EFSA's toxicological assessment of aspartame: was it even-handedly trying to identify possible unreliable positives and unreliable negatives?

BACKGROUND: A detailed appraisal is provided of the most recent (December 2013) assessment of the safety and/or toxicity of the artificial sweetener aspartame by the European Food Safety Authority's Panel on Food Additives and Nutrient Sources Added to Food. That appraisal is prefaced with a contextualising chronological account drawn from a documentary archive of the key highlights of the antecedent scientific and policy debates concerning this sweetener from the early 1970s onwards. The appraisal focuses specifically on Section 3.2 of the panel's review, which is headed 'Toxicological data of aspartame'. METHODS: The methodology of the appraisal focusses on the extent to which the panel was symmetrically alert to possible false positives and false negatives, which in toxicological terms denote misleading indications of possible toxicity or misleading indications of safety. The methodology involved identifying and tabulating the prima facie indications of each of 154 empirical studies, and then comparing them with the way in which the panel chose to interpret the studies' findings, by focussing primarily on whether the panel deemed those studies to be reliable or unreliable. If the panel had been even-handed, the criteria for assessing reliability should have been the same for both putative positive and negative studies. RESULTS: Eighty-one studies were identified that prima facie did not indicate any possible harm, and of those the panel deemed 62 to be reliable and 19 as unreliable. Seventy-three studies were identified that prima facie did indicate possible harm; of those the panel deemed all 73 to be unreliable; none were deemed reliable. A qualitative comparative review of the criteria of appraisal invoked by the panel to judge the reliability of putative negative and positive studies is also provided. CONCLUSION: The quantitative result indicate that the panel's appraisal of the available studies was asymmetrically more alert to putative false positives than to possible false negatives. The qualitative analysis shows that very demanding criteria were used to judge putative positive studies, while far more lax and forgiving criteria were applied to putative negative studies. DISCUSSION: That quantitative and qualitative patterns are very problematic for a body supposed to prioritise the protection of public health. Given the shortcomings of EFSA's risk assessment of aspartame, and the shortcomings of all previous official toxicological risk assessments of aspartame, it would be premature to conclude that it is acceptably safe. They also imply that the manner in which EFSA panels operate needs to be scrutinised and reformed.

Developing national obesity policy in middle-income countries: a case study from North Africa.

BACKGROUND: The prevalence of overweight and obesity is a rapidly growing threat to public health in both Morocco and Tunisia, where it is reaching similar proportions to high-income countries. Despite this, a national strategy for obesity does not exist in either country. The aim of this study was to explore the views of key stakeholders towards a range of policies to prevent obesity, and thus guide policy makers in their decision making on a national level. METHODS: Using Multicriteria Mapping, data were gathered from 82 stakeholders (from 33 categories in Morocco and 36 in Tunisia) who appraised 12 obesity policy options by reference to criteria of their own choosing. RESULTS: The feasibility of policies in practical or political terms and their cost were perceived as more important than how effective they would be in reducing obesity. There was most consensus and preference for options targeting individuals through health education, compared with options that aimed at changing the environment, i.e. modifying food supply and demand (providing healthier menus/changing food composition/food sold in schools); controlling information (advertising controls/mandatory labelling) or improving access to physical activity. In Tunisia, there was almost universal consensus that at least some environmental-level options are required, but in Morocco, participants highlighted the need to raise awareness within the population and policy makers that obesity is a public health problem, accompanied by improving literacy before such measures would be accepted. CONCLUSION: Whilst there is broad interest in a range of policy options, those measures targeting behaviour change through education were most valued. The different socioeconomic, political and cultural contexts of countries need to be accounted for when prioritizing obesity policy. Obesity was not recognized as a major public health priority; therefore, convincing policy makers about the need to prioritize action to prevent obesity, particularly in Morocco, will be a crucial first step.

The potential role of taxes and subsidies on food in the prevention of obesity in Europe.

BACKGROUND: Obesity implies costs not only for the individual but also for society. The authors explore the opinions of stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe. METHODS: Structured interviews were conducted using Multicriteria Mapping, a computer-based, decision-support tool, with 189 interviewees drawn from 21 different stakeholder categories across nine members of the EU interviews, to appraise 20 predefined policy options aimed at reducing obesity, including 'taxing obesity-promoting foods' and 'subsidising healthy foods.' A four-step approach involved selecting options, defining criteria, scoring options quantitatively and weighting criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. RESULTS: Compared with other policy options appraised, taxation and subsidies were not favourably received, mainly because they were considered difficult to implement. Overall, trade unions rated both options more favourably than all other stakeholder groups. As anticipated, both options received their lowest scores from representatives of the farming, food processing and advertising industries. Nutritional/obesity advisory experts and public sector caterers gave the most positive ratings to subsidies overall. Along with public health professionals, large commercial retailers were most in favour of taxation. CONCLUSIONS: Taxation and subsidies were poorly appraised compared with other policy measures, with stakeholders expressing reservations mainly focussed on the practicalities and cost of introducing such measures. Although applying taxes/subsidies could be useful to combat obesity, the study suggests that most stakeholders still need to be convinced of their viability and acceptability when compared with other measures.

Policy options for obesity in Europe: a comparison of public health specialists with other stakeholders.

OBJECTIVE: To explore policy options that public health specialists (PHS) consider appropriate for combating obesity in Europe, and compare their preferences with those of other stakeholders (non-PHS). DESIGN: Structured interviews using multicriteria mapping, a computer-based, decision-support tool. SETTING: Nine European countries. SUBJECTS: A total of 189 stakeholders. Twenty-seven interviewees were PHS and non-PHS included food, sports and health sectors. MEASUREMENTS: A four-step approach was taken, i.e. selecting options, defining criteria, scoring options quantitatively and weighting the criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. RESULTS: The PHS concur with other stakeholders interviewed, as all emphasised the importance of educational initiatives in combating obesity, followed by policies to improve community sports facilities, introduce mandatory food labelling and controlling food and drink advertising. Further analyses revealed several significant differences. The non-PHS from the private sector ranked institutional reforms favourably; the PHS from non-Mediterranean countries supported the option of medicines to prevent obesity; and those PHS from Mediterranean countries endorsed the use of activity monitoring devices such as pedometers. As far as appraisal criteria were concerned, PHS considered efficacy and the economic impact on the public sector to be the most important. CONCLUSION: There is clear consensus among PHS and other stakeholders concerning the need for a package of policy options, which suggests that European-wide implementation could be successful. However, it would be advisable to avoid more contentious policy options such as taxation until future changes in public opinion.