Lethal but Legal by Nicholas Freudenberg (Oxford U. Press 2014) takes on one of the great paradoxes of our time: we have the scientific capacity to support healthier, longer life spans for the earth’s population, but in fact we see the spread of novel plagues more devastating than the medieval Black Death. In place of bubonic plague, smallpox, and other old-time infectious scourges that killed millions, we kill tens of millions with scientifically engineered malnutrition and with alcohol, tobacco, and other noxious consumer products.

Freudenberg is Distinguished Professor of Public Health at City University of New York School of Public Health and Hunter College, and a public health community activist for many years.

The American food industry is Freudenberg’s Exhibit 1. This industry has come under intense scrutiny in the past couple of decades. Freudenberg’s chapters present a condensed array of much of this literature, pointing out how the major food producers tend to concentrate their production and marketing on “food” that contains high quantities of sugar, salt, and fat.

Highly sophisticated scientific research goes into designing this shit and into figuring out how to push consumer’s psychic buttons to keep buying it. The result is malnutrition on a massive scale, evidenced by rising rates of obesity, diabetes, and related diseases. People who consume this stuff feel full, but nutritionally they are empty.

Almost everyone in the US understands by now that tobacco is bad for you, and public health advocates have scored important victories against the industry. Nevertheless, as Freudenberg points out, industry profits are high. The companies have penetrated major foreign markets such as Russia, Indonesia, Latin America, and other areas of the third world, where tobacco education is weak and effective regulation is nonexistent. As a result, the number of people worldwide who die each year of tobacco-related diseases is growing, not diminishing.

Alcohol, long a major killer and wrecker of lives, is now in the hands of a far more concentrated set of industry giants than twenty years ago. With giantism comes multibillion dollar marketing, promotion, and control of governments. Freudenberg points out that marketing to minors has become a key industry strategy, and that, as before, the core of the industry’s market consists of pathological drinkers (alcoholics and alcohol abusers). Freudenberg is not fooled by the industry’s “drink responsibly” campaigns, which are mere windowdressing to deflect public dismay.

It isn’t news, as Freudenberg readily concedes, that the driving power behind the modern spread of these weapons of misconsumption is the capitalist corporation. In every case, the harm to public health from these poisons is well known and often demonstrably clear to industry insiders, but the systemic pressures to generate not only profits, but growing profits, override and squelch any feelings of empathy for the consumer that might have infiltrated the ranks.

The profits are great, but the human costs are staggering. World Health Organization research predicts that by 2020, three out of four deaths in the world will be from Non-Communicable Diseases, such as the cancers, heart diseases, and diabetes associated with corporate comestibles.  NCDs cause trillions of dollars in economic losses and push millions of people below the poverty line each year. Treating such conditions accounts for more than 75 per cent of U.S. healthcare costs.

The dramatic improvements in public health seen in recent decades have stalled and researchers forecast that average life expectancy in the US will decline; for women, the decline has already begun. Along with chronic diseases, there is an alarming worldwide rise in deaths and disabilties due to civil (not war-related) injuries. Traffic injuries due to the spread of motor vehicle use and casualties from interpersonal or self-inflicted violence show dramatic increases.

Virtually every metric of public health shows continuing and often increasing gaps between rich and poor, men and women, whites and others. The ambitious goals of flattening such inequities, announced decades ago, have not come close to fulfillment; on the contrary, many gaps are widening.

In addition to the big three industries that make us sick, Freudenberg cites three principal auxiliaries: automobiles, guns, and drugs. The auto industry contributes to illness in three ways: through pollution, through injuries, and through promotion of a sedentary life style. As with tobacco, modest advances in emission controls and collision safety in the US are overwhelmed worldwide by chaotic escalation of auto use in much of the third world; it’s estimated that auto crashes globally killed 1.3 million people in 2010. Meanwhile the car companies continue to resist every safety measure. They lobby for highway subsidies, and oppose development – or promote destruction – of public transit, worldwide.

The firearms manufacturers follow the same path: relentless promotion, vociferous opposition to regulation, despite massive and growing evidence that guns claim far more lives than they save.

A similar hypocrisy animates the pharmaceutical industry. Yes, prescription drugs save lives, but they also take lives; prescription drug mortality, according to the US Food and Drug Administration, is a leading cause of death. Heavy promotion of inadequately tested drugs (Vioxx, for example), deceptive advertising, results-oriented “science,” the invention of “diseases” to match profitable drugs, and obstruction or co-optation of cheaper generic alternatives are among the profit-motivated abuses that have turned Big Pharma into a dirty word.

A few hundred (perhaps fewer) corporations preside over this massive global carnage. Despite the variety of their products, their strategies are remarkably similar: harness science in the pursuit of deception, spend billions to disseminate lies and illusions, buy up governments, promote public subsidies for their private profits, oppose regulation, and shift their costs onto others. And these corporate interests pervasively infiltrate the very bodies designed to build awareness of their activities, and pull the teeth from the language of unbiased research findings and policy recommendations.

From Lethal but Legal, p. 96.

After an introductory profile of these six horsemen of the apocalypse, Freudenberg sketches the recent historical background: the rise of a self-conscious corporate power movement, aggressively targeting the modest advances in the realm of consumer protection and environmental regulation achieved during the 1960s and 70s. Key to this retrograde movement was the expansion of US based corporations abroad, and their conversion into multinationals that were “American” only in name. Along with their revenue base, they became more powerful in politics, tailoring fiscal and monetary policies to the advantage of their billionaire owners. Virtually every sphere of politics and culture fell under their dominance.

The result, Freudenberg writes, is that the “military-industrial complex” of which Eisenhower warned has been succeeded by a “corporate consumption complex.” This complex “has become the most powerful influence on the health of the world’s population and on the environment that sustains life.” The most problematic activity of this complex is what Freudenberg terms “hyperconsumption,” by which he means “patterns of consumption associated with premature death and preventable illnesses and injuries.”

Detailed profiles of the McDonald’s corporation (“A franchise for super-sizing children around the world”) and of the Pharma trade association stand as illustrations.

Buttressing the economic and political power that its money can buy is the complex’s ideological influence. It promotes a catechism of free-market, individualistic core beliefs which, needless by this point to add, are at direct loggerheads with its monopolistic, conformist actual practice.

A vast array of subsidized think tanks, academic departments, and a meretricious intelligentsia make a living pumping this garbage into the minds of the masses. It seems to work, at least for now; but public opinion polls show that a majority of Americans (and people in other countries) don’t trust corporations and want their influence scaled back.

To counter the corporate credo, Freudenberg proposes an alternative set of theses that rests on deeply and widely felt moral principles. It is worth quoting:

1. Making a profit by sickening others is wrong.

2. Parents, families, teachers, and health professionals, not corporations, should educate people about health, nutrition, and moral values.

3. Nanny corporations that seek to exploit children’s vulnerability and immaturity, not nanny states, are the real threats to health and freedom.

4. The goal of social policy should be to make healthy choices easy choices.

5. In a globalized world, economic activity anywhere affects people everywhere; shifting the harms of such activity to another region or country in order to protect one group is wrong.

6. Every generation has a responsibility to leave the world a better place for future generations. Knowingly bequeathing our children and grandchildren a burden of disease, damaged environments, or corrupted democracy violates most of the world’s moral codes.

7. Science belongs to all humanity; appropriating it to profit at the expense of health or the environment is wrong. (p. 152)

Counteracting corporate policies, like those policies themselves, needs to happen on a global scale, Freudenberg argues. A discussion of NAFTA and its impact on the economy and public health of Mexico is one of the most powerful case studies in the book. NAFTA opened the Mexican market to exports of US government subsidized corn and corn syrup, paved the way for Walmart and other big retailers to muscle into Mexico’s retail networks, and changed the diet of the average Mexican from a sustainable pattern based on local agriculture into a debilitating dependence on fast food, sodas, and other junk, with shocking increases in rates of obesity and diabetes.

Similar patterns are underway in China, India, South Africa, and Indonesia, among others.

NAFTA and the World Trade Organization have changed the whole framework of international commerce, from something that bore at least a resemblance to the free market template to a managed, closed-off commercial absolutism in which unaccountable big-corporate committees dictate terms to outside private parties and governments. Advocates of public health concerns are hermetically shut out of these bodies.

Foreign investment, tariff reductions, taxation cuts, and intellectual property laws are additional weapons by which the corporate consumption complex penetrates other countries and sickens their people.

In Part II, Freudenberg looks at countervailing efforts to promote public health and constrain corporate power. There are thousands of organizations at every scale of operation working on the issues Freudenberg has raised. He briefly surveys historic movements for food and drug safety, worker safety and health, and against child labor, as sources for a general sense of optimism that change can be made.

Among his more contemporary case studies is the food justice movement in New York City, the Black Community coalitions against the alcohol industry, the California Air Resources Board’s campaign against motor vehicle emissions, the Million Mom March against the gun industry, groups of medical professionals working to restrict the influence of Big Pharma, and the Corporate Accountability International’s (CAI) global campaign against Big Tobacco.

In the final chapter, Freudenberg returns to the paradox posed at the outset. He asks, “Can what is still the wealthiest nation in the world chart a new path in which our system of production and consumption is redirected to make health, sustainability, and democracy the priorities? … Or will a few hundred global corporations continue to have first call on these assets to advance their own profits at the expense of human well-being?”

What has to happen, he says, is to change the business and political practices of the multinational corporations. Toward that end, he offers a catalogue of lessons for popular movements, ranging from tactical advice (engage minds and emotions, target specific companies, propose alternatives, build partnerships, etc.) to strategic goals such as developing an alternative, healthy and ethical consumption ideology. It’s necessary, he concludes, to evict corporations from our minds, from our institutions and communities, and from our political system.

Freudenberg’s exposition throughout the book is densely factual, extensively documented, and clearly written. Freudenberg travels easily across the boundaries between medicine, politics, history, economics, and diplomacy, and has a knack for explaining highly technical topics in terms accessible to the lay person. His opinions are on the table, but his tone is never didactic or preachy (or at least it doesn’t seem that way to this reader). The book will not take the place of any of the specialized treatises devoted to one or another of the six deadly industries on which Freudenberg focuses. Nor will it supplant specialized studies about world health, the world economy, NAFTA, the WTO, and similar topics. However, it offers reliable, compact and well documented synopses of the best work that has been done in these different areas – itself a formidable accomplishment. What makes the work uniquely valuable is the synthesis of all of these problem areas into a single readable volume. I don’t know of another work that moves so comprehensively and systematically from a wide range of individual case studies to the global picture. Freudenberg makes this exceedingly difficult task look easy. The book comes from an academic press, but deserves a much wider readership.

Freudenberg’s analysis is tightly reasoned and supported by major bodies of research. There are some areas, however, where I felt there may be room for improvement. The term “hyperconsumption” is, I think, a misnomer. In terms, it means “excessive consumption.” To be sure, each corporation wants to maximize its sales, and getting people to consume bigger sodas and bigger bags of french fries is certainly a means toward that end. But seen from the societal standpoint, the hyperconsumption of one demographic goes hand in hand with the hypoconsumption, the food insecurity and hunger of another. Some 49 million Americans frequently go without food part of the month, including about 16 million children. Far from turning us into a “consumer society,” corporate rule is taking consumption out of the reach of millions. The picture is even more extreme on the global scale, where hunger is far more typical than excess consumption. Calls to “consume less,” which Freudenberg occasionally echoes, make sense for an affluent demographic, but ring hollow to the growing number of people at the bottom. It may also be worth pointing out in this context that the decay of the American infrastructure, notably water supply and sewage removal, is setting the stage for a comeback of traditional bacteria-borne scourges.  I’m sure that Freudenberg is not unaware of this point, but it would strengthen the book to acknowledge it more explicitly.

Freudenberg’s decision to limit the scope to just six industries is clearly defensible on the grounds of volume. A wider scope would make an unreadably long tome. Still, it might have been useful to include a few well-chosen paragraphs about industries such as chemicals, coal, nuclear, petroleum, mining, and other raw material and producer sectors. Although not “consumer” industries, both the harm and the operating methods would appear to have much in common.

The book could also benefit, in my opinion, by more systematically puncturing the corporate fiction. Sentences in which corporations are the subject of a verb (“Corporation A does XYZ”) remain, at bottom, spell-bound by the corporate veil. Corporations are nothing but masks worn by rich sons of bitches. Freudenberg knows this well, giving Mexico’s oligarch Carlos Slim as an example early on, but the point gets lost in most of the book. To drive home the injustice and brutality of what is going on, it’s important to be able to speak in personam. For example: So and so many millions of Americans suffer from cancer and other diseases so that Charles and David Koch can freely spew their chemical pollution into the air. The most important corporate reform is to hold this class of people and their lackeys accountable, haul them into modern-day Nuremberg trials, and put them in jail. Only after that is done can talk about revision of corporate priorities achieve real-world traction.

But, I suppose, a book published by Oxford University Press can’t speak in quite those bloodthirsty terms. Within the academic envelope, Freudenberg’s book is an outstanding piece of work, combining an enormous labor of research with a bright and optimistic activist’s passion. Well worth reading.