Coca-Cola’s secret influence on medical and science journalists.

A series of journalism conferences on obesity received covert funding from Coca-Cola.

 Paul Thacker investigates

Industry money was used to covertly influence journalists with the message that exercise is a bigger problem than sugar consumption in the obesity epidemic, documents obtained under freedom of information laws show. The documents detail how Coca-Cola funded journalism conferences at a US university in an attempt to create favourable press coverage of sugar sweetened drinks. When challenged about funding of the series of conferences, the academics involved weren’t forthcoming about industry involvement.

For drinks manufacturers such as Coca-Cola the idea that consuming their products is fine as long as you exercise—reinforced with expensive advertising campaigns associated with sport—has been an important one. As Yoni Freedhoff, assistant professor of medicine at the University of Ottawa, told The BMJ, “For Coca-Cola the ‘energy balance’ message has been a crucial one to cultivate, as its underlying inference is that, even for soda drinkers, obesity is more a consequence of inactivity than it is of regularly drinking liquid candy.”

The six figure bill for funding these journalism conferences was more than repaid in favourable press coverage, say critics. Documented evidence of the industry’s covert influence on the media is rare. In 2004, researchers examined secret documents made public during tobacco litigation. Attempting to derail the effect of the US Environmental Protection Agency’s 1993 report on secondhand smoke, the tobacco industry successfully placed stories in major print publications about the report’s “scientific weakness” to help “build considerable reasonable doubt . . . particularly among consumers,” the researchers wrote.1 They concluded that even journalists can fall victim to well orchestrated public relations efforts, regardless of the quality of the science used in these PR exercises.

Should healthcare professionals breach confidentiality when a patient is unfit to drive? 

While all are deeply sympathetic to the victims of road crashes, it is also important that we practice medicine that is evidence-based and supported by principles of public health. Among the many problems with mandatory reporting of medical conditions relevant to driving is the fact that it simply does not work, whether for epilepsy (1), dementia (2) or obstructive sleep apnoea (3) among other conditions. Indeed, there was less reporting of epilepsy in a state with a mandatory reporting regulation than in a state without one (1). The problem of lack of efficacy is compounded by the potential breach in clinician-patient relationship and trust, which may lead to avoidance of seeking treatment which reduce the risk to drivers and the general public.

The one condition for which further study might be helpful in considering mandatory reporting in terms of scale, relevance and major impact on road safety is that of alcohol and substance misuse and dependence. Worryingly, there is much less research in the biomedical literature on this topic (4), and due consideration would need to be given as to whether current guidelines of relatively long periods of driving cessation in many jurisdictions are appropriate in terms of ensuring congruence between mandatory reporting, effective treatment strategies and a due balance between safety and mobility.

Solutions to reducing the relatively modest impact (in public health terms) of other medical conditions on road safety include public campaigns to remind drivers of their responsibility for monitoring and maintaining their own health as well as following professional advice. This needs to be allied to stringent penalties for driving against appropriate professional advice, as occurred in this tragic case. In addition, it is of concern that traffic medicine occupies such a low or absent profile in medical school curricula (4), and it is important all doctors and related healthcare professionals attain a core competence in assessing medical fitness to drive within their scope of practice.

1. Drazkowski JF, Neiman ES, Sirven JI, McAbee GN, Noe KH. Frequency of physician counseling and attitudes toward driving motor vehicles in people with epilepsy: comparing a mandatory-reporting with a voluntary-reporting state. Epilepsy Behav. 2010 Sep;19(1):52-4.
2. Herrmann N, Rapoport MJ, Sambrook R, Hébert R, McCracken P, Robillard A; Canadian Outcomes Study in Dementia (COSID) Investigators.. Predictors of driving cessation in mild-to-moderate dementia. CMAJ. 2006 Sep 12;175(6):591-5.
3. Elgar NJ, Esterman AJ, Antic NA, Smith BJ. Self-Reporting by Unsafe Drivers Is, with Education, More Effective than Mandatory Reporting by Doctors. J Clin Sleep Med. 2016 Mar;12(3):293-9.
4. Mello MJ, Nirenberg TD, Lindquist D, Cullen HA, Woolard R. Physicians’ attitudes regarding reporting alcohol-impaired drivers. Subst Abus. 2003 Dec;24(4):233-42.
5. Hawley CA, Galbraith ND, deSouza VA. Medical education on fitness to drive: a survey of all UK medical schools. Postgrad Med J. 2008 Dec;84(998):635-8.