Sleeping With Big Soda: Diabetes and Cardio Organizations Cash In

Kristin Jenkins

October 21, 2016

UPDATED — Editor's note: This story has removed a reference to the American Medical Association's corporate sponsorship by Coca-Cola, which did not occur during the study period (it ended in 2008). The original study was in error and a correction is likely to be issued by the journal soon.

Over the past 5 years, some of the most highly respected, high-profile US medical and public-health institutions working to reduce obesity have accepted corporate sponsorships from the nation's two largest soda companies, according to researchers.

Records of corporate philanthropy and lobbying expenditures on public-health legislation by soda companies in the United States from 2011 to 2015 show that the Coca-Cola Company and PepsiCo sponsored a total of 96 national health organizations. The report was published online October 10 in the American Journal of Preventive Medicine.

Sixty-three public-health organizations, 19 medical organizations, seven health foundations, and five government organizations accepted sponsorship from Coca-Cola or Pepsi during the five years; they are listed in Table 1 in the paper. These included the Centers for Disease Control and Prevention, the American Diabetes Association, the American Heart Association, and the Obesity Society, as well as a number of cancer organizations.

At the same time, Coca-Cola lobbied against all 29 public-health bills intended to reduce soda consumption or improve nutrition, and PepsiCo opposed 26 of 29 bills (90%), say the authors, Daniel G Aaron and Michael B Siegel, MD, MPH, of Boston University School of Public Health, Massachusetts.

"Rather than supporting public health, organizations may become unwitting partners that contribute to corporate marketing strategy," they note, adding, "It is probable that corporate philanthropy is increasing consumption of soda throughout the country and causing substantial harm to Americans."

Shock That Medical Organizations Get Soda Company Sponsorship

While the extent of sponsorship of health organizations by alcohol and tobacco companies has been well documented, this may be the first systematic attempt to do the same for soda companies, Mr Aaron and Dr Siegel state.

Using Internet and database searches, they discovered that 83 organizations accepted money just from the Coca-Cola Company (86%), one accepted money from just PepsiCo (1%), and 12 organizations accepted money from both soda companies (13%).

In addition, Coca-Cola Company appeared to sponsor 99% of health organizations.

However, the data with regard to PepsiCo may be somewhat lacking, they observe, because while Coca-Cola recently disclosed its sponsorship information, that of PepsiCo has been "extremely difficult to track."

As a result, they point out that their findings are "certainly an underestimate of current sponsorship."

In addition, most sponsored organizations are city- or statewide, yet the researchers' cataloged only national organizations sponsored by the two companies and did not look at any other soda firms, again almost certainly underestimating the problem, they acknowledge.

They say while they were not surprised to learn that soda companies were spending millions of dollars on corporate sponsorships, they were taken aback at the number of medical organizations taking the money — particularly those with a specific mission to reduce obesity.

"I was shocked that the American Heart Association and American Diabetes Association are doing so," Dr Siegel told Medscape Medical News.

When a reputable medical organization accepts money from a soda company, it creates a conflict of interest that "introduces a subconscious bias in favor of the donor company," the researchers explain.

Attention gets deflected away from soft-drink consumption as a serious public-health problem, thereby muting or even neutralizing opposition to the role soda companies play in the obesity crisis.

"Physicians should use their influence to put a stop to this practice," Dr Siegel emphasized in an interview.

"Medical organizations have no business aiding in the marketing of soft drinks. The soda companies have plenty of resources to do that on their own. They don't need physicians' help."

Some Medical Organizations Seeing the Light

Some medical and public-health institutions appear to be getting the message. At the end of 2015, for example, the American Academy of Pediatrics made the decision to end its relationship with Coca-Cola.

"Our hope is that other medical organizations will follow their lead," the researchers say.

A number of other institutions also chose to say no to Big Soda at the end of 2015, including the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, and the American College of Cardiology (ACC). All chose not to renew their sponsorship agreements with the Coca-Cola Company.

Financial alliances between medical institutions and soda companies constitute a threat to public health not unlike that of tobacco and alcohol sponsorship, Dr Siegel told Medscape.

"It appears that the soda companies are basically taking a page out of the Big Tobacco playbook."

Clinicians should find out whether any of the organizations to which they belong accept funding from soda companies, he suggested.

If so, they should stimulate discussion about the inherent problems. "The burden of responsibility is on the organization itself to refuse to be used as part of a soda marketing strategy."

Organizations often rationalize corporate sponsorships by arguing that it's better to work with soda companies than against them. The problem with this strategy, Dr Siegel said, is that "it just doesn't work.

"We've seen this clearly with both the tobacco and alcohol industries. Every public-health collaboration with these industries turned into a disaster that was terribly counterproductive and that impeded progress in enacting effective policies to address these problems."

When it comes to protecting their own interests, Big Soda has deep pockets, just like Big Tobacco.

Between 2011 and 2014, Coca-Cola Company spent more than $6 million annually fighting legislation to curb soda consumption while PepsiCo spent more than $3 million per year. The American Beverage Association, which is funded by Coca-Cola and Pepsi, spent more than $1 million annually.

Yet this was small change compared with what was spent to oppose the federal soda tax in 2009. Coca-Cola spent $9.4 million, PepsiCo spent $9.5 million, and the American Beverage Association upped its budget almost 20-fold to $18.9 million.

Importantly, said Dr Siegel, there are no "tremendous barriers" to looking for funding elsewhere.

"There are many other potential sponsors that are not manufacturing products linked to obesity and that are not lobbying against public-health measures to reduce obesity."

A Sensitive Issue….

Still, the subject of Big Soda and corporate sponsorship is a sensitive one.

Even though the American Academy of Pediatrics ended its relationship with Coca-Cola last year, a request to interview the president — apparently one of several — produced an email apology from a spokesperson: "I am sorry, but we are going to take a pass on commenting for this article, as we have done with several other requests this week."

The American Academy of Family Physicians (AAFP) sent a statement issued in 2015 to explain the decision to end its Consumer Alliance Program with the Coca-Cola Company at year-end.

It said that all Coca-Cola banners would be removed from the AAFP website, FamilyDoctor.org, on December 31, 2015, and the soda company would stop using the tagline "Proud Partner of FamilyDoctor.org."

However, the statement also noted that "future project-specific funding for opportunities that will benefit members and their patients" would be discussed with the soda company.

"This partnership provided AAFP members with evidence-based information on sugary beverages, sweeteners, and healthy-living benefits," said Craig Doane, AAFP vice president of Journal Media and Strategic Partnerships, in the statement.

And patient-focused resources on nutrition and fitness that "support advice they receive from their family physicians" were underwritten by the funding, the statement continued.

"It's a benefit of the AAFP's and the AAFP Foundation's 60-plus-year history of mindfully managed relationships with external funders."

Meanwhile, the multiyear agreement between the ACC and Coca-Cola ended because "going forward, it did not appear to be in the best advantage of the ACC, our patients, or the Coca-Cola Company to continue the program," ACC president Richard Chazal, MD, explained in an email sent to Medscape Medical News.

The soda company had provided limited grants that supported community health screenings and education programs conducted by the ACC's CardioSmart program.

"These programs were designed such that there was a careful firewall to prevent any influence on content from commercial interests, consistent with ACC policy," noted Dr Chazal.

By way of explaining the ACC's decision to work with Coca-Cola, he said that in recent years, the organization chose to work with national consumer product companies valued for their expertise in consumer communication and their extended public reach.

These companies — which as well as Coca-Cola, included Colgate, Subway, and General Mills — have also been part of the CardioSmart program to help prevent, treat, and manage cardiovascular disease through sponsorship of community events, web-based education and online tracking tools, Dr Chazal said.

"These companies offer a variety of products that can have a place in a healthy lifestyle. At the same time, the American College of Cardiology is very sensitive to the role of some of the products in the development of obesity, diabetes, and downstream cardiovascular disease."

All Medical Associations Should Refuse Big Soda

The JDRF, which had a sponsorship agreement with PepsiCo during the 2011–2015 study period, also sent a statement to Medscape Medical News when asked about this relationship.

"JDRF carefully reviews national partnership opportunities to ensure that they are appropriate prior to joining corporate campaigns to raise funds," it reads.

"We understand that one of the criticisms mentioned in the study is the association with a sugary product, which the authors cite as contributing to diabetes; however, that statement perpetuates a common misconception."

"JDRF supports research to find ways to cure, prevent, and treat type 1 diabetes. Type 1 diabetes is an autoimmune disease…that is not preventable, it is not caused by diet or lifestyle choices, and currently, there is no cure," their statement continues.

Meantime at the American Diabetes Association (ADA), a press release dated October 11, 2016, has been posted to the corporate website.

ADA spokesperson Michelle Kirkwood told Medscape Medical News that two unrestricted grants received from Coca-Cola in 2012 were for locally based community education and outreach projects.

According to the press release, these grants included $100,000 for Live Empowered, a diabetes awareness and prevention initiative for African American children and adults in several major US cities, and $25,000 for Diabetes Education and Outreach to the Latino Community, in the greater Los Angeles area.

"We never allow corporations to place restrictions or conditions on their funding to influence the research we support or the policy positions for which we advocate," the statement indicates.

The ADA has "championed public-policy initiatives" at all three levels of government, including taxes and warning labels on sugar-sweetened beverages and food labeling and other initiatives to reduce sugar intake, it noted.

Meanwhile the Centers for Disease Control, which had a sponsorship agreement with Coca-Cola during the 2011–2015 study period, told Medscape Medical News that it has recently tightened up its criteria regarding public-private partnerships.

"Based on procedures in place at CDC today, it is highly unlikely that this [soda-company] project would have met the more stringent review," a spokesperson said.

And there is light at the end of the tunnel. In one particularly inspiring example of leadership, the University of Colorado opted to return a $1 million soda sponsorship at the end of 2015 rather than opt out of another contract.

"Other organizations should consider following this lead," the researchers say.

"Our hope is that all medical and public-health organizations refuse to accept soda-company sponsorships," Dr Siegel told Medscape.

"Today, you can't find any health groups that are willing to take Big Tobacco money. The same thing will eventually be true, we believe, with the soda companies."

Funding for this study was provided through a Babur K Zhalique Scholarship in Non-Traditional Medicine from the Medical Student Summer Research Project program. The authors report no relevant financial relationships.

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Am J Prev Med. Published online October 10, 2016. Article

 

 

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