Research is essential. But the research we hear about does not always reveal the truth. Why? Because internal industry documents show that numerous industries knew and hid the harms of their products – from tobacco to toxic chemicals – for decades. Not only that, industry also manufactures science and sways public policy to favour their products, which collectively are a leading cause of death and disease globally.
It’s time we recognise these corporate practices for what they are: Commercial Determinants of Health. And while the industries might be different (fossil fuels, ultra-processed foods), they use similar tactics. To protect public health, this “industry influence” needs to be countered, but how?
We brought together experts to share case studies and strategies to mitigate and prevent industry influence on public health. Here are some highlights from our symposium at the Charles Perkins Centre, The University of Sydney.
Industry tactic 1. Funding research to influence what we know about a product.
Systematic reviews have shown that industry-funded research tends to have results that are more favourable to sponsors’ products than independent research. Professor Lisa Bero, University of Colorado, described factors contributing to this bias, ranging from how industry conducts research, analyses reports and selective reporting.
These problems are compounded if industry funding dominates a field of research. For example, industry-funded 84% of infant formula trials. Industry-funded trials are at a higher risk of bias and report more favourable results, therefore skewing the entire body of available evidence.
Industry-funded trials may be suppressed when results are ‘unfriendly’ to the company sponsor’s interests. According to internal documents, Dupont had evidence of harms from PFAS (per- and polyfluoroalkyl substances) chemicals in Teflon, its non-stick coating, decades before these became public. PFOA’s (perfluorooctanoic acid) link to kidney and testicular cancers was not publicly established until 2011, even though a DuPont-funded Laboratory said it was “highly toxic when inhaled and moderately toxic when ingested” in 1970. PFAS have now been detected in ~80% of US waterways.
Industry Tactic 2. Agenda setting and shaping the narrative.
Ray Moynihan of Bond University discussed how industry sets the agenda for medical diagnoses. New Alzheimer’s drugs target build-up of amyloid plaque in Alzheimer’s patients. The aim is to prevent progression, but effects on cognition are minimal, and there are serious risks, including brain bleeds.
Intense lobbying from industry-funded Alzheimer’s groups supported these drugs’ approval, calling them “game changers.” Approval for mild cognitive impairment also casts a broad net, targeting people without Alzheimer’s disease. This problem is compounded by blood tests for amyloid plaque, which are not predictive of future disease. With a death rate of 1-2 patients per 1000 in trials, there is considerable potential for harm.
Industry Tactic 3. Funding others to advocate on your behalf.
We know that industries have ready access to policy makers through processes such as lobbying, political donations, and employment of recent regulatory and political personnel. Dr. Lisa Parker of University of Sydney described how industry co-opts advocacy organisations such as patient groups as another tactic. Pharmaceutical companies give a lot of money to patient groups, particularly those that focus on health issues for which the business has products under patent or in the research pipeline. The voices of these well-funded patient groups drown out less-funded support groups, meaning that medicine regulators hear the messages industry wants them to hear.
Process for change
It’s time to recognise that a fundamental barrier for evidence-based policy making in health is the influence of corporations over research and policy. We propose a 3-step process for change:
- Recognise industry influence in health research and policy as a mechanism for Commercial Determinants of Health. A solution should be to refine Risk of Bias tools to include industry funding and financial conflicts of interest as independent risk factors for research bias. To reduce suppression of research, all health study protocols must be pre published and publicly available.
- Mandate public transparency of industry funding to research and policy actors. We need to reform lobbying laws and disclosure policies. The Sunshine Act is a legislative model for publicly accessible databases of industry spending. Registries should disclose industry donations to policy makers, advocacy organisations, patient groups, academic institutions, publishing houses, researchers, and lobbyists. Registries should be easy to search, detailed and permanent.
- Interrupt current and future financial links between industry and researchers / policy makers. Solutions should include academic and research institution incentives to dissociate from commercial funders in favour of alternative sources and/or independently distributed funds (e.g., from tax on corporate marketing); spending caps on political donations from industry and temporal restrictions on movement from policy jobs into industry.
Corporate influence is systemic and damaging to public health. Cracking the code has given us targets. It’s time to untangle this web.
About the authors
Barbara Mintzes, PhD is a professor of evidence-based pharmaceutical policy in the School of Pharmacy and Charles Perkins Centre at The University of Sydney.
Lisa Parker, MBBS (Hons), PhD is an Honorary Senior Lecturer in the School of Pharmacy, based at the Charles Perkins Centre at The University of Sydney.
Nicholas Chartres, PhD is a Senior Research Fellow in the School of Pharmacy at The University of Sydney.
