THE PROGNOSIS

Six miles lie between the Centers for Disease Control and Prevention and Coca-Cola’s headquarters in downtown Atlanta. But more than just geographical proximity is fueling concerns that the soda giant is exerting undue influence over the federal agency that’s supposed to protect the health of Americans.

Emails sent between Coca-Cola employees and top CDC officials from 2011 to 2015 show the corporation tried to use its influence with the agency to push the World Health Organization to emphasize exercise over diet as the solution to the obesity epidemic, per a report published today in the health policy journal Milbank Quarterly.

It’s not the first time public health advocates have drawn attention to ties between Coca-Cola and public health agencies (check out this and this). But the exchanges provide fresh evidence of the ways the food industry  — in this case, the world’s leading producer of sugar-sweetened beverages — seeks to direct public policy in its favor, often in ways that run contrary to science.

Consumer groups have alleged that Coca-Cola tried to sway the CDC toward policies that would benefit its products by corresponding with top agency officials and donating to the CDC Foundation. The newly released emails are just the latest correspondence obtained by requests under the Freedom of Information Act.

In one email, former Coca-Cola senior vice president Alex Malaspina wrote that WHO “should not only consider sugary foods as the only cause of obesity but to consider also the lifestyle changes that have been occurring throughout the universe.”

"The emails we obtained using FOIA requests reveal efforts by Coca-Cola to lobby the CDC to advance corporate objectives rather than health, including to influence the World Health Organization," the report charges.

There’s a growing pile of evidence that a sugar-heavy diet contributes even more than previously thought to weight gain, and it’s hard to combat the effects simply through exercise. Yet Coca-Cola, PepsiCo and other beverage companies have sought — through influencing policymakers and lawmakers, misleading marketing campaigns and philanthropy — to shift the blame away from sugar consumption toward a lack of physical activity.

“One of the things that the sugar industry has so far been quite successful in is denying the strong and emerging science related to the adverse effects of surgary drinks,” said Peter Lurie, president of the Center for Science in the Public Interest.

That influence was apparent in former first lady Michelle Obama's well-documented pivot from criticizing the food industry to encouraging kids to exercise more with her "Let's Move" campaign.

Yet failing to tell the whole story about what really causes weight gain — and a host of related conditions including diabetes, heart attacks, strokes and cancer — carries huge ramifications. Obesity is estimated to generate $147 billion in medical costs in the United States every year. That number is expected to continue rising, as a generation of youth with unprecedented levels of obesity reach adulthood.

Some recent CDC officials have worked closely with Coca-Cola. The agency’s former director Brenda Fitzgerald, who resigned a year ago over financial interests from which she couldn’t divest, worked on a childhood obesity program partially funded by the Coca-Cola Foundation while serving as commissioner of Georgia’s public health department. That program emphasizes exercise while saying little about sugary soft drinks.

And Barbara Bowman, director of the agency’s Division for Heart Disease and Stroke Prevention, resigned after the disclosure of emails in which she appeared eager and willing to help the beverage industry create sway with the WHO.

“This looks like a local corruption story with global health implications,” Gary Ruskin, co-director of the public health group U.S. Right To Know and one of the report’s authors, told me. “The CDC is supposed to fight disease, not be a helpmate for these companies.”

Ruskin's group filed a lawsuit against the CDC in early 2018, saying the agency failed to fully comply with a request for correspondence between agency officials and Coca-Cola under FOIA.

Coca-Cola spokesman Ben Sheidler said the emails newly obtained by the group go back a number of years and pre-date a commitment the company made in 2015 to disclose on its website its funding for scientific research and partnerships, which is updated every six months. He added that Coca-Cola is focused on reducing sugar in its drinks and promoting more beverage options with less or no sugar, in support of WHO's recommendation that people limited added sugars to 10 percent of their daily caloric intake.

"We’ve continued our journey to be a more helpful and effective partner in efforts to address the serious problem of obesity around the world," Sheidler said. "Over the past four years, we’ve listened and learned from the public health community, our customers, associates and our consumers to understand the most appropriate role we can play to support the fight against obesity in a way that is credible, transparent, and beneficial for everyone ."

Here’s another sign of how the soda industry has tried to influence policymakers: through contributing to the CDC Foundation, a nonprofit organization established by Congress in 1992 to promote public health.

Coca-Cola donated more than $1 million to the foundation between 2010 and 2015, according to the company’s website. The foundation’s ethics guidelines prohibit it from accepting gifts that could compromise its integrity. But Ruskin and his colleagues write that studies reporting funding by the sugar-sweetened beverage industry “are more likely to find no association between the use of SSBs and obesity.”

The industry has been hugely successful in its efforts to duck the spotlight. While in the past Congress has conducted vigorous oversight of the tobacco industry, there have been virtually no hearings on how cheap products from the sugar and beverage industries are affecting the dismal U.S. showing when it comes to health-care spending and the day-to-day health of Americans.

“How many real investigations into the power of big sugar and big soda happened during the Obama or Trump years? The answer: zero,” Ruskin said. “How many major regulatory efforts were undertaken? Answer: zero. What more do you need than that?”

AHH, OOF and OUCH

AHH: Activists are urging Education Secretary Betsy DeVos to make sure bathrooms at K-12 schools have free menstrual hygiene products, our Post colleague Valerie Strauss reports

In a full-page ad in The Washington Post on Monday, Period, the world’s largest youth-run nonprofit looking to change the conversation around menstruation, and grass-roots campaign United for Access called on DeVos to “fulfill your agency’s charge to remove discriminatory barriers that hold students back.”

“Every student deserves the reassurance that their school restrooms are outfitted with necessities to accommodate their biological needs,” the ad reads. “Menstrual hygiene products are basic necessities, and the inability to access them affects a student’s freedom to study, be healthy, and participate in society with dignity.”

“Students and activists around the country have been pressing for years for school bathrooms to be supplied with menstrual products in what has become a national movement for ‘menstrual equity,’ ” Valerie writes. “Its aim is to provide access to menstrual products to anyone who needs them, especially those from low-income families.”

OOF: A Massachusetts judge ruled a complaint by the state against OxyContin maker Purdue Pharma for its role in the opioid crisis should be fully released to the public.

Judge Janet Sanders ordered the complaint to be made public by noon on Friday, Stat's Andrew Joseph reports. Previously released documents related to the lawsuit provided details about Purdue Pharma's marketing strategy but had redacted segments. 

The judge's ruling came in response to a motion filed by Stat and the Boston Globe to release the full document. Reuters, the Wall Street Journal, the New York Times and WBUR joined the publications in seeking to release the complaint, Andrew writes.

“The disclosure of the information — while it may prove embarrassing for some of the defendants — is not intensely personal or private,” the judge wrote. “In essence, the information describes the inner workings of a company and discussions about company business among its directors, officers, and employees. Any interest in keeping this information secret is hardly compelling and certainly not enough to overcome the presumption of public access.”

OUCH: During a nine-hour D.C. Council hearing, city lawmakers, public-health experts, doctors and addiction treatment providers aired grievances about the District’s response to the rise in fatal opioid overdoses, our Post colleague Peter Jamison reports.

Council member Charles Allen (D-Ward 6) and health committee chair Vincent C. Gray (D-Ward 7) called the hearing in response to a Post series by Peter last month revealing how the city has consistently fallen short in its response to the crisis, misspending grant funding and ignoring basic steps to combat the rise in opioid deaths. “There’s over 700 people who are dead, over the last four years, because of opioid overdoses,” Allen said. “I think we are being way too polite in our conversation today.”

LaQuandra Nesbitt, director of the D.C. Department of Health and interim director of the Department of Behavioral Health, expressed optimism about initiatives announced by Mayor Muriel E. Bowser (D) in the last month. “In an introductory letter, Bowser said the plan was a ‘blueprint for how best to continue moving forward with urgency and thoughtfulness as we work towards reversing fatal opioid overdoses,’” Peter writes.

“However, some speakers at Tuesday’s hearing complained that they were not consulted as the plan was prepared, and they described it as too thin,” he added. “Many initiatives described in the document echo programs previously planned by city officials, including some the District is already doing or has promised but failed to implement.”

HEALTH ON THE HILL

-- Sen. Kamala Harris (Calif.) shook up the Democratic primary race for president -- already -- by saying last night that she supported ending private health insurance as it currently exists, and embraced some kind of Medicare-for-all plan. At a CNN town hall one day after formally launching her bid for president, Harris said: "'We need to have Medicare-for-all,'" Harris told a questioner in the audience, noting it's something she feels 'very strongly' about.  When pressed by CNN's Jake Tapper if that means eliminating private insurance, the senator answered affirmatively, saying she would be OK with cutting insurers out of the mix. She also accused them of thinking only of their bottom lines and of burdening Americans with paperwork and approval processes. 'The idea is everyone gets access to medical care," she responded when Tapper asked if people who like their insurance would get to keep it.'

The response from Republicans was swift:

We're prepping for some serious multi-tasking today. Four health-related hearings are scheduled on the Hill, two in the House and two in the Senate.  Here's what to watch for:

— Senate Finance will convene at 10:15 a.m. for a hearing entitled "Drug Pricing in America: A Prescription for Change." Grassley could give further indications on how far he's willing to go in cracking down on the pharmaceutical industry overall, particularly drug companies that spike the prices of their medications. 

Grassley told Politico's Dan Diamond he thinks it will be "very easy" to work with ranking Democrat Ron Wyden (D-Ore.) on drug pricing -- with one caveat: He's not on board with allowing the government to negotiate lower Medicare drug prices. "I think it's going to be very easy, I think almost on anything — except a Democrat effort to have the government dictate prices," Grassley said on the "Pulse Check" podcast. "These hearings, talking to Senator Wyden … I think this is one place where he and I can have a very close working relationship." Witnesses and livestream here.

— House Oversight meets at 11 a.m. for "Examining the Actions of Drug Companies in Raising Prescription Drug Prices." Chairman Elijah Cummings (D-Md.) has said he's hopeful about the possibility for bipartisan work, but a memo for committee Democrats touts a Medicare drug price negotiation bill recently introduced by Cummings and Rep. Peter Welch (D-Vt.).

"There is broad, bipartisan consensus that drug companies are charging too much," the memo says, citing past statements by President Trump who said drug companies are “getting away with murder" and HHS Secretary Alex Azar, who said "we will not wait for an industry with so many conflicting and perverse incentives to reform itself." Witnesses here.

— Senate Health, Education, Labor and Pensions (HELP) will hold a hearing on the role the country's 1,400 community health centers play in underserved communities. "Community health centers are one way American families can have access to affordable health care close to home," Chairman Lamar Alexander (R-Tenn.) will say, according to prepared remarks shared in advance with Health 202. "This includes a wide range of health care, including preventive care, help managing chronic conditions like asthma or high blood pressure, vaccines, and prenatal care." Livestream and witnesses here.

— House Ways and Means will hold a hearing at 11 a.m. themed on protecting Americans with preexisting health conditions. Expect a lot of political fireworks here, as Democrats seeks to ping Republicans for supporting a state-led lawsuit that could end protections in the individual market for Americans with preexisting conditions. Witnesses here.

AGENCY ALERT

— The Centers for Medicare and Medicaid Services launched a new app that lets Medicare beneficiaries and caregivers see whether a specific medical product or service is covered. CMS administrator Seema Verma said the new app is meant to give seniors better access and control over information related to their benefits.

“President Trump is delivering on his commitment to Medicare by modernizing tools that deliver health information in the most convenient way possible,” Verma said in a statement. “This new app is the next in a suite of products designed to give consumers more access and control over their Medicare information.”

OPIOID OPTICS

— A new series from U.S. News & World Report examines whether any progress has been made on the opioid epidemic, the future of the crisis and how opioids have impacted diverse communities. Here are just a few of the pieces in the newly published package:

The three waves of the epidemic: Steve Sternberg and Gaby Galvin write about three waves over the last two decades — from 1999 to 2006; starting in 2007; and then again starting in 2014 — that led to the opioid death rate being five times as high as it was in 1999. “The epidemic's three waves — driven by a procession of legal and illicit opioids alike — have ricocheted across the country, creating a scenario in which Americans now are more likely to die from an opioid overdose than a car crash,” they write. “By slicing the epidemic into phases, the analysis offers a glimpse into how America's ever-changing drug habit morphed into an all-consuming crisis.”

Overlooked communities: The attention to the opioid crisis has been focused on mostly white communities and individuals impacted by a boom in prescription pills, Joseph P. Williams reports. “Yet population health analysts, academics and on-the-ground specialists say heroin and its related plagues of crime and death have stalked African-American neighborhoods for decades, garnering little to no attention,” he writes. “The disparities in attention, resources and long-term strategies have led to a tale of two opioid crises. One is white, a malady of medical and mental health, and worthy of a White House-level task force. The other is black, criminal and largely ignored, even as statistics show black opioid users are dying at a skyrocketing pace.”

Treating addicted youth: America’s youth have also been partly left out of the conversation. “The same opioids abused by adults have taken their toll on younger generations: prescription painkillers, heroin and, increasingly, the synthetic substance fentanyl,” reports Casey Leins. “Adolescents suffering from opioid addiction can face a difficult road to recovery, as only a small percentage receive medication-assisted treatment — a mix of counseling, behavioral therapy and craving-reducing medications like buprenorphine or naltrexone that's widely accepted as an effective means of rehabilitation.”

— And here are a few more good reads: 

TRUMP TEMPERATURE
Trump pushed for a federal right-to-try law in his last State of the Union — and it passed. But many patients still aren't getting treatment.
Stat
Style
Thirsty plants. Swollen inboxes. Lost passwords. After the shutdown, what awaits at the office?
Dan Zak, Caitlin Gibson and Ben Terris
MEDICAL MISSIVES
Fewer Americans are likely to own a gun now than 40 years ago, but those who do are more likely to own handguns over rifles or shotguns. As the proportion of those with handguns has increased, so has the number of children under the age of 5 who are dying from firearm injuries, according to a new study.
CNN
Morning Mix
As it turns out, Shirell Powell signed off on the death of a man she was told was her brother, she says in a lawsuit filed in the Bronx.
Meagan Flynn
INDUSTRY RX
Health & Science
Attracting and retaining patients are key goals of affiliations between community hospitals and big-name institutions.
Sandra G. Boodman
STATE SCAN
State leaders have said they plan to implement Medicaid expansion, but want to make changes to control costs
Associated Press
Capital Weather Gang
A portion of the polar vortex, the pool of sub-freezing air that normally swirls over the Arctic Circle, dives into the Midwest this week, pushing temperatures off a cliff.
Angela Fritz
DAYBOOK

Today

  • The Senate Finance Committee holds a drug pricing hearing.
  • The House Oversight and Reform Committee holds a hearing on drug companies and rising drug prices.
  • The House Ways and Means Committee holds a hearing on preexisting conditions.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on health-care access.
SUGAR RUSH

Do third-party candidates impact elections?

Former Starbucks CEO Howard Schultz, who said he may run for president as an independent, was heckled during his book launch event in New  York: