Changing Conditions Affecting Substance Use and its Societal Responses: Roles and Responsibilities o

1
Changing Conditions Affecting Substance Use and
its Societal Responses Roles and
Responsibilities of the Alcohol and Tobacco
Industries

• Thomas F. Babor, Ph.D., MPH
• University of Connecticut
• School of Medicine

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What are the Known Conditions?

• War
• Population growth and demographics
• Migration
• Poverty and relative deprivation
• Affluence
• Public policies
• The alcohol and tobacco industries

3
The changing international context of the alcohol
and tobacco industries

• Globalization of production, trade and marketing
  of tobacco and alcohol products
• Role of these industries in product design (e.g.,
  alcopops, flavored cigarettes), marketing to
  young people, and policy development, especially
  in developing countries 
• Increasing involvement of these industries in
  the collection, funding and interpretation of
  scientific information
• Growing involvement in prevention activities
• The concept of industrial or corporate-borne
  disease

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Corporate practices

• Activities of corporations and their allies to
  achieve their business objectives.
• Business objectives include maximizing profit,
  increasing market share, controlling uncertainty
  and shifting costs to others.
• Is corporate social responsibility and
  corporate support of science a business
  objective, a philanthropic gesture, or a
  combination of both?

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Public Health Model of Corporate-borne Diseases
The Agents Alcohol/Tobacco
Vector Alcohol/ Tobacco Industry
Host Vulnerable Populations
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Corporate Practices that Influence Alcohol and
Tobacco Use and Misuse

• Product design -- modifications of product
  increase sales, profits or market share
• Marketing -- advertising and product promotions
  increase sales and market share, attract new
  customers and retain customer loyalty
• Retail distribution -- activities such as
  convenience make alcohol and tobacco more
  accessible to consumers
• Pricing -- product costs increase sales, profits,
  and market share
• Political influence lobbying, political
  contributions, and public relations activities
  can affect the policy environment

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Questions for addiction field

• What is the impact of corporate practices on
  population health?
• Is industry collaboration (partnerships) with
  the scientific community, public health advocates
  and prevention professionals mainly designed to
  achieve their business objectives?
• What should be done about corporate intrusions
  into science and practice?
• Is there an opportunity to channel corporate
  responsibility into needed funding for research,
  prevention and treatment?

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Areas where industry interests interact with
addiction science

• industry sponsorship of research funding
  organizations
• direct financing of university-based scientists
  and centers
• research conducted through contract research
  organizations
• research conducted by trade organizations and
  SAPROs
• publication of scientific documents and support
  of scientific journals
• sponsorship of scientific conferences and
  presentations at scientific conferences
• efforts to influence public perceptions of
  research, research findings and alcohol/tobacco
  policies

9
Areas where industry interests interact with
practice and policy

• Industry sponsorship of prevention programs,
  especially alcohol and tobacco education
• Industry self-regulation of advertising
• Industry social responsibility advertising
  messages
• Industry positions on effective alcohol and
  tobacco policies
• Industry involvement in writing national alcohol
  policies

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History of the tobacco industry in relation to
scientific research

• Misuse of science and scientific information to
  market their products to vulnerable populations
  and to make cigarettes more addictive
• Internal documents show that the tobacco industry
  has used university-based scientists to oppose
  health policies designed to prevent diseases
  caused by cigarette smoking

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What is the history of the tobacco industry in
relation to scientific research?

• Until 1998, most tobacco industry funding for
  academic investigators came through the Council
  for Tobacco Research (CTR) and the Center for
  Indoor Air (CIAR).
• These organizations produced articles and books
  alleging that nicotine is not addictive and
  second hand smoke does not cause cancer
• These organizations were a primary target of the
  lawsuits filed in the USA against the tobacco
  industry in the 1990s alleging fraud

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What is the history of the tobacco industry in
relation to scientific research?

• Support of academic scientists through CTR and
  CIAR provided supportive publicity for the
  industry, allowing them to recruit outside
  scientists to serve as industry witnesses in
  lawsuits and regulatory forums.
• It also helped the industry raise questions about
  the science showing that smoking and secondhand
  smoke are dangerous

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What is the history of the tobacco industry in
relation to scientific research?

• Internal industry documents show that the tobacco
  industrys research funding programs are designed
  in part to cultivate naïve or venal scientists to
  serve their own public relations programs
• Industry research programs are designed to
  perpetuate the belief that the issues concerning
  cancer and addiction are still open to question
  and that further research is needed before public
  health measures are taken (see Michaels (2007)
  Doubt is Their Product)
• The industrys self-stated reasons for funding
  scientific research include building opposition
  to litigation and the regulatory process, and
  creating controversy about the health risks of
  smoking

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The Alcoholic Beverage Industry

• Producers - brewers, distillers, vinters
• (multinational, national, local)
• Wholesalers - marketing
• Retailers distribution through bars,
  restaurants, off-premise sales
• Advertisers
• Social aspect/public relations organizations
• Trade associations

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Sponsorship of Independent Research Funding
Organizations
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Sponsorship of Independent Research Funding
Organizations

• European Research Advisory Board (ERAB),
• Alcoholic Beverage Medical Research Foundation
  (ABMRF),
• Institut de Recherches Scientifiques sur les
  Boissons (IREB).
• a board of trustees that often includes industry
  representatives
• a scientific board charged with scientific review
  and grant awards
• a secretariat that administers the research funds
  to independent scientists.

These organizations generally consist of
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Research Funding Organizations

• Provide relatively small grants to younger,
  inexperienced investigators
• Provide travel expenses and consulting fees to
  experienced investigators to serve on their
  boards and review committees
• Often limit the research agenda to biomedical
  issues and the benefits of moderate drinking
• Provide industry with a basis to claim that
  scientific research is being supported

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Direct support provided to university-based
scientists
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Direct support provided to university-based
scientists

• the Portman Group (supported by UK alcohol
  industry) funded the positions of several
  researchers.
• Ernest Gallo Clinic and Research Center was
  established in 1980 at the University of
  California to study basic neuroscience and the
  effects of alcohol and drugs on the brain.
• Anheuser-Busch provided a 105,000 grant to open
  a social norms research center at Northern
  Illinois University.
• Diageo gave 1.5 million euros to University
  College Dublin to study the drivers of binge
  drinking

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Diageos Support of UCD

• In 2006, Diageo Ireland, part of Diageo PLC, the
  worlds largest producer and distributor of
  alcoholic beverages, announced a grant of 1.5
  million euros to the University College Dublins
  Geary Institute.
• The grant is supporting a three year study of
  health risk behavior in relation to hazardous
  drinking among young adults (ages 18-25) in
  Ireland.
• The Diageo funding has been given to social
  scientists who have little experience in alcohol
  research (Babor, 2006).
• As explained by Diageos global Chief Executive
  Paul Walsh the company did not want problems
  with binge drinking to lead governments to place
  higher taxes on its products and thus eat into
  revenues. (The Irish Times, April 8, 2006)

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Research conducted by industry scientists and
contract research organizations
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Research conducted by industry scientists and
contract research organizations

• Marketing
• Product design
• Sensory characteristics
• Market segmentation
• Drinkability

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A Syndicated Study of the Ready to Drink (RTD)
market to understand the Key Drivers of Consumer
Acceptance. (Quoted from www.brewingresearch.co.u
k)

• Where once potential young drinkers graduated
  from cider to beer and then onto spirits, now
  RTDs, along with lager, are the launching pad for
  most young people's drinking career. But what is
  it that makes these drinks so appealing? Is it
  all to do with branding or are there properties
  about the liquids that attract the young?
• This study which will include all the major
  players in the RTD market and will cover
• Preference maps correlated with sensory data to
  show which sensory attributes are driving the
  market or particular sectors of the market.
• Target sheets will be produced for each
  participant in the study to show improve/optimise
  his formulation.
• The extent to which branding effects consumer
  preferences and a preference map of branded
  products.

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Social Aspect Organizations
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Social Aspect OrganizationsOstensible Role

• Support youth prevention activities
• Promote road safety and crime reduction
• Support scientific activities through internal
  studies, book editing, conferences, literature
  summaries, commissioned reports, etc.

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Social Aspect Organizations Funded by Alcohol
Industry
Worldwide Brewing Alliance Global social
responsibility initiatives British Beer Pub
Association, 2003
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Actual Role of Social Aspect Organizations

• Public relations
• Lobbying for industry-favorable policies
• Neutralize opposing views and criticism
• Promote industry-favored scientists
• Oppose unpopular but effective policies
• Support ineffective but popular policies

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Research Conducted by Trade Organizations and
SAPROs

• Canadian Brewers commissioned a poll on the
  subject of public perceptions of beer and health.
  
• The International Center for Alcohol Policies
  (ICAP) has engaged in empirical studies and has
  presented its findings at scientific meetings.

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ICAP Survey of Health Authorities

• An international survey of 114 national health
  authorities
• Solicited views about alcohol policies and
  partnerships with the alcohol industry
• 42 response rate
• Concluded that alcohol education was a priority
  areas for partnerships, especially in developing
  countries

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Publication of scientific documents and support
of scientific journals

• Funding of edited volumes (ICAP, ILSI)
• Publication of literature reviews and short
  reports
• Distribution of abstracts
• Risks/Problems control the amount and kinds of
  scientific information presented to the public,
  policymakers and the scientific community

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Scientific Conferences
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Sponsorship of Scientific Conferences and
Presentations

• ICAP-sponsored symposia at RSA and presentations
  at ICAA
• Industry support of hospitality hours
• Payment of travel funds and honoraria
• Organization and sponsorship of scientific
  meetings (e.g., health benefits of alcohol)
• Risks Even small gifts, honoraria, and travel
  support can influence professional judgment and
  bias research results

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Influence public perceptions of research
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Efforts to influence public perceptions of
research

• California Wine Institute publications and its
  website 1) made exaggerated claims about the
  health benefits of alcohol and wine 2) regularly
  omitted the cautionary statements made by
  scientists whose studies it cited and 3) failed
  to mention the health risks of alcohol
  consumption (Steinhardt and Hacker, 1997).
• Representatives of Portman Group nominated to sit
  on governmental advisory counsels charged with
  research funding and policy (Alcohol Education
  and Research Council)
• Portman Group invited criticism of the book,
  Alcohol Policy and the Public Good (Edwards et
  al., 1994)
• Representatives of Portman Group contribute to
  drafting of "A Harm Reduction Strategy for
  England"
• Critique of Swiss tax study (Gmel, et al., 2005)
  by economist paid by Groupement Suise des
  Spirituex de Marque
• Distilled Spirits Council of United States
  supports letters to the editor questioning the
  methodology of an NIH study concluding that
  alcohol advertising is associated with increased
  alcohol use by youth

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Does industry funding affect alcohol policy and
program effectiveness?

• One study reported that industry funding of
  programs to prevent underage drinking was
  associated with an abandonment of a less
  expensive compliance check program
• Alcohol industry opposition to advertising bans
  in favour of self-regulation exposes millions of
  youth to alcohol marketing
• Industry opposition to alcohol taxes and
  availability restrictions leads to the adoption
  of less effective or ineffective policies (e.g.,
  alcohol education campaigns, designated driver
  programs) in many countries.

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Can industry funding bias research findings?

• In a comparison of the conclusions of 24
  published review papers, Jorgensen et al. (2008)
  found that industry supported reviews of drug
  medications had more favourable conclusions than
  corresponding Cochrane reviews of the same drugs,
  and were also rated as being of lower
  methodological quality.
• Studies of anti-hypertensive drugs funded by a
  single drug company have a 55 rate of favourable
  results, compared with 18 if they are not funded
  by an industry source (Yank et al. (2008).
• In a review of breast cancer clinical trials, it
  was found that pharmaceutical industry
  involvement may affect study design, focus and
  results (Peppercorn et al., 2007). Studies that
  reported drug company sponsorship were more
  likely to be positive than non-sponsored studies
  (Bekelman et al., 2003).

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Can industry funding bias research findings?

• A growing number of studies have shown that
  conflicts of interests in health research are
  associated with biased research findings that
  favor commercial interests at the expense of
  patient health
• It is 3.5 times more likely a study will yield a
  positive result about a product if that study is
  funded by industry (DeAngelis, 2007)
• In several integrative reviews of the evidence it
  has been argued that not only does this
  compromise scientific integrity, it also
  decreases public trust in research. (FASED, 2007
  Brennen et al., 2007 Kassirer, 2005 Krimsky,
  2003).

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What is the extent of industry involvement in
alcohol research and prevention?

• Despite claims that the industry devotes millions
  to health-related alcohol research and
  prevention, the evidence suggests a rather small
  direct contribution, one that is unlikely to
  contribute to alcohol science, lead to prevention
  breakthroughs, or reduce the burden of
  alcohol-related illness.

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What is the proper role of scientists and
prevention professionals?

• Alcohol scientists should be very wary about
  accepting research funding directly from the
  industry, its trade associations or SAPROs.
• Consulting arrangements wherein scientists are
  paid to critique the work of other scientists
  constitute a serious financial conflict of
  interest
• Acceptance of fees for book chapters, background
  reports, attending conferences and prevention
  activities should be prefaced by the following
  questions 1) To what extent is the activity
  designed to promote the commercial interests of
  the alcohol or tobacco industries? 2) Will the
  funding source be acknowledged?
• Funding from independent organizations (e.g.,
  ABMRF and ERAB) may be consistent with scientific
  and public health aims if the grant review
  process is independent, transparent and peer
  reviewed. But scientists and prevention
  professionals need to be careful that their
  objectivity and independence are not compromised
  by fraternizing with industry executives, paid
  travel to meeting sites, and consulting fees.

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What about industry-sponsored dialogues and
"partnerships" in relation to public health
issues?

• The hands-off position refuse to engage in
  communication or collaboration with industry
  representatives, based on the assumption that the
  industrys commercial interests are incompatible
  with the values and aims of public health and
  with scientific research.
• The hands-on approach engage in dialogue with
  industry representatives, accept industry
  funding, and participate as partners in
  industry-funded scientific activities as long as
  independent judgment is maintained

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A third way Engage with the industry only when
it promotes the interests of science and public
health

• Insist on industry support for evidence-based
  policies, and cessation of anti-scientific
  lobbying activities, as a precondition for
  dialogue about partnerships with scientists and
  prevention professionals
• Encourage monitoring of industry activities using
  advanced social science methods
• Be attentive to organizational legitimacy issues
• Conduct ethical hazard inventories before
  engaging in any partnerships, prevention
  initiatives, or mutual scientific activities
• Engage professional scientific organizations and
  NGOs in a critical review of industry-science
  relationships
• Insist on rigorous adherence to Conflict of
  Interest principles

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Should the alcohol and tobacco industries pay for
the societal costs of research, prevention and
policy?

• The attributable burden can be estimated
• The costs can be estimated
• It is agreed that alcohol and tobacco are no
  ordinary commodities
• General and dedicated taxation are accepted by
  governments and industry