Saturday, 22 December 2012

Peek into the politics, egos, personalities, and science of global health.

If you want to get a peek into the politics of the science of global health, read the article below.

Original link here.  

Vol. 338 no. 6113 pp. 1414-1416 
DOI: 10.1126/science.338.6113.1414

A Controversial Close-Up of Humanity's Health

Kudos and criticism greet a landmark new report, filling the largest ever issue of The Lancet, on the global burden of disease.
Expansive view. 
Christopher Murray led a massive analysis of the “health loss” caused by diseases and injuries.
SEATTLE, WASHINGTON—If you had stumbled into Christopher Murray's office in October without knowing who he is or what he does, the cryptic notations written in six shades of felt pen on the whiteboards on his walls would have told a tale as intriguing and revealing as cave paintings. The formulas, graphs, and arrows suggest an ambitious attempt to decipher something exceedingly complex. These are some of the words and symbols scattered about: 187 countries, health, disease, $, mortality, partnership, methods, and—in bright purple and all uppercase letters—UNCERTAINTY.
Murray heads the Institute for Health Metrics and Evaluation (IHME), a branch of the University of Washington (UW) that contends it has created the most detailed and authoritative report ever on the state of the world's health. The so-called Global Burden of Disease (GBD) 2010 study will appear on 15 December in the largest issue of The Lancet ever published, and Murray hopes it will have a major impact on how policymakers, donors, and researchers allocate resources to help people lead healthier, longer lives.
The effort, largely bankrolled by the Bill & Melinda Gates Foundation, is “a huge, ambitious, and highly disciplined attempt to describe the totality of death and illness in every part of the world,” says global health veteran Richard Feachem of the University of California, San Francisco (UCSF), who chairs an independent scientific oversight group for IHME. “There's nothing else like it or even approaching it.”
GBD 2010 consists of eight papers, 194 pages in total, that examine the epidemiology and loss of health caused by 291 diseases and types of injuries in 187 countries and a whopping 1160 of their lasting effects. It analyzes changes in disability and death from 1990 to 2010; using new computer models based on complex statistics, it ranks the major causes of mortality and morbidity in 20 age groups in 21 regions of the world and identifies 67 underlying risk factors. As Murray's whiteboard telegraphed, the studies give uncertainty intervals for the estimates as well, bringing scientific rigor to a field that often relies on squishy data.
But another type of uncertainty surrounds the project: How much credence will it have with fellow scientists and policymakers? Many have questions about how IHME arrived at its results and how they fit with similar efforts by the World Health Organization (WHO), until now the main source of global health data. IHME caused an uproar in February when it gave a sneak peak of GBD 2010 with a paper in The Lancet that tallied nearly twice as many malaria deaths as WHO did (Science, 15 June, p. 1372). Other numbers may well be equally contentious.
Passions run high about these fights in part because the money spent on research and control measures for any disease is determined largely by the perceived suffering that it causes. Advocacy groups and researchers alike try to trot out evidence that “their” affliction is a major global problem.
In IHME's case, the debates are intensified by some scientists' frustration about what they say is an arrogant attitude and a lack of transparency at the institute. Murray, widely admired for his intellect and abundant enthusiasm and energy, has come under criticism for his domineering style. “There are issues with methods, results, and personalities,” says Dean Jamison, a UW health economist who quit IHME 2 years ago and acknowledges that his views are “clouded by my general lack of perfectly good and cordial relations with Chris Murray.”
This much is certain, however: GBD 2010 demands serious attention. Even its sharpest critics can't ignore it.

Startling patterns

Murray's efforts to take stock of humanity's health go back 2 decades to when the World Bank published a watershed report called World Development Report 1993: Investing in Health, prepared by a team that Jamison led. Murray, who has a Ph.D. in international health economics and a medical degree, wrote an appendix that introduced the GBD concept to a wider audience, together with WHO epidemiologist Alan Lopez, who is now at the University of Queensland in Brisbane, Australia.
Until then, the relative importance of diseases had simply been assessed by the number of deaths they caused, which was fairly easy to track. Murray and Lopez wanted to “quantify the full loss of healthy life” and take into account nonfatal conditions such as paralysis, depression, and blindness. They devised a metric called the disability-adjusted life year (DALY), which combined the years of life lost because of a fatal disease or injury with the years of life lived with disability. Controversial at first, DALYs revealed startling patterns. According to the 1993 report, for example, neuropsychiatric diseases caused a higher burden worldwide than cancer.
Fresher air. 
Household air pollution from indoor cooking and other sources has decreased over the past 20 years.
In 1998, Murray moved from Harvard University to WHO's Geneva headquarters to head the Global Programme on Evidence for Health Policy, which created the organization's first burden of disease unit, led by Lopez. GBD reports soon became a mainstay of WHO. Murray returned to Harvard in 2003 hoping to form his own institute, but promised funding fell through; he came to Seattle in 2007 with a $105 million commitment from the Gates Foundation, which believed that all global health funders would benefit from better metrics to evaluate the impact of investments. UW contributed another $20 million. IHME's staff, now numbering nearly 100, built up a vast network of collaborators that included WHO: The new papers in The Lancet have 486 co-authors from 302 institutions.
The papers look at everything from DALYs to risk factors, causes of death, illness, and impairment, and how to weight the severity of nonfatal illnesses; their tables, maps, bar graphs, and charts reveal a multitude of intriguing patterns. Although mortality in children under age 5 has plummeted between 1990 and 2010, for example, more people now suffer from mental disorders and back pain. HIV/AIDS jumped from the 35th leading cause of death in 1990 to the sixth in 2010. Noninfectious diseases such as heart disease account for increasing amounts of “health loss.” Several infectious diseases, including diarrhea and malaria, are on the decline.
Some of the findings are perplexing. Tuberculosis mortality, for example, has dropped steeply, but new cases have not. In 2010, road injury accounted for 10.7% of deaths in males in the reproductive age bracket, but only 0.5% in females. Lower back pain ranks immediately below HIV/AIDS in DALYs.
Rank and rile. 
GBD 2010 documents major shifts in DALYs and risk factors since 1990, but some doubt the new data.
Geographic differences jump out as well. Mortality in people of reproductive age changed little in Russia between 1970 and 2010, but skyrocketed in southern African (because of HIV/AIDS) and dropped in upper-income countries. Self-inflicted harm, including suicide, ranks as the 13th most common cause of life-years lost worldwide but is rare in sub-Saharan Africa. Alcohol disorders have had a devastating impact in the former Soviet Union and parts of Latin America, where people drink more and liquor tends to be of lower quality.
Epidemiologist Peter Piot, who runs the London School of Hygiene & Tropical Medicine (LSHTM), says the absolute figures interest him less than the changes over time. “I don't care—and I don't think many people care other than disease advocates—whether 1.5 or 1.6 million die from a disease,” says Piot, who serves on IHME's board. “What's important is what direction the world is going in and what's happening in my region.”
Murray says that, after the fight over malaria, he doesn't anticipate much debate about other high-profile diseases, such as tuberculosis and HIV/AIDS. “The smaller diseases, those communities get more riled up,” he says. “If our numbers are smaller, it's going to hurt their bid for funding, so they get very restive. You'll have a million of those types of conversations.”
They're already beginning. Peter Hotez, a pediatrician at the Baylor College of Medicine in Houston, Texas, who specializes in neglected tropical diseases, is a co-author on the GBD 2010 paper about DALYs. But he thinks the paper's estimates for schistosomiasis and Chagas—which he cares greatly about—are too low. Jamison says that IHME didn't properly factor in stillbirth in its calculations of under-5 mortality—“a conceptual hole of some magnitude.”
Sandy Cairncross, a public health engineer at LSHTM who specializes in water and sanitation and who served on one of many expert groups for GBD, says that unsafe water and poor sanitation should have ranked much higher in risk factors. His concerns are so serious that he co-authored a commentary in this week's issue of The Lancet questioning whether policymakers should even use GBD 2010's rankings of risk in their decisions.
Cairncross says that IHME dismissed much of the literature he selected that showed the important health benefit of delivering water to houses through pipes. “They only accepted one study in the world that got over their bar of scientific rigor,” Cairncross says. “And that particular study apparently showed no significant effect on house connections, unlike most others that showed [disease] reductions of about 50%.”

Black box step

Cairncross and several other critics say a fundamental problem with IHME's conclusions is that researchers used complex statistical models and computer analyses—what he calls a “black box step”—that baffle outsiders. The GBD 2010 paper on years lived with disability gives a flavor: “To address these challenges, we have developed a Bayesian meta-regression method, DisMod-MR, which estimates a generalized negative binomial model for all epidemiological data.”
Diverse world. 
An analysis of changes in mortality among people of reproductive age over 3 decades reveals profound differences between countries.
UCSF's Feachem says this “analytical sophistication” presents real challenges, but he contends that it's required because the jigsaw puzzle is so complicated. “By the nature of the beast, it will be very hard to get it to the point where the average epidemiologist with the average mathematical skills will be able to seriously reanalyze and arrive at different conclusions,” he says.
UW's Jamison says his former employer would mollify many critics if it embraced the transparency it espouses. “There's a lack of access to data,” Jamison insists. “Their results can't be honestly checked and we don't have a capacity to interpret the underlying numbers.”
The complaint is part of a bigger gripe about IHME's headstrong ways—and what some assert is Murray's overcertainty about debatable issues—that has also frayed its ties with WHO. Initially, WHO envisioned working with IHME in a tight collaboration and even adopting its estimates. “We stepped into it because we thought it was a joint exercise,” says Ties Boerma, director of WHO's health statistics and informatics, “but it became more of an IHME exercise.”
A “briefing note” written by a WHO assistant director general last winter told WHO staffers that it would “not be appropriate” to be co-authors to the GBD 2010 papers or for WHO's logo to appear on IHME publications. According to the memo, obtained by Science, WHO developed serious concerns about the numbers in GBD 2010 after IHME researchers presented them to WHO staff members in September 2011. Based on those data, the memo says, big discrepancies between the GBD 2010 papers and WHO estimates were to be expected not just for malaria but also for child and maternal mortality, deaths due to neglected tropical diseases, vaccine-preventable diseases (including measles), cancers, and tobacco.
IHME subsequently adjusted its deaths for HIV/AIDS, Boerma notes, but in a commentary in this week's issue of The Lancet, WHO Director-General Margaret Chan says GBD 2010's estimates still “differ substantially from analyses by WHO and other UN entities.” Boerma notes that one major discrepancy is that GBD 2010 estimates the total number of deaths annually at 52 million, WHO at 56 million. More differences may come to light as the published reports receive closer scrutiny.
IHME alienated several other erstwhile contributors along the way, and an external evaluation completed in November concluded that the institute “is not consistent in when and to whom it shares methods, data sources, [and] authorship and this is perceived as not being transparent.” The report said that “IHME is viewed as a competitor vs. collaborator by many researchers in the health metrics field.” Murray has gone so far as to suggest that WHO get out of the business of assessing GBD. “Bureaucracies don't do statistical innovation. Researchers do.” But Boerma says that WHO will continue putting together its own GBD.
In a commentary in The Lancet package, Murray, Lopez, and other key IHME staff members say it's “reasonable and to be expected” that some contributors in an enterprise this large would disagree and choose not to be co-authors. But Murray challenges the accusation that IHME has not shared data and methodology. “The core tenet throughout this collaboration has been that an open and voluntary process would provide for rigorous debate to ensure the best possible results,” he says.
Hotez of Baylor says he has “a lot of sympathy” for Murray and his team. “It's incredibly complicated to bring all those investigators together,” he says. And in the end, policymakers should keep the findings in perspective, Hotez adds. “It's one of several metrics that should be used when trying to control disease and exploring policy,” he says, noting that it doesn't factor in economic costs of diseases, existing tools to combat them, or health system capabilities.

No fudged consensus

IHME intends to release another ocean of data in January, when it will report even more granular analyses of country-by-country information. It will also make a new interactive database publicly available that Murray says will lead people to explore questions that his team never imagined.
As debates about those data inevitably kick in, WHO plans to hold a meeting in February that will gather IHME scientists with experts from WHO and elsewhere to discuss how GBD 2010 reached its conclusions and how it differs from other estimates. Feachem says those discussions are exactly what's needed. “The last thing we want is fudged consensus,” he says. “Some of these disagreements are healthy because they force tough questions. And that's how science works. In time we'll find a better outcome.”
  • * With reporting by Gretchen Vogel.

Tuesday, 18 December 2012

Erasmus Mundus bioethics MA scholarships and fellowships

This particular Master's program exists since 2000 and is organized by the KU Leuven (Belgium), Radboud Universiteit Nijmegen (the Netherlands) and the Università degli Studi di Padova (Italy). The main objective of the Master of Bioethics is to train highly qualified students for research work or professional activities in the interdisciplinary field of bioethics, a field that is increasingly confronted with different moral questions and dilemmas. It approaches bioethics from an international perspective, paying special attention to European philosophical traditions in this area. More information on the program is available on our website
We are pleased to inform you that due to the grant of the Erasmus Mundus label we are able to offer scholarships for students for the academic year 2013-2014 (Category A and B scholarships).
For more information on the different scholarships please refer to .
The online application procedure is available on our website under the submenu ‘Application’
Please be sure to:
  1. Fill in the preregistration form for students and send this preregistration form + a letter of motivation by e-mail
  2. Fill in the online application form at
Due to the grant of the Erasmus Mundus label we are also able to offer scholarships for visiting scholars for a stay at one of the partner universities for a period of minimum 2 weeks and maximum three months. Visiting scholars may be either junior scholars involved in completion of a PhD. dissertation, post-doctoral scholars or professors. Please visit our website for more information.
The deadline for application is January 15th, 2013.

Monday, 17 December 2012

Brocher Fondation: call for visiting researchers, symposia and workshops

The Brocher Foundation is located on the shores of the Geneva Lake, in Hermance (Geneva - Switzerland).

The Brocher Foundation residencies last between one and four months. They give researchers the opportunity to work at the Brocher Centre on projects on the ethical, legal and social implications for humankind of recent medical research and new technologies. Every month a dozen of visiting researchers live and concentrate on their research project at the Foundation.

The Brocher Foundation offers to successful applicants an accommodation in the domain of the Brocher Foundation and work space with all facilities.

Developing a research project involving cooperation with a Swiss university, a European university, a governmental or non- governmental will be considered as an asset.

A researcher can apply with other researchers to work on a collaborative project.

For further information about the Brocher Foundation please visit our website:  

Topics of the Year 2014

Among the following disciplines:
  • Bioethics
  • Medical Anthropology
  • Health Economics
  • Health Policy
  • Health Law
  • Philosophy of Medicine and Health
  • Medical Humanities
  • Social Science Perspectives on Health
  • Medical Ethics
  • History of medicine
  • Why Apply?

  • Write a book, articles, an essay, a monograph or your PhD thesis in a peaceful environment
  • Have the opportunity to meet other researchers from different disciplines and countries
  • Have the opportunity to meet experts from numerous International Organizations & Non- Governmental Organizations based in Geneva (WHO, WTO, WIPO, UNHCR, ILO, WMA, ICRC, ...) 
Proposals of the following topics are notably welcomed:
  • Equitable access to medical care
  • Biobanks
  • Biosecurity and Dual Use Dilemmas
  • Clinical Trials and Research on Human Subjects
  • Genetic testing and screening
  • Health Care Reform
  • Nanotechnology
  • Neglected diseases

Calls for proposals

The Brocher Foundation launches every year two calls for proposals. One for the visiting positions and one for the workshops and symposia.

Next dates:

Visiting researchers 2014:

Call: Mid-November 2012
Deadline: Mid-January 2013

Symposia & Workshops 2014:

Call: Mid-January 2013
Deadline:  Mid-March 2013

  • Pandemic planning
  • Reproductive technology
  • Stem Cells and Cell Therapy
  • Organ transplantation
  • Cyber Health
  • Neurosciences
  • Synthetic 

Saturday, 15 December 2012

Justice and Development workshop in Frankfurt. (past)

This has already happened but I think it is worth noting.  original link here.

December 13th 2012, 2 pm - December 14th 2012, 6 pm

Workshop on "Justice and Development"

Hosted by the Centre of Advanced Studies "Justitia Amplificata" Goethe University of Frankfurt (funded by the Deutsche Forschungsgemeinschaft)
Julian Culp (Goethe-University, Frankfurt/M.)

Thursday, 13th of December 2012
2-4 pm
Panel 1: Justice and Development  The Contributions of Economics
Ingrid Robeyns (Erasmus University Rotterdam): "Justice, Development and the Assessment of Economic Policies, Institutions and Systems"
Sanjay Reddy (The New School, NY): TBA
4-4:30 pm Coffee Break
4:30-6:30 pm
Panel 2: Theories of Development  Post-Development and Justice-Based Perspectives
Aram Ziai, Center for Development Research at the University of Bonn: "Some Reflections on the Concept of Development"
Julian Culp (Goethe-University, Frankfurt/M.), "Justice-Based Development  A Discourse-Theoretic Approach"
Public Lecture7:15 pm
Martha Nussbaum (University of Chicago): "Development and Human Capabilities: The Contribution of a Philosophical Theory of Justice."
Introduction: Rainer Forst (Goethe-University, Frankfurt/M.)
Friday, 14th of December 2012

10-12 pm
Panel 3: Equality, Development and Democratic Justice
David Crocker (University of Maryland): "Agency and Democracy: Re-orienting Theories of Development and Justice"
Neera Chandhoke (University of Delhi): "Equality for What?"

1:30-3:30 pm
Panel 4: Development - Historical Foundations and Current ProblemsPhilip Lepenies (Institute for Advanced Sustainability Studies, Potsdam): "Us and Them: Reflections on the Historical Foundations of Development"
Joseph Agbakoba (University of Nigeria at Nsukka): "The Problem of Choice and Responsibility in Modern Africa's Development"
3:30-4:00 pm Coffee Break
4:00-6:00 pm 
Roundtable with Practitioners from Development Organizations
Stefan Gosepath, Professor of Moral and Political Philosophy, Freie Universität Berlin

Angela Hariche, Head of Unit, Gobal Well-Being Networks, OECD – Organization for Economic Co-Operation and Development, Paris

Michael Krempin, Senior Policy Advisor, Corporate Development Unit, GIZ  German Society for International Cooperation, Frankfurt/M.

Jean Saldanha, Policy and Advocacy Officer, CIDSE  International Alliance of Catholic Development Agencies, Brussels

Attendance of the workshop is free. Registration is required for organization and catering purposes by November 28.
Places are limited, and will be assigned on a first come, first serve basis. 
There is no registration needed for the public lecture. 
In order to register, please contact Ms Valérie Bignon:
The panels and the roundtable will take place in the "Eisenhower-room" of the main building, i.e. the "IG Hochhaus", on Campus Westend. The room number of this venue is 1.314.
The public lecture will take place in lecture hall 6 of the lecture hall building, i.e. the "Hoersaalzentrum", on Campus Westend.
A map of Campus Westend, which indicates the buildings of the venues of the panels, the roundtable and the public lecture, is available here:
Workshop description
The ‘Beyond-GDP’ discourse as to how to understand and measure social progress is no longer confined to social-scientific development researchers or other academics. Policy makers and civil society at national, inter- and transnational levels are engaged in discussing and devising concepts and indicators that would facilitate assessing social progress domestically and globally. Examples include the ‘Sarkozy-Commission’ on the Measurement of Economic Performance and Social Progress, the study commission on Growth, Wellbeing and Quality of Life of the German parliament and the European Framework for Measuring Progress of the EU.
In addition, the expiring of the Millennium Development Goals in 2015 currently provokes members of development institutions to reflect upon and search for a post-2015 normative framework for orienting international development policy. Several non-governmental organizations are deliberating about how to re-think development, for instance, the Beyond2015 campaign. And in the aftermath of the ‘Rio+20’ UN Conference on Sustainable Development the UN already actively promotes ‘Sustainable Development Goals’.
What is striking about these processes of opinion and will formation is how little attention they pay to theories of (global) justice. This is perplexing not only because theorizing justice has played such an important role in political philosophy and theory throughout the last decades but also because according to a very influential understanding justice is the ‘first virtue of social institutions’. Accordingly, one should expect that the various processes of opinion and will formation would be far more sensitive to the question as to what social progress and sound development policy would mean from the point of view of (global) justice.
This neglect is even more curious in light of the fact that the concepts of justice and development are often employed in very similar ways. Conceptions of both of these concepts usually outline a social ideal or provide a normative source of critique of existing social relations. Theories of justice ask both what an ideally just society would involve and what would effectively contribute to less injustice today. Likewise, theories of development in the social sciences also consider what would be the ultimate goal of social change and criticize actual social conditions for reflecting an underdeveloped state of affairs. Despite of these similarities of the aims and critical functions of the usage of the two concepts, few attempts have been made so far to clarify the conceptual relation and tensions between them.
The workshop aims at filling this gap by bringing together political philosophers and theorists as well as scholars working in development economics and social-scientific development research so as to exchange their understandings of both justice and development. The workshop thereby provides a dialogue platform that could enable enriching both theories of justice and of development. Eventually it will also make more intelligible as to why the conceptions of (global) justice have failed to attract more attention in the ongoing debates about social progress and development policy.

Tuesday, 11 December 2012

public ethics radio

Great site devoted to interviews with philosophers on various issues involving public ethics / social justice.

The idea of Public Ethics Radio is to engage ethicists in discussion of pressing practical dilemmas. Each program focuses on a particular theme—military intervention, international trade, political corruption—and takes as its starting point some more specific issue that is prominent in the public consciousness.
The show is hosted by Christian Barry and produced by Matt Peterson.
Christian Barry
Christian Barry
Matt Peterson
Matt Peterson
Public Ethics Radio is an independent production supported by the Centre for Moral, Social, and Political Theory at the Australian National University.
We’re grateful to Kompakt for permission to use their music in the show, and to Steve Rennicks for his original compositions. Thanks also to our friends at the Carnegie Council for Ethics in International Affairs, who are simultaneously podcasting this program in their own podcast feed.

Wednesday, 5 December 2012

politics and rhetoric of the food industry vs health debate in the US

Original post on NPR blog here

Can Big Food Kick Its Obesity Habit? Does It Really Want To?

A sign protesting a beverage tax in Richmond, Calif. The U.S. soft drink industry has fought proposals that would put a tax on sugar sweetened beverages like sodas and energy drinks.
Braden Reddall/Reuters /Landov
A few days ago, two big names in food policy squared off for a formal debate on the following proposition: There is a fundamental and irreconcilable conflict between the food and beverage industry's interests and public health policy interests on obesity.
Kelly Brownell,who leads the Yale Rudd Center for Food Policy and Obesity, led the anti-industry charge. He was opposed by Derek Yach, a soft-spoken South African who provoked much head-scratching in 2007 when he left the World Health Organization to take a senior executive job at PepsiCo. (Yach recently left PepsiCo to join The Vitality Group, an arm of a South African insurance company that promotes wellness.)
The proposition they debated contained some hidden historical spice. At the close of the debate, moderator Thomas Bollyky revealed that it was lifted from a landmark international treaty called the Framework Convention on Tobacco Control (FCTC), adopted in 2003. The words "tobacco industry" were simply replaced by "food and beverage industry," and "on obesity" added. (Interestingly, Yach was one of the architects of this treaty while at the WHO.)
So is PepsiCo really today's Phillip Morris?
Brownell certainly thinks so. At the debate, sponsored by the Council on Foreign Relations and held in its posh midtown Manhattan building, Brownell argued that food companies are fundamentally untrustworthy. He pointed to cases in which the industry set up front groups to fight a soda tax in California and fought national guidelines that would restrict the marketing of unhealthy food to children.
Perhaps because Yach stood beside him, or perhaps because of the pompous surroundings — David Rockefeller gazed down on the speakers from an enormous portrait on the wall — Brownell kept his rhetoric rather muted. In an article that he authored earlier this year, however, he hinted at parallels with Munich, 1938: "When the history of the world's attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry."
The food industry can do some good things, Brownell admitted, when it comes to fighting hunger or promoting sustainable agricultural practices. But "obesity is a different kettle of fish" because solving it conflicts directly with the industry's most basic imperative: To sell more food. All of the industry's much-celebrated "healthy eating" campaigns and partnerships with public health initiatives, Brownell says, amount to "baby steps" that simply obscure this basic fact. Brownell dismissed the idea that companies could also prosper by selling better, healthier, more expensive food. There's no evidence, globally, that this market will be more than a niche, he said.
Yach, for his part, didn't bother trying to defend the entire industry or its current practices and products. He pointed, instead, to signs of a future still unfolding.
The real parallel to obesity isn't tobacco, Yach said, but climate change - a problem that will demand the expertise of industry. Just as energy companies once just tried to sell more oil, "the multinational food and beverage business model has favored quantity over quality," he admitted. And just as energy companies are now investing in green energy, the food industry is starting to realize "that this must change if if is to survive and prosper. I witnessed the intensity of change while at PepsiCo for the last five years."
The market share of mid- and low-calorie beverages in PepsiCo's lineup, he said, was only 25 percent five years ago. Today, it is 50 percent, and "is likely to reach 75 per cent within the next five to eight years. And this is happening even in a recession, in a climate where short-term pressures are intense."
Yach's most powerful words came near the end of the debate, in impromptu remarks that he added to his prepared script. The debate, by this time, had turned to the question of whether food industry representatives should be barred from policy-making discussions related to food, similar to a ban that governments have placed on scientists sponsored by the tobacco industry.
Yach argued that the food industry is already changing, and there's more change in store, if the conversation continues.
"We have to recognize that drawing opponents into debate changes them forever," he said. "I saw that happen in South Africa [with apartheid]. And I don't think that obesity is a bigger problem than what could have happened in South Africa, if you hadn't gone down the road of constructive engagement. ... We need more engagement, not less."