Academic and professional conferences are important events in public health and nutrition calendars, offering participants the opportunity to interact and to develop the future agenda in the field and beyond, while allowing policymakers and practitioners to obtain up-to-date evidence that informs practice(Reference Fields, Stamatakis and Duggan1). Consequently, these events directly influence research, collaboration, policy and practice. With the rapid return of these events in the post-COVID-19 calendars, many events are now blended, offering online and in-person attendance, expanding reach and influence, and thus demanding evolving best practice in managing conflicts of interest.
Evidence from a broad range of fields suggests commercial entities seek to leverage events, specifically to promote information, viewpoints and scholars favourable to their commercial interests(Reference Miller and Harkins2), and to promote their products(Reference Ioannidis3). Past studies have shown they deploy ‘opinion-leaders’ – those able to influence their peers – paying up to $3000 for a single lecture at a conference, with talking points provided by the company(Reference Moynihan4). Studies also show companies find value in accompanying media and press releases seeing them as endorsements(Reference Baxendale, Macdonald and Wilson5), which give the impression that a position or product is promoted by an ‘expert source’ more widely(Reference DeBono and Harnish6). Studies of the tobacco industry identified instances where it sought to shape the narrative through conferences or, where it could not, engaged in media strategies to deflect attention from the public health messages these events contained(Reference Muggli and Hurt7,Reference Yerger and Malone8) . Research on the pharmaceutical industry identified billions spent by companies to interact with health professionals(Reference Fabbri, Santos and Mezinska9). Other research identifies that some companies, or the organisations they fund, hold conferences at prestigious institutions, with accompanying publicity using the institution’s name prominently, to imply endorsement, even though facility rental was the only connection(10).
An emerging body of evidence reveals that the food and beverage industries employ similar tactics(Reference Canella, Martins and Silva11–Reference Flint13), buying exhibits and advertising in conference materials, while underwriting food and beverage provision, providing gifts and giveaways, and offer awards and travel funding. This sponsorship not only influences what is presented and discussed, but what is not, with one Brazilian conference cancelling a debate on childhood obesity because of fears that it would deter sponsors(Reference Balmant and Saldaña14). However, researchers note that industry influence at public health and nutrition conferences is often not visible(Reference Matthes and Naderer15).
Here, we investigate the potential influence and intent to influence of The Coca-Cola Company (hereafter, ‘Coca-Cola) on public health institutions and organisations, associated conferences and events, and the researchers involved. We systematically evaluate a set of documents obtained through Freedom of Information (FOI) laws, in concert with Internet Archive materials, to analyse Coca-Cola’s involvement, and how the company works with the organisers and sponsored researchers.
Methods
Between July 2015 and 2018, US Right to Know (USRTK), a non-profit investigative public health group, made a series of FOI requests under state laws to public institutions in the USA, and under the Freedom of Information Act 2000 (FOI) to public institutions in the UK. The institutions were selected because their researchers either had acknowledged the receipt of corporate funding or were known to work with industry in their research. Subsequently, USRTK received twenty-two responses containing a total of 11 488 documents, including email threads and attachments from January 2012 to July 2018. The FOI document requests are listed in Appendix I.
The documents were initially reviewed by GR or his colleague Rebecca Morrison. Three other researchers then read the documents independently and manually, and JAG read and identified mentions of events in which public health researchers were invited to as academics and Coca-Cola was financially linked to, according to the information that was available in the emails and attachments. Coca-Cola’s influence was classified into three categories: (a) direct financial support to a conference or its organisers; (b) financing of non-profit bodies, which then sponsored events; or (c) financial support to the speakers, panellists and researchers for attending conferences. This categorisation was independently checked and validated by DS.
To validate the status of the sponsorship, and to check whether financial support from Coca-Cola was disclosed and reduce interpretive bias, we reviewed websites of the conferences identified, supplemented with searches of the Wayback Machine – an archive of websites which stores snapshots for future reference(Reference Archive16). We also used the website to determine whether the conference or event page overtly mentioned sponsorship, either of the whole event or part of it, by Coca-Cola.
Results
We identified 239 events, both public and private, in which the researchers mentioned in the FOI emails were invited to as academics, listed in Appendix II, with Coca-Cola funding 158 of them, either directly or indirectly. We found evidence that Coca-Cola funded ninety-eight conferences, twenty-one symposia, ten lecture rounds, fourteen private meetings, one workshop, three webinars, three seminars, three forums and three panel discussions.
Of the 158 events in our dataset supported by Coca-Cola, thirty-eight were related to obesity in general, thirty-four to physical activity, twenty-one to nutrition, twelve to collaboration between academia and private companies, nine to the use of sweeteners, six to paediatrics, five to Coca-Cola itself, three to diabetes and one on a soda consumption tax (see Appendix II).
Of the 158 events identified, twenty-eight involved Coca-Cola contributing funds directly to the organiser, seventy were funded by third parties that received funds from Coca-Cola and sixty involved Coca-Cola funding speakers directly. In nine cases, we found evidence that Coca-Cola supported both the conference organiser and the speakers directly.
In the twenty-eight cases where Coca-Cola contributed funds to conference organisers between 2009 and 2016, payments ranged from $2500 to $100 000 per event (Appendix III). However, our data on the range of funding is limited, as it is only based on six observations. Coca-Cola disclosed its support to many of these events on a special ‘Transparency List’ on the Company’s website in 2018. Coca-Cola has now removed the list from its website, but it can still be accessed by using the Wayback Machine(17). In many cases, Coca-Cola was an official sponsor and donated directly to the host organisation. For example, Coca-Cola agreed to be the keynote sponsor for the National Physical Activity Plan Congress in 2015, with a $30 000 payment, which allowed the company to influence the conference agenda by selecting a keynote speaker, as well as to advertise at the conference venue(18).
Coca-Cola paid a more active role in some conferences by being an official sponsor in addition to paying individual researchers to participate. This was the case for the International Convention on Science, Education and Medicine (ICSEMIS) in Glasgow in 2012, where the Company was listed as the main sponsor on the conference website(19). One email from a Coca-Cola representative explained to Dr Steven Blair, a professor in public health at the University of South Carolina, Coca-Cola’s plans to host a session at ICSEMIS:
[…] and myself have had a recent conference call to discuss the possibility of Coca Cola hosting a 2-hour Master Class at the ICSEMIS conference to teach physicians (GPs) how to motivate patients to be physically active as part of their health care. (18)
Coca-Cola also invited Blair to speak at this conference. In another email about ICSEMIS, Dr Rhona Applebaum, then Coca-Cola Chief Health and Science Officer, invites Blair to speak at one of Coca-Cola’s organised sessions, adding that:
Of course we will cover all expenses. (18)
In a following email, Blair accepted this offer. The same thing occurred when Coca-Cola was an official sponsor of the 2014 Nutritional Society of Australia’s Annual Conference and the European College of Sport Sciences Annual Congress the same year(20,21) . We found evidence that it funded both the event itself and expenses and honoraria for selected participants.
In our emails, Coca-Cola also acknowledges how important it is to amplify specific viewpoints among public health scientists, while it also admits using key opinion leaders to do amplify these viewpoints. After having accepted to speak at the Coca-Cola-funded 10th International Symposium on Body Composition, Dr Diana Thomas, a professor at Montclair State University, receives the following email from a Coca-Cola employee:
Many thanks for your collaboration. It is very important for us to amplify your scientific and health messages as Health Key Opinion Leaders. (18)
We note that in nine out of the fifty-eight events where Coca-Cola funded a speaker, Coca-Cola requests in their invitations for them to talk to the media(22). For example, Coca-Cola offered to pay $18 000 in travel expenses for a research team to participate in a symposium in South Africa in 2013(18). An email from a Coca-Cola employee to the head of the research team stated:
In terms of your visit to SA, we would like to ask if you and the ISCOLE team: […] would consider participating in media interviews/discussions regarding your research and also topics related to it. (22)
In another email sent a year earlier, Dr Applebaum sends the head of the same research group the following regarding an upcoming conference in Spain:
Do you want to speak to the media on Iscole? (22)
Coca-Cola paid the research team $15 000 in travel expenses for that conference(18).
A similar request followed in an invitation from Coca-Cola to Dr Hand to participate in a conference hosted by the South African Sports Medicine Association in 2015(22,23) . An email from Coca-Cola to Dr Hand includes the following:
We would also like to ask if possible, if you might be amenable to meeting with other stakeholders in the field of public health in SA and potentially also the media? (22)
This practice, found in several other cases, seems to be a part of a Coca-Cola strategy to promote the messaging of scientists whose views align with Coca-Cola interests(22).
Additionally, funding gave Coca-Cola opportunities to influence a programme. For the International Conference on Physical Activity and Public Health (ICPAPH) in 2012, a donation of $100 000 gave Coca-Cola opportunities to shape the conference schedule(18,24,Reference Wood, Ruskin and Sacks25) . An email from Dr Applebaum sent to a group of public health scientists states:
As you know – our sponsorships of ICPAPH allowed us two panels—which we had no part in designing other than suggesting a topic area. (18)
According to the programme, these topics were on sedentary behaviour and the future of physical activity policy and research(26).
Coca-Cola also supported sixty conferences indirectly, by funding other organisations. Although most of these organisations disclose their affiliation with Coca-Cola, the scale and nature of their relationship with the Company was not always clear. For example, the main sponsor of the ICPAPH in 2012 was the Beverage Institute for Health and Wellness, donating $100 000 (Appendix III). Coca-Cola set up this body in 2004 ‘to use evidence-based science to advance knowledge and understanding of beverages, beverage ingredients, and the important role that active healthy lifestyles play in supporting health and wellbeing’ and was headed at that time by Dr Rhona Applebaum, while she was still working for Coca-Cola(27).
We found several other instances of indirect funding to academic events through Coca-Cola-affiliated groups. One of these groups is called Exercise is Medicine (EIM), which was founded and funded by Coca-Cola but managed by the American College of Sports Medicine. Coca-Cola gave $968 000 to fund EIM between 2010 and 2015(17). Despite being ostensibly independent of the Company, our emails show that Coca-Cola could influence whether EIM was present at scientific conferences, as became evident in the World Congress of Cardiology Science in 2012, where Applebaum suggests an exhibition booth for EIM and offers support from Coca-Cola. In an email answering Dr Carl Lavie, a professor of cardiology at the University of Queensland, she responds to him tells her that EIM will host a lecture at the conference with:
This is great, I’m thinking EIM needs to have a presence here—somewhere Chip can direct folks to for more info. I’m thinking a booth in the exhibit area. Views? We can try to help here. (18)
Lavie responded positively to this suggestion in a following email. The close relationship between Coca-Cola and EIM was apparent in many ways. In addition to obtaining Coca-Cola’s help in arranging exhibition booths at academic events, EIM hosted international conferences in close collaboration with Coca-Cola and its initiatives. An example is the EIM World Congress in 2015, where Dr James Hill, a researcher at the University of Alabama, Birmingham, was invited as a keynote speaker by Dr Steven Blair, who was on the EIM advisory board at the time(28). In an email to Hill, Blair writes:
Jim Skinner and I would like for you to give the keynote lecture for the Exercise Is Medicine World Congress, and the topic would be ‘The Global Energy Balance Network’. (18)
Hill accepts this invitation in a following email. The Global Energy Balance Network (GEBN) was a Coca-Cola initiative, aimed at convincing public health professionals to emphasise physical inactivity, instead of sugary beverages, as a major cause of obesity(29,Reference Barlow, Serôdio and Ruskin30) . Both Hill and Blair were leaders of GEBN, which presented at multiple conferences hosted by EIM. In addition to the Network’s presence at the EIM World Congress in 2015, we found that Blair was invited as a speaker at another EIM conference hosted by the Royal Society of Medicine in London the same year. In an email answering the invitation, Blair writes:
Seriously, I will plan on focusing on energy balance and our Network. I also have new data from our Energy Balance Study. (18)
Just as with the GEBN, the Energy Balance Study (EBS) focused on physical inactivity as a major cause of obesity and was primarily funded by Coca-Cola. The Company disclosed its funding towards both initiatives on a list of its financial contributions on its website in 2018, showing a donation of $4·4 million to the EBS and $1 million to the GEBN. The list is no longer accessible on the Company’s website, but it can be accessed by using the Wayback Machine(17).
Notably, Coca-Cola has relationships with other non-profit organisations including the International Life Sciences Institute (ILSI), which was founded by former Coca-Cola Senior Vice President Alex Malaspina, and Coca-Cola also has funded ILSI. Previous research shows that ILSI has been an important vehicle for Coca-Cola to exert influence around the world, on policy, researchers, events, policymakers and practitioners, taking a role in promoting messaging that can further commercial interests(Reference McKee, Steele and Stuckler31–Reference Steele, Ruskin and Stuckler35). ILSI supported thirty of the events we identified. Sometimes, ILSI offered to act as a conduit to reimburse public health scientists through Coca-Cola by having them deliver presentations with selected topics. This was the case at the ILSI South Africa Risk Assessment Conference in 2014, where an ILSI employee wrote to a researcher at Imperial College London:
Hope all’s well with you? Are you free to speak at the above meeting, subject to us getting Coke to pay ? Topic would be ‘Food Additives and Risk Assessment’. (18)
However, the researcher turns down this offer in a following email. Coca-Cola invited researchers through ILSI at private stakeholder events as well. For example, ILSI invited Dr Russell Pate, a professor of public health at the University of South Carolina and then-Chair of the National Physical Activity Plan, which Coca-Cola has funded and is now a part of the Physical Activity Alliance, to attend a private forum in Colombia in 2014 stating(17,36) :
Dear Dr. Pate, My name is Olga Mora, Executive Director of the North-Andean International Life Science Institute, ILSI. As Alexandra Echeverria (Coca Cola Team) wrote you on Tuesday, July 29, we want to invite you as one of the academic speakers in a forum that will be held on September 4th, in Bogotá-Colombia…. (18)
Pate accepts this invitation in a following email. In other emails, ILSI employees explain that the forum was hosted by representatives of the private sector in Colombia and would be about the harms of a soda consumption tax(18).
The emails reveal Coca-Cola was also a founding member and an official sponsor of the EPODE International Network, an organisation supposedly aimed at tackling childhood obesity(37). EPODE hosted the Global Obesity Forum in 2012 and, according to our emails, Coca-Cola paid Dr Steven Blair $1877 to deliver his presentation(18).
Another example of Coca-Cola paying for a researcher through another organisation is the company’s endorsement for a researcher at Imperial College London who participated in a private meeting by the European Scientific Advisory Council (ESAC) in 2013. ESAC is a federation of European policymakers. Our emails indicate that the meeting was about low-calorie sweeteners. Coca-Cola offered to cover all travel expenses for the researcher as well as paying a participation fee through another agency, as can be seen in the following email from a Company employee:
Dear [BLANK], I didn’t have the pleasure of formally meeting you during the ESAC meeting but I am working with [BLANK] and [BLANK] on the low-calorie sweeteners project for The Coca-Cola Company. I’m reaching out to you with regard to the fees and expenses related to your participation in ESAC – wanted to let you know that payment for these will be made through our PR Agency… (18)
In addition to sponsoring organisations that were founded by Coca-Cola employees, Coca-Cola also often worked as a contact – an intermediary – between various public health institutions and scientists attending conferences. For example, the documents show Coca-Cola’s close collaboration with the American Academy of Pediatrics (AAP), the Academy of Nutrition and Dietetics (AND), The Institute for Excellence in Pediatrics (INEiP), The Obesity Society (TOS) and the American Academy of Family Physicians (AAFP). In one email, Applebaum writes to Dr Peter Katzmarzyk and Dr Timothy Church, professors at Louisiana State University, stating that she will try to arrange for them to give them a presentation at the AAP National Conference in 2014. Following up on that email, Applebaum writes:
As you know AAP is a great partner of ours… (18)
We could not, however, find mention of them in the conference programme, and therefore cannot be sure if they gave or did not give a presentation.
Similarly, we found evidence of Coca-Cola acting as an intermediary for AND by inviting a scientist to an academic event. In 2012, Joan Koelemay, the director of Health and Wellness programmes for Coca-Cola, writes the following email to Dr Joanne Slavin, a professor at the University of Minnesota:
Hi Dr. Slavin! By way of introduction, I am the director of Health & Wellness Programs for Coca-Cola […] I manage the professional meetings related to our health professional partnerships, including our support of the Academy of Nutrition and Dietetics – which is why I’m contacting you! We would like to invite you to speak at the Academy of Nutrition and Dietetic […] Nutrition News Forecast symposium… (18)
Slavin responds positively to this invitation in a following email. At the Nutrition News Forecast symposium, which was organised by the AND, Coca-Cola invited Slavin to speak at a Company-sponsored scientific event and put the media focus on the dangers of sugars in the diet ‘into [scientific] context’ (18).
Also, Coca-Cola invited Dr Gregory Hand, founding dean of the West Virginia University School of Public Health, to the same symposium in 2015, asking him to speak about GEBN(38). Emails show that Coca-Cola acts as a go-between with Hand and AND, receiving Hand’s presentation slides and forwarding them to the institution(18). In one email, Koelemay writes to Hand:
Good morning! So sorry to be a pest, but we do need to get a copy of Dr. Hand’s slides and his bio to AND in the next day or so. Please??? (18)
Coca-Cola reimbursed Hand for all of his expenses as well as providing him with a $1500 honorarium for presenting at that event(18).
Other emails also revealed the close partnership between Coca-Cola and AAFP. In one of them, L. Celeste Bottorff, then the Company’s Vice President of Health and Wellbeing Initiatives, wrote that she had:
A great relationship with the AAFP. (18)
Moreover, we also found that Coca-Cola had acted as an intermediary between the AAFP and public health researchers. At the AAFP Nutrition Theater in 2014, a Coca-Cola employee is a contact between Dr Hand, who was invited to speak at the event, and the AAFP. In an email to Hand shortly before the event, the Coca-Cola employee writes the following:
Hi Dr. Hand, As we are getting close to AAFP I wanted to share the final poster for your nutrition theater session. […] Finally, if at all possible, if you wouldn’t mind – can you share your presentation prior to the session? (18)
Additionally, we found two cases of public health organisations asking Coca-Cola to sponsor their conferences. In 2015, Dr Diana Thomas, a member of TOS, asks Susan Roberts, Director of Health and Nutrition at Coca-Cola, if it is able to sponsor a scientific session at their annual meeting(18):
I hate to talk to you regarding funding, but I’m the president of the Basic Science Section of TOS and they asked us to reach out to industry to ask for funding for the TOS BSS meeting next fall. (18)
Similarly, Russel Hale, a member of INEiP, sends Applebaum at Coca-Cola an email in 2015, asking for company funding(18):
I wanted to make contact early on this year to avoid the rush we had in 2014 to make sure the funding, speakers and even details such as the correct hotel used for Coca-Cola participants are put in place way ahead of time. (18)
In both these instances, Coca-Cola agreed to support the organisations by covering expenses for selected researchers at their conferences.
Additionally, we found sixty scientific events in which Coca-Cola-supported conference speakers by directly funding their participation, including through speaker fees and travel costs. We could not identify disclosure of this support in the conference programmes through internet searches. In nine out of those sixty conferences, Coca-Cola employees also asked the sponsored researchers to talk about their findings in media interviews(22). Most Coca-Cola speaker support related to two major studies on the causes of obesity: The International Study on Childhood Obesity, Lifestyle and the Environment (ISCOLE) and the Energy Balance Study (EBS)(22). Coca-Cola funded both studies, which focused on physical inactivity as a major cause of obesity.
Many researcher support arrangements were in the form of an honorarium. For example, Coca-Cola paid a public health researcher at Imperial College London for participating in the Panhellenic Diabetes Congress in Greece in 2013. According to an email from a Coca-Cola employee to the researcher, Coca-Cola was willing to pay for his presentation:
Apart from your honorarium (3000 euros) we have estimated an additional amount of 300 euros for transportation and other miscellaneous costs you may have had. (18)
At another conference in Greece, the 8th Diets Conference, organised by the European Federation of the Associations of Dieticians (EFAD) in 2014, Coca-Cola paid Hill to participate in a symposium by EFAD, by covering both his travel costs and accommodation, in addition to inviting Hill and his wife out for meals(18). In another email, the employee promised Hill not just full support for travel expenses, but also an honorarium and invitation to a dinner with Coca-Cola’s CEO:
Jim hello, Apologies for the delay! We are exchanging emails with Tim about the flight bookings and we will organise everything. Business class of course. The honoraria is fine and ISA will cover this entirely. […] Since the honoraria covers ISA but also some of the Coke activities, Coke will take care of all flights and accommodation costs. In terms of meeting with James Quincy, our CEO, and his leadership team, it seems that this will take place on Tuesday 14th, over a lovely dinner. (18)
The honorarium, which was $5000 according to another email, came from the International Sweeteners Association, a lobby group linked to Coca-Cola(18). We were unable to identify acceptance and transfer of funds in the emails received.
According to an email from Applebaum, the Company also provides different types of funding to researchers at public universities than those at private institutions. Before a 2015 conference hosted by the Chinese government and Coca-Cola, Applebaum reaches out to Dr Timothy Church, a professor of preventive medicine at Louisiana State University, to see if he could give a presentation there(39). When Church asks for an honorarium, Applebaum answers:
Depends—what are you? Private or Public? If private we can (but the bank is not very healthy; if public (e.g. LSU) will provide an unrestricted grant to your dept. (18)
The differences between Coca-Cola’s funding of public and private university scientists suggests that our set of emails may not be representative of Coca-Cola’s practices, as FOI legislation largely only applies to researchers at public universities in the UK and the USA.
Coca-Cola also invited scientists to closed forums for stakeholders to present results from company-funded research projects and discuss how to promote their scientific agenda. An example is the ‘Balancing the Debate’ symposium, which the Company hosted in its headquarters in Atlanta in 2012(18). According the invitation that Coca-Cola sent to a selected group of public health researchers, the theme of the symposium was ‘Coca-Cola’s Support of Evidence-Based Science, Systematic Reviews & Science Advocacy’. An invitation sent to Dr Gregory Hand, a professor of public health at West Virginia University, titled(38): ‘CONFIDENTIAL: Energy Balance – Internal Workshop. The Coca-Cola Company’, contained information on how the workshop would help promote a favourable narrative in public health, called Energy Balance:
We are planning to organize in Coca-Cola (Brussels), an internal session about Energy Balance […] We would like to know if you may be interested in to participate in this Workshop […] the workshop will provide an opportunity to increase the Coca-Cola EB strategy in: 1. Science […] 2. Business […] 3. Policy makers and Public Health… (18)
Notably, despite the emphasis that Coca-Cola places on media coverage of company-funded projects, we found one instance in our document set where Coca-Cola did not want to be associated with them. In 2012, Coca-Cola invited Dr Steven Blair to give a presentation on physical activity at a conference in Turkey. Although Coca-Cola wanted Blair to participate in a press conference after his talk, Isil Ulger, Coca-Cola’s Scientific Manager in Central Asia, explicitly stated that there would be no mention of Coca-Cola sponsorship at the event, according to one of our emails:
After our session we are trying to have a (media)press meeting with some members of Turkish health press. (Coke name, sponsorship will not be mentioned for sure!) (18)
Thus, by funding Blair, Coca-Cola was able to place a speaker at a conference to talk about a topic of their own choice and have his message conveyed by local media, without it being seen as a sponsored message. This was a notable exception.
Discussion
We found evidence of all three types of support in the documents: (1) funding conference organisers, (2) funding through non-profit organisations and (3) funding conference speakers privately. These different forms of support could result in numerous benefits for Coca-Cola. Coca-Cola often obtained advantages in exchange for funding like the opportunity to propose topics for keynotes, to suggest or place plenary speakers, and to undertake marketing. Other funding enabled lunchtime seating with conference VIPs and advertisement of their brand at the venue(18,40) . The effect of this industry involvement is to expose professionals to the brands and marketing of certain products, including ultra-processed foods and sugar-sweetened beverages, while also allowing the brands to build their image by affiliating with scientific and research communities(Reference Monteiro, Cannon and Moubarac41).
Where individuals lack knowledge about industry influence and conflicts of interest, events may therefore become a mechanism for industry to access and tacitly influence researchers, even hiring them, something particularly relevant to consider around early career individuals(Reference Marks42). The instances of funding through third parties suggest there may be researchers who find themselves in the situation of taking support and then, only subsequently, realising who they have taken it from, after a company attempts to or inputs into studies or other activities, or when introductions to prominent individuals from the corporate entity take place(Reference Steele, Ruskin and Stuckler35). Notably, this influence and the benefits for industry flow long after conferences themselves impacting on research agendas and collaborations, and with funding generating goodwill among researchers towards the company(Reference Ludwig and Nestle43). It is critical to research and understand such engagement of public health experts to amplify corporate messaging because credible and trusted experts may appear as neutral and informed and thereby influence policymakers, practitioners and the public at large, with medical doctors being especially trusted by the public(Reference Clemence44–Reference Fabbri, Lai and Grundy47). The failure to declare conflicts of interest and funding sources obscures corporate influence over what is said and to whom it is stated.
Furthermore, even if researchers are not influenced in practice, the involvement of the industry in these events risk the public and peers perceiving influence, potentially impacting trust and credibility of both of the research and the researcher’s professionalism and expertise(Reference Marks42). Education on conflicts of interest, and how to avoid them, is especially important considering the use of third parties funded by industry as conduits for travel funding. Also, with increasing pressure to find funding, particularly private support, placed on researchers and academics across the higher education sector in most countries, training on conflicts of interest is critical at the earliest stages of research careers.
Also, we are concerned about the linking of funding to the undertaking of media coverage. By pushing speakers towards the media, a company’s influence over science communication may be significant and therefore should be fully disclosed(Reference Miller and Harkins2). With online coverage not a common feature of conference, webinar content and press even has the capacity to spread worldwide, being present for many years on sites like YouTube. Concealed influence therefore matters as Coca-Cola has clear interests in spreading favourable conference content internationally, including content which runs counter to public health(Reference Sacks, Swinburn and Cameron48).
Conclusion
Coca-Cola has funded numerous professional conferences, events, activities, and stakeholder talks, both overtly and covertly. The documents we obtained show that Coca-Cola seeks to place favourable speakers and influence conference panels through direct funding and via third-party conduits. Public health organisations have sometimes abetted this process, often receiving financial support, either from Coca-Cola or Coca-Cola-funded organisations, for hosting conferences and other academic events. In so doing, the Coca-Cola may be able to influence conference agendas, including by choosing speakers, workshops and plenary speakers. This evidence corroborates other evidence that Coca-Cola attempts to cultivate relationship with leading public health organisations(Reference Nestle49,Reference Maani Hessari, Ruskin and McKee50) .
Study limitations
Before interpreting our findings further, we must note several important limitations. First, our study did not observe actual downstream impacts on population or whether such attempts to influence conference agendas succeeded in doing so. Second, as with all FOI studies, our document set is partial. It is impossible to ascertain whether FOI responses form a complete sample of communications between Coca-Cola and associated researchers. There is always a possibility that some relevant documents were not provided and/or withheld. Certain documents may be excluded in accordance with provisions in relevant legislation, and the research team may not have known these documents were redacted or removed prior to the relevant body providing the data in response to the request.
Second, it is impossible to capture the full universe of Coca-Cola-funded conferences, as we only detect those referenced in FOI-released email exchanges. Ideally, Coca-Cola would fully disclose conference activity. Yet as we found, often corporate funding is not disclosed in conference programmes.
Third, while we sought to retrace online records of historical conferences, the Wayback Machine was unable to retrieve information from all the academic events identified in the dataset. The Wayback Machine captures snapshot data on websites on a fixed date or set of dates, rather than indexing content and allowing for notation of changes. It is possible, therefore, that a website was updated after the indexation to note the sponsorship.
Fourth, as with all mixed-method research, there is the potential for bias in interpreting qualitative data. We report extracts as they appear in the agreements and quote any related emails ‘in their own words’ to allow readers to critically assess our interpretations. Also, members of the research team engaged reflexively and discussed all interpretations after an independent reading of the relevant documents, thereby encouraging the identification of continuities and discontinuities in the document batch. We sought to actively disconfirm interpretations and note that we were unable to do so.
Finally, our study was limited to Coca-Cola, but it is highly likely that other multinational food corporations also seek to exert influence on academic nutrition conferences and events. Future research is needed to extend this study to investigate potential food industry influence among different companies and at academic conferences.
Implications for research and policy
Notwithstanding these caveats, our findings have significance for public health policy and especially conference management. Our analysis demonstrates that the prominence of Coca-Cola as a funding source has been obscured in several leading conferences. This appears to be by design; individuals involved received guidance specifically not to mention Coca-Cola. We therefore observe that Coca-Cola-academic relationships, both financial and non-financial, are often not visible to attendees or the public. On multiple occasions, Coca-Cola supported and selected conference speakers without being listed as an official sponsor, and without researchers declaring how their participation was funded. Financing was difficult to track, and we identify instances where it was funnelled via affiliated non-profit organisations. For participants at conferences, it is impossible to differentiate information produced via industry ties.
Our research highlights the use of Coca-Cola’s ‘soft power’ to attempt to set the public health agenda on obesity and nutrition(Reference Lukes51). By sponsoring conferences, Coca-Cola can directly shape what is included and not included in conference proceedings. This is of tremendous value to the company. It can promote its own favoured solutions to obesity and public health nutrition more widely. It can also shape the narrative about what constitutes appropriate interventions. Participating in mainstream public health events can lend credibility to Coca-Cola itself and its messaging and create a platform for further media engagement. Coca-Cola often conditioned payments to researchers on engaging in media events that it organised in connection with the conference.
With a rapid return to events and conferences in the post-pandemic period, the implications are clear. There should be robust financial and conflict-of-interest disclosures for public health conferences, not only for the conference organisers, but also for speakers. Policymakers and institutions should insist upon researchers including declarations on their presentations, websites and research outputs that indicate potential influences on their work and all funding received not just across the project being discussed but more widely. Only by making transparent the full financial relationships between companies, researchers and institutions, the public, researchers and policymakers will be better able to fully understand influence and to interpret any bias in research outputs. Requiring researchers and institutions to highlight funding and relationships in outputs and in press activity is a critical step towards transparency.
Acknowledgements
Acknowledgements: The authors wish to recognise and thank Rebecca Morrison of US Right to Know for her contributions to this work. She designed and executed much of the research strategy to obtain the documents for this paper, and first read many of the documents as well. Authorship: The authors all made substantial contributions to the conception and design of the work; the analysis and interpretation of data; and the drafted work and revisions. All authors have approved the submitted version and agreed both to be personally accountable for their own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Ethics of human subject participation: Not applicable to studies using Freedom of Information requests.
Financial support:
This article was funded in part by a grant from the Laura and John Arnold Foundation. The sponsor had no input into: the study’s design; the collection, analysis, and interpretation of data; the writing and revision of this article; or in the decision to submit the article for publication.
Conflicts of interest:
J.A.G., D.S. and S.S. have no competing interests to declare. G.R. is executive director of US Right to Know, whose major donors have been: Organic Consumers Association ($1 007 500); Dr Bronner’s Family Foundation ($550 000); Laura and John Arnold Foundation ($392 600); US Small Business Administration ($119 970); Westreich Foundation ($110 000); Ceres Trust ($70 000); Schmidt Family Foundation ($53 800); Bluebell Foundation ($50 000); CrossFit Foundation ($50 000); Thousand Currents ($42 500); Community Foundation of Western North Carolina ($25 000); Panta Rhea Foundation ($20 000); California Office of the Small Business Advocate ($15 000); Pollinator Stewardship Council ($14 000); Swift Foundation ($10,000); ImpactAssets ReGen Fund ($10 000); Aurora Foundation ($5000); Janet Buck ($5000).
Appendix I List of FOI document requests, sorted by request date and corresponding time frame
Appendix II I List of scientific events identified in the dataset
Influence by Coca-Cola is classified into three categories:
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A = Direct financial contributions to conference organisers
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B = Indirect financial support through non-profit organisations
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C = Direct financial contributions to conference speakers
Appendix III List of events where Coca-Cola funded conference organisers
Open access
