Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Mechanisms for addressing and managing the influence of corporations on public health policy, research and practice: a scoping review

Melissa Mialon ‍ ‍ ,1,2 Stefanie Vandevijvere,3 Angela Carriedo-­Lutzenkirchen,4 Lisa Bero,5 Fabio Gomes,6 Mark Petticrew,7 Martin McKee ‍ ‍ ,7 David Stuckler,8 Gary Sacks9

To cite: Mialon M, Abstract Strengths and limitations of this study Vandevijvere S, Carriedo-­ Objective We identified mechanisms for addressing and/ Lutzenkirchen A, et al. or managing the influence of corporations on public health Mechanisms for addressing ►► This review is the first attempt to develop an inven- policy, research and practice, as well as examples of and managing the influence of tory of mechanisms for addressing and managing corporations on public health where these mechanisms have been adopted from across the influence of corporations on public health policy, policy, research and practice: the globe. research and practice. a scoping review. BMJ Open Design We conducted a scoping review. We conducted ►► Many of the mechanisms identified in our review 2020;10:e034082. doi:10.1136/ searches in five databases on 4 June 2019. Twenty-­ have been developed with no restriction on the type bmjopen-2019-034082 eight relevant institutions and networks were contacted of industries targeted. ►► Prepublication history and to identify additional mechanisms and examples. In ►► The list compiled here is non-exhaustive­ and by na- additional material for this addition, we identified mechanisms and examples from ture, subject to changes, as an increasing number of paper are available online. To our collective experience working on the influence governments and other institutions take measures view these files, please visit of corporations on public health policy, research and to prevent undue influence from industry. the journal online (http://​dx.​doi.​ practice. ►► Not all mechanisms have yet been thoroughly evalu- org/10.​ ​1136/bmjopen-​ ​2019-​ Setting We identified mechanisms at the national, ated; therefore, we did not assess the validity of the 034082). regional and global levels. included studies. http://bmjopen.bmj.com/ Received 05 September 2019 Results Thirty-one­ documents were included in our ►► Mechanisms at the subnational level have not been Revised 05 March 2020 review. Eight were peer-­reviewed scientific articles. included in our study. Accepted 18 May 2020 Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, Background we identified 49 mechanisms for addressing and/or There is growing evidence, coupled with managing the influence of corporations on public health policy, research and practice, and 43 of these were public awareness, that the economic power of

adopted at the national, regional or global level. We corporations, particularly that of large trans- on September 29, 2021 by guest. Protected copyright. identified four main types of mechanisms: transparency; nationals, has led to the defeat, delay and management of interactions with industry and of conflicts weakening of public health policies around 1–3 of interest; identification, monitoring and education about the world. Perhaps the best evidence of the the practices of corporations and associated risks to harmful influence of corporations on public public health; prohibition of interactions with industry. health policy is in the field of tobacco control. Mechanisms for governments (n=17) and academia In the 1990s, during litigation in the USA, (n=13) were most frequently identified, with fewer for the leading tobacco companies released large media and civil society. quantities of internal documents,4 5 revealing © Author(s) (or their Conclusions We identified several mechanisms that could how, over decades, they sought to deny the employer(s)) 2020. Re-­use help address and/or manage the negative influence of threat that tobacco posed to health and to permitted under CC BY-­NC. No corporations on public health policy, research and practice. 6–8 commercial re-­use. See rights thwart measures to reduce smoking. Recent and permissions. Published by If adopted and evaluated more widely, many of the research has shown that influence of tobacco BMJ. mechanisms described in this manuscript could contribute industry has resulted in a policy shift towards For numbered affiliations see to efforts to prevent and control non-­communicable industry interests in some regions, such as the diseases. end of article. European Union.9 Tobacco continues to kill Trial registration details The protocol was registered millions.10 An emerging body of evidence is Correspondence to with the Open Science Framework on 27 May 2019 revealing the use of similar corporate efforts Dr Melissa Mialon; (https://osf.​ ​io/xc2vp).​ melissa_​ ​mialon@hotmail.​ ​fr to defeat, delay and weaken the public health

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from policies and influence research and practice, from a increasing awareness and acceptance among the public range of sectors including the alcohol, food, gambling, health community, particularly in high-income­ countries, oil and pharmaceutical industries, among others.1 11–15 that interactions with these industries require extreme These corporate practices that have a negative impact on caution, and, at the minimum, transparency coupled with health, and that are used across industries, are increas- a detailed understanding of their mode of operation.30 31 ingly referred to as ‘commercial determinants of health’ The public health community looks for inspiration to in the literature.16 the WHO Framework Convention on Tobacco Control Industry efforts to influence public policy, research (FCTC),32 with recent calls for a Framework Convention and practice are often referred to as ‘corporate political on Food Systems (FCFS)3 and a Framework Convention activity’ (CPA). The CPA includes: coalition management on Alcohol Control (FCAC).33 Article 5.3 of the FCTC bars (influence on third parties such as health organisations, any interactions between governments and the tobacco communities and the media); information management industry except for implementing tobacco control, led by (manipulation of the evidence base, through the funding public health officials.32 As of December 2018, 181 coun- of research, ghost-writing,­ and so on); direct and indirect tries had ratified the WHO FCTC, covering 90% of the involvement in policy-making;­ litigation or the threat of world population.34 The extent of implementation of key legal actions; and discursive strategies seeking to frame FCTC regulatory measures in countries is significantly the dominant narrative in their favour.8 associated with lower smoking prevalence.35 However, the Several institutions have been established to monitor tobacco industry, often through pseudo-scientific­ front the influence of corporations on public health policy, groups, still wields influence that allows it to avoid or research and practice, such as Corporate Europe Obser- water down regulatory initiatives.36 vatory in Europe and US Right to Know in the USA (see The demand for mechanisms to protect the policy online supplementary file 1 for a non-exhaustive­ list process from undue corporate influence is growing. One of such organisations). Major reviews of the determi- example of how this became evident is when, in 2012, nants of health also increasingly and explicitly examine Member States requested the World Health Assembly the influence of corporations on public health policy, (Resolution WHA65.6) to develop risk assessment, disclo- research and practice.3 Approaches have recently been sure and management tools to safeguard against conflicts developed to analyse this influence systematically. The of interest (COI) in policy development and implementa- ‘Corporate Permeation Index’ developed by Lima and tion of nutrition programmes.37 The WHO also recently Galea measures “the extent to which corporations are declared that it would no longer partner with alcohol embedded in the political, legal, social, economic and industry actors during the development of policies to cultural fabric of a country”.17 This index seeks to quan- reduce harmful drinking.38 The need for guidance on

tify the penetration of corporations in a given country, how to address and manage undue influence from corpo- http://bmjopen.bmj.com/ and was recently implemented for 148 countries over rations is also evident in research and practice.39 40 the period 2010–5.17 The results showed extensive inter- Identification and monitoring of the industry influence national variation.17 The WHO, as well as institutions in on public health policy, research and practice is a neces- academia and civil society, have made recommendations sary but insufficient step in protecting and promoting to identify and monitor the influence of the tobacco public health. It is essential that international organisa- industry on public health policy, research and prac- tions, governments, academia, the media and the civil tice.18–20 Mialon et al built on this work and developed society are equipped to tackle potential threats to global

a step-by-­ ­step approach to monitor the CPA of the food health. Our study objective was, therefore, to identify on September 29, 2021 by guest. Protected copyright. industry within countries, using publicly available infor- mechanisms for addressing and/or managing the influ- mation.11 To date, the approach has been implemented ence of corporations on public health policy, research in more than 20 countries.21–27 One commonly identified and practice, as well as examples of where these mecha- drawback of such approaches is that they are limited by nisms have been adopted. a lack of relevant and comprehensive publicly available information for most industries other than tobacco, where millions of internal documents are now freely avail- Methods able to the public.21 23 24 27 Evidence of this influence for We conducted a scoping review, where we searched other industries is typically sparse and not systematically scientific publications (peer-reviewed­ articles, letters compiled. It is obtained from a range of sources, including to the editor, commentaries, and so on) and reports internal documents, primarily leaked by whistle-blowers,­ from governments, international organisations and civil publicly available information (eg, from media releases, society. We excluded books, as well as presentations from companies websites, data on lobbying, and so on) and conferences, and other events where no full articles were interviews with those who interact with these companies. available. National health authorities and civil society organisa- A scoping review was deemed to be the most suitable tions have increasingly been concerned with the weak- method for this study as we intended to summarise ening, delay and obstruction of public health policies evidence from a heterogeneous body of research, from due to harmful corporate practices.2 28 29 There is also academia, governments, civil society organisations and

2 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from other actors in public health.41 A scoping review also Our search strategy for Web of Science Core Collection advances knowledge in an emerging field of research, (Web of Knowledge interface) was: which is the case for mechanisms to address the influ- TO= ((corporat* or industr* or compan* or business* ence of corporations on public health.41 In addition, or firm*) AND (address* or manag* or “guid*” or “codes it helps examine the nature of available research and of conduct” or framework* or standard* or governance)) research gaps in the literature, which could inform future AND TI= ((diet or nutrition or food or obesity or alcohol research.41 or drink or pharma* or gambl* or tobacco or smok* We used the Preferred Reporting Items for System- or cigarette* or oil or “public health”) AND (interact* atic Reviews and Meta-­Analyses (PRISMA) Extension for or conflict* or “public*private” or poli* or legislat* or Scoping Reviews (PRISMA-ScR,­ see online supplemen- lobb*)) tary file 2) to prepare our scoping review protocol and Indexes=SCI-­EXPANDED, SSCI, A&HCI, CPCI-­S, our manuscript. The protocol was revised by the research CPCI-­SSH, BKCI-­S, BKCI-­SSH, ESCI, CCR-­EXPANDED, team and registered with the Open Science Framework IC Timespan=2003 to 2019 on 27 May 2019 (https://osf.​ io/​ xc2vp).​ The search strategies for other databases are presented In our scoping review, the term ‘mechanism’ refers to: in online supplementary file 3. Databases were searched policies, regulations, guidelines, codes of conduct, frame- on 4 June 2019. works, standards, initiatives or other tools to address and/ or manage the influence of corporations on public health Eligibility criteria policy, research and practice. To be included in this review, publications had to: The terms ‘industry’ and ‘corporations’ are employed ►► Be published in 2003 and later, when the WHO-FCTC­ interchangeably in this manuscript to refer to the manu- came into effect; facturers, wholesalers, retailers, distributors, food service ►► Be published in English, French, Spanish, Portuguese, providers, as well as producers of raw material. We also or Italian—languages for which members of our team include those organisations acting on their behalf, overtly had at least working proficiency; or covertly, including some trade associations, public rela- ►► Analyse, use, compare, propose or evaluate one or tions firms, ‘philanthropic’ organisations, research insti- several mechanisms for addressing and/or managing tutions and other individuals and groups. the influence of corporations on public health policy, research and/or practice; Database searches ►► Focus on the influence of the alcohol, food, gambling, Search strategy oil, pharmaceutical and/or tobacco industries on public health policy, research and practice; The development of the search strategy was informed ►► Focus on mechanisms at the international, regional http://bmjopen.bmj.com/ by previous systematic and scoping reviews that analysed (eg, Europe) or national level. the influence of corporations on public health policy, 7 12 13 research and practice or that presented mechanisms Selection of sources of evidence to address and/or manage that influence (for the food All citations identified were downloaded and imported to 40 industry, for example ). We used keywords and Medical the web-based­ bibliographic manager F1000 Workspace, Subject Headings (MeSH) terms. The search strategy was where duplicate citations were removed. Data extraction developed with the help of a librarian at the University of and analysis were led by the first author. MM screened Antioquia, Colombia.

all titles and abstracts, when available, for eligibility. GS on September 29, 2021 by guest. Protected copyright. We conducted systematic searches in five databases: double-­screened 10% of the material. MM then obtained ►► Web of Science Core Collection (Web of Knowledge the full-­texts of potential eligible material. When publi- interface); cations were not available online, MM contacted the ►► BIOSIS (Web of Knowledge interface); first authors of the materials to obtain a copy of the ►► MEDLINE (Web of Knowledge interface); documents (n=13). MM assessed the eligibility of that ►► Embase (Embase interface); material against the eligibility criteria. GS assessed the ►► Scopus (Scopus interface). eligibility of 10% of the documents. Disagreement was The terms used in the search strategy were tailored to the resolved by consensus after discussion between MM and requirements of each database and included ((corporat* GS. For documents that were included in our review, MM or industr* or compan* or business* or firm*) AND searched their bibliographic reference sections (back- (address* or manag* or ‘guid*’ or ‘codes of conduct’ or ward searches) and searched documents that were citing framework* or standard* or governance)). In addition, them; using Scopus (forward searches) to identify addi- we searched the following key terms in the titles only, tional relevant material. as a broader search yielded too many irrelevant results: ((diet or nutrition or food or obesity or alcohol or drink Additional searches or pharma* or gambl* or tobacco or smok* or cigarette* Twenty-­eight institutions and networks working on the or oil or ‘public health’) AND (interact* or conflict* or industry influence on public health policy, research and ‘public*private” or poli* or legislat* or lobb*)). practice, as detailed in online supplementary file 1, were

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 3 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from contacted in May 2019 to identify additional mechanisms particular aspects of corporate influence were identi- and examples. These institutions were identified through fied, we only included the most stringent mechanisms, as the authors’ networks. Only one of these institutions determined by ourselves. answered our requests. In addition, we identified mecha- We also include examples where these mechanisms have nisms and examples of their adoption from our collective been adopted, fully or to some extent, as identified in the experience working on the influence of corporations on documents collected during our systematic searches or as public health policy, research and practice. identified through additional searches. The URLs for the We included documents from the grey literature, examples included in our scoping review are available in including from international agencies (eg, WHO, World online supplementary file 4. We made a particular effort Bank, and so on), national government agencies, univer- to represent a broad range of countries from different sities, academic journals, international professionals asso- regions of the globe in these examples, although our list ciations, the media, research funders and civil society is non-­exhaustive. organisations. Exclusion criteria Data charting process and data items We excluded documents funded by corporations or whose Data was charted by MM in an Excel table, and the vari- authors were employed by corporations in the alcohol, ables for which data were sought were: food, gambling, oil, pharmaceutical and tobacco indus- ►► Whether or not the study was funded by corporations tries (as disclosed in the documents identified through or had authors that were employed by corporations our searches), as these represented an inherent COI in the alcohol, food, gambling, oil, pharmaceutical in the development of mechanisms to address and/or or tobacco industries (as disclosed in the documents manage the influence of these industries. identified through our searches); In our analysis, we excluded mechanisms: ► ►► Individuals and institutions targeted by the mecha- ► that were proposed or developed by the industries nism: governments and international organisations mentioned above when these were presented among (with details about specific institutions targeted by the other mechanisms in non-industr­ y funded documents mechanisms within these organisations); academia (eg, reports from multi-­stakeholders platforms); (including researchers, universities, scientific jour- ►► only addressing marketing practices, for example: nals, research funders, ethics review boards, and so –– the sponsorship of sport; on), the media and the civil society; –– the interactions between pharmaceutical com- ►► Details about the mechanism for addressing and/or panies and doctors, pharmacists and other managing the influence of corporations on public healthcare professionals (including during their

health policy, research and practice, including the training) when those have the sole purpose of sell- http://bmjopen.bmj.com/ type of mechanism described; ing products. ► ►► Information about specific examples where the ► targeted at corporations for managing their interac- mechanism has been adopted, either fully or to some tions with government, academia, the media and the extent, including the name of the country, the name civil society; of the policy and the URL. ►► targeting corporate practices that are almost univer- sally illegal, such as criminal activity and bribery of Synthesis of results government officials, although we recognise that these

We identified four broad types of mechanisms for other forms of influence exist. These are beyond the on September 29, 2021 by guest. Protected copyright. addressing and managing the influence of corporations scope of this manuscript. on public health policy, research and practice, through We also excluded documents that did not analyse, use, our interpretation of the data, and as presented at the compare, propose or evaluate a mechanism per se, but beginning of our results section. Most mechanisms iden- instead discussed its adoption in a specific context (for tified in this review pertain to one or more of these four example the adoption in nine countries of a transparency broad categories policy for the interactions between healthcare profes- We present the results of our review in two tables: one sionals and the pharmaceutical industry42). In this case, table with mechanisms for governments and interna- we used these examples in our results section to illustrate tional organisations and one table with mechanisms for instances where a mechanism was adopted. academia, the media and civil society. We decided to first present data for individuals and institutions in govern- Patient and public involvement statement ments as they may have a legal obligation to address Patients and the public were not involved in this research. undue influence from corporations and conflicts of interest, while this might not be the case for other actors in public health. Results We then grouped each mechanism by institution The PRISMA flow diagram for our scoping review is (ministries, universities, academic journals, and so on), in presented in figure 1. In total, 2015 documents were iden- no specific order. Where multiple mechanisms targeting tified in the databases searches (excluding duplicates).

4 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from one for the media. We found many examples where these mechanisms have been adopted, as described below. Many of the mechanisms identified in our review, as discussed in the sections below, focus on the management of COI. COI provisions might not be sufficient to reduce industry influence and that interactions with industry can be ethically problematic and may influence public health policy, research and practice even when COI poli- cies are not implemented.43 44 We identified four main types of mechanisms to address undue influence from corporations (categories are not mutually exclusive): (i) managing the interactions with industry and COI; (ii) increasing transparency about these interactions and COI; (iii) identifying, monitoring and educating third parties in academia, civil society and the media about the practices of corporations and associated risks to public health; and (iv) prohibiting any interaction with industry. There are other types of mechanisms discussed in the literature, such as the protection of whistle-blowers,­ or mandatory taxes for companies to be used by an inde- Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-­Analyses) flow diagram. pendent organisation to fund public health research and practice, as detailed below.

Governments and international organisations After screening of their titles and abstracts, 1998 docu- International organisations and governments have a ments were excluded and 17 were included. In addition, mandate to protect and promote public health. Govern- 6 documents were identified through backward searches ments are in charge of the initiation, development, and 12 documents were found through additional implementation and evaluation of public health policies. searches. No new documents were identified through As such, they are a primary target of corporations whose forward searches. In total, 35 full-texts­ were included profits might be threatened by such policies, during all for analysis. Subsequently, two articles were excluded phases of the policy cycle but in particular during initia- because they did not present mechanisms for addressing

tion and development of policies. http://bmjopen.bmj.com/ and/or managing the industry influence; one article In our scoping review, we identified 23 mechanisms for was excluded because we could not retrieve its full-­text, addressing and/or managing the influence of corpora- despite contacting its first author; and one article was tions on governments and international organisations excluded because it only discussed marketing practices. (table 1). In total, 31 documents were included in our scoping There are growing concerns about how international review. All references included in our scoping review organisations, including the WHO, engage with corpora- came from high-­income countries, in particular the USA tions and in response, the WHO has recently addressed (n=9). Eight documents were published by international

some of these concerns, most notably in its Framework for on September 29, 2021 by guest. Protected copyright. organisations based in France, Switzerland and the USA. Engagement with non-­State Actors (FENSA).37 45 There is Only eight documents were peer-reviewed­ articles. Other criticism of FENSA, as it could be interpreted as an invi- documents included letters to the editors, commentaries tation for increased collaboration between the WHO and and other pieces in scientific/clinical journals, as well as industry, suggesting that this is acceptable if managed as per reports by national and international organisations. Nine WHO guidelines.46 documents discussed mechanisms to address and/or The Organisation for Economic Co-­operation and Devel- manage the influence of all sorts of industries. The other opment (OECD) published several documents that are rele- documents targeted specific industries (these categories vant for the current scoping review, including guidelines are not mutually exclusive): six for the alcohol industry; for the management of conflicts of interest.47 48 In 2017, it seven for the food industry; five for the gambling developed a framework for ‘Preventing Policy Capture’.49 industry; five for the pharmaceutical industry; and six for It also published a series of reports on lobbying regula- the tobacco industry. None of the documents discussed tion50 and on the funding of political parties and elections mechanisms to address and/or manage the influence campaigns.51 of the oil industry. Most documents included mecha- The World Bank developed a ‘Public Accountability nisms for governments (n=17) and academia (including Mechanisms Initiative’, which includes specific recommen- researchers, universities, scientific journals, research dations and “provides assessments of countries’ in-law­ and funders, ethics review boards, and so on) (n=13). Three in-­practice efforts to enhance the transparency of public documents proposed mechanisms for civil society and administration and the accountability of public officials”.52

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 5 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from ­ State Actors Continued cular no. 2010–01 on otection of the Department ficials ­ Making and Implementation - Conduct of Public obacco Control - Joint Memorandum Cir against Tobacco of the Bureaucracy Protection Industry Interference. 2010–0126 on Pr Health, including all of its Agencies, Regional or Specialised/Attached Offices/ Bureaus Offices, Industry Interference. Units, against Tobacco T (FENSA) – – – – Brazil - Presidency of the Republic - Code Conduct Brazil - Presidency for Senior Federal Administration of Colombia - Law 190 1995, Colombia - Congress article 15 - Regime of civil servants and Union (EU) - Guidelines on the prevention European management of COI in EU decentralised agencies France - Penal Code Article 432–12 (individual conflicts of interest) Mexico - Chamber of Deputies the High Congress of - Secretariat of the Union - General Secretary Parliamentary Services - Law of Administrative of civil servants (individual conflicts responsibilities interest) and Regulatory Control Product Nepal - Tobacco in Interference 2014 - Chapter 3: Controlling Directive Policy- Philippines: – Civil Service Commission - Department of Health – Department of Health - Memorandum No. Act Control Uganda - Ministry of Health Tobacco policies of tobacco control (2015) - Part VIII Protection of the and other vested interests commercial from tobacco industry WHO: – Article 5.3 of the Framework Convention on – Framework for Engagement with non- of Colombia - Law 190 1995, Colombia - Congress article 15 - Regime of civil servants - Parliament - Declarations of interests EU - European Parliament Members of the European in Public Life France - High Authority for Transparency Mexico - Chamber of Deputies the High Congress of - Secretariat of the Union - General Secretary Parliamentary Services - Federal Law for administrative of public servants, Article 8, XV responsibilities on “Revolving USA - State Legislative Prohibitions or employees Doors”, a ‘practice of public officials abandoning public service for lobbying positions’ Agency Of ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► Examples where these mechanisms have been adopted Examples where (fully or to some extent) X ­ exhaustive) X X Prohibition Other type X X Identification, monitoring and education Type of mechanism Type X X http://bmjopen.bmj.com/ X X Transparency Management 47 49 62 63 est on September 29, 2021 by guest. Protected copyright. ­ kind) ­ inter 47 48 ­ of- 62 63 48 52 48 62 63 65 ), as well sanctions in case of 62–64 e (combination of income, assets, ­ owned company essing and/or managing the influence of corporations on public health policy (non- 62 63 ­ compliance with the policy 62 63 om specific industries related to health (eg, tobacco om specific industries information about whom to accept funding from, based information about whom to accept funding from, on a risks analysis and description of circumstances a clear and realistic that can lead to a conflict- relationships information about how interactions with corporations parties acting on behalf of the industry) (and third both at the individual and conflicts of interest, reviewed, and institutional levels, will be reported, and managed (including documented, monitored if necessary restricted, to declare for government officials requirements in specific interests and divest themselves of direct to health (eg, tobacco industry) industries related on government institutions and their bodies restrictions in specific industries having financial interests from to health (eg, tobacco industry), unless they are related ownership for managing a government’s responsible in a State- interest on government institutions and their bodies restrictions accepting contributions (financial or in- from fr those working to further its interests, industry) or from except for compensations due to legal settlements or mandated by law or legally binding and enforceable agreements non- ► ► ► ► ► ► A set of policies related to conflicts of interest: A set of policies related liabilities, business activities and incompatibilities with public mandates) for individuals in government. This would contain or not filled are these disclosures if sanctions include omissions or misleading information Public financial disclosur Policy on mandatory waiting periods after the termination a company that individuals from of employment before by a government agency can work in this is regulated government agency and vice versa Officials that should be covered by the above mechanism that should be covered Officials include: ministers; senior public servants; customs officers; judges; tax officials; contract managers; prosecutors; auditors ministerial cabinet staff; officials; procurement Public health plan or strategy that explicitly includes the industry interests, of public health policies from protection including the possibility to challenge demonstrable industry influence ► ► ► ► ► ► Mechanisms identified through our scoping review our scoping Mechanisms identified through Mechanisms for addr

Ministries and related Ministries and related agencies in charge of health, agriculture, education, environment and trade/industry Parliament and Senate Table 1 Table Individuals and institutions

6 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from ess of Continued evention of ficials Ministerial Commission ­ ­ FZ of February 23, 2013 On ee on conflict of interest related to working ee on conflict of interest esidency of the Republic - Agenda obacco Control Inter- obacco Control cent of tobacco excise tax.’ Decr groups of - Secretariat the Union - General Secretary Parliamentary Services - Regulation of the Scientific Council for the Health Risks Regulatory Agency Committee Conflicts of Interest of the Republic: (agenda available for President other government officials) otecting the Health of Citizens from the Effects of the Effects otecting the Health of Citizens from per

– – – – – – Brazil: – Brazilian Health Regulatory Agency (Anvisa) - –T Food Safety Authority - Declarations of EU - European - Panel on nutrition interests Mexico: – Chamber of Deputies the High Congr – Ministry of Health - Ethics and Pr Australia - Australian Public Service Commission Sect 4.12 Gifts and benefits Brazil - Code of Conduct for Senior Federal Administration 2014 and Ethics of the Conflict Interest Canada - Office Commissioner - Registry of gifts Parliament - Register of gifts 8th EU - European parliamentary term Brazil: –– Anvisa - Agenda of senior Pr Canada - Government of Canada - Meetings and on healthy eating correspondence Parliament - Committees Draft EU - European agendas Canada - Government of Canada - Meetings and on healthy eating correspondence is included in Russian Federation - public disclosure the Federal Law N 15- Pr Smoke and the Consequences of Secondhand Tobacco Consumption Tobacco Australia - Australian National Health and Medical Council (NHMRC) - Public submissions Research Open public consultations Commission - Consultations Public EU - European Health USA - US Food and Drug Administration –Code of Federal Regulations Title 21 - Food and Drugs 2012) - Act, 2005 (revised Control Mongolia - Tobacco activities: - Financing of tobacco control Chapter Three Foundation: ‘The Article 10 - Health Promotion Foundation shall be comprised by the budget, equal to 2 ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► Examples where these mechanisms have been adopted Examples where (fully or to some extent) X X X Prohibition Other type X X X X X Identification, monitoring and education Type of mechanism Type X X http://bmjopen.bmj.com/ X X X X X Transparency Management 62 63 on September 29, 2021 by guest. Protected copyright. 62 63 66 67 49 62 63 66 66 48 62 63 size constituency membership role members duties and rights of the composition group public disclosure of the minutes meetings public disclosure of the declarations conflicts public disclosure for all members interest potential exclusion of individuals who have a conflict of interest ► ► ► ► ► ► ► ► ► Policy for the receipt of gifts and donations to individuals Policy for the receipt as well public in government (including prohibitions), of the list such donations when these are disclosure permitted and employees’ Ministers’ and other government officials with an indication of dates, times, diary public disclosures, and individuals met, as well purpose organisations minutes of all meetings (including emails) of correspondence Public disclosure and transcriptions of telephone conversations between parties acting on behalf of the corporations (and third industry) and individuals institutions in government of the list and content submissions Public disclosure and closed) to public consultations on (current the health issues, as well dedicated personnel to review evidence in these submissions Mandatory tax for companies to be used by an independent (government agency for example) to fund public organisation and practice health research That might include a prohibition for any person employed by That might include a prohibition related to health (eg, tobacco industry) or specific industries to be a member any entity working to further their interests that committee or advisory group of any government body, sets or implements public health policy Procedural guidelines for committees or advisory groups guidelines for committees or advisory groups Procedural to public health on: related Mechanisms identified through our scoping review our scoping Mechanisms identified through ► ► ► ► ► ► ► ► ► Continued

Table 1 Table Individuals and institutions

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 7 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from er and ohibition on Continued 285 on access to public information

­ Making and Implementation - Pr ­ Making and Implementation - Manufactur Canada - Alberta Securities Commission System for Document Analysis and Retrieval (SEDAR) Electronic USA - US Security and Commission Exchange: Edgar, company filings Court portal Brazil - Supreme Court portal Chile - Supreme of Information Australia - NHMRC Freedom - of the Presidency Chile - Ministry General Secretariat Law n°20 of the Republic Colombia - Colombia – Presidency and right to access Law 1712 of 1994 on transparency to national public information Commission - Public access to EU - European documents India - Right to Information Act, 2005 Mexico - Chamber of Deputies the High Congress of - Secretariat of the Union - General Secretary Parliamentary Services - Federal Law of transparency and access to public information of South Africa - African Government - Promotion Access to Information Act 2 of 2000 of Information Disclosure Australia - NHMRC Freedom Log portal Brazil - Transparency portal Chile - Transparency of Information - Department of Health Freedom Ireland Request Log FOI Request Logs - UK Parliament UK - House of Lords: 2012) - Act, 2005 (revised Control Mongolia - Tobacco Control Chapter 1: Article 4. State Policy on Tobacco and Regulatory Control Product Nepal - Tobacco in Interference 2014 - Chapter 3: Controlling Directive Policy- to Participate in Tobacco Related Parties Prohibited and Regulatory Task Control Product Act Control Uganda - Ministry of Health Tobacco policies of tobacco control (2015) - Part VIII Protection of the and other vested interests commercial from tobacco industry 2012) - Act, 2005 (revised Control Mongolia - Tobacco and Chapter 2: Article 8. Ban on advertising, promotion sponsorship of tobacco products and Regulatory Control Product Nepal - Tobacco Interference 2014 - Chapter 3: Controlling Directive in Policy- Partnerships and Participations Act Control Uganda - Ministry of Health Tobacco policies of tobacco control (2015) - Part VIII Protection of the and other vested interests commercial from tobacco industry ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► Examples where these mechanisms have been adopted Examples where (fully or to some extent) X X Prohibition Other type X X Identification, monitoring and education Type of mechanism Type X http://bmjopen.bmj.com/ X X X X Transparency Management 52 on September 29, 2021 by guest. Protected copyright. 62 63 68 ­ compliance 62 63 ­ personal information ­ making procedures for accessing information, including procedures retrieval fees for and reasonable search justifiable and non- and explicitly identified limitations to disclosure narrow requirements mechanism enforcement of information deadlines for the release sanctions for non- for certain type of information disclosure proactive ► ► ► ► ► ► Public disclosure of legal disputes and corresponding of legal disputes and corresponding Public disclosure involved and are decisions in which corporations were with: process of Information (FOI) request Formal freedom log, containing information which has been FOI disclosure to an FOI access request in response released Policy which aims to minimise industry involvement in health policy- with partnerships, including in research, Policy to reject specific industries (eg, tobacco industry) Public availability of companies’ financial reports Public availability of companies’ financial Mechanisms identified through our scoping review our scoping Mechanisms identified through ► ► ► ► ► ► Continued

Table 1 Table Individuals and institutions

8 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Continued Blowers in Africa ­ ficials are prohibited from from prohibited ficials are ­ blowers) participating in any tobacco industry sponsored participating in any tobacco industry sponsored as to accept assistance or awards, programmes well as participate in national and international like meetings, trips, training, seminars programmes with invitation and organised and conferences tobacco industries.’ assistance from – Mongolia - Tobacco Control Act, 2005 (revised 2012) - Act, 2005 (revised Control Mongolia - Tobacco and Chapter 2: Article 8. Ban on advertising, promotion - ‘It shall be prohibited sponsorship of tobacco products financial, material aids and contributions to to provide organisations and environmental social, health, welfare another by the tobacco industry or through under the name of “Social responsibility”’ organisations Whistle- Africa - Platform to Protect Canada - Government of Canada - Justice Laws website - Criminal Code France - Maison des lanceurs d’alerte (House of whistle- of the Presidency Chile - Ministry General Secretariat - Platform Lobby Law Code of good practices for lobbyists Australia - Australian Government Lobbyists Register - of the Presidency Chile - Ministry General Secretariat Platform Lobby Law - Registry of lobbyists in Public Life - France - High Authority for Transparency Registry of Lobbyists - of the clerk - House Representatives USA - Office Lobbying Disclosure and Regulatory Control Product Nepal - Tobacco Interference 2014 - Chapter 3: Controlling Directive on in Policy Making and Implementation - Prohibition Social Responsibility - Assuming Organizational – ‘The public agency of to accept tobacco industry assistance ‘It is prohibited in the name of educational or collaboration offered development, ethnic or social class upliftment services; and manufacturers supporting emergency such providing from prohibited parties are and related assistance’ ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► ► Examples where these mechanisms have been adopted Examples where (fully or to some extent) X X X X Prohibition Other type X Identification, monitoring and education Type of mechanism Type X http://bmjopen.bmj.com/ X X Transparency Management

47 48 on September 29, 2021 by guest. Protected copyright. 50 eporters, 49 50 62 63 70 ­ blowers which: blowers and investigative r ­ 69 47 49 50 62 63 fers and senior public servants ­ year ban on lobbying for former ministers, 62 63 guarantee of confidentiality communication secure legal assistance civil and criminal sanctions against the perpetrators of against whistle- retaliation a clear and unambiguous definition of lobbyist provides by regulation and lobbying activities targeted for example, to for expected behaviour, set standards avoid misuse of confidential information, conflict door practices revolving and prevent interest for securing compliance, in a includes procedures spectrum of strategies and mechanisms, coherent including monitoring and enforcement includes a 5- ministerial staf includes mandatory penalties in case of the provision with of false or misleading information in accordance national law ► ► ► ► ► ► ► ► ► which could include: Lobbying regulation Protection of whistle- Protection of lobbyists and information on objectives, Public disclosure and targets beneficiaries, funding sources government to endorse, support, Policy that prohibits activities, partner with or participate in industry sponsored (eg, tobacco including ‘corporate social responsibility’ industry) Regulation to restrict direct industry contributions to civil direct Regulation to restrict society organisations Mechanisms identified through our scoping review our scoping Mechanisms identified through ► ► ► ► ► ► ► ► ► Continued

Table 1 Table Individuals and institutions

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 9 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from ning Organization ning Organization L Concer

e of Election Candidatures Accounts e of Election Candidatures – – Djibouti - Law n°175/AN/07/5 Habit of Health against the Tobacco for the Protection - Chapter VIII: Education, communication and public awareness and Regulatory Control Product Nepal - Tobacco 2014 Chapter 4: Develop Public Awareness Directive and Make Public Places Smoke Tobacco Consumption Free Panama - Ministry of Health Resolution No. 745 on the National Commission for the Study of Tobacco Brazil - Superior Electoral Court: –– Accountability of candidates and political parties Chile - Electoral Service Donations Disclosur ► ► ► ► ► France - National Assembly Financing of political life: parties and electoral campaigns ► ► ► ► ► Examples where these mechanisms have been adopted Examples where (fully or to some extent) X Prohibition Other type X X Identification, monitoring and education Type of mechanism Type X http://bmjopen.bmj.com/ X Transparency Management ­ on September 29, 2021 by guest. Protected copyright. 48 62 63 68 49 51 62 63 nmental advocacy); ­ gover governmental administrative circulars (circulars); governmental administrative circulars and consultations meetings, workshops, presentations (meetings); (training), in which awareness training based measures raising is embedded in the training of civil servants and legal adviser of government ministries; intra- intelligence to specific agencies) aimed at providing by the industry other parts of government targeted in the context of specific policy conflicts (intra- gover nmental advocacy by health ministries (or and local ongoing campaigns by national, regional aimed at highlighting the policy value health officials industry interference health policy from of protecting (campaigning); mass media campaigns which use local television advertisements, newspaper articles, radio call in shows of industry interference and websites to raise awareness among the general public (public awareness raising). accessible and intelligible public reliable, timely, of donations disclosure for certain type of private contributions prohibitions or corporations interests such as foreign parties acting on behalf of the information about third industry limits on donations limits on anonymous donations sanctions for violators of the law oversight independent and efficient ► ► ► ► ► ► ► ► ► ► ► ► ► Awareness raising activities to inform and educate all Awareness of branches of government and the public about nature public health policies the need to protect harmful products, of corporations and other vested interests commercial from (eg, tobacco industry) and the strategies tactics used by with the setting and implementation the industry to interfere of public health policies: Mechanisms identified through our scoping review our scoping Mechanisms identified through ► ► ► ► ► ► ► ► ► ► ► ► ► Regulation of the funding political parties and elections campaigns: Continued

Table 1 Table Individuals and institutions COI, conflicts of interest. Political parties and of commissions in charge elections campaigns

10 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Many countries and international organisations have had all been implemented and had been determined to internal policies and procedures to manage COI, some be effective. of which require the disclosure of these interests to the There is currently limited research in this area, with public. There are, in addition, existing tools that can help only a few peer-reviewed­ scientific articles published in assessing risks to individuals and institutions in public in the literature. We also noted that there is a lack of health when they are considering engaging with corpora- research from low-income­ or middle-income­ countries. tions, such as the Purpose, Extent, Relevant-harm,­ Iden- We identified limited evidence on mechanisms targeted tifiers, Link (PERIL) indicators53 or the decision-­making at the media and the civil society, compared with those tool developed by the WHO for the prevention and targeted at governments and academia. We found no management of COI in nutrition programmes.54 information for schools on ways to address and manage For 22 of the 23 mechanisms identified in our scoping the influence of corporations on their institutions, in review, we found evidence of their adoption, in different relation to public health (for example, through the provi- parts of the world, to various degrees. Many of the sion of health or nutrition education or physical activity examples identified in table 1 refer to the interactions programmes). We identified limited information about of governments and international organisations with mechanisms that could address the influence of corpo- the tobacco industry, following the ratification of the rations; most mechanisms seek to manage that influence WHO FCTC. However, no country, to date, has entirely (through transparency, for example). Managing the restricted the influence of corporations on public policy. influence of corporations is an important first step, but is not sufficient, or could even be counterproductive in 44 Academia, the media and the civil society some circumstances. We identified, through our systematic searches, 26 mech- To our knowledge, this review is the first attempt to anisms for addressing and managing the influence of develop an inventory of mechanisms to address and corporations on academia, the media and the civil society manage the influence of corporations on public health (table 2). policy, research and practice. Among its strengths is its Individuals and institutions in academia, the media and breadth. Although we limited our searches to mecha- the civil society (including public health professionals, nisms developed to address and/or manage the influence civil society organisations, and so on) often engage with of the alcohol, food, gambling, oil, pharmaceutical and corporations, through the sponsorship of events, funding tobacco industries, many of the mechanisms identified in of research project, scientific awards or other types of our review were developed with no restriction on the type interactions. These are standard practices, and while of industries targeted. Hence this inventory may help in there are multiple reasons for them to happen, the scar- building efforts to address and/or manage the influence city of public funding and the vast resources of corpora- of all types of industries. http://bmjopen.bmj.com/ tions are often mentioned.43 There is, however, growing The list compiled here is non-­exhaustive and by nature, concern that the influence of the industry poses threats subject to changes, as an increasing number of govern- to the independence, integrity and credibility of these ments and other institutions take measures to prevent individuals and institutions.29 55–61 undue influence from industry. It rather was intended to We found examples, from across the world, where these be a first attempt to identify mechanisms that exist across 21 of these 26 mechanisms have been adopted. Some the globe, as well as examples where these mechanisms universities refuse funding from the tobacco industry; have been adopted. It thus provides a firm footing for some make transparent interactions between their staff further work in this area. on September 29, 2021 by guest. Protected copyright. members, students and corporations. Many institutions in In this scoping review, we did not assess the quality of academia and civil society have conflicts of interest poli- the included studies, as we only used them to identify cies, which is also the case for some scientific journals and mechanisms. In addition, mechanisms at the subnational professionals associations. The provision of education in level were not included here and might be the subject of universities, conferences and other meetings and to jour- future investigations. Moreover, we excluded work funded nalists was also cited. by the industry, but it is possible that some authors did not declare their sources of funding in the publications. In this case, their work is included in our analysis, which represents a COI with regards to the issues at stake. Discussion Ideally, corporations should refrain from influencing Our searches identified 49 mechanisms for addressing public health policy, research and practice. Governments, and/or managing the influence of corporations on international organisations, academia, the media and the public health policy, research and practice. The primary civil society should avoid interacting with corporations purposes of the mechanisms identified are to manage whose interests risk damaging their independence, integ- conflicts of interest and increase the transparency of rity and credibility.43 However, in reality, these interactions public-­private interactions. Based on publicly available often are the default approach in public health, prob- information, we found that 43 of these mechanisms had ably driven by a strong influence exerted by businesses.43 been adopted, although we could not confirm that they These interactions, the reasons for them to happen and

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 11 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from ect or Continued ­ Industry , Charles Perkins Centre - , Charles Perkins Centre 78 om tobacco companies indirect funding from or enter into any partnership other funding from indirect an organisation arrangement with the tobacco industry, a foundation that accepts in the tobacco industry or from the tobacco industry.’ funds from fr Engagement with industry guidelines Scholarships and Prizes prizes ­ exhaustive) – – – – – Australia – Deakin University - ‘the must not accept dir – The University of Sydney - ban on acceptance funding – The University of Sydney - USA - American Association of University Professors Recommended Principles to Guide Academy- USA - National Institutes of Health Financial Conflict Interest Australia – The University of Sydney - School Molecular Bioscience – Flinders University - School of Health Science – Student USA - The University of California - General University Policy- academic appointees - Conflict of APM - 025 regarding Commitment and Outside Activities of Faculty Members Relationships France - Education Code, L952-2 on academic freedom New Zealand - Education Act 1989 No 80, Public 161 Academic freedom University industrial University - Standford USA - Standford Working with Industry Guide to - Researcher’s contracts office Interactions Pharmaceutical Representative USA - Structured sessions as Components of Medical and Counterdetailing Resident Education ► ► ► ► ► ► ► ► ► Examples where these mechanisms have been adopted (fully or Examples where to some extent) ► ► ► ► ► ► ► ► ► Other type X Prohibition X X X Identification, monitoring and education Type of mechanism Type X X X

http://bmjopen.bmj.com/ X X

Transparency Management ­ on September 29, 2021 by guest. Protected copyright. 71 74 71 est ­ inter ­ of- 40 68 74 essing and/or managing the influence of corporations on public health research and practice (non- research essing and/or managing the influence of corporations on public health 71 66 68 71 74–77 40 68 71–74 a clear and realistic description of circumstances and description of circumstances a clear and realistic that can lead to a conflict- relationships (including information about whom to accept funding from specific industries, such as the on funding from restrictions tobacco industry), based on a risks analysis both at the information about how conflicts of interest, (and individual and institutional levels, will be addressed documented, reviewed, avoided, if necessary), reported, managed or eliminated, as well sanctions in case of non- compliance with the policy and of funding sources for full disclosure requirements publications and media research in financial interests releases projects from for continuous reporting requirements with industry funding if institutional policy permits active management of obvious conflicts interests no money should be accepted if it explicitly constrains the capability of institutions to do their work without interference the funder from if doing so pushes Institutions should not accept money, them to be something that is not consistent with their the health of public) mission (eg, to promote of individuals, the declarations of conflicts interests all stages of design, implementation and throughout reporting corporations (and and other donations from funding sources parties acting on behalf of the industry) to individuals third and institutions corporations (and and other prizes from fellowships, awards parties acting on behalf of the industry) to individuals third and institutions ► ► ► ► ► ► ► ► ► ► Mechanisms identified through our scoping review our scoping Mechanisms identified through Policy on conflicts of interest and external engagement that Policy on conflicts of interest includes: Public disclosure and reporting to the institution’s conflict of to the institution’s and reporting Public disclosure committee of: interest autonomy and control Policy on academic freedom, Policy on academic publication rights of education to students on how evaluate Provision by corporations information provided ► ► ► ► ► ► ► ► ► ► Mechanisms for addr

Table 2 Table Individuals and institutions Universities and other institutions* research

12 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Continued UK - National Health Service (NHS) England Managing Conflicts Statutory Guidance for Clinical Commission Groups of Interest: management templates, including and Conflicts of interest of gifts and hospitality registers policy - Conflicts of interest UK – Wellcome USA - National Institutes of Health (NIH) Financial Conflicts operating procedure - standard for Awardees Interest - a public database operated by the NIH USA - ClinicalTrials.gov conducted by pharmaceutical companies) (most clinical trials are Munich - Policy on Germany - Institute for Therapy Research Competing Interests Medical Association Declaration of International - World Involving Helsinki - Ethical Principles for Medical Research Human Subjects - Ethics Committees ‘This committee must in its functioning, must be independent of the be transparent the sponsor and any other undue influence must researcher, be duly qualified’ ► ► ► ► ► ► Examples where these mechanisms have been adopted (fully or Examples where to some extent) ► ► ► ► ► ► X X Other type X Prohibition X Identification, monitoring and education Type of mechanism Type X X

http://bmjopen.bmj.com/ X

Transparency Management on September 29, 2021 by guest. Protected copyright. 66 68 79–81 79 75 40 66 72 79–81 72 egistry of all clinical trials and other research activities egistry of all clinical trials and other research research priorities and the distribution of funding is research or direct who have not received determined by researchers corporations institutions) funding from third (through indirect should not include those who have academic reviewers industry who have accepted funding in the past 3 years from to be conducted research in the a conflict of interest ► ► Public r involving patients with information on the study design, methods and full results. Mechanisms identified through our scoping review our scoping Mechanisms identified through Policy to ensure that: Policy to ensure Publication of all relevant data, outcomes and results of clinical data, outcomes and results Publication of all relevant activities involving patients, including trials and other research and stopping rules, administrated adverse effects null results, by an independent institution. and monitored relationships Policy for government to conduct clinical trials and other research Policy for government to conduct clinical trials and other research who activities involving patients or to choose the researchers would design and conduct the tests ► ► Continued

Table 2 Table Individuals and institutions Research funding Research committees, panels or boards Ethics review boardsEthics review of funder–researcher Policy to assess the appropriateness

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 13 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Continued Milk Substitutes ­ International - Cochrane policy on commercial sponsorship of International - Cochrane policy on commercial Cochrane Reviews and Group International - Journal of Human Lactation does no publish not compliant with WHO funded by companies that are research Code on the Marketing of Breast- BMJ, Heart, Thorax, BMJ Open, control, International - Tobacco Journal of Health PLoS Medicine, One, Biology, journals published by the American Thoracic Society Psychology, funded by the tobacco industry - do not publish research Journals - Authorship and Disclosures Neurology Ghosts and Unwelcome Annals of Internal Medicine - Exorcising Guests declarations International - the BMJ Staff International - Public Health Nutrition Editors conflict of interest statements International Society of Addiction Journal Editors - declarations for contributors and editors of conflicts interest International Committee of Medical Journal Editors (ICMJE) - form Conflict of Interest USA - American Journal of Clinical Nutrition - information for authors: format and style requirements International - BMJ The and sister journals no longer carry substitutes advertisements for breastmilk ► ► ► ► ► ► ► ► ► ► ► Examples where these mechanisms have been adopted (fully or Examples where to some extent) ► ► ► ► ► ► ► ► ► ► ► X Other type X X Prohibition X X X Identification, monitoring and education Type of mechanism Type X X X

http://bmjopen.bmj.com/ X X X

Transparency Management led ­ on September 29, 2021 by guest. Protected copyright. 72 77 68 72 75 77 83 73 73 77 79 68 72 73 75 77 82 83 82 83 ­ writing’ or ghost authorship a mandatory declaration and disclosure of conflicts a mandatory declaration and disclosure for contributors (which would include details interests parties acting on behalf of the about conflicts with third industry) a positive statement that all contributors in publication had process over the research complete control of the a statement, in the methods section, about role in the design, conduct, analysis and reporting funding source of the data additional steps that will be undertaken by the journal to authors, such from obtain the most meaningful disclosures of the tobacco industry documents for as quick search names of authors papers on tobacco or the invitation with tobacco industry document research a peer reviewer experience ► ► ► ► Mechanisms identified through our scoping review our scoping Mechanisms identified through from specific industries (and third parties acting on behalf of the specific industries (and third from industry) ‘ghost- Policy to discourage individuals from engaging in industry- Policy to discourage individuals from declarations and managing, through Policy for addressing, for editors conflicts of interests disclosure, Policy including: at the time of that all trials be registered Policy that requires initiation of the study is independent of that advertising revenue Policy to ensure with the journal’s corporations that have a conflict of interest main mission ► ► ► ► Continued

Table 2 Table Individuals and institutions Academic journals manuscripts funded by or written contributors Policy to reject

14 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Continued Canada - In 2017, the Canadian Medical Association’s policy on Canada - In 2017, the Canadian Medical Association’s physicians’ interactions with industry was formally adopted by 22 out of 60 Canadian medical associations International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA) - Position Statement on the alcohol industry International Society of Behavioral Nutrition and Physical Activity - Partnership, sponsorship and donation policy (ISBNPA) UK - Royal College of Paediatrics and Child Health (RCPCH) with formula milk companies RCPCH statement on relationship Public Health Obesity Financial Relationship PolicyWorld World and and Nutrition Association (WPHNA) – Conflict of interest ethics policy USA - American Academy of Nutrition and Dietetics Meet our sponsors online supplementary file 1 for a list of institutions working on ► ► ► ► ► ► Examples where these mechanisms have been adopted (fully or Examples where to some extent) See research and the influence of corporations on public health policy, practice, some of which are implementing this mechanism ► ► ► ► ► ► Other type X Prohibition X X X X Identification, monitoring and education Type of mechanism Type X

http://bmjopen.bmj.com/ X X

Transparency Management on September 29, 2021 by guest. Protected copyright. ­ compliance with 71 80 85 62 80 69 82 71 84 including information about: 72 69 e of: 84 69 whom to accept funding from, including bans on the whom to accept funding from, specific industries (eg, tobacco acceptance of funding from parties acting on behalf of the industry) (including third industry) based on a risks analysis both at the individual and how conflicts of interest, (and avoided if institutional levels, will be addressed documented, managed or reviewed, necessary), reported, eliminated, as well sanctions in case of non- the policy specific individuals should not solicit or accept gifts from parties acting industries (eg, tobacco industry) (and third on behalf of the industry) that might influence or appear to independence or fairness in clinical and influence objectivity, judgement professional no money should be accepted if it explicitly constrains the capability of institutions to do their work without the funder from interference institutions should not accept money if doing so pushes them to be something that is not consistent with their the health of public mission to promote corporations (and from funding (or other donations) received parties acting on behalf of the industry) to individuals third and institutions and other prizes funded by/ list of fellowships, awards parties acting on behalf corporations (and third from received of the industry) parties acting made with corporations (and third agreements on behalf of the industry) ► ► ► ► ► ► ► ► Mechanisms identified through our scoping review our scoping Mechanisms identified through Policy or code of conduct The above strategies could be mandated by law, with substantial The above strategies could be mandated by law, fines for those who fail to comply. Governance workshops: governance boards are assisted in Governance are workshops: governance boards their deliberations on industry involvements by presentations of the issues and help or workshops to raise their awareness an informed position on the extent of industry them reach involvement on public health: interests Monitoring of influence commercial and international comparisons annual reports Public disclosur ► ► ► ► ► ► ► ► Continued

Table 2 Table Individuals and institutions Professional Professional associations and civil society organisations†

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 15 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from Continued ISBNPA - policy for sponsors of annual meetings ISBNPA 2016 - Conflict of interest Nutrition Congress WPHNA - World and ethics policy Latin America - Sociedad Latinoamericana de Nutrición (SLAN) policy Conflict of Interest of 2018 abstracts (including sources USA - Obesity Week funding) ► ► ► ► Examples where these mechanisms have been adopted (fully or Examples where to some extent) ► ► ► ► X Other type X Prohibition X X X Identification, monitoring and education Type of mechanism Type X

http://bmjopen.bmj.com/ X X

Transparency Management on September 29, 2021 by guest. Protected copyright. compliance with ­ 75 86 87 75 87 ­ compliance Individuals and institution responsible for the content, Individuals and institution responsible quality and scientific integrity of activities. This necessitates and bias for or against any product eliminating commercial faculty design, programme planning, over control maintaining selection, educational methods, materials and evaluations and how to document whom to accept funding from made with corporations, based on a risks agreements analysis both at the individual and how conflicts of interest, (and avoided, if institutional levels, will be addressed documented, managed or reviewed, necessary), reported, eliminated, as well sanctions in case of non- the policy or company ways to avoid focus on a single product branded items, exhibit halls and booths, (including through use of brand or trade names) mailing addresses of the access to registrants’ control of educational materials and whether or not to ban review materials in educational the distribution of promotional sessions for general oversight to which party is responsible as well sanctions for compliance with policy, ensure non- organisers for conference declarations of conflicts interest and all participants of sponsorship, as well list of sponsors, nature made with sponsors agreements or supported made by individuals from, list of presentations parties acting on behalf of the corporations (and third by, industry) corporations (and third and other prizes from list of awards parties acting on behalf of the industry) list of booths ► ► ► ► ► ► ► ► ► ► ► ► Mechanisms identified through our scoping review our scoping Mechanisms identified through Policy including information about: Public disclosure of: Public disclosure of education to participants on how evaluate Provision by corporations information provided ► ► ► ► ► ► ► ► ► ► ► ► Continued

Table 2 Table Individuals and institutions Conferences and Conferences other meetings in public health

16 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from 89 ransparency - Health Law No. ransparency e and Medicaid Services - Open 42 2011–2012 of 29 December 2011 on the Strengthening of 2011–2012 of 29 December 2011 on the Strengthening for Medicinal and Health Products Health Protection the Physician Payments Payments, established through Sunshine Act (PPSA), also known as section 6002 of the Act (ACA) of 2010 Care Affordable – – International - Association of Health Care JournalistsInternational - Statement - Association of Health Care Journalists of Principles the Association Health Care (CSPI) used to have for Science in the Public Interest The Centre than 4000 scientist and universities that had a database of more ties with the industry (the list is no longer available) policies with Several countries have adopted transparency and professionals to the interactions between healthcare regard pharmaceutical companies: – France - Public database T – USA – Centers for Medicar ► ► ► Examples where these mechanisms have been adopted (fully or Examples where to some extent) ► ► ► Other type X Prohibition X X X X Identification, monitoring and education Type of mechanism Type X

http://bmjopen.bmj.com/ X X X

Transparency Management on September 29, 2021 by guest. Protected copyright. kind support ­ 88 ests for individuals and ed prizes and educational 88 40 68 83 ­ sponsor 88 elevant to each article or commentary piece r requiring that journalists disclose financial or in- requiring not acceptable (eg, that are specifying the relationships by or services produced on products journalists reporting or companies paying companies in which they hold shares, for the travel expenses of journalists’ families) opposing industry- endowments ► ► ► Mechanisms identified through our scoping review our scoping Mechanisms identified through Education and certification programmes to be developed for Education and certification programmes on health, which would emphasise the journalists who report risks of conflicts interest institutions in public health Where countries regulate journalism, the above strategies could countries regulate Where with substantial fines for those who fail to be mandated by law, comply Where countries regulate journalism, the above strategies could countries regulate Where with substantial fines for those who fail to be mandated by law, comply between industry of relationships Publicly accessible register parties acting on behalf of the industry) and journalists, (and third and journalism organisations editors, media organisations and educational bodies) (including professional Public database of conflicts inter Codes of ethics: ► ► ► Continued

Table 2 Table Individuals and institutions governments and academic medical centres. agencies from research organisations, and their institutions, including universities, research and other academic professionals, at individuals in academia, including students, researchers directed *These mechanisms are organisations. health/public health professionals and their institutions, including patient consumer organisations, at individuals, including health and public professionals, directed †These mechanisms are Media Other

Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082 17 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. Downloaded from associated risks for public health were recently discussed 4World Public Health Nutrition Association, London, UK 5 in the literature.43 Public institutions sometimes lack Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia resources, particularly financial resources, to address 6 43 Pan American Health Organization, Washington, District of Columbia, USA urgent public health issues. Academic institutions might 7Faculty of Public Health and Policy, London School of Hygiene and Tropical want to contribute to the economic development in their Medicine, London, UK country, thus partnering with corporations.43 The current 8Dondena Research Centre and Department of Policy Analysis and Public situation is perhaps challenging, but there is scope (and Management, Bocconi University, Milano, Lombardia, Italy 9Global Obesity Centre, Deakin University, Burwood, Victoria, Australia need) for change. Many of the examples we identified in our review related to the implementation of the WHO Twitter Martin McKee @martinmckee FCTC, the only global treaty that explicitly addresses the Acknowledgements The authors would like to acknowledge Jaramillo Ferney, a interference of an industry with public health policy. The librarian at the University of Antioquia, for his support during the development of the proposed FCFS and FCAC are therefore potential solu- search strategy for this scoping review. tions to address and manage the influence that vested Contributors MM and GS contributed to the conception of the work, with support interests could have on public health policy, research from SV and LB. MM led data collection and analysis, with support from SV, AC-L,­ and practice. If adopted and evaluated more widely, LB, FG, MP, MMcK and GS. MM led the writing of the manuscript and all authors have substantively revised it. All authors have approved the submitted version. many of the mechanisms described in this manuscript All authors have agreed both to be personally accountable for the author’s own could contribute to efforts to prevent and control non-­ contributions and to ensure that questions related to the accuracy or integrity of any communicable diseases. part of the work, even ones in which the author was not personally involved, are More research on each of these mechanisms is needed, appropriately investigated, resolved and the resolution documented in the literature. including on their effectiveness in addressing and/or Funding MM received a Fellowship from the São Paulo Research Foundation (FAPESP), Brazil (grant number 2017/24744–0). MM obtained seed funding from managing the influence of corporations on public health the Faculty of Health Sciences (FHS) at the American University of Beirut (AUB), as policy, research and practice. There is a need to under- part of a grant funded by the International Development Research Centre (IDRC). stand if these mechanisms are effective in addressing the This funding supported her fieldwork in Colombia and Chile in 2019. DS is funded influence of all industries, or of only some industries, and by a Wellcome award. then study the political, social and other factors respon- Competing interests None declared. sible for these differences. Collectively, public health Patient consent for publication Not required. professionals might also develop, in the future, new mech- Provenance and peer review Not commissioned; externally peer reviewed. anisms not described in our manuscript. Some countries Data availability statement Data are available upon reasonable request. The have already adopted some of the mechanisms proposed data sets used and/or analysed during the current study are available from the in this manuscript; others have done little, including corresponding author on reasonable request. countries facing strong resistance to developing and Open access This is an open access article distributed in accordance with the implementing them. An evaluation of the implementa- Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which http://bmjopen.bmj.com/ permits others to distribute, remix, adapt, build upon this work non-commercially­ , tion of these mechanisms, which could include a bench- and license their derivative works on different terms, provided the original work is marking exercise, is therefore needed and will inform properly cited, appropriate credit is given, any changes made indicated, and the use governments, universities and other actors in public is non-­commercial. See: http://​creativecommons.org/​ ​licenses/by-​ ​nc/4.​ ​0/. health. In addition to these mechanisms, a module on ORCID iDs ‘corporations and health’ could be part of the curriculum Melissa Mialon http://orcid.​ ​org/0000-​ ​0002-9883-​ ​6441 for professionals being trained in public health policy, Martin McKee http://orcid.​ ​org/0000-​ ​0002-0121-​ ​9683 research or practice. Conferences and other meetings of public health professionals should also be used as a on September 29, 2021 by guest. Protected copyright. References platform where to discuss the influence of the industry 1 Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: on public health policy, research and practice. This may prevention of harmful effects of tobacco, alcohol, and ultra-­ processed food and drink industries. Lancet 2013;381:670–9. be particularly important in the case of academic confer- 2 World Health Organization. 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20 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082