Editor’s Note: Derek Fields and Russ Greene collaborated on this piece.
Soda Advocacy Groups Exploit the Nonprofit Loophole
Wenhua Zhao and Junshi Chen both serve as preeminent public health officials in China. At the same time, Zhao and Chen have led Coca-Cola’s propaganda and lobbying efforts in China. They have fooled not only the Chinese government but also the Western academic journals they’ve published in. They have declared no conflicts of interest while publishing in outlets such as the Journal of the American Medical Association and the American CDC’s publications.
China is just the latest example in a global trend: the soda industry’s exploitation of the nonprofit conflict of interest loophole. That is, the industry has exploited this loophole in the conflict of interest policies of worldwide public health agencies and academic institutions. It has founded and funded public health-oriented nonprofit organizations such as “Exercise is Medicine” (EIM) and the “International Life Sciences Institute” (ILSI). Leaders of these industry proxy organizations have maintained government public health positions in countries such as the United States, South Africa, Malaysia, and China. No one would accept a government health official simultaneously working for Coca-Cola. Yet these officials have simultaneously served on nonprofits founded and funded by Coca-Cola. And only a single case, that of former U.S. CDC official Barbara Bowman, had any apparent repercussions.
Junshi Chen Does Double Duty At China’s CDC and ILSI
On first glance, Junshi Chen’s academic and government credentials appear unassailable. He is Senior Research Professor of the Institute of Nutrition and Food Safety at the Chinese Center for Disease Control and Prevention. Chen is also a Visiting Scholar and Adjunct Professor at Cornell University and has served as an Associate Professor, Professor, and Deputy Director of the Institute of Nutrition and Food Hygiene at the Chinese Academy of Preventive Medicine in addition to a host of other official public health positions.
Yet at the same time, Chen serves as the “National Center Director” of Exercise is Medicine in China and the Director of the International Life Sciences Institute’s Chinese arm, ILSI Focal Point China. Note that Coca-Cola was the “first founding partner” of EIM, a program that promotes exercise as the answer to chronic disease while silencing fitness professionals on the subject of nutrition. And Coca-Cola has used EIM to fight soda taxes in Mexico.
As for ILSI, it has led the industry’s assault on the World Health Organization’s tobacco policies, the CDC’s chronic disease efforts, and most recently, the dietary guidelines that limit sugar intake.
In 2016, an ILSI review on the health impacts of sugar alleged that its authors “wrote the protocol and conducted the study independently from ILSI.” Yet Candice Choi published emails in the Associated Press proving that ILSI did ask the authors to edit their paper.
“ILSI’s funding comes primarily from its corporate membership and supporting companies,” according to its own website. Its 2015 members included Coca-Cola, Dr. Pepper/Snapple, Hershey, Kellogg’s, Kraft, Mars, McDonald’s, Pepsi, and other food industry giants that have an interest in shifting the burden of chronic disease from nutrition to physical activity. Note that the 2015 members link lists the members of the ILSI China branch, as well as ILSI’s other branches.
Chen also worked on an extremely influential nutrition study with T. Colin Campbell titled “Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study.” Campbell later expanded on this in the bestselling book “The China Study.”
Chen’s name appears in the internal U.S. CDC emails with Coca-Cola obtained by U.S. Right to Know. In the emails, former Coke VP and ILSI Founder Alex Malaspina says that he is going to discuss lobbying the World Health Organization with Junshi Chen.
Despite all this advocacy for industry, Chen’s published papers in the Lancet declare “no competing interests.”
Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies
Adherence to a healthy lifestyle and the risk of type 2 diabetes in Chinese adults: a prospective, longitudinal cohort study
Chen is a local ILSI director. And ILSI has advocated against tobacco control policies on behalf of the tobacco industry, and against sugar control policies on behalf of the soda industry. Clearly, then, his ILSI position represents a conflict of interest for both papers. Chen had an ethical duty to declare it.
Zhao is a member of the Chinese CDC’s Division of Academic Publication, the Deputy Director of ILSI China, and a member of the Chinese Exercise is Medicine organization’s National Advisory Board.
Hong Kong lists Zhao as the Deputy Director of the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention. Zhao is also the chair of the Chinese Chronic Disease Control and Prevention Society of Chinese Preventive Medicine Association (CPAM), and the vice president of the Beijing Municipality Nutrition Society. Zhao’s material on “Healthcare Policy and Burden of Diet and Nutrition-Related Chronic Diseases in China” mentions fat and/or oil consumption five times, but does not mention sugar a single time.
Zhao is the Deputy Director of ILSI Focal Point China, one step below her China CDC colleague Junshi Chen. Zhao is also a member of the EIM National Center Advisory board. Note that EIM declares that one of its 2017 goals is to “form an official partnership with government officials in the General Administration of Sport of China and in the Family Planning Commission.” It may help that EIM has already penetrated the highest levels of China’s government health efforts.
Zhao was also on the executive board of the now-defunct Global Energy Balance Network (GEBN) that Anahad O’Connor exposed in the New York Times as a Coca-Cola front group. Zhao served as GEBN’s Asian Vice President.
The connections between the Chinese CDC, Coca-Cola-founded Exercise is Medicine, food industry-funded International Life Sciences Institute, and the Coca-Cola-funded Global Energy Balance Network are extensive. The ILSI presentation highlighted below talks about promoting EIM and shows that one of the speakers at the conference was Steven Blair of the GEBN. Blair made himself famous by claiming that there was “virtually no compelling evidence” linking food and beverage intake to obesity.
As we see with Chen, Zhao’s published work declares “no conflicts of interest relevant to this article,” despite her conflicted positions with EIM and ILSI.
Hypertension Prevalence, Awareness, Treatment, and Control and Sodium Intake in Shandong Province, China: Baseline Results From Shandong–Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011
Breast Cancer Screening Among Adult Women in China, 2010
In fact, in several instances Zhao listed her ILSI email as her official email address and still declared no conflicts of interest:
Healthcare Policy and Burden of Diet- and Nutrition-Related Chronic Diseases in China
Prevalence and Control of Diabetes in Chinese Adults
Zhao has been instrumental in bringing Coca-Cola-founded Exercise is Medicine onto Chinese University campuses. EIM couldn’t hope for a better situation. It has a representative from its own organization who also holds an official position in the Chinese CDC advocating for EIM’s program and helping spread it.
Chen and Zhao co-authored an article titled “Diet, Nutrition and Chronic Disease in Mainland China.” It somehow avoids mentioning sugar at all, but warns of edible oil and fat consumption dozens of times.
We’ve seen this same pattern, not just in China, but in Malaysia, South Africa, and the United States. It is tempting to place all the blame on soda companies. And they do deserve it, but Big Soda’s penetration would not be possible if these public health agencies and academic institutions implemented clear conflict of interest policies and closed their nonprofit loopholes. As Derek Yach remarked of ILSI’s role in the World Health Organization:
“You can blame the corporations … but you also need to place blame on not having very clear, very transparent review of conflict-of-interest procedures internally.”
Most of these problems would be avoided if agencies such as the American and Chinese CDCs, journals such as JAMA and the Lancet, and standard-setting organizations like the International Committee on Medical Journal Editors, began to recognize a simple fact:
If a corporation presents a conflict of interest, then a nonprofit it founded and/or funds presents a conflict as well.