Out of the Box

This month I define ‘fast food’; develop a big picture from snapshots of nutrition and food and drug policy taken in the USA; note the proliferation of ‘public–private–people partnerships’ also known as ‘the new philanthropy’; and identify the colour of money.

By the way, some readers have said that this column has a point of view. Yes indeed; I do not believe that science is an elaboration of the one times table. And I echo the request made last month by Agneta Yngve in her inaugural editorial. If you want to disagree with, clarify or amplify anything said here, or want your own point of view represented on any matter – not just those I touch on – write a letter for publication, or ask her to invite you to write a commentary.

Collective nouns make you think

The lexicographer Eric Partridge enjoyed collective nouns. Thus, he recorded ‘an exaltation of larks’ and invented ‘a schism of archbishops’¹. You get the general idea. Thus in Britain, topical collective nouns could include ‘a bung of football managers’ and ‘an F-word of celebrity chefs’; and in the USA ‘a trump of property speculators’ and ‘a dynasty of presidents’.

The trick is to think up collective nouns that are universal as well as toothsome. So what about scientists, or other health professionals? It depends, as all in life, on your point of view. Scientists may appreciate ‘an enlightenment of scientists’. Surgeons might accept ‘a precision of surgeons’ (the bombing of targets within cities in Iraq and Afghanistan – what's left of them – is said to be done with ‘surgical precision’, and ‘terrorist cells’ are said to be ‘taken out’ or even ‘lifted out’, as if tumours miraculously isolated from adjacent tissue, like ping-pong balls). Others might prefer ‘a mystification of scientists’ and ‘a sanctimony of surgeons’. (I always feel nervous teasing surgeons, in case I suffer a hernia, say, and the great man with the knife whom I consult is a reader.)

So what about researchers in the biological sciences? Researchers might like ‘an objectivity of research scientists’. Others might prefer ‘a confounding of research scientists’. But let's seek consensus, and so use an ambiguous term that we all can interpret as we wish and therefore live with. I offer ‘an intervention of research scientists’ or, in the case of a bunch of seniors convened to sit in judgement, ‘an eminence of research scientists’.

Fast food makes you eat

At a recent eminence held in Amsterdam, about which I must be discreet, John Milner of the US National Cancer Institute said that fast food is not in itself bad food, and as such does not contribute to obesity and diseases caused by obesity. A colleague made a broader point in response, saying that in many cities where churches are empty and youth clubs and sports facilities have been bulldozed, McDonald's™ ‘restaurants’ and Starbucks™ coffee bars may be the only safe spaces for young people to hang out.

John made me think, as he often does. Besides, any country boy from Arkansas who in his position as a senior US civil servant evangelises for garlic² is, if only for this reason, an unforgettable character. But in the matter of fast food, he is mistaken.

True, foods designed to be consumed quickly may be nourishing. The case I used to cite was the UK franchise Spud-U-Like™ and its Notting Hill Gate outlet (now long gone, although the chain is still in business) where a microwaved potato was served with your filling of choice. Baked beans: good. Cheese and butter: bad; or as health educators say, not quite so good. Also, in my column last month I celebrated the Street of Snacks off Hefang Street in Hangzhou, where a cornucopia of seafood and exquisite freshly cooked rice, noodles, meats and vegetables are served immediately.

Again when in London, I frequent the branch of the Giraffe™ group of twelve London ‘world food’ restaurants (motto ‘Love Eat Live’)³ in Blandford Street. On weekdays between 17.30 and 19.30 the el cheapo tasty soup of the day and vegetable stir-fry, and the quaffable house wine, is doubly cut-price, overall costing not much more than takeaways from the Indian food counter and wine section in Waitrose on Marylebone High Street. In Giraffe there is a secluded corner where I can spread out papers, think, plan and work, and I can ask for my favourite Latin and other music to be played from one of the Putamayo world music range on display for sale. Diners should not be deceived: all Giraffe dishes are standard, soups come from a central kitchen, and afters are outsourced. But the imaginative menu includes fresh fish specials, and perishables are prepared on the premises – perhaps why most of the managers, cooks and waiters are cheerful. My point here, though, is that I habitually eat at Giraffe because it is convenient: I get my grub quickly.

Further, Caroline Walker pointed out that the staple takeaway of the British working classes – fish and chips, preferably also with a whopping gherkin (known to the London working class as a wally, for why see Wikipedia) – is a nourishing meal, provided the fish are fried in fresh oil, the chips are thick and the holes in the salt dispenser are small⁴. As I write now I can sense me age 8–10, savouring the aroma of hot batter soaking through newsprint, as I hurry back from the ABC chippie in the Seven Sisters Road in London's Finsbury Park, taking away two cod and chips irrigated with Sarson's Malt, plus three wallys forked up from a vast jar on the counter above my head, one wrapped separately so I could wolf it before I turned the corner into Wilberforce Road and home. Ever since, I have enjoyed vinegar and also pickles – walnuts, onions, cabbage, cauliflower, cucumbers, you name it, yummy.

Fast food makes you fat

So, much depends on what is meant by ‘fast food’. John Milner also said that the term is vague and should not be used in scientific discourse. I disagree; when a term is commonly used, it is better to define it than ignore it. I also disagree for biological, social and environmental reasons.

So, what can ‘fast food’ be taken to mean? Studies producing evidence that fast food makes you fat, and therefore more likely to suffer from the various debilitating, disabling and deadly disorders and diseases of which overweight and obesity is a cause, are unlikely to be of fish and chips or of baked potatoes. I have not seen results from any cohort studies on the black rice and stir-fried shrimps and greens served by Hefang Street. And fruits are not seriously identified as ‘fast food’. Indeed, my good friend and colleague Barry Popkin points out that studies of ‘fast food’ in the current literature are of the food and drink that is served in transnationally owned fast-food ‘restaurants’ such as McDonald's, Pizza Hut™ and KFC™ (Popkin B, personal communication). Aha!

So I propose the following definition, as part of my campaign for consensual terminology, without which research studies are a waste of time and money. ‘The term “fast food” is used in common and also scientific discourse. It does not refer to fruits or to dishes or foods low in energy and high in nourishment that can be consumed immediately or quickly. It refers to ready to cook and eat or quickly available energy-dense fatty, sugary or salty meals, snacks, foods and drinks, often offered in large portion sizes, usually relatively low in nutrients, served in transnational franchised “restaurants” and their national and local equivalents, and also stocked in supermarkets, convenience stores, vending machines, sandwich shops, takeaways and bars. The term can also be taken to refer to alcoholic as well as soft drinks. It usually refers to heavily advertised and marketed branded products, but may also refer to traditional and street food, when this is both served fast and is also energy-dense, fatty, sugary or salty, and relatively low in nutrients’.

Phew! But you get the gist. Biologically the relevant factors are high energy density; high content of processed fats, added sugars or salt, and in the case of alcoholic drinks ethanol; and corresponding low nutrient density; low content of dietary fibre, water, essential fats, vitamins, minerals and other bioactive compounds.

Now also consider the social and environmental dimensions. I further disagree with John Milner when he avers that food that is served and eaten fast is not for this reason alone a cause of obesity. True, wolfing wallys did not make me a fat kid. But thinking back, I think that listening to the radio at home while doing my homework as I devoured a super-size carapace of batter and one and a half adult portions of chips (yes, right down to the crispy bits floating in vinegar at the bottom of the bag), plus a bottle of Tizer, having pestered my mother for an extra tanner, was why aged 12 I was more than a stone (6 kilos) heavier than normal in those days, and also why this childhood overweight tracked into my adult life.

That is to say, fast food makes you fat for social reasons. It is now marketed ferociously⁵ by transnational companies such as Coca-Cola™, McDonald's and Yum Brands™. In my last column I mentioned the conspicuous presence of McDonald's and KFC (one of the Yum Brands) in Hangzhou, and readers suggest that I was over-impressed. Well, currently 1.8 million Chinese people visit the 770 and rising McDonald's joints in mainland China every day, and the company is shooting for 1000 by the time of the 2008 Beijing Olympics. Also, McDonald's have signed a deal with Sinopec, the state-owned oil company, for first refusal on human fuelling stations within its 30 000 automobile fuelling stations across China; and the middle-term target, in common with Starbucks, is to make China its second biggest market after the USA⁶.

Expect to see stories featuring Chinese and US officials shaking hands under the Golden Arches. Honoraria for such occasions will not be disclosed.

Fast food also contributes to the destruction of the meal, and so the family, as well as of the planet⁷. In a family or other social setting, people usually are relatively constrained in what they eat and drink, and the mother or other member of the family who buys food to prepare and cook, is more likely to think about the health of her family than is a child or an adult attracted to what is most heavily advertised and marketed⁸.

For analogous reasons, dietary guidelines addressed to individuals are not part of the solution but part of the problem. Personal dietary guidelines should be addressed to people as members of families and communities, and as citizens as well as consumers, as they are in Brazil⁹.

Also, the concept of the supremacy of the individual, applied to nutrition and in particular to dietary guidelines, is itself obesogenic and generally pathogenic. But this is another riff.

Ephemera make you think

After a while ephemera can gain a special significance. I owe this next item to Robert F Byners of 5944 Woodland Drive, Waunakee, WI, who left his copy of Time magazine dated 2 October 2006¹⁰ in an eaterie in Schiphol airport with a reading counter; I picked it up a month later. The 10-page cover story featured Time correspondent Michael Weisskopf who, embedded in the US army in Baghdad, fielded a grenade thrown into the humvee in which he was riding, and so now has a hook in place of his right hand.

In the same issue, twin articles featured a Democrat–Republican alliance for global justice and equity. That signed by Bill Clinton said: ‘We have seen the terrifying power of individuals to do great harm’. That signed by Laura Bush said: ‘In partnership with the Pfizer drug company, the US is working to tackle tuberculosis, malaria, and HIV/AIDS. In partnership with Starbucks and the government of Rwanda, the US supports farmers developing speciality coffee’¹¹. In the humorous ‘punchline’ section, a bemused couch potato watches a television news flash, SPINACH WARNING! and hears a voice-over: ‘This just in! Broccoli and Brussels sprouts are bad for you too!’

Glancing at these snapshots of the US take on the world in general and public health in particular, an overall big picture developed: ‘private–public–people partnerships’ or, in another phrase designed to make rich people feel cosy, ‘the new philanthropy’. The issue contains four remarkable full-page advertisements. One from Chevron oil preaches the virtues of energy conservation. Another, with the headlines ‘helping all people lead healthy lives’ and ‘partnering to save lives’¹², boasts about BD's gift to UNICEF of 135 million auto-disposable gadgets supposed to protect against maternal and neonatal tetanus: the visual represents an African mother injecting her child. BD is Becton Dickinson, a medical supplies manufacturer.

GlaxoSmithKline features a photograph of a man with a serious demeanour identified as ‘Bill, Scientist’ holding up a prescription card with the legend: ‘Keep people from getting it’, the ‘it’ here being diabetes. The blurb says: ‘You might not think a drug company would want to prevent disease. But GSK support[s] programs that reward schools for replacing junk food with healthier food choices’¹³.

The photograph in the fourth advertisement poses male models as if high school jocks in the locker room, with a speech bubble out of the mouth of the young athlete holding the football saying: ‘Dude, it's all about the food pyramid’. The headline helps to explain: ‘Nutrition isn't what's on their minds, but we know it's on yours’¹⁴. The copy goes on: ‘Working together with the Alliance for a Healthier Generation – a joint initiative of the American Heart Association and the William J Clinton Foundation – we've developed new School Beverage Guidelines which you'll see in many schools starting this fall… It's all part of a broader effort to teach children the importance of a balanced diet and exercise’.

And who is behind the School Beverage Guidelines? Coca-Cola, Pepsi™ and Cadbury Schweppes. I am reminded that the US satirist Tom Lehrer announced his retirement on hearing that Henry Kissinger had been awarded the Nobel Peace Prize, explaining that from then on, nothing he could dream up could trump reality.

Expect to see stories featuring present or past US presidents and first ladies singing songs together with smiling healthy children in a school setting. The fees for such occasions will not be disclosed.

Greed makes you sick

You need only riffle through current newspapers to notice other examples of what might more accurately be termed publicity–profit–pillage partnerships.

A coda to Laura Bush's reference to ‘partnerships’ between the US government, Starbucks and the Rwandan government appeared in late November. The Times reports that Starbucks is opposing Ethiopia's attempts to trademark its varieties of coffee in the USA, as a way to increase the prices paid to growers. Explaining that such branding would not help farmers, a Starbucks statement says: ‘We support the recognition of the source of our coffees and have a deep appreciation for the farmers that grow them’ (italics mine) and, in a classic reach-me-down sprinkle of buzz-phrases, adds ‘we are committed to working collaboration and continuing dialogue with key stakeholders’.

The price paid by Starbucks for Ethiopian coffee beans is between $US 0.75 and 1.50 a pound. The sale price of Starbucks Ethiopian beans is up to $US 26 a pound. The gross national product of Ethiopia is $US 11.2 billion; the annual revenue of Starbucks is $US 7.8 billion. Douglas Holt, the L'Oréal professor of marketing at the Saïd business school at Oxford University, was reported as saying – rather bravely, given the evident sources of his endowment – that Starbuck's attempt to control Ethiopia, 90% of whose exports are of coffee, was short-sighted¹⁵.

Another late November story in The Observer comments on the UNICEF policy of partnering with firms such as McDonald's, and more recently with Gucci, who have pledged 20% of the net proceeds of the sales of their Christmas 2006 UNICEF collection of scarves and bags to support education of children in Mozambique. John Fernie, professor of business studies at Heriot-Watt University in Edinburgh, says that partnerships such as this are ‘the perfect way to build brand awareness and establish brand credibility and ultimately boost profits’. Referring not specifically to Gucci but to all big companies whose profits derive from goods made in Asian sweatshops in quasi-slave conditions, Sam Maher of the UK citizen's action group Labour Behind the Label¹⁶ says that such ‘partnerships’ are ‘like a soldier shooting someone, then giving them a bandage and taking credit for their survival’¹⁷.

Money makes a difference

This year Tim Lang and I have been comrades for a quarter of a century. Comrades are more than colleagues. They may engage in different campaigns, even on opposing sides; but maintain and develop sympathy. Our comrades inhabit our conscience.

In the early 1980s Tim directed the London Food Commission, founded with £1 million of rate-payers' money from the Greater London Council as then run by ‘Red’ Ken Livingstone, salvaged from its demolition by then Prime Minister Margaret Thatcher. Tim foresaw the rapacity of transnational food corporations 20 years ago, in the era when globalisation was known as the Uruguay Round. In the early 1990s he was co-creator of SAFE (Sustainable Agriculture, Food and Environment, now merged into the UK umbrella group Sustain) partly with money donated by the far-right plutocrat Sir James Goldsmith, who had been encouraged by his elder brother Teddy Goldsmith, founder of The Ecologist, to transmogrify into Jimmy Greensmith.

Now professor of food policy at London's City University, Tim made sure that such benefactions had no formal strings attached. At the same time, he knew his work magnetised money from sources whose interests were convergent with his. You can know a man – and a woman – from the funds they attract.

Tim put me right about funding. There is, he says, no such thing as white money. Some is black. Almost all is shades of grey. Money, whether for salaries, core funding, projects, honoraria, expenses, or travel and accommodation, always comes with explicit or tacit expectations.

Also, the most serious forms of corruption are not so much about money, but what is even more alluring: status and power. Mephistophelean tempters offer seats on boards. But this too is another riff.

I suggest some tests of conscience. Who is paying you? Who controls them? What do they want with you? Would you mind if the source of your payments were publicly disclosed? Such easy questions are not always easy to answer. Nutrition scientists and such-like health professionals, when approached in some way by junk food manufacturers or their fronts or flacks, are not told: ‘Our products wreck the health of children, and in return for this suitcase full of banknotes we want you to tell lies so that we can increase our profits’. The line is more suave. Indeed, both the manufacturer and the scientist may believe that the products are harmless.

After all, as some shill once said, there is no such thing as a good or bad food, only good or bad diets. In London this morning as I write, I was on the exercycle in the gym, watching the banks of television screens without earphones. Ah! An item appeared on the salt content of cheap supermarket ready-to-heat foods . The admirable Amanda Ursell seemed to be pasting Lord Larry Whitty, now chair of the UK National Consumer Council; his eyes swivelled, his moustache drooped, even his gut looked glum. My lip-reading skills are poor, but could he possibly have been saying that sausages can form part of a healthy balanced diet.

So why do I cite Tim Lang on the colour of money, and why the references to soft corruption? This month my time is up and my space is filled. Watch this space, for next month I witness the breech presentation of the World Public Health Nutrition Association.