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Healthy Skepticism Library item: 19494

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Stuckler D, Basu S, McKee M
Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed?
PLoS Med 2011 Apr; 8:(4):


Institutional Relationships and
Global Health
The institutional relationships that
exist in global health are a growing area
of inquiry. This has been most evident in
work examining corporate involvement
in health, because tensions can arise
between the profit motives of corporations
and the promotion of public health.
Whereas corporations make products
that can improve health (such as pharmaceuticals
and vaccines) and relationships
between public health institutions
and for-profit corporations can be seen
as positive opportunities for corporations
to improve public health [1], corporations
also make products that damage
health (such as tobacco or unhealthy
foods). And because some corporations
have a vested interest in the activities of
public health bodies, there have been
documented attempts to influence the
public health agenda by establishing
associations with health care institutions
The relationships of concern between
for-profit institutions and health-related
organizations can involve direct financing—
such as when pharmaceutical companies
give gifts to physicians in a manner
that has been shown to increase prescribing
of the promoted drugs [3,4]—or
indirect relationship-building, such as
when corporate staff or paid consultants
act as board members or strategic advisors
to health organizations. There are many
documented examples of corporate tactics
by the tobacco, mining, alcohol, asbestos,
food, and petrochemical industries aimed
at influencing public health promotion
(Table 1) [5–7].
In addition to examining corporate
relationships in the health arena, public
health advocates have also expressed
concerns about whether potential conflicts
of interests among state development aid
programs could negatively affect health
outcomes. Many government development
agencies act explicitly in the interests
of their own country [8–13]. This has
taken the form of conditionalities on
development aid and when aid is linked
to other political agendas such as reduced
tariffs or privatizing state-owned assets
[14,15]. Government aid has also been
criticized for causing unintended health
consequences—for example, by distorting
recipient government health budgets by
focusing on one or a few diseases at the
expense of others [16], by creating a
misalignment between health funding
and the observed burden of disease due
to external donations [17], and by inappropriately
displacing government funds
that would have otherwise been invested
in health [18].


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What these howls of outrage and hurt amount to is that the medical profession is distressed to find its high opinion of itself not shared by writers of [prescription] drug advertising. It would be a great step forward if doctors stopped bemoaning this attack on their professional maturity and began recognizing how thoroughly justified it is.
- Pierre R. Garai (advertising executive) 1963