Public health is challenged by lobbies : “Decisions should not be imposed by economical interests, but by those of consumers, patients.”

Should public health decisions be guided by the interests of consumers and patients or by the economic imperatives of companies?

In a joint interview with Le Monde, Serge Hercberg, a nutritionist and initiator of the Nutri-Score, and Stéphane Besançon, director of the NGO Santé Diabète and advocate for insulin access, denounce the pressures exerted by the agri-food and pharmaceutical industries.

In light of health challenges, they call for stricter regulation and decisions based on scientific evidence rather than economic interests. Their message is clear: ensuring healthier nutrition and equitable access to treatments requires strengthening the independence of health authorities.

We publish the full article in English below :

Public health is challenged by lobbies : “Decisions should not be imposed by economical interests, but by those of consumers, patients.”

 

In a joint interview for “Le Monde”, nutritionists  Serge Hercberg, who worked for the Nutri-Score labeling system, and Stéphane Besançon, head of the Santé Diabète NGO, call for an improved pressure on the pharmaceutical industries and those of processed food.

Words gathered by Sandrine Cabut. Published on February the 17th 2025 

Despite being a generation apart, they lead more and more projects in common, on thematics such as nutrition and chronic diseases, with the goal to make public health move forward while repelling the grip of pharmaceutical industries and those of processed food on political decisions. Serge Hercberg, who’s a doctor, a researcher, an epidemiologist and a nutritionist, started the Nutri-Score label, that he keeps on defending and promoting at 73. In 2022, he published the book “Eat and keep quiet. A nutritionist against the lobbies of processed food ” (HumenSciences) (“Mange et tais-toi”) in which he told the story of his long battle for this system of information regarding the nutritional quality of foodstuff, which is represented by five letters and colours.

Stéphane Besançon, 47, is a biologist and a nutritionist. He’s at the head of an NGO based in Mali, Santé Diabète and an associate professor of global health at the National Conservatory of Arts and Métiers. He has been among the key actors of a resolution of the World Health Organisation, which was adopted in 2021 to grant universal access to insulin. Joint interview.

What was it that brought you to work together ?

Serge Hercberg : Our paths have been similar for a long time and we were aware that we had values in common but there were no direct links between us. The source of our collaboration was the common writing of a chapter on the influence of lobbies on public health politics, for the book : “Our health belongs to us” (“Notre santé nous appartient”) (directed by Pauline Londeix and Jérôme Martin, Armand Colin, 2024). Moreover, Stéphane Besançon has recently led, alongside with others, works on the Nutri-Score. Through 134 articles related to that topic, which were published within a journal with a reading committee, his coworkers and himself proved that 83 % of them were in favour of this nutritional labelling. Although their work also showed that it was 21 times more possible for a study to be against it if the authors had declared a link of interest with the processed food industry, or if their work was funded by it.

Our main goal is that of defending public health for the good of consumers, patients, citizens and everyone. Throughout our careers, both of us have been confronted to lobbies and to the difficulty of implementing public health measures, when they happen to go against economic interests, and even those that are based on science ! This strengthened us and made us bond through work.

Stéphane Besançon : Being involved in my NGO, Santé Diabète, I spent the recent years working on the issue of universal access to insulin. It is a vital medicine for people affected by type 1 diabetes. However, it used to be inaccessible for a majority of patients around the world for financial reasons. This issue, for which we finally obtained a resolution from the WHO in 2021, led me to interact with several speakers, including those who work in pharmaceutical labs as well as their shifts. Due to several reasons and especially because there are also emergencies in this field, I want to be just as involved when it comes to nutritional issues.

Serge Hercberg and I demand for a form of activism that is based on science. This scientific basis is crucial because that’s what enables us to move forward and make a significant impact, since raising fists isn’t enough. Lobbies obviously try to counter us, especially when we publish studies, but doing so is harder for them when we’ve got our solid and rational weapon beside us, which is science. Right now, only a few of us adhere to this approach, which explains why we seek to build ties, so as to become stronger and more resistant.

 

In the past, several specialists who partnered played a significant role when it came to making public health issues move forward, on the political front. The five “wisemen” come to my mind, whose interventions and recommendations led to, but not only, the Evin Law in 1991, which forbade the marketing of tobacco and alcohol. Have such collective and cross-cutting movements become scarce ?

S.H : Those five pioneers, Claude Got, François Grémy, Albert Hirsch and Maurice Tubiana, had allied their skills in each field of public health to convince political leaders of the necessity of implementing coherent measures. Apart from the Evin Law, they tackled other issues, such as road safety. Since 1988, the health Club which they created has organised itself to call out candidates during each presidential election, on major public health matters. Throughout time, its team has evolved, and I have been a part of it for about fifteen years. I intervene on nutrition related issues. Although the composition of the club has changed, this mission remains active and takes place at each election. Having a collective voice that can get itself heard is important, although we’re not fond of terms such as “wise” or “experts”, which often have a negative connotation.

 

Let’s come back to the Nutri-Score. You both signed, alongside the nutrition epidemiologist Mathilde Touvier and the philosopher Cynthia Fleury, a paper in our divisions on October the 24th in 2024, in which you expressed a demand towards the Prime Minister to make it obligatory and to support this position on the European scale. Any updates regarding that ?

S.H : During the last update, which was on February the 5th,  1,777 health professionals as well as scientists, expressed their support for this appeal. It’s relevant to note that among them were 55 learned institutes, associations and NGOs. That is encouraging considering the fact that it represents thousands of specialists, field interveners, consumers, patients etc., all of which are involved. Although it is a shame that a learned institute such as the Société Française de Pédiatrie, which usually supports our work, didn’t sign it. That can probably be explained by the existence of links of interest that some of its members have with the processed food industry.

Recently, on BFM-TV, Catherine Vautrin, who’s the Minister of labour, health, solidarity and families, declared she wanted to move even further regarding the Nutri-Score, for the sake of prevention. We’ll see what will come out of it, but we must in fact progress at two different levels. First, we need to work on the obligatory status of the Nutri-Score display on all types of food. The European Commission was supposed to impose legislation regarding this in 2022, but that’s still not the case. It seems like Europe is giving in to the lobbies. It’s worth reminding that there are over 50 000 lobbyists in Brussels, which means that there are more of them than government officials !

In parallel, we’ve been awaiting the publication of an interministerial decree, regarding topics such as health, agriculture and economy, to establish an update of the Nutri-Score which was decided in 2023 on the basis of scientific arguments. This new version, which was supposed to take effect on January the 1st in 2024, penalises unhealthy products even more, such as those that are too high in sugar or salt, but also meat or drinks to which artificial sweeteners have been added, and more generally speaking, extremely processed food. The government keeps telling us that it is only a matter of days, but for now, we’ve yet to see any change.

We could think that, this too, is being countered by industries and growers that do not view this evolution as something positive. Let’s take Danone for an example : it had applied the Nutri-Score since its beginnings in 2017 and announced in september its decision to remove it from certain of its brands, such as, for instance, their Actimel yoghurt drinks, Activia or Danonino, whose scores have legitimately started to degrade after the update, because of their high content in sugar.

S.B. : When faced with this type of situation, political leaders always bring the same argument : “That’s too complicated, we can’t…”. But when there is actual willingness, we can see that many things become possible. For the cost of insulin for example, things went in order when the president of the United-States, Joe Biden, announced that the cost would go from 250 dollars to 35 dollars (approximately 242 euros to 34 euros). Then, a laboratory said it would comply with it, a second laboratory said it would lower the cost, a third one announced it would put an even lower one etc. Although this resolution has not yet been fully applied on the field, it is now doable, thanks to our long battle. In fact, this argument of “complexity” in relation to Europe or some other regulations, often serves as an alibi to not implement certain measures.

 

You’re yourself sometimes called a lobbyist by your speakers and institutions ?

S.B : Exactly. Many people, and especially political leaders, tell us “Many lobbyists are in touch with us and you’re only a category among others”. Some use the expression “social lobbying”. Whilst it is true that we use strategies of advocacy that can sometimes seem similar to those of lobbyists, their vocation is based on economy, whereas we seek to defend public policies, public health, and a reasonable cost of medication. Speaking of that, we are now labeled as “anticapitalists” as soon as we criticise the pharmaceutical industry or private interveners. That’s not the matter. I am not against pharmaceutical laboratories, I interact with them and always do so as a volunteer, to avoid having any links of interest. My problem is not them existing, I simply want them to be at their right place.

S.H. : Absolutely. The same thing can be noticed with the processed food industry. We’re not countering certain industries because of some ideology of ours, but because they go against public health measures whose necessity and efficiency has been backed by science. We simply want regulations so that decisions will not be imposed by economic interests of certain groups, but by those of consumers and public health.

 

You’ve been warning against the dangers of the existence of links of interests between scientists and industries for years now. Did their methods change ?

S.B. : I can tell you what hasn’t changed much, and it’s the funding system of opinion leaders by industries, as well as its consequences on their freedom. Pressure does not necessarily imply threats, it’s often way more subtle. However, when an industry funds a research project, it is impossible to have the same freedom and not to be influenced, even subconsciously. There can be no subvention without compensation.

However, what has changed in the course of recent years, is something that I’ve noticed regarding NGOs or civil society and it is the increase of public-private partnerships. Due to the scarcity of public fundings, partnerships with private institutions are becoming more common, which helps research. We’ve also witnessed the development of some form of greenwashing from industries, along with some polished speeches. They make it seem like they’re humanitarian agencies but we must keep in mind that their financial power is significant. Thanks to the Ozempic and the Wehovy (analogues of commercialised GLP-1s to treat diabetes and obesity), the market value of the Danish Novo Nordisk group has exceeded the gross domestic product of Denmark. Its foundation is the richest non-profit foundation in the world, above the (Bill and Melinda) Gates Foundation. When a group possesses this amount of economic power within a country, it raises democratic problems, especially considering the fact that the pharmaceutical market is about to experience exponential growth.

S.H. : The lobbies have been funding studies that go against the results of academical science for a while now. The way they proceed is also more and more clever. Nowadays, in an attempt to discredit works that bother them, not only do they lead other works to counterbalance or attack their methodologies, but they trick people into believing that researchers who publish works that go against their interests, themselves have conflicts of interests ; and that constitutes their new strategy. Besides, since they could not find any about us on the economic front, they invented the notion of economic or intellectual conflicts of interest.

For some time, people tried to discredit me by saying that I was defending the Nutri-Score because it was my “baby”. One of the expressions that was used was “the Smarties of professor Hercberg”, as if it was some whim or personal opinion, but not science. A few months ago, during a meeting organised by the Belgian presidency in Brussels, some lobbyists called me out, questioning me on whether my works that had been published within international journals were really worth it or not, since I had designed, alongside with my team, the Nutri-Score.

 I always explain that my coworkers and I would immediately let go of the Nutri-Score if somebody was to prove that another label was more effective, and that we’re not viscerally attached to it and that we’ve got nothing to gain from supporting it. That’s the reason why I dislike being called the “father of the Nutri Score”…The real “father” is the research.

We’re also accused of making science “between buddies”. Stéphane Besançon was accused of this when he analysed the studies regarding the Nutri-Score. However, even if we remove publications from our team, he found that the probability of an article being adverse to the Nutri-Score was 7 times more significant when the authors had links of interest with the industry, against 21 in total.

 

What about scientists ? Are they more educated regarding these issues of conflicts of interest today ?

S.H. : The media coverage of health scandals of the past few decades, such as the Mediator case, have been extremely useful. It’s what led to the creation of the Transparence.sante.gouv base, which enables us to see the links of interest of healthcare professionals with pharmaceutical industries. It’s true that some contracts protected by industrial secrets do not appear within the base, and it is unfortunate that the processed food industries do not face the same obligations, but it’s a great beginning to move towards transparency. Healthcare professionals will obviously keep on having links of interest, but it is now a choice, a conscious one. A few decades ago, that wasn’t really the case, and no one was really questioning it. I’ve noticed that younger generations of healthcare professionals that are part of the research teams are far more educated on these issues and are more aware of the complexity of working with economic operators than I was at the beginning of my career

S.B : The topic of climate is one of the reasons for this awareness. Younger generations can definitely see that conflicts of interest are terrifying in this field. The problem is that, while all of this is happening, we’re within a system that is facing a real scarcity of public resources but also private finding which are becoming more and more significant…The message is clear : putting an end to conflicts of interest also means reinjecting public funds…and taking radical decisions. It’s been quite a while now since people have started to suggest the idea of endowment funds in which industries would disburse money that would then stop having control over. If they genuinely are ready to make fundings, let them do it, the redistribution would then take place without them having control over it. These suggestions have been laid on the table for years, but no change so far. I believe that the priority today is to control the lobbies by imposing strict standards and better regulation of the industries. If we want this to work out, we need to act on both levels.

 

Translation by Amina Taguirov.