Should we use regulation to demand improved public health outcomes from industry? No
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1761 (Published 02 October 2008) Cite this as: BMJ 2008;337:a1761
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The debate by Sugarman and Pramming in the October 2, 2008 issue of
BMJ is extremely important in our efforts to better understand how public
health and private industry can interact in advancing the common good.
Professor Sugarman’s approach of performance-based regulation, which
allows the regulated industry the prerogative of “how” it is going to
achieve its public health performance measure, is innovative and deserves
to be tested.
Similarly, Professor Pramming’s perspective of advancing private-
public partnerships has merit, given that some segments of the private
sector are at least partly responsible for the very public health problem
under consideration. Accordingly, these companies should be given the
opportunity to be part of the solution as well. This is precisely the
point expressed by Professor Sugarman – make the private sector
responsible for reducing the public health toll their products create.
The goals are the same, the means are different.
To work successfully with the private sector, however, there must be
full and transparent disclosure. This point is properly reflected in the
Oxford Health Alliances guidelines for interacting with the private sector
http://www.oxha.org/about/supporting-
oxha/OxHA%20guidelines%20for%20funding%20and%20interaction%20with%20industry%20version%201%20February%202008.pdf.
However, it appears that the Alliance hasn’t followed its own guidelines
in terms of disclosing real or perceived conflicts of interest. The
Alliance’s guidelines state that it “…is also committed to transparent,
ethical behaviour with respect to funding sources and interactions with
the private sector.”
In his essay, Professor Pramming does not declare any competing
interests. He is, however, the Executive Director of the Oxford Health
Alliance, which receives a portion of its funding from the private sector,
in fact, some of the very companies that he touts in his essay. It is
difficult to determine the proportion of the Alliance’s budget that is
provided by private industry because the Alliance appears to be out of
compliance
http://www.charitycommission.gov.uk/ShowCharity/RegisterOfCharities/Char...
in submitting its annual reports to The Regulator of Charities for England
and Wales, the Commission that is responsible for assuring that “…that
they (charities) operate for the public benefit and independently of
government or commercial interests.”
To be successful in advancing a constructive and effective approach
to solving some of our greatest public health problems, cooperation and
involvement of the private sector is critical. However, to be successful,
it must be based on full disclosure and transparency.
Competing interests:
Serve as a consultant to the Bill and Melinda Gates Foundation and the Robert Wood Johnson Foundation.
Competing interests: No competing interests
Inclusive Stakeholder Consultation Important For Improved Public Health Outcomes
It is encouraging to note that both authors acknowledge that there is
a role for ‘industry’ to play in positively impacting public health
outcomes through partnerships with governments, policymakers and other
stakeholders (1,2).
We, at British American Tobacco, believe that truly effective
regulation needs co-operation between governments and industry, and we
welcome constructive discussion with governments through a fully inclusive
stakeholder consultation process. This process should achieve effective,
evidence-based regulation which can help measurably to reduce the public
health impacts of the use of tobacco products, while respecting the
choices and rights of adults who decide to use these products and allowing
our business as part of a legal industry to compete for their custom.
One of our core beliefs (3) is that the health impact of tobacco
consumption should be reduced, while respecting the right of informed
adults to choose the products they prefer. Consumers should have access to
a range of tobacco products, including potentially reduced-risk tobacco
products. We believe, along with a proportion of the public health
community, that regulators could achieve further public health gains
through regulatory approaches that include potentially reduced-risk
products, as well as continue with the current public health policies of
prevention and cessation.
We think that cooperation between regulators and the industry would
achieve suitable regulatory frameworks for assessing and bringing to
market potentially reduced-risk products, and for facilitating appropriate
consumer communications to enable informed choices based on the risks and
relative risks of different tobacco products – a so-called “Comparative
risk reduction continuum” (4).
One such potentially reduced-risk tobacco product is the smokeless Swedish
-style snus product. Based on epidemiological data, leading medical
experts agree that “health risks associated with snus are lower than those
associated with smoking…” specifically for lung cancer and cardiovascular
disease, and that “for most of the major health effects of tobacco,
smoking is many times more dangerous than smokeless tobacco use” (5).
Understandably, there is considerable debate about what the public
health impact of products like this might be and whether they would
actually contribute to a reduction in total tobacco-related harm on a
population basis. However, it seems invidious that while consumers in
Sweden are allowed to buy snus, there is a current legal ban preventing
millions of smokers elsewhere in the EU having that same option of
choosing a potentially reduced risk product. Similarly, in the vast
majority of countries worldwide, no regulatory framework yet exists to
encourage innovation of potentially reduced risk tobacco products and
allow communication about their relative risks compared to combustible
products.
In our view, regulatory frameworks drawn up through a consultative
and collaborative process involving all stakeholders can best achieve
government and public health objectives, while incentivising industry
innovation in developing and bringing to market consumer acceptable
reduced-risk products.
References
1. Head to head: Should we use regulation to demand improved public
health outcomes from industry? Yes. Stephen D Sugarman, BMJ 2008;
337:a1750
2. Head to head: Should we use regulation to demand improved public
health outcomes from industry? No. Stig Pramming, BMJ 2008; 337:a1761
3. www.bat.com
4. “Tobacco and tobacco products: At a crossroads in the 21st
century”. Scott D Ballin, August 2006. http://www.tobaccoatacrossroads.com
5. “Harm reduction in nicotine addiction- Helping people who can’t
quit”. A report by the Tobacco Advisory Group of the Royal College of
Physicians. October 2007.
Competing interests:
None declared
Competing interests: No competing interests