Joshua Freeman, MDLeft Forum, 2011

Corporate Influence on Medicine and Health Drug and device makers Insurance companies Conflict of interest Support for health organizations

◦ “Non-health related”◦ Tobacco

AAFP Case: “Anti-health” corporate support

Corporate profit taken out of the system Administrative costs to garner the profit Should there be insurance companies? If so, should they be for-profit? “Bribery” suggestion

Drugs◦ High cost of drugs◦ Variable pricing in different markets◦ “Me-too” drugs

Devices◦ Create demand◦ Lack of interoperability◦ “Make the most irritating noise”

Direct payments to physicians: consultant, speaker fees

Funding research Advertising funding medical journals Heightened awareness New rules in AHCs, Hospitals, Practices Decrease in drug “paraphernalia”, samples

From “non-health-related” businesses The AMA and Sunbeam, 1997 Public outcry (unanticipated) Now a Harvard Business School case study AMA cancelled contract and Sunbeam sued AMA paid $9.9 M settlement in 1998

Classic: Tobacco Before and after “Doll and Hill”, 1950

“Food” and drink companies High-calorie, high-fat, non-nutritive Major contributors to the Obesity epidemic Case: the American Academy of Family

Physicians (AAFP) and Coca-Cola

The American Academy of Family Physicians is partnering with consumer products companies to develop robust new programs and educational materials for consumers and medical professionals about making better choices with regard to nutrition, physical activity, emotional well-being, and other ways to achieve a balanced and healthy lifestyle

Consumer Alliance PartnershipsThe American Academy of Family Physicians is partnering with consumer products companies to develop robust new programs and educational materials for consumers and medical professionals about making better choices with regard to nutrition, physical activity, emotional well-being, and other ways to achieve a balanced and healthy lifestyle.

AAFP recognizes that consumer products companies can have significant influence over consumer health. That’s why the AAFP created its Consumer Alliance program, a strategy whereby the AAFP aims to partner with companies who demonstrate good corporate stewardship and a strategic focus on consumer health.

FamilyDoctor.org, the AAFP’s award-winning consumer health and wellness resource, is the fundamental core of the AAFP Consumer Alliance. Through partnerships in the Consumer Alliance, AAFP will continue to expand educational content that focuses on healthy living to help consumers make informed decisions about nutrition, physical activity, emotional health and prevention of disease.

Partners include:

                                                                    

                                         

Howard Brody addresses justifications put forward by AAFP for the Coke relationship:

“Premature accusation” “Wrong not to engage” “Other party not evil”

Response by AAFP-President Heim Annals of Family Medicine, Jul-Aug 2010

Conflict of interest does not require demonstration of favoritism

Analogy to a judge In the AAFP case, if the final educational

material includes a strong statement against sugary soft drinks, we will never know whether, absent the Coca-Cola funding, the statement would have been even stronger. That such questions will inevitably be raised shows the conflict of interest is both present and serious, quite apart from the eventual contents of the educational materials”.

Is there a strong statement?

Sugary drinks, including soft drinks, sports drinks and fruit drinks, are the number 1 source of added sugar in

the American diet. A 12-ounce can of non-diet (regular) soda can contain 8 or more teaspoons of sugar and over 130 calories. That’s more sugar than

the American Heart Association recommends for an average American woman in 1 day!

http://familydoctor.org/online/famdocen/home/healthy/food/general-nutrition/1005.html

This content was developed with general underwriting support from The Coca-Cola Company

Skip sugary drinks and choose water instead

“Wrong not to engage”◦ Arthur Schafer noted “…noted the propensity for

engagement with industry, in such discussions, magically to convert itself into accepting large sums of money from industry.”

“Other party not evil”:◦ The question is whether their interests may lie in

opposition to the interests of the health of doctors’ patients

Non-polemical article Heim article non-responsive

Not only doctors Are dieticians more trustworthy? “Partnership” with: Hershey’ Chocolate! Yum. I guess it is healthful!

Press ReleaseHershey Teams Up With ADAMonday, July 19, 2010 American Dietetic Association and the Hershey Center for Health & Nutrition Join Forces to Educate Americans on Better, Balanced Eating

Healthy Balanced LivingAbout Consumer Consultations with RDs - Click here to learn about how consumers can receive a complimentary visit with an RD.About our Collaboration - Click here to find out more about the Hershey Center for Health & Nutrition's collaboration with the ADA.What RDs are Saying - Find out more about our recent survey of dietitians and their thoughts on chocolate's role in a balanced lifestyle.The Facts - Click to learn more about "Fitting Chocolate into Your Diet", "Responsible Snacking" and "100 Calorie Portions" of your favorite candies.

Parallel to national policy Increase corporate influence (e.g., “Citizens

United”) Decrease alternative sources of funding (tax

dollars) Increase dependence on corporate

“largesse” Unwillingness to “tax” members (esp with

recession) Undermines trust (Brody on AAFP)

Joshua Freeman, MDjfreeman@kumc.eduwww.medicinesocialjustice.blogspot.com