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Lifting the Veil of Secrecy from Industry Funding of Nonprofit Health Organizations MICHAEL F. JACOBSON, PHD Those who provide information about scientific issues and science policy normally present themselves as being objective and "scientific." This article describes a range of health charities, professional associations, nonprofit advocacy organizations, and industry-created organizations that receive significant funding from industry. In some cases, industry appears either to influence an organization's positions or to limit an organization's freedom to speak out on matters of interest to the funders. Nonprofit organizations need to consider the potential influence on their independence if they accept funding from interested companies and trade associations. Key words: industry funding; conflicts of interest; health charities; professional organizations. INT J OCCUP ENVIRON HEALTH 2005;11:349355 Nonprofit organizations traditionally have been a bulwark of independent thinking and action in American society, a pillar of our democracy. Be they health charities, health-professional associations, or universities, they are usually considered to be objective and serving the public interest. And, indeed, over the years, organizations as disparate as the American Heart Association and World Wildlife Fund have made enormous contributions in their spheres of interest. In recent decades, though, a new factor has crept, often secretly, onto the scene. Corporations have learned that they can influence public opinion and public policy more effectively by working through seemingly independent organizations rather than-- actually, in addition to--under their own names. Just as companies have sought to influence and make use of politicians and journalists, they have recognized that it can be very useful to get an apparently independent nonprofit organization to advocate on their behalf. Dr. Jacobson is the executive director of the Center for Science in the Public Interest, a nonprofit organization based in Washington, D.C. This paper is adapted from a CSPI report that details industry funding received by more than 100 nonprofit organizations (see "Lifting the Veil of Secrecy" at <www.IntegrityInScience.org>). Citations for facts in this article, unless otherwise provided, as well as information about corporate support of professors, will be found in that report. CSPI is funded largely by the 900,000 subscribers to its Nutrition Action Healthletter and does not accept funding from industry or government. Address correspondence and reprint requests to Michael F. Jacobson, PhD, 1875 Connecticut Avenue, Suite 300, Washington, DC 20009, U.S.A.; e-mail: <mjacobson@cspinet.org>. That's one reason we have seen tobacco, soft drink, oil, automobile, and other companies that market controversial products developing relationships with nonprofit groups. People would be far more skeptical of a Corporate Polluters Lobbying Association than an industry-funded Prestige University Center on Public Health. As one advertising company stated, "Gatorade uses the expert opinion of a university PhD--much better than just having someone from the company say it--to encourage more people to consume its sports drink." Similarly, companies hope that a nonprofit's or university's good name will burnish their reputations. Call it "innocence by association." Many nonprofit groups welcome corporate support. The funds allow them to have a higher public profile (which may translate into increased donations), hire new staff, and expand their programs. However, notwithstanding insistence by both the donors and the recipients that such grants come with no strings attached, a price usually is paid for accepting corporate funding. That payment may be in the currency of credibility and independence. (Of course, receipt of industry funding hardly proves that an organization has lost its independence or is irresponsible. Some groups with industry funding have some excellent publications, sponsor sound research, and make valid criticisms of independent organizations and government policies.) PROFESSIONAL ORGANIZATIONS Medicalprofessional organizations and health charities are among the biggest recipients of industry funding. Drug and other companies have provided substantial funding to such groups to publicize and give credibility to the companies' high-profit products. In 1997, for instance, the American Medical Association generated a firestorm of outrage when it agreed to a scheme endorsing products made by the Sunbeam Corporation. The five-year agreement would have placed the AMA's logo on a line of thermometers, blood pressure monitors, and other home healthcare products and generated millions of dollars in royalties for the medical group. Unfortunately, the AMA hadn't even evaluated the quality and cost of the products. Many AMA members were outraged, and the AMA became engulfed in a widely publicized scandal. Ultimately, more sober-minded AMA members forced the departure of five of the group's executive leaders and 349 ended the Sunbeam relationship. But that didn't stop Sunbeam from suing the AMA for breach of contract and winning a $9.9 million settlement. (Around the same time, the AMA issued a statement that was supportive of Procter and Gamble's fat substitute olestra. That support, though, began to look more like a quid pro quo than an independent scientific judgment when the Chicago Sun-Times discovered that the AMA was negotiating with Procter and Gamble to pay $800,000 to sponsor an AMA fitness program.) Medical conventions sometimes end up looking like trade shows, because of massive corporate support. According to a Washington Post article on the role of industry in medical meetings, "in several dozen symposiums during the week-long [American Psychiatric Association] meeting, companies paid the APA about $50,000 per session to control which scientists and papers were presented and to help shape the presentations." The 2002 Annual meeting had a total of 42 industry-sponsored symposiums sponsored by Abbott Labs, Eli Lilly, Pfizer, Novartis, and others. In 2003, the American Academy of Pediatric Dentistry, a small professional association, accepted $1 million from Coca-Cola. The academy was widely and publicly criticized when the public (and its members) learned of the deal--imagine, an organization ostensibly concerned about children's teeth taking money from arguably the world's biggest producer of sugary foods. But the situation got worse when AAPD President David Curtis defended his group. He stated: "Scientific evidence is certainly not clear on the exact role that soft drinks play in terms of children's oral disease." That was quite different from a previous statement by the group: Frequent consumption of sugars in any beverage can be a significant factor in the child and adolescent diet that contributes to the initiation and progression of dental caries. Additionally, the acids present in these beverages can have a greater deleterious effect (erosion) on enamel than the acids generated by oral flora from the sugars present in the drinks. Many soft drinks also contain significant amounts of caffeine which, if consumed regularly, may lead to increased, even habitual, usage. Apparently, the gift affected the organization's views. And Coca-Cola apparently turned a potential critic into an ally. While Coke's contribution supposedly is no-strings-attached, what generally guarantees good behavior by recipients of corporate funding is not a contract requiring fealty at every turn, but a desire for more, and increased, funding in the future. Associations of minority health professionals are much smaller than their mainstream counterparts and have greater difficulty raising money. That makes them especially vulnerable to corporations. Thus, in a recent year the Association of Black Cardiologists obtained 80% of its $5 million budget from the drug industry. In 2000, the group received $2.2 million from BristolMyers Squibb. Professional associations may claim that they are concerned about the public interest, but, understandably, their primary mission is to advance their members' interests. And their members' interests sometimes conflict with a broader public-service function. For instance, the 70,000-member American Dietetic Association focuses primarily on increasing the credibility and income of dietitians, many of whom work directly for, or serve as consultants to, food companies. That immediately raises conflict-of-interest issues, because what is good for the public may not be good for the ADA's book balance and many companies. The food industry sees the ADA as a vehicle for reaching the hearts and minds of dietitians and the general public. Thus, many major food companies--from Mars to Gerber--contribute to the ADA, advertise in its journal, and exhibit at its annual meeting. They also sponsor "fact sheets." The National Soft Drink Association sponsors the fact sheet on soft drinks. The biotechnology industry sponsors a fact sheet on agricultural biotechnology. McDonald's sponsors the fact sheet on "Nutrition on the Go." Ajinomoto, the maker of MSG, sponsors the fact sheet on "Food Allergies and Intolerances." The fact sheets typically are written by corporate PR firms and are lightly veiled defenses of the sponsors' products or practices. At least, though, the fact sheets do disclose who funded them. Even an organization of medical journalists has gotten in on the drug-industry gravy train. The American Medical Writers Association (AMWA), which calls itself the "leading professional organization for biomedical communicators," has received funding from the likes of Eli Lilly, Abbott Laboratories, and Pfizer. One would think that journalists would studiously avoid entanglements with special interests. It could get pretty dicey for a journalist to be trying to write an objective story while encouraging a company to support his or her organization. But, in this case, maybe objectivity is not the goal for AMWA members, considering that many of them do PR for drug and other companies. (Be sure not to confuse the AMWA with the AMWA--the American Medical Women's Association. That group also gets funding from the likes of Eli Lilly, Abbott Laboratories, and Pfizer. The women's medical group used to sponsor a Product Acceptance Program that, in exchange for $25,000, allowed packages of vitamin pills and other products to be emblazoned with an "AMWA Approved" label.) Companies have no confusion about professional associations: They see them as Trojan horses that they can use to promote sales and influence public policies. To cite one of many examples, veterinarians view their American Veterinary Medicine Association (AVMA) as a professional organization. But makers of animal 350 Jacobson www.ijoeh.com INT J OCCUP ENVIRON HEALTH drugs see the AVMA as a means of advancing their interests. A "landmark day" for the president of the AVMA was when drug-giant Bayer announced a "longrange, five-year financial commitment to the AVMA." AVMA appears to have reciprocated by defending the routine feeding of antibiotics to healthy animals, a great profit center for the antibiotics industry, but a cause of antibiotic resistance in bacteria, a phenomenon that reduces the effectiveness of such drugs when used to treat food-borne illnesses in humans. HEALTH CHARITIES Health charities--such as the American Cancer Society and American Heart Association--are distinctly different from professional associations. The charities are often founded by two groups with symbiotic interests: victims of various diseases and researchers who study potential cures. In a further symbiosis, companies that make drugs and medical devices often are major supporters. Who better to support, say, the American Diabetes Association than companies marketing existing treatments and investigating new ones? Thus, that group has received contributions of $750,000 or more from such companies as Abbott Laboratories, BristolMyers Squibb, Eli Lilly, GlaxoSmithKline, and Merck. As some of those (and other) companies' drugs have been discovered to have serious unsuspected side effects, the health groups have been largely silent. It's all too easy for donors and recipients to develop a mutually back-scratching relationship that translates into "see no evil, hear no evil, speak no evil." The American Diabetes Association is also a beneficiary of "cause-related marketing"--in which companies boost their images and profits by supporting worthy causes. That's what's behind the proliferation of 10K runs and bike-athons sponsored by drug, liquor, and other companies. For prices between $25,000 and $100,000, Kraft, General Mills, and Quaker have sponsored "aisles" in the diabetes association's "virtual supermarket" on its Web site. Even though the association denies that it is endorsing the brand-name products featured on its virtual shelves, it's hard to see that activity as something other than product promotion. Another health charity, the Arthritis Foundation, found itself in the headlines in an unwanted way after it licensed its name to McNeil Consumer Products. The company marketed aspirin, acetominophen, and ibuprofen under the Arthritis Foundation brand name. Of course, they were just neatly packaged versions of the common drugs, but they generated $2 million in income for the foundation. A coalition of Minnesota and 18 other states' attorneys general sued McNeil and won a $2 million settlement in 1996 for implying that the products were new medications created by the foundation. Minnesota Attorney General Hubert Humphrey said, "When a nonprofit's credibility is sold LIST 1--Amounts Contributed to the Arthritis Foundation by Corporate Funders in 2001 $500,000$999,999 Amgen Inc. Bayer Consumer Care Immunex Corporation Rexall Sundown Inc. Wyeth Pharmaceuticals $250,000$499,999 GlaxoSmithKline Merck & Co. Inc. Pharmacia Corp. $100,000$249,999 Abbott Laboratories Aventis Pharmaceuticals Barr Laboratories Inc. Centocor Inc. HealthSouth Corp. The Hoglund Foundation New York State Laborers' Health & Safety Trust Fund ScheringPlough HealthCare Products Inc. Weider Nutrition $50,000$99,999 Pfizer's Warner Lambert Consumer Group Royal Appliance Mfg. Co. Watkins Manufacturing Co. $25,000$49,999 Cardinal Brands Grabber Performance Group Leading Lady The J. M. Long Foundation Pactiv Corporation The Roslyn Savings Foundation Sonic Corp. Medical Research Foundation Wyeth Consumer Healthcare $10,000$24,999 Daiichi Pharmaceutical Corp. Garden Pals Hillcrest Medical Center Foundation Oxnard Foundation Pfizer Inc. Pilot Pen Corporation of America Quick & Reilly Dr. Scholl Foundation Tucson Marriott Business Council UPMC Health System Webster Industries Source: Annual Report 2001, Arthritis Foundation; <http:// www.arthritis.org/resources/aboutus/annual_reports/2001/ 2001report.asp>; accessed 5/28/03. for profit, the public has a right to know who's behind the name, what's inside the product, and where the money is going." The corporate funding received by the Arthritis Foundation (see List 1) is an example of the major corporate ties that a mid-sized health charity may have with companies that have a stake in the charity's field of interest. Charities generally portray themselves as vigorous proponents of the public interest, helping victims, seek- VOL 11/NO 4, OCT/DEC 2005 www.ijoeh.com Industry Funding of Nonprofit Health Organizations 351 LIST 2--Members of the Corporate Advisory Council of the Society for Women's Health Research 3M Abbott Laboratories AdvancePCS AmericasDoctor Amgen AstraZeneca Aventis Pharmaceuticals, Inc. Barr Laboratories, Inc. Baxter Healthcare Corporation Bayer Corporation Berlex Laboratories, Inc. Boston Scientific Corp. BristolMyers Squibb Co. The Chlorine Chemistry Council Cytyc Corporation Digene Corporation Dow Corning Corporation Eli Lilly and Company GE Medical Systems GlaxoSmithKline Gynecare HoffmanLa Roche Inc. IRISGlobal Clinical Trial Solutions Johnson & Johnson KimberlyClark Corporation Medtronic, Inc. Merck & Co., Inc. Novartis Corporation Organon Inc. Ortho Biotech OrthoMcNeil Pharmaceutical, Inc. Pfizer Inc. Pharmacia Playtex Products, Inc. PPD Procter and Gamble Roche ScheringPlough Corporation Solvay Pharmaceuticals SynerMed Communications Wyeth Pharmaceuticals Source: <http://www.womens-health.org/contribution/CAC. htm>; accessed 2/24/03. ing cures, and investigating preventive measures. But taking corporate donations puts enormous constraints on an organization's activities and raises questions about a group's objectivity and independence. For instance, does a group such as the American Cancer Society not focus on dangers of chemicals or pollution because of funding it receives from DuPont, BP America, Alabama Electric Cooperative, and similar companies? What about the American Heart Association's acceptance of funding from the National Cattlemen's Beef Association--might that be a small reason for its lack of zeal in promoting diets that prevent heart disease? And might the fact that the heart association receives more than $2 million a year by certifying brand-name foods reduce the group's ability to criticize products? Corporate funding is likely a reason that some health charities focus on cures and forget about prevention. Relatively benign image-enhancing relationships may be converted into protective shields when circumstances dictate. For instance, the Society for Women's Health Research played a major role in stimulating government sponsorship of research on women's health. But a decade down the line, according to the Washington Monthly, the group vigorously defended the pharmaceutical company Wyeth, which markets the most widely used hormone replacement therapy (HRT), when a major new study provided strong evidence that the dangers of long-term use of HRT outweighed its benefits. Wyeth has given donations as large as $250,000 to the association and was the "Grand Benefactor" of the society's 2003 annual gala. The society also has lent its name to a multi-million-dollar campaign by one of its sponsors, Novartis, to market a drug for irritable bowel syndrome. The members of the society's corporate advisory council are shown in List 2. NONPROFIT GROUPS CREATED OR SUSTAINED BY INDUSTRY Health charities and professional organizations typically retain a substantial degree of independence and undertake worthy projects, even while they receive funding from dubious donors. Having much less credibility are the organizations that corporations create from scratch. Those organizations often have beneficent-sounding names, like the International Life Sciences Institute (funded by food and chemical companies), the Coalition for Animal Health (funded by the cattle, hog, and other agribusinesses), the Center for Consumer Freedom (funded initially by a $300,000 grant from Philip Morris, but which now receives much of its funding from agribusiness, food, and restaurant industries), the Foundation for Clean Air Progress (funded by the petroleum, trucking, and chemical industries), and the American Council for Fitness and Nutrition (funded by food manufacturers). Their corporate affiliations are sometimes hidden or mentioned only in the small print at the back of the brochure. Such groups pretend to be serving the public interest by publishing pamphlets, holding conferences, sponsoring research, or appearing on television shows. But scratch the surface and all semblance of independence and objectivity vanishes. Those are plain and simple industry front groups. Their whole raison d'tre is to advance their corporate sponsors' interests. Most industry front groups, for obvious reasons, decline to provide detailed information about their funding. The executive director of the Center for Consumer Freedom (CCF) told the author that disclosing the group's funders would only help the group's opponents strike back at its funders. Indeed, considering the vehemence of CCF's attacks on health, vegetarian, and animal-rights organizations (such as the Physicians Committee for Responsible Medicine, People for the Ethical 352 Jacobson www.ijoeh.com INT J OCCUP ENVIRON HEALTH LIST 3--Corporate Funding Received by the Center for Consumer Freedom in 2001 and 2002 2001 Anton's Airfoods, Inc. . . . . . . . . . . . . . . . . . . . . . $3,000 Applebee's International, Inc. . . . . . . . . . . . . . $15,000 Cameron Mitchell Restaurants . . . . . . . . . . . . . . $1,250 Campagna-Turano Bakery, Inc. . . . . . . . . . . . . . . $500 Casual Restaurant Concepts . . . . . . . . . . . . . . . $3,300 Coca-Cola Company . . . . . . . . . . . . . . . . . . . $200,000 Coldwater Seafood . . . . . . . . . . . . . . . . . . . . . . $15,000 Crystal's International . . . . . . . . . . . . . . . . . . . . . . $252 Custom Cuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 Daisy Brand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000 Excel/Cargill . . . . . . . . . . . . . . . . . . . . . . . . . . . $100,000 Fired Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $6,000 Hatfield Quality Meats . . . . . . . . . . . . . . . . . . . . $33,700 HMS Host Corporation . . . . . . . . . . . . . . . . . . . . $50,000 Jeff's Gourmet Pies . . . . . . . . . . . . . . . . . . . . . . . $1,000 John R. Daily Company . . . . . . . . . . . . . . . . . . . . . $750 Kagome, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,086 King and Prince Seafood . . . . . . . . . . . . . . . . . . $9,200 KorBert, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 KPR Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000 LTP Management Group . . . . . . . . . . . . . . . . . . . $3,250 Marie Callendar Pie Shops . . . . . . . . . . . . . . . . $11,900 Mexican Restaurants . . . . . . . . . . . . . . . . . . . . . . . $750 Monsanto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200,000 National Steak and Poultry . . . . . . . . . . . . . . . . $10,000 North American Enterprises . . . . . . . . . . . . . . . . . $500 North American Provisioners . . . . . . . . . . . . . . . . . $150 Not Your Average Joe's . . . . . . . . . . . . . . . . . . . . . $347 Outback Steakhouse . . . . . . . . . . . . . . . . . . . . $164,600 P. F. Chang's China Bistro . . . . . . . . . . . . . . . . . $15,000 Packaging Corporation of America . . . . . . . . . $10,000 Performance Food Group . . . . . . . . . . . . . . . . $15,000 Pilgrim's Pride Corporation . . . . . . . . . . . . . . . $100,000 Pro Edge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,400 Quantum Foods . . . . . . . . . . . . . . . . . . . . . . . . . $18,000 Raising Cane's Chicken Fingers . . . . . . . . . . . . . $1,000 Rare Hospitality . . . . . . . . . . . . . . . . . . . . . . . . . $15,000 Real Food Marketing . . . . . . . . . . . . . . . . . . . . . . . $500 Restaurant Concepts . . . . . . . . . . . . . . . . . . . . . $6,000 Rosemount Estates (Southcorp) . . . . . . . . . . . . . $5,300 Royal Cup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000 Save-on Seafood . . . . . . . . . . . . . . . . . . . . . . . . . $2,000 Sugar Foods Corporation . . . . . . . . . . . . . . . . . . $5,000 T. Marzetti Company . . . . . . . . . . . . . . . . . . . . . $10,000 TriOak Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,100 Tyson Foods, Inc. . . . . . . . . . . . . . . . . . . . . . . . $100,000 Wendy's International, Inc. . . . . . . . . . . . . . . . $200,000 White Castle System . . . . . . . . . . . . . . . . . . . . . $43,872 Worldwide Restaurants Concepts . . . . . . . . . . . $1,500 2002 Brinker International, Inc. . . . . . . . . . . . . . . . . . . $25,000 Cameron Mitchell Restaurants . . . . . . . . . . . . . . $1,250 Campagna-Turano Bakery, Inc. . . . . . . . . . . . . . . $500 China Mist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $400 Coffee Reserve, Inc. . . . . . . . . . . . . . . . . . . . . . . . . $140 Darifair Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,000 Dean Foods Company . . . . . . . . . . . . . . . . . . . . $5,000 Eli's Cheesecake Company . . . . . . . . . . . . . . . . $1,000 Excel/Cargill . . . . . . . . . . . . . . . . . . . . . . . . . . . $100,000 Good Humor/Breyer's Ice Cream . . . . . . . . . . . $1,500 HMS Host Corporation . . . . . . . . . . . . . . . . . . . . $25,000 John Soules Foods . . . . . . . . . . . . . . . . . . . . . . . . $1,000 Ken's Foods Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . $5,000 Michigan Turkey Producers Coop . . . . . . . . . . . $7,000 National Everclean Service . . . . . . . . . . . . . . . . . . $500 Not Your Average Joe's . . . . . . . . . . . . . . . . . . . . . $347 Paradise Tomato Kitchens, Inc. . . . . . . . . . . . . . . $7,500 Perdue Farms, Inc. . . . . . . . . . . . . . . . . . . . . . . . $40,000 Pro Clean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 Revolution, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000 Royal Cup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 RTM, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $64,872 Simmons Foods, Inc. . . . . . . . . . . . . . . . . . . . . . . $5,000 Sun Orchard, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . $2,000 Syracuse's Italian Sausage . . . . . . . . . . . . . . . . . . $500 Tyson Foods, Inc. . . . . . . . . . . . . . . . . . . . . . . . $100,000 Source: <http://www.disinfopedia.org/wiki.phtml?title=Center_for_Consumer_Freedom>; accessed 7/10/03. Treatment of Animals, and the Center for Science in the Public Interest) that it dislikes, that secrecy might be warranted. Nevertheless, a nonprofit organization, PRWatch, received and publicized a list of CCF's funders that shows widespread support from major food corporations (see List 3). Companies that contributed $100,000 or more include Coca-Cola, Excel/Cargill, Monsanto, Outback Steakhouse, Tyson Foods, and Wendy's. Somewhere between health charities and industry front groups are organizations that were not complete creations of corporate interests, but that rely largely on corporate support. They claim to be independent, but much of what they do is consistent with their supporters' interests. One prominent example is the American Council on Science and Health (ACSH). It receives funding from corporations and foundations (mostly conservative, pro-business foundations). ACSH long ago stopped disclosing from which companies it received funding, but according to the group's 1991 annual report, major funders include chemical companies, food companies, oil companies, energy companies, and auto companies. Considering those funders, it should not surprise one that ACSH devotes much of its energy to trying to debunk concerns raised by environmental and consumer groups. It downplays risks of air and water pollution, poor nutrition, dangers of pesticides, global warming, and other problems. The group speaks out on concerns related not just to its current donors, but also to other companies, perhaps in the hope that its utterances will lead to new funding. In other words, every whitewash serves both as a repayment and as a marketing tool (and, to be fair, as an expression of the group's apparent actual beliefs). Another such organization is the International Society for Regulatory Toxicology and Pharmacology (ISRTP), which serves to "inform and educate scientists, policy makers, the media and the public about the scientific issues affecting the regulatory process." VOL 11/NO 4, OCT/DEC 2005 www.ijoeh.com Industry Funding of Nonprofit Health Organizations 353 ISRTP publishes the scientific journal Regulatory Toxicology and Pharmacology. Its sponsors include Dow AgroSciences, Eastman Kodak, Gillette, Merck, Procter and Gamble, R. J. Reynolds Tobacco, and other corporations that have an interest in weakening government regulations of toxic chemicals. The journal's editorial board is dominated by industry lawyers and scientists who consult for industry. In one egregious episode, the journal's editor was paid $30,000 by the tobacco industry to write a paper--which was published in the journal--downplaying the risks of second-hand smoke. UNIVERSITIES University affiliations are particularly effective surrogates for propagating industry's views, helpful in burnishing companies' reputations and giving companies access to respected faculty members. The most notorious such group is the Harvard Center for Risk Analysis. It was launched primarily with gifts from Bethlehem Steel, British Petroleum, Coca-Cola, Dow Chemical, Merck, Monsanto, and a dozen other companies. It now gets funding from everyone from AT&T Wireless and the California Avocado Commission to the Chemical Manufacturers Association and the Chlorine Chemistry Council, as well as the government. Its studies generally exonerate technologies alleged to cause problems and provide academic back-up for corporate initiatives in beating back government health and safety rules. No surprise that the director at that time, John D. Graham, would ask Philip Morris for $25,000, saying, "I would like the opportunity to meet with you personally. . . . It is important for me to learn more about the risk-related challenges that you face." Other university-based groups include: Center for the Study and Improvement of Regulation is housed in the Department of Engineering and Public Policy in the Carnegie Institute of Technology. It is funded by several corporations, foundations, and trade associations including: Exxon, Ford, Alcoa, the Chemical Manufacturers Association, and the American Petroleum Institute. Center for Food and Nutrition Policy was started at Georgetown University and is now at Virginia Polytechnic Institute and State University. This "independent, nonprofit" group does not disclose who its backers are, despite claiming that it has a "full disclosure" policy. (In fact, it has received funding from the Grocery Manufacturers of America, the Animal Health Institute, the Sugar Association, and other food and drug companies and trade associations.) The group regularly files comments on regulatory and policy issues at the U.S. Food and Drug Administration and U.S. Department of Agriculture. The Vanderbilt University Medical Center's Institute for Coffee Studies was established with funds from the Association of Coffee Producing Countries, the National Coffee Association of the U.S.A., and the All-Japan Coffee Association. Also, it received $275,000 from KraftGeneral Foods, the maker of Maxwell House coffee. The institute unapologetically states that its mission is to "study the possible health benefits of coffee." It would be interesting to see what this university-based organization would do if it discovered a health problem caused by coffee. Mercatus Center at George Mason University is "an education, research and outreach organization [working] with scholars, policy experts, and government officials to bridge academic learning and real world practice." Its funders have included Enron, International Paper, Microsoft, Pfizer, Xerox, and other corporate giants. The Mercatus Center focuses heavily on what it considers excessive and unwise government regulatory activities.1 Of course, aside from those special academic centers, companies provide funding for many regular academic departments. The most controversial of those arrangements was between drug giant Novartis (later Syngenta) and the University of California at Berkeley's Department of Plant and Molecular Biology. In exchange for $25 million over five years, Novartis had a say in what studies were conducted, first rights to negotiate patents on some of the department's research, and, obviously, close relationships with many professors.2 (The agreement was not renewed, and it is unclear whether Novartis' funding had any untoward effect on the department.3) Smaller deals are legion. Tufts University's School of Nutrition Science and Policy has received funding from Kraft Foods, Procter and Gamble, and a maker of dietary supplements. The School of Medicine at the University of North Carolina at Chapel Hill received $500,000 from Bristol-Myers Squibb Company. Merck gave $1 million a year for five years (19982003) to Harvard University's Institute of Chemistry and Cell Biology. And, not to play favorites in Cambridge, Merck is giving the Massachusetts Institute of Technology (MIT) up to $15 million over five years and is providing funding for 18 "Merck Scholars." While those companies may have nothing more in mind than simply wanting to have the inside track in identifying profitable new products, the intertwining of universities and corporations may jeopardize universities' traditional independence. Students (and professors) who are assisted by corporate funding see expressions of gratitude to corporate sponsors as the norm, and develop close relationships with corporate officials may find it hard to criticize certain companies or industry practices. INDUSTRY FUNDING INTERNATIONALLY As a few examples from the United Kingdom demonstrate, the co-optation or use of nonprofit organiza- 354 Jacobson www.ijoeh.com INT J OCCUP ENVIRON HEALTH tions by industry is not limited to the United States, but probably occurs wherever industry feels threatened by government activities. The British Dental Association rents out its logo to companies, but in 2001 it became enmeshed in a controversy over its endorsement of Ribena Toothkind drink, which is made by SmithKline Beecham. The company had paid the association 55,000. The British High Court ruled that Ribena misled consumers by claiming that "it does not encourage tooth decay." In fact, the drink contains sugar and does promote tooth decay. In 2000, the British Heart Foundation let Nestl use its logo as part of the charity's program to raise 250,000. Nestl was fined three times that amount for advertising that its Shredded Wheat would reduce the risk of heart disease, a violation of Britain's foodlabeling laws that prohibit medical claims. The British Nutrition Foundation says little about the harmfulness of trans fat and salt, matters of concern to most health experts. That foundation is funded largely by McDonald's, Nestl, British Sugar, Cadbury, the Meat and Livestock Commission, Unilever, and others. With units around the globe, the International Life Sciences Institute (ILSI) is another story. It was founded in 1978 "to work toward a safer, healthier world." The question is, safer and healthier for whom? ILSI was founded by major coffee and soft-drink makers, including Coca-Cola, Procter and Gamble (Folger's coffee), Nestl, and Kraft Foods (Maxwell House Coffee), as well as many other companies. They were stirred into action by criticism of caffeine and the major caffeine-containing foods: coffee and soft drinks. The group sponsors conferences and sends scientists to government conferences to represent industry's take on controversial issues. To a degree unusual in the normally genteel world of science, ILSI has been harshly criticized by the World Health Organization (WHO) for its lobbying and other practices. The WHO chastised ILSI for "the failure to fully disclose ILSI's funding sources," advocacy of "public health policy directions . . . that are counter to accepted nutrition policy (especially related to obesity, alcohol, caries and chronic disease causes and means of control); and a perception that many of [ILSI's] developing country partners and recipients of funds are unaware of ILSI's [industry] funding base." The WHO greatly restricted ILSI's interactions with the WHO. *** Nonprofit organizations, at least those that wish to protect their independence and best serve the public interest, need to grapple with the issue of corporate funding. Many--such as Consumers Union, Public Citizen, and the Center for Science in the Public Interest--reject all such funding and rely more on membership donations and foundation grants. Others believe that they can maintain their independence even while receiving industry funding, sometimes adopting policies to aid that effort. Of course, some of those groups have been the subject of intense media scrutiny and criticism, because conflicts of interest, be they real or apparent, real warning flags. And other groups simply may not be concerned about what the public or their members think of their receiving corporate support. At the very least, nonprofit organizations and their top officials should disclose, in annual reports, studies, and web sites, as well as when appearing in the media or giving speeches, their sources of funding. Doing so would allow the public to understand better some of the influences and constraints on the organizations. Unfortunately, many organizations (such as the Center for Food and Nutrition Policy, Center for Consumer Freedom, and the American Council on Science and Health mentioned above) refuse to disclose their funders. It is critical that policy makers, such as legislators, and policy advisors, such as the National Academy of Sciences, know the conflicts of interest of organizations that seek to influence their decisions. Researchers who have direct conflicts of interest should not be permitted to serve on panels. If conflicted organizations testify at public hearings or provide written statements, they should be required to disclose their conflicts so that their views could be placed in the right context. The public counts on journalists to expose undisclosed financial relationships, and it is heartening that some media, including the New York Times and the Washington Post, as well as an increasing number of academic journals, are making disclosure the norm. References 1. Dudley S, Warren M. Regulatory spending soars in fiscal year 2003. July 22, 2003. Press release. <http://www.mercatus. org/article.php/359.html>; accessed March 12, 2005. 2. Buchanan B., Chapela I. Novartis revisited. California Monthly, February 2002. <http://www.alumni.berkeley.edu/Alumni/ Cal_Monthly/Februar y_2002/Novartis_revisited__.asp>; accessed March 12, 2005. 3. Schoch R. Novartis: gone but not forgotten. California Monthly, December 2004. <http://www.alumni.berkeley.edu/Alumni/ Cal_Monthly/Februar y_2004/Novartis-_Gone_but_not_forgot ten_.asp>; accessed March 12, 2005. VOL 11/NO 4, OCT/DEC 2005 www.ijoeh.com Industry Funding of Nonprofit Health Organizations 355