Seventy years ago, two scientists working for the American Cancer Society, E. Cuyler Hammond and Daniel Horn, published one of the first studies definitively linking cigarette smoking to lung cancer, adding to a growing scientific consensus that cigarettes were behind a worldwide spike in the disease. This might have been the moment when Americans realized the risks of smoking and gave up their cigarettes for good. But of course, it wasn’t.
Faced with mounting evidence that their highly profitable product was harming its users’ health, the tobacco industry pushed back. That same year, it formed the Tobacco Industry Research Committee with an aim of sowing doubt about the science. And it worked. Pseudoscience created by industry had more influence on public beliefs about smoking than rigorously sifted data. People kept puffing away, and through the 1950s even many doctors remained unconvinced that cigarettes cause cancer. Only in the mid-1960s did U.S. cigarette sales begin to decline—a decade-long lag 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 harmful or unhealthy products—from ultra-processed foods to prescription opioids to social media—often follow a familiar playbook of misdirection and denial to extend their sales for as long as they can. Their strategies can be so effective that public perception takes decades to catch up, fueling public-health crises that seem almost impossible to control. Companies often manufacture doubt just as effectively as they manufacture unhealthy products.
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As public-health scholars, we recently introduced the concept of “market-driven epidemics” to describe the dynamics of such harmful consumer products. We estimate that these market-driven epidemics contribute to the deaths of 850,000 people in the U.S. and 23 million worldwide each year. They underlie some of the most urgent health crises on the planet, including heart disease, obesity, diabetes, drug addiction and overdose, and certain cancers, and cost health systems trillions of dollars 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 sooner, and work more assertively to counteract predictable corporate resistance.
We recently studied three of the largest scale market-driven epidemics in modern history—cigarettes, prescription opioids, and sugary foods and beverages—to understand how this might be possible. In each of these cases, companies aggressively marketed products despite proven harms and actively resisted public-health efforts to control them. The tobacco industry, for example, funded research aimed at blaming cancer on other causes, like certain foods or hormones, rather than cigarettes. The sugar industry took a page from the tobacco script by funding research that dubiously shifted the blame for America’s obesity crisis toward saturated fats, launching a wave of low-fat foods that conveniently boosted their sugar content to preserve flavor.
In the late 1990s, Purdue Pharma relied on many of the same tactics to ramp up demand for its prescription opioid, OxyContin. They continued to falsely claim OxyContin had a misuse rate of less than 1%, even while the opioid crisis was starting to build in rural communities. Many doctors accepted these specious claims of low misuse rate, and it was not until 2011 that the U.S. Centers for Disease Control and Prevention acknowledged the overdose crisis in the U.S.
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Eventually, the overwhelming evidence of these products’ harmful effects and the persistent messaging of public-health authorities was enough to overcome corporate resistance. From the peak of consumption, U.S. cigarette sales have fallen by 82%, and use of prescription opioids has dropped by 62%. Even consumption of sugar has declined by 15% from its peak as consumers shift away from soft drinks and sugar-laden foods.
This evolution, however, was painfully slow. In the three scenarios we studied, the gap between the first suspicion of harm and a decline in consumption ranged from one to five decades. Even when overconsumption or misuse abates, companies are often adept at shifting focus to less-regulated markets abroad or encouraging consumers to switch to alternative products that still cause harm.
It’s not always obvious when a market-driven epidemic starts. Many of the products we now know to be harmful were seen as innocuous or even beneficial when consumers first began adopting them. But there are clear steps public-health authorities can take to recognize and interrupt market-driven epidemics before they inflict widespread harm. Emerging market-driven epidemics that warrant close attention include ultra-processed foods, since there is mounting evidence of harm but the evidence has not yet persuaded policymakers to act, along with nutraceuticals and dietary supplements. The U.S. remains the only high-income country that does not require companies to provide any efficacy or safety evidence for the long-term use of nutraceuticals and dietary supplements, yet these very widely used products are known to cause health harms.
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First, researchers must act more quickly to investigate the earliest evidence of emerging health threats, ensuring credible science moves faster than corporate efforts to debunk it. Governments also need to strengthen the requirements on companies to study and report the impacts of their products on health and hold them accountable when they hide evidence of harm.
Second, public-health leaders need to recognize the important role they have in bending the consumption curve. When the U.S. Surgeon General finally issued its first official warning about smoking in 1964, the bombshell report blanketed newspapers and television, becoming the authoritative voice the public could no longer ignore. It’s no surprise, then, that cigarette consumption in the U.S. began falling from around 1964 onwards.
Third, the voices of professional organizations, journalists, and even pop culture figures can have outsized influence in beginning to change the direction of a market-driven epidemic. In the case of sugar, for example, a 1999 report by the Center for Science in the Public Interest called “America is Drowning in Sugar” stands out as one of the watershed moments that began to turn the tide on America’s sugar habit.
Appealing 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 see dramatic changes in the consumption of such products over time, and that these shifts, while slower than we might like, save lives. Our research has shown that there are ways to intervene to accelerate the shifts, so that the consumption tipping point comes sooner, averting illness and death.
The bigger question is how we will react the next time that astute observers begin to point out adverse health effects that appear connected to the use of a popular consumer product. Will we listen? Or will we let the cynical machinations of companies seeking to preserve their profits succeed yet again? If we get better at recognizing the early warning signs—and calling out the inevitable attempts to distract us from them—perhaps the next market-driven epidemic won’t be so costly.
