Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr Jessica Vitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
Americans love caffeine, and not just in soda and coffee. Sales in caffeinated energy drinks may reach $19 billion this year. Sales in new caffeinated snacks and candy, like Energy Gummi Bears and Jolt Gum, exceeded $1.6 billion last year. But the Food and Drug Administration is concerned about the potential health impacts of these new caffeinated products, particularly those that appeal to children. The FDA is reviewing reports of six deaths allegedly associated with energy drinks. But companies that make caffeinated food and drinks argue their products are safe and that they don’t market to children.
- Dennis Herrera city attorney of San Francisco.
- Bob Arnot physician and former medical correspondent for NBC and author of 14 books including, "The Aztec Diet," and "The Prostate Cancer Prevention Plan."
- Barry Meier staff reporter for "The New York Times" and author of "Pain Killer: A 'Wonder' Drug's Trail of Addiction and Death."
- Michael Jacobson co-founder and executive director of the Center for Science in the Public Interest and author of "Restaurant Confidential," "Marketing Madness," "What Are We Feeding Our Kids?" and "The Fast Food Guide."
- Michael Taylor deputy commissioner for foods and veterinary medicine at Food and Drug Administration.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. This summer the Food and Drug Administration will begin a review of all new caffeinated products on the market from energy drinks to caffeinated maple syrup. Some health experts worry many of these caffeinated products appeal to children.
MS. DIANE REHMThe City of San Francisco is suing Monster Beverage for marketing to kids. With me in the studio to talk about caffeinated energy drinks, candy and snacks, Michael Jacobson of the Center for Science in the Public Interest, joining us by phone from New York, Barry Meier of The New York Times and by phone from New Hampshire, Bob Arnot, a medical consultant from Monster Beverage.
MS. DIANE REHMBut before we begin our conversation with our guests, joining us by phone from Washington, D.C. is Michael Taylor. He's deputy commissioner for foods and veterinary medicine at the FDA. As I said, the FDA is reviewing the health effects of these products. Good morning to you sir.
MR. MICHAEL TAYLORGood morning, Diane, great to be with you.
REHMThank you. Michael Taylor, tell us why the FDA launched a review regarding the potential health effects of these caffeinated energy drinks and food?
TAYLORWell, Diane, as you know, food safety is really central to our mission here at FDA. We take a broad view of food safety. We do a lot of work as you know in the area of controlling microbiological hazards. We have a new food safety law on that topic.
TAYLORIt's getting a lot of attention. But chemical safety, the safety of chemical additives in food is a front-burner issue for us. And caffeine and energy drinks and other products in which caffeine is being used are of central concern to us.
TAYLORAnd it's a challenging problem, you know, we know that caffeine is not just another food additive. It's a potent, central nervous system stimulant. You know, on the one hand however, there are long-standing and accepted uses of caffeine in coffee and tea and to a limited extent in soft drinks but these uses have all been undertaken with a traditional sense of limits on use.
TAYLORPregnant women should avoid drinking substantial coffee. Kids should stay away from caffeine. What we're seeing now with these new products is new uses that have broken out of the traditional boundaries and the traditional sense of limits on intake of caffeine...
TAYLOR...but what we're really saying is, you know, let's be sure we're asking the right questions about the safety of these products particularly, you know, for certain sub-populations. And so that's really what we're doing now scientifically, is being sure we understand the potential risks.
TAYLORAnd then we will look at what other regulatory options that might be appropriate to address any concerns that are demonstrated through this scientific process.
REHMAnd do I understand correctly that the FDA is reviewing at least six reports of deaths allegedly associated with the consumption of energy drinks?
TAYLORWe have gotten a number of reports of deaths. These are reports however that typically come in with very limited information about the actual consumption of the product, the actual levels of the caffeine people might have taken in and so we've investigated each of these as thoroughly as we can with the information available and we take the reports seriously.
TAYLORWe have yet to be able to demonstrate causally a link between the energy drinks and these deaths but we do have reason to ask questions about whether vulnerable populations, children, adolescents, might be at risk for these products.
TAYLORYou know, these products are being consumed differently from the traditional uses of caffeine. They're being marketed, you know, for their stimulant properties, for their so-called energy properties. They're being marketed and used by adolescents.
TAYLORThey're being used under conditions of physical stress...
TAYLOR...and we just want to be really certain that we're, you know, we're asking the right questions...
TAYLOR...so that we know what the risks are.
REHMAnd my question is, are there any limits of the FDA or any other regulatory body which can be put on a product containing caffeine? I'm looking at popcorn. I'm looking at Choco Mallows. I'm looking at caffeine-infused gum, syrup.
REHMI mean, how much caffeine can go into these products without drawing your attention?
TAYLORWell, the only added use of caffeine, as caffeine as an added ingredient that FDA has formally recognized in its regulations, is a use that, of caffeine in cola soft drink beverages. Under the food additive laws of, that we use to regulate these ingredients there's a provision of the law that says that if companies make their own independent determination that their use of caffeine or other additives is generally recognized as safe then they're free to undertake those uses without coming to FDA and based again on their own independent determination of safety.
REHMSo wait a minute, wait a minute. You're saying to these companies, you create your product. You decide what's safe and you then market it as safe without any oversight at all?
TAYLORWell, let me be really clear, they don't get to make up the safety standard. Congress has proscribed what we think is a sound, reasonable and strong safety standard which is the use must present a reasonable certainty of no harm.
TAYLORAnd furthermore, that use has to be supported by scientific evidence that the companies can point to that is in the public domain and on the basis of which experts have it that there is general recognition among experts that that science supports safety.
TAYLORSo the standard is strong but under the law companies can make a determination of whether a new use of a substance meets that standard and market until we challenge that finding. And so what we're in the process of doing is assessing, you know, whether the basis upon which companies have made these determinations and whether we need to impose some restrictions on some of these uses...
REHMSo, so how long is your study going to take and in the meantime what would your recommendation be to consumers?
TAYLORWell, the, you mentioned in the lead-in that we are working with the Institute of Medicine to have a public workshop this summer that will bring together experts with diverse expertise and perspective.
TAYLORAnd on the basis of that we will be formulating, you know, possible regulatory options. The regulatory process takes time which is why we ask companies who are thinking about new products in this domain to exercise restraint.
TAYLORYou know, we need to figure out what the right boundaries are. In the meantime, you know, consumers should follow the traditional advice. You know pregnant women should avoid these products. Kids should stay away and adolescents should stay away from caffeinated, you know, products including...
TAYLORBut isn't that exactly to whom they're being marketed right now?
TAYLORWell, again, I think that's an issue that's on the table and you'll be talking about it with your guests today. We need to look at whether there are labeling options that we can implement at FDA. The advertising of course is regulated by the Federal Trade Commission so there are going to be multiple elements to figuring out, you know, what are the right boundaries? How do we ask the right questions and take prudent steps just to be sure people aren't being put at risk?
REHMAll right. Michael Taylor, he's deputy commissioner for foods and veterinary medicine at the FDA. Thanks for joining us.
TAYLORThanks for having me, thank you Diane.
REHMAnd turning to you now Barry Meier, a health reporter for The New York Times, what is the health concern about these energy drinks?
MR. BARRY MEIERWell, Diane, the basic health concern is simply this. You don't want to have 12-year-olds, 13-year-olds, 14-year-olds jacked up on high levels of caffeine. You can go to any school in the country, talk to school nurses and they will tell you stories about kids who come into their schools with sweating, rapid heartbeats, the types of symptoms that are the symptoms that are associated with excessive caffeine consumption.
MR. BARRY MEIERNow we've got an industry that sees these age groups as potential, current customers and future customers and I think that's where the real issue is. I mean we're not talking about caffeine for adults. I drink caffeine all the time. I love caffeine. I'm a caffeine addict.
MR. BARRY MEIERWe're talking about very young kids and an industry that sees them as customers.
REHMCan you talk about the six people who died over the past three years apparently after drinking the popular energy drink Monster Energy? Barry?
MEIERWell, there, these are reports Diane as Mr. Taylor pointed out. We don't know whether Monster played any role whatsoever in the deaths of these individuals and in fairness to Monster similar death reports have been filed in connection with other energy drinks like 5-hour ENERGY.
MEIERSo while we don't know anything about the link, if there is one, between these drinks and these deaths, what we do know is that increasing numbers of people, many of them young people, are reporting to emergency rooms with rapid heartbeats, jitters, shakes, the kinds of things that as a parent you don't want your kid to have, particularly when they're going to school.
REHMAnd of course Michael Jacobson, with all of these products in front of you you've been watching this for quite a while.
MR. MICHAEL JACOBSONWell, we petitioned the Food and Drug Administration to label the caffeine content then it was beverages, in 1997. Sixteen years and the FDA has done nothing and I'll be surprised if the FDA does much after that Institute of Medicine meeting that Michael Taylor referred to.
MR. MICHAEL JACOBSONIt's really, an uncontrolled marketplace with, as you pointed out, caffeinated waffles, pancake syrup, all kinds of things and we need to get some controls.
REHMMichael Jacobson, executive director of the Center for Science in the Public Interest, short break, right back.
REHMAnd welcome back. We're talking about caffeine and its widespread infusion into a variety, not only of drinks, but of foods like popcorn, like chocomellows, like syrup, like gum. And here in the studio is Michael Jacobsen. He's with the Center for Science in the Public Interest. Joining us from New York is Barry Meier, health reporter for the New York Times. Joining us from New Hampshire is Bob Arnot. He's a physician and medical consultant for Monster Beverage.
REHMAnd Bob, I'd like to bring you into the conversation. You are a doctor and consultant for Monster Energy. Do you have any reason to believe that energy drinks could've been a factor in these six deaths?
MR. BOB ARNOTWell, it's a very good point. I think all three of your guests have made superb points so far. I just wanted to say that, you know, Monster did, uh, find itself faced with a number of medical problems or medical issues and did want to reach out to a physician. I was only too happy to do that because I'm actually been a long time user of energy drinks. I'm an enthusiastic bike racer and standup paddle racer and iron man and whatnot and I've used these for years. I do want to say that, you know, Monster's given me a complete free hand to look at the data, look at the studies, consult with experts with no pressure or interference to report anything but what I see as a medical doctor.
MR. BOB ARNOTSo in terms of these cases, I've had a chance to look at these. The first one that came up was this Fournier case. And I just want to say at the outset that, you know, I've seen these cases in the emergency room. You know, what a terrible, just unimaginable tragedy for these families to lose a daughter at 14 or a son at 19. So, you know, I feel terrible for these families. But in terms of cost and effect, let's look at these two cases.
MR. BOB ARNOTSo in the Fournier case, you know, cardiac pathologists had a very good look at the case and determined that she died of myocarditis. Now this is an infection of the heart. And if you go to the Myocarditis Foundation site, for example, on the web or you read through the literature, there is no link between caffeine and sudden death in myocarditis. It's a tragically frequent cause of death but again, there's no link between these.
MR. BOB ARNOTThe most recent case that came up just the other day was of a 19-year-old. And the allegation in the lawsuit, which had no medical doctor or no medical expert in the actual filing, was trying to say that energy drinks over the course of three years caused his cardiomyopathy. It's simply unfounded and untrue. If you, for instance, right now were to go to the mayo clinic site, you'd see that there are a variety of different causes such as long term high blood pressure, drug abuse, alcohol, genetic causes and whatnot.
MR. BOB ARNOTHe took the equivalent of about 320 milligrams of caffeine a day in Monster energy drinks over the course of three years. The average American drinks about 300 milligrams. So it's just unfounded that caffeine would've caused this underlying condition which is cardiomyopathy. Then in terms of sudden death, again, the main way that somebody dies from cardiomyopathy is sudden death. And there were other potential triggers there. He was having sex at the time that he passed away. He was a smoker and there were other factors there. So again, no trigger.
MR. BOB ARNOTAnd, you know, a lot of people think that just because they've had some caffeine and their heart rate goes up, that triggers phala arrhythmias. Well, a very famous study was done by Tom Graboys at Harvard Medical School, published in the New England Journal of Medicine. And it showed for what we call malignant arrhythmias. And those are the arrhythmias likely to go into ventricular fibrillation, which is the one that killed this 19-year-old. And Tom, who I know well, found that there was no correlation. They gave them 200 milligrams or so of caffeine. It did not trigger fatal arrhythmias.
REHMOkay. I have a...
ARNOTSo again, tragic cases but no link.
REHMI have a question. How many milligrams of caffeine are there in a single cup of regular -- I'm not talking about Starbucks but regular coffee, Barry Meier?
MEIERIn regular coffee it depends on the strength of the bean, but usually around 80 to 100 milligrams.
REHMEighty to a hundred.
MEIERYeah, in an eight-ounce cup of coffee. Higher, nearly twice as much of that in Starbuck's coffee. So on an ounce per ounce equivalency basis, the amount of caffeine in an energy drink, sort of the more popular ones like Monster, is really about the same as in a cup of coffee. Here's the difference though. People don't drink 24 ounces of coffee at a sitting. Teenagers do. They are not encouraged by coffee shops to bolt back a huge can of their product. Energy companies do promote that.
MEIERAnd I guess, along with Dr. Arnot presenting his expert witness testimony about these deaths, I'm curious about what he's telling his employer about whether they should be marketing these products to 12 and 13-year-olds.
ARNOTWell, let me answer that, Barry. It's a very, very good question and it's come up quite frequently. And of course the commissioner answered -- asked that as well. You know, when Monster first came on the market, they looked at the child market and they determined that there just was not enough information as a natural beverage company either way to market to them. And they made the determination right off the bat that they simply were not ever going to market to children.
ARNOTNow, I had an opportunity to talk to one of their marketing people yesterday. And he made the point that they basically market to their core audience, which is 18 to 35. It's very edgy, it's action oriented, X-games, punk rock. When they, for instance, use video games they use the mature rating. They're sweepstakes are all aimed at 18 plus. And you might say, well gee, is there spillover to these younger groups?
ARNOTWell, if you wanted to market to adolescence, as an example, you'd use, you know, top 40 radio, you'd use Disney. But the marketing people feel that it would actually destroy their base if they were to market to adolescents, that it just wouldn't make sense. It would be like marketing Shirley Temple to a NASCAR driver as an example.
REHMOkay. But Bob, let me ask you this. Knowing that these drinks are on the counter, do you have to directly market to the 12 and 13-year-olds if they know they're there and if there is no restriction to buying them? Aren't they going to buy them, Michael Jacobsen?
JACOBSONYeah, absolutely. As a former 15-year-old boy, I can tell you that I would've been very attracted to the Monster website and to the websites of other companies that use the same sort of extreme sports, pretty women, that kind of marketing. So I don't think there's any restraint exercised by these companies and it's really unfortunate. There's no restraint in terms of the sizes of the cans. You know, Monster I think comes in cans as large as 32 ounces.
REHMBarry, tell us about the families of the victims who are suing Monster because of the deaths of these young people.
MEIERWell, you know, I don't know any of these families personally at all. Obviously these are tragedies that have befallen the families. And the families believe for whatever reason that the energy drinks played a role in their child's death. And again, it's not simply limited to Monster. I would take exception with Dr. Arnot's statements on many accounts. There's clear evidence that these drugs -- these drugs -- they are drugs -- these energy drinks are marketed to people under the age of 18. He should know that. And if he doesn't...
ARNOTWell, certainly Monster doesn’t. I wouldn't disagree that there are other...
MEIERBob, you know there are -- extreme sports are marketed...
REHMHold on. Go ahead, Barry.
MEIER...you know that ads are out there on ball fields where little league kids play. They're in convenient stores where kids walk into. There's all kinds of paraphernalia and gear aimed at young kids. So I don't understand what you're -- what's the basis for your statement, other than what Monster's telling you.
ARNOTWell, they're not really telling me. I had an opportunity to talk to their marketing people and they said it's a fatal flaw for them to market to adolescents. They just don't want to do it. They don't do it. You know, for instance, when they look at movies they look at "Hangover", example, as one of the movies they want to put their products. And they don't go after these kids.
ARNOTNow, you know, they do have what's called Monster army and they do have a worldwide, you know, athlete development program that supports up and coming young athletes. But it's only with parental permission. They're not given product. They're not encouraged to product. And again, Barry, I take serious issue with what you say, that is, this is not anything the company has told me to say. I'm not a spokesperson. I've been given a freehand to look at this and to report on it...
REHMAll right. And I'd like to ask you, Michael Jacobsen, has anyone come up with a safe level of caffeine that anybody from age 12 to 50 should reasonably take in in a single drink?
JACOBSONNo. There's no one specific level, but a guideline might be soft drinks, where the FDA said 71 milligrams per 12 ounces -- 71 milligrams per 12 ounces. And these energy drinks have much more than that. You know, so FDA could simply say, we said you could use 71 milligrams in 12 ounces of Coca Cola. We're going to keep that limit for beverage -- any other kind of beverage.
REHMSo why did they permit these energy drinks with so much more than 71 milligrams onto the market?
JACOBSONThey didn't formally permit them. The companies just brought them to the market. And the companies can say, we believe that 360 milligrams in a quart-size Monster is safe. The FDA could say, we don't think it's safe. You haven't provided the evidence. Get it off the market. But the Food and Drug Administration has been a toothless tiger for as long as I've been Washington, 40 years working on these issues. It's not until a death occurs and, you know, tightly linked to the product that the FDA then may take action. But they fear pressure from companies, lawsuits, conservative Republicans in congress going after them. So it's a very timid watchdog.
ARNOTI just want to jump in here too, if I just might. It'd Bob Arnot.
ARNOTI've been a huge admirer of Michael's and I follow all his guidelines. I have his newspaper. When I was on the networks I regularly reported and very much enjoy the relationship. And I think he's right. I mean, I think that there needs to be labeling. Monster does label caffeine on all of the cans. And I think there are two issues here. One, when you look at caffeine intake for kids -- and this is a study that was done by Penn State and Emory University -- take six to twelves.
ARNOTTwenty-eight milligrams a day comes from caffeinated beverages, twenty-four from coffee, twenty-three from tea and only 1.9 from energy drinks. So there is a problem with these kids taking too much caffeine. But the energy drinks surprisingly are a low denominator. Take also adolescents, 13 to 17. Again, soft drinks they're getting 28 milligrams, coffee they're getting 24. They're only getting 6 milligrams from energy drinks.
ARNOTI think, Diane, that the core issue here is -- and, you know, I think the (word?) was right -- that is there are outliers here in terms of energy drinks that have tremendous amounts of caffeine.
ARNOTIf you go to a site called Energy Fiend for instance, in terms of milligrams per just a fluid ounce -- one single fluid ounce -- I'm reading off here -- I won't give you the brand names -- but 475 milligrams, 434 milligrams, 235 milligrams. Staggering amounts.
ARNOTNow Monster would have ten in there. I think the fundamental issue is that we need to know how much caffeine we can tolerate. Kids need to be educated about this and, you know, I would agree with Michael on this issue that you need to know how much is in there, how much you can tolerate.
REHMAll right. Bob Arnot...
ARNOTAnd this is not something that should be marketed to children.
REHM...Bob Arnot is a physician and medical consultant for Monster Beverage. Joining us now from San Francisco is Dennis Herrera. He's the city attorney for San Francisco and is suing Monster Beverage Corporation, complaining that it illegally markets energy drinks to children. Thanks for joining us, sir.
MR. DENNIS HERRERAThanks for having me.
REHMIn May you filed a lawsuit against Monster Beverage Corporation. Tell us why.
HERRERAI've been listening to a little of the conversation as I've been waiting on the line to come on. And, you know, I'm fascinated by the discussion. I heard I think it was Michael talk a little bit about the FDA being a very timid regulator. And I think that's unfortunate when you see really the scary health impacts that energy drinks have had.
HERRERASo we have been involved in this issue for quite some time, started out first working with alcoholic energy drinks, working with 18 attorneys general across the country over the course of the last several years. And became aware of the health risks posed by energy drinks and were quite alarmed. So under my authority to sue in the name of the people of the State of California, we used Monster, which does business here in California and is based here in California for -- under our Sherman Law for -- it's saying, number one, it's mislabeled as a dietary supplement. And number two, as an adulterated food product in the hopes that it would change the components of its product to make it more safe.
HERRERAAnd secondly, with direct relevance to its marketing, because Monster aggressively markets to young people to the degree that no other energy drink markets. So that was a concern as well.
REHMAll right. Can you give me some examples of just how Monster allegedly markets directly to children?
HERRERAI think the best way to summarize it is to go to their Monster Army social networking site, which encourages athletes, including minors and adolescents to post photos and videos of their extreme sports performance and allows them to earn perks, including sponsorships from Monster, and encourages them to drink the product as often as possible. And also markets it as a sports performance enhancing energy drink.
HERRERATheir monster Army social networking site, which is designed to appeal to young people, has thousands and thousands of posts and encouraging information and advertisements. And that is the most aggressive form of marketing they have in addition to sponsoring a variety of extreme sports endeavors and the like, which are designed specifically to go to young people and adolescents.
HERRERAAnd the websites themselves have photos of children as young as six years old on the website encouraging them to drink a product that has incredibly high levels of caffeine.
REHMSo what does the lawsuit aim to do?
HERRERAThe lawsuit aims to do two things. Number one, to get Monster to create a safe product, and number two, to change their marketing practices that are specifically designed to attract young kids and adolescents. And to have it be more socially responsible and to be more direct with respect to the health risks posed by their product.
REHMDennis Herrera. He's city attorney for San Francisco suing Monster Beverage Corporation claiming it illegally markets energy drinks to children. And we're going to have to take a short break now. When we come back we'll open the phones and hear what our listeners have to say. Stay with us.
REHMAnd welcome back. Here in the studio Michael Jacobson of the Center for Science in the Public Interest. He is author of the book "What Are We Feeding Our Kids?" and "Marketing Madness." Joining us from New York Barry Meier, a health reporter for the New York Times, he's won two George Polk awards for his reporting.
REHMBob Arnot joins us from New Hampshire. He's a physician and medical consultant for Monster Beverage. He's former medical correspondent for NBC and the author of 14 books including "The Aztec Diet." We're going to open the phones now. First to...
ARNOTOh, Diane just before you open the phones.
ARNOTI just needed to respond to the city attorney. I just think -- I'm a big admirer of his and what he's done in terms of advocacy, but he's just wrong on these points. Monster is not mislabeled as a supplement. It's labeled as a beverage. It does not aggressively market to children. I'm, in fact, on the site he's talking about. It does not say drink as often as possible. These children are not encouraged to do this. It does help young athletes, including young athletes I know, improve their performance and their shot at sports.
ARNOTAnd it doesn't have incredibly high levels of caffeine. I would just, again, ask you to go to the energy fiend site where you will find Starbucks coffees at 330 milligrams for a Starbucks grande coffee versus just 160 for Monster. So, yes, there are energy drinks out there incredible amounts of caffeine, but on average you'd find that Monster has caffeine at roughly half that of a cup of Starbucks coffee.
REHMAll right. Barry Meier, do you want to comment?
MEIERI guess my only comment would be that apparently Dr. Arnot sees his future lying in the medical -- in the legal profession since he is making a number of statements, a number of claims that seem to be of a legal nature rather than addressing what the health issues are with these products. And whether children...
ARNOTI'd be delighted to...
REHMHold on, Bob.
MEIER…Who are (unintelligible)...
REHMBob, excuse me, Bob, if you'll let Barry Meier finish please. Go ahead, Barry.
MEIERI'll just ask you a simple question, Bob. Do you think that a kid who's 12 or 13 years old should be drinking a 24-ounce can of energy drink?
ARNOTNo, I do not. I totally agree with you. I do not think a 12...
MEIERWhat about a kid who's 13 or 14 years old?
ARNOTI don't think that adolescents should be drinking large amounts of caffeine.
MEIERSo why don't you go on the air on behalf of your -- the company that you're consulting with and send out that public message?
ARNOTWell, I would say, you know, Monster has never and will not and does not market to children 12 and under and does not market to adolescents, doesn't intend to, doesn't want them in the market, does not reach out to them in any kind of advertising. It's not part of their policy.
REHMAl right, Barry.
MEIERI guess you're saying two different things, Bob.
ARNOTWell, I'm really not. I'm (unintelligible).
MEIEROne is there shouldn't be marketing -- can I finish what I'm saying?
MEIEROne is that they shouldn't be marketing to kids and they're not marketing to kids. What -- what you might think about saying is that kids shouldn't be drinking this. And that part of your outreach for your client should be getting that message out there also.
ARNOTWell, the key point is that kids should not be taking a lot of caffeine. Energy drinks are a small percentage of the caffeine they get. As you know, we heard from the FDA commissioner and others and Michael Jacobson. I mean it's in pancake syrup. You know, it's a lot like the acetaminophen problem in that people didn't realize they were getting acetaminophen not just in say, oh, Tylenol, but they might be getting...
REHMOK, and Michael Jacobson...
ARNOT...And here you're getting caffeine in lots of things and kids do need to be aware of the amount of caffeine that they are taking. I totally agree (unintelligible)...
REHMAnd, Michael Jacobson.
JACOBSONI'm glad to hear Bob Arnot saying that 12, 13 year olds shouldn't be consuming any caffeine...
JACOBSON...Or much caffeine. And I think it's a mistake -- I think it's a mistake to focus totally on Monster. You know, you have a $10 billion industry out there that's marketing these products. Some more to kids, some less to kids and we need some kind of government intervention. The San Francisco city government is using one approach. Hopefully the FDA will do something and the Federal Trade Commission. So far the most aggressive advocates, I think, have been Senator Blumenthal, Senator Durbin and now Senator Markey who have been pressuring the FDA to take some actions.
REHMAll right. Let's open the phones now to Fort Lauderdale, Fla. good morning, Louis.
LOUISHi, Diane, thanks for having me.
LOUISI'm also an attorney here in south Florida. I run a website for consumers and activists on Facebook called People Over Politics. I just want to expand the debate here because the problem isn't caffeine or any one drug or product. The bigger problem here is the culture of corruption that has taken the FDA and the rest of our government far outside the realm of the public interest. I find it laughable that anyone can even refer to the FDA as a regulator in any meaningful sense of the term. Michael Taylor, if my memory serves me correctly, was the former vice president and lobbyist for Monsanto. It's not hard to follow the money here and understand exactly what the FDA is and is not doing and why.
REHMAll right, sir. Barry Meier, would you chime in on that please.
MEIERWell, the -- the FDA certainly can be criticized for many things. I won't criticize it for all things. I will say that Michael's point is absolutely right and, with respect to Bob, as well. This is not a Monster related problem. This is a huge industry. There are many competitors to Monster that are putting more caffeine in their products or less caffeine in their products and marketing them in more or less similar ways.
MEIERSo I think Bob is absolutely right to say that adolescents shouldn't be using these drinks, or certainly young adolescents shouldn't be using these drinks. And that, I think, is the essential message that I would hope that he and others would put out there.
REHMAll right, here's an email from Los Angeles. She says, "The main thing for me is we need to keep these caffeine and sugar loaded drinks out of our K-12 schools. A big obstacle to this is that corporations are trying to sell these products to school. Michael Jacobson.
JACOBSONWell, first let me just defend Michael Taylor. We have -- at CSPI we have a lot of issues with the Food and Drug Administration, but Taylor, over the last decade, has proven to be an extraordinarily dedicated first professor and now government official who's trying to improve the safety of the food supply, you know. So I think it's inappropriate to question his integrity regardless of working for Monsanto.
ARNOTAnd this is Bob here. I totally agree with you. I mean Michael has been spectacular.
REHMOK, let's get to the question.
JACOBSONNow -- now for schools it's a timely question because today the Department of Agriculture is coming out with rules to limit the junk in schools. And they've already dealt with it in school meals. Today they're dealing it in vending machines, school stores and those other places outside of the official lunchroom. And it's going to limit the sugar content to about one third as much as is in a regular soft drink.
REHMNow, talk about the combination of the sugar and the caffeine which is in these soft drinks and power drinks.
JACOBSONYeah, well, we've forgotten -- all this talk about caffeine you forget that this is sugar water. That they're adding various stuff, too. And we've had a tripling of obesity rates in children over the last 30 years or so. Energy drink do not help. They rot the teeth. Kids become addicted because of the caffeine or possibly sugar and they absolutely have no place in schools. And if the Food and Drug Administration were really on top of things it would limit the sugar content of beverages.
REHMHow much sugar is in a 12-ounce soft drink.
JACOBSONSoft drink -- about nine or ten teaspoons of sugar.
JACOBSONAnd about the same amount in an energy drink. Now when you get...
ARNOTAlthough half of energy drinks -- half of the Monster drinks have no sugar at all.
JACOBSONRight, well there are diet sodas and diet energy drinks and so on.
JACOBSONBut it's the one -- the sugary ones that we're concerned about, especially, for the -- for the sugar content. So the FDA isn't doing anything about sugar as it's not doing anything about a whole lot of other things.
REHMAll right, we have a question here. What about the trend of college students to combine energy drinks with alcohol, Barry Meier.
MEIERThis has been going on for quite a while. In fact, when Red Bull, sort of -- the use of Red Bull first exploded in Europe it was as a mixer with alcohol over there. And that kind of translated over here. And so you've got various shots in bars where these energy drinks are available on the bar. There are some theory that because one is a stimulant and one is a depressant you can mix the two together and you don't realize how much alcohol you're taking in. It's not clear whether this is founded or not, but the two seem to go along very well together and kids seem to drink a lot of alcohol along with their energy drinks.
REHMAll right. To Erie, Pa. good morning Adam.
ADAMGood morning. Thanks for taking my call.
ADAMWe (word?) alcohol and on sugar, but a number of these products have different supplements and different compounds in them that I don't think are well advertised or disclosed. And I didn't know if there was any studies that talked about caffeine's interaction in the body with those compounds, particularly on adolescents.
JACOBSONWell, there are products -- there are ingredients like taurine and ginseng that I suspect are added in microscopic amounts that have no effect whatsoever. And the only purpose is to put those -- the names of those ingredients on labels so people think they provide some special powers, but they don't and the FDA should ban the presence of those ingredients in those drinks.
REHMBarry -- OK, Barry Meier, on June 18 the American Medical Association said it would support a ban on the marketing of energy drinks to children under 18 saying the high caffeine beverages could cause heart problems and other health issues. Bob Arnot says that at least Monster Energy is not marketing to young children. Do you have evidence that indicates otherwise?
MEIERWell, clearly a lot of energy drink producers do market to children and Bob and Dennis Herrera can have a spirited debate over whether Monster does, but I would just say that if Bob and Monster feel so strongly that Monster is not marketing to people under 18 years old then they should go with representatives of the American Medical Association, to the American Beverage Association which represents companies like Monster and come up with a statement to that effect and enforce policies to that effect. Right now the basic policy of this organization is that these products should not be marketed or used by children -- by children. And they define children as people under the age of 12. That's where things stand right now.
REHMBob Arnot, do you have any plans to do that?
ARNOTSo I mean I don't -- I'm not a member of the company. I don't -- I don't make...
REHMBut you're advising them.
ARNOTRight. So in terms of advice a couple things here. First of all, in terms of the AMA when the New York delegation brought this in they said that these high stimulant drinks have the equivalent amount of caffeine of 50 cups of coffee, which is just clearly not true. I mean that's a lethal dose there. I would agree with the AMA that we do need to be concerned about the very high stimulant drinks. And, again, there are energy drinks out there with 180, 235, 434, 475 milligrams per ounce where Monster is at the -- at 10 milligrams per ounce, which is, you know, less than half that you find in a cup of Starbucks coffee.1
REHMBut if you've got a 24-ounce can you've got 240 ounces -- 240 milligrams right there. That is a pretty his dose is it not, Michael Jacobson?
JACOBSONIt's a -- it's a pretty high...
ARNOTIt's still less than...
ARNOTIt's still less than the Starbucks grande and it has a resealable cap so it's not meant to be drunk by one person or all at one time.
JACOBSONIt's a pretty high dose of caffeine and unlike a coffee that typically you sip out for, I don't know, 20 minutes, half an hour with an energy drink you can gulp it down. And some of the marketing encourages gulping it down. So that may make a difference...
ARNOTHalf of Starbucks...
REHMHold on, Bob. Hold on. Bob, excuse me. Let Michael finish.
JACOBSONYeah, that might be a difference between the marketing of -- between the consumption of an energy drink and a coffee, but, you know, I think we need to get the Food and Drug Administration involved and, you know, come up with some reasonable restrictions or labeling systems to protect the public.
REHMAnd you're listening to "The Diane Rehm Show." To Greensboro, N.C. good morning, Nathan.
NATHANGood morning. Thanks for taking my call.
NATHANMy question is in regards to, like, the other supplements in the -- in the drinks. Is the FDA going to be looking into the effects of, like, the other stimulants in combination with the caffeine as well as the taurine...
REHMAll right, Barry Meier.
MEIERI don't know. I think they're dealing basically with caffeine because that's the principle component. And basically the -- the issue with these drinks is that there's absolutely no scientific evidence that the additives that companies like Monster put into these drinks do anything for their customers. The caffeine certainly does. It's a stimulant.
REHMWhat kinds of additives are you talking about?
MEIEROh, my God, I'd need a science degree to list them all. There's, like, taurine, glucuronolactone, all kinds of stuff. We did a story back in January of this year looking at the scientific information about these various ingredients and there's really absolutely nothing to suggest that they provide any value. I spoke, in fact, with people at the United State Army performance laboratories. These are the folks that design caffeinated gums, caffeinated products to keep soldiers active in combat situations, the most stressful situations. They told me that they would never, you know, incorporate energy drinks and these other additives in energy drinks into the products they produce -- they provide soldiers.
REHMSo, Michael Jacobson, what would your advice be to ordinary folks no matter what age, but especially to parents of young children.
JACOBSONI'd say keep the energy drinks out of the home and discourage their kids from consuming energy drinks. For older people it's -- I would say be careful, you know, just like drinking too much coffee be careful don't -- don't take in more caffeine than you can handle. Pregnant women or women who are trying to become pregnant absolutely should stay away from caffeine.
REHMSo do you ever indulge in these high caffeinated drinks?
JACOBSONI'm not exactly the average consumer.
REHMYeah, I know.
JACOBSONI have a -- I have a cup of tea a day.
JACOBSONThat's as far as I go.
REHMAnd Bob Arnot it -- do you think that these companies might change their approach. We've got about 5 seconds.
ARNOTYes. The ABA has a site coming up quickly in terms of the various caffeine contents. Monster is now labeling...
ARNOT...all of its beverages and encourages...
ARNOT…others to follow suit.
REHMAll right. Bob Arnot, he is a consultant for Monster Beverage. Barry Meier reports for the New York Times. Michael Jacobson, thank you so much all of you for being with us. I'm Diane Rehm.
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