Study: Coca-Cola Doesn't 'Walk Its Talk' On Research Independence

The Coca-Cola Company may be exerting undue influence over public health studies that it funds at universities and other institutions, according to an analysis published Tuesday in the Journal of Public Health Policy.

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"We found evidence that in at least one study Coca-Cola discontinued funding, seemingly without reason given to those involved, but found no evidence that this related to unfavorable findings or prospective publications," wrote Sarah Steele, DPhil, PhD, of the Department of Politics and International Studies at the University of Cambridge in England, and colleagues. "We did find evidence suggesting that Coca-Cola exerts influence on the design, conduct, and write-up of studies, retaining rights to comment and have input throughout the research process."

In the study, the U.S. Right to Know organization -- which is co-directed by study co-author Gary Ruskin -- filed 129 Freedom of Information Act requests to governmental bodies in the U.S., Australia, Great Britain, Canada, and Denmark related to Coca-Cola's links with public health actors, including academics.

Steele's team said they chose Coca-Cola because the company announced an explicit set of principles that it says it began following in 2016 in all of its funded research. However, an examination of the contracts it actually signed with those independent researchers revealed language that violated many of those same principles, the investigators concluded.

Walking the Talk

The principles that the company referred to -- and the ones the researchers focused on -- included the following guidelines stating that study investigators:

• Were "expected to conduct research that is factual, transparent and designed objectively"

• Would have "full control of the study design, the execution and the collection, analysis and interpretation of the data"

• Were "encouraged to publish"

• Were "expected to disclose their funding sources in all publications and public presentations of the data"

The principles also noted that funding from the Coca-Cola Company was not "conditioned on the outcome of the research" and that the company did not "have the right to prevent the publication of research results."

"We found that Coca-Cola did not walk its talk. There's no question about that," Ruskin told MedPage Today.

For example, although Coca-Cola claims to encourage researchers to publish and says that Coca-Cola does not have the right to prevent the publication of research results, "Coca-Cola retained varied rights throughout the research process, including the power to terminate studies early without giving reasons," he said.

In another example, many of the contract agreements it signed with researchers restricted publication following the termination of an agreement or study. One agreement said that the publication of an article in a peer-reviewed journal "must be approved in writing by both parties prior to such publication."

"The results of this paper show that in the realm of public health, Coca-Cola funds work that looks like science but is really public relations," Ruskin said.

"This is unsurprising, because Coca-Cola is a master of public relations and has been so for more than a century," he said. "Their efforts in science are just one more facet of their sophisticated, public relations effort to protect and expand their profits and to escape accountability and liability for their role in the global obesity epidemic."

Favorable Contract Terms

The authors emphasized that they have no evidence that Coca-Cola directly influenced publication of incorrect or misleading findings from a study. But in one case involving a contract with the University of South Carolina, Coca-Cola allegedly terminated the project with no reason.

Coca-Cola "plainly does interfere with researchers' ability to publish, and in fact we found one case where research was terminated and the researchers didn't even know why," said Ruskin. "It was just over." That was a University of South Carolina "Active Healthy Living Incentive Program" the company had agreed to fund, in which "Coca-Cola just stopped communicating with them and that was it," he said, adding that "the researchers were mystified."

Coca-Cola is probably not alone in its success in influencing favorable contract terms, he continued. "The contracts that we have reviewed are not much out of line with other research contracts that we have seen."

The University of South Carolina did not respond to requests for comment about its contract with Coca-Cola.

Other universities mentioned in the study included:

The University of Toronto (U of T). In 2013, the university signed a contract with Coca-Cola for $45,000 to support research into the effect of fructose-containing sugars on cardiometabolic risks, according to documents cited by the study. The principal investigator, John Sievenpiper, MD, PhD, initially objected to some elements of the contract involving disclosure and publication, including a provision that stated, "U of T will afford TCCC [The Coca-Cola Company] the prior right to review and approve (or reject) any communication or other material developed by U of T or its employees, contractors or agents discussing this Agreement or ... the related work or accomplishments of U of T and/or TCCC ... U of T or its employees, contractors or agents will not have the right to publish or otherwise disclose any such communications or materials to any third party(ies) unless TCCC provides its approval in writing."

That provision was removed. "I expressed concerns about the original agreement, and they were amenable to changing the wording to ensure it was an unrestricted grant," Sievenpiper said in an email to MedPage Today, noting that "Coca-Cola was not involved in the design, conduct, analysis, interpretation or the decision to publish any of our research."

Louisiana State University. The university's Pennington Biomedical Research Center (PBRC) signed a contract with Coca-Cola in 2010 for $1 million to "plan and design an international collaborative study on physical activity and obesity in childhood." The contract contained a review clause stating, "Each Party agrees to submit to the other Party, for review, the draft of any proposed oral or written disclosure of the results at least sixty (60) days in advance of any disclosure of such. The Party preparing such disclosure shall consider any suggestions from the other Party concerning the disclosure, but is not bound to incorporate such suggestions in any oral or written publications."

Another clause stated that "PBRC agrees that if [the] Sponsor so requests, and only if [the] Sponsor requests, substantive releases and/or written reports contemplated by this Article may include language to the effect that 'The study was funded by Coca-Cola.'" PBRC also signed another contract with Coca-Cola in 2012 for $268,000 to study whether carbohydrate-electrolyte beverage intake promotes fluid balance during exercise in the heat compared with water or placebo intake.

Asked to comment on the contracts, the PBRC sent a statement issued in 2016 saying that "Our partners in research include a variety of governmental and private sponsors, which is standard protocol with our peer academic research institutions around the world. Results of our research are published in leading peer-reviewed scientific journals, whether the outcome is favorable to the sponsor or not. We also disclose funding sources and potential conflicts of interest in published papers and press releases."

The University of Washington. In 2015, the University of Washington received a "restricted gift" of $25,000 "to support activities related to the implementation and analyses of National Nutrition and Health Surveys." University of Washington spokesman Victor Balta said in an email to MedPage Today that the gift agreement -- which he said was incorrectly characterized as a "study" in the paper by Steele and Ruskin -- didn't allow Coca-Cola to exercise any control over the conduct of the study, or influence its results.

Call for Better Disclosure

Ruskin called for a universal change in disclosure requirements "so that when authors present corporate-funded papers, there is disclosure of the research agreement so that we can see the extent of the funders' influences on papers."

Ruskin added that with this Journal of Public Health Policy paper, the authors are asking for changes in the way that all medical and public health study funding is disclosed. "Corporate funders are so crafty, there appears to be ways that they are influencing papers that have not been previously discussed and addressed before. That's a much bigger thing than just Coca-Cola," Ruskin said.

In response to a query from MedPage Today, Coca-Cola issued the following statement regarding the way the company funds health research: "The Coca-Cola Company does not conduct its own research on topics related to health and well-being. Rather, we support research efforts by independent and respected research institutions and universities. Under our guidelines, we provide financial support for such research only if a non-Coca-Cola entity funds at least 50% of the cost." Several of the contracts mentioned in the study -- all of which were signed before the 2016 principles came out -- do not list any other sponsors.

In an email, a company spokesperson also referred MedPage Today to Coca-Cola's transparency page, which lists its partnerships and research grants dating back to 2009. "Research funded by The Coca-Cola Company and disclosed on our site is expected to be conducted in accordance with our publicly stated approach to funding scientific research, including the fact that we do not have the right to prevent the publication of research results nor do we provide funding conditioned on the outcome of the research," the spokesperson wrote.

Coca-Cola-funded research efforts and policies have recently been on the hot seat. In January, an article in The Milbank Quarterly, written by Ruskin and others detailed numerous attempts by Coca-Cola to lobby the CDC to "advance corporate objectives rather than health" and "to shift attention and blame away from sugar-sweetened beverages."

In 2015, a New York Times article explored how Coca-Cola provided financial and logistical support to a nonprofit group called Global Energy Balance Network to promote the argument that overweight Americans should worry more about how little exercise they get and less about what they eat and drink. Experts called the campaign an effort to deflect attention away from sugary drinks in the epidemic of type 2 diabetes and obesity.

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