Rugby, corporations and risk

In recent years, I have been involved in various efforts to advocate for accurate representations of injury risks. In rugby specifically, challenging erroneous and misleading claims about injury risk is important, so teachers, parents and players can be given accurate and pertinent information about risk. I and my co-authors have applied our analytical skills to the background processes of risk reporting – that messy and complex interplay of research, policy and practice that eventually manifests as risk information. Speaking of which …

In 2016, I was amongst a group of 73 sport scholars, academics, doctors, and public health professionals who signed an open letter arguing that it was necessary to remove the collision elements of the school game so that children play touch and non-contact rugby.

At face value, the open letter focused on a very small part of school sport. We were only arguing for …

  • one rule change …
  • to one sport …
  • at schools …
  • in one country.

The letter attracted a lot of media attention. And rugby governing bodies devoted a significant amount of resources, time and energy which resisted the proposal. These were press releases, media interviews, and resources seemed to be devoted to journal article writing. Now 6 years has passed since the open letter, it is a useful moment to reflect on some of the claims that were made at the time, particularly as brain health/risk has become very prominent in recent years (which I think makes the open letter particularly prescient).

So a few of us have published an article (behind a paywall at the moment) analyzing some of the responses to our open letter. These responses in academic journals are worth examining for how the proposal was framed by others, and the problems that come with such framing. Feel free to read these articles for context if you have access.

In 2016, Tucker et al. published Article 1 “Injury risk and a tackle ban in youth Rugby Union: reviewing the evidence and searching for targeted, effective interventions. A critical review.”

Then in 2017, Quarrie et al. published Article 2 ‘Facts and values: on the acceptability of risks in children’s sport using the example of rugby — a narrative review’.

In our own article, we argue there are a number of omissions, distortions, and misleading remarks which frame the ideas in our original open letter quite differently. These issues include:

Both articles omitted a long list of proposed reasons/motives for making a rule change, including issues around a duty to inform, a duty of care, issues of compulsory participation, and time loss from school.

Both articles omitted any reference to the proposed solution of children playing touch and non-contact rugby. By only mentioning half the solution, they did a disservice to the open letter.

Article 1 seemed to mis-attribute “cited” “terms”, to make a point about the “acceptability” of rugby participation.

Can all childhood injuries even be prevented?

Article 2 suggested that the open letter signatories believed that “all childhood injuries, regardless of origin, are inherently undesirable and should be prevented.” To be clear, I have never met anyone who has ever proposed that “all childhood injuries should be prevented”. As an approach to daily life and risk management, this idea seems nonsensical. So I found it strange, by virtue of signing a letter about school rugby injuries that I was being implicated with this idea. And it propagated an unbecoming trope – that a group of academics were out of touch with reality to the extent that they wanted to “wrap kids in cotton wool” and would never tolerate any injury. The article even included a quote from a former NZ rugby captain:

If you look too closely at the game it’s silly really when you bash the hell out of each other. But it’s fun and if you took the risk out of everything you wouldn’t do anything in your life.” Richie McCaw, former All Blacks captain, 2017, (bold added).

Aside from the possible confirmation bias that comes from quoting a successful rugby player in a medical journal, five years on, this quote can be read more critically. With the brain injury crisis that has enveloped collision sports around the world, the inclusion of McCaw’s quote might lead readers to ask questions like – is it really all or nothing? Is “bashing the hell out of eachother” tolerable for me? Is it tolerable for school children? Especially when the long term effects of rugby injuries for former players are beginning to be understood in more detail now.

McCaw’s quote can also be read in contrast with another former national team player from England. Steve Thompson recently said:

“Would I let my kids play rugby at the moment? No, I wouldn’t. Touch rugby, yes. …. Do I think it’s safe for kids to do tackle rugby? No, I don’t…”.

Of course, the letter writers never wanted to take the risk out of everything. It is intriguing that such a trope would be advanced in an article having ostensibly been through a peer review process. A reading of the 1-page text of the open letter would have shown that touch and non-contact rugby was being proposed as an alternative – a sport that of course has injury risks. Unfortunately, the trope of extreme risk-averseness is presented in the form of a rhetorical question for the signatories:

“… what level of injury to children resulting from participation in rugby would be seen by her [Pollock]and the signatories of the open letter as ‘acceptable’, or even ‘tolerable’. If the answer is ‘none’, there is no debate to have. It follows that if no injuries to children are acceptable, contact rugby for children should be banned, with similar logic presumably resulting in bans for other activities that carry risks of injury and/or death to children such as football, gymnastics, cycling/mountain biking, fairground rides, swimming, climbing trees, hiking, rock climbing, snow sports, sailing, fishing, equestrian and being transported to and from school by car or motorcycle.”

And so significant attention in an academic article is devoted to a rhetorical question about all sorts of common activities such as football, hiking and going to school, with the possibility left hanging in the article that these are activities which the signatories would be against. The effect of all this is the signatories are painted as extreme risk avoiders.

What would the equivalent be at the other end of the risk spectrum? I imagine it would be similar to a school rugby promoter being accused of believing that “any” sort of high-risk behaviour should be compulsory for school children. So compulsory unaided rock climbing, compulsory jousting, compulsory bare-knuckle boxing, or whatever other high-risk activity they want to administer. Of course, these suggestions are fanciful, and I would not offer these in an academic discussion as plausible equivalents to the various risks of rugby.

Relatedly, we contest the veracity of the claim that there is a “‘dominant paradigm’ among those working in childhood injury prevention that ‘all childhood injuries, irrespective of origin, are unacceptable’.” Instead we suggest the references supposedly used to support that argument say the opposite – that “injuries can be ‘prevented or controlled’ (italics added) through either primary, secondary, or tertiary prevention – ‘preventing new injuries, reducing the severity of injuries, or decreasing the frequency and severity of disability after an injury’”. Again, the accusations levied in the direction of the open letter signatories do not seem to hold water.

On sociology

Article 2 claimed ‘The values of the signatories of the open letter, most of whom are scholars of sociology, rather than injury prevention or public health, are relevant to what level of risk they believe is acceptable in rugby’. We did a count ourselves on this, and even being generous towards ‘sociology’ in cases of multi-disciplinarity, only 34 out of 73 were predominantly ‘scholars of sociology’. Does 34 out of 73 count as most? No, we don’t think so.

We wonder how this claim was created. It also buys into the trope of positioning the signatories as particularly unknowledgeable about the topic (despite the signatories ironically being accused of deploying the dominant paradigm of injury prevention moments earlier). This frames the letter writers as inexpert in the subject, which would certainly be a tactic deployed by those with an interest in defending the status quo of rugby tackling in schools. In various media, attacking the legitimacy of the signatories seemed to be a popular technique when the letter was first published.

And speaking of sociology, despite not accounting for ‘most’ of the signatories, scholars of sociology focus on a range of closely-related themes – risk, danger, education, policy, power, and control across a wide range of settings and cultures. Sociologists often need to be interdisciplinary, often traverse a wide range of social problems, including different types of risks, and often view social practices holistically. Since the open letter intersected with health, education, safe-guarding, physical education and physical activity, it would seem that sociologists are well placed to contribute. In any case, the 73 signatories of the letter, whatever their background or professional discipline, would have a wide variety of beliefs about all sorts of risks. For example, sociology can be a risky thing to do itself!

Other motives? Or omitted motives?

Article 2 uses an example of one signatory, who once remarked (in a different setting, in a different context), of his apparent contempt for ‘men’s team sports’. This remark was used as the basis to claim that ‘If reasons other than those concerning player welfare were a motive for the authors of the open letter calling for a ban on contact in schools’ rugby, then stating those reasons in the letter would have helped clarify the debate’. But when the article in question had already omitted discussion of many ‘motives’ which were explicitly emphasised in the open letter (including issues of compulsion, consent, and the duty to protect children), this doesn’t quite seem like fair play. This echoes a trope of the letter writers as have ulterior motives. Sure, critical analysis of motives is a good thing, but the clearly stated motives (in paragraphs 3, 4, 6 and 7 from the open letter) are entirely ignored in favour of an insinuation of “other reasons” being motives. Advocacy is certainly made more difficult when the original issues raised are not considered at all in responses, and further, when the issues raised are conflated with other matters entirely.

Competing and confounding interests

Speaking of declaring ‘other reasons and motives’, the logical extension of such a suggestion would become quickly unmanageable and probably uncomfortable for the declarers. For example, employees of World Rugby or England Rugby (for example) would need to disclose their specific financial interests at every instance of advocacy as well as all the other benefits they have received through their connection with the sport, as this would surely ‘motivate’ their involvement. I look forward to any author beginning such transparent declaration to ‘clarify the debate’.

Cheekily, and taking declarations to their logical extreme, I wonder if “confounding interests” would be useful to disclose too. For example, I signed the open letter and:

I played collision sports for 7 years.

My support of both the All Blacks and Buffalo Bills for has spanned two millennia.

I own a rugby ball.

Do these factors make the proposal more palatable now that I’ve declared my interests? Or should I not have declared any of this? It certainly grates against a narrative that a signatory supposedly doesn’t like rugby.

Distortions of school decision making  

Article 1 claimed that “effective (risk management) interventions must, by definition, be realistic and obtain the support of the major stakeholders within the specific target population”. However, this framing doesn’t work in the UK school setting. If an activity involving an external stakeholder is deemed to be too injurious, then it would not matter whether a ‘major stakeholder’ supports its removal. That’s a decision for the school and education leaders.

Article 1 also frames tackling in school rugby as essential, by claiming that “the danger then, of removing the tackle from compulsory rugby in schools as has been proposed, is that it would deny the need and opportunity to many young players to begin learning a skill set …“. Is there any evidence that shows tackling needs to be learnt by school children? This claim seems more ideological than evidenced based. It is entangled with corporate interests, rather than a pedagogical justification. An imperative to learn to tackle would cement rugby as an essential part of schooling, and would be useful for the corporations who would be detrimentally affected by the removal of tackling from schools.

This point is worthy of a bit more exploration. Which activities for children should we endorse as children “needing” to learn at school? Swimming? Cycling? Self defense? Throwing? Catching? Where does tackling feature in a hierarchy of essential skills to learn?

Incredibly, article 1 concludes by claiming that the proposal “may also lead to unintended consequences such as an increase in the risk of injury later in participation”. I would have thought that any new adult player later in life would be looked after by rugby clubs they join to ensure they are well prepared before being placed in tackle situations. Isn’t progression an important part of skill development, after all?

Corporate interests in rugby research

What I found interesting is that both articles included declarations of ‘competing interests’ from various authors connected to various rugby governing bodies. Many of the claims and distortions mentioned above seem to favour the interests of rugby organisations. We found no distortions and claims in either article that worked against the interests of rugby organisations. Did we not look hard enough? Was this our bias at work? It would be interesting to see if anyone can find any such distortions.

There was one quote, in article 1, which read – “This proposal does, however, deserve substantial scrutiny for the possibility that it may be an effective (albeit extreme) means to improve player welfare…” (bold added). Despite this quote, not only was the potential effectiveness not investigated, the proposed solution of touch and non-contact rugby was not even mentioned. Oh well, so much for the “substantial scrutiny”.

Was the proposal to remove tackling ever really “extreme”?

A recent survey in the UK found more than half of respondents favoured ‘a ban on tackling at Under-14 (65%), Under-16 (58%) and Under-18 (55%) level.’ So even if removing tackling for children (at schools) used to be an ‘extreme’ idea, it’s not anymore.

How influential were corporate interests in all this? Well, there is certainly an entanglement of corporate rugby interests and defense of the status quo. Whether this framing (as we discuss in the article) was accidental or unconscious is a matter for the writers. We assume that no one would try to purposefully mislead readers. I think we should assume that people in professional positions are making genuine attempts to make the world a better place. But equally, there’s a reason why competing interests sections exist. Whether through unconscious drift, or by accident, or both, I think a range of pressures, assumptions, and ways-of-being can affect the messages that are produced, no matter how much science, objectivity, and integrity is espoused. And so, while unaffiliated advocates can be easy targets for claims of bias and skewed opinions, I suspect it can work both ways.

There is nothing sacred about school sport policies. Sports are added to schools, and removed, for all sorts of reasons. For rugby governing bodies, I suspect the removal of tackling from schools would be unbearable (even as a short term, localised, comparative intervention).

Joe Piggin

The Int. Society for Physical Activity and Health Conference 2018 – An unofficial review

I have not been to an ISPAH conference since Rio, 2014. I have noticed quite a few changes since then. It seems more mature now. The talks I saw involved critical reflection, and there were entire sessions dedicated to health inequalities. And it was great to see far less Coca Cola, and much more “co-creation” (see what I did there).

Given the propensity for graphs at the conference, here is another one:

Presentation1What the chart above shows with magnificent precision is that after initial calls for and hopes for change at the start of conferences, research presentations often are forced to acknowledge a lack of policy traction, barriers to implementation and modest intervention success, as well as many arguments about what best practice actually is. Along with this is often palpable frustration about the “slow progress” of policy change and the subsequent hoped-for population change. Maybe this is an essential part of all conferences, especially ones which are associated with major public health goals.

Set in the Brutalist QE2 Conference Centre in the heart of London, it is clear ISPAH is becoming physically and politically closer to decision makers around the world. While intersectoral partnerships take time to cultivate, it seems progress is being made. Professor Fiona Bull, working for the WHO on disease prevention, is a spokesperson for the movement and a connected and successful policy entrepreneur in the realm of PA promotion. And it appears there is an ever-growing legion of evangelical enthusiasts making connections with the various sectors, from state to transportation and town planning.

“Systems approaches” continued to get a lot of air time throughout the conference. Mapping systems is a logical and noble pursuit, though the limitations need to be, and were, acknowledged early in the conference.

While a small point, I would encourage no one to call the Morris et al London busmen study (1953) the “birthplace of physical activity”. Two presenters seemed to do so. Perhaps it was a slip of the tongue(s), or clunky explanation, as I’m certain “physical activity” was born earlier than 1953.

chart
Milestones in knowledge according to GoPA

Overall, ISPAH 2018 was a slick affair, which ended with challenges and optimism. The WHO target of a 15% change in global activity levels by 2030 is a lofty goal – I suspect that aiming for less would not generate the political will to mobilize resources and change minds about the seriousness of the issue.

Conference
The launch of WHO’s “Active”

I have always intuitively favoured the social benefits that come from physical activity, as opposed to the changes in disease risk. Perhaps that is just my personal bias. Upon leaving the venue, one delegate, carrying a WHO football was accosted by one of the conference centre doormen, who enthusiastically exclaimed “Throw it here”. Two strangers briefly throwing a football to each-other might not lower the risk of anything, but it shows humans crave connection with one another. ISPAH are trying to make the world a better place, and it seems they are gaining traction. Maybe I should join?

Joe P

The Physical Activity Pandemic – Round 2

Today I attended an event launching a special issue of The Lancet on Physical Activity. It was the second such event, 4 years on from the first. The event was well organised and well attended. So, how did it go?

Judging a book by its cover …  yes, it’s a better cover image than last time. Well done there ; )

20160728_160554_resized

Pamela Das opened proceedings by warning the audience that this was “not [only] about sport”.

The presenters all spoke well on their areas of expertise. Ding Ding highlighted the enormous economic cost of inactivity (after a paper in 2012 highlighted life years lost to inactivity). She also compared and contrasted the economic and disease burden between low/middle and high income countries. It did make me think that after the medical and economic arguments have been made, it will surely be time to bring discussion of the social to the fore. Next time!

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Ulf Ekelund discussed links between PA, sitting time and mortality. A range of interesting questions followed culminating in musing about the differences between squatting and sitting. Pedro Hallal and Rodrigo Reis spoke well about progress over the last 4 years and the potential to “scale up” interventions. This did make me think about the specific lack of published physical activity policy literature, and how there is a need for robust analysis of PA policy processes. This is especially true given Reis pointed out that “political support” is considered by stakeholders both important and very difficult to obtain.

IMG-20160728-WA0001

The panel discussion which followed produced some of the more provocative exchanges. Richard Horton warned against being overly positive about the speed of change, and he asked some challenging questions, in the form of “What is the biggest challenge and biggest opportunity?” Here the presenters allowed their passion about PA to be displayed. Pedro Hallal in particular noted that there was not enough “indignation” about the current state of affairs. Interesting stuff. Richard questioned the Sport England term “customer” … “Do you mean people?”

It was incredible to hear Coca Cola referred to in discussion about “toxic” private interests. Nobody in the room disagreed. How the world has changed from Rio 2014, when the ISPAH conference was literally festooned with Coca Cola sponsorship! It was also fascinating to hear from one panellist who was extremely disappointed at the attempts by physical activity advocates to cooperate with Nike and the Designed To Move initiative … saying it did not work at all. His conclusion was that “their interests are not our interests”. Great critical analysis.

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Richard Horton concluded by encouraging the audience to be more involved in advocacy, with opportunities for researchers and students to be spokespeople for PA in a variety of advocacy roles. He also noted that we should have an element of humility about our advocacy. People sometimes value things other than “health”, and we all might “trade off” some health for other experiences. It reminded me of what Alan Bairner once said about the physical health benefits accrued from walking. They ‘may well be of secondary importance to the lessons that can be learned from the pedagogies of the street’ (p. 373).

Looking forward to the next one (2020?), I think I understand the reason for publishing the Special Issue just before the Olympic Games. But perhaps the next issue should be moved away from the Olympic month. Using the Olympics to capture attention is one thing, but I suspect it also serves to conflate the issues for many people.

Joe Piggin

Reference:

Bairner, A. (2012). Urban walking and the pedagogies of the street. Sport, Education and Society, 16, 371–384. doi:10.1080/13573322.2011.565968

Ethics in sport, exercise and physical activity scholarship

Ethical principles are clearly very important in sport, exercise and PA research and practice. Here are some possible ways of addressing a variety of difficult ethical issues:

REFLECTION: Academics should be committed to considering their ethical positions with regard to the funding they receive.

DECLARATIONS: Academics should be committed to making explicit their ethical positions with regard to the funding they receive.

DISCLOSURE OF FINANCIAL GAIN: Academics should be committed to disclosing fees received from private funders for their research, even in cases where this is not a requirement to do so through contractual arrangements.

HUMAN RIGHTS: Academics should be extremely wary of engaging with funders from states / governments and NGO’s which are criticised by human rights organisations. If academics do become involved with such organisations, they should articulate their reasons for their involvement explicitly.

DUE DILIGENCE: Academics should critically investigate the background of the commercial partners they engage with.

IMPLICATIONS: Academics should reflect on the possible use of research data, particularly when it might be used in the manipulation of an organisation’s public image.

Academics should reflect on the motives of research funders and the wider implications of potential involvement with corporate partners, who promote goods, services and ideas to vulnerable populations.

SCEPTICISM: As producers of knowledge, sport and PA academics are in a powerful, privileged position. They should automatically treat funders with scepticism.

EDUCATION: Academics involved in sport, exercise and physical activity curriculums should give attention to “ethics” in their courses. They should emphasise ethics throughout the qualification and find suitably qualified people to teach this.

PROMOTION: Through their involvement with academic journals, professional organisations and conferences academics should promote discussion themes of “ethics”, “conflicts of interests” and “vested interests”. Academic journals, professional organisations and conferences should promote these discussions too.

Note: I appreciate the helpful contribution of my peers in forming these proposals.

A response to an editorial in the Journal of Physical Activity and Health

We were very disappointed to read the editorial in the recent issue of the Journal of Physical Activity and Health, written by the journal’s Editor-in-chief. The editorial is entitled “Corporate-Sponsored Obesity Research: Is Sugar Really Coating the Truth?”.

The editor, Prof DiPietro, criticises a NY Times article which itself criticised the Global Energy Balance Network. In our view, her editorial contains an unfortunate mixture of hyperbole, poor logic and short-sightedness. We contend that the arguments presented by DiPietro do little to enhance readers’ understanding of the political and economic forces that are involved when corporations sponsor physical activity research and promote physical activity to populations. Here are our main concerns, underneath extracts from DiPietro’s editorial:

1.

DiPietro: “The [Times] article, titled “Coca-Cola Funds Scientists Who Shift Blame for Obesity Away from Bad Diets,” goes out of its way to discredit the GEBN due to its funding source” (p. 745, 2015).

Our Response: The article does not “go out of its way to discredit the GEBN”. It provides a variety of evidence and sources to highlight significant issues with the GEBN. This is investigative journalism. The journalist has quoted the GEBN and people affiliated to it; so for want of a better description, it is actually a “balanced” article.

There have been major ramifications as a result of the Times article being published. For example Steven Blair asked that his “video addressing energy balance be taken down from the GEBN website” … and wrote “My dismissal of diet as a cause of obesity did a disservice to [top nutrition experts’] work” (Blair, 2015). Also, Coca Cola has been pressured into being more transparent with regard to their sponsorship of research and promotion of PA and health.

DiPietro’s accusation actually impugns the integrity of those involved in the Times article, for which an apology might be appropriate.

2.

DiPietro: “The science leading to these [energy flux] conclusions was not funded by Coca-Cola or any other industry and it proposes that weight regulation is best achieved at levels of high energy expenditure plus matching energy intake and low energy storage. There are numerous scientists around the world who support this claim that are also not funded by the food or beverage industry. Sadly, this message was distorted rather remarkably in the Times article, which indicated that the GEBN feels that “diet is not important.” (p. 745, 2015).

Our Response: Given Steven Blair’s initial comments in the now-retracted video, and his subsequent statement about the disservice he had done, it is clear that Blair, not the Times article, was the source of significant distortion.

DiPietro fails to identify specific instances of where the “distortions” she claims actually occur in the article. We can find a reference to the GEBN’s Dr James Hill: “On its website, the group recommends combining greater exercise and food intake because, Dr Hill said, “ ‘Eat less’ has never been a message that’s been effective. The message should be ‘Move more and eat smarter.’ ” (p. 745, 2015).

So from our interpretation, the Times article does not distort a message about “energy flux” – it actually quotes the GEBN’s spokesperson James Hill making a statement about it. Therefore we suggest DiPietro might be (hopefully unintentionally) misleading readers.

Conclusion: We challenge DiPietro to identify specific instances of where the “distortions” she claims actually occur in the article.

3.

DiPietro: [Regarding weight loss and weight regulation] “If the Times article had solicited input from scientists not affiliated with the GEBN who were also experts in exercise and metabolism (rather than only experts in nutrition), this message might have been conveyed more accurately” (p. 745, 2015).

Our Response: The Times article actually featured responses from: Michele Simon, a public health lawyer; Dr. Yoni Freedhoff, an obesity expert at the University of Ottawa; Barry M. Popkin, a professor of global nutrition at the University of North Carolina at Chapel Hil; Professor Marion Nestle, professor of nutrition, food studies and public health at New York University; Dr. Anne McTiernan, a cancer prevention researcher at the Fred Hutchinson Cancer Center in Seattle; Professor Kelly D. Brownell, dean of the Sanford School of Public Policy at Duke University; Link to research from: Professor Aaron E. Carroll, a professor of paediatrics at Indiana University School of Medicine.

To suggest that the Times article needed “experts in exercise and metabolism (rather than only experts in nutrition)” does a disservice to the Times article, which was clearly not focused on ideas about energy flux, but rather the political economy of obesity and physical activity research. DiPietro focuses on micronutrient systems, rather than macro-political systems, while the Times article clearly focuses on the latter.

4.

DiPietro: “Another source of contention in Times article [sic] is the perceived conflict of interest as a result of taking money from an industry that may have a vested interest in the very nature of your findings. The implicit concern is that the scientific findings will waver from truth and toward benefitting that very industry” (p. 745, 2015).

Our Response: There is no “implicit concern” with conflicts of interest in corporate funded research. The Times article is explicitly concerned with conflicts of interest.

Further, there is no “perceived” conflict of interest in this case. There is an actual conflict of interest. To be clear, for a conflict of interest to occur, it is not necessary to show that a sponsor is using its position to further a particular cause. It is enough that there is a perceived conflict of interest before data is even gathered. We encourage PA researchers to act with extreme caution regarding sponsored funding. We wonder if the International Society for Physical Activity and Health might be able to provide ethical guidance to researchers who want to avoid such conflicts of interest.

5.

DiPietro: “The implicit concern is that the scientific findings [sponsored by the GEBN and Coca Cola] will waver from truth and toward benefitting that very industry. If that were really the case, however, why do we not express equal outrage and judgment of studies funded by pharmaceutical companies? (p. 745, 2015).

Our Response: Of all of DiPietro’s comments, this is the most concerning. DiPietro’s logic is faulty in several respects. Sound reasons why there might not be “equal outrage and judgment of pharma” include:

  1. A lack of transparency by companies leading to a lack of understanding by consumers
  2. A lack of perceived influence on the part of consumers
  3. Different tactics employed by concerned consumers
  4. A lack of resources available to citizens

There are a number of other concerns about DiPietro’s comparison. The two contexts of obesity research and pharmaceutical research need to be examined on their own merits. The pharma industry, despite profit motives and examples of dubious drug effects, has far more merit than Coca Cola as a mechanism for saving lives and reducing pain and suffering. The pharma industry has a long history of contributing to health and wellbeing, which can scarcely be said of the soft drinks industry.

Most importantly, downplaying conflicts of interest in obesity/PA research because consumer engagement in another industry is addressed differently is alarmingly simplistic. We wonder, therefore, if editorials in JPAH should be peer reviewed to avoid such worrying causal leaps. We certainly hope that this faulty causal logic is not endorsed by the Journal of Physical Activity and Health in its reviewing process.

Also, actually, for many years there has been protest directed at pharmaceutical companies, much of which is synthesised at Ben Goldacre’s website, Bad Science badscience.net and in Jacky Law’s (2006) book, Big Pharma. This protest may not be as large or as apparent as the recent Coca Cola scandal, but to downplay the protest that does occur, as DiPietro does, is problematic.

The Times article which DiPietro critiques clearly points out that “A recent analysis of beverage studies, published in the journal PLOS Medicine, found that those funded by Coca-Cola, PepsiCo, the American Beverage Association and the sugar industry were five times more likely to find no link between sugary drinks and weight gain than studies whose authors reported no financial conflicts.” We are amazed, and quite frankly alarmed that this extract from the Times article does not appear to resonate with DiPietro.

DiPietro’s conclusion is particularly alarming and we offer a challenge to her overly simplistic defence of corporate funding to be substantiated. We sincerely hope that students of physical activity, sedentary behaviour and exercise science do not draw the same conclusions about corporate involvement in health promotion as DiPietro does.

6.

DiPietro: “Although the funding disclosures were initially and unintentionally omitted from the GEBN website when it was first launched, they were added immediately when the GEBN was notified of the error.” (p. 745, 2015).

Our Response: DiPietro’s commentary here merely repeats information already in the Times article. We wonder if DiPietro is or ever has been a member of the GEBN. We seek clarity on this issue (and a response to our other challenges here).

7.

DiPietro: “Science advances in steps and the field of physical activity and health is still learning to walk. Maybe the real issue in the Times article is that one of the funders of GEBN research is Coca-Cola, the world’s largest producer of sugary beverages and in many people’s minds the source of all that is evil.” (p. 745, 2015).

Our Response: We think this comment is poorly thought out. We contend that few people think Coca-Cola is “evil”. We believe that most would acknowledge Coca-Cola for what it is, a global corporation with a stated aim and obligation to maximise a return for its shareholders. We contend that whether it is through greenwashing its products, promoting Coke to children, being charged with tax evasion, or sponsoring physical activity research (and ISPAH conferences), Coca Cola is simply acting as it is obliged to act. Therefore, accusing Coca Cola critics of thinking Coke is “evil” is a poorly thought out argument and does not give appropriate credit to the concerted efforts of activists who are concerned by the Coca Cola Company’s behaviour.

Note: DiPietro’s repeated use of the words “real” and “really” in the editorial suggest a limited understanding of the complex mechanisms to which she herself alludes in the article.

8.

DiPietro: “In today’s fiscal environment, it is extremely difficult for scientists to get their work funded. Hopefully, the government will soon decide that science is worth supporting again, and researchers will no longer need to turn to corporations with fat wallets for the funding of their ideas. Until that time, we must judge the quality of the science instead of baselessly impugning the reputations of the scientists.” (p. 745, 2015).

Our Response: If we conclude that the government implied by the Editor-in-chief is the USA government, then this is a particularly US-centric approach to editorial writing. It is unworthy of a journal that is claimed to be the “official journal of the International Society for Physical Activity and Health”. We encourage DiPietro to clarify which government she means.

At the same time, we also seek clarity on her suggestion that “science” is not currently being supported. This claim is vague.

Lastly, given the significant limitations of the editorial, we hope that DiPietro’s claim of scientists having their reputations “baselessly impugned” will be retracted in the same way that the founding editor of the JPAH (Steven Blair) retracted his video.

We welcome a response from Loretta DiPietro.

Dr Joe Piggin, with guest contributor Prof Alan Bairner

POSTSCRIPT – 2 December 2015. In an email to Prof. DiPietro, I asked:

1) Do recent media reports this week [showing internal Coke emails with Prof James Hill] lead you towards a different conclusion about Coca Cola’s involvement with the GEBN and the GEBN’s involvement with Coca Cola[?]

2) Would you consider writing a new editorial with these recent events in mind?

3)  Would you be willing to consider a short commentary for your journal on this topic? I have recently published about corporate lobbying in physical activity (see J Piggin 2014), and I would be willing to write a piece for your Journal. Please let me know.

I appreciated the response. I have reproduced the email below in its entirety:

 

No thank you.

 

Active and Inactive People in Policy

Health policies are often thought of as text-heavy documents combining aspirational rhetoric with references to “stakeholders”, “step changes”, “targets” and “outcomes”. Of course, it is through words and numbers that resources and budgets are decided. However, imagery plays an important (subtle) role in shaping how policy problems and solutions are defined in the first place. I offer a few examples of how imagery in physical activity policy documents can powerfully (but subtly) affect how readers of policy understand an issue.

Healthy Weight Health Lives, UK Department of Health 2008

This was a major “anti-obesity” policy in the UK, written by the Cross-Department Obesity Unit, Department of Health and Children School and Families.

Picture1
Cover Page of Health Weight, Healthy Lives, UK Government, 2008.

The front cover connotes leisure, pleasure, 2.0 children, freedom, fashion, and a local council with immaculate greenkeeping. A slim, active life is a good life. Now, compare that to how “THE CHALLENGE” is visualised (p. xvi).

Challenge
Image from Health Weight, Healthy Lives, p. xvi.

This image (subtly) tells UK policy readers many things. We are encouraged to look at the anonymous bodies with disgust, and to judge their ill fitting clothes, their gorging, their loitering. Why are these women not frolicking on a grassy field? Rather than judging these people, we should ask questions about the process of image production.

Q: How could “THE CHALLENGE” be framed differntly? Is it obesity? Or is it economic poverty?

Q: Why are we looking at these bodies without faces? One might argue removing the heads is conscientiousness, ensuring the anonymity of those in the photo. However, there is another reason. Deborah Thomson refers to this practice as spectacular decapitation – a powerful shaming practice. It encourages the viewer to assimilate all the surrounding signifiers (the clothes, the gorging) with the shape of the bodies to make a judgment about those bodies.

Q: Does it matter that this image is not from the UK? Tracing the photo credit reveals the image is actually from the USA. The photo is of “Overweight New Yorkers eating ice cream on West Fordham Road at Grand Avenue in the Bronx, NY on Tuesday, August 12, 2003.”

Q: More importantly, was permission sought and received from the three women involved? I suspect permission was not sought. The photo, like many others on the site, is clearly taken in a public place. If permission was not gained, does this make it ethical?

Of course, these images are only two of many in the document, but it should encourage us to consider how people are presented in official policy.

Joe Piggin

For more see,

Piggin, J. & Lee, J. (2011) ‘Don’t mention obesity’: Contradictions and tensions in the UK Change4Life health promotion campaign. Journal of Health Psychology, 16, 1151-1164.