Conflicts of Interest in Public Health & Research Examined in School Symposium

By Ángela Carriedo & Adrian Paul Rabe

13 April 2016, 19:30; Keppel St – A symposium on conflicts of interest was held at the John Snow Lecture Theatre of the London School of Hygiene & Tropical Medicine. The event, entitled “Conflicts of Interest in Public Health and Policy Research: What are the Solutions?” was organized by Angela Carriedo, Adrian Paul Rabe, Tessa Roberts, Alissa Pries and supported by the School’s Student Representative Council members. It was chaired by Professor John Porter, Chair of both of the School’s Observational and Interventional Research Ethics Committees.

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From left to right: Adrian Paul Rabe, Patti Rundall, Modi Mwatsana, Ben Hawkings, Patricia Henley, John Porter, Angela Carriedo

 

The session started with a fiery talk by Patti Rundall, policy director of the International Baby Food Action Network. She spoke on how “Big Food” companies have utilized varied strategies to influence research and policy around the world. These strategies have included measures that gain trust of policy makers and the public, such as conflating discourses and campaigns of corporate interests with consumer rights, producing policy documents, marketing campaigns and publicizing biased research findings endorsed by experts and higher education institutions.

This talk was followed by an interesting discussion led by Dr Ben Hawkins, lecturer of the Faculty of Public Health and Policy at the School. He discussed how alcohol companies have influenced the UK’s alcohol policy. He started by providing his COI Declaration, followed by some examples of the framing used by alcohol, and the efforts of the industry in influencing regulation. These examples included portraying the alcohol industry as a positive contributor to the economy, downplaying the harms of alcohol. Hawkins also showed how they slanted policy approaches by highlighting weaker but favorable evidence, and the creation of external organizations (e.g. Drinkaware) as a front of credibility. Hawkins also reiterated Rundall’s observation that these industries champion self-regulation, which has proven to be ineffective for health policies.

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For a perspective on Public-Private Partnerships, Dr Modi Mwatsama, director of Global Health at the UK Health Forum, spoke of a growing international trend for governments to partner with private entities in policies and projects. She highlighted the need to create better mechanisms to guard against conflicts of interest in these partnerships, including defining which aspects of policies and projects the private sector is allowed to be involved in. A third party assessment of the ethical implications was recommended. Mwatsama also suggested the need for continual review processes to assess PH impacts and efforts of these partnerships, especially the evaluation of system-wide effects and exit mechanisms from these partnerships.

To round out the discussion, Professor John Porter spoke about the role of the three Research Ethics Committees at the School (observational, intervention and MSc programme committees). He explained the meaning of justice, governance and human rights. Porter highlighted the role of the RECs in guarding and protecting the rights of both research participants and researchers, while ensuring justice and transparency. The RECs are also tasked with monitoring legal issues that may arise in research. He closed with some key questions to the audience on how school’s values are reflected and maintained by the RECs.

More light was shed on the School’s solutions for conflicts of interest by Professor Patricia Henley, the School’s Quality and Governance Manager. Henley pointed out that some grant-awarding bodies require declarations of conflicts of interest in their applications. However, the School’s governance bodies are looking into a more comprehensive solution to improve transparency on conflicts of interest. Henley also showed how conflicts of interest may arise from small associations (e.g. supporting Big Food or tobacco companies by patronizing products from subsidiaries) to substantial associations such as financial aid for specific research topics. Determining which conflicts are significant will be an important challenge in School policy, and forms the basis of some of the discussions currently being held under her role.

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The symposium ended with a panel discussion and open forum. A student questioned whether private interests have any place in policy making at all, even in consultations, as Rundall and Mwatsana appeared to have contrary stands on this. Both speakers agreed that the roles have to be clearly defined, but differed as to where the line should be drawn.

The panelists were then asked whether it would really be possible to have researchers without any conflicts of interest. Porter and Rundall responded that transparency would be the first step in solving these, since researchers rarely do not have a conflict of interest.

Another participant queried whether there exists a hierarchy of “bad” conflicts of interest. Mwatsana spoke about the “Squeal Test”. In this test, the effectiveness of a policy/project is based on how loud Big Food, Soda, Tobacco rally against it. Hawkins added that financial links are definitely on top of such a hierarchy.

The event closed with a statement from Professor Porter that stakeholders from the School’s faculty and students will be part of an ongoing process to bolster School policies to protect against potentially harmful conflicts of interest. A reception followed in the South Courtyard.

Audio recording

Presentation slides:

Conflicts of interest, funding and policy advocacy on infant feeding by the Big Food
Ms. Patti Rundall, Policy Director, IFBAN Global Advocacy

The case of alcohol corporate actions to influence research for regulatory measures in the UK
Dr. Ben Hawkins, MA MSc PhD, Faculty of Public Health & Health Policy, Department of Global Health, London School of Hygiene & Tropical Medicine

Ethical considerations on public-private engagements for public health: Emerging lessons from a UK Health Forum project on nutrition governance
Dr. Modi Mwatsama, Director, Global Health UK Health Forum

Ethics of doing health research, rules and the governance process to protect independent research
Professor John Porter, Chair, Observational and Interventional Research Ethics Committees, London School of Hygiene & Tropical Medicine

What is LSHTM doing to consider conflicts of interest?
Ms. Patricia Henley, Quality & Governance Manager, Research Governance & Integrity Office

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