ADA industry ties - "conspiracy" my ass

http://www.nytimes.com/2006/11/25/health/25ada.html?_r=2&hp&ex=1164517200&en=1&oref=slogin&oref=slogin

November 25, 2006
In Diabetes Fight, Raising Cash and Keeping Trust
By MARC SANTORA
SnackWell's Sugar-Free Lemon Creme cookies have nearly as many
calories as some sugar-rich cookies. Yet until recently the box
featured an American Diabetes Association logo, advertising the cookie
as a "proud sponsor" of the charity's efforts on behalf of the
nation's 21 million diabetics.

Foods like the Sugar-Freedom Eskimo Pie and Frosted Shredded Wheat have
also sported the American Diabetes Association logo over the years. The
companies paid the A.D.A. to be associated with a respected voice for
healthful eating. The association wanted the money to finance its
uphill battle against a widening epidemic of Type 2 diabetes, which is
associated with obesity.

But in the last year the A.D.A. began rethinking how it raises money
from companies, especially from those whose primary business is selling
foods and beverages that are high in calories, even if they have
created some sugar-free items.

The group has allowed some food company deals to expire and has turned
down millions of dollars in new sponsorships.

Many public health charities, from the American Heart Association to
the Lupus Foundation of America, raise money from businesses. But for
the A.D.A., and some other charities, the effort has increasingly
become an exercise in balancing the need to raise money with core
matters of conscience.

"We tightened things up," Dr. Richard Kahn, a top A.D.A. executive,
said of the association's new guidelines for corporate fund-raising,
"because we were beginning to be bombarded by all kinds of food
companies selling all kinds of products with requests to be a 'proud
sponsor' or to advertise."

Some consumer and food activists say the guidelines, while good, do not
go far enough.

They say the A.D.A. remains too wedded to benefactors in the food and
pharmaceutical industries, who provided more than $23 million last
year.

Of particular concern: a three-year, $1.5 million sponsorship deal with
Cadbury-Schweppes, the world's largest confectioner. Under the deal,
which meets the new guidelines, Cadbury is promoted as an A.D.A.
sponsor in several settings, and has permission to use the A.D.A. logo
on its Diet-Rite sodas, Snapple unsweetened tea and Mott's Apple
Sauce, among other products.

Critics say the A.D.A. affiliation has helped Cadbury pose as a
concerned corporate citizen, even as it supplies grocery stores with
sugary and fattening foods like Dr Pepper and the Cadbury Creme Egg.

"Maybe the American Diabetes Association should rename itself the
American Junk Food Association," said Gary Ruskin, director of
Commercial Alert, a consumer advocacy group.

Others remain concerned about the A.D.A.'s relationships with
pharmaceutical companies. Their presence is evident throughout the
charity, from its annual convention, which is largely underwritten by
drug makers, to its board meetings, where pharmaceutical executives
have served on the volunteer committees that set policy.

The A.D.A. says its independence is evident because it has often acted
against the interests of the pharmaceutical industry. Last month, for
example, a panel it appointed to study how to treat people at
heightened risk of developing diabetes decided against recommending the
use of higher-priced brand-name drugs.

But critics say the drug industry's influence can be seen in the
A.D.A.'s emphasis on the treatment of diabetics, which often involves
drug therapy, over efforts to persuade people to change the way they
live so that the disease can be prevented in the first place.

"I'm glad the A.D.A. finally took its logos off of sugary
cereals," said Marion Nestle, a professor of nutrition and food
studies at New York University. "Nevertheless, the A.D.A. still needs
to pay more attention to prevention. Right now, it puts way more
resources into treatment."

Companies say they give to the A.D.A. because they share the goal of
helping people lead healthier lives. Drug makers say their products
work hand in hand with A.D.A. efforts to better treat diabetics. Food
company executives say they hope to give consumers greater choice by
drawing attention to new, healthier products, which are increasingly
popular.

The A.D.A., more than many other charities, already has a tough time
raising money. Type 2 diabetics, frequently old and overweight and
judged by some as partly responsible for their own plight, do not
generate as much sympathy, or contributions, as many other sick people.

Faced with financial pressures, A.D.A. officials say they try to focus
on practical solutions, like treatment options, more than lifestyle
modifications. It is not favoritism toward pharmaceutical companies, as
some suggest, Dr. Kahn said. It is skepticism toward the notion that
many Type 2 diabetics have the discipline to eat less and exercise
more.

"Ninety percent of the people out there still can't lose 10 percent
of their body weight and keep it off for four years," he said.
Nonetheless, he said, the A.D.A. will continue education efforts to
reverse the tide of obesity.

With the emergence of Type 2 diabetes as the nation's fastest growing
health problem, increasing by 80 percent in the last decade, this is an
important time for the A.D.A. The 66-year-old charity, based in
Alexandria, Va., is the primary coordinator for the national response
to the disease and directs much of the lobbying, treatment guidelines
and education efforts that address the major forms: Type 1, a genetic
disorder that usually surfaces in children, and Type 2, a far more
prevalent illness in which genetics plays a role, but in which obesity
and inactivity are the key risk factors.

Each year, diabetes causes hundreds of thousands of Americans to suffer
heart failure, lose limbs, go blind, or die. Yet even with corporate
support and substantial grass-roots fund-raising, the A.D.A.'s $210
million budget is stretched by its many missions: educating
legislators, publishing medical journals, running camps for diabetics
across the country.

From the A.D.A.'s perspective, no charity is more rigorous about
ethical standards or more transparent about where its executives earn
and invest their money. Even unpaid volunteers must detail their income
and financial holdings.

"I want to be able to sleep at night," said Vaneeda Bennett, the
A.D.A.'s chief fund-raiser, "knowing that we are doing the right
thing for people with diabetes, not doing anything that could, in any
way, jeopardize that trust."

Dr. Peter Lurie, deputy director of the Health Research Group of Public
Citizen, the government watchdog group, said the influence of
pharmaceutical money can be very subtle.

"The question is what happens in the close calls," he said. "If
you are at more cocktail parties, if you have more mugs from the
company in your kitchen, you are just going to be more receptive."

A.D.A. officials cited an event from several years ago to illustrate
their resistance to such influence. An A.D.A. panel found that
antipsychotic drugs could help fuel diabetes. The announcement angered
a drug manufacturer, Eli Lilly and Company, a longstanding A.D.A.
benefactor that stood to lose hundreds of millions of dollars in
lawsuits.

Some A.D.A. officials said they believed the company became so angry it
sought to have Dr. Kahn fired, a charge the company denies.

Either way, nothing happened. Dr. Kahn, the association's chief
scientific officer, kept his job.

"Show me one instance where money has caused us to do something that
is wrong," Dr. Kahn said in an interview. "You can't."

Corporate Friends

When the A.D.A.'s executive committee met at the W Hotel in Seattle
in 2003, a special handout circulated around the room.

It outlined a business deal so sensitive it had not been listed on the
official agenda and the handouts were collected at the meeting's end.

Two words on the handout stood out.

Burger King.

Even within an organization that had made deals with food companies,
the fast-food business was different.

Like McDonald's, Burger King had become a lightning rod for criticism
of junk food and its impact on childhood obesity.

But Burger King told the A.D.A. that it was coming out with more
healthful products, like a grilled sandwich and a side of vegetables,
and hoped the charity would consider a partnership.

"They assured us that this was not just something they were doing to
respond to the criticism over their role in the obesity epidemic,"
said Nancy Stinson-Harris, the A.D.A.'s managing director for
corporate alliance and cause-related marketing.

To review the A.D.A.'s dealings with Burger King is to understand its
struggle to raise money and preach health without crossing lines or
demonizing foods.

"There are some within A.D.A. who say no fast food whatsoever and
there are some that say that eating healthy is about choice and people
need to make good choices," said Ms. Bennett. "We want to embrace
the healthy choices and work from within the tent."

For the A.D.A., working within the tent has meant choosing persuasion
over protest. Critics say the organization is too silent on vanguard
issues like special taxes on foods like soda. But the A.D.A. says it
will take more than shouting to change America's eating habits. It
will take focused efforts to prod mainstream manufacturers toward
offering healthier products.

To that end, the association signed deals with more than a dozen food
companies over the years, including Bird's Eye, Campbell's, General
Mills and Coca-Cola.

Each deal was distinct, but generally the companies financed an A.D.A.
health campaign and were recognized as sponsors. Some received
permission to use the A.D.A. logo on select products, generally
sugar-free and diet brands.

Kraft, for example, as part of a four-year, $1 million deal that
expired this year, was recognized as an A.D.A. sponsor and could post
the A.D.A. logo on products like SnackWell's cookies, Post Raisin
Bran, Cream of Wheat cereal and Sugar-Free Jell-O.

In some cases, the products that had permission to use the logo were
only slightly healthier than those that did not.

Kraft, for example, never used the logo on Cool Whip Lite, but it had
permission, even though the topping had just five fewer calories per
serving than regular Cool Whip.

In Burger King's case, negotiations toward a deal stretched on for
nearly a year. Then the A.D.A. learned that the company was coming out
with another new product. "It was a burger that would have the most
fat that has ever been on the market," Ms. Stinson-Harris recalled.
Burger King did not respond to several requests for comment.

The A.D.A. dropped negotiations at that point. But officials of the
charity seized the opportunity to create a more formal set of policies
about corporate fund-raising. The guidelines installed this year are 54
pages long and cover the gamut of corporations, from food manufacturers
to drug makers.

"The association," they say, "should refrain from associating
with companies that have the potential to damage A.D.A.'s image
because of the nature of the companies' products, services or
reputation."

Because of the guidelines, several deals with food companies that
expired could not be renewed, officials said. Hershey and the A.D.A.,
for example, could not come to terms on renewing an agreement, worth
more than $200,000 a year. A.D.A. officials said they would not agree
to the use of their logo on a sugar-free chocolate candy because of its
fat content.

"Now the first thing we do is look at the content, the label," Ms.
Bennett said. "In the past we didn't. The fat was not a
consideration."

The A.D.A., which took in more than $3 million from food companies last
year, has not signed a new agreement with a national food company since
the guidelines took effect. One obstacle is that the guidelines set a
minimum contribution of $500,000 for any company that would seek
permission to use the A.D.A. logo, a new provision borne of the
organization's belief that an association with its name has
undeniably high value.

"There are still some people who are pained by the fact that we
cannot do a deal on this or that because of the guidelines," said Dr.
John Buse, the incoming A.D.A. president.

Though they often present the most difficult choices, food companies
represent a small segment of the A.D.A.'s corporate support.
Pharmaceutical companies remain the largest corporate contributors, but
the guidelines have not affected them as much because the A.D.A. has
never allowed its logo to be put on specific medicines.

And for all the scrutiny the new guidelines are said to have brought,
critics are quick to note that they did nothing to block the A.D.A.
from doing business with Cadbury, a $12 billion-a-year empire built on
the consumption of sweets.

"This isn't really rocket science," said Mr. Ruskin, the consumer
activist. "This is damage to their integrity. And this is a serious
matter."

Cadbury officials say their association with the A.D.A. is a good-faith
effort to promote health. At one point last year, Dr. Kahn also tried
to defend the Cadbury deal by telling an online publication: "There
is not a shred of evidence that sugar, per se, has anything to do with
diabetes." To Dr. Kahn it was a matter of basic science. Though
diabetics should watch their sugar intake, many foods, not just sugar,
he said, carry the kinds of calories that can lead to obesity and
ultimately diabetes.

But the remark struck some as careless, given concerns about excess
sugar in many diets.

Ms. Bennett acknowledged that negotiating deals like the Cadbury
agreement are difficult "when a good company offers several 'good
for you' as well as 'bad for you' products." In the end, she
said, Cadbury improved the deal by agreeing to use its own advertising
budget to promote the A.D.A.'s new Weight Loss Matters program.

More than a year into the arrangement, the A.D.A. says it is happy with
how it turned out. At a meeting this fall, it honored Cadbury with a
corporate recognition award.

Valuable Advice

At a Chicago hotel last month, the A.D.A. brought together seven
medical experts, widely viewed as stars in their field, to consider an
issue that could radically alter the way people at heightened risk of
developing diabetes are treated. It also had bearing on the fortunes of
at least one A.D.A. benefactor.

For years, doctors have debated whether to use drugs to treat people
who are prediabetic, meaning their blood sugar is elevated, but not to
the level considered diabetic.

An estimated 41 million people in America are viewed as prediabetic, in
danger of developing the disease. One drug manufacturer,
GlaxoSmithKline, recently completed trials of a new drug to treat this
potentially huge market and, in several months, the A.D.A. panel will
publish its recommendation on whether drug treatment for prediabetes is
warranted.

A.D.A. rules prohibit such panels from reviewing the efficacy of an
individual brand. But the A.D.A.'s perspective on whether a class of
drugs should be used in treatment often carries great weight with the
Food and Drug Administration, which must approve the Glaxo drug for
use, and with doctors who write prescriptions.

So the appointed panel's perspective is likely to be closely watched
by Glaxo, which donated more than $1 million to the A.D.A. last year.

All but one member of the panel reported receiving fees or research
funding from pharmaceutical companies on their A.D.A. financial
disclosure forms. Three reported direct compensation from Glaxo, though
no amounts were listed.

Few in medical care believe such payments disqualify experts from
serving on panels. Many research scientists receive such funding.

They are, nonetheless, representative of the sort of complications that
arise when the work of charities and corporations become significantly
intertwined.

The A.D.A.'s relationship with drug companies dates to 1940, when 26
doctors met at Schrafft's Restaurant in Manhattan to create the
association, using a $1,000 gift from the drug maker Eli Lilly. Twice
in the past decade, the A.D.A.'s 12-member Executive Committee has
been led by the former top executives of drug or medical equipment
companies. Today the A.D.A.'s treasurer is the director of investor
relations for Johnson & Johnson.

Pharmaceutical companies sell $15 billion worth of diabetes drugs in
the United States each year and the A.D.A. is now a fixture in their
marketing strategy. The companies advertise in A.D.A. journals and
announce new medicines at A.D.A. conventions, where a coming-out party
for a touted new drug can drive a stock higher.

The convention, known as the Annual Scientific Sessions, routinely
draws some 15,000 doctors, health care workers and experts to a
conference center where everything from the water bottles to the
chartered buses are plastered with ads from drug companies.

"It's not quite brainwashing, but they have a way of influencing
your thinking," Dr. Buse said of the companies. He said some
companies sent hundreds of employees to the convention, nearly all of
them there to promote new medicines.

Dr. Buse said he did not believe that the money, or the manpower,
ultimately influences A.D.A. policy. But he said the level of
fraternization made him uncomfortable, and might hurt the A.D.A.'s
image. He said it was one of the more pressing issues facing public
health charities, who have come to rely on pharmaceutical money for a
large portion of their budget.

"It is a real problem," he said.

One of its members of the A.D.A. panel studying prediabetes, Dr. Ralph
A. DeFronzo, chief of the diabetes division at the University of Texas
Health Science Center, said the panel had decided to recommend
lifestyle interventions and some use of a generic drug for
prediabetics, but had stopped short of advocating the use of newer,
brand-name drugs, such as the one being developed by Glaxo.

The decision can potentially affect billions of dollars in sales
because the prediabetic market is so large and the difference in price
so great between generic and "branded" drugs. The generic drug the
panel recommended, for example, metformin, costs about $240 a year,
just a fifth to a tenth of what a branded drug prescribed in the same
setting might cost, experts said.

"I think the panel's recommendation was really quite
conservative," Dr. DeFronzo said.

In the past year, Dr. DeFronzo has received compensation from seven
drug companies, though not Glaxo. The companies either financed his
research or paid him for work as a speaker or as a consultant,
according to his disclosure form. He said he was confident that such
support never influenced his judgment.

"To be honest," he said, "if you are the best person in the
world, why wouldn't a company, why wouldn't the A.D.A., want you on
a panel?"

Dr. Kahn said that, even with extensive safeguards, he and his staff
ultimately must rely on the integrity of the people they appoint. It
becomes an act of faith, and like all acts of faith, he said, there may
well be nonbelievers when the panel's report comes out.

"We have no choice," he said. "There will always be a few people
who think that we are biased."

*******

TC

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