I wrote this piece for The Guardian in response to the New York Times article earlier this week about Coca-Cola’s funding of scientists who think obesity is more about exercise than drinking sodas:

These days, you almost have to feel sorry for soda companies. Sales of sugar-sweetened and diet drinks have been falling for a decade in the United States, and a new Gallup Poll says 60% of Americans are trying to avoid drinking soda. In attempts to reverse these trends and deflect concerns about the health effects of sugary drinks, the soda industry invokes elements of the tobacco industry’s classic playbook: cast doubt on the science, discredit critics, invoke nanny statism and attribute obesity to personal irresponsibility.

Casting doubt on the science is especially important to soda makers. Overwhelming evidence links habitual consumption of sugary drinks to poor health. So many studies have identified sodas as key contributors to chronic health conditions – most notably obesity, type-2 diabetes and coronary artery disease – that the first thing anyone trying to stay healthy should do is to stop drinking them.

Soda companies know this. For at least the last 10 years, Coca-Cola’s annual reports to the US Securities and Exchange Commission have listed obesity and its health consequences as the single greatest threat to the company profits. The industry counters this threat with intensive marketing, lobbying and millions of dollars poured into fighting campaigns to tax or cap the size of sugary drinks.

But it is also pours millions into convincing researchers and health professionals to view sodas as benign.

Just last month, the Mayo Clinic Proceedings published a study arguing that the results of national dietary surveys, such as those that link sugary drinks to type-2 diabetes, are so flawed that they constitute a major misuse of public funds. The authors report honoraria, speaking and consulting fees from Coca-Cola.

This week’s revelation of Coca-Cola’s funding of the Global Energy Balance Network is only the latest example of this strategy in action. The Network promotes the idea that to prevent obesity you don’t need to bother about eating less or drinking less soda. You just have to be more active. Never mind that most people can’t lose weight without also reducing their intake.

A reporter who looked into this group discovered that Coca-Cola had funded the research of the scientists behind it, and generously. The network’s website was registered to Coca-Cola. None of this, however, had been made explicit.

Most nutrition professional journals now require researchers to declare who funds their studies, making it possible to compare study outcomes with funding sources. Studies sponsored by Coca-Cola almost invariably report no association of sugary drinks with diabetes, they question the validity of studies that do find such associations or, as in the case of Global Energy Balance Network investigators, they find activity to be the most important determinant of body weight.

Analyses of studies funded by Coca-Cola or its trade association demonstrate that they have an 83% probability of producing results suggesting no harm from soda consumption. In contrast, the same percentage of studies funded by government agencies or independent foundations find clear linkages between sugary beverages and such conditions. Coincidence? I don’t think so.

Since March, I’ve been posting industry-funded studies with results that favor the sponsor’s interests every time I find five of them. They are easy to find. Despite pleas to readers to send me industry-funded studies that do not favor the sponsor, I hardly ever get them. Whenever I come across a study that shows no harm from sodas, I immediately look to see who paid for it.

Soda companies spend generously to convince researchers and health professionals not to worry about sodas’ health effects. But why do researchers take the money? It is too simplistic to say that they are “bought.” Industry-funded investigators say they believe the funding has no effect on the design, conduct or interpretation of their research. But research involves choices of questions, assumptions and methods. It is not difficult to carry out a study that appears to meet high scientific standards yet fails to include critical controls that might lead to alternative conclusions.

Researchers funded by Coca-Cola need to take special care to control for unconscious biases but can only do this if they recognize the possibility. Many do not. Neither do many peer reviewers or editors of scientific journals. Although food-company financial support should not necessarily bias results, it appears to do so in practice.

Industry-funded scientists resent questioning of the influence of sponsorship on the quality of their science. They charge that investigators who find adverse effects of sodas on health are equally biased by career goals, righteous zeal or anti-corporate morality. Yes, independent scientists may have biases of their own, but their overarching research goal is to improve public health. In contrast, the goal of soda companies is to use research as a marketing tool.

Disclosure is essential. If a study is funded by Coca-Cola, caveat emptor.

I’ve had a busy week dealing with the aftermath of Anahad O’Connor’s New York Times story about how Coca-Cola pays scientists who argue that obesity is more about activity than what you eat—drinking sodas, for example (I’m quoted).   It’s gotten 1180 comments.

Here’s Dan Wasserman’s from the Boston Globe:

In all fairness, let’s see what Coca-Cola’s Chief Technical Officer, Dr. Ed Hays, says in response (straight out of the tobacco industry’s playbook):

I was dismayed to read the recent New York Times’ inaccurate portrayal of our company and our support of the Global Energy Balance Network (GEBN). The story claimed Coke is funding scientific research to convince people that diets don’t matter – only exercise. In fact, that is the complete opposite of our approach to business and well-being and nothing could be further from the truth.

Yes, we fund scientific research through GEBN and we are proud to support the work that scientists such as Dr. Jim Hill and Dr. Steve Blair do – because their type of research is critical to finding solutions to the global obesity crisis.

At Coke, we believe that a balanced diet and regular exercise are two key ingredients for a healthy lifestyle and that is reflected in both our long-term and short-term business actions.

The article even got the attention of Congress.  Here’s the statement from Rosa de Lauro (Dem-CT), sponsor of The SWEET Act to tax sugars:

This research is reminiscent of the research conducted by the tobacco companies to mislead the public about the health risks of smoking.  The American public will not be fooled. There is a wealth of sound scientific research that demonstrates the link between sugar-sweetened beverage consumption and a host of health conditions, including diabetes, heart disease, and obesity.  This new group and their research are a sham,” DeLauro said.  “People want to be healthy and they want their kids to be healthy and realize that drinks full of empty calories are not good for them. That is why more and more Americans are opting to drink less soda every year.

I wrote a piece for The Guardian, which I will post tomorrow.

I don’t keep track of my interviews or media appearances unless people send me links (I post them under Media), but Rachel Harrison at NYU kept score yesterday.  As I said, a busy couple of days.

• Fortune
• RT
• USA Today
• US News & World Report
• NPR
• Washington Post Wonkblog
• Washington Post Health Section
• CBS Atlanta
• CBC
• PLoS Blog
• Take Part
• Huffington Post
• Latina
• Business Insider
• Journal of Public Heath Policy 

Additions, August 14

Fox News, August 11

• Shepard Smith says “the story “reminds you of exactly what the tobacco industry did back in day, and more recently, it also reminds you of what the climate deniers — the climate change deniers — are doing as well.”
• Rush Limbaugh said the Times‘ Coca-Cola story “undermine[s] the whole notion of a scientific consensus,” because it “can be bought and paid for.”

New York Times editorial, August 14

the evidence continues to mount that sugar-sweetened drinks are a major contributor to obesity, heart disease and diabetes, and that exercise makes only a modest contribution to weight loss compared to ingesting fewer calories.

Don’t miss the article on the front page of today’s New York Times about Coca-Cola’s paying scientists who argue that obesity is more about exercise than diet (I’m quoted).

Last week, I posted two industry-funded studies with results that must have made their sponsors extremely unhappy.

But results like that are rare—so rare that the Washington Post wrote about one of them.

Today, I’m doing another in my series of posts of 5 (sometimes 6) studies sponsored by food and beverage companies for the purpose of obtaining results that can be used in marketing.

Since March, the count is 42 studies with results favorable to the sponsor but only 1 unfavorable (the other was from last year).

If you run across either kind, but especially industry-funded studies that don’t produce expected results, please send.

Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Berger, S., Raman, G., Vishwanathan, R., Jacques, P.F., Johnson, E.J., 2015. Am J Clin Nutr ajcn100305. doi:10.3945/ajcn.114.100305.

• Conclusion: Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk.  [Implication: suggestions that eggs might raise cardiovascular risk are unwarranted]
• Sponsor: Supported by USDA agreement 1950-51000-073 and the American Egg Board, Egg Nutrition Center.

Milk intake is not associated with low risk of diabetes or overweight-obesity: a Mendelian randomization study in 97,811 Danish individuals.  Helle KM Bergholdt, Børge G Nordestgaard, and Christina Ellervik.  Am J Clin Nutr.  doi: 10.3945/ajcn. 114.105049

• Conclusion: High milk intake is not associated with a low risk of type 2 diabetes or overweight-obesity, observationally or genetically via lactase persistence. The higher risk of type 2 diabetes in lactasepersistent individuals without milk intake likely is explained by collider stratification bias..
• Funding source: HKMB’s PhD project was partly funded by the Research Unit at Naestved Hospital, the Danish Dairy Research Foundation

Dietary Approaches to Stop Hypertension diet retains effectiveness to reduce blood pressure when lean pork is substituted for chicken and fish as the predominant source of protein. R Drew Sayer, Amy J Wright, Ningning Chen, and Wayne W Campbell. Am J Clin Nutr 2015; 102:302-308 doi:10.3945/ajcn.115.111757

• Conclusion: The results indicate that adults with elevated BP [blood pressure] may effectively incorporate lean pork into a DASH-style diet for BP reduction.
• Sponsor: This paper is sponsored by the national pork board.

Relationship between lifestyle behaviors and obesity in children ages 9-11: Results from a 12-country study. Katzmarzyk PT, Barreira TV, Broyles ST, Champagne CM, Chaput JP, Fogelholm M, Hu G, Johnson WD, Kuriyan R, Kurpad A, Lambert EV, Maher C, Maia J, Matsudo V, Olds T, Onywera V, Sarmiento OL, Standage M, Tremblay MS, Tudor-Locke C, Zhao P, Church TS; ISCOLE Research Group.

• Conclusion: Behavioral risk factors are important correlates of obesity in children, particularly low MVPA [moderate to vigorous physical activity], short sleep duration, and high TV viewing.  [Implication: what they eat and drink doesn’t matter]
• Sponsor: This research was supported by The Coca-Cola Company.

A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. M. Elia, C. Normand, A. Laviano , K. Norman.  Clinical Nutrition 2015, online ahead of print. doi:10.1016/j.clnu.2015.05.010

• Conclusions: Overall, the reviewed studies, mostly based on retrospective cost analyses, indicate that ONS [oral nutritional supplement] use in the community produce an overall cost advantage or near neutral balance, often in association with clinically relevant outcomes, suggesting cost effectiveness. There is a need for prospective studies designed to examine primary economic outcomes.
• Authors’ disclosures: ME, CN and AL have received honoraria for giving independent talks at national/international conferences supported by industry. KN has received speakers’ fees as well as financial support for research projects by commercial companies.
• Comment: most studies of supplement use find little evidence of benefit.  Taking honoraria from industry doesn’t sound like much of a problem unless these financial ties are with supplement companies.  The authors do not specify and the journal’s editors must not require such specification.  They should.

Cricket Azima.  Everybody Can Cook.  DRL (Different Roads to Learning) Books, 2015.

This is for kids ages two and up.  It’s more than a cookbook.  It’s a curriculum. Cricket Azima, who founded and heads The Creative Kitchen, aims this at all kids, but especially those with physical and developmental disabilities.

I gave it a blurb:

People like me are always talking about how important it is to teach kids to cook.  You aren’t sure how?  Cricket Azima’s Everybody Can Cook is just what you need to have fun with your kids in the kitchen.  The recipes are easy and delicious.  Get your kids to start making dinner!

As regular readers know, I’ve been posting studies funded by food companies with results favorable to the companies’ interests whenever I run across five of them.   Since mid-March, I’ve posted 7 such collections for a total of 37 studies (two of the posts listed 6 studies).  These are all papers published since March.

With each set, I asked readers to send examples of studies that do not favor the sponsor’s interest.

They are rare, but do exist.  I’ve been sent two so far.  I’m guessing it will be a long time before I collect five, so have a look:

Butter increased total and LDL cholesterol compared with olive oil however resulted in higher HDL cholesterol than habitual diet. Sara Engel and Tine Tholstrup.  American Journal of Clinical Nutrition, July 1, 2015, doi: 10.3945/​ajcn.115.112227.

• Conclusions: Moderate intake of butter resulted in increases in total cholesterol and LDL cholesterol compared with the effects of olive oil intake and a habitual diet (run-in period). Furthermore, moderate butter intake was also followed by an increase in HDL cholesterol compared with the habitual diet. We conclude that hypercholesterolemic people should keep their consumption of butter to a minimum, whereas moderate butter intake may be considered part of the diet in the normocholesterolemic population.
• Sponsor: Danish Dairy Research Foundation
• Comment: The data clearly show that butter raises blood cholesterol levels.  The authors spin it as positively as possible—higher HDL and it’s OK for people with normal cholesterol to eat moderate amounts of butter—but they make the downside quite clear.  In this study, “moderate” butter means 4.5% of calories or just 2/3 of a tablespoon for someone eating 2000 calories.  That’s not much, alas.

Influence of Pistachios on Performance and Exercise-Induced Inflammation, Oxidative Stress, Immune Dysfunction, and Metabolite Shifts in Cyclists: A Randomized, Crossover Trial.  David C. Nieman, Johannes Scherr, Beibei Luo, Mary Pat Meaney, Didier Dréau, Wei Sha, Dustin A. Dew, Dru A. Henson, Kirk L. Pappan.  PLoS One, November 19, 2014. DOI: 10.1371/journal.pone.0113725

• Conclusion: In summary, 2-weeks pistachio nut ingestion was associated with reduced 75-km cycling time trial performance and increased post-exercise plasma levels of raffinose, sucrose, and metabolites related to leukotoxic effects and oxidative stress.
• Funder: This work was supported by American Pistachio Growers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Comment:  It’s obvious that the funders had no role.  I’ll bet they are quite unhappy with the results.

This second study came out last year but I’ll take any of these I can get.  Please do send.

But if I’m just counting since March, the ratio is 37 studies favoring the sponsor’s interest, to 1 that doesn’t.  Coincidence?  I’m not convinced.

Earlier this week, President Obama announced a plan to reduce toxic emissions from coal-burning power plants.  The purpose of the EPA’s Clean Power Plan  is to reduce greenhouse gases that contribute to climate change.

But from the standpoint of food politics, the new rules do something really important.  They will force coal-burning power plants to further reduce emissions of mercury.

In 2005, the EPA promulgated a rule to control mercury emissions from fossil fuel-fired power plants under section 111(d): the Clean Air Mercury Rule (CAMR). The EPA established a nationwide cap-and-trade program that took effect in two phases: In 2010, the cap was set at 38 tons per year, and in 2018, the cap was lowered to 15 tons per year. The EPA expected, on the basis of modeling, that sources would achieve the second phase, 15-ton per year cap cost-effectively by choosing among a set of measures that included shifting generation to lower-emitting units.

Mercury from coal-burning power plants is the largest human-induced source of methymercury in the fish food chain, accounting for 40% of the amount that gets into oceans (most of the rest comes from underseas volcanos).  Mercury is converted to toxic methylmercury in seawater, and the toxin moves up the fish food chain as bigger fish eat smaller fish.  Methylmercury does very bad things to the nervous system of the growing fetus (recall the mass poisonings in Minamata, Japan in the 1950s and the shocking photos of the victims). 

Fish advisories

Large, predatory fish have the most methymercury and should not be eaten in large amounts, or at all by pregnant women.

Fish advisories expect pregnant women to know the kinds of fish they can and cannot eat, and how much.  This is not easy.

Wouldn’t it be better to prevent mercury from getting into seawater in the first place?

I like to use eliminating methylmercury as an example of why public health (“upstream”) approaches work better than personal responsibility (“downstream”) approaches.

An exceptionally clear example is how to avoid toxic levels of methylmercury in fish.   We can teach pregnant women to recognize which fish are high in methylmercury and hope this works well enough so they will avoid buying such fish (personal responsibility) or we could–as a society–require coal-burning power plants to scrub their emissions so mercury doesn’t get into ocean or lake waters in the first place (public health).

That’s what this rule does.

For explanations of how the Clean Power Plan will work, see the Union of Concerned Scientists’ review.

Vox.com explains:

The basics of the Clean Power Plan are fairly simple. The EPA is giving each state an individualized goal for reducing emissions from their electric power plants. States can then decide for themselves how to get there…. Power plant emissions have already dropped 15 percent between 2005 and 2013, thanks to a brutal recession, cheap natural gas pushing out coal, the rise of wind power, and improved efficiency. So with this new plan, EPA is expecting a further 20 percent cut in power-plant emissions from 2013 levels by 2030.

For what Obama stands to gain from this rule, see the New York Times.

But hold the celebration.  Politico Pro Energy reports that Republicans in Congress view the rule as a key component of the administration’s “war on coal” and will try to block it or sue to stop it.   The Supreme Court says that the EPA has the authority to issue this rule, but “Challengers are expected to argue that the rule is invalid because it exceeds EPA’s authority, contradicts a Clean Air Act provision meant to avoid duplicative rules, and violates the 5th and 10th Amendments to the Constitution.”   And, of course, a post-Obama president could undo the whole thing, as it is an executive branch action, not a law passed by Congress.

Yesterday’s New York Times had a front-page story on how coal lobbyists and corporate lawyers started organizing more than a year ago to fight this plan.

An important ally in the effort was the American Legislative Exchange Council, or ALEC, a conservative advocacy group that pushes policy through state legislatures. Typically, the council’s committees of corporate members will craft a model bill designed to push through policies it supports, such as rolling back environmental regulations.

The Clean Power Plan deserves massive support.

This may be a climate-change plan, but it is also a critically important public health measure.

Anyone who likes eating fish should do everything possible to support this measure.

On my 12th-floor Manhattan terrace, I grow cilantro every summer.  I like to have it handy.  And I know it’s local, organic, seasonal, and deer-free—and unlikely to be contaminated with Cyclospora.

The CDC reports 358 people to be ill with Cyclospora, most likely because they ate cilantro imported from Mexico.

It doesn’t take much web surfing to find out anything you want to know about such problems.  I like to use three sources:

The CDC

• Information about Cyclospora
• A paper on Outbreaks of Cyclosporiasis — United States, June–August 2013
• A fact sheet
• An explanation of investigations of foodborne outbreaks
• 2014 Outbreak Investigations
• 2013 Outbreak Investigations
• Advanced Molecular Detection for Cyclospora
• Time to Think About Cyclosporiasis
• A Webinar for health-care providers

The FDA

• A statement
• Advice for consumers.
• An import Alert
• An explanation of how the US is working with Mexico to make cilantro safer
  

Bill Marler

• His blog

Despite my long interest in and dubious opinion about the benefits of Golden Rice (genetically modified to contain the beta-carotene precursor of vitamin A), I somehow completely missed the huge and highly embarrassing uproar over a study demonstrating the effectiveness of this rice in raising vitamin A levels in young children.

This particular uproar began with publication of the study in the American Journal of Clinical Nutrition in 2012.  Last week the journal announced that it has retracted the study—on ethical, not scientific, grounds.

To explain:  Dr. Guangwen Tang, a long-time researcher at Tufts University, and her colleagues at Tufts, in China, and at Baylor and the NIH, compared the effectiveness of vitamin A capsules, Golden Rice, and spinach in raising vitamin A levels in the blood of Chinese schoolchildren.  They reported that Golden Rice proved just as effective as capsules, and somewhat better than spinach, in inducing higher vitamin A levels, just as it is supposed to do.

Golden Rice, of course, is the poster child for the benefits of GMOs, extolled by many as the solution to the developing world’s high prevalence of vitamin A deficiency (I’m dubious because I view vitamin A deficiency as a social problem requiring policy and cultural shifts).

Soon after, Greenpeace, which is decidedly anti-GMO, challenged the ethics of the study, charging that the children were being used as “guinea pigs.”

As reported in Nature,

none of the children, their parents or school teachers was aware that Golden Rice was involved, according to a 45-minute investigative news programme broadcast on 8 December on CCTV, China’s state television channel.  The informed-consent form said that the rice contained β-carotene, but not that it was genetically modified or that it was Golden Rice. Nor did it highlight uncertainty around any potential risks of ingesting such rice…Moreover, Wang didn’t apply for ethical evaluation of the trial, instead fabricating the approval documents, according to CDC. And Tang brought Golden Rice from the United States to China illegally, without due declaration to the relevant Chinese authorities, it said.

According to a report on NPR, Tufts University did a year-long investigation and agreed that ethical standards had been violated:

the study was not “conducted in full compliance with … policy or federal regulations”… the researchers did not adequately explain the nature of golden rice and made some changes in the study without getting approval from the committee at Tufts that is supposed to review all research involving human subjects.  Guangwen Tang will be banned from conducting research on human subjects for two years. For two years after that, any research that she conducts will be under the direct supervision of another investigator.

A report on the case in ScienceInsider explains the ethical problem raised by the study’s informed consent form :

U.S. guidelines stipulate that such forms use plain language understandable to lay people, and the IRB [the Tufts Institutional Review Board] agreed to let Tang say that “Golden Rice is a new rice which makes beta-carotene,” without using the loaded words “genetically modified.” (The consent form for a very similar study by Tang among adults in Boston, published in 2009, didn’t use that term either.) Given the sensitivities over transgenic food, which existed in China as well, that was the wrong decision, according to the external panel.

In 2014,  Dr. Tang sued the ASN:

ASN twice asked Tang and her six co-authors to withdraw the paper voluntarily, which they declined to do. The society recently decided to retract the paper on its own…but it has agreed to a 90-day stay after Tang filed her lawsuit, to see if the matter can be settled out of court.

But the court ruled in favor of ASN.  Hence, the retraction.  ASN issued a press release:

In a ruling by the Massachusetts Superior Court, Judge Salinger…cleared the way for the American Society for Nutrition (ASN) to retract the article “β-Carotene in Golden Rice is as good as β-carotene in oil at providing vitamin A to children”…ASN is very pleased that the Massachusetts courts have upheld the organization’s First Amendment rights and have allowed ASN to move forward with the retraction of the article.

In its online retraction notice, ASN states the reasons:

1. The authors are unable to provide sufficient evidence that the study had been reviewed and approved by a local ethics committee in China in a manner fully consistent with NIH guidelines….
2. The authors are unable to substantiate through documentary evidence that all parents or children involved in the study were provided with the full consent form for the study.
3. Specific eligibility issues were identified in regard to 2 subjects in the study.

Last week, Retraction Watch published a lengthy summary of this case that includes a long statement from Tufts University:

No questions were raised about the integrity of the study data, accuracy of the research results or safety of the research subjects…Tufts University has always been and remains deeply committed to the highest ethical and scientific standards in research.  In September 2012, w …convened an external review committee to interview those involved and to review documentation of the study…There was no evidence found of falsification or fabrication of the data that underlie the study’s primary findings. Those reviews did, however, determine that the research had not been conducted in full compliance with Tufts research policies and federal research regulations.

The retraction is a huge embarrassment, not only for the researchers involved but also for Tufts University’s Friedman School of Nutrition Science and Policy, Tufts’ Institutional Review Board, the American Journal of Clinical Nutrition, and the American Society for Clinical Nutrition.

The study was funded by NIH, USDA, as well as a program in China.  NIH takes research ethics very seriously and expects the researchers it funds to adhere to the highest possible standards for research on human subjects.  Because the study did not follow standard ethical guidelines, especially with regard to research on children, Tufts had no choice but to investigate and impose sanctions, and the journal had no choice but to retract the paper.

This case reinforces my views about GMOs in general and Golden Rice in particular.

The controversies are not (or not usually) about the science.  They are very much about ethics and other questions of values.