Defining Appropriate Roles for Corporations in Public Health Research and Practice

Does industry sponsorship of health research influence the public health research agenda? Does it shape public health policy and priorities? In a scoping review designed to provide answers to these questions, Fabbri et al. (p. 1527) synthesized 36 studies that examined industry influence on the public health research agenda. Across studies of the role of research funding from medically related, tobacco, food, biotechnology, and other industries, the authors found that in general (and not surprisingly) industry funding focused on research topics with commercial applications.

Fabbri et al. identified three common strategies industry uses to influence research agendas. First, industry sponsors research to establish priority research agendas that are favorable to industry’s legal and policy positions. Second, corporate sponsors strategically fund priority research areas to enhance the appearance of scientific credibility. Third, industries disseminate their corporate research agenda by enrolling nonindustry stakeholders through conferences, committees, and other joint initiatives. Fabbri et al. concluded, “Corporate funding of research with commercial implications drives the research agenda away from public health priorities.”

The authors’ recommendations provide a starting point for developing public health responses to reduce harmful industry influences. Fabbri et al. suggest routine requirements for disclosing funding, reporting investigator conflicts of interest, developing research institute policies to regulate interactions with commercial entities, and paying more attention to recognizing when industry agendas are hijacking genuine research.

But the public health community also needs to formulate a more comprehensive response to commercial influences on health. Separately studying industry influences on the research agenda, research findings, conflicts of interest, public policies such as regulation and taxation, and public opinion risks missing the bigger picture. For example, extensive scholarship on the tobacco industry shows that its ability to develop a comprehensive and coordinated portfolio of strategies to advance its business and political goals allowed it to resist scientific evidence and public health advocacy for decades.¹ More recent investigations have shown similar practices by the food, alcohol, firearms, energy, and pharmaceutical industries.^2–4

Developing comprehensive and effective responses that can mitigate or prevent the harmful practices of lethal but legal industries is a vital public health priority. Corporate practices have become primary social determinants of premature death and preventable illnesses from noncommunicable diseases, injuries, and environmental exposures.^3,4 Modifying harmful practices is a practical strategy for promoting health and reducing health inequalities.

What additional research is needed to integrate the finding of Fabbri et al. on the impact of corporate sponsorship of research into a deeper understanding of the cumulative impact of the many industry practices that influence population health? Several topics have recently attracted research attention. How can public health researchers best reduce conflicts of interest? Conflicts of interest occur when the public obligations of researchers, government officials, or corporations conflict with their private interests.⁵ Undetected or undisclosed conflicts of interest taint the validity of findings and threaten the credibility of public health researchers.

In an era when trust in many forms of authority is declining, industry affiliations that pose conflicts of interest could jeopardize the capacity of public health professionals to communicate credibly with the public to address future public health crises. Empirical research on the real-world impact of various approaches to reducing and eliminating conflicts of interest will provide evidence to inform more effective conflict of interest policies.

Another task is to define and assess appropriate roles for industry in setting public health policy. In the case of tobacco, the World Health Organization used the Framework Convention on Tobacco Control to draw a clear boundary for the industry role in shaping public policy. Article 5.3 of the convention excludes tobacco industry representatives from participating in setting tobacco policy.⁶ Tobacco was excluded from the policy process because of the industry’s history of misrepresenting science and manipulating the policy process.¹ Should this approach also apply to the food, alcohol, and other industries? Or, as industry representatives argue, are the products of these industries so different from tobacco as to suggest another approach? Research that compares the practices of these industries as well as their products may provide more useful evidence for setting policies.⁷

Researchers also debate the value of public–private partnerships, agreements in which representatives of industry, civil society, and government together set public health policies. Industry representatives claim they have the needed expertise and the resources to bring about changes. However, existing evidence on the impact of public–private partnerships shows disappointing contributions to improvements in health.⁷ Policy research that compares the longer-term impact on the population health of various regulatory regimes can provide policymakers with the evidence needed to find an appropriate balance between government and industry roles.

GOVERNMENT, CIVIL SOCIETY, AND UNIVERSITY ROLES

In the late nineteenth and twentieth centuries, research by publicly funded and independent scientists contributed to dramatic advances in public health protection and declines in mortality and morbidity. Today, corporations and their allies and the scientists they hire are creating new bodies of faux science on climate change, nutrition and health, tobacco, pharmaceuticals, firearms, and other topics. This corporate-produced science is created not primarily to uncover new knowledge or improve human well-being but to develop and market more profitable products and to defend business interests from public interference.

As Fabbri et al. note, corporate sponsors seek to enlist nonindustry stakeholders in promoting their agenda. Universities have a key role to play in protecting scientific integrity from corporate interference. When academic institutions accept funding from the Coca-Cola Company, Diageo, PMI (formerly Philip Morris International), or other corporations whose products and practices play a key role in rising global rates of noncommunicable diseases, they tarnish not just their own credibility but that of the public health enterprise as well. When universities agree to limit corporations’ public disclosure of research findings or to allow the intellectual property of its researchers to benefit private interests at the expense of public ones, they compromise basic public health values. By insisting that our universities develop and enforce clear rules on transparency, public disclosure, and conflict of interest, public health researchers and professionals can protect our research agenda from inappropriate corporate influence.

If, as seems likely, public funding for science declines and corporate funding increases, policymakers and advocates may lose the reliable evidence they need to make informed public health policy decisions about emerging threats to health. Mixing the apples of independent science designed to inform policy with the oranges of science designed to advance corporate interests leaves policymakers with a fruit salad that may be a faulty guide to public health practice. By engaging policymakers and the public in a conversation about the type and quality of evidence that will be needed to protect public health in the future, public health researchers and professionals can help to define appropriate roles for government, civil society groups, and industry.