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Editor's Choice

Big food, big pharma: is science for sale?

BMJ 2015; 350 doi: (Published 12 February 2015) Cite this as: BMJ 2015;350:h795

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Re: Big food, big pharma: is science for sale?

It is always timely to discuss the role of science in public policy and how it is used, abused or misused by stakeholders, including governments. However, there is some shrillness to this editorial comment that I think needs a degree of response.

First a short history of industry and science. Many years ago Eisenhower warned of the creation of the military-industrial complex to characterise the relationship between military needs and those of the defence industry. It should not be surprising that similar complexes exist including with the pharmaceutical industry, medical device industry, auto industry, food industry, etc. There is also a similar complex involving academic research and public research funding bodies and private research funding bodies (what I call the "research welfare state"). Today, perhaps sensitised through research on these complexes we better understand the risks but I suspect we don't understand enough whether the benefits arising outweigh those risks. My suspicion is that they do, but I'd be pleased to be proved wrong.

What that does mean, though, is that at some level of activity, science is indeed for sale, and has always been. As J Robert Oppenheimer remarked reflecting on the detonation of the first atomic bomb: "Now I am become Death, the destroyer of worlds." This is the public policy risk we need to be alert to as science is always in the service of something, it is purposeful, even when it is most pure. How we deal with this our neverending task given the dynamic complexity of our modern scientific, academic, research, and industrial communities. We will continue to get it wrong by some measure, perhaps because we chose to eat the apple and embrace knowledge, than follow the lesser path of obedience. A priori prohibitions on who is fit to participate in the public policy arena, though, are a mistake and undermine both an open society and how public policy should be made.

In policy systems, one should understand what the US calls the "iron triangle" linking government, the civil service and stakeholder communities. Public policy emerges from this cauldron of competing interests, it is not owned by government (though they might think they do), but they are really custodians of policy processes.

Author Loder seems to lament that there might corporate influences over public policy making. It is right and proper that interest groups participate in policy processes. The risk is when those groups "capture" policy makers (and that is the risk I think she was thinking of) through well-paid lobbyists who may indeed promote selective science as much as any other lobby group, from housing to social welfare to education and academia (indeed, to medical journals). But policy making processes themselves are also to blame, because this process is fraught with risks, of favoured consultations, of civil servants and politicians choosing to disenfranchise certain interest groups, or failing to seek out groups lacking political "voice". Policy processes are powerfully skewed by their use of experts (usually from academia) who promote their own agendas to influence the shape and form that policy problems take to fit what they perceive to be the problem.

I agree with Loder that we must be vigilant to perverse influences and be particularly cautious when there is no scientific consensus. In the absence of such consensus, my experts are just as good as your experts, and how is a policy maker to decide? The health economic models used in assessing health technologies have a veneer of scientific certainty, perhaps because they are quantitative. But governments can also frame the context for decision-making by, for instance, making price the denominator not "value"; considering value, though, means opening up the debate to those who would have views on value, and that isn't going to be a quantitative or scientific discussion, but one about preferences.

To prohibit "people with close links to industry [from being] involved in decision making" is an authoritiarian and illiberal view. The only real objective of advocating this would be to silence those with whom one disagrees. Regretfully, even democratic governments can behave like authoritarians when their own interests are challenged, and when political expediency over-rides careful assessment and balance of competing claims. Sometimes governments are not good custodians of public policy either.

Competing interests: No competing interests

18 February 2015
Michael Tremblay
health policy advisor
Cassis Limited
Oylers Folly, Pound Lane, Brabourne Lees, Kent TN25 6RJ