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Lethal But Legal: Corporations, Consumption, and Protecting Public Health

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Decisions made by the food, tobacco, alcohol, pharmaceutical, gun, and automobile industries have a greater impact on today's health than the decisions of scientists and policymakers. As the collective influence of corporations has grown, governments around the world have stepped back from their responsibility to protect public health by privatizing key services, weakening regulations, and cutting funding for consumer and environmental protection. Today's corporations are increasingly free to make decisions that benefit their bottom line at the expense of public health.

Lethal but Legal examines how corporations have impacted -- and plagued -- public health over the last century, first in industrialized countries and now in developing regions. It is both a current history of corporations' antagonism towards health and an analysis of the emerging movements that are challenging these industries' dangerous practices. The reforms outlined here aim to strike a healthier balance between large companies' right to make a profit and governments' responsibility to protect their populations.

While other books have addressed parts of this story, Lethal but Legal is the first to connect the dots between unhealthy products, business-dominated politics, and the growing burdens of disease and health care costs. By identifying the common causes of all these problems, then situating them in the context of other health challenges that societies have overcome in the past, this book provides readers with the insights they need to take practical and effective action to restore consumers' right to health.

344 pages, Hardcover

First published January 1, 2014

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About the author

Nicholas Freudenberg

11 books19 followers
Nicholas Freudenberg is Distinguished Professor of Public Health at the City University of New York School of Public Health. For more than 30 years, he has worked with community groups, public agencies and others to create programs and policies that improve community health and reduce health inequalities. He is also co-director of the New York City Food Policy Center at Hunter College. His 2014 book Lethal but Legal, published by Oxford University Press,describes how corporations contribute to global epidemics of chronic diseases and injuries and how activists and health professionals can take action to change health-damaging corporate practices

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Displaying 1 - 15 of 15 reviews
220 reviews14 followers
January 5, 2026
If someone robs a gas station and kills the clerk, most Americans would support a severe penalty for the perpetrator. By contrast, if an industry produces a product its CEO knows is harmful, yet he suppresses the information to continue making profits, it is highly unlikely that perp will ever do even a day in jail. At most the company might pay a fine — even though the dangerous prodict may have killed thousands of people. 

How do we know? We have all too much experience with industries that produce asbestos, lead, and tobacco.

The thesis of "Lethal But Legal" is that maximizing corporate profits is good for shareholders but can sometimes harm public health. For example, if the company pollutes the environment, the costs are borne by society — unless the corporation is required to pay for the harm it has caused.  When government abdicates its responsibility to regulate industries to protect the public, then public health suffers even as profits grow.

This book is a clarion call to restore a better balance between profit and public health by making the case for effective regulation.

A public health researcher and teacher, Nicholas Freudenberg focuses on six large industries whose products contribute to millions of premature deaths and preventable illnesses around the world. 

Noncommunicable diseases (NCDs), aka chronic diseases, account for a steadily growing share of human deaths, currently about two-thirds. NCDs include cardiovascular ailments, cancers, chronic respiratory diseases, and diabetes.

Since 1980, the rate of obesity among U.S. children and adolescents has almost tripled; for adults the rates have doubled.

“Diabetes follows obesity like night follows day...If increases in obesity and diabetes persist, our children and grandchildren will have shorter lifespans than the current generation."

What is causing today’s health problems? Some dismiss the causes as the results of bad choices by individuals, not of the environment influencing behavior.

Part of that environment is food and beverages. The food industry designs products to be hyperpalatable so consumers want to eat more. As Harvard evolutionary biologist Daniel Lieberman put it, “The food industry has made a fortune because we retain Stone Age bodies that crave sugar but live in a Space Age world in which sugar is cheap and plentiful.”

The food industry "relies on intrinsic human cravings for sugar, fat, and salt developed over the span of human evolution." For example, Hardees markets its Monster Thickburger, which contains 1,420 calories and 107 grams of fat.  

Food marketed to children is likely to contain high levels of sugar, carbs, and/or salt.  The food and beverage industry engages in sophisticated marketing of junk food to children, including in school.  They use techniques discovered by neuroscience to engage in neuromarketing, aka "hacking the brain." The food industry is heavily advertising on social media where their claims face little to no regulation. "What is new is the pervasiveness and ubiquity of advertising."

Tobacco use is the world’s leading cause of preventable deaths, causing 100 million premature deaths worldwide in the 20th Century.

In 2006, a federal court found five defendant tobacco companies guilty of having conspired to minimize dangers, distort facts, and confuse the public about the health hazards of smoking. They were also guilty of concealing and suppressing scientific evidence that showed that nicotine is addictive, misleading people about the benefits of light and low-tar cigarette brands, and purposely marketing to young people to recruit “replacement smokers” and preserve the industry’s financial future.

In the United States, excessive alcohol consumption is the third leading preventable cause of death. Its risks are less widely recognized than tobacco's. For example, cancers account for one in five alcohol-related deaths.

"The alcohol industry targets its advertising at underage and problem drinkers, the two most reliable markets—and the populations most harmed by excess alcohol consumption." Those two customer groups account for a highly disproportionate portion of total sales. 

"Fruit-flavored vodka-based drinks and sweetened fruity wine coolers were conceived to compete with beer makers to win over young drinkers, especially young women." Like the tobacco industry, Big Alcohol fights higher taxes and stricter regulations of its products.

The goal of the food, tobacco, and alcohol industries is increased consumption of their products, regardless of the effects on consumer health. Industry concentration into fewer and larger corporations means more political clout to thwart public health policies that could prevent millions of premature deaths. 

Motor vehicles also undermine public health. About four million Americans have been killed in crashes since the invention of motor vehicles. In addition, vehicles increase air pollution,  while overreliance on driving means less Americans get less exercise.

The growing popularity of SUVs is harmful because "SUVs pollute 47 percent more than do conventional sedans, and have higher rates of roll-overs and pedestrian and driver deaths." Pick-up trucks are no better.

The industry has a history of opposing and delaying safety regs, such as airbags, while supporting highway construction over spending on mass transit, which is far safer and cleaner.

Since 1960, more than one million people in the United States have been killed by guns, and more than two million more have suffered non-fatal gun injuries. Americans have a much higher firearms death rate than any other affluent country. The gun industry effectively blocks safety regulations such as requiring  guns to only fire when held by their owners. 

Big Pharma merits a chapter for misrepresenting drugs and concealing harmful side effects. The most notorious recent example is OxyContin, which Purdue marketed by minimizing its addictiveness. The company focused its marketing in states with lighter prescription regulation. 

An example from 1999 is when Merck began selling Vioxx, a painkiller for arthritis, which it advertised as having fewer side effects than other drugs. It was later revealed the the data had been fabricated. Five years later is was shown that Vioxx caused heart attacks and strokes.

When such drugs kill thousands, fines for the companies may be seen as a cost of doing business. A more effective deterrent would be holding CEOs personally responsible in criminal court.

In sum, six industries contribute substantially to chronic diseases and injuries. They seek to maximize profits despite harmful effects their products have. They lobby to prevent or weaken regulations to protect public health while concealing information about harms their products cause. They put responsibility on consumers. In other words, they follow the playbook written by Big Tobacco and implemented during the 20th Century.

"The industries described here spend billions of dollars to persuade people to buy their unhealthy products, and those marketing costs are tax-deductible." 

They say they just cater to consumer demand, but "companies aggressively market their products based on their customers’ fears, insecurities, addictions, and primitive and precognitive urges."  
           
While lifestyle changes will always be  part of the answer, a bigger part of the solution is to curb harmful corporate practices. This can't currently be done because the six industries wield substantial political power that they use to block new regulations and to weaken older ones that could reduce profits.

President Reagan led an era of derregulation, essentially weakening or rolling back protections installed in the previous decades. In 1984, for example, the FCC repealed the rule restricting TV advertising to children. This opened the door to a flood of ads for fast food, soda, sweetened cereals, and candy targeting young children. That decade marked the beginning of the dramatic rise in child obesity.

In 1994, responding to lobbying, Congress exempted food supplements from FDA regs, which led to products contaminated with lead or pesticides and sold with unproven health claims.

Deregulation of the alcohol industry in the UK has led to big increases in alcohol-related problems higher than in the USA.

In addition to deregulation,  corporate tax cuts are another plank in the conservative  platform. Between 1955 and 2010, the percentage of federal revenues generated by corporate taxes fell from 27.3 percent to 8.9 percent.

By 2010, compared to other nations, U.S. corporate taxes constituted a smaller percentage of the GDP (1.8 percent) than those in Australia (5.9 percent), Japan (3.9 percent), or Great Britain (3.6 percent).

By 2012, the effective corporate tax rate in the United States had dropped to 17.8 percent, about 40 percent of the 1960 rate.

Meanwhile, there is a marked trend toward concentration of industries in the hands of bigger and bigger corporations. Between 1979 and 2006, the ten largest global beer makers more than doubled their global market share, from 28 percent to 70 percent. Giant corporations have more political influence, and lobbying is a bigger presence than ever.

Court decisions have reduced or repealed limits on campign contributions, and corporations  dominate donations to legislators. This is how the political and economic system is maintained "that allows companies to produce and market lethal but legal products and to promote unhealthy lifestyles and unsustainable practices at the expense of healthier alternatives."    

"Legal but Lethal" could be a companion to an earlier book I reviewed called "The Corporation" by Joel Bakan (2013). Baken shows that corporations exist to maximize profits.

Freudenberg clearly describes the status quo and explains how we got here. So long as government regulations are seen as excessive, if not unnecessary,  to protect public health,  corporations will be free to pursue profits at the expense of the public good. -30-
Profile Image for Richard.
1,190 reviews1,162 followers
Want to read
October 17, 2015
From the New York Times:
In the last few years, it’s become increasingly clear that food companies engineer hyperprocessed foods in ways precisely geared to most appeal to our tastes. This technologically advanced engineering is done, of course, with the goal of maximizing profits, regardless of the effects of the resulting foods on consumer health, natural resources, the environment or anything else.

But the issues go way beyond food, as the City University of New York professor Nicholas Freudenberg discusses in his new book, “Lethal but Legal: Corporations, Consumption, and Protecting Public Health.” Freudenberg’s case is that the food industry is but one example of the threat to public health posed by what he calls “the corporate consumption complex,” an alliance of corporations, banks, marketers and others that essentially promote and benefit from unhealthy lifestyles.
Read the rest at Mark Bittmam's Op-Ed at Rethinking Our ‘Rights’ to Dangerous Behaviors.
Profile Image for Du.
2,070 reviews16 followers
July 7, 2014
It is always a bit painful to read about things you know are bad for you and yet you also know that you do the stupid thing like eat/drink/support the habit forming corporation.

That said, just like Supersize Me, and other exposures this is a thought provoking and intelligent book that we should all read once a month. It is so startling how much corporations get away with in the name of public need and good. Disgusting, really. The book itself is a well written look at the fast food, alcohol and tobacco industries and how they treat consumers.
Profile Image for Libby.
19 reviews3 followers
May 6, 2015
This book was at times difficult to get through, but it was extremely well-researched and provided a very good look at: a) how corporations have undermined public health, b) what has been done to combat this (covering both what worked and what didn't), and c) how to forge a path toward protecting public health using a combination of tactics. This last section is the part that so many similar books are missing, so I appreciated Freudenberg's effort to cover it in detail.
Profile Image for Elizabeth Henry.
29 reviews2 followers
June 14, 2015
I recently won a copy of this book in a contest. I would love to write a review of this book, but unfortunately, I never received my copy.
Profile Image for Margherita Melillo.
59 reviews1 follower
January 20, 2022
This book is widely considered foundational for anyone interested in what are now called "commercial determinants of health". Nick Freudenberg did not coin the term, but he made a comprehensive and in-depth analysis of how corporations affect public health.

The book focuses on 6 industries: food, tobacco, alcohol, pharmaceutical, automobile, guns. This is an interesting choice that represents a middle ground between those who like me focus on the determinants of non-communicable diseases (food, alcohol, tobacco), and those who rightly contend that the corporations that affect public health are many more, and include the fossil fuel industry, the health care industry, the gambling industry, etc. This choice in a way makes the arguments of the book less homogeneous, but on the other hand, it is great because it shows the broader impact that corporations can have on public health.

I guess I read this book too late in my exploration of the topic to be enthusiastic about it, but for those who have little knowledge of the topic, it's a great start.

Profile Image for Katie.
8 reviews
January 22, 2018
Excellent, factual low-down on the 6 biggest industries in America: food, gun, automobile, tobacco, alcohol and pharmaceutical. By no means is this a "jump in and read for 6 hours straight." It's packed with research, history and facts, and it is in-depth and sometimes meandering. It took me over a month to plow through, reading a few pages a day. But if you're serious about learning every mind-blowing fact about these industries, you absolutely must read. If you're interested and passionate about public health, YOU MUST READ. If you need a place to start learning about corruption in America's biggest corporations, and how that affects the individual and communities, then this is a perfect place to start. It's not even a book about learning, it's a book about un-learning. Fascinating information organized in a cohesive, digestible manner. Kudos to the editor, as well.
65 reviews
July 31, 2020
Another read for school. This is a detailed overview of the ways that corporations impact health, focusing specifically on industries like food, substance use (alcohol/tobacco), automobiles, and guns. It's not just about the products they sell, but how the corporations exert influence on the individual and community level to sell those products-- usually, at the expense of health. Can we be optimistic about change? Yes, thanks to the success stories and advocacy frameworks described in this book.
12 reviews
March 2, 2025
A lot of good information on corporate practices in public health and health policy. Dragged at times, he throws a lot of numbers at you. He’s at his best talking about the food industry. Got soc dem vibes but I can appreciate his optimism for movement success going forward. I’d be interested to hear his 2025 takes. Might read his 2021 book too but if the sentence structure and grammatical errors don’t get better I’m crashing out.
6 reviews
December 12, 2020
Really up and down. Would give 3.5/5. Some pets very interesting and eye-opening but other segments superficial and informational only.
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520 reviews8 followers
Currently reading
August 25, 2021
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Vertaler(s): Sonja Matthews-Marrevee
Hoe de grote industrieen onze gezondheid bedreigen

Nicholas Freudenberg, hoogleraar Public Health in New York, is de eerste die ongezonde producten, tekortschietende overheden en de groeiende druk op de gezondheidszorg met elkaar verbindt in een veelomvattend boek. En dat levert een schokkend beeld op. De industrieën die alcohol, auto’s, wapens, voeding, medicijnen en tabak produceren hebben veel meer impact op de volksgezondheid dan beleidsmakers en wetenschappers. De manier waarop de industrieën in verschillende sectoren opereren, blijkt verrassende overeenkomsten te vertonen. Vrijwel altijd is hun beleid gericht op het omzeilen, ontkrachten of tegenhouden van overheidsmaatregelen die de verkoop van hun eigen producten zouden kunnen belemmeren. En dat met zeer schadelijke gevolgen voor de volksgezondheid. En de overheid? Die is vooral gevoelig voor de wensen van de industrieën en blijkt niet in staat om haar burgers effectief te beschermen tegen het op de markt brengen van ronduit schadelijke producten.

Nicholas Freudenberg is hoogleraar Public Health in New York en oprichter en directeur van Corporations and Health Watch (www.corporationsandhealth.org), een internationaal netwerk van activisten en onderzoekers dat de bedrijfspraktijken in de gaten houdt van de grote industrieën die alcohol, auto’s, vuurwapens, voeding, medicijnen en tabak produceren.
Profile Image for Andy.
2,122 reviews617 followers
May 15, 2016
Important topic.
Apparently accurate information.
Unfortunately somewhat of a chore to read.
Like a list of bullet points.
Covering many topics without much depth: e.g., tobacco corporations are bad, okay.
Useful as a reference.
Has some encouraging stories at the end; that's nice.


Corporations put profits before public health. But that doesn't seem like news. I wish the author had summed up the problem much more briefly and spent more time on the solutions. In his recommendations, he notes that it is important to make things personal. Unfortunately, he fails to do that himself in his writing, referring to his heroes without even naming them, let alone giving the stories of their struggles. I'm the last one to advocate for all non-fiction to be written like a novel, but this is at the opposite extreme of being almost a textbook.
Profile Image for Ariadna73.
1,726 reviews124 followers
April 24, 2014
Not many new things in this book, but confirmation on what one may intuitively know: that he ho has the most money is he who rules the world. Sadly, it happens once an over and over again. :-(
147 reviews8 followers
June 29, 2014
highly uneven — vacillates between insightful and compelling arguments and one-sided arguments that reach well beyond the evidence provided.
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