ETHICS OF ALCOHOL POLICY IN BRAZIL: WHY IT IS POSSIBLE TO BE INDEPENDENT WHEN WE SIT AT THE SAME TABLE WITH THE ALCOHOL INDUSTRY

Authors


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We are pleased to comment on Adams' paper [1] published in Addiction.

A variety of risks are involved in receiving funds from the ‘dangerous consumptions industry’. However, the possible conflict of interest concerns not only the alcohol, tobacco and gambling industry; we agree with Moscalewicz [2] that ‘the ethics of a relationship between industry and research cannot be reduced to the moral conflict between the public good and the commercial agenda of the dangerous consumption industry’. In fact, other industries, such as the pharmaceutical industry, should be included.

As stressed in Adam's paper [1], it is necessary to develop awareness of the level of an organization's involvement with industry funding. It is also crucial to create evaluation mechanisms to ensure the independence of the organization.

The Center for Information on Health and Alcohol (CISA), mentioned in a negative manner in ‘Ethics of an unregulated market’[3], is an example of how funding by the alcohol industry is used to invest in a serious project in which the independence of the research team is ensured. CISA's project was conceived in 2003 by its Executive President, a professor from the medical school at the University of São Paulo for more than 20 years, and in 2004 the organization was established with the financial support of the alcohol industry. The name of the centre was chosen exclusively by the Executive President without any interference of the alcohol company representatives. The organization comprises three committees: the Deliberative Committee and the Financial Committee, which have a number of members from the alcohol industry, and the Scientific Committee which is made up by seven PhD investigators with no ties with the alcohol industry, six of whom are professors in medical schools.

The formal nomination of all committee members is made through an Assembly composed by four associates: two from the alcohol industry and two professionals from other fields, including the executive president. The Deliberative Committee is responsible for the Executive President's appointment.

CISA's independence is guaranteed by the following: (i) the staff members are chosen only by its Executive President and the donors are not allowed to interfere in this process. The core team is made up of a psychiatrist who is also a PhD student from the medical school at the University of São Paulo, a psychologist with a master's degree in psychology who is a graduate student from the medical school at the University of São Paulo, and a PhD biomedical researcher; (ii) CISA's information is reviewed systematically by the Scientific Committee; (iii) CISA's activities are planned by its team and they were not required to consult its sponsors to execute them; (iv) the Executive President and its team are completely free to apply CISA's funds in projects that are relevant to the organization's interests, such as the donation of grants to scientific investigations.

Nowadays CISA is 90% supported by the alcohol industry, and 10% of its funds comes from the National Federation of Private Insurance Companies and a Medicare cooperative.

In short, CISA offers society at large a reliable database on alcohol and health. The organization's website is available in three languages (Portuguese, English and Spanish), and more than 90% of the information posted pertains to the harmful effects of alcohol consumption, reflecting the percentage of studies published in the most reliable scientific periodicals. Among other actions, CISA supports the alcohol section of the Brazilian branch of the World Mental Health Survey Initiative by the World Health Organization, a study conducted in 26 countries that investigates the prevalence of mental disorders world-wide. The goal of the alcohol section is to gather epidemiological data about the pattern of alcohol use in Brazil and its consequences on people's behaviour and mental health, including the occurrence of domestic violence and accidents.

Drinking is clearly a very important problem in Brazil, and to address this issue we are deeply aware that solid scientific data are required.

Declaration of interest

AGA is the Executive President of CISA.