Multinational corporations and addictive disorders: Analytic framework and sites for public health intervention

After a brief review of addictive mechanisms common to different diseases and disorders, this presentation will focus on multi-national corporations that derive profits from domestic and worldwide sales of products to which consumers become addicted. To increase profits and overcome competitors, corporations use various inducements to sell their products, including product modification to strengthen addictive properties and environmental modifications to elicit potential consumers' knowledge of, interest in, and attractiveness to the products. I demonstrate a cyclic epidemiologic cascade framework, ECF, whose main features apply to diverse potentially addictive products. The framework includes two bow-tie knots (sites, where inputs converge leading to divergent outputs), at the corporate and consumer levels, respectively, and three zones. In Zone A, outputs from the corporation cascade through conduits along five sectors to reach the consumer; Zone B contains inputs and outputs between corporation and governments along the same five sectors; in Zone C, outputs of product sales, consumer health and behavioral effects, and public and professional actions emerge and return as inputs to the corporation to start a new cycle. Notably, the government does not act as a bow-tie knot. I shall present various public health policy interventions for addiction related disorders and diseases that can be conducted within each Zone.