Conflicts of interest: moving towards zero tolerance

Harmful industries still exert their influence over health professionals, academia, and health systems; robust change is required, write Chris van Tulleken, Nigel Rollins, and Rebecca Coombes In the 1950s, smoking was proven beyond doubt to cause cancer and yet efforts to curb this pandemic were stalled over the next half century by a network of individuals and institutions with competing interests. The industry paid doctors, academics, charities, and policy makers to dilute and distort the science and public health messaging.1 By the 1980s, the largest tobacco companies bought the largest food companies2 and used the same methods to create a food environment where poor diet has overtaken tobacco as the leading cause of early death globally.3 Food and tobacco are just two of the industries that use their economic power to evade effective regulation; food, alcohol, pharmaceuticals, gambling, and fossil fuels, among others, have the same commercial incentives and obligations as the tobacco industry and directly impact human and planetary health. The World Health Organization (WHO) has defined these commercial determinants of health as “…private sector activities that affect people’s health, directly or indirectly, positively or negatively”. To varying degrees, all these industries fund and partner with those that would regulate them. From de facto regulators, including charities, press offices, health professional associations, academic departments, doctors, and influencers, to formal …