Medical congresses. Enough with the sponsors

Adriano Cattaneo

Healthcare marketing exerts an important influence on the contents of a congress, bending science in its favor, corrupting healthcare policies and practices, and creating conflicts of interest that tarnish the reputation of operators and compromise their integrity, loyalty and independence of judgment

A little over two months ago, in the second article of the Lancet series on breastfeeding (also commented on this site), one could read the following: “Health professional associations should set robust standards and require independent sources of funding for research and congresses. Industry sponsorship of breastmilk substitutes should not be permitted”.[1] The article was mainly referring to the handful of multinationals that dominate the global market: Abbott, Danone, Feihe, Freisland Campina, Nestlé and Reckitt Benckiser. Said and done, even if not by a congress dedicated to infant nutrition.

ECO2023 is the acronym used to identify the European Congress on Obesity, which this year will be held from 17 to 20 May in Dublin, Ireland. It is a leading global conference for clinicians, practitioners, physicians, nutritionists, surgeons and researchers in the field of obesity. As in all congresses of this type, there is no shortage of sponsors.[2] The so-called “main” ones (major sponsor) pay £85,000 and are entitled to: a sponsored symposium, exhibition space, exhibitor and delegate registrations, invitations to the speakers’ dinner, a full-page color advertisement, a half-page company profile in the conference programme, the recognition on the ECO2023 website and first choice of all other sponsorship opportunities including the company logo on delegate bags, branded lanyards, screens and signage around the congress.[3]

As a BMJ news report reports,[4] when the site of was made visible ECO2023, among the sponsors was Nestlé. The company logo was later replaced by that of PronoKal, a brand of weight loss products. However, someone has pointed out that PronoKal is a brand owned by Nestlé. Save yourself heavens! Both because many professionals who deal with obesity do not like the presence of foxes in the chicken coop, and because of the history of Nestlé, which has been boycotted since the 1970s for its unethical marketing of infant formula (artificial milk), on social a furious protest against the presence of this sponsor was unleashed. The noise was not made in vain because in the end the organizers of ECO2023, the European Association for the Study of Obesity (EASO) and its Irish affiliate, had to remove PronoKal and Nestlé from the list of sponsors and return the more than £35,000 that had already been paid.

But that’s not enough. Stimulated by the episode, a group of obesity experts and consultants, mainly from Ireland, in the company of a couple of researchers with an impressive track record on the impact of marketing on health, have drawn up an appeal which, in addition to purporting to oust Nestlé from ECO2023, calls for an end to all sponsorships.[5] Recalling that:

• Nestlé is one of the global leaders in the production, marketing and sale of ultra-processed foods, which are now proven to be harmful to health;[6]
• Nestlé itself acknowledges that more than half of its products should be considered unhealthy;[7]
• a recent study shows that in some regions of the world, 88% of nutrition conferences show some industry involvement;[8]

the signatories of the appeal explain the reasons.

First of all, the presence of the industry at congresses should be called by its name: marketing. The same brochure dedicated to the sponsors of ECO2023 clearly states this: “You can tailor your marketing strategy by purchasing individual sponsor products that fit your specific needs. We look forward to working with you to maximize the return on your investment by helping you choose from our list of sponsor products to create a package that will ensure success for your organisation. Also, any additional ideas you have to promote your products and services will be welcome and given due consideration.”[3]

Second, multinational corporations have a legal obligation to their shareholders: to make a profit by selling more and more. Marketing is an essential tool to achieve this goal. Sponsorships are clearly a marketing tool. No shareholders’ meeting would renew the mandate of a chief executive officer (CEO) who fails to demonstrate that sponsorships have a return, obviously higher than the amount invested. Those who go to a sponsored congress should be aware of this and of the fact that health is not a commodity and should therefore be immune from marketing.

Thirdly, the presence of marketing exerts an important influence on the contents of a congress, bending the science in its favor,[9] corrupting health policies and practices,[10] and creating conflicts of interest that tarnish the reputation of the operators and compromise their integrity, loyalty and independence of judgement.[11] There is also very strong evidence that interaction with the pharmaceutical industry subconsciously influences drug prescribing.[12]

Finally, there is an imbalance of power in sponsored congresses. While sponsors can participate directly in the works, indicate speakers, organize exhibition banquets and finance participants, individuals and civil society organizations who are the bearers of requests independent of commercial interests are excluded or do not have the same spaces and privileges because they cannot afford the investments necessary.

The signatories of the appeal propose some strategies to solve the above problems. According to them, committees of health congresses should:

• Be composed of individuals wholly independent of commercial interests and free from conflicts of interest.
• Have transparent policies on sponsorships and any other type of industry involvement.
• Include reports and debates on the commercial determinants of health in congress programmes.
• Consider ending sponsorships altogether, as some and sadly a few small professional associations have already done.

On the third point, the commercial determinants of health, the Lancet has just published a series of articles.[13] In the third article, devoted to what can be done to reduce the influence of these specific determinants, the authors cite, among many other actions, “ending sponsored science education.” From the series: small recommendations grow.

Adriano Cattaneo, Epidemiologist, Trieste.

Bibliography

1. Rollins N, Piwoz E, Baker P et al. Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Lancet 2023; (published online Feb 7) https://doi.org/10.1016/S0140-6736(22)01931-6
2. https://eco2023.org/?p=Main-sponsors
3. https://eco2023.org/docs/eco2023_sponsorship.pdf?a=456
4. Wise J. Obesity conference ditches Nestlé as sponsor after protests. BMJ 2023;380:p737
5. Mialon M et al. A call to the European Congress on Obesity: It’s time to remove corporate sponsorship. BMJ 2023;380:p755
6. Swinburn BA, Kraak VI, Allender S, etal. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 2019;393:-846
7. Kirby J. Nestlé says less than half of its main portfolio is ranked as healthy. Wall Street Journal. www.wsj.com/articles/nestle-says-less-than-half-of-its-main-portfolio-is-ranked-as-healthy-53778554
8. Mialon M, Jaramillo Á, Caro P et al. Involvement of the food industry in nutrition conferences in Latin America and the Caribbean. Public Health Nutr 2021;24:1559-65
9. Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS. Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med 2007;4:e5
10. Legg T, Hatchard J, Gilmore AB. The Science for Profit Model-How and why corporations influence science and the use of science in policy and practice. PLoS One 2021;16:e0253272
11. Bes-Rastrollo M, Schulze MB, Ruiz-Canela M, Martinez-Gonzalez MA. Financial conflicts of interest and reporting bias regarding the association between sugar-sweetened beverages and weight gain: a systematic review of systematic reviews. PLoS Med 2013;10:, e1001578
12. Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open 2017;7:e016408
14. 14. Friel S et al. Commercial determinants of health: future directions. Lancet, Published online March 23, 2023