So far it looks like just a local skirmish, but the release last week of a hard-hitting report from the UK’s National Institute of Clinical Excellence (NICE) could rapidly develop into a full scale attack on the European Food industry (htttp://tinyurl.com/CVD-NICE). NICE is the body set up by the British government to advise on the cost-efficiency of modern medicines and whether they should be made available on the country’s state-funded health service. Typically, NICE’s remit runs to examining the (usually extremely high) cost of, say, a newly developed anti-cancer drug in the light of its clinical efficacy, expressed usually in terms of how long it might prolong the lives of terminally-ill cancer patients. By carrying out agonizingly difficult calculations, which basically come down to putting a monetary value on a human life, and which understandably give rise to howls of protest from patients who could learn that their last hope of treatment will not be reimbursed, NICE is thus no stranger to controversy. Last week however, NICE departed from its usually purely clinical area of activity and entered full-blown into the debate on the responsibility of the food industry for the huge cost of cardiovascular diseases. On the face of it, NICE’s argument is simple. Literally hundreds of thousands of patients suffer (or die) from some form or other of cardiovascular disease, and since a major contributing factor to such disease is poor diet, cardiovascular diseases (CVD) in general should be considered as highly preventable by improvement in diet. NICE considers that the stakes are so high that legislation should be used to force the food industry to introduce dramatic changes in the food we eat. Specifically, NICE recommends a ban on all trans fats; halving the individual daily salt intake; slashing the content of hidden saturated fats in food; ensuring that low-fat and low-salt versions of foods are cheaper than the unhealthier versions; banning TV ads, especially those aimed at children for high-salt and high-fat food products and outlawing take-away shops and junk food outlets in the vicinity of schools. In addition, despite the European Parliament’s recent rejection of the “traffic light” food labeling system, NICE remains firm in its belief in the system and recommends that national authorities should adopt consistent and clear food and drink labeling in formats such as the traffic light color-coding.
The medical community has to a large extent already endorsed NICE’s suggestions. For example the European Society of Cardiology (ESC) has already unambiguously welcomed the NICE suggestions, believing that the NICE approach of “setting out a range of evidence-based recommendations for effective action to help reduce CVD levels should make it easier to enable individuals to make healthy choices” also “delivers important messages for the rest of Europe”. As the ESC spokesman put it, “Currently even if individuals try to eat healthy diets there are issues out of their control, such as the salt content in bread, that have an adverse effect on their cardiovascular health. The NICE document details the legislative changes that could be introduced to protect them”.
Predictably enough the food industry has been a lot less welcoming to the NICE suggestions. The UK Food and Drink Federation suggested that NICE has over-reached itself and is in fact out of touch with the reality of the market, pointing out that voluntary measures introduced by the industry had already brought down salt, sugar, saturated fat and trans fat levels. NICE’s retort is that with the continuing high levels of the incidence of CVD in Europe, such measures are clearly not good enough.
The debate looks set to run and run and is one that the food industry ignores
at its peril.