Personal Reflections on Conflict of Interest

There is a scene in the film Alice’s Restaurant, one of those anti-war films from the Vietnam War era, where an overly zealous police officer brings “27 8X10 color glossy photos” of a minor crime scene (the unlawful dumping of garbage) to a court proceeding presided by a judge who turns out to be blind.  It is a tale of overstating the seriousness and engaging in too many steps to prove the crime.  The photos have no use to the judge, who then levies a $50 fine on the defendant.  We understand that the main characters here – the “criminal”, the judge and the police chief all play themselves in the film, which contributes to its ironic punch.  The film was built around a folk song about a “massacree” at this same “Alice’s Restaurant”, performed by Arlo Guthrie (the “criminal”), describing a Thanksgiving gathering with a bunch of bohemians in an abandoned church in small-town New England. 

The film and the song have been part of our annual Thanksgiving celebrations ever since, which is why it remains a memorable scene for us some fifty years later!   (It came out in 1969.) As Americans living abroad, we have maintained the tradition of a Thanksgiving feast even though we usually do it now on a Saturday rather than the Thursday of the US holiday.  It has been a pleasure to share this modified tradition – serving a big turkey with stuffing, cranberry sauce, sweet potatoes, green beans with mushrooms and French-fried onion rings and pumpkin pie – with our French neighbors and friends.

It is more the challenge of finding a big turkey rather than continuing the underlying tale of Alice’s Restaurant that has occupied the telling of anecdotes involving our expat Thanksgiving adventures over the years, but more can be said about that issue closer to our next Thanksgiving celebration.  Meanwhile, this particular musing is inspired by the phenomenon of too many bells and whistles in building the case against the private sector in engagement with non-state actors at the World Health Organization (WHO).

The Context

That does sound a bit stodgy.  Who really cares about the WHO and the private sector?  Well, this has been an important personal campaign of mine, in spite of my own love/hate relationship with “the private sector”.  My personal campaign has been driven by my personal belief that transparency and inclusiveness of good and bad guys is far better in hammering out an effective and enlightened public policy, whether on health or any other important social concern, than excluding any or all bad actors. It has been based on my belief that inclusive processes do produce constructive solutions based on a consensus and that a consensus is what makes it possible to implement these solutions credibly, legitimately and fully.  This is what participatory democracy is all about.

Of course, this runs contrary to the very premise that the WHO adopted a few years ago of excluding both the tobacco and arms industries from any public health deliberations.  Although my US-based experiences prior to coming to Geneva did include awkward interactions with these two sectors from time to time, I did come around to recognizing that certain activities may be so contrary to public health interests, with no saving grace about mitigating actions by those same actors, that they should be kept out of the picture.

I do admire the boldness of the likes of Dereck Yach, who was in the forefront of the WHO Framework Convention on Tobacco Control but who recently became the head of the newly established Foundation for a Smoke-Free World, funded by a tobacco company!  He has apparently concluded that even the bad tobacco companies are looking for ways to come up with products that are not damaging to health – at least one company, at least, and more likely a matter of coming up with products that might be “less damaging” to one’s health.  But that is his chosen path.

The overkill phenomenon in nutrition

Mine is to set that one aside and to focus instead on where the current political environment happens to be moving regrettably toward a broadening of this exclusionary philosophy. I am especially dismayed that this mentality has been picking up steam by directing the same exclusionary principle to other industries, like those in the food and beverage sector. Because of their manufacturing and selling of unhealthy processed foods and sugary drinks, food and beverage companies are being targeted by many in the public health world.

These same companies are essential for delivering healthy products, unless one wants to go completely local.  But even at the local level, food and beverages are things we buy. We all depend on the market unless we produce everything and enough of everything for our own consumption. I can confirm that I have met one or two highly self-sufficient farmers that could serve as a model for this, but I am personally not one of them.

Recent proposals from the WHO to develop guidance on conflict of interest in nutrition have built an elaborate set of rules and procedures, similar to the overkill of the sheriff in Alice’s Restaurant, to establish the “guilt” of companies that are trying to get away with their bad products – i.e. their “trash”.  Of course, Arlo Guthrie was found responsible for throwing away this trash, but he was duly fined for the act, not thrown into prison or some such.  The elaborate steps in the WHO guidelines are unrealistic to implement and conducive to an adversarial mentality rather than a receptivity to collaboration and mutual benefit.

What is more, these same commercial entities are being described by advocates of this WHO proposal as “interfering” with public health goals merely because they promote their own economic viability.  Maybe the critics of any inclusive approach for these industries think that one can distinguish between good and bad companies, but there is also an underlying hostility to commercial interests generally, as though the profit motive is inconsistent with a public health goal.

My personal campaign

One’s concern, therefore, should be with the overall idea that one should exclude anyone who is perceived to be “interfering” with public health goals (or civil liberties or social welfare or whatever) because their involvement has a commercial interest, regardless of whether there are good or bad outcomes of that particular entity’s commercial activities.  This is the focus of my personal campaign – to persuade the critics of engaging with the private sector that there are benefits to inclusiveness. These benefits include the capacity to regulate the private sector for the common good, as well as the opportunity to channel private sector resources for that same common good.

In the nutrition arena, we are undergoing a changing environment in search of healthier sustenance to eliminate under-nutrition as well as over-nutrition – and micronutrient deficiencies, too.  I see this in our personal lives as we become more attentive to the salt, fats and sugars in our food and beverages.  It may even require us to find a new menu for our Thanksgiving feasts in the future!  But we all need to be involved in making this happen, including the businesses and farms (who are, after all, businesses) and governments and NGOs and academics who can all help us to end both hunger and obesity!

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