to add it if warranted. This enables real-time decision support, so that clinicians can provide better care.

CAPD becomes even more interesting when the rules engines start doing even more work on behalf of the clinician. For example, in addition to auto-populating decision support rules, the system might even save time by auto-generating some of the doctor’s notes, auto-generating billing and regulatory reporting codes, and automatically building a provisional set of orders based on the doctor’s notes.

One of the most exciting promises of Big Data combined with advanced technologies like NLU is its ability to “bootstrap” — to identify important missing data and either grab it from another source, infer it from existing data, or prompt the clinician to add it during the normal course of documentation. With these technologies in place, we can reap the value of Big Data without paying the heavy cost of Big Data entry. The result will be better and faster healthcare for all.

Dr. Jonathan Handler is the Chief Medical Information Officer at M*Modal.

facts & data points, healthy habits, policy

RAND: Impact of food environment

  • studies prove that people’s choices are heavily influenced by the setting, context, framing, and characteristics of the environment in which they make food purchasing decisions.
  • In the early 1980s, manufacturers discovered that how their products were marketed in stores was among the most important factors in influencing the buying habits of consumers. That fueled an acceleration in the practice of buying supermarket shelf space, a deal in which retailers give preferred placement to the products of wholesalers who pay for it. The ends of aisles, near the check out lines and stand-alone floor displays are choice product locations. This is how that Santa cutout ends up hawking candy canes in the middle of the produce section. People are very sensitive to such displays. As a consequence, purchases from these locations are between two and five times higher than when the same items are placed elsewhere. The products displayed in this way comprise an estimated 30 percent of all supermarket sales and provide the largest profits for manufacturers.
  • Lame remedies then follow…

‘Tis the Season to Be Wary

Deborah Cohen  December 23, 2013
 

During the holiday season it’s more important than ever that consumers consider the fundamental force driving the obesity epidemic in America: the tsunami of novel strategies used to market food. When shopping for holiday food, keep in mind that the treats being proffered by that smiling, life-sized Santa cutout in the aisle of your favorite supermarket may not be the healthiest gift for you and your waistline.

During the holiday season, a time when overindulgence is a tradition for many, food marketing creates especially serious challenges for people trying to limit their intake and make careful decisions about healthier eating. Walk through any supermarket or big box store this time of year and it’s impossible not to be confronted with promotions for fatty appetizers and snacks, processed cookies and cakes, holiday themed sugary drinks and cereals and super-sized chocolates and candy canes.

To be sure, it is ultimately up to individuals whether to reach for that highly processed treat that is all but devoid of nutritional value. Yet the common belief that everyone has the capacity to consciously and independently control what they buy or how much and what they eat is challenged by studies that have proven that people’s choices are heavily influenced by the setting, context, framing, and characteristics of the environment in which they make these decisions. This is a problem all year, of course, but it becomes even more difficult to resist in-store temptation when it is bathed in images of holiday good cheer.

Food purchasing environments are controlled by the food industry, whose goal, like all other businesses, is to increase profits. And the food industry is free to craft a seasonal marketing environment that portrays poor nutritional choices as cherished holiday traditions without regard for the consequences on consumers’ health.

In the early 1980s, manufacturers discovered that how their products were marketed in stores was among the most important factors in influencing the buying habits of consumers. That fueled an acceleration in the practice of buying supermarket shelf space, a deal in which retailers give preferred placement to the products of wholesalers who pay for it. The ends of aisles, near the check out lines and stand-alone floor displays are choice product locations. This is how that Santa cutout ends up hawking candy canes in the middle of the produce section.

People are very sensitive to such displays. As a consequence, purchases from these locations are between two and five times higher than when the same items are placed elsewhere. The products displayed in this way comprise an estimated 30 percent of all supermarket sales and provide the largest profits for manufacturers. They also disproportionately feature highly processed, low-nutrient, “value added” products — the worst for your health. People typically do not recognize that placement figures in their selection of such products, and instead, tend to blame themselves when their holiday shopping trip yields enough fat and sugar to swell even Santa’s ample waistline.

With increasing demand from manufacturers for this premium shelf space, supermarkets have grown larger and larger. The growing variety of products, especially when the holidays are here, can lead people to resort to a type of cognitive processing that relies on mental shortcuts instead of thoughtful decisions. This can lead to impulsive, poor choices based upon superficial characteristics like appearance, pricing, and salience. Thus, the modern supermarket is an environment that increases the risk of chronic diseases all year, but especially now.

Unless we grow our own food, we humans have a limited capacity to avoid exposure to these risk factors. The burden on individuals to keep up their guard, to be wary, and to actively resist an overwhelming food environment has become more than most of us can bear. If we really want to help consumers achieve their long-term goals of controlling their weight and eating a diet that won’t lead to heart disease or diabetes, we need solutions that won’t force people to work so hard.

So how do we make it easier? We need very specific consumer research on how to place products in stores so they don’t overwhelm consumers. Maybe we should segregate all the foods known to increase the risk of chronic diseases from the foods that don’t. Then people who want to limit their exposure can do so, and those who don’t will still be able to choose what they want. Maybe we should set limits on which products can be placed in salient promotional displays. Would consumers feel that their rights had been abridged if they had to travel to the back of the store to get candy and soda, but could find skim milk right up front?

Ordinarily our society does not tolerate flawed designs or business practices that increase the risk of illness or injury. We should no longer accept food marketing practices that undermine our health. As the most important consumer season gets underway, we need to start mitigating these factors if we want better health in 2014.

Deborah A. Cohen, M.D., is a senior natural scientist at the RAND Corporation and the author of the forthcoming book, A Big Fat Crisis: The Hidden Influences Behind the Obesity Epidemic — and How We Can End It.

This commentary appeared on The RAND Blog on December 23, 2013.

business, data saving lives, entrepreneurship, healthy habits, meaning, policy, rapid learning health systems

FDA rearguard frame…

It’s all happening anyway. Eventually, the tide will surge and the wall will burst.

Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.

http://www.wired.com/opinion/2014/01/the-fda-may-win-the-battle-this-holiday-season-but-23andme-will-win-the-war/

Regulating 23andMe to Death Won’t Stop the New Age of Genetic Testing

  • BY LARRY DOWNES AND PAUL NUNES
  • 01.01.14
  • 6:30 AM

 

Image: ynse/Flickr

 

Market disruptions often occur — or not — as the direct result of unintended collisions between breakthrough technologies and their more incremental regulators. In the latest dust-up, the U.S. Food and Drug Administration (FDA) last month ordered startup 23andMe to stop marketing its $99 genetic analysis kit, just before the Christmas shopping season kicked into high gear.

To date, over half a million customers have taken the swab in return for detailed ancestry data and personalized information on 248 genetic traits and health conditions. The company, which launched in 2007 with substantial backing from Google, has been working closely — albeit more slowly than the FDA would have liked — with the FDA to ensure it complies with federal health and safety regulations. But the agency concluded in its recent warning letter that 23andMe was marketing a “device” that was “intended for use in the diagnosis of diseases or other conditions,” and as such, its marketing materials required pre-approval from the FDA, which includes extensive research studies.

23andMe is an example of what we call a “Big Bang Disruption” — a product or service innovation that undermines existing markets and industries seemingly overnight by being simultaneously better andcheaper than the competition. What’s happening in genomic testing (and healthcare in general) is consistent with our research in over 30 different industry segments, from manufacturing to financial services to consumer products.

When technologies improve exponentially, many industry incumbents — and the regulators who oversee them — are kept constantly off-balance. That’s because incumbents have been indoctrinated by a generation of academic literature and MBA training to ignore disruptive products until they had a chance to mature in the market, assuming they would first appear as cheaper but inferior substitutes that would only appeal to niche market segments.

Doctors — who are also incumbents in this situation — are struggling to respond to disruptive medical technologies that change the power dynamic in the patient relationship. Several 23andMe users have reported taking the FDA’s advice of reviewing their genetic results with their physicians, only to find the doctors unprepared, unwilling, or downright hostile to helping interpret the data.

Often, incumbents’ only competitive response — or the only one they can think of — is to run to the regulators. That’s what’s has been happening to car-sharing services such as Uber, Lyft, and Sidecar; to private drone makers; and casual accommodation services such as Airbnb, to name just a few examples. And now it’s happening to 23andMe, one of hundreds of new startups aimed at giving healthcare consumers more and better information about their own bodies — information that has long been under the exclusive and increasingly expensive control of medical professionals.

Absent any real law on the subject, the agency has strained credulity to categorize 23andMe’s product as a diagnostic “device” — making it subject to its most stringent oversight. The FDA’s letter focuses intently on the potential that consumers will both under- and over-react to the genetic information revealed. The agency fears that users will pressure their doctors for potentially unnecessary surgery or medication to treat conditions for which they are genetically pre-disposed, for example. And it assumes that the costs of such information abuse outweigh any benefits — none of which are mentioned in the agency’s analysis.

The company, of course, has agreed to comply with the FDA’s stern warning, and has ceased providing its customers with anything other than hereditary data. For now. Perhaps it will reach some accommodation with the agency, or perhaps the FDA’s ire will prove untamable, an end to the innovative startup and whatever value its technology might have delivered.

But as with every Big Bang Disruptor in our study, winning the battle and winning the war are two very different things.

The FDA is applying a least common denominator standard to 23andMe, and applying it arbitrarily. Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.

The information flood is coming. If not this Christmas season, then one in the near future. Before long, $100 will get you sequencing of not just the million genes 23andMe currently examines, but all of them. Regulators and medical practitioners must focus their attention not on raising temporary obstacles, but on figuring out how they can make the best use of this inevitable tidal wave of information.

Whatever the outcome for 23andMe, this is a losing battle for industry incumbents who believe they can hold back the future forever.

 

Larry Downes & Paul Nunes

Larry Downes and Paul Nunes are co-authors of Big Bang Disruption: Strategy in the Age of Devastating Innovation (Penguin Portfolio 2014). Downes is Research Fellow with the Accenture Institute for High Performance, where Nunes serves as its Global Managing Director of Research. Their book has been selected as a 2014 book of the year by the Consumer Electronics Association.

business, cool, data saving lives, healthy habits, policy

A behavioural vaccine

  • the marshmallow experiment gone wild >> a behavioural vaccine
  • paying tobacconists for cigarettes they refuse to sell to kids
  • paying smoking mothers to quit

 

Listen to the story: 

Good Behavior’ More Than A Game To Health Care Plan

by KRISTIAN FODEN-VENCIL

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.” Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a studythat found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership with NPR, Oregon Public Broadcasting and Kaiser Health News.

healthy habits, policy, politics

Multinational businesses harming health

Strong article. Nothing new. Keeping the message out there.

Source: http://www.theage.com.au/comment/unhealthy-big-business-spreading-great-harm-20140105-30bnk.html

Unhealthy big business spreading great harm

January 6, 2014

Rob Moodie

If our negotiators buckle under the pressure applied by third parties, the price of a new trade agreement will be very high.

Illustration: Jim Pavlidis.Illustration: Jim Pavlidis.

Two-thirds of Indonesian men smoke and more than half of Chinese men smoke. Even more disturbing is that 40 per cent of 13-15-year-old Indonesian boys smoke. How have these levels been reached while the world has known for more than 50 years that tobacco is such a deadly habit?

In China, it is now estimated that 114 million people have diabetes. South Africa has one of the highest per capita alcohol consumption rates in the world, with more than 30 per cent of the population struggling with an alcohol problem or on the verge of having one.

Tobacco, alcohol, and diabetes related to overweight and obesity all have one feature in common. They are each largely driven, and in the case of tobacco completely caused, by powerful commercial interests in the form of transnational corporations. It has been said that China’s booming economy has brought with it a medical problem that could bankrupt the health system.

We now face a major dilemma: unrestrained commercial development is pitted against the health and wellbeing of populations. This dilemma is not new – opponents of the abolition of slavery complained it would ruin the economy – but it is manifesting in more obvious ways in the 21st century.

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The tobacco, alcohol and ultra-processed (”junk”) food and drink industries have been rapidly expanding in low and middle-income countries. In the past decade, tobacco retail sales growth in these countries was 20 times that of the developed world. For alcohol consumption it was three times; sugar-sweetened beverages it was twice. But it isn’t only Indonesia, China and South Africa where we find this dilemma; it is alive and well in Australia.

For years we have known that the tobacco industry promotes and funds biased research findings, co-opts policy makers and health professionals, lobbies politicians and officials to oppose public regulation, and influences voters to oppose public health measures through expensive public relations campaigns. This success has been noticed and over the past decade alcohol and ultra-processed food and drink companies have been emulating these very same tactics.

This is of little surprise given the flow of people, funds and activities across the industries. For example Philip Morris owned both Kraft and Miller Brewing; the board of SAB Miller (the second largest alcohol manufacturer) includes at least five past or present tobacco company executives and board members; and the Diageo executive director responsible for public affairs spent 17 years in a similar role at Philip Morris.

Economic development plays an important role in the health and wellbeing of populations. Income, employment and education levels are all major determinants of good health. Businesses create wealth, provide jobs and pay taxes (but as we have seen, not all of them). One of the best ways to protect and promote health is to ensure people have safe, meaningful jobs. The more evenly wealth and opportunity are distributed, the better the overall health and wellbeing of a population.

But clearly not all businesses are good or healthy – yet we see some of them expanding their markets and influence across the globe – seemingly with no capacity to diminish or mitigate the harm they do. It is astonishing that an industry such as tobacco, which is so harmful to human health, can wield so much power. In Indonesia, Philip Morris and its affiliate, Sampoerna, will invest $US174 million to improve production capacities so, as Sampoerna’s president has said, ”Indonesia would be the centre of the Marlboro brand production to cater [for] demands in the Asia-Pacific region”.

Why do they need to expand their activities? Aren’t the existing 700 million smokers in the region enough? Especially when we know that more than half of them will die prematurely, losing about 20 years of life to tobacco.

The major tobacco, food, and alcohol companies have assets that are greater than many countries and can wield this power in parliament, law courts and the media, against the interests of the public’s health.

A new battlefront in this power play is the Trans Pacific Partnership Agreement (TPP). This trade agreement among 12 countries (including Australia, Japan and the US) represents about 40 per cent of the global economy.

The Australian government aims to ”pursue a TPP outcome that eliminates, or at least substantially reduces, barriers to trade and investment” and that will ”also deal with behind-the-border impediments to trade and investment”.

It is highly complex, has 29 chapters, is being negotiated in secret and is provoking considerable criticism on the basis that it could greatly strengthen the hand of some industries to sue national governments for their domestic policies and also greatly weaken the capacity of governments to buy cheaper generic drugs. The Nobel prize-winning humanitarian group Medicins sans Frontieres says the TPP ”could restrict access to generic medicines, making life-saving treatments unaffordable to millions”.

If our trade negotiators buckle under the pressure from other governments, which are, in turn, highly influenced by transnational companies, then Australia will have to confront some major problems. These include delayed availability of cheaper generic drugs and increased cost of medicines; interference with our Pharmaceutical Benefits Scheme; enshrining of rights to foreign corporations, such as tobacco companies, to sue our government; interference with our capacity to introduce health warnings on alcohol packaging, and the limiting of future options for food labelling.

Surely we must find a balance between unrestrained commercialism and maximising health and wellbeing. We need business for our individual and collective wellbeing. However, the benefits unhealthy businesses bring are outweighed by the costs – in terms of premature death, chronic illness, limited healthcare finances, overcrowding of hospitals and loss of productivity from unhealthy employees.

This is why we have governments – to ensure a balance among the rights of individuals, consumers, businesses and society as a whole. If, as Prime Minister Abbott has said, Australia is open for business, then we need to make sure it’s open for good business. If we can’t control the vested interests of unhealthy industries in trade agreements or in our domestic regulations, unhealthy business will come back to bite us all.

Rob Moodie is professor of public health at the University of Melbourne

Read more: http://www.theage.com.au/comment/unhealthy-big-business-spreading-great-harm-20140105-30bnk.html#ixzz2pbgfIvAZ