The Fizzy Healthcare Industry

It's probably important to make a disclosure at the outset that I hate fizzy drinks. I fail to understand why would anyone consume these slow poisons. I also happen to be an ultra runner who advocates physically active lifestyle for all.

But very similar to Veeru in Sholay, the Bollywood blockbuster movie of the 1970s starring Amitabh Bachchan and Dharmendra, I must confess, I only have fizzy drinks when I have my cheese burst Gourmet Domino's Pizza, along with some Pringles Sweet & Sour Potato Chips. Just to end it off, I have Choco Lava cake. I really crave for this stuff even during my long runs, when I have done 4-5 hours and still have a few more left.

I bring up the issue of fizzy drinks as currently there is a big move on in the UK where the Academy of Medical Royal Colleges, comprising of 220,000 doctors, is demanding the government to levy extra taxes on fizzy drinks.

The thought process behind this is that obesity is responsible for 10-20% of National Health Service (NHS) bill. It's been proven beyond doubt that fizzy drinks, fast food and sugar have an important role to play in obesity and other chronic diseases. The idea behind extra taxes for fizzy drinks, leading to increased prices, is to discourage people from consuming them. Also, it is suggested that extra tax be used for treating obesity.

I don't disagree with any of their arguments that fizzy drinks are bad for you. Just that I fail to understand how will taxing fizzy drinks alone will solve the whole problem. The colas will be a lot more expensive. Would that stop people from buying them? Or maybe reduce them at least?

Going by the above logic, there should have been a lot lesser cars in Delhi today. As compared to a decade ago, price of petrol has more than doubled, from less than Rs 30, to now touching Rs 70. Guess what's happened to number of cars in Delhi? Registered vehicles have doubled during the same period. In 2012, over 75 lakh vehicles were registered in Delhi.

The problem with this approach is that like the tunnel visioned religious leaders, the advocates of 'extra taxes alone on fizzy drinks will solve all medical woes' think there is only one approach that'll work, that too in isolation, and everything else is blasphemy and will only lead us to hell.

So, what is the solution then? Let's first critically look at folks who are the custodians of your health, my colleagues, the doctors themselves. How often does the doctor community world over, take the pains of educating the patient each time they have an opportunity to interact with them? How often have they made an effort to help the communities to make better choices? How about themselves, are they leading by example? If not, they first need to get their-/our-own-house in order before complaining about everything else.

In a recent interview on Channel 4, Dr Aseem Malhotra, a cardiologist at Royal Free Hospital, London, who is at the forefront of this 'tax on fizzy drinks movement', rightly takes Gavin Partington, Director General of British Soft Drinks Association, to task when Partington says, "Over the last twenty years, the proportion of low and no calorie drinks has doubled from 30% of market to 61%". Partington very conveniently ignores to point out that bottled water is also included in that 61% statistic.

Dr Malhotra has got so engrossed in his crusade against sugar and fizzy drinks, that he is also guilty of abusing statistics no different from Partington. In his recent BBC article, Dr Malhotra quotes from the journal Nature that over last five decades, sugar consumption has tripled. But he forgets to look up what has happened to the population during the same time period. The world population has also increased by 233% (from 2,982 million in 1960 to 6,972 million in 2010).

In a separate video interview, Dr Malhotra says, "The food industry has a tremendous lobbying power. Even someone such as Michelle Obama, who has been an inspiration in trying to improve eating and food habits for children in the US, has now diverted her attention to physical activity because of powerful lobbying from food industry." There just might be a possibility of him being right in his conspiracy theory. But his taunt and criticism of physical activities' role in obesity or health or fitness just went to show him being fixated with the idea of levying extra taxes on fizzy drinks.

I disagreed with Dr Malhotra's stand and wanted to have an intelligent discussion about the same. I had been following him on Twitter at the time because I respected his passion. I got in touch with him on it. Instead of responding to me, he blocked me on Twitter. That made me curious about him and I dug into his interviews and articles in newspapers. What disturbed me the most about his attitude was that even though he had good intentions, he too suffered from 'the God complex'. For a holistic solution of anything, we need to engage all parties involved, especially the one directly affected, that is, you.

In New York City, a ban on large sugary drinks, which would have limited their sale including non-diet sodas, fruit drinks, sweetend teas and other high calorie drinks to only 16 ounce, was to get into effect from 12th March 2013. The policy was halted by a New York state judge less than 12 hours before the city was to begin enforcing the regulation.

This ban, championed by Mayor Michael Bloomberg, was supposed to be implemented, with all good intentions, without even a vote of the New York City Council, leave alone taking the common man into confidence. 51 percent of New York City residents were opposed to the new regulation, as shown by a recent Quinnipiac University poll.

Over last 50 years, if there was a way to assess the amount of time spent being sedentary, it would be phenomenal. In a recent tweet, Dr Malhotra suggested that over last three decades, the time spent being physically active hasn't changed. Really! I am not sure where does my friend come from. He was naive enough to think that the public would fall for this without thinking even once.

In another tweet, he says, 'scientific evidence shows that physical activity is not useful to reduce obesity' and then goes on to give a link of a study that shows that even though increased physical activity is being promoted, it's not something that's being followed enough. Very misleading indeed.

In the introduction of the best selling book 'Outliers', Malcolm Gladwell talks about Roseto, a small town in Philadelphia, US, which is inhabited by immigrant from a village called Roseto Valfortore, 100 miles southeast of Rome, Italy. The setting is 1950s. Many of the residents of this town were either over-weight or obese. They would get up late, not exercise enough, smoked heavily and used lard for cooking, instead of healthy olive oil. They loved their American Pizzas with pepperoni. Perfect recipe for disaster, right? Wrong.

But to the dismay of the extra-tax evangelists, the Family Physician practicing for over 17 years in that region wasn't getting Roseto residents under 65 years of age as patients. This was the era of heart attacks being the leading cause of death in US, as neither were there any cholesterol lowering drugs, nor aggressive prevention of heart diseases. Surprisingly, in Roseto, no one under 55 years of age was dying of heart attack. Even over 65, death rate because of heart attack was half of the national average in the US. Death rate from all other causes was 30-35% lower than the rest of the US. There were no suicides, no alcoholism, no drug addiction, and very little crime. None of the residents were on welfare and no one was suffering from peptic ulcer.

There was something definitely amiss, or at least as far as our evangelists would be concerned. The Roseto residents were only dying of old age. What was it that they were doing right, or wrong, depending on which side you look at it from?

They were late risers, so would happily give any form of exercise a miss. They would stroll down the streets. At the very opportunity, they would sit down to exchange greetings and play some board game. And then move to the next pit stop. They would almost always get late to work. Under one roof, three generations were happily living together where elders would be respected a lot. They were a happy community with a very thick social fibre, which wasn't even seen in the next town which was English dominant.

I am by no means recommending the lifestyle followed by Roseto residents in the 1950s, but there are some amazing learnings to be made from them. Lets look at the bigger picture which we doctors and scientists ignore because we have no way to measure it, and also, it's not our expertise.

Same would apply to the any Indian diet. Go back only a decade to village in Punjab or Haryana. Folks loved their parathas with desi makhan along with a large glass of butter-milk for breakfast. But then there was lot more holistic community living along with being very active lifestyle. Now to remove community living and active lifestyle from the equation would obviously change things drastically.

Physically active lifestyle and good diet is very important, but not enough in isolation. It's very important to have a multi-modality approach to fix these problems that we have invited upon ourselves by making the wrong decisions. Multiple studies that have looked at the common denominator in people who have lived for over a hundred years, happiness and social environment has a bigger impact. Throughout life, they eat right and have been active throughout their days, not usually allocating separate time for exercising. It's not fair on our part to then blame everyone around for the choices we make. It's a team work, all of us need to contribute. This Rambo approach is best left to Hollywood and Bollywood.

I appreciate Dr Malhotra's passion to get NHS healthy by getting UK rid of obesity, but he has knowingly or unknowingly misled others, either not being excusable. Does it make him right if he misquotes figures for a good cause? This is very relevant in Indian context as in all fields, we are simply tend to mimic the west. In healthcare industry, there is a desperate need for original local research and since I am at it, let me actually throw in a conspiracy theory as well.

It's being calculated that 20% taxes on fizzy drinks would add up to over a billion pounds a year. It's being recommended to use that money for treating obesity. Dr Malhotra makes a strong allegation that "Sugar industry and soft drink association are only interested in protecting their profits". But it makes you wonder if Dr Malhotra is simply looking at making as well as diverting the money to the healthcare industry, that I and he belong to. Are there bigger powers at play here, than meets the eye. Just a food for thought, literally.