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Can Public Health Advocates in Europe and the United States Together Protect Public Health Regulation?

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Nicholas Freudenberg speaks on corporations and health at DeBalie, a public lecture hall in Amsterdam.

In both Europe and the United States, public health regulation is under attack.  Despite the Volkswagen Dieselgate emission cheating scandal, the European Union has not yet developed guidelines to prevent future cheating.  Monsanto continues to block stronger regulation of glycophates in Europe and North America. In the United States, President Trump and the Republican Congress are slashing funding and rescinding public health regulations at several federal agencies.  Can public health professionals and advocates in  two of the world’s largest markets join forces to resist these trends?

At a recent series of lectures in Brussels, Amsterdam and The Hague, Nicholas Freudenberg, Distinguished Professor of Public Health at the City University of New York School of Public Health and author of Lethal but Legal: Corporations, Consumption and Public Health examined some of the issues confronting those seeking to reduce corporate practices that harm health.  In his lectures, he suggested five broad goals for a transatlantic agenda to protect public health against corporate efforts to roll back regulations.  These included:

  1. Remove corporations from public health and trade policy decisions
  2. Protect science from corporate manipulation and conflicts of interest
  3. Revitalize public sector in food, medicines and transportation to provide an alternative to corporate control
  4. Protect democracy from corporate interference
  5. Challenge the view that no other world is possible

The lecture and trip was sponsored by Wemos Foundation, a Dutch global health foundation, the European Public Health Alliance and Corporate Europe Observatory, timed to coincide with the translation of Freudenberg’s book into Dutch, Legaal Maar Fataal. Each of these organizations provides useful resources for North American public health professionals who want to better understand recent developments in Europe.

The Wemos Foundation, for example,  sponsored a forum on the interactions between the European Medicines Agency (EMA) and the pharmaceutical industry and explored strategies for reducing conflicts of interest.  A summary of the event is available here.

The European Public Health Alliance(EPHA), an organization of public health NGOs, patient groups, health professionals and disease groups, works to improve health and strengthen the voice of public health in Europe. Several recent reports focus on issues also of concern in the United States:

  • In another recent  report, EPHA and other groups call for the United Nations Institute for Training and Research (UNITAR), to end a newly formed partnership with the world’s largest beer producer, AB InBev.
  • The Unhealthy side effects of CETAexamines the Comprehensive Economic and Trade Agreement (CETA) between the European Union and Canada, the first trade agreement  between  the  EU  and a  major  world economy and  the  most far-reaching  bilateral  trade and  investment  agreement negotiated  to  It concludes that the agreement “limits the  policy  space of  governments  in the  area  of public health, tariff elimination, market access commitments, negative listing of services, its  lack  of recognition  of  the health-relevant  aspects  of the  Sustainable  Development Goals (SDGs) and ignoring key health risk  factors  and threats  such  as alcohol-related  harm  or antimicrobial  resistance.  In short, CETA fails to ensure policy coherence between trade and public health.”

The Corporate Europe Observatoryis a research and campaign group working to expose and challenge the privileged access and influence enjoyed by corporations and their lobby groups in EU policy making.

For public health advocates in the United States, these organizations and their reports can be useful resources for developing strategies to resist deregulation and reduced enforcement.  “As the U.S.  government dismantles the public health regulatory agencies developed over the last 50 years,” said Freudenberg, “researchers need to document the impact of these changes and develop new strategies to protect public health.  By partnering with European scientists and advocates, we can accelerate this process.”

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Judge: Assault weapons ban doesn’t violate 2nd Amendment

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Assault weapons and large-capacity magazines are not protected by the Second Amendment, a federal judge said in a ruling upholding Massachusetts’ ban on these weapons, reports the Washington PostU.S. District Judge William Young dismissed a lawsuit challenging the 20-year-old ban, saying assault weapons are military firearms that fall beyond the reach of the constitutional right to “bear arms.” Regulation of the weapons is a matter of policy, not for the courts, he said. 

Cutting-edge NHS drugs do more harm than good

Almost all new drugs approved for Britain’s National Health Service  do more harm than good, according to a study using  modelling adopted by the government, reports The Times (London).  Saving a life with a new drug can cost about twice as much as doing the same through more staff or equipment, according to official calculations that led to calls for reform of the way the NHS pays for medicines. The Department of Health and Social Care has implicitly conceded that the cost of most cutting-edge medicines kills more people through diverting money from other NHS services than the treatments themselves save.

Corporate practices and health: a framework and mechanisms

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Steve Lukes’ Three-Dimensional View of Power  credit

The Global Burden of Disease estimates that approximately a third of deaths worldwide are attributable to behavioral risk factors that, at their core, have the consumption of unhealthful products and exposures produced by profit driven commercial entities, write Joana Madureira Lima and Sandro Galea  in a new report in Globalization and Health. They use Steven Lukes’ three-dimensional view of power (see above) to guide the study of the practices deployed by commercial interests to foster the consumption of these commodities. They propose a framework to systematically study corporations and other commercial interests as a distal, structural, societal factor that causes disease and injury. Their framework offers a systematic approach to mapping corporate activity, allowing public health researchers to anticipate and prevent actions that may have a deleterious effect on population health. They conclude that their framework may be used by, and can have utility for, public health practitioners, researchers, students, activists and other members of civil society, policy makers and public servants in charge of policy implementation. It can also be useful to corporations who are interested in identifying key actions they can take towards improving population health.

Spotlight on harmful pharmaceutical industry practices: Educating the public to build a foundation for reform

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In the last year, policy makers, the media and the public have focused new attention on the harmful practices of the pharmaceutical industry. This scrutiny provides an opportunity for health faculty, journalists and advocates to educate their students, readers and members about the near daily revelations around these practices and their policy solutions. Dividing these practices into specific categories, we have highlighted some of the industry’s egregious practices that have surfaced under society’s microscope.  By engaging their constituencies in learning about harmful pharma industry practices and considering options for reducing such risks, health professionals and activists can lay the foundation for meaningful reform.   By having our students read and critically analyze these sources, we prepare them to contribute to solutions.

Pricing

Drug pricing has been a hot topic this year for both consumers and legislators. With as many as one in four of constituents reporting difficulty in paying for prescription medications, this issue has been brought to the forefront of American politics. For example, this past April, legislators in Maryland passed an Anti-Price-Gouging Law to protect its citizens and taxpayers from price increases within “…noncompetitive off-patent drug markets.” While this is a great first step for Maryland, there is still more to be done. This law does not affect specialty drug innovators or generic drug manufacturers. So specialty drugs like medications to treat cancer can still be priced exorbitantly high, much higher in fact than patients in the UK pay for the same medications.

If you are looking for more information on America’s fight against Big Pharma, consider watching Drug Short, a documentary in the Netflix Dirty Money video series that shows the rise and fall of Valeant Pharmaceuticals, led by a CEO who declared that his goal wasn’t to make new drugs but simply to “create stockholder value.”

 Distribution of opioids

Another big ticket item taking the stage in American politics this year was the country’s current opioid epidemic and the role that pharmaceutical companies have played in the issue. A recent article from Reuters reported on a suit filed by Kentucky’s attorney general against drug distributor McKesson Corp. The suit claims that the distributor failed to flag large opioid orders being delivered different pharmacies in the state, fueling the current epidemic. While our country has seen a decrease in opioid prescriptions, according to a report from the CDC, the amount of currently prescribed opioids remains roughly three times the amount as was prescribed in 1999. What started off as a family business for the Sacklers, owners of Purdue Pharma and manufacturers of OxyContin, has generated billions of dollars for the family and company—and millions of addicts, as described in a recent New Yorker article.

 Intellectual prosperity protections

Doctors Without Borders, Oxfam, the AFL-CIO and about 100 other groups focused on health standards and workers’ rights are urging NAFTA negotiators not to use the intellectual property chapter of the trade agreement to protect pharmaceutical companies and jeopardize affordable access to medicine. “It is vital that the NAFTA party governments reject any provisions that would expand or strengthen pharmaceutical monopolies and enforcement at the expense of access to affordable medicines,” the groups wrote in a letter to the top health and trade ministers of the U.S., Canada and Mexico.

In recent years, we have seen more examples of pharmaceutical monopolies and the powers that they hold come to light. Drug manufacturers like Celgene Corp., the makers of the cancer drug Revlimid have been able to extend their patent exclusivity for decades. This is especially problematic for consumers as generic medications are not developed and price gouging occurs.

 Safety & Regulations

 American consumers and patients rely on the FDA to approve and monitor safe prescription medications and medical devices. It’s common to see drug warning labels updated with newer side-effect information or even a black box warning if potentially adverse side-effects are known. These black box warnings often warn consumers of serious side-effects, as in the case of the blood thinner Xarelto which lacks an approved antidote causing serious bleeding incidents which have led patients to file thousands of lawsuits. Sometimes, however, this warning can hurt the drug manufacturer more than it benefits the consumers as shown in the case of varenicline, a prescription medication used to treat nicotine addiction.

For a more in-depth look into the medical device industry, consider the new book, The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It, an investigation of the products, practices and regulation of the medical device industry in the United States.

Tax Avoidance and Tax Evasion

A report from Americans for Tax Fairness examines the profits, taxes, and drug prices of the 10 biggest U.S. pharmaceutical companies: Johnson & Johnson, Pfizer, Merck & Co., Gilead Sciences, AbbVie, Amgen, Eli Lilly & Co., Bristol-Myers Squibb, Biogen and Celgene. The Pharma Big 10 had $506 billion in untaxed profits stashed offshore in 2016. These profits increased by 65% from 2011, as drug prices soared. U.S. tax law allows companies to indefinitely delay paying federal taxes on profits booked and kept offshore. The new US tax law could offer these companies a tax cut of up to $80 billion.

The late January US budget deal that reopened the federal government included a two-year delay of a proposed 2.3 percent tax on medical devices, originally included in the Affordable Care Act to help pay for the law’s health insurance subsidies. Industry had been demanding relief from the tax for months. The two-year suspension will cost the federal government about $3.7 billion. Medical device companies cheered the legislation.

Caitlin Hoff is a Health and Safety Investigator, aiming to educate people about consumer rights, and industries that seek to diminish them. Nicholas Freudenberg is founder and director of Corporations and Health Watch.

The New Corporate Social Responsibility: Accountability or Public Relations?

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Last month, Larry Fink, the CEO of BlackRock, the nation’s largest asset manager, wrote in his annual letter to CEOs:

To prosper over time, every company must not only deliver financial performance, but also show how it makes a positive contribution to society. Companies must benefit all of their stakeholders, including shareholders, employees, customers, and the communities in which they operate. Without a sense of purpose, no company, either public or private, can achieve its full potential. It will ultimately lose the license to operate from key stakeholders. It will succumb to short-term pressures to distribute earnings, and, in the process, sacrifice investments in employee development, innovation, and capital expenditures that are necessary for long-term growth. It will remain exposed to activist campaigns that articulate a clearer goal, even if that goal serves only the shortest and narrowest of objectives. And ultimately, that company will provide subpar returns to the investors who depend on it to finance their retirement, home purchases, or higher education.

Fink’s argument that a social purpose was good for the corporate bottom line has attracted scrutiny from researchers as well as the media.  A few recent studies illustrate the scope of this debate:

Researchers at the University of California San Francisco studied African media coverage of tobacco companies’ corporate social responsibility initiatives.  Of the 288 news items they found, the majority relied solely on tobacco industry representatives as news sources, and portrayed tobacco industry CSR positively. When public health voices and tobacco control themes were included, news items were less likely to have a positive slant. They concluded that their finding suggests a foundation on which to build media advocacy efforts. Drawing links between implementing the Framework Convention on Tobacco Control and prohibiting or curtailing tobacco industry CSR programs may result in more public dialogue in the media about the negative impacts of tobacco company CSR initiatives.

In Science, a research team based at City University of New York describes a study that an asset owner, an asset manager, and two research universities are designing. They are developing a next generation of traceable indicators to quantify external context and impact of investments on the environment and health and place these into a decision-making framework useful to investors. Tests of these science-based sustainability metrics are under way on a $2.1 billion portfolio of public equities invested on behalf of a large European pension fund.

Another study compared the appeal of a fast food company’s public health related corporate social responsibility message with a more generic social issue-related message. The generic message elicited significantly more positive perceptions of CSR motives, supportive communication intent and investment intent than public-health related CSR.  However, when a company has a healthier image, stakeholders do not distinguish between health-related and other types of CSR messages. Researchers also found that positively perceived CSR motive plays a determinant role in anticipating communication, investment, and purchase- intents, reinforcing Fink’s message that at least perceived CSR can contribute to the bottom line.

Corporations and Health News from the World Economic Forum at Davos

 82% of new wealth last year went to the richest 1%- while the  poorest half got nothing, says Oxfam

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Eighty two percent of the wealth generated last year went to the richest 1% of the global population, while the 3.7 billion people who make up the poorest half of the world saw no increase in their wealth, according to a new Oxfam report released at the World Economic Forum.  Billionaire wealth has risen by an annual average of 13% since 2010 – six times faster than the wages of ordinary workers, which have risen by a yearly average of just 2%. The number of billionaires rose at a rate of one every two days between March 2016 and March 2017. This huge increase could have ended global extreme poverty seven times over.