Inside ILSI: How Coca-Cola, Working through Its Scientific Nonprofit, Created a Global Science of Exercise for Obesity and Got It Embedded in Chinese Policy (1995-2015).

CONTEXT: Industry influence on health science and policy is a critical issue of our day. In 2015 the New York Times revealed that Coca-Cola paid scientists to form a Global Energy Balance Network promoting the notion that exercise, not dietary restraint, is the solution to the obesity epidemic-a claim few accept. This article examines the organizational dynamics and policy process behind Coke's efforts to sway obesity policy-globally and in China, a critical market-during 1995-2015. METHODS: In-depth, qualitative research during 2013-18 involved 10 weeks of fieldwork in Beijing, interviews with 25 leading experts, analysis of newsletters documenting all major obesity-related activities in China, interviews with 10 Euro-American experts, and extensive internet research on all major actors. FINDINGS: This article tells two intertwined stories (institutional dynamics, science making and policy making) at global and local-Chinese levels. Coke succeeded in redirecting China's obesity science and policy to emphasize physical activity. Key to its success was the industry-funded global nonprofit International Life Sciences Institute (ILSI). Beneath ILSI's public narrative of unbiased science and no policy advocacy lay a maze of hidden channels companies used to advance their interests. Working through those channels, Coca-Cola influenced China's science making and policy making during every phase in the policy process, from framing the issues to drafting official policy. CONCLUSIONS: Though China is exceptional, ILSI promoted exercise globally, suggesting potentially significant impacts in other ILSI-branch countries.

Non-profit Drug Research and Development at a Crossroads.

In wealthy nations, non-profit drug R&D has been proposed to reduce the prices of medicines. We sought to review the ethical and economic issues concerning non-profit drug R&D companies, and the possible impact that their pricing strategy may have on the innovation efforts from for-profit companies targeting the same segment of the pharmaceutical market. There are two possible approaches to pricing drugs developed by non-profit R&D programs: pricing that maximises profits and "affordable" pricing that reflects the cost of manufacturing and distribution, plus a margin that ensures sustainability of the drug supply. Overall, the non-profits face ethical challenges - due to the lack of resources, they are unable to independently commercialize their products on a large scale; however, the antitrust law does not permit them to impose prices on potential licensees. Also, reduced prices for the innovative products may result in drying the for-profit R&D in the area.

Nurturing compassion through care-giving and care-receiving: the changing moral economy of AIDs in China.

Based on the case study of an Aids clinic operated in Nanning by MSF, this paper looks at how one international NGO, Médecins Sans Frontières (MSF, or Doctors Without Borders), deals with the HIV-carrier patients in Nanning, the capital of Guangxi province in China. It explores the process of care-giving to the HIV patients by MSF employees (both foreign and local) and how the patients react to the 'care-receiving' provided by this foreign NGO. This is especially pertinent in China today as HIV-patients are the victims of discriminating policies and are still very much discriminated by the general population. MSF, viewed by the victims as a foreign NGO, is regarded as an organization seen as promoting a changing and compassionate attitude toward AIDs patients through their anonymous and non-discriminating practices. Through the practices and the discourse of MSF workers and the testimonies of the patients, this paper looks at how the moral economy of AIDs is evolving from a repressive and discriminative attitude towards the compassionate attention to individual suffering. As such, MSF, through its actions, is seen as one of the agents promoting attitudinal changes toward disadvantaged groups and is facilitating the emergence of an emotional and compassionate subject.

Board oversight of community benefit: an ethical imperative.

Board oversight of community benefit responsibility in tax-exempt organizations in the nonprofit health care sector is attracting considerable attention. Scrutiny by the IRS and other official bodies has led to stricter measures of compliance with the community benefit standard. But stricter compliance does not sufficiently engage the underlying ethical imperative for boards to provide effective oversight--an imperative that recent research suggests has not been sufficiently honored. This analysis considers why there is a distinctively ethical imperative for board oversight, the organizational nature of the imperative involved, and practical ways to fulfill its obligations. We adopt an organizational ethics paradigm to illuminate the constituent components of the ethical imperative and to clarify emerging benchmarks as flexible guidelines. As these emerging benchmarks enhance board oversight of community benefit they also can shed light on what it means to be a virtuous organization.

Ethical climates in for-profit, nonprofit, and government skilled nursing facilities: managerial implications for partnerships.

This study investigates ethical climates in government, nonprofit, and for-profit nursing homes and determines their similarities and differences. Surveys were collected from 656 (21.4%) licensed nurses who worked in 100 skilled nursing facilities in one Midwestern state. Shared law and code and caring ethical climates were identified across the 3 sector nursing homes. Those climates were also polarized. Important implications were drawn for consideration of ethical perceptions of each sector during negotiations and contract management.

Impact of donors' financial fairness perception on donation intention in nonprofit organizations after COVID-19 outbreak.

Based on the investigation of financial fairness perception and donation intention of individual donors in non-profit organizations (NPOs), this paper uses structural equation model to analyze the impact of individual donors' financial fairness perception on donation intention. The results show that individual donors' perceptions on financial result fairness, financial procedure fairness and financial information fairness all have positive impact on donation intention; among which the perception on financial result fairness only has direct impact on individual donation intention, while the perceptions on financial procedure fairness and financial information fairness have direct and indirect impact on individual donation intention.

Ethics in Eye Banking: Understanding Professional Attitudes Toward Industry Changes.

PURPOSE: To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution. METHODS: Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or presidents) for the Eye Bank Association of America-accredited eye banks completed a 22-question interview, focusing on corneal donation industry changes, including the entry of for-profit institutions. RESULTS: Most participants in both study groups agreed that they have concerns with the entry of for-profit businesses into eye banking (62% corneal surgeons, 68% eye bank leadership), although physicians partnered with a for-profit corneal processor were significantly more likely to have no concerns with the entry of for-profits into eye banking than corneal surgeons partnered with a nonprofit processor (P = 0.04). The most frequently identified concerns with the entry of for-profit businesses into corneal banking were the hypothetical loss of donor trust (56% corneal surgeons, 64% eye bank leadership, P = 0.04) and the potential exploitation of donor generosity (72% corneal surgeons, 60% eye bank leadership). Qualitative theme analysis suggests that both study groups may view increased research/innovation as a potential benefit (64% corneal surgeons, 66% eye bank leadership) of for-profits in eye banking. CONCLUSIONS: Key stakeholders in eye banking do hold relevant ethical beliefs toward recent industry changes, and these attitudes should be considered in the future creation of the ethical corneal donation policy. Further research is needed to assess the attitudes of potential donors and donor families.

The role of ethical banks in health care policy and financing in Spain.

OBJECTIVES: Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. METHOD: We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. RESULTS: Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. CONCLUSIONS: Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

Steps towards Collective Sustainability in Biomedical Research.

The optimism surrounding multistakeholder research initiatives does not match the clear view of policies that are needed to exploit the potential of these collaborations. Here we propose some action items that stem from the integration between research advancements with the perspectives of patient-advocacy organizations, academia, and industry.

Sexual and Reproductive Health Services and Related Health Information on Pregnancy Resource Center Websites: A Statewide Content Analysis.

BACKGROUND: Pregnancy resource centers (PRCs) are nonprofit organizations with a primary mission of promoting childbirth among pregnant women. Given a new state grant program to publicly fund PRCs, we analyzed Georgia PRC websites to describe advertised services and related health information. METHODS: We systematically identified all accessible Georgia PRC websites available from April to June 2016. Entire websites were obtained and coded using defined protocols. RESULTS: Of 64 reviewed websites, pregnancy tests and testing (98%) and options counseling (84%) were most frequently advertised. However, 58% of sites did not provide notice that PRCs do not provide or refer for abortion, and 53% included false or misleading statements regarding the need to make a decision about abortion or links between abortion and mental health problems or breast cancer. Advertised contraceptive services were limited to counseling about natural family planning (3%) and emergency contraception (14%). Most sites (89%) did not provide notice that PRCs do not provide or refer for contraceptives. Two sites (3%) advertised unproven "abortion reversal" services. Approximately 63% advertised ultrasound examinations, 22% sexually transmitted infection testing, and 5% sexually transmitted infection treatment. None promoted consistent and correct condom use; 78% with content about condoms included statements that seemed to be designed to undermine confidence in condom effectiveness. Approximately 84% advertised educational programs, and 61% material resources. CONCLUSIONS: Georgia PRC websites contain high levels of false and misleading health information; the advertised services do not seem to align with prevailing medical guidelines. Public funding for PRCs, an increasing national trend, should be rigorously examined. Increased regulation may be warranted to ensure quality health information and services.

Sponsorship of National Health Organizations by Two Major Soda Companies.

INTRODUCTION: Obesity is a pervasive public health problem in the U.S. Reducing soda consumption is important for stemming the obesity epidemic. However, several articles and one book suggest that soda companies are using their resources to impede public health interventions that might reduce soda consumption. Although corporate sponsorship by tobacco and alcohol companies has been studied extensively, there has been no systematic attempt to catalog sponsorship activities of soda companies. This study investigates the nature, extent, and implications of soda company sponsorship of U.S. health and medical organizations, as well as corporate lobbying expenditures on soda- or nutrition-related public health legislation from 2011 to 2015. METHODS: Records of corporate philanthropy and lobbying expenditures on public health legislation by soda companies in the U.S. during 2011-2015 were found through Internet and database searches. RESULTS: From 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor a total of 95 national health organizations, including many medical and public health institutions whose specific missions include fighting the obesity epidemic. During the study period, these two soda companies lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition. CONCLUSIONS: There is surprisingly pervasive sponsorship of national health and medical organizations by the nation's two largest soda companies. These companies lobbied against public health intervention in 97% of cases, calling into question a sincere commitment to improving the public's health. By accepting funding from these companies, health organizations are inadvertently participating in their marketing plans.

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey.

BACKGROUND: Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs. METHODS: Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews. RESULTS: Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the media's mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured. CONCLUSION: Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.

Stepping Into and Out of the Void: Funding Dynamics of Human Embryonic Stem Cell Research in California, Sweden, and South Korea.

Nonprofit organizations and philanthropists stepped into a funding void caused by controversies over public funding of human embryonic stem cell (hESC) research. Based on interviews of 83 representatives of 53 funders, we examine the motivations and accountability structures of public agencies, corporations, fundraising dependent nonprofit organizations and philanthropic organizations that funded hESC research in three jurisdictions: California, Sweden, and South Korea. While non-traditional forms of funding are essential in the early stages of research advancement, they are unreliable for the long timeframes necessary to advance cell therapies. Such funding sources may enter the field based on high expectations, but may exit just as rapidly based on disappointing rates of progress.

Lifting the veil of secrecy from industry funding of nonprofit health organizations.

Those who provide information about scientific issues and science policy normally present themselves as being objective and "scientific." This article describes a range of health charities, professional associations, nonprofit advocacy organizations, and industry-created organizations that receive significant funding from industry. In some cases, industry appears either to influence an organization's positions or to limit an organization's freedom to speak out on matters of interest to the funders. Nonprofit organizations need to consider the potential influence on their independence if they accept funding from interested companies and trade associations.

Stewardship and accountability.

In March 2003 The Chronicle for Philanthropy reported a sea change in fund development. After 25 years of consistent research on donor motivation, a study came out with new information. Donors ranked on a scale of 1-10 what mattered most to them when considering giving. Until now, most donors reported that a belief in the mission of the organization and the desire to have an impact on the people served was their number one motivation. Certainly gratitude for life-saving or life-changing service made that belief in mission and impact that much more powerful as a motivation. Improving their community was consistently the number two reason for giving. But, according to the 2003 survey, something changed. Six of the 10 reasons involve stewardship and accountability.

Financial conflicts of interest and their association with outcome and quality of fibromyalgia drug therapy randomized controlled trials.

AIMS: To evaluate the association of financial conflicts of interest (FCOI) with the characteristics, outcome and reported methodological quality of fibromyalgia drug therapy randomized controlled trials (FM-RCTs). METHODS: A cross-sectional study of original, parallel-group, drug therapy FM-RCTs published between 1997 and 2011 from Medline and Cochrane Central Register of Controlled Trials was conducted. Two reviewers independently assessed each RCT for funding source, authors' FCOI(s), study characteristics, reporting of methodological measures important for internal validity and outcome (positive [statistically significant result favoring experimental drug for the primary outcome] or non-positive). RESULTS: Forty-seven RCTs were eligible with funding source as: 26 (55.3%) industry; eight (17%) non-profit source(s); five (10.6%) mixed; and eight (17%) unspecified. Industry-funded RCTs were more likely to be multicenter and enroll greater number of patients. Reporting of key methodological measures was suboptimal; however, industry and non-profit funded RCTs did not differ in their reporting. Thirty (63.8%) RCTs had ≥ one author who disclosed an FCOI (receipt of research grant [21, 44.7%], industry sponsor employee [20, 42.6%], receipt of consultancy fee/honorarium [16, 34%] and stock ownership [11, 23.4%]). Although industry funding and certain authors' FCOIs (employment and receipt of consultancy fee/honorarium) were univariately associated with positive outcome, such association was not observed after adjusting for study sample size. CONCLUSIONS: The majority of FM-RCTs were industry-sponsored, and had at least one author with an FCOI. Reporting of key methodological measures was suboptimal. After adjusting for study sample size, no association of industry funding or author's FCOI with study outcome was seen.

Two cheers for physicians' conflicts of interest.

This paper will attempt to demonstrate that conflict of interest is an unavoidable feature of medical practice, medical institutions, medical publications, and medical research. It also seeks to show how and why current regulations are ineffective in curbing fraud and abuse. The paper goes on to argue that, in light of the incentives incorporated into current reimbursement arrangements, physicians have to learn how to manage the conflicts they face and keep true their fiduciary responsibility to patients.