‘Once you are dancing with the devil, the prettiest “footwork” won't help you.’ Thirty years ago the British tobacco industry set up a health promotion research trust which offered substantial research funding—but specifically prohibited tobacco-related studies. Although government-endorsed, the approach was loudly and soundly condemned by leading journals and professional associations for distorting research proprieties and creating a supportive environment for Big Tobacco (Chapman, 1987). After several board resignations and funds being returned by researchers, the trust was wound up but not after millions of pounds had been spent on supposed ‘health promotion’ research. Spurred on by this and related events many health organizations, research institutes and universities from around the world introduced policies that specifically forbade accepting funding directly from the tobacco industry for research, sponsorship and other purposes. Support from hypothecated taxation of tobacco products was excluded as it was considered to beat ‘arm's length’, in that the industry could not control the use of the funding. Similar to the concerns raised about tobacco sponsorship of research in the 1980s, a growing number of independent researchers and health professionals are becoming vocal about recent tactics of the alcohol and gambling industries and their attempts to influence health research. This paper outlines the key arguments for policies proscribing funding, partnerships or other arrangements with the gambling and alcohol industries. Alcohol is now recognized as one of the four major common risk factors for non-communicable diseases, along with tobacco, diet and lack of physical exercise. The World Health Organization and the International Agency for Research on Cancer (IARC) found that ‘alcoholic beverages are carcinogenic to humans’, within the highest classification of causality (IARC, 1988). The list of cancers impacted by alcohol now includes breast and colorectal cancer as well as oral cavity, pharynx, larynx, oesophagus and liver (Baan et al., 2007). The effects of alcohol consumption go beyond diseases, accidents and injuries to a range of adverse social consequences, both for the drinker and for the wider community. These include alcohol-related assault, family violence and child abuse as well as mental health harms such as depression, anxiety and suicide. Gambling is also recognized as both a public health and a mental health issue. Over half of problem gamblers experience depression, suicidal ideation, anxiety and higher levels of substance abuse. The adverse community impacts of gambling include crime, family break up, financial ruin, bankruptcy, suicide and self-harm (Productivity Commission, 2010). What families and communities see as ‘problem gamblers’ the gambling industry sees as their best customers. Australian data confirm ‘the bulk of gaming revenue is from regular gamblers’ (Productivity Commission, 2010). Around 15% of regular players are problem gamblers, who contribute about 40% of revenue/losses. As a consequence, community opposition to gambling is high. Alcohol use substantially increases the risk of gambling and explains why drinks are often cheaper or free at gambling venues. There is diminished decision-making capacity after two drinks, and this reduces further with increased alcohol dose. The alcohol industry has an undistinguished track record that includes opposition to the introduction of random breath testing and minimum blood alcohol levels for driving, as identified in the Phillip Morris legacy documents (Bond et al., 2009). In the early 1990s, the Australian alcohol industry also opposed alcoholic drink labelling to allow consumers to monitor their alcohol intake (Jones and Gregory, 2009). More recently, we have seen the production of: At the same time, the industry spends <1.25% of its advertising budget encouraging drinkers to drink responsibly. alcopops—spirits-based drinks designed to appeal to the taste of very young people, and now the drink most preferred by people under the age of 16; low carb beers—which have increased consumption and falsely purport to be more healthy than regular beer; alcopops casks—which deliver a standard drink for under $1 to young drinkers; and, most recently, alcoholic energy drinks on tap—where licensees can adjust the caffeine content according to their own whim and unknown to patrons. Leaked documents have shown that problem gamblers are enticed by loyalty reward schemes and that gambling-related industries deliberately target their ‘best customers’. These are women from whom up to two-thirds of revenue is obtained (Doughney, 2007). A gambling industry focused primarily on profit maximization compromises its commitment to consumer protection and the precautionary principle of a public health approach to the prevention of harms. The Productivity Commission reports (1999, 2010) confirmed the need for independent research on gambling. The ‘alcohol and gambling industry’ is in fact many different industries with elaborate chains of supply and interlocking, frequently transnational, commercial and political interests. The distinction between the alcohol industry, the gaming industry and the tobacco industry deny the reality of the multinational corporations which control these different industries (Miller and Kypri, 2009). For example, the largest shareholder of the world's second largest brewer and owner of Fosters brewing in Australia, SAB Miller, is the former Phillip Morris—now rebranded as Altria (Daube, 2012). The relationship between these industries is multi-layered and enduring. This was most clearly demonstrated in the ‘Legacy documents’ which were handed over by Phillip Morris as a part of a legal settlement in the USA (Bond et al., 2009). These documents demonstrated the systematic and brutal manner in which tobacco companies planned to manipulate science and public health policy through commissioning poor research, and befriending and hiring compliant researchers. The seized documents also mentioned Phillip Morris's plans to create similar initiatives for the alcohol industry up to 20 years ago, because the tobacco company was aware that the alcohol industry was going to face similar issues. Industry funds research in these ‘dangerous consumptions’ as a public relations tool, so that it can claim ‘corporate responsibility’. The research literature has clearly demonstrated that funding by tobacco, alcohol or gambling industries is primarily aimed at supporting their overall agenda of ineffective industry-friendly interventions, such as school education or TV advertising campaigns. In addition, they seek to muddy the water around interventions which have a sound evidence base, such as higher taxes on alcoholic beverages (Miller, 2008; Babor, 2009; Bond et al., 2009). Grant amounts are normally small and widely spread, and some specifically target early career researchers. They are in effect cheap forms of advertising. Both industries have a vested interest in normalizing consumption. For example, the gambling industry claims gambling is recreational or ‘entertainment’, thus diverting attention from the individual and societal costs of the predictable and known harms (Hancock, 2010). Researchers should be aware that research funded by the gambling or alcohol industries will be unlikely to gain publication in reputable journals. Research is likely to be seen as tainted and to address industry-friendly topics and perspectives, and as a consequence will invariably fail to pass stringent peer review. There is also a substantial reputational risk to organizations in accepting funds from ‘Big Booze and Big Bet’. In 2009, 58 of Australia's leading alcohol researchers signed a Letter to the Editor of the Medical Journal of Australia stating that they would not seek or accept alcohol industry-sponsored funding, in particular from DrinkWise (Miller et al., 2009). This action was prompted by the alcohol industry placing unprecedented pressure on the federal government to wind back the effective ‘alcopops tax’ and support industry-friendly but ineffective interventions such as media education campaigns. Organizations can, however, use funds derived from taxation of the alcohol and gambling industries under conditions of third-party independence. For example, several health promotion agencies are funded on this basis, but they still run the risk or ‘moral hazard’ of becoming dependent on these unhealthy behaviours as do the industries' customers themselves. The guiding principles for acceptance of such funds are: a contractual guarantee of the independence of the research; retention of intellectual property by the author; lack of censorship of research reports and that the industries do not gain any form of social capital or credibility through such funding arrangements. Like Big Tobacco, the global alcohol and gambling industries have moved beyond the boundaries of the traditional nation-state in their governance and accountabilities (Jernigan, 1997; Adams, 2004). The scale at which this is happening has gone largely unmapped, but its health effects are beyond doubt. Some authors argue that these industries have eroded the traditional global governance systems, and that in particular the gambling industry—through massive enterprises in cyberspace—contributes to the deterioration of democratic and social capital in many countries and regions (Adams, 2004, 2011). The pattern paints a bleak picture for the orthodox global health governance system, either through bilateral or through multilateral (WHO) collaboration, to effectively act on these challenges. Although the action in the area of trade and global intellectual property rights may redress some of the issues and their impact on health and disease (Labonté et al., 2011), some authors (e.g. Bartsch and Kohlmorgen, 2007; Townsend et al., 2012) argue that a new architecture for global health governance in the face of the cynical powers of industry should rely more profoundly on civil society than on the nation-state. Activist scholarship, an ethical international peer-reviewed scholarly press, and empowered communities, play critical roles in this new global health governance architecture. So, health researchers and health promoters beware. Funding received directly from the alcohol and gambling industries for research and other purposes is likely to: Receiving alcohol and gambling funding is particularly compromising for health and social agencies, sport and fitness organisations, universities and research groups. The time has come for those values-based organizations that already have agreed not to accept funding from Big Tobacco to extend this to Big Booze and Big Bet. And for those who have not done so—to do the same. compromise the objectivity and independence of the research and the maintenance of integrity and standards by creating a conflict of interest for researchers; foster poor quality or compromised research which may then produce biased and erroneous results favourable to the interests of these industries; create a dependence on this form of research funding which may then inhibit other independent research and inquiry; reduce the ability of researchers to publish the outcomes of research in reputable, high-quality journals which may have policies which preclude industry-funded research; restrict groups from receiving other funding from reputable funding bodies, which will then damage and restrict growth of research performance; indicate to the public, professional groups, and government—by associating with these industries—that organization endorses the activities and products of these industries; create a more favourable climate for these industries so that regulators will not need to enforce or further restrict the promotion of alcohol and gambling to youth and vulnerable people; compromise the organization's reputation, mission, core commitments and values. Reputable health-funding agencies also have a responsibility to consider whether they should support researchers and practitioners who have an unduly close relationship with the alcohol and gambling industries. Finally, I call on all health-related journals to request details of any financial or other support that their prospective authors may have received directly or indirectly from the alcohol and gambling industries. In considering such papers, editors should ensure the highest quality scrutiny and peer review process. On the rare occasions when publication is considered appropriate, full disclosure of the financial and other support should be provided, as well as the opportunity for others to comment. Health Promotion International will lead by example.
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John Catford (2012) studied this question.
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