Conflicts of interest in public health research and publications

HARMFUL INDUSTRY INFLUENCE OVER SCIENCE

Providing communities and knowledge users with reliable, independent, and evidence-based information has always been a core function of public health (Thomas and Daube 2023). As part of a comprehensive approach, public education and health literacy initiatives based on rigorous independent evidence have been important in informing individuals, building collective empowerment, and influencing health policies (Okan et al. 2023). However, researchers have increasingly documented the challenges that are faced when some industries and corporations make use of research for purposes that run counter to the interests of public health (Daube 2018). This includes the role that they play in polluting independent science and disrupting and manipulating the public health evidence base (Bero 2019; Reed et al. 2021; Thomas et al. 2024).

Those with powerful vested interests use a range of strategies to undermine some research and researchers and promote others to build public trust and legitimacy in their own involvement in science (Brandt 2012; Legg et al. 2024a; Pitt et al. 2024). This includes their role in:

• Shaping research agendas and framing how problems are defined (Fabbri et al. 2018; Dun-Campbell et al. 2023; Buchman et al. 2025);

• Determining and influencing scientific integrity principles (Mialon et al. 2021; Ralston et al. 2021);

• Developing “spoiler” research designed to mislead (McKee and Allebeck 2014); and;

• Using agnogenic strategies to create doubt and mistrust about evidence on the harms associated with their products or business practices, and disrupt policies designed to protect public health (McKee 2017; Bell et al. 2019; Legg et al. 2021; van Schalkwyk et al. 2024).

Such practices have been documented across a range of industries—including tobacco (Legg et al. 2024b), pharma (Gupta et al. 2024), alcohol (McCambridge and Mialon 2018), commercial gambling (Thomas et al. 2023; Van Schalkwyk et al. 2024), sugar-sweetened beverages and ultra-processed foods (Atli Gunnarsson et al. 2023; Garde et al. 2024), fossil fuels (Goldberg and Vandenberg 2021), and arms (Hussain et al. 2023), as well as global consultancy and communications firms (Daube 2018; Bell et al. 2019; Bogdanich and Forsythe 2022; Anaf and Baum 2024). Since the advent of social media, people’s information ecosystems have been increasingly bombarded with health mis- and disinformation, adding to the overall confusion concerning evidence-based information (Thomas and Daube 2023; Zenone et al. 2023).

RELATIONSHIPS WITH PUBLIC HEALTH RESEARCHERS AND GROUPS

Evidence clearly demonstrates the impact of harmful industries on the manipulation of science (Buchman et al. 2025). However, despite this obvious threat, academics (Adams and Gregan 2024), universities (Marks 2019; Hiltner et al. 2024), professional associations (Bombak et al. 2022; Wise 2023), and patient advocacy groups (Rose et al. 2017; Parker et al. 2021; Hennessy et al. 2024) continue to form a range of direct and indirect relationships with these industries. These relationships may create conflicts of interest (COIs), which are facilitated, enabled, and legitimized by academic institutions and associations (Carriedo et al. 2022), as well as the journals that choose to publish this research (Maddox et al. 2021; Adams and Gregan 2024). The risks that are posed to public health by these relationships and the evidence that they generate have led to increased calls for “firewalls” to protect science from the influence of industries that are harmful to health (McGarity and Wagner 2012; Grundy 2024; van den Berg et al. 2024).

CURRENT COI PROCEDURES RELY ON TRANSPARENCY AND INDIVIDUAL ACTION

To date, approaches to acknowledging and improving systems associated with COIs have largely focused on individual-level mechanisms to improve transparency in reporting. In academic publishing, these efforts are mostly focused on an author’s responsibility to declare any relationships, activities, or interests relating to the content of a manuscript (Misra and Ravindran 2019). However, researchers have argued that these individual level solutions may deepen ethical worries about industry-sponsored research (Buchman et al. 2025). While transparency is important, it does not in and of itself remove the public health concern, and simply reporting a conflict does not take the conflict away. Current approaches to transparency may contribute to an illusionary system that legitimizes and amplifies problematic partnerships and perspectives (McCartney 2024) and do little to create “a norm of separation” between public health research and harmful industry funding (Grundy 2024, p. 536).

Current COI systems can also be messy and confusing—and at times can seem largely tokenistic and performative. They are mostly based on an honor system that relies on researchers to make an accurate judgement about their interests. This includes what (if anything) they perceive is appropriate to declare in relation to a specific piece of work, and the time period for which a declaration is required. Researchers have documented that declaration processes are “plagued” with nondisclosure and inconsistent reporting (Grundy et al. 2020, p. 1), as well as obfuscation (McKee and Allebeck 2014; Gupta et al. 2024). For example, a study investigating COIs in tobacco and e-cigarette-related academic publications found that only a third of authors provided full declarations of interest (McDonald et al. 2023).

There are also issues relating to how authors navigate discussions with collaborators and coauthors about COIs—especially when there are power differentials or different ideologies within a team about the acceptability (or not) of partnerships with different industries (Adams and Gregan 2024). In some cases, researchers may try to avoid full and transparent declarations about their links to industry through third-party groups, foundations and charities (Legg et al. 2024b). In other cases, they may find it difficult to identify relationships between harmful industries and research partners or coauthors (van den Berg et al. 2024), which may have longer-term consequences for future funding or partnerships. Journal editors have also documented these difficulties in justifying decisions to cease accepting industry-sponsored research (McKee and Allebeck 2014). Finally, onerous responsibilities are placed on knowledge users, who are left with the problem of evaluating the findings of research against often lengthy and inconsistent declarations and justifications of activities that can seem more designed to legitimize COIs than to illuminate them.

OUR EXPERIENCES AT HEALTH PROMOTION INTERNATIONAL

As editors we have experienced the practical difficulties of assessing and implementing robust COI declarations firsthand. We largely work in a voluntary capacity and have limited time to conduct anything other than preliminary scans of different sources such as institutional websites, previous papers, and funding bodies to thoroughly investigate whether authors have appropriately or fully declared their interests. Beyond that, we rely on our own knowledge of our respective fields and the diverse expertise of our advisory and editorial boards, as well as peer reviewers (through our single anonymized peer review process) to alert us to any potentially problematic relationships that may need to be declared.

We have found that on occasion researchers may be reluctant to declare relevant interests—even when prompted to do so. And even when we have worked to ensure transparency, there is no guarantee that this will occur for subsequent manuscripts from the same authors in other journals. There may also be different requirements for reporting COIs across different research and policy contexts, which may partly contribute to inadequate declarations (Randle et al. 2024).

At Health Promotion International we have tried to play a role in disrupting the influence of harmful industries over science. While some journals have implemented policies about the tobacco industry (McKee and Allebeck 2014), we took the decision in 2023 to preclude research or commentary directly or indirectly funded by the tobacco, alcohol, commercial gambling, ultra-processed food, fossil fuel and arms industries. While we acknowledge that there are other industries that are problematic for health and equity (such as the pharmaceutical industry and global consultancy and communications companies), our policy aims to take a first step in creating a “norm of separation” (Grundy 2024, p. 536) between harmful industries and academic publishing. We invite other journals to join us in these efforts.

TRANSFORMING SYSTEMS TO PROTECT SCIENCE AND CHAMPION THE VALUES OF PUBLIC HEALTH

As public health researchers, we must acknowledge that we are living in a new, and arguably politically charged, era of health mis- and disinformation (Lancet 2025), which poses a significant threat to public trust in science and the health and well-being of our communities. While systemic changes will not “fix” COIs, some fundamental changes could help support improvements in COI processes. As researchers, we can all identify with the challenges we face in securing funding for research that aims to promote and protect the health and well-being of people and planet. We can also identify with the pressures that we experience from our institutions to attract research funding and retain staff who are already facing precarious employment contracts. We face new funding paradigms that champion partnerships between industry and academic institutions (Baum and Anaf 2023). We also acknowledge that with limited independent funding in some contexts, researchers may argue that if money from some sources was not available, no research would occur in their area. However, given the human and financial toll, ‘business as usual’ should not be an acceptable option. Now is the time to strengthen our systems for addressing COIs, separating harmful industry funding from science, and acknowledging that public health research should seek to serve the public good, not the profit motives of vested interests.

CONFLICT OF INTEREST

S.T.: is Editor in Chief of Health Promotion International. She receives an honorarium for this role. M.D.: Chair of the Advisory and Editorial Boards, Health Promotion International. M.H., K.F., C.W., A.H., S.K., and O.O.: Associate Editors Health Promotion International. They receive honorariums for this role.

REFERENCES