IHPS Research Focus: Industry Influences on Health

A critical barrier to our ability to advance science and health safeguards is the influence of industry on science and regulatory policy. Research documents industries’ collective influence on science and public policies that can weaken laws and regulations to protect public health and thus contribute to adverse health and equity impacts.

Industry as the 21st Century Vector of Disease Partnership
UCSF's Program on Reproductive Health and the Environment (PRHE) directed by Tracey Woodruff, PhD, is exploring the creation of an academic hub for research, education and curriculum development, and communication about industry influence on science, policy, and health inequities. PHRE, is exploring this in collaboration with over a dozen faculty from all four UCSF Schools (Medicine, Nursing, Pharmacy, and Dentistry), four UCSF Institutes and Centers (Cardiovascular Research Institute, Institute for Health Policy Studies, Institute for Health & Aging, Hellen Diller Family Comprehensive Cancer Center), and the UCSF Library.

The "Industry as the 21st Century Vector of Disease Partnership” at UCSF will leverage UCSF's transdisciplinary expertise and the rich resources of the UCSF Industry Documents Library to connect researchers, public health, and community from different knowledge areas to identify, quantify, and analyze the impact of industry influence on health.

UCSF Industry Documents Library

Cristin Kearns, DDS, MBA, has built her academic career around investigating the commercial determinants of health. After discovering a cache of confidential sugar industry documents in a public archive, her document collection efforts culminated in the launch of the UCSF Food Industry Documents Archive (FIDA) in 2018, a collaboration between the Philip R. Lee Institute for Health Policy Studies and the UCSF Library. FIDA is part of the Industry Documents Library, a digital archive of documents created by industries which influence public health that is hosted by the UCSF Library. Dr. Kearns’ current research projects utilizing the FIDA include a National Institute of Dental and Craniofacial Research grant exploring sugar industry influence on the dental profession, a UCSF Nutrition and Obesity Research Center RAP grant exploring sugar industry influence on nutrition governance, and a California Breast Cancer Research Program grant that brings together a transdisciplinary team of UCSF experts and community activists to scope the UCSF Industry Documents Library for evidence of cross-industry strategies to influence science linking breast cancer to environmental exposures. Dr. Kearns also leads the commercial determinants sub-group of the Lancet Commission on Global Oral Health

Inorganic Dust Trades and Autoimmune Disease Risk

Occupational exposures have a well-established association with rheumatoid arthritis (RA) and autoimmune diseases. Work-related exposure to silica, in particular, has been linked to RA, as well as to other autoimmune diseases. Traditional silica sources have included silica in abrasives, including abrasive blasting, quarrying and stone cutting, and foundry work and, more recently, heavy silica exposure in artificial stone fabricating has been identified to carry risk of disease. 

Gabriela Schmajuk, MD, Ed Yelin, PhD and their colleagues have recently studied coal mining-associated risk of rheumatoid arthritis (RA). In a recent paper they observed a strong association between coal mining and other silica-exposing dusty trades and RA, finding the odds of RA increase with higher intensity and longer duration of likely silica exposure in coal mining.

Schmajuk along with colleagues, also conducted the first study of dusty military occupations, where inorganic dust exposure had occurred. They found the exposure was associated with increased odds of rheumatoid arthritis, sclerosis, vasculitis, or inflammatory myositis. (paper here)

Schmajuk, Yelin and colleagues find that clinicians and insurers should consider occupational histories in the aetiology of RA.

Opioid and Cannabis Industry Practices

Dorie Apollonio, PhD and colleagues explore the detrimental health effects of the opioid and cannabis industry practices. In a recent paper looking at the effect of this lobbying and information campaign on veterans, Apollonio and colleagues reviewed internal pharmaceutical industry documents released in legal discovery to determine how companies targeted these groups to increase prescribing and sales. All documents in the archive were reviewed to identify how opioid manufacturers targeted specific groups to increase sales, and analyze corporate goals and plans identified through internal emails, sales pitches, and presentations. These policy and advertising campaigns focused on (a) lobbying policymakers, (b) unbranded campaigns, and (c) promoting opioid use in research and the popular media. Opioid manufacturers claimed that opioids could resolve preexisting concerns identified among military veterans and older adults, and that the use of opioids would improve quality of life. These campaigns were positioned as public health initiatives and efforts to increase disease awareness.

Apollonio and colleagues are also looking at the cannabis industry, which has an interest in creating a regulatory environment which maximizes profits at the cost of public health, similar to the tobacco, alcohol, and food industries. A recent study sought to describe the cannabis industry's lobbying activities in the Colorado State Legislature over time. The cannabis industry dedicated significant resources towards lobbying the Colorado State Legislature on behalf of policies intended to increase cannabis use. 

Apollonio urge creating transparency about the relationships between the cannabis industry, related industries, and policymakers to ensure appropriate regulation of cannabis products.

Chemical Exposure and Obesity

Robert Lustig, MD has a recent paper about chemical exposure and obesity. The prevailing view is that obesity results from an imbalance between energy intake and expenditure caused by overeating and insufficient exercise. Rather, stig and colleagues describe obesogens as environmental chemicals that act as endocrine disruptors affecting metabolic endpoints. The obesogen hypothesis posits that exposure to endocrine disruptors and other chemicals can alter the development and function of the adipose tissue, liver, pancreas, gastrointestinal tract, and brain, thus changing the set point for control of metabolism. The most sensitive time for obesogen action is in utero and early childhood, in part via epigenetic programming that can be transmitted to future generations. This paper provides evidence supporting the obesogen hypothesis, and highlights knowledge gaps that have prevented widespread acceptance as a contributor to the obesity pandemic. Critically, the obesogen hypothesis changes the narrative from curing obesity to preventing obesity. 

World Bank Health Tax Training for Policymakers

The World Bank has recently launched a series of consultations and webinars on health taxes aimed at Ministry of Finance and Health policymakers. This utilizes the Joint Learning Network of peer learning for policymakers in low- and middle-income countries to work towards fiscal solutions to health. Based on Laura Schmidt, PhD’s research on the food and beverage industry globally, including work in the FIDA, she has been participating in the network to educate these policymakers at the country level on how to anticipate and overcome opposition from business and industry to food and beverage taxation.

Youth Empowerment via Arts

Dean Schillinger MD co-directs an ongoing public health communication initiative with Youth Speaks whose objectives include raising awareness about and motivating action to reverse the food and beverage industry’s discriminatory behaviors and resultant health disparities. Through the intersection of arts education and youth development practices, public narrative strategies, and high-quality artistic presentation, Youth Speaks creates safe spaces that challenge youth to develop and apply their voices as creators of just and inclusive futures. In 2012, The Bigger Picture (TBP) project was launched in partnership with the UCSF Center for Vulnerable Populations (CVP). Using spoken-word poetry and a youth leadership model as a public health communication intervention, TBP informs and instigates social action regarding the environmental inequities driving the Type-2 diabetes epidemic in California’s youth. Through digital media, public health education, and dynamic live presentations, the campaign prepares youth to be at the center of the critical public health conversation about sweet-sugary beverage consumption, diabetes epidemic, and exploitative marketing tactics, and to act in capacities as civic-minded, cultural changemakers. A school-based version of the campaign is being considered for a City of Oakland initiative funded by the city’s sugary beverage tax.