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Susan Greenhalgh is a professor emerita of anthropology and the John King and Wilma Cannon Fairbank Professor of Chinese Society at Harvard University. An anthropologist by training, she has spent decades studying the entanglements of the state, corporations, science, and society in China. She is the author of a new book, Soda Science: Making the World Safe for Coca-Cola, which tells the story of how the iconic American soft drink producer secretly funded scientific research that minimized its role in driving up obesity rates around the world, especially in the U.S. and China. In this lightly edited Q&A, we discussed the findings of her decade-long research project and the dynamics that led Coca-Cola-sponsored research to become China’s public health dogma, as well as what this scandal reveals about the nature of U.S.-China scientific cooperation.

Q: Your book tells the story of how Coca-Cola and other corporate sponsors created an “alternative scientific story” about obesity, one that downplayed the role of sugary soda and emphasized exercise as the way to combat the obesity epidemic. Researchers call this kind of research “product defense science.” Could you explain that term and how Coca-Cola achieved this? 

A: The term product-defense science is not very familiar to people, but I hope it will become more familiar over time. It’s a kind of science created by an industry, in this case the food industry, not to find the cause and solution to a particular problem, but to protect a harmful product from critiques. In the case of soda defense science, the soda industry sponsored studies to defend sugary soda from public health critiques that sugary drinks were a major factor behind the rise of the obesity epidemic. That idea was a big threat to their profits and they wanted to protect their product.

Coca-Cola and its friends in the Big Food community had a secret weapon: the International Life Sciences Institute. ILSI was an industry-funded scientific nonprofit whose job was to create science that was helpful to the food industry. This was a shadowy and secretive organization. It first recruited advisors to help it create this new science. And no sooner did the chief executives of the top food industries announce that they would support only a solution to the obesity epidemic that prioritized exercise, then these advisors, working through ILSI, began to organize a series of scientific conferences, inviting scientists that would, over time, promote the idea that exercise is the priority solution. They constantly stated that, of course, dietary restraint and caloric limitation are important too; but exercise is the primary solution. If you look at the science that was created, it turns out that almost all the scientific activity was devoted to studying exercise; little research was devoted to food, per se. In time, exercise-first became a main scientific strand.

When did this campaign begin?

It began in April of 1999, when ILSI hosted a secret meeting of top CEOs of the food industry to consider a growing public health critique that sugary soda was a main factor in the rising obesity epidemic, especially among children. At the meeting, the speakers proposed a broad program that would include exercise and diet. The CEOs said, no, we’re not doing diet, we’re only promoting exercise. So with that, the core idea of this new science was born. The CEOs provided the main idea behind the science, and then, starting immediately, ILSI took this on and began sponsoring conferences to create a supportive science. These continued over the next 15 years.

I started looking at this issue in 2013. A lot of evidence had just come out showing that Big Food was taste engineering what we ate. It was working very hard to create these highly unhealthy, but very tasty foods that were becoming a major part of our diet. I had a hunch that if they were engineering the food, maybe they were also engineering the science behind what we should eat, and what caused the chronic diseases of modern life. 

So I set out to study China’s obesity work by mapping the science and policy of obesity. Then in 2015, an expose came out in the New York Times showing that Coca-Cola had allocated $20 million to a global network of energy balance scientists who were promoting activity first. Whew! I realized I was working on the single biggest case of ILSI promoting that science abroad. So I decided to focus on the food story. To do that, I needed to tie all the information I had gathered from China to what was going on around the world, tracing the complex links between Chinese developments and big corporations like Coca-Cola, as well as global scientific and health organizations like ILSI Global, the WHO and the U.S. CDC.

How did soda defense science arrive and take root in China? And why was it such an important market for Coca-Cola?

Coca-Cola was the very first foreign company allowed to do business in China after the opening in late 1978. Deng Xiaoping himself had approved the deal. For Coca-Cola, China was a critical market with 1 billion potential customers. China was growing rapidly; its people had extra change in their pockets and were eager to taste the fruits of modernity. 

The vice president of Coca-Cola, Alex Malaspina, was the head of ILSI Global. He was very savvy. He knew that in China, scientists work within and with the state, tying science closely to the state. My interviews suggest that he had this in mind when he chose as the head of ILSI China a former official in the Ministry of Health. He seemed to realize that once you start working with a prominent scientist in China, you gain direct connections to the state. The evidence suggests he was hoping that the industry-friendly kind of policies that ILSI wanted to promote could actually be adopted by the government. 

That head of ILSI China, you wrote, was a top scientist named Chen Chunming. Could you tell us about her and what made her so influential in advancing the soda industry’s interests?

One thing about this story is it’s really about just a handful of people with really distinctive personalities. Chen Chunming is a prime example. Chen was a smart, charming, cosmopolitan scientist and her English was really quite good. I interviewed a dozen global experts on obesity who all described her in glowing terms. In addition, her father had been personal secretary to Chiang Kai-shek, who, of course, became the head of the government in Taiwan. After the Communist Party took over in 1949, her father moved to Hong Kong and became a calligrapher, while Chen Chunming stayed in China. She presented herself as very modest and patriotic, a scientific official who devoted her whole life to making nutrition an important part of China’s health policies. Chen is widely admired in China. She passed away in 2018.

So how did Chen get to know all of the people in the soda industry?

When Malaspina [the head of ILSI Global and vice president at Coca-Cola] traveled to China in 1978 to scout for Chinese collaborators, he identified Chen Chunming and her partner (who started out as deputy director) as promising partners. The late 70s and early 80s were very chaotic times in China. After the Tiananmen Massacre in 1989, Deng Xiaoping took his famous “southern tour” in 1992, reopening China to the global marketplace. It was then that ILSI China was formed. 

ILSI Global had worked with Chen Chunming informally for some 15 years, and in 1993 opened a formal branch in China. But it was only after that 1999 CEO meeting in the U.S. that ILSI Global asked all its branches to start working on obesity. For the first few years, Chen Chunming worked with her community of scholars to create the BMI cut points [Body Mass Index risk cut-off figures] for China. They’re a little different from those used globally. 

Then, starting in 2004, Big Food began promoting the notion of “exercise first” internationally. That’s when “exercise first” ideas began to make their way into China. Chen Chunming was gung ho about the exercise idea. ILSI Global had created a school-based exercise program for kids; Chen grabbed it and ran with it, creating a version that was introduced in China in late 2004. ILSI China was located within the Chinese Center for Disease Control, which was a branch of the Ministry of Health. So here we have a Big Food-funded organization located within a ministry of the PRC. From that location, Chen began organizing conferences on obesity, inviting none other than the scientists who had created soda science in the U.S. to give key speeches. Virtually all the foreign speakers were affiliated with ILSI Global, and many of these folks who argued for exercise first were presented as the best scientists in the world. In this way, Coca-Cola, working through ILSI, ensured that its exercise-first science of obesity was accepted as authoritative, and then gradually, with Chen Chunming’s assistance, built into Chinese policies.

Was there a particular set of policies that Chen Chunming helped write that spread the idea of “exercise first” around the country? 

Chen and ILSI China were personally involved in creating China’s first two obesity policies. The first was a set of guidelines for the management and prevention of obesity. That was published by the Ministry of Health in 2003 and, interestingly, said both diet and exercise are important. Coca-Cola’s voice had not yet been heard.

The exercise-first campaign by Big Food started in 2004, and was reflected in the second policy Chen and ILSI China created, “healthy lifestyle for all.” This was an annual campaign based on the patriotic health campaigns which Mao Zedong had made famous. “Healthy lifestyle” was a national campaign to mobilize everybody around the country to exercise and eat better to improve the profile of chronic diseases, especially obesity. The campaign became an annual event that’s still happening today. The “healthy lifestyle for all” campaign was very much based on soda science, with a lot of targets to do with exercise, and few to do with food. 

If you asked any Chinese health expert, they would absolutely deny that diet was being neglected. But if you looked at what was getting the most money and the most energy, it was research into physical activity.

How did the idea of exercise first spread? Around 2012-13, obesity was merged with chronic diseases more generally in a five year plan for the prevention of chronic or non communicable diseases. The action was built right into that national plan. And then in 2016 Xi Jinping announced his Healthy China 2030 plan to tackle chronic diseases, and so the action got built into Healthy China 2030. At the core of all the health policies on chronic disease is the notion of exercise first for obesity.

Of course, the idea of promoting exercise and active lifestyles is not new in China right? That has been a consistent theme for much of Chinese history. Was there ever an effort by Chinese scientists to diminish the importance of reducing food consumption? 

If you asked any Chinese health expert, they would absolutely deny that diet was being neglected. But if you looked at what was getting the most money and the most energy, it was research into physical activity. Proportionately, the investment in diet was declining, even if in absolute terms it may have been increasing. 

But you’re absolutely right about there being a long standing theme, especially in communist societies, of needing a strong physical body to support a strong country — just think of Mao swimming in the Yangtze river. But after the reforms of the late 70s, exercise levels declined and people were becoming very unfit. The public health community felt a need to promote more exercise. The push from Coke thus melded with existing emphases in China. 

After Coke was exposed in 2015 for sponsoring these studies, you write the whole ‘soda science’ field in the U.S. basically collapsed. Yet in China, you note that this strain of industry-friendly bias continues to shape official thinking and policy to this day. Why was there no comparable fallout in China for the institutes and people pushing Coke’s agenda? 

The Chinese government has been very market friendly ever since the beginning of the reform period. In the early 80s, Deng emphasized fostering the economy first, saying “let some get rich to lead all to common prosperity.” He also defunded the health sector, allocating the majority of funds to projects for economic growth. The health sector was told to rely on the market. Health researchers had to go to market forces like corporations to get money, while practitioners, like doctors and hospitals, had to make their own money. Hospitals turned to selling all sorts of drugs at a premium so they could get money to operate. 

Also, China loved Coca-Cola. As I mentioned, it was the first company let in after Deng Xiaoping became the top leader. The Chinese saw Coca-Cola as this major U.S. company and a source of advanced technology and scientific ideas. From the beginning, Coca-Cola has worked with the state owned enterprise COFCO [China Oil and Foodstuffs Corporation] to distribute the drink within China. Today, there’s a partnership, COFCO Coca-Cola, which bottles and distributes Coke for 81 percent of the geographical area and 49 percent of the population of China. COFCO owns 65 percent of the shares, Coca-Cola 35 percent. So the government is deeply financially invested in having Coca-Cola remain within the Chinese market. There are many good reasons that the downfall of soda science in the U.S. was not repeated in China. 

Do you think it’s fair to say that the state affiliation of China’s research institutes chills scientific disagreement and dissent?

Absolutely. That’s why nobody could ever undo the policy initiative that had been taken under Chen Chunming, because to say a prior policy was wrong is to admit that the Communist Party can make mistakes. These institutions within China are embedded in a political culture that is explicitly hierarchical. The leader of a Chinese institution is a leader of everybody within it, and no one challenges the leader. In these scientific institutions, the leader articulates the truth, and those working under them are supposed to do the scientific research that supports that truth. I interviewed many people who emphasized this point. 

By investing so heavily in exercise programs for obesity in China, when no other party was investing much in any solution, Coke easily biased China’s policy toward its preferred solution, with apparently little concern for the impact on human health.

When I talked to very senior scientists, some who were as accomplished as Chen Chunming herself, they confided that they knew deep in their hearts that the science of obesity was being biased by corporate influence. But there was nothing they could do except leave the scene, exit ILSI and go work with another organization. Junior scholars also stressed they could never question the leader. That would mean questioning the whole system they were in, disqualifying them from having a career within it. The system of statist science is very hierarchical, and anybody who’s not a leader has to keep critical views to themselves.

What does your book show about how China regulates? 

In the U.S., there are all sorts of detailed rules about corporate investment in science. In China, there’s little regulation of any sort. The scientists I talked to there were deeply distressed because they knew there was no concrete state guidance for this kind of activity. Thestate just had two general norms. One was that industry should fund science, the other was, industry must not bias science. 

But those norms conflict: of course, if industry was going to fund it, it was going to shape it to its needs. The state did not acknowledge the bias, so the scientists were left on their own to figure out how to manage this. There was a strong, informal norm that companies working with ILSI were not supposed to benefit, but it was not enforced. Nor were there enforcement mechanisms. I witnessed a Coke officer at an ILSI-sponsored conference advertising their Coke on PowerPoint slides. That was absolutely not allowed, but ILSI China could not say no to Coca-Cola because it sponsored the conference!

One of the most interesting dynamics you explore in your book is the perceived “global hierarchy of science,” which puts a premium on “western” science, enabling corporate-influenced research to be accepted in China almost as fact. Could you say more about this dynamic? Do you think it still persists today?

There is an idea among scientists around the world that the center of science globally is in Euro-America, where the best science in the world is produced. Other nations are located on the periphery, and must copy the core’s science to catch up. In China, such views were deeply held because of a long standing national narrative lamenting China’s scientific backwardness. Among those I interviewed, there was a strong consensus that we’re backward now, but if we learn from the West and adopt their scientific practices, eventually we’ll become a global leader too. This narrative goes back a long way. 

China’s embrace of modern science and technology did not occur until the Opium Wars of the mid-19th century, when Western nations launched incursions into Chinese territory with gunboat diplomacy. China saw the West as the master of this advanced military technology that it needed to defend itself and, more generally, challenge the west and regain its former glory. A similar mindset is still present today in certain fields of science.

Today China is known around the world for being at the top of the game in certain high tech and scientific fields. But Chinese science is stratified. Some of those sciences the state wants to promote for essentially status reasons, and others because they’re crucial to advanced industrial development. These fields get a lot of state investment. But what I call the everyday sciences — health, medicine, environment, education — those are not top-priority fields. They get much less state funding and often have to fend for themselves in the market. Some of those sciences still are less advanced than those of the West, and so there’s reason to learn from them.

The issue of U.S.-China scientific cooperation has become fraught in recent years. A landmark agreement between the two countries — one of the oldest — was allowed to expire last year and has not been renewed. Many scientists have lamented the loss of this framework for bilateral scientific collaboration. Yet here we have an example of where the cross-border diffusion of science may actually have done real harm. Do you see this as an example of where transnational science can actually be a net loss rather than a benefit?

[Note: On December 13, the U.S. and China announced the renewal of the U.S.-China Science and Technology Agreement, after this interview was conducted.]

I absolutely do. And the real target of my critique here is Coca-Cola and all the scientists and organizations that allied with it to go to China and basically take advantage of the naivete of the Chinese. The Chinese trusted these foreign corporations to come and share their advanced bottling technology and scientific ideas. But will the Chinese hear the critique in this book? I’m not so sure. The market approach to chronic disease is deeply entrenched, and Chen Chunming, who passed away in 2018, is untouched. She’s a hero and a patron of public health. 

After Chen Chunming passed, what became of ILSI China?

ILSI China disbanded. I was told by the most recent leaders that it closed in 2019. It folded because I published some of the main results from my research in early 2019 in the very prestigious British Medical Journal. That article documented how China’s approach to obesity became ever more exercise-focused once Coca-Cola entered the field of public health. ILSI Global was deeply incensed and published a scathing critique of my work on its website. Unhappy about my research on ILSI China, and the research of other scholars working elsewhere, ILSI Global decided it needed to reorganize. It did that by sloughing off the branches that had engaged in ethically troubling behaviors. 

But the ideas that Coke and ILSI propagated are stickier. They’ve been built into policy and are unlikely ever to be removed. 

When it comes to tackling obesity, is your sense that the pendulum has now swung back in the direction where more people are talking about consumption and are not just concerned about exercise?

Probably the dominant view today is that the single most important force behind the global obesity epidemic is the excessive consumption of ultra processed food, including sugary sodas. They account for 60 to 70 percent of the U.S. diet in part because the companies have done such a brilliant job of marketing their junk. Leading public health scientists never agreed with the view that physical activity is the most important thing. But because the soda scientists had so much funding from Big Food, they were able to widely promote their ideas, especially in the Global South, where people didn’t really know about the conflict in obesity science in the U.S..

Can you tell us about some of the discoveries you made along the way that shocked or surprised you? 

There were so many interesting things that turned up that I just never imagined. For example, I suspected that after Big Food began promoting soda science in China, if there was some way to measure it, we would see a growing influence of exercise-related activities in China’s antiobesity work. During my fieldwork, I discovered that ILSI China put out semi-annual newsletters documenting all its work. Not expecting much, I turned those newsletters into a source of data, pulling out all the articles on ILSI’s anti-obesity work, classifying the activities as emphasizing exercise or diet, and then arranging them by year. And sure enough, there was a dramatic increase in the proportion of anti-obesity related activities promoting exercise, and an equally big drop in the proportion promoting dietary change. I was stunned by the size of the change. Using those same data, I discovered that when you remove the Coke-funded anti-obesity activities emphasizing exercise, the increase in exercise disappears. That tells us that Coca-Cola single-handedly biased China’s approach toward exercise first. By investing so heavily in exercise programs for obesity in China, when no other party was investing much in any solution, Coke easily biased China’s policy toward its preferred solution, with apparently little concern for the impact on human health.

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