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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.

AMS
London, UK

8 Comments

  1. Well that nice. For my comments, after that last exchange, I will hang my comments on my own site.

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  2. Industry’s goal is selling its products.
    Any co-operation with gov’t heath will be subservient to that goal.
    Beware.
    (Excellent on this topic: Your colleague Dr Freedhoff at Weighty Matters blog)

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  3. I find it hard to accept that an organization should take money from a company that would be negatively impacted in a large way if the organization were to achieve its ultimate objective.

    If we were to eradicate obesity, many of the big pharma and big food companies that sponsor these organizations would lose massive amounts of money. It is not in their interest for us to succeed, but for us to fail so they can continue to generate profits.

    Why would we take sponsorships from those who are counting on us to fail?

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  4. @Mark: you raise a good point but I do not think that the companies would stand to lose if organizations like the IDF fail.

    For one, the chances that any efforts will substantially reduce or even eradicate the problem entirely in our lifetime are virtually zero. As long as societies continue to industrialize and prosper, humans continue to live to longer ages, and no one wants to go back to a pre-industrialised lifestyle, conditions like diabetes, obesity, high-blood pressure, and cancers will continue to manifest themselves.

    For a company in this business, early identification and better treatments (e.g. for diabetes, or breast cancers) means MORE not FEWER patients. As treatments (including those for diabetes and cancer) are seldom curative, more patients surviving and living with these conditions – means even MORE business and earning (a perfect example is HIV/AIDS, where most of the money is not earned by ‘saving’ but by ‘maintaining’ lives).

    Similarly, food companies will never go out of business because there are 8 billion mouths to feed everyday on this planet. Only industrial production and distribution of foods can feed this many people (growing plants on your balcony cannot) – so unless someone has a suggestion on how to reduce the number of folks living on this planet, the industrial food complex will always be around and always find a way to make money for its shareholders (whilst providing jobs for its employees).

    The reason that it is easier for food companies to make more money off selling ‘less nutritious’ energy dense foods is simply a matter of the reality of food and agricultural production and policies. As long as governments support the cheap production of corn, which can be made into cheap corn syrup, which in turn can be made into cheap sugary pop, which in turn can be sold for high profits to people who are seeking ‘happiness’, food companies will continue making sugary pop. If governments actually did come down on cheap corn syrup (despite the screams and shouts from the agricultural lobbyists), companies would find ways to make money by selling something else (not necessarily healthier).

    I think the wrong assumption is that industry wants to sell ‘unhealthy’ products, when in reality industry just wants to make a profit. Which company would not rather sell healthier products if they could make the same (or more) profit by doing so? If food companies could show the same returns by selling more fruit and vegetables, that would be exactly what they’d be doing – the reality is that no one has ever figured out how to do that for the masses (forget about the elitist ‘Farmer’s Markets’ that do not feed even 1% of the population).

    So how about this scenario: a food company partners with an NGO to teach people that healthier food is worth spending money on (rather than on your plasma TV), thus creating a critical mass of people, who will actually demand healthier foods (and be willing to pay the actual cost of such foods), allowing food companies to actually make a profit by selling such foods – consumers feel healthier – demand even more healthy foods and happily pay even more for such foods, allowing food companies to produce even more healthy foods – everyone is happy.

    In the context of pharma: a diabetes company supports IDF – which trains more doctors to screen people for diabetes and the importance of treating to target, which allows the company to sell even more of their products (and spend part of their profits on developing even more products) – as a result of which more people with diabetes can live longer with fewer complications – allowing the companies to sell even more of their meds (remember: there is no money to be made off dead patients).

    Only if you believe that not taking money from pharma or food will eradicate obesity, diabetes, cancer or anything else, would you find yourself in the moral or ethical dilemma that you discuss.

    If we accept that in our world, obesity, diabetes, cancers and everything else will continue to affect millions of people (for reasons that have nothing to do with food or pharma) – we actually begin being grateful for what these companies can do and have to contribute.

    If their money can help do more research, bring more public awareness to the problem, teach health professionals and patients how to better diagnose and treat these conditions, and help reduce the pain and suffering that comes with these problems, all while still making a healthy profit – all power to them I say.

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  5. “a food company partners with an NGO to teach people that healthier food is worth spending money on”

    Huh?
    My chain supermarket already has cheap food – carrots, cabbage, turnip, potatoes, frozen spinach and peas, rice, dried beans and lentils, sale cuts of meat. etc. etc.

    The idea that a healthy diet requires extreme variety of exotic and expensive ingredients is a scam – the food industry wants people to spend more money on food , so that’s great for them. The food industry would ensure that the nutrition would come at the highest price possible.
    The NGO would be better off promoting simple menus with basic ingredients, with the help , not of the food company, but of health professionals to ensure nutrition.

    The food industry will do everything it can to make people believe that they have to spend a lot of money to get healthy food.

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  6. @Anonymous: good point – however, this also assumes that people know and have the time to cook healthy meals from scratch – also that they actually have a supermarket or store that sells fresh groceries in their neighbourhood. It still leaves the issue of how an NGO will fund itself to do what it does – even the health professionals won’t work for free or actually pay the NGO to what it does.

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  7. Yes, a health NGO can take money from the food industry. We already have that “marriage” with the Heart Health Choice endorsement on many processed food products.

    However, when a health NGO accepts money from the food industry the NGO should provide full disclosure, such as how much money they received and exactly what they did for that money.

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  8. Just popped back in to read the blog and noticed this extensive answer. Thanks for taking the time to address my concerns.

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