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Should a hefty tax be slapped on fattening sugar-sweetened soft drinks for the public's own good?

In this week's edition of the New England Journal of Medicine, two leading medical experts argue that a tax is the best way to curb cravings for sugary beverages which are fuelling the obesity epidemic.

One study, cited by the authors, suggests that for every 10 per cent increase in price, consumption drops by 7.8 per cent.

"The hope is that people would switch to healthier beverages ... such as non-sugared beverages and ones with more nutrients," said Kelly Brownell one of the authors of the article and director of the Rudd Center for Food Policy and Obesity at Yale University.

Although many factors lead to obesity, sugary drinks are a major culprit, according to Dr. Brownell and his co-author Thomas Frieden, health commissioner for New York City.

"In the mid-1990s children's intake of sugared beverages surpassed that of milk," they write in the journal, noting that the marketing efforts of soft-drink companies have been heavily targeted at youth.

"For each extra can or glass of sugared beverages consumed per day, the likelihood of a child becoming obese increases by 60 per cent."

They would like to see an excise tax of one cent per ounce imposed directly on the manufacturers so it becomes incorporated into base price of the product. If it's added later as a sales tax, then consumers might not realize its full magnitude until they get to the check-out counter.

"Think about buying a 64 ounce bottle; the tax would make it 64 cents extra - that's a lot," Dr. Brownell said in an interview.

Several state governments, including Maine and New York, are mulling over just such a proposal.

"This idea has been around for a long time," Dr. Brownell said. "But what has made it come to the limelight right now is the bad economy and the need for [tax] revenue." In New York state, alone, it could raise $1.2-billion (U.S.) annually.

He points to the example of tobacco taxes which have shown that the public can be nudged in a healthy direction through higher prices. "Taxes were the single most effective approach used to curb smoking."

Some Canadian obesity experts also think a beverage tax is worth considering. "You don't need soda pop ... and it certainly contributes dramatically to obesity," said Yoni Freedhoff, medical director of at the Bariatric Medical Institute in Ottawa.

Asthma and heart burn

For decades, physicians have been prescribing heart-burn medications to some asthma patients, hoping these drugs would help reduce symptoms of wheezing, coughing and breathlessness.

Many asthma patients, do indeed, suffer from heart burn, medically known as gastroesophageal reflux disease, or GERD, in which stomach acids back up into the esophagus. Doctors assumed that gastric reflux could contribute to some asthma symptoms by irritating the esophagus, the long tube that connects the stomach and the throat.

But doctors also thought these medications could benefit patients without obvious signs of heart burn. Patients, whose symptoms were not well controlled with standard asthma drugs, were often deemed to have "silent GERD" and treated with gastric-reflux drugs.

Now, however, a new study involving 402 adults at 20 medical centres across the United States found no benefit from the added treatment. Half the patients were given a heart-burn medication called esomeprazole, while the others received a placebo. All the patients continued to take their regular asthma drugs such as inhaled corticosteroids.

The findings, published in The New England Journal of Medicine, found no difference in symptoms between the two groups after six months of observation.

"I was surprised," Nicola Hanania, one of the researchers located at Baylor College of Medicine in Houston, said in a statement. "It was disappointing for us, but that's why we do research."

The researchers stressed that medications like esomeprazole do a good job controlling gastric reflux. But, if an adult asthma patient doesn't have GERD, prescribing a gastric-reflux drug is an "ineffective and unnecessary expense."

Meanwhile, another study is looking at the use of GERD medications in asthmatic children. It's still possible children might benefit from the drugs because they have a shorter esophagus than an adult, increasing the potential irritation caused by a back up of stomach juices, say researchers.

Licorice alert

A key ingredient in licorice, a sweet substance known as glycyrrhizin, appears to reduce the effectiveness of cyclosporine, a drug used by transplant recipients to prevent organ rejection.

The discovery, presented at a recent meeting of the American Chemical Society, was made by researchers in Taiwan when they fed the pure extract to laboratory rats.

Licorice is found in a variety of foods as well as herbal remedies. For instance, some traditional health practitioners use licorice root to treat a wide range of conditions, from the common cold to liver disease.

The researchers aren't sure how much licorice would be required to trigger a potentially deadly reaction because the glycyrrhizin contend varies from product-to-product.

"I would suggest that transplant patients avoid taking licorice," Pei-Dawn Lee Chao, the lead researcher at China Medical University in Taichung, said in a prepared statement.

Other patients should be put on alert, too. Cyclosporine is sometimes prescribed to people with rheumatoid arthritis, certain skin conditions and other ailments.

This isn't the first time licorice has been linked to a drug interaction. Other studies suggest it could interfere with high blood pressure medications, Aspirin, anti-inflammatory drugs, insulin and oral contraceptive. And, for this reason, it's always important to let your doctor know what herbal remedies you're taking.

ptaylor@globeandmail.com