Attitudes and practices of public health academics towards research funding from for-profit organizations: cross-sectional survey

For-profit organization (FPO)-sponsored academic education, research, and practice have increased recently in parallel with dwindling alternative sources of funding, or because they are perceived to permit more innovation and translation (Nestle 2016; Fabbri et al. 2018). We use the term FPO to mean any national or international organization that sells consumer products related to food and beverages, tobacco, alcohol, and other organizations like pharmaceutical, gambling, arms dealing or manufacturing, health insurance companies, and the petroleum industry. The collaboration between research, science, academics, and FPOs has recently been a widely debated topic globally (Readon 2018; Marks 2019; Marten and Hawkins 2018; Dyer 2020).

The growing trend of FPO-funded university research has led to concerns about potential COI and biases in research methods, results, and interpretation. Industry-funded research tends to produce results favouring the benefits or reducing the harm of the sponsor’s products, as opposed to results produced by independent research (Nestle 2016; Bero et al. 2007; Lundh et al. 2017; Moynihan et al. 2019; Babor and Robaina 2013). FPOs have manipulated the research process on multiple levels including the design, results, and publication (Brandt 2012). Scoping and systematic reviews examining the influence of industry funding have found interference in the research agenda, the selection and framing of research priorities, and research questions, and in design and data analysis (Fabbri et al. 2018; McCambridge and Mialon 2018; Rasmussen et al. 2018). In response, Cochrane has recently proposed a more rigorous conflict of interest (COI) policy (Lundh et al. 2017; Soares-Weiser 2019). Despite this overwhelming evidence of industry interference in research, interactions between health researchers and FPOs remains common and often hidden. Recent scholarship also suggests that mere disclosures of COI should not be the priority for governing interactions, rather ‘sequestration’—elimination of the relationship, is necessary (Goldberg 2019).

Behaviours are influenced by attitudes. Despite different levels of awareness of the tactics of different industries (Collin et al. 2017), health stakeholders generally acknowledge the fundamental disconnect between the goals of industry (tobacco, alcohol, food) and of public health (Collin et al. 2017). Specifically to researchers, studies (including systematic reviews) indicate that—although industry-funded researchers acknowledge the potential for shifting agendas and risk to scientific integrity—they have less negative attitudes than those not funded by industry (Nestle 2016; Fabbri et al. 2018). Researchers who had more positive attitudes towards industry-funded research were more likely to accept industry funding (Fabbri et al. 2018).

Although research to date on attitudes of researchers to for-profit funded research has included health and public health research and researchers, the specific attitudes of public health academics have not been explored (Nakkash et al. 2016). COI and biases around FPO funding of research are particularly relevant when public health programmes, whose mission is to promote population health, receive funds from corporations whose products have negative public health implications. Our study aimed to assess attitudes and behaviours of public health academics globally towards receiving funding from FPOs for research, practice, and education.

Our study assessed the attitudes and behaviours of public health academics globally towards accepting funding for research and practice from FPOs. Research on this topic specifically focused on public health academics is still nascent (Nakkash et al. 2016). Overall, over half of our respondents were in favour of accepting this funding. This is concerning given that many of these FPOs market products that have negative health consequences; and given evidence that research funded by FPOs is biased in favour of the corporation’s products (Nestle 2016; Bero et al. 2007; Lundh et al. 2017; Moynihan et al. 2019; Babor and Robaina 2013). Research in the University of California system has found similar attitudes among academics generally (not specifically public health) (Lipton et al. 2004). However, a survey of health researchers, advocates, and policymakers in 40 countries found overwhelming agreement that there was a ‘conflict between industry objectives and public health objectives’ (Collin et al. 2017).

Our results further suggest that only region, gender, and % salary offset were significantly related to attitude towards accepting funds. In contrast, when asked whether industry sponsorship of research was necessary, respondents from medical institutions in both developing and developed countries overwhelmingly agreed (84%), with no differences between them (Abbas 2007).

Our respondents generally had more favourable attitudes towards accepting funding from certain FPOs over others, depending on their ‘product’, with alcohol, gambling, tobacco, and arms receiving the least favourable responses. Collin et al. (2017) similarly found stronger negative reactions towards partnership with alcohol and tobacco companies than food companies. Notwithstanding, these findings are of great concern given documented actions by all these FPOs to negatively impact health outcomes and to interfere with research. One of the key strategies employed by FPOs to influence policy and protect their interests is to influence research and the production of evidence (Fabbri et al. 2018), including challenging independently produced evidence, aiming to discredit the quality of the research, and the reputation of the researcher(s); and producing and disseminating irreproducible research (Savell et al. 2014, 2016; Petticrew et al. 2012).

Specific to certain ‘products’, responses of participants in our research to the three scenarios linked to pharma indicated refusal rates for funding from pharmaceuticals of at most 50% (scenarios 3, 10, 11). This, despite the fact that the pharmaceutical industry, currently facing multiple lawsuits due to their complicity in the opioid epidemic, has a history of interference in health research and policy (Sismondo 2008; Bero et al. 2007; Dyer 2020). The alcohol industry has successfully infiltrated government research bodies and established partnerships to bolster its influence (Readon 2018; Paixão and Mialon 2019); yet, less than half of our respondents stated that they would refuse funding from the alcohol industry (scenario 12). With regard to tobacco, although our respondents were most likely to refuse one of the tobacco-related scenarios (scenario 6), other such scenarios seemed to be seen as more acceptable (scenarios 13, 18). These scenarios differed on several of the features, e.g. nature of the funded activity, type of grant provider. The tobacco industry has stymied tobacco control efforts globally (Malone et al. 2017).

Despite these attitudes that seem somewhat accepting of funding from FPO, the majority of our respondents acknowledged that such funding leads to bias in multiple aspects of research. Our results also corroborate other studies of researcher perceptions of bias (Lipton et al. 2004). As a result of these perceptions of bias, almost all our respondents agreed that it would be useful to have university guidelines to govern receipt of these funds. Several such guidelines have been proposed (Cohen et al. 2009; Adams 2007). More recently, a recommendation has been made for the elimination of any research funding relationships with FPOs (Moynihan et al. 2019; Goldberg 2019).

Interestingly, exposure to research ethics education had no bearing at all on any of the outcomes described above (attitude, behaviour, and scenario response). Although our non-significant results could be related to the temporality of the questions around ethics (ever), and the response to the attitude and scenario questions (the present), as well as the behaviour (past 5 years), it remains concerning that exposure was unrelated to attitude or behaviour. This suggests that research ethics training may not necessarily create a more reflective researcher or practitioner. Evaluation research on the impact of ethics training suggested that, while knowledge gain was the most salient outcome, no or limited improvement in moral reasoning was demonstrated (Rosenbaum 2003; Schmaling and Blume 2009). One possible explanation for limited impact on attitudes and behaviours could be that ethics instruction may make people feel immune to risky behaviour (Antes et al. 2010). In fact, ethics training in some instances had unintended consequences and was harmful as students expressed inflated confidence in their problem-solving skills when it came to ethical issues (Kalichman 2013). Although none of these studies specifically tackled ethics of FPO funding, their results on the difficulty of changing attitude and behaviour are likely generalizable. It may be timely to review online and curricular research ethics course content and instructional method—to ensure adequate coverage of topics around governance, ethics, and COI in the interaction between public health research, practice, and policy and for-profit corporations, and enhance their capacity to influence attitudes and behaviours.

Finally, in our sample of surveyed public health professionals, almost 20% reported receiving funding from FPOs—usually pharmaceutical companies—in the past years, with males being more likely to have done so. Previous studies have reported a wider range reporting current funding from industry—17%–70%, depending on region and type of professional (Abbas 2007; Harman 2001; Blumenthal et al. 1986a, b). This topic is perceived to be sensitive and inflammatory which also may explain the wide range of responses across studies. Some of our respondents indicated that the results of their FPO funded research had been unfavourable to the funding organization, but most stated that the results were still published without delay. Rasmussen et al. (2018) found that only 33% of academic researchers indicated that they had the final say in the design of studies funded by FPOs, but did not report delays in publication or disagreements with funders.

Our study failed to obtain the representative sample intended from the five regions. In the Americas, we only focused on North America. Many universities in LMICs did not have websites, or when they did, did not include email addresses of their faculty members on the website, making the creation of a comprehensive sampling frame difficult. Also, for researchers that did receive the survey, very few—particularly from the global South—completed it, potentially due to the sensitive nature of these questions. We recognize that this limits the generalizability of the findings, but we believe our findings fill an important gap in the literature given the dearth of research in this topic area. A non-random sampling strategy was also necessary in other similar research (Collin et al. 2017). Moreover, despite this limitation, at least one person replied from 74 out of the 119 institutions that were included in our sampling frame. Future research should consider actively engaging associations of schools of public health in all regions where these exist, rather than only contacting the member institutions, as we did. This may provide ease of access, increased legitimacy, and response rates, but may bring its own biases. In addition, we used an online survey, which has been suggested as an alternative method to traditional surveying, though not without its own biases (Braithwaite et al. 2003).

These results of this study suggest the need for increasing dialogue in public health academia around the potential harms of research and practice funded by FPOs whose products have negative public health consequences. Recently, a global network entitled ‘Governance, Ethics, and COI in the interaction of industry and public health research, practice and policy (GECI-PH)’ has been established. It consists of over 80 academics, researchers, and practitioners committed to controlling FPO influence on public health. Our study further suggests the imperative for universities to develop policies on whether and how to accept such funds. Potential avenues for further research can include (1) conducting systematic reviews of the literature on the methods and/or effects of FPO influence on research and the production of evidence; (2) research on the usability of the research produced, and how users of such evidence—such as policymakers and practitioners—should assess its validity and susceptibility to bias—other than by using standard critical appraisal tools; (3) qualitative research with academic and non-academic (e.g. research councils) stakeholders, and in different geographical regions to gain their views and experience on this subject, and to further inform the areas for analyses; (4) evaluation of ethics training for its impact on attitudes and behaviours related to accepting funding from FPOs. Finally, we call on public health academic associations to develop specific public health degree education competencies to ensure awareness of the potential biases and concerns related to for-profit corporation interference in public health education, research, practice and policy; and endorsement of attitudes refusing such engagement.