The five things most likely to kill you. And the people selling them know.
- Adam Spencer
- May 26
- 7 min read
The Sydney-led team compared multinational corporations to malaria-carrying mosquitoes. The New England Journal of Medicine didn't blink.
I said NEJM. Not TMZ.
The New England Journal of Medicine has been around since 1812.
It is the most cited general medical journal on Earth. Its 2024 impact factor was 78.5, sitting in the top 1% of all medical journals. About 5% of papers submitted to it actually get published.
We are talking the Serena Williams of top shelf medical literature.
Trust me. Doctors don't read NEJM for hot takes. They read it the way lawyers read the High Court.
So when a paper appears in NEJM accusing the world's biggest corporations of behaving like disease vectors, the same wording epidemiologists use to describe one of the world's deadliest scourges, that is not a headline you breeze past.
“The claims are unusually feisty for an article in the venerable New England Journal of Medicine. The authors essentially equate multinational corporations to malaria-carrying mosquitoes." — Liam Mannix and Kate Aubusson, *Sydney Morning Herald, 26 March 2026.
The lead author is Dr Nicholas Chartres at the University of Sydney's Faculty of Medicine and Health, who also leads the science at UC San Francisco's Center to End Corporate Harm.
The University of Sydney says this is the first time NEJM has published a paper recognising corporations that make and market health-harming products as primary vectors of non-communicable disease.
A first. In 214 years.
The five (un)natural born killers.
Chartres and his colleagues went through Global Burden of Disease data and identified five everyday commercial products as key factors in 31% of all deaths every year.
Here they are, ranked by body count:
- Fossil fuels: 8.1 million deaths a year.
- Tobacco: 7.2 million.
- Ultra-processed foods: 2.3 million.
- Commercial chemicals and pesticides: 1.8 million.
- Alcohol: 1.8 million.
The paper notes a further 600,000 deaths a year from drug use, primarily opioids.
These aren't obscure substances cooked up in a back-shed lab. They're the things stocked in every petrol station, supermarket and bottle shop in Australia.
And here at home, the chronic diseases these products fuel are absolutely surging. Between 1990 and 2023, Australian diabetes diagnoses rose 115%. Cancer 151%. Alzheimer's 162%. Parkinson's 182%.
The reasons are multifactorial. But the trajectory is unmistakable.
The tobacco playbook.
And the big boys know exactly what they are doing.
Chartres' team didn't just count bodies. They went through the UCSF Industry Documents Library — a public archive of more than 24 million internal corporate documents prised loose by decades of litigation, mostly against tobacco. And they found the same three plays running, over and over, across completely different industries.
Play one: knowledge capture. Bury the bad studies. Fund your own research that points the finger somewhere else. Sugar is the textbook case. The sugar industry funded research pinning heart disease on dietary fat — some of it published in, ahem, the New England Journal of Medicine. Result? Decades of "low-fat" diet advice, while sugar consumption climbed. And climbed.
Play two: regulatory capture. Stack the policy table. Lobby through front groups. Walk staff through the revolving door between industry and government. The US tobacco lobby once set up a Consumer Tax Alliance specifically to fight cigarette tax rises, dressing up an industry campaign as a grassroots taxpayer movement.
Play three: shape the public story. Aggressive marketing. Unbranded campaigns. And when you can, target the kiddies! Opioid manufacturers, the paper notes, recruited youth coaches and school nurses to encourage children to use opioids.
And here's the kicker. As anti-smoking laws kicked in across the West, what did US tobacco giants do? In the 1980s Philip Morris bought General Foods then Kraft. R.J. Reynolds bought Nabisco. Then they quietly applied the same playbook they'd spent decades perfecting on cigarettes — engineering products to keep us reaching for the next packet.
Same companies. Same playbook. New product.
"I think it absolutely stacks up. All the incentives are built in. To be able to get that level of profit in a short-term way, they have to create a policy and a regulatory environment to enable them. It's a very sensible way of operating as a corporation. And that comes at a cost to the environment and society." — Professor Sharon Friel, Australian Research Centre for Health Equity.
The last line is the killer (pun fully intended).
None of this is new. At the turn of the last century, the Wild West of industrial food meant the things people regularly ate and drank contained everything from formaldehyde in milk to copper sulfate in canned peas. Red lead was used to give butter its sheen.
Manufacturers used these toxic shortcuts to mask decay or mimic freshness, treating the human stomach as a laboratory. It took the amazing Dr. Harvey Wiley and his ethically edgy ‘Poison Squad’ experiments, wherein men volunteered to eat these toxins, to prove that ‘embalmed’ meat wasn’t a preference, but a crisis.
But when regulation was proposed, big food hit back hard.
One industry campaign even claimed people were dying because borax wasn’t in their food. Another insisted “the British love the taste of borax in their butter.” More than a century later, the playbook feels eerily familiar.
It’s the system man.
These companies aren't villains in capes. They're doing exactly what shareholders ask them to do. The system rewards exactly this behaviour. Which is why a paper in NEJM calling them disease vectors is, in its quiet way, radical. It reframes the problem from individual willpower to industrial design.
Of course education and personal choice are important here. I know not to smoke, and god knows that I know that a bottle of red wine and a bag of chilli chips ain't brilliant for me, but surely we can also curtail the power of the behemoths pushing these poisons?
You don't tell an African villager to take personal responsibility for malaria. You drain the swamp.
Australia has tried to drain one swamp already. Tobacco lobbying success here was so blatant that Australia has effectively restricted politicians' ability to consult tobacco companies on policy. But a 2023 University of Sydney study published in the Sax Institute's Public Health Research & Practice found 48% of in-house tobacco lobbyists in Australia have held positions in Australian government either before or after working for the industry. For lobbyists hired on behalf of tobacco companies, that figure rises to 55%.
Other industries — alcohol, food, chemicals — still have a chair at the policy buffet. When it comes to food labelling battles:
"They are at the table, making policy. It's not a secret." — Associate Professor Gyorgy Scrinis, University of Melbourne.
The empires push back.
Predictably, the industries named have not taken this lying down.
The Minerals Council of Australia says it engages "ethically and transparently" with government. Alcohol Beverages Australia chief Alistair Coe says the paper "reflected ideology" and noted that risky drinking and underage drinking are both declining. Chemistry Australia says Australia has one of the world's best chemicals management frameworks.
These are fair things to put on the record. And there is genuine progress in some sectors.
But there is also a movement to stop relying on the industry's own homework. San Francisco is currently suing Kraft and other food giants over allegedly deceptive marketing of ultra-processed foods. California is suing ExxonMobil over allegedly deceptive recycling promotion.
Whether those cases land in court is anyone's guess. But the legal pressure is building.
So what do we do?
Chartres' team aren't just shaking their fists. They've put policy proposals on the table.
A global treaty restricting how the most harmful industries influence public-health policy, modelled on the existing tobacco treaty. Public databases tracking industry payments to scientists and policymakers. A government levy on industry to fund independent product safety research, so the science isn't paid for by the people selling the product.
None of this is radical. It's just the policy machinery you'd build if you took the NEJM paper seriously.
And one country has just gone harder still. On 29 April 2026, the UK's Tobacco and Vapes Act became law, permanently banning the sale of cigarettes to anyone born on or after 1 January 2009. The idea is to create a final generation of smokers who simply age out.
It's the world's second proper attempt at switching off a deadly product by legislative attrition. The first, in Jacinda Ardern's New Zealand, was passed in 2022 and repealed before it ever came into force by the new conservative government.
If you can do that to tobacco, you can do it to others.
“I don't think you should be able to advertise junk food at all to children. I think it should be illegal to have Paw Patrol on kids' cereals. I think this whole thing where we allow endless advertising children is completely insane and it makes every parents life in the grocery store a nightmare, myself included.” — Ezra Klein, NY Times audio.
And the doctors who matter most are paying attention. As Chartres himself notes:
"Clinicians read the NEJM. It is their bible."
A bible that just listed five everyday corporate products as the modern world's deadliest contagions.
Hey, I'm also on [Substack]
References;
Corporations as Vectors of Noncommunicable Disease — Using Internal Industry Documents to Craft Counterstrategies (https://www.nejm.org/) Chartres N, et al. New England Journal of Medicine, 25 March 2026. DOI: 10.1056/NEJMms2507028
Five everyday products linked to one-third of global deaths, scientists warn (https://www.smh.com.au/) Mannix L, Aubusson K. Sydney Morning Herald, 26 March 2026.
Ultra-processed foods, lifestyle management, and cardiovascular diseases: A clinical consensus statement of the European Society of Cardiology (https://academic.oup.com/eurheartj) Guasti L, et al. European Heart Journal, 6 May 2026.
The Borax Dinner Party That Kickstarted The FDA, Wisconsin Public Radio 17 Oct 2018
Scientists call out health-harming corporations driving rise in chronic disease (https://www.sydney.edu.au/news-opinion/news/2026/03/26/scientists-call-out-health-harming-corporations-driving-rise-in-.html) University of Sydney media release, 26 March 2026.
How tobacco companies use the revolving door between government and industry to influence policymaking: an Australian case study (https://www.phrp.com.au/issues/december-2023-volume-33-issue-4/how-tobacco-companies-use-the-revolving-door-between-government-and-industry-to-influence-policymaking-an-australian-case-study/) Watts C, Jones M, Lindorff K, Freeman B. Public Health Research & Practice, Sax Institute, December 2023.
Tobacco and Vapes Bill becomes law (https://www.gov.uk/government/news/tobacco-and-vapes-bill-becomes-law) UK Government / Department of Health and Social Care, 29 April 2026.
The Ezra Klein Show: GLP-1s and the ‘Wild West’ of Wellness, 8 May 2026
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