Appropriating Medicine and Public Health for Marketing Ill Health

In the last century, corporations have found new ways to appropriate medical authority to improve marketing of products that harm the health of the public. In a special section of the January 2012 issue of the American Journal of Public Health, researchers describe some of the ways that the alcohol, tobacco and pharmaceutical industries have undermined medical and public health professionalism in order to advance their economic interests.

In the first article,[1] James Mosher, a long-time alcohol policy researcher, describes how the distilled spirits industry developed new products such as alcopops, sweetened soda-like beverages, to regain the youth market after losing market share to beer makers. The article focuses on Smirnoff Vodka brand, a product of Diageo, the world’s largest producer of distilled spirits. Through sophisticated marketing, public relations and lobbying campaigns, Diageo was able to overcome public health opposition to win tax and regulatory changes that allowed them to target their products at young people, especially young female drinkers. These victories enabled Diageo to regain market share among young drinkers and to secure brand loyalty from future generations of spirits drinkers. In achieving their business objective, Diageo undercut progress toward the national health goal of reducing youth drinking.

Smirnoff Ice, a citrus-flavored malt beverage

In a second article on the alcohol industry,[2] David Jernigan of the Johns Hopkins Center on Alcohol Marketing to Youth at the Johns Hopkins School of Public Health – and a CHW Contributing Writer – describes the International Center for Alcohol Policies, created by the global alcohol industry to advance its business, political and scientific objectives. Jernigan documents how ICAP has sought to counter the World Health Organization and independent alcohol researchers by producing reports, sponsoring scientific meetings and commissioning industry-friendly researchers to contest scientific findings that threaten industry profits.

In another article Allan M. Brandt,[3] the Harvard historian who wrote The Cigarette Century: The Rise, fall and Deadly Persistence of Product that Defined America, also looks at industry efforts to challenge medical and scientific research that show a product’s harm. Brandt explains how the tobacco industry “invented the modern problem of conflict of interest” by seeking to “erode, condemn and confuse” the growing body of scientific evidence that “threatened to destroy its prized, highly popular and exclusive product.”

Finally, Joseph Ross and his colleagues[4] at the Yale University School of Medicine analyze how pharmaceutical industry practices “distort the medical literature and undermine clinical trial research, explicitly by obscuring information that is relevant to patients and physicians.” Among the practices they examine are seeding trials, publication planning, messaging, ghost writing and selective publication and reporting of trial outcomes.

In an editorial[5] accompanying the special section, David J. Rothman, a historian at Columbia University, suggests policy options for reducing harmful corporate influences on professional practice of medicine and public health. These include requiring food, tobacco and alcohol companies to disclose all gifts and funds given to physicians, as is now required for the pharmaceutical industry, and strengthening federal regulation of health claims made by the food and alcohol industries, paralleling the new authority given to the Food and Drug Administration to provide oversight of tobacco industry advertising claims. Rothman also urges academic medical centers to ensure that corporate research grants to its physicians are not “marketing ventures in disguise.”


These articles make an important contribution to the small but growing literature that compares the strategies that different industries use in order to develop more effective public health approaches to minimizing their harm. For example, several comparisons of the food and tobacco industries have analyzed their similarities and differences.[6, 7, 8, 9] More specifically, researchers have compared the use and misuse of health claims[10] and the value of regulation and self-regulation, [11, 12]analyzed how different industries have used the legal concept of preemption to weaken regulation;[13, 14]and examined the use of commercial speech protections by the food, pharmaceutical and tobacco industries.[15] Some studies look at the cumulative impact of several industries on single outcomes, e.g. the influence of the food, alcohol and tobacco industries on cancer[16] or on classes of outcomes, e.g., these same three industries influence on NCDs.[17] Finally, several analysts have compared the success and limitations of public health strategies to counter industry influences such as litigation,[18, 19] media advocacy,[20] counter advertising,[21, 22] and advocacy campaigns.[23]

The articles in the American Journal of Public Health special section and the others cited above show how corporations and their allies have sought either to use the authority and credibility of medicine and public health to advance their business interests, or, failing that, to undermine their legitimacy or sow confusion. Too often, scientists and their institutions have entered into Faustian bargains, trading their public trust for industry financial support for their research. Public health and biomedical researchers now have both an opportunity and a responsibility to undo this damage and restore public credibility by advancing a research and policy agenda that puts the public’s health first.

Possible goals for such an agenda include ongoing surveillance of business practices that endanger health in order to provide early warning signs for public health action; research on the effects of misleading or deceptive health claims and the effectiveness of various strategies to discourage such claims; and the development and enforcement of  university and medical center standards to prevent researchers from becoming unidentified marketing agents for specific products, companies or industries.

To date, few governments have the political will to advance such an agenda and non-governmental organizations lack the mandates, capacity or resources to take on these tasks. Perhaps mobilized public health and biomedical researchers can help to spark the changes needed to better protect the health of the 99% of the world’s population whose health now suffers because of the practices of the corporations owned by the 1%.

 


References



[1] Mosher JF. Joe Camel in a Bottle: Diageo, the Smirnoff Brand, and the Transformation of the Youth Alcohol Market. Am J Public Health. 2012;102(1):56-63.

[2]Jernigan DH. Global Alcohol Producers, Science, and Policy: The Case of the International Center for Alcohol Policies. Am J Public Health. 2012; 102(1):80-89.

[3] Brandt AM. Inventing Conflicts of Interest: A History of Tobacco Industry Tactics. Am J Public Health. 2012; 102(1): 63-71.

[4] Ross JS, Gross CP, Krumholz HM. Promoting Transparency in Pharmaceutical Industry-Sponsored Research. Am J Public Health. 2012; 102(1): 72-80.

[5] Rothman DJ. Consequences of Industry Relationships for Public Health and Medicine. Am J Public Health. 2012; 102(1):55.

[6] Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q. 2009; 87(1):259-94.

[7] Alderman J, Daynard RA. Applying lessons from tobacco litigation to obesity lawsuits. Am J Prev Med. 2006 Jan;30(1):82-8. Erratum in: Am J Prev Med. 2006;30(4):363.

[8] Kersh R, Morone J. The politics of obesity: seven steps to government action. Health Aff (Millwood). 2002;21(6): 42-5.

[9] Courtney B. Is obesity really the next tobacco? Lessons learned from tobacco for obesity litigation. Ann Health Law. 2006 ;15(1):61-106.

[10] Ellwood KC, Trumbo PR, Kavanaugh CJ. How the US Food and Drug Administration evaluates the scientific evidence for health claims. Nutr Rev. 2010;68(2):114-21.

[11] Sugarman SD. Performance-based regulation: enterprise responsibility for reducing death, injury, and disease caused by consumer products. J Health Polit Policy Law. 2009 Dec; 34(6):1035-77.

[12] : Jernigan DH. Public health tools for holding self-regulators accountable: lessons from the alcohol experience. Health Promot Pract. 2011 May;12(3):336-40.

[13] Annas GJ. Good law from tragic facts—Congress, the FDA, and preemption. N Engl J Med. 2009; 361(12):1206-11.

[14] Gorovitz E, Mosher J, Pertschuk M. Preemption or prevention?: lessons from efforts to control firearms, alcohol, and tobacco. J Public Health Policy.1998;19(1):36-50.

[15] Orentlicher D. The commercial speech doctrine in health regulation: the clash between the public interest in a robust First Amendment and the public interest in effective protection from harm. Am J Law Med. 2011;37(2-3):299-314.

[16] Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved. 2008 Feb; 19(1):26-40.

[17] Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable. disease crisis. Lancet 2011; 377: 1438–47.

[18] Parmet WE, Daynard RA. The new public health litigation. Annu Rev Public Health. 2000;21:437-54.

[19] Lytton TD. Using litigation to make public health policy: theoretical and empirical challenges in assessing product liability, tobacco, and gun litigation. J Law Med Ethics. 2004; 32(4):556-64.

[20] Dorfman L, Wallack L, Woodruff K. More than a message: framing public health advocacy to change corporate practices. Health Educ Behav. 2005 Jun; 32(3):320-36.

[21] Agostinelli G, Grube JW. Alcohol counter-advertising and the media. A review of recent research. Alcohol Res Health. 2002; 26(1):15-21.

[22] Agostinelli G, Grube JW. Tobacco counter-advertising: a review of the literature and a conceptual model for understanding effects. J Health Commun 2003; 8(2): 07- 27.

[23] Freudenberg N, Bradley SP, Serrano M. Public health campaigns to change industry practices that damage health: an analysis of 12 case studies. Health Educ Behav. 2009;36(2):230-49.

 

Image Credits:

1. Corporations and Health Watch

2. Seidoger via flickr.

3. Gullig via flickr.

4. Rennett Stowe via flickr.