Tuesday, December 31, 2013

An Expanded Definition for Public-Private Partnership Conflict of Interest

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post includes the what and the why of my addition to the definition of conflicts of interest when it comes to public-private partnerships between health and food.
This month the Annals of Family Medicine published a point/counterpoint discussion of last year's awful decision by the American Academy of Family Physicians (AAFP) to partner up with Coca-Cola.

Howard Brody, arguing that the AAFP's deal was clearly a conflict of interest, explains that by definition a conflict of interest,
"arises when individuals or organizations enter into a set of arrangements which under usual circumstances would lead to the reasonable presumption that they will be tempted to put aside their primary interests in favor of a secondary set of interests."

and that,

"It is true that where a conflict of interest exists, no actual unethical behavior has necessarily arisen."
Meaning that simply having the opportunity for a conflict of interest is in and of itself a conflict, and certainly having Coca Cola fund and/or write educational materials on beverage consumption for the AAFP in return for $600,000 sure smells like a conflict of interest waiting to happen.

Howard then does a fine job of describing the most common arguments against perceived conflicts which include:

Premature accusations
: How can you accuse the AAFP of having a conflict? You haven't even seen the educational materials yet!

The other party's not evil: There's no conflict - just because Coca-Cola contributes to obesity doesn't make their parent company evil.

It'd be wrong not to engage
: Conflict or not, it'd be wrong not to enter into a partnership with Coca-Cola because we'd be missing out on an opportunity to influence their behaviour for the good.

Counterpoint was delivered by Lori Heim, current President of the AAFP (I interviewed her about the Coca-Cola partnership when it went down).

Basically Lori's argument boils down to Howard's premature accusations piece as she notes,
"Integral to this discussion is the transparency of the interaction, the rules governing the interaction, and the outcome of the agreement. Examined only in a philosophical vacuum, issues of conflict of interest and the underlying ethics governing behavior become an ideological straitjacket."
She then goes on to talk about the AAFP's great core values, the scourge of obesity in society and finally how great the educational materials are on the AAFP site and cites two statements that explicitly call for a reduction in sugar sweetened beverages.

You know, I agree with Lori - you can't examine the partnership in a philosophical vacuum, nor a practical one. What do I mean? Well while the duelling Annals pieces were an interesting read, I think they're rather beside the point as I'd argue there's a further litmus test for a conflict of interest, one that a philosophical or practical vacuum would ignore. I'm calling it the, "innocence by association" test.

Here's the basic premise: If your partnership with a corporation, regardless of the details or outcomes of that partnership, provides that corporation with the ability to use your partnership as a means to defend products, practices or positions that in turn are contrary to your or your organization's primary obligations, then partnership with said corporation should rightly be described as a conflict of interest.

In this case, if Coca Cola can or does use their partnership with the AAFP, an organization whose obligations lie with the betterment and protection of public health, to defend products, practices or positions which in turn are harmful to public health, then AAFP's partnership with Coca-Cola should be considered a conflict of interest.

So can or do they?

Let's ask Sandy Douglas, President of Coca-Cola North America.

Here's Sandy on April 6th 2010 in the Atlanta Journal-Constitution citing Coca-Cola's partnership with AAFP as part of his case for why soda taxes aren't necessary or appropriate,
"We're for education, through support for organizations such as the American Academy of Family Physicians, which is providing consumers science-based information about sweeteners."
Want to see another similar type example?

Here's Coca-Cola Canada's Amy Laski defending Coca-Cola's sponsorship of the 2010 Winter Olympics (sorry the article itself isn't linkable),
"We formed a red ribbon panel of experts from organizations such as the Heart and Stroke Foundation and the Canadian Diabetes Association to nominate torchbearers for Coca-Cola who committed to leading more active lifestyles and encouraging others to do the same."
Maybe I'm just a simple man, but to me it seems pretty black and white. If you enter into a partnership with an organization whose products are anathema to you or your organization's aims it's a conflict of interest. The fact that the AAFP doesn't admit to that in the case of Coca-Cola is shameful and disingenuous and frankly I'd have preferred it if they simply came out and admitted the truth - yes, it's a terrifically unsavory conflict of interest, but hey, we needed the money.

Brody, H. (2010). Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues The Annals of Family Medicine, 8 (4), 354-358 DOI: 10.1370/afm.1140

Heim, L. (2010). Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization's Code of Ethics The Annals of Family Medicine, 8 (4), 359-361 DOI: 10.1370/afm.1146