Products can harm people for decades before companies change. Here’s how to stop them

STwenty years ago, two scientists working for the American Cancer Society, E. Cuyler Hammond and Daniel Horn, published one of the first studies to definitively link cigarette consumption to lung cancer, contributing to a growing scientific consensus that cigarettes are behind the worldwide increase in the disease. This may have been the moment when Americans realized the risks of smoking and gave up cigarettes for good. But of course it wasn’t.

Faced with mounting evidence that its highly profitable product was harming its users’ health, the tobacco industry backed down. That same year, he formed the Tobacco Industry Research Committee with the aim of sowing doubts about science. And it worked. Industry-created pseudoscience has had more influence on public beliefs about smoking than rigorously analyzed data. People continued to smoke, and during the 1950s, even many doctors were not convinced that cigarettes caused cancer. It was only in the mid-1960s that Cigarette sales in the US begin to fall—a decade-long delay in public awareness that cost many smokers their lives.

Tobacco’s stubborn resistance to public health common sense is an all too predictable story. Companies that profit from products that are harmful or harmful to health – from ultra-processed foods to prescription opioids to social media– often follow a familiar playbook of disorientation and denial to extend their sales for as long as possible. Their strategies can be so effective that public perception takes decades to recover, fueling public health crises that seem almost impossible to control. Companies often manufacture doubts as effectively as they manufacture unhealthy products.

read more: Why are so many young people getting cancer?

As public health scholars, we have recently introduced the concept of “Market-Driven Epidemics” to describe the dynamics of these harmful consumer products. We estimate that these market-driven epidemics contribute to the deaths of 850,000 people in the US and 23 million worldwide each year. They are at the root of some of the planet’s most urgent health crises, including heart disease, obesity, diabetes, drug addiction and overdose, and certain types of cancer, and cost trillion-dollar healthcare systems to combat.

But these staggering social and economic costs are not inevitable. We could save countless lives if we did a better job of recognizing market-driven epidemic patterns earlier and working more assertively to counter predictable corporate resistance.

We recently studied three of the largest-scale market-driven epidemics in modern history – cigarettes, prescription opioids, and sugary foods and drinks – to understand how this might be possible. In each of these cases, the companies aggressively marketed products despite proven harm and actively resisted public health efforts to control them. The tobacco industry, for example, funded research aims to blame cancer on other causes, such as certain foods or hormones, rather than cigarettes. The sugar industry took a page from the tobacco script by research funding which dubiously shifted the blame for America’s obesity crisis to saturated fats, launching a wave of low-fat foods that conveniently increased their sugar content to preserve flavor.

In the late 1990s, Purdue Pharma had many of the same tactics to increase demand for its prescription opioid, OxyContin. They continued to falsely allege OxyContin had a misuse rate of less than 1%, even as the opioid crisis began to grow in rural communities. Many doctors accepted these misleading claims of low rate of misuse, and it was not until 2011 that the U.S. Centers for Disease Control and Prevention recognized the overdose crisis in the US

read more: Long Waits, Short Appointments, Huge Bills: The US Healthcare System Is Causing Patient Burnout

Eventually, the overwhelming evidence of the harmful effects of these products and persistent messages from public health authorities were enough to overcome corporate resistance. Since peak consumption, U.S. cigarette sales have fallen 82% and prescription opioid use has fallen 62%. Even sugar consumption is down 15% from its peak as consumers ditch sodas and sugar-laden foods.

This evolution, however, was painfully slow. In the three scenarios we studied, the difference between the first suspicion of harm and a decline in consumption ranged from one to five decades. Even when overconsumption or misuse decreases, companies are often able to shift focus to less regulated foreign markets or encourage consumers to switch to alternative products that still cause harm.

It is not always obvious when a market-driven epidemic begins. Many of the products that we now know to be harmful were seen as harmless or even beneficial when consumers began adopting them. But there are clear steps public health authorities can take to recognize and stop market-driven epidemics before they cause widespread harm. Emerging market-driven epidemics that deserve close attention include ultra-processed foods, as there is a growing evidence of harm, but the evidence has not yet persuaded policymakers to act, along with nutraceuticals and dietary supplements. The US remains the only high-income country that does not require companies to provide any evidence of efficacy or safety for the long-term use of nutraceuticals and dietary supplements, but these widely used products are known cause harm to health.

read more: Why ultra-processed foods are so bad for you

First, researchers must act more quickly to investigate early evidence of emerging health threats, ensuring that credible science advances faster than corporate efforts to debunk it. Governments also need to strengthen requirements for companies to study and report the health impacts of their products and hold them accountable when they hide evidence of harm.

Second, public health leaders need to recognize the important role they play in shaping the consumption curve. When the US Surgeon General finally issued its first official notice about smoking in 1964, the bombshell report covered newspapers and television, becoming the authoritative voice that the public could no longer ignore. It’s no surprise, then, that cigarette consumption in the US began to decline from around 1964 onwards.

Third, the voices of professional organizations, journalists, and even pop culture figures can have an outsized influence in initiating the change in direction of a market-driven epidemic. In the case of sugar, for example, a 1999 report report by the Center for Science in the Public Interest called “America is drowning in sugar” stands out as one of the defining moments that began to turn the tide on America’s sugar habit.

Attractive and often addictive products such as cigarettes, sugar and prescription opioids will, of course, continue to be marketed by companies seeking to capitalize on human needs and desires. But understanding the life cycle of these three market-driven epidemics shows us that it is possible to observe dramatic changes in the consumption of such products over time, and that these changes, although slower than we would like, save lives. Our research has shown that there are ways to intervene to accelerate changes, so that the turning point in consumption arrives sooner, avoiding illness and death.

The big question is how we will react the next time astute observers start pointing out adverse health effects that appear to be linked to the use of a popular consumer product. Shall we listen? Or will we let the cynical machinations of companies seeking to preserve their profits succeed again? If we get better at recognizing the early warning signs – and alerting ourselves to the inevitable attempts to distract us from them – perhaps the next market-driven epidemic won’t be so costly.