“He who pays the piper calls the tune.”  (British proverb) – “There is no free lunch”

04/02/2023

Babies before business – Conflicts of interest

How baby food business infiltrates the health system. Summary published by BMJ Global Health

• The commercial milk formula industry’s duty to maximise profits conflicts with the health system’s duty to protect health and to support breastfeeding.

• The marketing tactics and relationships with the commercial milk formula industry including financial or material support, sponsorship of training or research and advertising in journals or at events contribute to conflicts of interest within the health system.
• Employers of health workers, academic institutions, professional associations and governments all have a duty of care to protect health systems from predatory marketing and to facilitate individual health workers to practice in an ethical manner.
• National regulatory measures to implement and ensure monitoring of compliance with the International Code of Marketing of Breast-milk Substitutes protect health workers in addition to children and their families.

Read the article:

Becker GE, Ching C, Nguyen TT, et al. Babies before business: protecting the integrity of health professionals from institutional conflict of interest. BMJ Global Health 2022;7:e009640 https://gh.bmj.com/content/7/8/e009640

Individual conflicts of interest:

“An [individual] conflict of interest is a set of conditions in which professional judgment concerning a primary interest […] tends to be unduly influenced by a secondary interest […].” (D. F. Thompson)

 Through gifts and gratuities of all kinds, companies producing breastmilk substitutes and other infant foods use their considerable economic and financial power to encourage some health professionals to recommend their products. As a result, parents are often deprived of adequate and impartial advice on best feeding practices for the benefit of their child. Such abusive commercial practices lead to the cessation of breastfeeding (see WHO recommendations on breastfeeding) and the widespread use of industrial products for infant feeding, with dramatic effects on public health: increase in infant mortality and morbidity rates, increase in the number of overweight or obese children, resurgence in the incidence of non-communicable diseases in children and adolescents, among others.

“Institutional conflicts of interest arise when an institution’s own financial interests or those of its senior officials pose risks of undue influence on decisions involving the institution’s primary interests.” (B. Lo and M. J. Field)

Institutional conflicts of interest:

At the institutional level, multinational companies attempt to influence decision-making (national or international) through direct or indirect partnership agreements and funding. Moreover, those companies multiply their participation in multi-stakeholder initiatives (MSIs) and other public-private partnerships (PPPs) launched on an international scale.

In so doing, companies promote the creation of non-mandatory standards (such as “voluntary” codes of conduct), developed without democratic control and allowing them to unduly evade their obligations under international law. Indeed, these new strategies prevent, replace or circumvent efforts to develop legally binding regulatory tools and structures. These strategies, which have the advantage of giving companies a positive and “ethical” image at little cost, have been on the rise for the past 15 years or so, although they seem incompatible with the duty of United Nations agencies to promote the public interest through the respect, protection and fulfilment of human rights.

Bluewashing: The expression “bluewashing” refers to the practices of companies that use the United Nations blue banner to brand their activities in order to improve their social image.

IBFAN-GIFA’s position

IBFAN-GIFA considers that economic and commercial interests must under no circumstances interfere with the public interest. For this reason, we are actively engaged in identifying all situations that could lead to the relegating of the public interest to a secondary position in favour of commercial interests, whether they result from the financing of individuals or institutions, such as the World Health Organization. We denounce these risky situations and propose sustainable solutions to ensure that the public interest mission of international agencies is preserved and that companies comply with their human rights obligations as prescribed by international law.

Acting on its convictions, IBFAN-GIFA also commits itself not to receive any funding, direct or indirect, from commercial companies. Furthermore, IBFAN-GIFA is a member of the Conflicts of Interest Coalition.

Role and responsability of health workers

Healthcare professionals – men and women – have the confidence of their patients and the families they care for. In the field of health and nutrition, the message that professionals convey through words, but also through posters in their offices and waiting rooms and through the brochures they distribute can be strategic for commercial enterprises. In most cases, these messages are ambiguous when it comes to breastfeeding. The purpose of this type of marketing is to sell a product, and the promotion of breastfeeding is a booster. And health professionals are the vehicles for this marketing. On this topic, see the WHO page on Roles and responsibilities of Health Workers in relation to the International Code of Marketing of Breast-milk Substitutes.

For more information

• IBFAN GIFA, 2018, Health governance in the public interest? Who redefines conflicts of interest and risks undermining public health mandates, Press conference at the Geneva Press Club
• IBFAN, 2016, Understanding conflicts of interest to safeguard democratic & evidence-based health and nutrition governance, annotated presentation by Judith Richter
• Right to Food WATCH, 2012 “Conflicts of Interest and Human Rights-Based Policy Making: The Case of Maternal, Infant, and Young Children’s Health and Nutrition” (pages 31-36)
• Social Medicine, March 2012 “WHO Reform and Public Interest Safeguards: An Historical Perspective“
• IBFAN, 2011 “Sponsorship and conflicts of interest – Position Statement“
• IBFAN, 2005 “Conflicts of Interest and Policy Implementation – Reflections from the fields of health and infant feeding“
• IBFAN-GIFA, 2003 “We the Peoples’ or ‘We the Corporations’? Critical reflections on UN-business “partnerships”

Readings on Conflicts of interest

1) Granheim SI, Engelhardt K, Rundall P, Bialous S, Iellamo A, Margetts B, et al. Interference in public health policy: examples of how the baby food industry uses tobacco industry tactics. World Nutr. 2017;8(2):288–310.

2) L Lake, M Kroon, D Sanders, A Goga, C Witten, R Swart, H Saloojee, C Scott, M Manyuha, T Doherty. Child health, infant formula funding and South African health professionals: Eliminating conflict of interest. SAMJ December 2019, Vol. 109, No. 12

3) Film TIGERS (2014) Ayan, a pharmaceutical salesman in Pakistan, takes on the multinational health care corporation he works for after he realizes they knowingly marketed a baby formula that’s responsible for the death of hundreds of babies everyday. Director: Danis Tanovic

4) Corporate Influence on the Business and Human Rights Agenda of the United Nations (June 2014)

5) Freedom from Want: The Human Right to Adequate Food, George Kent, Georgetown University Press 2005 see her