Calling for the expanded use of evidence in practice and policymaking is a focus of my interaction with public health professionals as I travel across the country as the American Public Health Association’s president. There is a particular challenge to evidence when the interest of keeping populations healthy and the interest of corporations collide. Collide is actually misleading as it implies big noise when in reality the influence of companies, labeled by some as corporate determinants of health, may be so subtle as to be missed.
An article appearing in this issue by Rosner et al. (p. 969) illustrates that corporations can and do influence the development and use of evidence. It is based on data found on the site launched in 2018 by Columbia University’s Center for the History and Ethics of Public Health and City University of New York, Project Toxicdocs (https://www.toxicdocs.org). The searchable database of corporate documents illuminates activities corporations seek to keep out of the public realm.
The article outlines historic challenge to talc standard setting with terminology shifting from “asbestos-free” to “nondetected,” to questions of validity and reliability of methodology used to determine fiber counts, and to the susceptibility of electing not to follow through with regulatory action when pushback by corporations occurs.
Talc products, a ubiquitous staple in households, have been advertised, particularly to women, as a sign of cleanliness and freshness and as safe for babies. This view is shifting as manufacturers settled their first talc lawsuits earlier this year, and the US House Subcommittee on Economic and Consumer Policy decided to focus its first meeting of 2019 on baby powder.
Two recent events further highlight concerns. In June 2018, the director of the National Institutes of Health (NIH) halted a study because of bias introduced through interactions among government officials, university researchers, and alcohol manufacturers. In July 2018, the US delegation to the United Nations disrupted what was expected to be routine passage of a breastfeeding resolution by proposing wording changes to the World Health Organization (WHO). The changes would have weakened support for breastfeeding, to the advantage of formula and baby food industries. While the breastfeeding wording was not modified because of the actions of other countries, the United States at the same meeting was successful in removing statements, opposed by the soft drink industry, suggesting taxes on soft drinks as a primary prevention strategy to lower consumption.
Skepticism is requisite to remain objective when one is performing scientific inquiry and evaluating existing evidence. Potential corporate strategies include sowing confusion about validity of findings, acknowledging only favorable or biased evidence, establishing impossible proof-of-harm standards, paying false experts, promoting logical fallacies, relying solely on their own corporate research, undermining confidence in outcomes, redefining what constitutes scientific evidence for policymaking, debating the social value of regulation, rejecting empirical evidence to avoid undesirable facts or conclusions, and reframing of questions to be investigated. Think tanks that operate under the veil of academic independence, but in reality do not, may sway public opinion or set the terms of public discourse. Corporations, by framing public health issues in terms of personal responsibility, shift the onus of harmful product use solely onto individuals. The flow of personnel between the public and private sectors complicates the clarity of their objectivity.
Yet, we do not want our healthy skepticism to slide into cynicism where sound evidence, when provided, is rejected. Nor do we want to be preoccupied with looking for something under every rock. Let us explore what principles should guide interactions among corporations, public health researchers and practitioners, and policymakers. Is there space for mutually agreed-upon health goals? Shared wins? If so, how do we most appropriately reach these endpoints?
14 Years Ago
Manufacturing Uncertainty
Opponents of public health and environmental regulation often try to “manufacture uncertainty” by questioning the validity of scientific evidence on which the regulations are based. Though most identified with the tobacco industry, this strategy has also been used by producers of other hazardous products. Its proponents use the label “junk science” to ridicule research that threatens powerful interests. . . . Although there are no magic bullets to cure this problem, increased transparency concerning conflicts of interest, especially involving the financial relationship between the authors and sponsors of studies used in regulatory and legal proceedings, is clearly warranted.
From AJPH, Supplement 1, 2005, pp. S39 and S45
17 Years Ago
Protecting Against Attacks on Science
As government agencies, academic centers, and researchers affiliated with them provide an increasing share of the science base for policy decisions, they are also subject to efforts to politicize or silence objective scientific research. Such actions increasingly use sophisticated and complex strategies that put evidence-based policy making at risk. To assure the appropriate use of scientific evidence and the protection of the scientists who provide it, institutions and individuals must grow more vigilant against these tactics. Maintaining the capacity for evidence-based policy requires differentiating between honest scientific challenge and evident vested interest and responding accordingly.
From AJPH, January 2002, p. 14
Biography
