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Ethics Talk: Why is Meat So Cheap?

Learning Objectives
1. Identify key ethical values or principles at stake, as described in the program
2. Distinguish among factors of ethical, clinical, legal, social, and cultural significance
3. Articulate how central themes of clinical and ethical relevance in the program can influence health care practice
4. Explain at least one way in which micro-level clinical ethics questions intersect with broader macro-level policy questions in health care
0.25 Credit CME

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The AMA Journal of Ethics exists to help medical students, physicians and all health care professionals navigate ethical decisions in service to patients and society. The journal publishes cases and expert commentary, medical education articles, policy discussions, peer-reviewed articles for journal-based, video CME, audio CME, visuals, and more. Learn more

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Audio Transcript

Tim Hoff: Welcome to Ethics Talk, the American Medical Association Journal of Ethics podcast on ethics in health and health care. I'm your host, Tim Hoff. How much do you think a fast-food burger would cost without the federal subsidies to the meat industry lowering its price? Some estimates suggest your standard issue $5 drive-thru burger would cost as much as $13. Maybe you could save some money and cook a burger at home. Probably not. Grocery store ground beef might run you as much as $30 per pound. In order to keep butcher counters stocked and fill the menu orders of hundreds of thousands of restaurants around the country, the US government, mainly through the US Department of Agriculture, subsidizes industrial meat production with about $38 billion each year.

Making animal protein cheap to US consumers is clearly a priority to the US government, and that makes at least some good nutritional sense. Protein is a key macronutrient after all, especially for growing children. Yet more consumers have become aware of global and domestic environmental and health risks of excessive meat consumption. And interestingly and strangely, federal agencies warning of these risks can be the same federal agencies promoting consumption and supporting industrial meat production.

Joining us to help untangle economic incentives driving industrialization of meat is Dave Simon. Dave is a lawyer, advocate for sustainable production, and author of Meatonomics. Dave, thanks for being on the podcast. [music fades out]

Dave Simon, JD: Hi, Tim. Thank you for having me. It's a pleasure.

Hoff: So, the high-level explanation of why meat is so cheap in America that listeners might be familiar with is because meat is subsidized to the point that it can be sold essentially for less than what it costs to raise, slaughter, and process the animals. Cheap sources of meat mean that American consumers buy and consume more meat than people in most other countries. Your work suggests that the relationships between meat producers and government are a little bit more complicated than simply subsidies. Can you help our listeners understand what they should know about checkoff programs, what they are, how they encourage production, advertising, and consumption of meat and meat products?

Simon: Sure. So, checkoffs are something that a lot of Americans have never heard of, or if they have, wouldn't necessarily understand the significance of. But they're incredibly important federal programs established by Congress to promote foods in various categories. Now, there are some checkoffs for fruits and vegetables, things like mangoes, blueberries, and avocados. But most of the money in checkoffs is spent on animal foods, particularly beef, pork, eggs, and dairy, and to some extent, lamb.

The way checkoffs work is Congress basically passes legislation that imposes a relatively small tax at the producer level, less than 1 percent typically. Those funds are collected, and then they're spent to promote foods in that category. So, for example, we've heard and seen messaging throughout our lives, all of us who live in this country, in every medium—Internet, TV, radio, you name it, bus, signs on buses, etc.—like, “Beef. It's What's For Dinner.” “Pork. The Other White Meat.” “Milk. It Does a Body Good.” “The incredible edible egg.” There are many of these, and they are extremely effective. The industry's own research showed that several years ago, for example, they spent a little over $500 million in checkoff funds to promote beef, pork, lamb, eggs, and dairy, and the extra sales that resulted from those promotion efforts were on the order of four-and-a-half billion dollars, so slightly greater than 8 to 1, which is a very effective use of funds.

Now, the reason that I think we need to pay particular attention to checkoff programs is that the federal government is so heavily involved in them. There's a US Supreme Court case that was handed down a couple of decades ago called Johanns v. Livestock Marketing. And in this case, the Supreme Court heard a challenge from some beef producers who didn't want to participate in a checkoff program. They basically wanted to opt out. They didn't want their money being used to further this message promoting beef. The Court held that they didn't have the ability to do that, that the checkoff was actually government speech and that they could be compelled to participate. And it went on in its holding to explain why a checkoff message is government speech. And it includes the fact that the USDA is involved in collecting the money, spending the money, overseeing how people get hired. It sits on committees. It approves actual ad campaigns. So, the US Department of Agriculture is so integrally involved in these programs that when a checkoff program speaks, when it says, “Pork. The Other White Meat. Beef. It's What's For Dinner,” as a matter of law, that is the federal government telling us to eat those foods.

Hoff: Yeah, I think a lot of people might be surprised to hear the level of influence that the USDA has in things like these marketing campaigns. And it reminds me of a concept you discuss in your book called “regulatory confusion,” which is when the conflicting aims of governments and other organizations leads, obviously, to public confusion. The example I think you provide is the US Department of Agriculture's nutritional arm recommending reducing saturated fat intake by asking for half-cheese on your pizzas while the marketing arm of the USDA is approving a campaign with Wisconsin's dairy farmers to market pizzas with 40 percent more cheese. So, obviously, there's going to be this confusion about what kind of advice we should even be taking from the USDA. So, which guidance could really help consumers parse this kind of conflicting information when they see it?

Simon: [sighs] This is really an incredibly frustrating issue. The USDA has two conflicting goals. One goal is to promote the sale, in this country and abroad, of the products that it's concerned with, which are animal foods for the most part. But its other goal is to provide nutrition advice to America. And every five years or so, the USDA and the US Department of Health and Human Services together combine to produce what's called the Dietary Guidelines for Americans. And this is an important—even though nobody ever reads this, at least at the consumer level—it's an important document because it guides a lot of things like school lunch programs and supplemental assistance given to people and things like that.

As you point out, these conflicting goals of the USDA make it impossible for it to deliver a consistent message, because on the one hand, it's saying, for example, “Try to minimize your intake of animal-based protein. Eat more nuts, legumes, and things like that.” On the other hand, it's saying [laughs], “Eat more cheese, buy more beef, buy more pork, etc.” The simple solution to this problem would be to just have the USDA exit the business of providing nutritional recommendations to Americans. Let the Department of Health and Human Services do that exclusively. Give the USDA the role of promoting foods and give HHS the role of explaining to Americans what's good for us. At least, I mean, we'd still have conflicting messages coming from the government, at least they'd be coming from different agencies, not from the same agency.

Hoff: So, you mentioned earlier that checkoff programs exist for many other foods. I imagine there's probably programs for, I don't know, the lettuce growers of California or something like that. Would you say that these programs exist for most other foods and that these advertising programs just kind of take place in the background where consumers might not see them? And also, how do they stack up to meat industry checkoff programs with I think you said $500 million in ads and $4.5 billion in sales. Do these other programs come anywhere close?

Simon: No, the dollar amounts. Now, and I also wouldn't say these programs exist for most foods. These programs exist where a particularly aggressive and well-organized special interest group like blueberry growers or avocado growers has managed to convince their congressperson to introduce legislation that ultimately gets passed, setting up a checkoff program for their food. But they're not common. I know of them for blueberries, mangoes, avocados, popcorn, oddly, and a few other fruits and vegetables. But no, the list is pretty short, and the funding is much, much different. It's tiny. I think I mention in the book that the dairy program spends in a week what half a dozen fruit and vegetable checkoffs spend in their entire annual budget. So, it's one or two orders of magnitude smaller than what the animal foods checkoffs are collecting and spending.

Hoff: Hmm. That's interesting. Thank you. Well, while we're on the subject of government agencies, can you clarify the role of the USDA versus the role of the FDA? I think people generally know that both are involved in food regulation in some capacity, but they might be mixing up the specific sort of spheres of influence that each of these agencies have.

Simon: Yes. And it's a very complicated and somewhat arbitrary line that's drawn between the USDA and the FDA. USDA is responsible for regulating the production and sale of things like pork and beef, whereas FDA is responsible for food components of those commodities, so things like sausage on pizza, powdered milk, or milk additives. And it's a fair— You wouldn't, one would not be able to intuitively figure out, without looking at [chuckles] legislation, which organization is responsible for which area. There's also, there's always been talk, there's routinely talk about trying to take the FDA out of the food regulation business and just have it regulate drugs, which, again, would make a lot of sense. You don't need multiple agencies doing this.

Hoff: Hmm. Yeah, that does seem like a prime spot for that kind of regulatory confusion to creep in. You mentioned that these checkoff programs in the meat and dairy industry are well funded and well organized, and I think that leads well into another topic I wanted to get your input on of regulatory capture. And I think that many people may've heard of regulatory capture but might not know the specifics. So, can you tell us a little bit about how this practice has influenced, for example, the USDA and their nutritional recommendations?

Simon: Sure. So, industry actually—and this is counterintuitive—but industry seeks to be regulated. Why? Because it provides a barrier to entry. If you were Monsanto or you're Tyson or Cargill or some big producer of something related to the animal food industry, if you can successfully get regulations established that protect your position, then smaller players can't enter the market. Foreign players have a harder time entering the market. It makes the market less competitive. So, starting from that basic goal, as the industry establishes regulation, they then seek to capture that regulatory framework by various methods. Probably the most basic and simple is to install industry personnel into the regulatory framework. Great examples of this: At the moment, the USDA Secretary is Tom Vilsack. Tom Vilsack, until he was appointed Secretary of the USDA, was the president for four years, of the United States Dairy Export Council. In other words, he was one of the most important figures selling dairy to the rest of the world, and he transitioned directly from that dairy role into a regulatory, the most important regulatory role in the USDA.

Another example, we talked about the dietary guidelines for Americans that USDA and HHS together produce every five years or so. And in the last committee that oversaw and produced these dietary guidelines, 19 out of 20 committee members had ties to an industry organization. These included Kellogg, Abbott, Kraft, Mead, Johnson, General Mills, Dannon, and others like that. So, how do you take a committee that is almost completely comprised of industry participants and ask it to recommend what Americans should be eating for their health? It's just…. Obviously, there's an enormous conflict there.

Hoff: So, setting—and this might be [chuckles] easier said than done—but setting all of that concern about regulatory capture and regulatory confusion aside for a moment, some listeners might wonder why subsidizing meat production could be a bad thing from an ethics standpoint, sort of in a vacuum. After all, protein, obviously, as you know, is a necessary macronutrient, and protein deficiency is a harm to humans, especially children. So, what should we know about animal-based and other sources of protein from a nutritional standpoint and how governments might support human nutritional goals?

Simon: There is an overwhelming body of published, peer-reviewed research that shows that plant-based sources of proteins are healthier for humans than animal-based sources of protein. As with any scientific finding, there are always going to be exceptions, and I'm sure that there are some outlier studies out there that tend to show something different. But again, the overwhelming body of evidence is that humans on a plant-based diet are healthier than those on an animal-based diet. Just to give you some of these issues quickly, some of the studies that I talk about in the book show that, among other disadvantages of an omnivorous diet compared to a plan-based diet are a lifespan up to ten years shorter, double the risk of diabetes, 50 percent higher risk of heart disease and colorectal cancer, two-and-a-half times higher risk of prostate cancer in men, and double the risk of breast cancer in women. Again, this is not freak science. These are studies published in major journals like the New England Journal of Medicine, American Journal of Clinical Nutrition, etc.

So, not to belabor this point, the WHO, the World Health Organization, now categorize processed meat as a Class 1 carcinogen, which puts it in the same category as asbestos. And they categorize red meat as a Class 2 carcinogen. So, ethically speaking—I'm a lawyer, not a clinician—if I were a clinician, I would think my ethical duty would be to advise my patients about this science and encourage them, particularly those who have diseases like cancer, diabetes, and heart disease that we know are often causally related to consumption of animal products, to eat less animal products or even go on a plant-based diet.

Hoff: Do you know of any government-led programs to bolster the use of alternative sources of protein? I imagine some checkoff programs for things like the almond industry or something might make claim to be good sources of protein. But besides those sorts of things, do you know of any government-led initiatives that we might look toward for the advancement of non-animal protein sources?

Simon: Not in this country so much. And at the level of the European Commission or the World Health Organization, we tend to see more government or institutional-based advocacy for plant-based diets or even to reduce meat consumption. I would say this country is certainly not a leader in that area. And yeah, I mean, there are checkoffs for blueberries. There are checkoffs for mangoes. Things like that are helpful, but those are very limited, as we discussed.

Hoff: Right. And I imagine those barriers to entry are a big thing, especially for those smaller growers.

You talked a little bit about this in your previous response, but clinicians might find themselves on the receiving end of a lot of these difficult questions from patients who see them as trusted sources of nutrition information. So, how should clinicians prepare themselves to have helpful conversations about animal versus non-animal sources of protein or what kind of nutritional information they can trust from the USDA, for example?

Simon: Well, dialing this back to the level of medical school, there is a significant body of commentary now that is saying students in medical schools should be given more instruction in nutrition. And I don't know what the state is today, but as of 2017, there was a study that showed that fewer than one in five medical schools require a single nutrition course for graduation. And if we really want to have a conversation about ways to reduce heart disease, and if one of the standards of care is ultimately going to be patients with heart disease need to change what they eat, it would seem to me like that needs to start at the level of medical school. And right now, it just isn't really happening. [theme music returns]

Hoff: Yeah, that's reminding me of an article that we published back in October of 2018 in our Health and Food Ethics issue about produce prescription programs that expand patients' food choices and provide financial incentives to change eating behaviors. So, listeners who are interested in learning more about that can check out that article. But in the meantime, Dave, thank you so much for your time on the podcast today and for sharing your expertise with us.

Simon: Thank you.

Hoff: That's all for this episode of Ethics Talk. Thanks to Dave Simon for joining us. Music was by the Blue Dot Sessions. To read our latest issue on Meat and Health, visit our site, JournalOfEthics.org. And for all of our latest news and updates, follow us on Twitter and Facebook @JournalOfEthics. We'll be back next month with an episode on Interprofessional Education. Talk to you then.

Audio Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 0.25  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 0.25 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 0.25 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 0.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 0.25 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 0.25 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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