In 1966, the National Institute of Dental Research (NIDR) began planning a targeted research program to identify interventions for widespread application to eradicate dental caries (tooth decay) within a decade. In 1971, the NIDR launched the National Caries Program (NCP). The objective of this paper is to explore the sugar industry’s interaction with the NIDR to alter the research priorities of the NIDR NCP.
Methods and Findings
We used internal cane and beet sugar industry documents from 1959 to 1971 to analyze industry actions related to setting research priorities for the NCP. The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake. Industry tactics included the following: funding research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay with questionable potential for widespread application, cultivation of relationships with the NIDR leadership, consulting of members on an NIDR expert panel, and submission of a report to the NIDR that became the foundation of the first request for proposals issued for the NCP. Seventy-eight percent of the sugar industry submission was incorporated into the NIDR’s call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP. Limitations are that this analysis relies on one source of sugar industry documents and that we could not interview key actors.
The NCP was a missed opportunity to develop a scientific understanding of how to restrict sugar consumption to prevent tooth decay. A key factor was the alignment of research agendas between the NIDR and the sugar industry. This historical example illustrates how industry protects itself from potentially damaging research, which can inform policy makers today. Industry opposition to current policy proposals—including a World Health Organization guideline on sugars proposed in 2014 and changes to the nutrition facts panel on packaged food in the US proposed in 2014 by the US Food and Drug Administration—should be carefully scrutinized to ensure that industry interests do not supersede public health goals.
Tooth decay (dental caries) is the leading chronic disease of children and adolescents. Although largely preventable, 42% of children in the US have some decay in their baby (primary) teeth, and 59% of adolescents have cavities in their permanent teeth. Tooth decay occurs when the hard enamel covering the tooth surface is damaged by acid, which is produced by bacteria in the mouth. Plaque, a sticky substance of bacteria, food particles, and saliva, constantly forms on teeth. When you eat food—particularly sugary foods and drinks—the bacteria in plaque produce acids that attack the tooth enamel. The stickiness of the plaque keeps the acids in contact with the teeth. Plaque buildup can be prevented by regular brushing and flossing. Dentists can detect tooth decay before it causes toothache through visual examination or by taking dental X-rays, and can treat the condition by removing the decay and plugging the hole with a “dental filling.” However, if the decay has damaged the nerve in the center of the tooth, root canal treatment or removal of the tooth may be necessary.
Why Was This Study Done?
Experts generally agree that sugars play a causal role in tooth decay. Consequently, in 2014, the World Health Organization (WHO) issued a draft guideline that recommended a daily limit on the consumption of “free” sugars (sugars added to food by manufacturers, cooks, or consumers). Also in 2014, the US Food and Drug Administration (FDA) proposed that the nutrition facts panels on US packaged food products should list added sugars. As with similar proposals made in the past, the World Sugar Research Organisation, a trade organization that represents companies with economic in