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Concerns are widespread about the influence of pharmaceutical and other corporate interests on health and medical research, education, practice and policy.
The Crikey Register of Influence, for example, documents the involvement of health and medical experts in many industry advertising and marketing campaigns.
But we hear far less about how the corporate sector seeks to influence those working in public health.
Traditionally, the public health community may have regarded itself as a relative “cleanskin” when it comes to commercial conflicts of interest.
But as the food, beverage, alcohol, transport, gambling and energy industries, to name a few, come under increasing regulatory pressure, they are turning to some strategies that are worth documenting.
One such strategy is to make friends of those who could become influential critics. Typical strategies include sponsorship of research, conferences, and professional organisations, or inviting experts to join advisory boards.
This recent paper outlines for example, how the tobacco industry has used so called “corporate responsibility” initiatives to leverage its influence.
Below begins an effort to document these activities more widely, and the ties between public health professionals and the industries whose activities are often to the detriment of public health.
The Croakey Register of Influencers in Public Health (CRIPH) also includes links to relevant articles, with the aim of encouraging greater awareness and discussion about such ties, their impact, and their appropriateness.
I am looking for collaborators to help build and maintain the CRIPH – to contribute content and also to create a searchable database. Contributors will be acknowledged, and there may also be opportunities for cross-postings/publishings.
It would be useful, for example, to be able to search on particular companies, industries, institutions, researchers etc.
Are there any database-savvy public health/journalist/researcher/student types interesting in collaborating?
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Croakey Register of Influencers in Public Health (Aug 2011)
Food and beverage companies
• Dietitians Association of Australia. Corporate partners include global dairy company Fonterra, Kellogg’s, Meat and Livestock Australia, Unilever Australia, Nestle, Dairy Australia and Nutricia (part of the international food company Danone). Sponsors of its 2011 conference included Coca Cola South Pacific, Kellogg, Mars Chocolate, McDonald’s Australia and Nestle.
• Sponsors of The American Dietetic Association, “the world’s largest organization of food and nutrition professionals”, include the Coca-Cola Company, National Dairy Council, PepsiCo, Kellogg Company, Mars, and Unilever.
Source: 2010 annual report
• Coca-Cola Co donated $US250,000 to San Francisco Parks Trust, an organisation that supports San Francisco’s Recreation and Parks Department. Source: The Bay Citizen (http://s.tt/12N6Y)
• A Pepsi campaign promoted mega-size Pepsi to raise funds for the Juvenile Diabetes Research Foundation in the US.
Documented by Marion Nestle.
• The American Academy of Family Physicians has entered into a corporate partnership with the Coca-Cola Co, which is making a grant for the Academy to develop consumer education content related to beverages and sweeteners for the AAFP’s consumer health and wellness Web site, FamilyDoctor.org. Dr Michael Siegel, a Professor in the Department of Community Health Sciences, Boston University School of Public Health, has critiqued the arrangement.
• The soft drink industry in the US (via the Foundation for a Healthy America, created by the American Beverage Association, the national trade group representing manufacturers and bottlers) is making a $US10 million donation to the Children’s Hospital of Philadelphia to fund research into and prevention of childhood obesity. The ABA was seen as influential in blocking plans for a tax on sugary drinks. Analysis by Marion Nestle is here.
• In the US, the PepsiCo Foundation has contributed $2.5 million to the Healthy Weight Commitment Foundation — a coalition of businesses, non-profit organizations and athletes committed to reducing obesity by 2015. The grant is being used for a public education campaign for mothers and children, and to implement a school-based program. PepsiCo is also continuing to support the YMCA of the USA to improve the health, nutrition and well being of underserved African-American and Latino populations — a collaborative program that has reached nearly 40,000 people in 85 communities. The Foundation’s partnership with Save the Children has reached approximately 850,000 people in India and Bangladesh to help improve health and nutrition. And the Foundation’s partnership with the World Food Program (WFP), which “leverages PepsiCo’s supply chain expertise to improve the WFP’s logistics efficiency, will indirectly benefit approximately 90 million people served by the program”.
PepsiCo’s 2010 annual report.
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Background reading
Public health workers should avoid ties with the alcohol industry, says Dr Richard Smith, a former editor of the BMJ and now director of the United Health Group’s chronic disease initiative. “Organisations promoting health in the broadest sense should stay away from alcohol companies,” he writes.
• Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed?
Stuckler D, Basu S, McKee M, 2011 Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed? PLoS Med 8(4): e1001020. doi:10.1371/journal.pmed.1001020
• A Wall Street Journal article about PepsiCo’s health push.
• The Center for Science in the Public Interest in the US has a long list of not for profits that take corporate funding.
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Individuals or organisations named in the Register are welcome to provide their responses below. Other commentary is also welcome.
This is a great idea and important to document the breadth of these relationships as well as to get this information out in the public domain. I think that it is timely to start a discussion of the issues raised by these partnerships.
Greenpeace runs a website, http://www.exxonsecrets.org, which allows the tracing of funding links between Exxon and those who speak against climate change. I wonder if they’d let you borrow their back-end system to record links between corporations and public health professionals?
The gambling industry and state governments dependent upon gambling losses funding that directs research topics. The result is an emphasis on rehabilitation and away from public health prevention focussed upon the machines themselves.
My area of experience is mental health. I’ve been a consumer for 30 years and an occasional advocate for about 10. I’ve worked with NGO’s as well. The influence of Big Pharma and the contracting out of public services are of concern. I have personal knowledge of the impact of drug companies. If you want help in this area just ask. I’m a subscriber and twitter follower.
What bugs me is that these companies cuddle up to the health system and its professionals but that does not stop them charging the health system the living earth for their products, whether it is pharmaceutical, medical equipments, instruments or whatever. If they think they can load on another 10 or 20% on the price of the product because the public health system, ie the government is paying, they have no shame or concern. Those who are concerned about rising costs in the health system should consider what goes on in this area of spending carefully before slashing into staff numbers and skills.
Comparing the private breast cancer treatment I received in 2007, to public hospital policy manuals and Cancer Council Guidelines on early breast cancer, has revealed shocking differences. These include pathology testing, hospital admissions, treatments prescribed, quality of care delivered, conflict of interests, and unexpected out of pocket costs to patients.
Pathology tests – prior to surgery, and with no physical signs except a small lump on my breast, the private surgeon requested full body CT scans with contrast, nuclear med bone scans, CXR, liver ultrasound and bloods. These same tests were all repeated two years later, when I had an elective surgical removal of my non cancerous breast and plastic reconstruction. If I had been a public patient – no tests would have been requested prior to surgery, and limited scans would be only done if cancer is found in the lymph nodes. No scans would be done for any elective procedure involving reconstructive plastic surgery. The scans were all done at the private hospital where the surgeon worked.
Hospital admissions – All patients given chemotherapy in this private hospital are sent for an overnight stay in the private hospital after the first treatment for ‘monitoring’. This is never done in the public sector, patients are sent home with anti nausea drugs and a phone number to call a junior doctor if they need other scripts.
Medical treatments – Despite only having grade one cancer, most of it DCIS, I was told I ‘needed chemotherapy’. In the public hospital system, chemotherapy is only given if cancer is actually found to have spread to the lymph nodes or around the body.
Quality of care – I received no pre chemo education, no health assessments during and after chemo, no access to anti nausea drugs in between treatments and no follow up care after treatment, despite severe and chronic ill health. I was never reweighed during chemotherapy, despite losing 15% of my body weight during treatment. In the public health system all these things are mandatory. The private oncologist I saw actually works at a large public hospital less than half an hour’s walk away, where he has to reweigh all his public patients before they are given any chemotherapy, to ensure correct dosage. His private patients, who pay thousands for their treatment, are never reweighed.
Cost – the overall cost of my treatment was $20,000 out of pocket. I received no upfront quotes for all of these costs, and was continuously caught unaware. I eventually had to sell my house to pay the bills.
Conflict of interest – It turned out that the private clinic I had been attending, had no relationship to the Australia wide Catholic Health network who’s name it bore. It is actually a private company, run by the three doctors who work there. Any increases in safety standards, and restricting treatments for their private patients to what is strictly necessary, would mean a drop in income for the private doctors. The private doctors are all closely involved in the hospital they refer their patients to.
I asked a retired bureaucratic from public hospitals section of DHS why there was no investigation into private hospitals, despite these sorts of gaps between public and private cancer treatments. I pointed out to him that the majority of cancer treatment is now conducted in the private health system, despite the fact that there has been no review of this change in delivery of the most expensive and complex of all the medical treatments. He replied that private hospitals simply refused to cooperate with DHS and given information about staffing levels, adverse patient events like infections, and clinical practices. Why was this allowed to continue I asked? ‘Lobbying’ he