The Controversy Over ILSI's Role in China Heats Up
On February 11, the industry-funded nonprofit, the International Life Sciences Institute (ILSI), posted on its website a lengthy rebuttal1 of my January 9 feature article, Making China Safe for Coke: How Coca-Cola Shapes Obesity Science and Policy in China,2 and companion piece in the Journal of Public Health Policy.3
ILSI’s rebuttal contained two serious distortions of my arguments, one misleading statement, and two dubious claims. There was also one critically important point of agreement.
On February 15, I asked ILSI to correct the two distortions, and it did so the same day. The other issues remain unaddressed, however. ILSI has declined invitations to submit a rapid response to The BMJ. In the absence of such a statement, I address those problems here, relying primarily on direct quotations to reveal the misrepresentations.
Distortion (Now Corrected): Author Claims That China Focuses Almost Exclusively on Physical Activity
ILSI: “The articles published by the BMJ and the Journal of Public Health Policy state that ‘public health advocates in China have always almost entirely focused on physical activity’ is unequivocally not true.”
SG: That is a blatant misrepresentation of my work. I say repeatedly that in its response to obesity, China has advocated both diet and exercise improvements. Yet between 1999 and 2015 – and this is my main point -- the emphasis on physical activity increased. Here is what I write:
“Before 2004... some prevention activities focused on nutrition, but none centered on physical activity.... In the coming years... ILSI-China’s focus on physical activity began to overshadow nutrition. Between 2004 and 2009, a third of ILSI-China sponsored or co-sponsored obesity activities focused on physical activity. Between 2010 and 2015, the proportion rose to almost two thirds while obesity activities focused on nutrition sank to around one in five.” (BMJ)
China’s chronic disease policies have the same focus. I write: “[China has] a host of national plans and programs stipulating improved diets and exercise, yet these emphasize physical fitness. In health targets and indicators, for example, nutritional targets are generally limited to restricting salt intake. Concrete policies are few and weakly enforced, with emphasis on healthy-lifestyle education rather than industry regulation.” (JPHP)
Distortion (Now Corrected): Author Suggests that ILSI Promotes Soda Consumption
ILSI: “No program has ever been a platform to promote the consumption of soft drinks.”
SG: This implies I say that, but of course I do not. To the contrary, I write that: “Support for limiting sugary-beverage consumption in China’s 2016 dietary guidelines is encouraging.” (JPHP)
My point is that China’s policies fail to tax soda consumption: “Hard hitting dietary policies recommended by the World Health Organisation – taxing sugary drinks and restricting food advertising to children – were missing.” (BMJ)
Misleading Statement: Coke “Dictates” Policy to China
ILSI: “Coke has not dictated ILSI Focal Point in China’s agenda nor the Chinese Health Ministry policies.”
SG: This implies I say that, but I do not. Coke is far more cunning than that. In China, I found: “Through a complex web of institutional, financial, and personal links, Coke has been able to influence China’s health policies. The company has cleverly manoeuvered itself into a position of behind-the-scenes power that ensures that government policy to fight the growing obesity epidemic does not undermine its interests. It has done this by leveraging the Chinese branch of ... ILSI.” (BMJ)
Dubious Claim: All Projects are Funded by at Least Three Companies
ILSI: “ILSI Focal Point in China complies with ILSI’s Mandatory Policies, which require a minimum of three companies to fund all projects, to ensure that no one company dominates the research agenda.”
SG: This may be the policy, but it was not always the practice during 1999-2015. Coke was the sole corporate funder of the ILSI China-Coca-Cola fellowship program in exercise science.4 Coke is the only (known) corporate supporter of the school exercise program Happy 10 Minutes, which was funded through the ILSI Center for Health Promotion led by Alex Malaspina, senior vice president at Coke. Happy 10 received financial support from Coke-China and was proudly featured in Coca-Cola’s corporate responsibility reports.5 Finally, Coke was the founding corporate partner of Exercise in Medicine (EIM), which has become a major enterprise in China.6
Dubious Claim: ILSI Merely Advises the Government on Health Policy
ILSI: “ILSI Focal Point in China and the relevant expert institutions... have worked together, under the leadership and coordination of government related departments, to provide technical support and recommendations for the formulation of ‘Guidelines on the Prevention and Control on Overweight and Obesity for Chinese Adults.’”
SG: In fact, according to Chen Chunming, ILSI-China’s long-time director and senior advisor, ILSI took the initiative in drafting those guidelines and proposing them to the Ministry of Health. Chen was proud of ILSI’s tight connections to the ministry, and used the promise that ILSI translates science into policy to encourage corporations to become supporting companies. In a 2013 interview, she told me: “The Chinese branch emphasizes that we do not just hold scientific meetings. Instead, we focus on major public health issues in China, and we put the scientific evidence into policy.” (JPHP, online appendix 2, Excerpts from Interviews)
In the same interview, Chen described how ILSI-China crafted the guidelines, asked the ministry to request that ILSI draft them, then worked with ministry officials to revise them. “Between 1999 and 2003, ILSI-China... created guidelines for the prevention and management of obesity and overweight in adults. Those guidelines were issued in the name of the Ministry of Health. ILSI-China’s involvement was not mentioned, even though it had prepared the guidelines.” (BMJ)
Point of Agreement: ILSI Plays a Critical Role in Obesity Work in China
ILSI: “ILSI Focal Point in China was the first to organize and lead a series of scientific discussions on the prevention and control of obesity in China... ILSI Focal Point has proactively led the dialogue for obesity prevention in China.”
SG: On this we are in full accord: ILSI-China’s “substantive role in tackling obesity was arguably greater than that of the government.” (BMJ)
And that is why scrutiny of ILSI’s work is so vitally important to the global health community – and to China itself.
My hope is that this conversation about ILSI’s work might prompt China to take a fresh look at its policies on chronic disease prevention and control, and to consider the possibility that a friendly American company that has generously funded health work might be supporting policies that are not in the best interest of the health of China’s people.
Rapid Response:
The Controversy Over ILSI's Role in China Heats Up
On February 11, the industry-funded nonprofit, the International Life Sciences Institute (ILSI), posted on its website a lengthy rebuttal1 of my January 9 feature article, Making China Safe for Coke: How Coca-Cola Shapes Obesity Science and Policy in China,2 and companion piece in the Journal of Public Health Policy.3
ILSI’s rebuttal contained two serious distortions of my arguments, one misleading statement, and two dubious claims. There was also one critically important point of agreement.
On February 15, I asked ILSI to correct the two distortions, and it did so the same day. The other issues remain unaddressed, however. ILSI has declined invitations to submit a rapid response to The BMJ. In the absence of such a statement, I address those problems here, relying primarily on direct quotations to reveal the misrepresentations.
Distortion (Now Corrected): Author Claims That China Focuses Almost Exclusively on Physical Activity
ILSI: “The articles published by the BMJ and the Journal of Public Health Policy state that ‘public health advocates in China have always almost entirely focused on physical activity’ is unequivocally not true.”
SG: That is a blatant misrepresentation of my work. I say repeatedly that in its response to obesity, China has advocated both diet and exercise improvements. Yet between 1999 and 2015 – and this is my main point -- the emphasis on physical activity increased. Here is what I write:
“Before 2004... some prevention activities focused on nutrition, but none centered on physical activity.... In the coming years... ILSI-China’s focus on physical activity began to overshadow nutrition. Between 2004 and 2009, a third of ILSI-China sponsored or co-sponsored obesity activities focused on physical activity. Between 2010 and 2015, the proportion rose to almost two thirds while obesity activities focused on nutrition sank to around one in five.” (BMJ)
China’s chronic disease policies have the same focus. I write: “[China has] a host of national plans and programs stipulating improved diets and exercise, yet these emphasize physical fitness. In health targets and indicators, for example, nutritional targets are generally limited to restricting salt intake. Concrete policies are few and weakly enforced, with emphasis on healthy-lifestyle education rather than industry regulation.” (JPHP)
Distortion (Now Corrected): Author Suggests that ILSI Promotes Soda Consumption
ILSI: “No program has ever been a platform to promote the consumption of soft drinks.”
SG: This implies I say that, but of course I do not. To the contrary, I write that: “Support for limiting sugary-beverage consumption in China’s 2016 dietary guidelines is encouraging.” (JPHP)
My point is that China’s policies fail to tax soda consumption: “Hard hitting dietary policies recommended by the World Health Organisation – taxing sugary drinks and restricting food advertising to children – were missing.” (BMJ)
Misleading Statement: Coke “Dictates” Policy to China
ILSI: “Coke has not dictated ILSI Focal Point in China’s agenda nor the Chinese Health Ministry policies.”
SG: This implies I say that, but I do not. Coke is far more cunning than that. In China, I found: “Through a complex web of institutional, financial, and personal links, Coke has been able to influence China’s health policies. The company has cleverly manoeuvered itself into a position of behind-the-scenes power that ensures that government policy to fight the growing obesity epidemic does not undermine its interests. It has done this by leveraging the Chinese branch of ... ILSI.” (BMJ)
Dubious Claim: All Projects are Funded by at Least Three Companies
ILSI: “ILSI Focal Point in China complies with ILSI’s Mandatory Policies, which require a minimum of three companies to fund all projects, to ensure that no one company dominates the research agenda.”
SG: This may be the policy, but it was not always the practice during 1999-2015. Coke was the sole corporate funder of the ILSI China-Coca-Cola fellowship program in exercise science.4 Coke is the only (known) corporate supporter of the school exercise program Happy 10 Minutes, which was funded through the ILSI Center for Health Promotion led by Alex Malaspina, senior vice president at Coke. Happy 10 received financial support from Coke-China and was proudly featured in Coca-Cola’s corporate responsibility reports.5 Finally, Coke was the founding corporate partner of Exercise in Medicine (EIM), which has become a major enterprise in China.6
Dubious Claim: ILSI Merely Advises the Government on Health Policy
ILSI: “ILSI Focal Point in China and the relevant expert institutions... have worked together, under the leadership and coordination of government related departments, to provide technical support and recommendations for the formulation of ‘Guidelines on the Prevention and Control on Overweight and Obesity for Chinese Adults.’”
SG: In fact, according to Chen Chunming, ILSI-China’s long-time director and senior advisor, ILSI took the initiative in drafting those guidelines and proposing them to the Ministry of Health. Chen was proud of ILSI’s tight connections to the ministry, and used the promise that ILSI translates science into policy to encourage corporations to become supporting companies. In a 2013 interview, she told me: “The Chinese branch emphasizes that we do not just hold scientific meetings. Instead, we focus on major public health issues in China, and we put the scientific evidence into policy.” (JPHP, online appendix 2, Excerpts from Interviews)
In the same interview, Chen described how ILSI-China crafted the guidelines, asked the ministry to request that ILSI draft them, then worked with ministry officials to revise them. “Between 1999 and 2003, ILSI-China... created guidelines for the prevention and management of obesity and overweight in adults. Those guidelines were issued in the name of the Ministry of Health. ILSI-China’s involvement was not mentioned, even though it had prepared the guidelines.” (BMJ)
Point of Agreement: ILSI Plays a Critical Role in Obesity Work in China
ILSI: “ILSI Focal Point in China was the first to organize and lead a series of scientific discussions on the prevention and control of obesity in China... ILSI Focal Point has proactively led the dialogue for obesity prevention in China.”
SG: On this we are in full accord: ILSI-China’s “substantive role in tackling obesity was arguably greater than that of the government.” (BMJ)
And that is why scrutiny of ILSI’s work is so vitally important to the global health community – and to China itself.
My hope is that this conversation about ILSI’s work might prompt China to take a fresh look at its policies on chronic disease prevention and control, and to consider the possibility that a friendly American company that has generously funded health work might be supporting policies that are not in the best interest of the health of China’s people.
1. http://web.archive.org/web/20190214205955/http://ilsi.org/setting-the-re...
2. https://www.bmj.com/content/364/bmj.k5050
3. https://link.springer.com/article/10.1057/s41271-018-00158-x
4. ILSI FP-China-Coca-Cola Food Safety and Physical Activity Scholarship Winner Meeting. ILSI Focal Point in China Newsletter 2013;38(1): 14-15.
5. “Happy 10" Project Are (sic) Expanding in China. ILSI Focal Point in China Newsletter 2006;24(1): 9-10.
6. https://en.coca-colaarabia.com/stories/the-coca-cola-company-sponsors-ex...
Competing interests: No competing interests