Statements on conflicts of interest provide important information for readers of scientific papers, write David Stuckler, Gary Ruskin and Martin McKee in the Journal of Public Health Policy in a case study of emails exchanged between Coca-Cola and the principal investigators of the International Study of Childhood Obesity, Lifestyle and the Environment. There is now compelling evidence from several fields that papers reporting funding from organizations that have an interest in the results often generate different findings from those that do not report such funding. The authors describe the findings of an analysis of correspondence between representatives of a major soft drinks company and scientists researching childhood obesity. Although the studies report no influence by the funder, the correspondence describes detailed exchanges on the study design, presentation of results and acknowledgement of funding. This raises important questions about the meaning of standard statements on conflicts of interest.
Excerpts from Amici Curiae Briefs filed in Newtown parents vs. Bushmaster Firearms
Advertisement by Bushmaster, the company that made the weapon Adam Lanza used in Newtown, Connecticut. Appeared in Huffington Post on Dec. 17, 2012. Credit.
A lawyer for families who lost loved ones in the 2012 Sandy Hook school shooting told Connecticut’s highest court this week, reports Reuters, that Remington Outdoor Co, the maker of the AR-15 Bushmaster rifle, should be held responsible because its military-themed marketing was designed to appeal to young men like killer Adam Lanza. “They knew they were hitting their mark and Lanza was responding to their marketing,” said lawyer Joshua Koskoff. Lanza, 20, used a Remington AR-15 Bushmaster rifle, a semi-automatic civilian version of the U.S. military’s M-16, to kill 20 school children between the ages of 6 and 7, as well as six adult staff members, at Sandy Hook Elementary School in Newtown, Connecticut, on Dec. 14, 2012. To take CHW readers behind the headlines, we excerpt from three of the requests to appear as amicus curiae that were submitted to the Connecticut Supreme Court earlier this year.
From request to appear as amici curiae by physicians Katie Bakes M.D., William Begg M.D., Barbara Blok M.D., Kathleen Clem M.D., Christopher Colwell M.D., Marie Crandall M.D., Michael Hirsh M.D., Stacy Reynolds M.D., Jeffrey Sankoff M.D., and Comilla Sasson M.D.
Amici curiae are emergency physicians and trauma surgeons. Many have been responsible for the treatment of patients who have been shot or affected by the AR-15 or similar military assault weapons, including at Newtown, Aurora, San Bernardino, and Columbine. Their brief elaborates on the reasons why the trial court erred in failing to recognize a Connecticut common law cause of action for negligent entrustment against the makers and sellers of the intrinsically dangerous AR-15 when plaintiffs alleged defendants knew or should have known that entrusting the AR-15 to civilians created an unreasonable risk of harm to the public. The trial court’s holding, if upheld, may have very significant consequences.
The right to be free from the violence and carnage of military weapons, and from the fear of such carnage, is central to our society and our way of life. Connecticut recognized this, as a matter of public policy, when it enacted its semiautomatic assault weapons ban. But this right will be continually threatened if the accountability that a common law cause of action provides is not allowed.
From the request to appear as amici curiae by Trinity Church Wall Street, Attorneys Howard Zelbo, Evan Davis and Elizabeth Vicens of Cleary, Gottlieb, Steen & Hamilton.
The operative complaint alleges that each of the defendants was required to take the “most careful precautions” in the conduct of their business of manufacturing, distributing, and selling firearms to consumers. The complaint details the many respects in which the Bushmaster AR-15 is an especially dangerous firearm. It is Trinity’s position that the AR-15 is so dangerous that it should not be sold in the civilian market….
The question thus presented — whether the defendants exercised due care in the context of marketing an especially dangerous weapon — is a question for the finder of fact, here the jury. Notably, knowledge of the absence of precautions need not be actual, it may be constructive, i.e., what the defendants should have known in the exercise of due care. Equally significant, the question of precisely what precautions due care mandates be taken so that an especially dangerous weapon does not fall into incompetent hands also is a question for the jury to decide. In that regard, it is fundamental to the law of torts that the greater the magnitude of the potential harm, the greater the duty of care… Mass slaughter unquestionably ranks at the top of the magnitude of harm spectrum.
In sum, there is a basic question of negligence in this case, and “the trier of fact is, in [Connecticut], given a wide latitude in drawing the inference of negligence.” Unless the Court is willing to hold as a matter of law that sellers of weapons that deliver high-speed death have no duty to take any reasonable precautions to safeguard against those weapons falling into the hands of incompetent and even criminal users, then this case presents the basic, unremarkable jury question of just what due care required.
From the amicus curiae brief of National Shooting Sports Foundation in Support of Defendants-Appellees (Bushmaster Firearms LLC)
These lawsuits have most typically assigned blame to firearm industry members for damages caused when criminals misuse lawfully sold, non-defective firearms. The burden of litigating these lawsuits poses a threat to the hunting and shooting sports industry and to the constitutionally-protected right of access to firearms by law-abiding citizens… The basic tort alleged in this case is negligent entrustment. Contrary to Plaintiffs’ claims, this tort is not predicated on unbounded foreseeability such that the manufacturer of a lawful product may be subject to liability whenever that product goes through a daisy chain of exchanges and ends up in the hands of someone who uses it in a violent and unlawful manner. Rather, as this brief shows, the tort is properly limited to situations in which the person or entity entrusting a product to another actually knows or has reason to know that a specific recipient is likely to use the product in an unlawful or dangerous manner… Plaintiffs’ argument is, at bottom, an effort to have a firearm manufacturer internalize the costs of gun violence because the mother of the perpetrator of a mass shooting happened to lawfully purchase that company’s particular firearm product. This contravenes both well-reasoned tort law and an express purpose of the PLCAA to “prohibit causes of action against manufacturers . . . for the harm solely caused by the criminal or unlawful misuse of firearm products or ammunition products by others when the product functioned as designed and intended.”
A recent commentary in the American Journal of Clinical Nutrition offered a “critical appraisal” of NOVA as a system of classifying foods. NOVA (a name not an acronym) classifies all foods and food products into four clearly distinct groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed food and drink products. The authors of the AJCN commentary challenge many of the basic arguments of using the NOVA food classification system to examine the link between food and health.
In a response to this commentary in Public Health Nutrition, Carlos Monteiro and other developers of the NOVA system, correct inaccurate statements made about NOVA in the ‘appraisal,’ rebut points raised, and discuss the larger issue of scientific responsibility for publishing opposing views on controversial topics. They conclude, “the NOVA classification system challenges a much older and dominant system of classifying foods based on nutrient composition. Of course, it should be appraised. But scientific advances come from the exchange of well-reasoned and supported arguments, and from balanced debate. We invite further discourse on the topic of ultra-processed foods, for the sake of science and public health. We also respectfully suggest that all journals take on the responsibility of encouraging the informed and constructive exchange of ideas in controversial areas.”
Mega-mergers are sparking unprecedented consolidation across food systems, and new data technologies represent a powerful new driver. For decades, firms in the agri-food sector have pursued mergers and acquisitions and other forms of consolidation as part of their growth strategies. However, the recent spate of mega-mergers takes this logic to a new scale. Since 2015, the “biggest year ever for mergers and acquisitions”, a number of high-profile deals have come onto the table in a range of agri-food sectors – often with a view to linking different nodes in the chain. These include the $130 billion merger between US agro-chemical giants,
Dow and DuPont, Bayer’s $66 billion buyout of Monsanto, ChemChina’s acquisition of Syngenta for $43 billion and its planned merger with Sinochem in 2018. These deals alone will place as much as 70% of the agrochemical industry in the hands of only three merged companies. A new report Too Big to Feed Exploring the impacts of mega-mergers, consolidation and concentration of power in the agri-food sector from the International Panel of Experts on Sustainable Food Systems analyzes this issue.
Nestlé candies from Brazil. Credit.
A New York Times examination of corporate records, epidemiological studies and government reports — as well as interviews with scores of nutritionists and health experts around the world — reveals a sea change in the way food is produced, distributed and advertised across much of the globe. The shift is contributing to a new epidemic of diabetes and heart disease, chronic illnesses that are fed by soaring rates of obesity in places that struggled with hunger and malnutrition just a generation ago. “What we have is a war between two food systems, a traditional diet of real food once produced by the farmers around you and the producers of ultra-processed food designed to be over-consumed and which in some cases are addictive,” said Carlos A. Monteiro, a professor of nutrition and public health at the University of São Paulo. “It’s a war,” he said, “but one food system has disproportionately more power than the other.” Watch a Times video of the story.
Food and beverage product reformulation is a public health nutrition policy of recent prominence; it is a so-called ‘win-win’ policy, as unlike other nutrition policies, it has the potential to also benefit the food and beverage industry. This study investigates how and why reformulation became a public health initiative by conducting a framing analysis on 278 US newspaper articles from 1980 to 2015. Three primary frames of reformulation were identified: business, health, and political. The political frame of reformulation grew in importance after 2001, to describe reformulations occurring in response to public health policy initiatives aimed at obesity and noncommunicable diseases. The increasing use of a political frame suggests that voluntary reformulation followed a growing threat of policy change and litigation facing the industry, a finding that provides important context to debates about voluntary reformulation initiatives.
Scott C, Nixon L. The shift in framing of food and beverage product reformulation in the United States from 1980 to 2015. Critical Public Health. 2017 Jun 7:1-3.
The Food and Drug Administration has filed court papers in support of an effort to overturn a New York City law requiring calorie counts to be posted by certain establishments, reports The New York Times, at least the second time the Trump administration has inserted itself into a local case. The plaintiffs have asked a judge to grant an injunction to keep the city from enforcing the law, which it plans to start doing on August 21. In response, New York City Health Commissioner Mary Bassett observed, “The F.D.A. has taken the position that chains can stop providing customers with critical nutrition information. Poor nutrition is fueling an epidemic of chronic diseases, and this basic information should be accessible and transparent to all.”
Trade agreements are increasingly recognized as playing an influential role in shaping national food environments and the availability and nutritional quality of the food supply. Using the INFORMAS trade monitoring protocol, investigators reviewed available food supply data to understand associations between Fiji’s commitments under WTO trade agreements and food import volume trends. The study suggests that Fiji’s WTO membership, in conjunction with associated economic and agricultural policy changes have contributed to increased availability of both healthy and less healthy imported foods. The study highlights an increase in healthy foods such as fresh fruits and vegetables and whole-grain refined cereals. The study also shows that there has been an increase in less healthy foods including fats and oils; meat; processed dairy products; energy-dense beverages; and processed and packaged foods. Monitoring the trends of imported foods at country level from the perspective of trade agreements, we enable the development of appropriate and targeted interventions to improve diets and health and inform national health interventions to identify areas of concern.
Citation: Ravuvu A, Friel S, Thow AM, Snowdon W, Wate J. Monitoring the impact of trade agreements on national food environments: trade imports and population nutrition risks in Fiji. Global Health. 2017;13(1):33.
Non-communicable diseases (NCDs) represent a significant threat to human health. Risks for many of the major NCDs are associated with the production, marketing and consumption of commercially produced food and drink, particularly those containing sugar, salt and transfats, alcohol and tobacco. Governing determinants of risk frequently brings public health into conflict with the interests of profit-driven food, beverage, alcohol and tobacco industries. In this article, authors use a conceptual framework to review three models of governance of NCD risk: self-regulation by industry; hybrid models of public-private engagement; and public sector regulation. They analyze the challenges inherent in each model, and review what is known (or not) about their impact on NCD outcomes. They identify reforms that will be needed to the global health architecture to govern NCD risks, including to strengthen its ability to consolidate the collective power of diverse stakeholders, its authority to develop and enforce clear measures to address risks, as well as establish monitoring and rights-based accountability systems across all actors to drive measurable, equitable and sustainable progress in reducing the global burden of NCDs.
Citation: Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health. 2017; 13(1):34.
When the city council of Santa Fe, New Mexico, placed a measure on the local ballot to tax sugary drinks earlier this year, writes Rob Waters in Forbes, the soda industry responded quickly, pouring $1.3 million into the anti-tax campaign. To cover their bases, industry lobbyists also pursued a back-up plan: they backed a bill in the state legislature to strip local governments of the power to levy such taxes. In the end, the state language was added to another bill that sailed through the New Mexico House before dying in a Senate committee, shortly before Santa Fe voters defeated the local soda tax. But as a growing number of cities consider and increasingly pass soda taxes and other measures designed to combat obesity and promote healthy eating, the food industry has turned to preemption, a strategy used extensively by the tobacco and gun lobbies.