commercial determinants of health (3). Setting out industry tactics.

 

Industry tactics and the playbook around the commercial determinants of health

 

This is the third in a series of blogs

 

1    the broad playbook - The 3 Ds Distortion / Denial or Doubt / Distraction   

Tactics are well documented from the fossil fuel industry hiding the environmental impact of fracking to the pharmaceutical industry misleading the medical community about the dangers of opioid use. 

The tactics used to avoid regulation include (building on Mark Petticrew’s 3 D’s that policy makers at all levels need to remember in response to industry supplied evidence / those with industry interests – Distortion / Denial / Distraction – especially alternate causation strategies). Often these seek to forestall or delay (“we should avoid restriction until we are sure”), weaken, or disrupt effective public health policy.

There are many who have set out the broad playbook. McKee and Stuckler  identified how corporations influence policy through narrative framing, rule-setting, commodification of knowledge, and ‘undermining political, social and economic rights’. Knai and others also helpfully set out the tactics used to shape the policy environment in their corporate interests (at the expense of health) and similar strategies used across different industries and products. The NCD alliance on Signalling virtue, promoting harm set out many hundreds of examples from across the globe. Merchants of Doubt  mainly focuses on climate change and the petrochemical sector, this excellent piece by Luke Allen, van Schalkwyk described tactics of the gambling industry. Rose also wrote on tactics and counter tactics. This article on the tobacco industry’s renewed assault on science is an excellent insight into tactics and some thought on counter tactics. It is written about tobacco but could apply to many other industries. Mialon et al also wrote a comprehensive guide identifying almost 50 separate tactics.  Ilona Kickbusch gave some useful pointers towards drivers, channels and outcomes – each of which might be used to help frame specific interventions

2    Lobbying obviously gets a special mention 

Corporations commonly influence public health through lobbying and party donations. This incentivizes politicians and political parties to align decisions with commercial agendas

To further shape preferences, industries may seek to capture civil society through corporate front groups, consumer groups and think tanks, allowing them to manufacture doubt and promote their framings.

This often also involves feeding information to friendly media to shape public opinion and public attitudes towards government ready regulation, often using catchy phrases (for example such as this is the Nanny State gone mad”, “encroaching on your freedoms”) to bias the minds of policy makers (or media consumers, which in turn has secondary impact).  Many companies make significant investments in lobbying to shape the three choices we make, witness the enormous expenditure on advertising of gambling and unhealthy foods.

Following the link between corporate money, think tank and policy maker is usually very difficult. Some have done this. See this article in the BMJ trying to get under the skin of the political donations of think tanks is not well documented, and it is covert for a reason. The full story is here - Big tobacco, the new politics, and the threat to public health

This short piece set out a short agenda and insight into industry tactics around net zero, some have suggested the right wing media (who ARE influential) and others might turn their sights on climate and net zero next.

Exxonmobil lobbying tactics revealed in this piece that framed Greenpeace as waging a multi decade campaign against the industry. The subtext of the news pieces is “how big oil tries to manipulate big power” by use of a range of tactics such as shadow groups, fishing, the kingmaker, the whipping boy – hiding behind trade bodies to avoid public scrutiny, Say one thing in public do something else in private, working to limit political will for change, active intervention to diffuse the build up of political will. There is nothing illegal here, but the broad tactics of delay, doubt, deflect were prominently on display.

Legg et al set out a comprehensive overview of strategies that essentially set out how to use science for profit, and Ulucanlar et al setting out more specifically the strategies used by tobacco companies to forestall or delay regulation. It is widely acknowledged that the same broad playbook is in use across many companies. 

From Legg:

and Ulucanlar : 

Nichols also set out tactics and counter tactics 

3    Specific strategies

Framing

seeking to frame health as a concept of individual responsibility. Over emphasising some aspects of the evidence at the expense of others to shape the overall narrative.  

Companies go to great lengths to shape an environment that maximises consumption, often actively supporting measures that strength and individual responsibility and education at the expense of regulation.

discredit the science or the scientists, influence science  

The Tactics used by commercial organisations around shaping research agenda have been well described in lots of places. There are a wide range of tactics around managing the research base neatly set out by Rose amongst many others:

 

methods of representing, communicating and producing scientific research and evidence which work to create ignorance or doubt irrespective of the strength of the underlying evidence’ 

JUUL and Philip Morris have injected their narrative into scientific circles by publishing sponsored research in scientific journals. JUUL recently sponsored an entire special issue of the American Journal of Health Behavior to showcase its industry-funded research

academic conference participation, where industry will introduce questionable findings, muddle earnest research efforts, and stifle honest debates among legitimate experts.

Tobacco industry–funded “research” groups 

evading conflict-of-interest documentation and policies or by obscuring their role in funding

Subtly, corporations influence the direction, volume of research and understandings through funding medical education and research, where data may be skewed in favour of commercial interests.

Sponsoring research – see the excellent series from Marion Nestle on industry sponsored research reaching industry friendly conclusions. Obviously this is exceptionally well documented in pharma research.

Alternative causation arguments - to present alternative, misleading explanations for product harms in an effort to downplay their risk. Well used by the tobacco industry  through promoting alternative causes for lung cancer in an effort to cast doubt about the link to smoking. Of note this is a well used strategy in antivax narrative also.

 

Misuse of published evidence

‘confounding referencing and misleading summaries’;

‘misuse of raw data’

‘evidential landscaping’ including cherry-picking and selective quotations;

‘hyperbolic accounting’ to build an overarching narrative of ‘policy dystopia’ that exaggerated the impact of a policy re loss of jobs and harms to economic development,

‘source laundering’,

‘false attribution of focus’,

‘illicit generalisation’,

‘double-counting’,

‘hen’s teeth method of cherry-picking’ and ‘black box computation’

 

presenting false balance or sowing doubt

Mani in this excellent thread accompanying a study set out many insights into how many industries such as fossil fuels, smoking, alcohol, and sugar sweetened beverages manufacture doubt and spread misinformation to downplay harms

sowing doubt in the minds of policymakers that there is some uncertainty about the science isnt strong enough. Often using the wrong evidential paradigm (trying to apply RCT thinking to a social policy problem but saying the evidence isnt good enough)

We need balance, and there are some scientists who don’t believe that climate change IS caused by fossil fuels. Yes there are some, but the science just isnt balanced on this one.

 

use of corporate social responsibility or self-regulation approaches to demonstrate to governments that Industries are acting responsibly. See this short note on how CSR might be used by companies with some helpful thoughts on searching questions public health advocates might use in the panel.

Also the use of philanthropy is worth noting in this area

Fostering partnerships with governments, international agencies and NGOs to give legitimacy in the minds of policy makers.

Corporations may work to capture branches of government to shape their preferred regulatory regime, leading to unregulated activity, limiting their liability and bypassing the threat of litigation and pre-emption.

questioning the effectiveness of statutory regulation

Shaping and crafting political and policy narratives that appeal to all political sides

for example in Gambling developing a Labour narrative this is “middle class do gooders interfering in a working class pursuit”.

sponsoring education

This article on distilling the curriculum sets out the dangers (using alcohol education as an example). They are unlikely to be effective , can serve as covert marketing, and are unlikely to be critical of their funders. The materials produced and funded tend to propose solutions that focus on individual ‘choices’ and decision-making, and peer pressure. They deflect away from harmful industry practices, instead conferring upon them a ‘health’ halo, with a dominant aim of avoiding tighter restrictions. They distil complex social issues down to often over-simplified dichotomies of ‘good choices’ and ‘bad choices’, and place the burden on children and youth to take responsibility for a major public health issue and their ‘lifestyle choices’, thereby closing down opportunities for critical thinking and debate. The delivery of corporatized health education programmes, such shifts restrict teachers and students in their opportunities to question and challenge the status quo and the role of corporations and neoliberal logics in shaping their health.

 

 

The next blog in the series will focus on counter tactics