Monday, October 19, 2009

Why Things Don't Go Better with Commercial Sponsorship--Coke and AAFP

I don't get any joy out of using this blog to tattle on my own professional medical society, the American Academy of Family Physicians (AAFP)-- but they recently cut a "high six figure" deal with Coke:

The support is to pay for educational materials on beverages and other nutrition issues. The way the general public is likely to see this deal is well captured by the first paragraph of coverage on NPR's health blog by Maggie Mertens:

When health questions crop up, the first resource for answers is often the family doctor. But if eating right is on your mind, how would you feel if the doctor's professional society is taking money from the soft-drink industry?

It is interesting to review the quotes in the blog coverage in which both AAFP and Coke try to defend this deal. Normal people, hearing those words come out of their mouths, would be clued into the fact that their having to say those words is a clear sign that something is rotten in Denmark. Yet they seem oblivious and somehow imagine that what they are saying actually constitutes a justification. They nicely illustrate the classic line from Upton Sinclair, "It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Coke CEO Muhtar Kent, writing recently in the Wall Street Journal: "Obesity is a serious problem," he wrote. "But are soft drinks the cause? I would submit to you that they are no more so than some other products -- and a lot less than many, many others."

AAFP President Dr. Lori Heim: obesity is more complex and that "there's no one evil out there." Sure, she said, some people make "the wrong choices" on drinks. "But I have plenty of patients that even if they gave up sweetened beverages, it's what their forks are carrying that's the bigger problem."

Question number one: if this deal is on the up and up and AAFP retains strict scientific editorial control of these "educational" materials, then why does the statement by its president sound eerily like an echo of that of Coke's CEO? Question two: sure, obesity is complex, and it's precisely in the complexity that the danger lies. Even adopting a strictly scientific view, one can question whether we are over-vilifying the soft drink industry. Since you have a good deal of wiggle room with the science even when you have no commercial bias, as soon as you do have some commercial bias, then it is all that much more tempting to take advantage of the wiggle room. You can say, "Sure, sugary sodas help cause obesity, but so do potato chips, and since Coke gave us money, and the potato chip people didn't, then there's nothing scientifically wrong with shining the spotlight on the potato chips and giving Coke a little bit of a break." So then next year Frito-Lay comes after the AAFP with a "high six figure" deal. (By the way, AAFP, what kinds of pikers do you have for your negotiating team? Can't even get a cool million out of these guys? You look pretty sad compared to AMA and Sunbeam.) And now that Frito-Lay is paying the piper, well, suddenly, scientifically, it's not all that clear that it's either the soft drinks nor the potato chips that are the main cause of obesity; maybe it's those nasty fast food people. And next year McDonalds comes along with a deal. And so on. Now do you guys get it? (Pity the poor purveyor of calories that's last in line to buy off the AAFP.)

Final question: Why does the question of whether it's a good idea for AAFP to take money from Coke so quickly segue into the question of whether Coke is "evil"? (For our blogger colleague who likes logical fallacies, Roy Poses, this sounds like "straw man.") Why does it have to be: either they are evil or else it's just fine for us to take their money? What cannot it simply be that they have different interests--they are trying to make a buck selling beverages (some of which I enjoy drinking myself, I am pleased to report, if they don't have calories in them) while AAFP is trying to protect the public interest through credible health education? What part of conflict of interest don't you understand?

Addendum 10/30/09: For more on this development see a great commentary in the Columbia Journalism Review by Trudy Lieberman: She notes that the press has been very slow to pick up this story, to her chagrin, but the Los Angeles Times did do an appropriate piece. She provides a great piece of historical background:

This is not the first time Coke has teamed up with a physician group, hoping to give its brand a clean bill of health. In 2003, Coca-Cola gave the American Academy of Pediatric Dentists $1 million. According to CSPI, before it got the money, the dental group spoke about the link between sugary drinks and dental disease. After the payment, the group’s president told reporters that the “scientific evidence is certainly not clear” about the role of soft drinks in causing poor oral health.

According to Lieberman, a family doc has started a petition on Facebook to complain. This reminds me that I am a bad boy as I have not directly written to the AAFP president, as a member, voicing my dissent. (And I just got my annual dues renewal notice from AAFP!)


Anonymous said...

Have you ever heard of diet coke?

Anonymous said...

Roy Poses doesn't like logical fallacies, he likes to dissect them.

Marilyn Mann said...

A group of California physicians resigned from AAFP in protest of the alliance with Coca-Cola.