Conflicts of Interest why do they matter? Patti Rundall, Baby Milk Action, IBFAN Global Advocacy, Baby Milk Action LSHTM, 13th April 2016

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1 Conflicts of Interest why do they matter? Patti Rundall, Baby Milk Action, IBFAN Global Advocacy, Baby Milk Action LSHTM, 13th April 2016

2 The se ret of su ess is sincerity. Once you can fake that you e got it ade Jean Giraudoux ( )

3 .i ter atio al apital at the top is o ile and is running circles around go er e ts... Jeffrey Sachs quoting a CEO and talking about The Price of Civilisation BBC Radio 4 Today :

4 Spo sorship is "a payment by a business firm... for the purpose of promoting its name, products or services. It is a o er ial deal, ot a phila thropi gift. UK Government definition, quoted in, The Spread of Sponsorship, Bloodaxe Books (Shaw 1993),

5 Persuasion works best when its invisible. The most effective marketing worms its way into our consciousness, leaving intact the perception that we have reached our opinions and made our choices independently. The Fake persuaders, George Monbiot, The Guardian,

6 1 Things that we know

7 Breastfeeding is the cornerstone of child survival reducing under-5 mortality by 13% saving 820,000 babies lives each year millions more do not reach their full potential

8 The commercialisation of artificial feeding started when Nestlé created a su stitute for other s ilk in Since that time it has dominated the market. This advert is from Patti Rundall, Baby Milk Action/IBFAN

9 The market was reated y uildi g trust I less de eloped ou tries, the best form of promoting baby food formulas may well be the clinics which the company sponsors Nestlé in Developing countries 1970

10 UK: has one of the lowest breastfeeding rates in the world 120 Million Europeans are at risk of poverty or social exclusion

11 Baby foods: fastest growing food sector >7% 2014 global sales US$58 billion (Euromonitor) US$ 70.6 billion expected by 2019 (Lancet). All these sales are generated through marketing that iolates hildre s rights to health.

12 The environmental impact 800 litres of water to make a 1 litre of milk 4700 litres of water for 1 kilo of milk powder IBFAN s Carbon Footprint due to milk Formula. April

13 Baby food market: built o trust I less de eloped ou tries, the best form of promoting baby food formulas may well be the clinics which the company sponsors Nestlé in Developing countries 1970

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15 Marketing needs a global response Although not legally binding, the International Code is the expression of the collective will of the membership of the WHA the orld s highest health poli y setti g ody. All Member States are urged to implement the International Code as a minimum e ui e e t i its e ti ety.

16 What the Code does NOT do It does not stop the sale of safe products It does not put pressure on women to breastfeed against their will IT DOES ensure protection from misleading promotion - sound objective independent information and support.

17 Civil society has to stay focused International Baby Food Action Network, founded in a people s et ork of o er 273 groups in over 168 countries - one of the longest-surviving single-issue organisations.

18 And keep pace with marketing and science

19 1996: 1 st Resolution on Conflicts of Interest

20 and Conflicts of Interest WHA Resolution passed in May 1996 urged Member States to: ensure that financial support for professionals working in infant and young child health does not create conflicts of interest Patti Rundall, Baby Milk Action/IBFAN

21 What is a Conflict of Interest? [I di idual] o fli ts of i terest are defi ed as ir u sta es that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced by a secondary interest. I stitutio al o fli ts of i terest arise he a i stitutio s own financial interest or those of its senior officials pose risks of u due i flue e o de isio s i ol i g the i stitutio s pri ary i terests. Lo, B. and M. Field, Inst of Med. (US) Committee on Conflict of Interest in Medical Research, Education and Practice, Eds. (2009).

22 Conflicts of Interest are INTERNAL It is critically important to define what your PRIMARY purpose/mandate is. Then you can decide whether your secondary purpose (getting enough money) is diverting YOU.

23 Strong legislation is essential The International Code and the Framework Convention on Tobacco Control are key tools that really work. 1 The majority of countries have taken some action to implement the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly (WHA) resolutions. 39 have strong all encompassing legislation Controls on marketing alongside good support and maternity leave leads to increased breastfeeding rates 1 An international legal strategy for alcohol control: not a framework convention at least not yet Pre Publication in Addictions _ Allyn L. Taylor1 & Ibadat S. Dhillon2

24 Independent monitoring

25 (Watchout: GAIN sponsored index rewards all the wrong things promotion of fortified foods Ignores claims Promotes consumer 'edu atio engagement with 'stakeholders' in public private partnerships

26 The industry is fighting a rearguard action against regulation on a country-by-country basis..

27 The corporate plan

28 Tobacco and baby food: the same playbook 1. Hijack/manipulate the political and legislative process; 2. Exaggerate the economic importance of the industry; 3. Manipulate public opinion /look respectable; 4. Use front groups; 5. Discredit science/fund science; infiltrate food safety systems 6. Intimidate governments - threat of litigation

29 Thanks to Tim Lobstein

30 Displacing real food Thanks to Tim Lobstein

31 Tyi g orporatio s up i regulatory straightjackets is unnecessary when companies such as Nestlé already have sound principles and core alues. Peter Brabeck, Nestle Chair and CEO, AGM Vice-Chairman, Foundation Board, World Economic Forum.

32 Watch out: self regulation works only as long as companies want it to. Doesn t reduce the extent and impact of marketing -the volume can increase. undermines governments resolve to legislate. 1 1 Taken from a presentation at the European Platform for Action on Diet and Physical Activity by Corinna Hawkes, the International Food Policy Research Institute, Washington. Feb 2007 For analyses of the weaknesses of voluntary approaches:

33 Cosying up to norm-setting bodies

34 Framing the Debate Trust Mutual a ou ta ility stakeholder Part ership

35 Framing the debate

36 Discrediting science/fund science

37 What about my right to advertise? (freedom of expression) What about my right to health? Due to constitutional concerns voiced by some Member States over those restrictions, a recital is included into the text to clarify that the provisions of the regulation do not affect fundamental rights and the freedom of expression.

38 Manipulating the legislative process Codex standards are used as benchmarks in trade disputes. Typically: 40% are food industry, 59 as Business Interest NGOs (BINGOS). Codex standards should be coherent with WHO policy Governments could use them as a safe ha e Food industry sponsors of the 19th Session of the FAO/WHO Coordinating Committee for Africa 2011.

39 Pepsi Breakfast at the UN before the Political Declaration was adopted.

40 Hijacking the science

41 What level of science is safe? Codex refers to ill-defined scientific terms such as ge e ally accepted Histo y of safe use scie ce based scie tifically de o st ated WHO uses: Relevant convincing / generally accepted scientific evidence or the comparable level of evidence under the GRADE classification This really matters

42 .e e trivial cues can create an appeara e of a s ie tifi asis.. graphs or a chemical formula increase belief in a produ t s effi a y. Tal A, Wansink B (2014). Blinded with science: Trivial graphs and formulas increase ad persuasiveness and belief in product efficacy. Public Understanding of Science, 25 (1):

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44 (EFSA, 2014) stated that, whilst there are phospholipids naturally present in breastmilk: there is o o i i g e ide e for a e efi ial effe t of usi g LCPUFA supplied as phospholipids i i fa t for ula.

45 Creating new markets Baffle with science and innovation Trigger fears that normal foods lack essential micro-nutrients Build trust i pro essed foods and promote as the healthy option Extend the bottle feeding period

46 Infiltrating food safety systems: UK/India

47 Inflitrating the UN system The World E o o i Foru s Global Redesign Initiative proposes that issues are taken off the agenda of the UN system and are addressed instead by plurilateral, ofte multi-stakeholder, oalitio s of the illi g a d the a le. WEF envisages a world managed by a coalition of multinational corporations, nation states (including through the UN System) and select civil society organisations.

48 Tackling Conflicts of Interest

49 First step tra spare y. Before 2000 EU scientific advisors did not have to declare interests leading to many bad decisions IBFAN has helped change this but problems persist.

50 Why does this matter? The Lancet Child Survival series In 2003 breastfeeding topped the list of interventions to prevent under-5 deaths much more emphasis on micronutrient-based foods and supplements. 8 of the 10 recommended intervention packages involve products of some kind. The private sector is also called on to generate 'evidence about the positive and negative effects of private sector and market-led approaches to nutrition.'

51 Is education a corporate core activity? All too ofte the education process is entrusted to people who appear to have no understanding of industry and the path of progress...the provision of education is a market opportunity and should be treated as su h European Round Table of Industrialists, 1988

52 Fererro s interpretation of child rights

53 The business of malnutrition

54 Building Coalitions to tackle COI Conflict of Interest Coalition launched at the UN in NGOs - including 4 UK Royal Colleges. It aims to safeguard public health policy-making from commercial influence. Baby Feeding Law Group: 20 leading UK health professional and lay organisations - working to strengthen UK and EU marketing legislation. Members meet quarterly.

55 Choosi g part ers. The UN oll Ba k Malaria i itiati e is often used as a model Does anyone suggest partnering with the mosquito?

56 Key messages Policy formation must be kept separate from commercial interests. Policy implementation may require action by the private sector and input of data (all carefully and appropriately scrutinised) Governments must not forget to govern that is their duty - it is not the duty of corporations

57 Thank you!