Contagious Corporate Influence: Should the IFMSA partner with Pharma-Influenced organisations?
This is the third post of a blog series written by delegates to the International Federation of Medical Students’ Associations (IFMSA), March Meeting 2016 (MM16) in Malta. Stay tuned to this blog series to hear about Medsin’s work at the most recent General Assembly (GA)! For more information, email email@example.com, and join our Medsin International Facebook page!
At the IFMSA March Meeting 2016, the IFMSA formalised a relationship with the International Alliance of Patients’ Organisations (IAPO) through the creation of a Memorandum of Understanding (MoU). The IAPO has been known to support the positions of private industry in international fora, perhaps as a result of the large proportion of its budget that it receives from the Pharmaceutical Industry. In this blog, Matt Quinn explores the ethical implications of the IFMSA forging a relationship with potentially pharma-influenced organisations.
*Please note that the following represents the views of the author and not the official stance of Medsin-UK*:
Ethical Financing & Partnerships
Ethical financing is a core value of the IFMSA and many of its National Member Organisations (NMOs), including Medsin-UK. The Federation refuses to accept funding from industries which profit at the expense of public health, on the basis of strong evidence that accepting such funding generates an unacceptable conflict of interest when advocating on Global Health issues. A key example would be widening access to medicines, for which many of the most effective policies are opposed by the pharmaceutical industry.
Importantly, this rule does not apply to many of the organisations the IFMSA considers partners. This is fortunate as several, including the World Medical Association, accept large amounts of support from “unethical” sources. This arguably impacts on their ability to take strong stances on public health issues in which their funders have a vested interest.
At March Meeting 2016 the IFMSA Team of Officials proposed forming a new Memorandum of Understanding (MoU), or becoming a little bit more than just-friends, with the International Alliance of Patients’ Organisations. It was expected to be fairly straightforward agreement. After all, what could be more reasonable that a partnership between medical students and an organisation which claims to represent patients?
The plot thickens – Flawed Financing & Funky Statements
This is where things get shady. The IAPO Funding Transparency Document (2014) indicates that 82% of their funding is received from the Pharmaceutical Industry.1 Furthermore, 12% of their total budget comprised contributions from the Pharmaceutical Research and Manufacturers of America (PhRMA) a trade group representing the interests of the Pharmaceutical Industry in the United States of America. The IAPO Annual Financial Report 2014 also details that in the financial year ending 31 December 2014 IAPO received over GBP30000 from each of Amgen, Eli Lilly, GSK, Merck, Novartis, Pfizer and PhRMA.2
At March Meeting 2016 (MM16) Medsin-UK raised this issue, arguing that IAPO’s funding led to it voicing the views of its sponsors rather than the patients it claims to represent. We found that IAPO have made statements in the WHO in support of private interests, specifically in regard to the Framework of Engagement with Non-State Actors and in conflict with statements made by the IFMSA on the same topics.3
In addition, numerous publications 4,5 have outlined how the pharmaceutical industry “mobilised patient groups”, which they funded, to lobby against EU plans to force companies to publish secret documents on drug trials, which directly contravenes the statement passed at MM16 on Access to Medicines. Other reports have used IAPO as a case-study of unhealthy influence of industry over Civil Society.6
What did we do about it?
Medsin-UK, along with IFMSA-Spain, SISM-Italy, AMSA-Australia, and many others from a wide-variety of regions, lobbied hard to raise awareness about this issue throughout the March General Assembly of the IFMSA. These efforts culminated in a final statement made by the wonderful Natasha Matthews, Medsin Director of International Affairs, against the formation of an MoU until further evidence had been gathered on the implications of a partnership. While supported by over 20 other NMOs, the MoU was unfortunately pushed through in a confusing rush of voting – but not without the significant concession of reducing the length of the partnership from 3- to 1-years in duration, meaning it will be up for review at March Meeting 2017.
Peanut Butter Partnerships
One of the major arguments in favour of the IFMSA signing this MoU was the existing partnerships between IFMSA and other industry-funded organisations. This flaw in this argument was neatly described by one NMO like “if you’ve eaten peanut butter before and then realise you’re allergic it’s a really bad idea to keep eating peanut butter”. It’s a pretty simple rebuttal to what is essentially a sunk-cost fallacy.
It is of course vitally important that the IFMSA partner with patients’ organisations in order to support the most essential part of any healthcare system – the patients it serves. I had a chance to speak with Margaret Murphy, the external lead for the Patients for Patients Safety programme at the WHO, from which IAPO derives much of its official recognition. She pointed out that;
“If we believe the voice of patients is important for health, patients’ organisations should have ring-fenced funding from within government health budgets in order to ensure their independence and transparency. They should not have to rely on pharmaceutical industry support."
This is absolutely true. In order for organisations to have integrity they must have the ability to take positions representative of their members and not their funders. Patient groups are notoriously underfunded, and it is no fault of their own that they must rely on dubious sources of cash.
In our statement we called on the IFMSA to form a Working Group on Ethical Financing, and search for partners who exhibit ethical financing policies in line with our own.
Despair or be hopeful?
The IFMSA should be a leader in Global Health. As the representative voice of 1.2 million medical students it has a duty to use its voice to advocate for Global Health issue. The IFMSA is not a baby World Medical Association or a training ground for the World Health Organisation. It is an independent, civil society organisation which can make a difference if it chooses to be brave.
While it was still signed, albeit significantly weakened, this MoU united Medical Students from around the world in real debate on what it means to truly represent your membership, and provided a real insight into the flawed system in which many of us will be working in the future.
That being said, it was an amazing experience. The most valuable thing I gleaned was the real passion, humour and dedication to public health that I found in so many of our fellow delegates. It made me realise that, despite its flaws, the IFMSA is a powerful force for bringing together people who care about issues relevant to patients, systems, governance and health, and putting them in a position to enact tangible change. While, as with all large organisations, it has some flaws, this has got to be one of its greatest strengths.
(1) IAPO Funding Transparency Document (2014). Available at: https://www.iapo.org.uk/finances
(2) IAPO funding source https://www.iapo.org.uk/goldindustrypartnerpfizer