Can a Health NGO Take Money From Industry?

So on the final day of the World Diabetes Congress, I attended a debate on whether an organization like the International Diabetes Federation, should be accepting money from corporations.

The ‘in favour’ position was argued by Sir Michael Hirst from the United Kingdom, who is currently the President-Elect of IDF and will take the office of President of the Federation in 2012.

The ‘opposed’ postion was argued by John Yudkin, Chairman of the International Insulin Foundation and Emeritus Professor of the London School of Hygiene.

Hirst eloquently (and predictably) pointed to all the good that IDF does by driving the global diabetes agenda, fostering the international diabetes community, increasing diabetes awareness, engaging governments, publishing position papers and the diabetes atlas, and hosting countless roundtables, task-forces, and congresses like this one, would not be even remotely possible without strong corporate sponsorship.

As he noted, diabetes simply does not have the same appeal of infectious diseases like malaria or HIV/AIDS, which draws a flock of Hollywood celebrities, philanthropic associations (Gates Foundation), and publicity seeking politicians to throw money at the problem.

Focussing on the relationship with the pharmaceutical industry (which provides most of the corporate funding for IDF), Hirst argues that without an organization like the IDF, these companies would simply hold their own conferences and educational events – with no checks and balances – without any need for transparency or ethical standards – events would be driven solely by profit.

In contrast, with IDF in charge, it provides a credible channel, can impose checks and balances, provide and enforce an ethical framework, and clearly drive the agenda of these meetings and publications.

Thus, as was plainly evident at this (and all medical conferences I tend to go to), speakers have to publicly declare their ‘conflicts of interest’, ‘sponsored symposia’ are clearly marked and declared as such, and the industry exhibits are recognizably exactly what they are – industry exhibits.

In his counterargument, Yudkin (also rather predictably) argued that although pharma companies do make and continue to develop effective treatments for diabetes, these newer treatments are often far too expensive for people in developing countries (where most people with diabetes live).

Thus, although generic insulin is listed in the WHO compendium of essential drugs and newer (more expensive) insulins have yet to prove their clinical benefits, when prescribers (read ‘doctors’) come to conferences such as this World Congress, and learn about all the latest diabetes treatments, they are far more likely to return to their countries and prescribe these expensive drugs to their patients, thereby using up more of the health care budgets in their countries than would actually be required.

Yudkin also pointed out that the 95% of IDF funding (about 8-10 million in a non-congress year) comes directly from corporate support makes up a tiny fraction (2%) of these company’s sales – so it is easy to see how every dollar spent on the IDF likely delivers 100-fold in returns to their bottom line.

Yudkin challenges the notion that Codes of Conduct or Ethical Frameworks do much to counteract corporate influence. He also notes that by accepting corporate funding, it will be impossible for IDF to demonstrate real ‘outrage’ about corporate promotion of expensive (and not necessarily more effete) drugs in these countries.

He held up the International Union Against Tuberculosis and Lung Disease as a shining (albeit only) example of a major health organization that does not accept core funding from pharma. The Union interestingly gets all of their over $50 million in annual funding from governmental developmental funds, major charitable and philanthropic foundations, and (interestingly) Big Oil (who all appear to have jumped on the infectious disease cause).

So, all in all, a very predictable debate with very predictable arguments on an issue that will likely remain as unresolved in the future as it is now.

Somewhat disappointingly, the entire debate focussed on taking money from pharma – no discussion of engaging with food companies, city builders, car manufacturers or any of the other countless industries that one would assume are both part of the problem as well as potentially parts of the solution.

In balance, I believe I am more for disclosures, codes of conduct, and transparency when engaging industry as partners to actually get something done, rather than simply waiting and hoping for governments or benevolent billionaires to step up to the plate (remember governments and billionaires also have their own ‘agendas’).

I guess there is a fine but distinct line between dancing and sleeping with a porcupine.

London, UK