Coca-Cola Contracts Allow Research to Be Suppressed, Says Report

Marlene Busko  

May 08, 2019

Wording in five contracts for Coca-Cola funding of health research at four North American universities would have allowed the company to quash studies, although this never actually happened, according to a new report.

The "unrestricted funding" contracts had restrictive clauses, but scientists could negotiate to remove them, reveal Sarah Steele, DPhil, PhD, University of Cambridge, UK, and colleagues, in their study published online May 7 in the Journal of Public Health Policy.

The contracts were obtained under a freedom of information request by the nonprofit consumer and public health research group US Right to Know, which receives funding from a variety of sources, with the main donor over the past 5 years being the Organic Consumers Association.  

The group's co-director, Gary Ruskin, PhD, is a study author.

The authors aimed to see if Coca-Cola contracts reflected the company's intention to be transparent in their health research funding, as implicitly stated on their website.

Coca-Cola's transparency initiative followed a New York Times blog article in 2015 that revealed the company funded a Global Energy Balance Network (GEBN) "to divert attention from the role that sugar-sweetened beverages play in the obesity epidemic by excessively emphasizing the role of lack of exercise," Steele and colleagues write. GEBN was closed soon after.

Supporting research into physical activity is "just a classic tobacco-industry tactic" to draw attention away from how excess sugar-sweetened beverage consumption contributes to obesity, Ruskin told Medscape Medical News.

The current study shows that Coca-Cola's "transparency initiative was window dressing," he said. "They're still trying to do everything they can to evade their responsibility for their role in the global obesity epidemic." 

Moreover, "with the power to trumpet positive findings and bury negative ones, Coke-funded science seems more like an exercise in public relations," he added in a press release by the University of Cambridge.

Steele added: "The lack of robust information on input by industry and on studies terminated before results are published makes it impossible to know how much of the research entering the public domain reflects industry positions."

However, scientists involved in these studies who were contacted by Medscape Medical News say this is a storm in a teacup, and they did not perceive any interference from the company, which was very "hands-off."

Coca-Cola has also defended its funding transparency policies.

Group Analyzed Over 87,000 Pages to Find Five Contracts

The US Right to Know group sent 129 freedom of information requests between 2015 and 2018 to institutions who received research funding from Coca-Cola.

From the more than 87,000 documents they received, the group identified emails during 2010 to 2016 about five health research contracts between Coca Cola and four schools — Louisiana State University, University of South Carolina, University of Toronto, and University of Washington — for studies mainly about energy balance and beverage intake during exercise.

They report that contract "termination provisions could allow [Coca-Cola] to prevent publication through [study] termination and recall of documents," which "should be cause for concern."

If the trials weren't registered, termination could act as "suppression of critical health information," according to Steele and colleagues.

"We therefore call for industry funders to publish complete lists of terminated studies as part of their commitment to act with integrity," they write, "and for clear declarations of involvement as standard publication practice."

"We propose far more 'hard' information about funding, rather than relying on self-reports."

Storm in a Teacup? Study Scientists Did Not Feel Pressured

However, three scientists mentioned in the study did not perceive any undue pressure from the corporate funding source.

John L. Sievenpiper, MD, PhD, associate professor, University of Toronto, and physician at St. Michael's Hospital, Toronto, Ontario, Canada, told Medscape Medical News that the current study refers to email correspondence in 2013 about an unrestricted donation to the University of Toronto.

"We found working with [Coca-Cola] on this issue to be easy," he said.

The company representatives "were very amenable to changing the wording [in what appeared to be standard wording] to fit with the unrestricted nature of the agreement. They seemed to get it. They did not want a restrictive agreement or any perception of that."

"I can also say," Sievenpiper added, that Coca-Cola staff "never acted inappropriately or interfered in our research. They were not involved in the design, conduct, analysis, or interpretation of any of our research or the decision to publish any of our research."

Therefore, "the article seems pretty banal from the perspective of our part in it. Agreements of any type are often an iterative process."

Nevertheless, "I think greater disclosure is a good thing," he emphasized. "We have always supported and followed disclosure of all types of conflicts of interest from financial to intellectual to familial to the point that some commentators have criticized us for over-disclosure."

Meanwhile, Steven N. Blair, PED, University of South Carolina, Columbia, who is also mentioned in the article, told Medscape Medical News: "I have always been transparent...The bottom line is, as far as I'm concerned, the scientist determines how we will collect the data, what we will do with the data, where we'll publish it, etc. People can criticize and say I'm lying, but that's the way we operate."

Similarly, Timothy S. Church, MD, MPH, PhD, from Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, who is also cited in the article, told Medscape Medical News: "This whole thing is silly...We were just looking at Powerade compared to water on a bike test."

Powerade is a sports drink manufactured and marketed by Coca-Cola, and its primary competitor is PepsiCo's Gatorade. Church was tasked with conducting studies of Powerade that had been done with Gatorade.

"When you work with any industry, it's always got to be eyes wide open," he added. "It is what it is...Every time I ever worked with them, [Coca-Cola] were about as hands off as you get."

Studies will always be terminated for causes such as not recruiting people or hurting people, which is as it should be, Church noted.

"There was never a perception that they were trying to influence me," he reiterated. "Physicians have been dealing with [disclosure and influence issues] for years with the drug companies."

Influence Can Be Conscious or Unconscious

Trudo Lemmens, LicJur, LLM bioethics, DCL, a professor in health law and policy at the University of Toronto, who published a related article in BMJ about clinical trial transparency (BMJ. 2018;362:k2493), shared his thoughts from a legal point of view with Medscape Medical News.

"The study reveals that, Coca-Cola's broad funding principles aimed at safeguarding the independence of researchers notwithstanding, the company keeps through its contracts a significant level of control over the research through a combination of prior review and termination provisions, and sometimes even the right to ask for the return of all research materials and all work done."

"A person who accepts significant funding from an industry source knows what research findings will interest the sponsor and what will likely create future research funding opportunities," he told Medscape Medical News.

"This can clearly influence researchers, consciously or unconsciously."

Going forward, Steele and colleagues call for better conflict of interest (COI) disclosure in their article.

"Our research reveals a need to improve reporting of COIs," they write. "Many declarations of funding and routinely employed COI statements fail to specify the true amount of input and influence Coca-Cola has (irrespective of whether it chooses to exercise it)."

US Right to Know often receives COIs reported in journalistic exposés.

"We call for journals to require authors receiving Coca-Cola or other industry financial support to provide more robust COI and funding statements, including declaring the specifics of input allowed in the study's research agreements."

Journals should also require authors of funded research to upload the research agreements for studies as appendices to any peer-reviewed publication, they indicate.

Coca-Cola Replies to Critics

Invited to comment on the article, the media department at Coca-Cola told Medscape Medical News that "in 2015 we announced our commitment to disclose our funding of health and well-being related scientific research and partnerships going back to 2010 on our website."

The company has continued to update this report every 6 months.

"In 2016, we also adopted guiding principles that define our approach to health and well-being oriented research and engagement with third parties," the company adds.  

Under these guidelines, the company says it supports "research efforts by independent and respected research institutions and universities. Under our guidelines, we provide financial support for such research only if a non-Coca-Cola entity funds at least 50% of the cost."  

The company is continuing their "'journey' to be a more helpful and effective partner in efforts to address the serious problem of obesity around the world," it adds.

"Today our focus is on reducing sugar in our drinks and promoting more no- and low-sugar options as we work to support the World Health Organization's recommendation that people limit added sugars to 10% of their daily caloric intake."

The work was funded by the Laura and John Arnold Foundation. Ruskin has reported being a co-director of US Right to Know, a non-profit public interest, consumer advocacy, and public health organization. Since its founding in 2014, USRTK has received the following gifts of $5000 or more: Organic Consumers Association: $554,500; Laura and John Arnold Foundation: $198,800; Dr Bronner's Family Foundation: $183,000; CrossFit Foundation: $50,000; Westreich Foundation: $25,000; Panta Rhea Foundation: $20,000; and Community Foundation of Western North Carolina (Little Acorn Fund): $5,000. Steele and McKee have reported no relevant financial relationships. Stuckler was funded by a grant from the European Research Council.

J Public Health Policy. Published online May 7, 2019. Full text

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