Critics have long accused food and beverage companies of trying to exonerate their products from blame for obesity by funding organizations that highlight alternative causes. We investigate the supposed model of transparency between Coca-Cola and China’s private and government research institutions and its implications for public health.
In January 2019, an investigative report published by Dr. Susan Greenhalgh unraveled how through the International Life Sciences Institute, Coca-Cola has been quietly influencing the means in which China tackles the growing rates of obesity and brought attention to the manner by which companies can effectively exonerate their products and advance corporate interest in the realms of both profit and health policy. However, conclusions about the intentions of food and beverage companies in funding scientific organisations have been prevented by limited access to industry’s internal documents. Dr. Paulo Serodio’s research focuses on the health effects of corporate influence on health outcomes and public policy and utilizes network science and machine learning tools on innovative text-based datasets. Dr. Serodio has conducted an extensive systematic review on studies that have received funding from Coca-Cola and observed that most research focuses on nutrition and emphasizes the importance of physical activity. Here, US-China Today conducted an email interview with Dr. Serodio to gain more insight into how corporations can influence public policy in countries where such practices undergo less scrutiny and how the scientific and political climate in China allowed for American corporate interests to gain such a significant foothold.
Recently, you commented that you were surprised at the extent to which Coke was able to penetrate the Chinese government. What factors/characteristics makes a country particularly vulnerable to having its public policy influenced by corporations?
The lack of democratic institutions and basic accountability. Without the ability to vote out of office in free and fair elections, [and with] politicians who cater to special interests, then accountability is unachievable.
In your publication examining Coca-Cola’s research funding, you mapped all scientific research acknowledging funding from Coca-Cola, identified the institutions/authors, and used the company’s disclosure to gauge whether its funded researchers acknowledge the source of funding. In lamest terms, describe the process by which you were able to acquire all of the data for your study. For example, you mentioned that you utilized the Web of Science database and the conservative eligibility criteria. Were there any barriers/conflicts you faced when collecting data? Knowing that there has been relatively little access to the industry’s internal documents, how were you able to gain access to all of these studies? If any, what were some of the possible flaws/biases in the method by which you retrieved and analyzed the studies?
The exercise of mapping industry funding of scientific research is a very difficult one. To begin with, we still rely on self-reporting. Even though (some) journals have put in place strict guidelines on reporting funding sources and competing interests, we are still relying on the authors themselves to reveal them. And as we pointed out in the paper, they don’t always do it.
Secondly, until recently we had no way of systematically collecting this information: we could conduct thorough literature searches in bibliometric databases by author, institution, journal and even “topic”/”theme”, but not by funding source. This changed when Thomson Reuters’ Web of Science began to parse the funding/competing interest statements in published articles and including them as metadata in its databases. This allowed researchers (with institutional access to Thomson Reuters’ resources) to conduct systematic searches of industry-funded articles.
Collecting the information isn’t difficult. I wrote a script in an open-source programming language that scraped and parsed all the metadata pertaining to articles funded by Coca-Cola from the Web of Science platform. The process is akin to automating what a human would do in collecting and storing this information, but several orders of magnitude faster. The final sample of articles we collected does suffer from some limitations (for example, metadata on funding statements is only available for studies indexed by Web of Science after 2007), but the search was comprehensive enough as not to introduce any bias in the final sample.
I wouldn’t say we faced barriers in the data collection (apart from the obvious one: access to Web of Science, which is behind a paywall), but we certainly did face the following in the analysis stage:
Thomson Reuters has a proprietary algorithm that parses the conflict of interest/funding statements in published articles and automatically identifies the funding source. As with any automated procedures, this leads to some misclassification – for example, it may identify Coca-Cola as the funding agency for the paper, when in fact the COI statement refers to Coca-Cola as having funded a conference that was attended by one of the authors of the paper. We double checked the accuracy of the algorithm by, essentially, doing this classification procedure (identifying articles in which Coca-Cola is referred to as the funding source) ourselves.
In many cases of co-authored articles, the funding statement did not reveal who was the Principal Investigator on the grant awarded by Coca-Cola. This added an extra hurdle in identifying those researchers that had been funded by the company but were missing from their transparency disclosures.
We had strong priors about the network of researchers who had ties to Coca-Cola before conducting the search. These stemmed, on the one hand, from Anahad O’Connors article in the NYT, which unveiled Coca-Cola as the main funding body behind the Global Energy Balance Network and, on the other, from email communications between researchers in public universities and Coca-Cola officials obtained by US Right to Know. A comprehensive analysis of this data revealed a strong, cohesive network of researchers who, unsurprisingly, were the most central players in the data we retrieved from Web of Science.
While the goal of the aforementioned study was to evaluate the extent to which Coca-Cola’s Transparency Lists are truly comprehensive, was there anything in the examined studies that stood out? For example, you mentioned that you observed that the funded research emphasizes the importance of physical activity and the concept of energy balance. Were there any noticeable trends in the studies?
The trend was certainly a focus on the concept of energy balance, which was key to Coca-Cola’s strategy to position its products in the market without suffering a backlash from the public health community. A strong body of research giving seemingly independent scientific support to the idea of energy balance was of utmost importance because it accomplishes two things: (1) it detracted attention from the growing body of research documenting the negative effects on health of consuming sugary beverages; (2) it provided a way to reverse these negative effects (aka increase energy expenditure via exercise). It was a very effective way of reframing the debate, turning the focus onto personal responsibility arguments, whilst promoting physical activity as the solution to restore the energy balance. We certainly saw these arguments in the literature. It also forced us to take a step back and understand that it wasn’t only about funding research projects, it was a much more intricate, multi-layered PR campaign which involved creating seemingly independent scientific research groups that pushed the energy balance agenda, funding academic conferences worldwide where these topics were given visibility, promoting and funding a variety of important sports-related events, and funding training events for health journalists from the top news outlets in the country where Coca-Cola funded academics would push the energy balance agenda.
Ultimately, these were very resourceful tools that could be used in lobbying efforts to push back on, for example, proposals on a sugar tax. Elements of this multi-layers strategy could be used to convince policymakers that the science isn’t settled, or that promoting physical activity in schools (rather than nutrition education) yields better results in tackling the obesity epidemic, therefore maintaining the status quo that benefited the company.
Coca-Cola has unapologetically revealed its intentions to advance its interests by funding a scientific organization. Particularly, the company has sought to advance its energy balance framework by establishing an ostensibly independent broker with assistance from scientists, such as GEBN. How is this possible? Why are the scientists that are a part of GEBN sympathetic with their goals? Would any other scientific institution have been possible? Are there any other organizations Coca-Cola has specifically targeted in recent news?
It isn’t clear at the moment whether Coca-Cola approached the academics or whether the academics approached Coca-Cola. I think one ought to look at one of the main incentives that academics have in establishing partnerships with industry: funding. In the “publish or perish” world of academia, research funding has become increasingly important, literally making and breaking careers. This is especially true in fields where the research output is often a product of experiments, which can be very expensive to run. Setting up randomized controlled trials may require hundreds of thousands of dollars, and public funding is very competitive and not always available. The problem with the GEBN was that Coca-Cola was not just a funder, but played a much larger role in the network. This may put off researchers to a certain extent, whilst others are so convinced of their work that they believe a partnership with a beverage company in these terms will not bias their thinking nor their work.
However, there is compelling evidence that conflict of interests do induce bias in ways that we are not aware of. There are certainly mechanisms through which industry can make available research funds without tainting the outputs, so a new GEBN would certainly be avoidable. Coca-Cola also has very close ties with ILSI and other organizations around the world through its subsidiaries and bottlers.
Coca-Cola spokeswoman Ann Moore said in a statement that the company supports the current recommendations by the World Health Organization to limit intake of added sugar. She remarked that the company “recognize[s] that too much sugar isn’t good for anyone” and that the company decided in 2017 to stop providing 100 percent of the funding for any research related to well-being, either directly or through a trade group. Under their new guidelines, the company will only provide financial support for such research only if a non Coca-Cola entity funds at least 50% of the cost. In your opinion, what are the implications of this statement? Does it imply that there will be more research transparency in the future? How would this affect the current situation in China?
We hope that the company carries out a major overhaul of the way in which it has been funding science thus far. However, I think this approach is misguided. It’s not about whether the company funds a research project in its entirety, but whether it funds research on topics in which it has conflicting interests. It’s not credible that a corporation is willing to gamble on research which can hurt its own business interests. It’s akin to Philip Morris International announcing that it will work towards a world with no smokers. In my opinion this is not a credible commitment to science and will not yield more transparency: it’s worth reminding ourselves that researchers funded by Coca-Cola can opt out from having their names listed in the company’s transparency disclosures.
The current situation in China is likely to be unaffected. Coca-Cola (and other companies in the industry) are important funders in the Chinese market, and academics appreciate the availability of resources to advance their research agendas. At the same time, the level of scrutiny of Coca-Cola’s operations in China will remain low.
If any, what do you believe is the solution to addressing Coca-Cola’s lack of research transparency and the company’s influence over the country? Is it possible for these challenges to be resolved? What can we do to prevent further manipulation of China’s public policy?
Pepita Barlow has a very interesting study where she demonstrates how trade agreements carry important consequences in terms of public health by changing the availability of particular products on the supermarket shelves and, as a consequence, change the diets of an entire country. A globalized world will have globalized problems, and although dietary habits will not homogenize, the prevalence of certain products in the food chain certainly contribute to similar health trends in non-communicable diseases. The response should be one of international cooperation, which can rise above the localized lobbying efforts by the food and beverage industry has in individual countries. An international debate on the scientific literature around the topics of obesity, diabetes and nutrition ought to expose the efforts of the food and beverage industries in disingenuously framing the debate around physical activity.