Currently browsing posts about: Conflicts-of-interest

A big question for discussion is whether plant-based meat alternatives are better for health and the environment than regulat meat.  Are they?  Here is one study.

Plant-based animal product alternatives are healthier and more environmentally sustainable than animal products.  
Christopher J. Bryant.  Front Nutr.  2022 Jul 19;9:934438.   doi: 10.3389/fnut.2022.934438. eCollection 2022.

Rationale:   There are strong reasons to move away from industrial animal agriculture for the good of the environment, animals, our personal health, and public health. Plant-based animal product alternatives (PB-APAs) represent a highly feasible way to reduce animal product consumption, since they address the core consumer decision drivers of taste, price, and convenience.

Method: This paper reviews 43 studies on the healthiness and environmental sustainability of PB-APAs compared to animal products.

Findings:  In terms of environmental sustainability, PB-APAs are more sustainable compared to animal products across a range of outcomes including greenhouse gas emissions, water use, land use, and other outcomes. In terms of healthiness, PB-APAs present a number of benefits, including generally favourable nutritional profiles, aiding weight loss and muscle synthesis, and catering to specific health conditions.

Conclusion:  As more conventional meat producers move into plant-based meat products, consumers and policymakers should resist naturalistic heuristics about PB-APAs and instead embrace their benefits for the environment, public health, personal health, and animals.

Conflict of interest: Although there is no specific conflict of interest or funding related to this project, the author is an independent research consultant and works with alternative protein companies.

Comment:  You would think that plant-based meat alternatives would be better for the environment than beef but without an agreed-upon method for assessing environmental impact, much depends on researchers’ assumptions.  This literature review was done by a consultant who does research for companies making alternative-to-meat proteins.   His conclusion based on his study—the takeover of small plant-based meat companies by Big Meat is a Good Thing—is predictable from his conflicted interest.  I’d prefer an independent assessment of the environmental implications of these products.

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The advocacy group, U.S. Right to Know, sent out a press release to announce publication of an article in the British journal, Public Health Nutrition: The corporate capture of the nutrition profession in the USA: the case of the Academy of Nutrition and Dietetics.

The Academy of Nutrition and Dietetics [AND, formerly the American Dietetic Association] accepted millions of dollars from food, pharmaceutical and agribusiness companies, had policies to provide favors in return, and invested in ultra-processed food company stocks, according to a study published today in Public Health Nutrition…The study was produced by public health scholars and U.S. Right to Know, a nonprofit investigative public health group that obtained tens of thousands of pages of internal Academy documents through state public records requests.

I’ve been writing about corporate capture of AND (formerly the American Dietetic Association) for years (see below), but this study shocked even me, for two reasons.

• AND holds stock in food companies making ultra-processed foods.

The documents show that the Academy and its foundation invested funds in ultra-processed food companies. The Academy’s investment portfolio in January 2015 included $244,036 in stock holdings in Nestle S.A. and $139,545 in PepsiCo. The Academy foundation’s investment portfolio in June 2013 included $209,472 in stock holdings in Nestle S.A and $125,682 in PepsiCo.

• The list of food companies donating to AND is extraordinarily long; it goes on for pages.

The Academy accepted more than $15 million from corporate and organizational contributors in the years 2011 and 2013-2017. The Academy’s top contributors in 2011 and 2013-2017 were:

• National Dairy Council $1,496,912
• Conagra Inc. $1,414,058
• Abbott Nutrition $1,246,389
• Abbott Laboratories $824,110
• Academy of Nutrition and Dietetics Foundation: $801,261
• PepsiCo Inc. $486,335
• Coca-Cola Co. $477,577
• Hershey Co. $368,032
• General Mills Inc. $309,733
• Agency for Healthcare Research and Quality $296,495
• Aramark Co. $293,051
• Unilever Best Foods $276,791
• Kellogg USA $273,272

The Academy’s response: Inaccuracies in U.S. Right to Know Article

The report is disjointed, mostly opinion, emails taken out of context, picking and choosing items based on words out of Board reports, etc.

The Academy lists facts

• One of the authors has strong financial ties to CrossFit, a staunch opponent to RDN licensure.
• Less than 9% (12 out of 149) of named scholarships, awards and named research grants were established through industry. The funds that are established have input into scholarship criteria, which are approved by the Foundation’s Board. An independent review committee then reviews applications and selects recipients.
• Less than 2% (32 out of 2,812) of donors to the Academy’s Second Century were industry donors.

Additional Academy facts

• Fact: The Academy is NOT influenced by sponsorship money
• Fact: Less than 3% of the Academy’s and the Foundation’s investments are in food companies.
• Fact: The Academy has never changed a position at the request of sponsors.
• Fact: Less than 9% of Academy funding comes from sponsorship.
• Fact: The Foundation’s Fellows program allows participants to serve as catalysts for change and advancement in emerging areas of need for the evolving nutrition and dietetics profession.
• Fact: The Academy and Foundation have always been committed to accountability through transparency and fiduciary responsibility.

Comment

I have been writing about the Academy’s ties with food companies for years.  See, for example,

• March 17, 2008  OK. Time to talk about the American Dietetic Association’s alliances with food companies
• March 13, 2015  Dietitians put seal on Kraft Singles (you can’t make this stuff up)
• March 18, 2015  Dietitians in turmoil over conflicts of interest: it’s about time
• March 1, 2017  The recent Academy of Nutrition and Dietetics’ election: controversy over non-disclosure of industry ties
• September 9, 2020  Dietetic Association lets Bayer, owner of glyphosate, educate its members about pesticides (but see correction below)
• A chapter in my book, Unsavory Truth: How the Food Industry Skews the Science of What We Eat

In my book, I document how food companies exert influence through sponsorship of research and professional societies.  Typically, recipients of industry funding do not recognize the influence of sponsorship and deny it, as we see here.

If AND wants to be taken seriously as an organization devoted to public health, it needs to set strong guidelines for conflicts of interest and adhere to them.  At the moment, this organization gives the appearance of a public relations arm of the food industry.

The same can be said of the American Society of Nutrition, but that’s another story.

Resources

• U.S. Right to Know publishes a fact sheet on AND: available here.
• MedPage: Nutrition Group Has Close Ties to Food, Pharma Companies —
• Washington Post: Group shaping nutrition policy earned millions from junk food makers (I’m quoted in this)

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I haven’t posted anything about pistachio industry conflicts of interest since 2019 so it’s time for another one.

Here’s a press release sent to me by a reader, Matthew Kadey:

NEW STUDY REVEALS PISTACHIOS ARE AN ANTIOXIDANT POWERHOUSE…Antioxidant-rich foods are regularly encouraged as part of a healthy lifestyle, and research suggests that a diet high in antioxidants may even help to reduce the risk of death.¹ While certain fruits and vegetables are often thought of as high-antioxidant foods, a new study conducted by Cornell University and published in the journal, Nutrients, produced surprising results². Pistachios have a very high antioxidant capacity, among the highest when compared to values reported in research of many foods commonly known for their antioxidant capacity, such as blueberries, pomegranates, cherries, and beets.^3,4,5  (I’ve posted the references at the end).

My first question, as always when I see a press release like this: Who paid for it?

The study: uan, Wang, Bisheng Zheng, Tong Li, and Rui Hai Liu. 2022. Quantification of Phytochemicals, Cellular Antioxidant Activities and Antiproliferative Activities of Raw and Roasted American Pistachios (Pistacia vera L). Nutrients 14, no. 15: 3002. https://doi.org/10.3390/nu14153002

Conclusion:  It is shown that the roasting of pistachios could produce a series of beneficial phytochemical changes, leading to enhanced biological activity. Pistachios are a nutrient-dense food containing a unique profile of good-quality protein, fats, minerals, vitamins, and antioxidants, such as carotenoids and polyphenols, with cellular antioxidant activity. Dietary Guidelines for Americans 2020–2025 suggested including nuts as a health dietary pattern. Further research on antiproliferative activity and mechanisms of action of free-form extracts of roasted pistachios, and more biological activities related cellular antioxidant activity and oxidative stress, are worthy of further investigation.

Funding: This study was partially supported by Innovative Leading Talents Project of Guangzhou Development Zone and 111 Project: B17018, Cornell China Center, and American Pistachio Growers: 2021-09.

Conflicts of Interest: The authors declare no conflict of interest.

Comment: Roasted pistachios are healthy?  No surprise here.  Further research needed?  Also no surprise.  This is another example of an industry-funded study with unimpressive results but plenty of interpretation bias, along with the usual contention that industry funding does not induce conflicts of interest.  Alas, it does.

References to the press release paragraph

¹ Jayedi A, Rashidy-Pour A, Parohan M, Zargar MS, Shab-Bidar S. Dietary Antioxidants, Circulating Antioxidant Concentrations, Total Antioxidant Capacity, and Risk of All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Observational Studies. Adv Nutr. 2018 Nov 1;9(6):701-716. doi: 10.1093/advances/nmy040. PMID: 30239557; PMCID: PMC6247336.
² Yuan W, Zheng B, Li T, Liu RH. Quantification of Phytochemicals, Cellular Antioxidant Activities and Antiproliferative Activities of Raw and Roasted American Pistachios (Pistacia vera L.). Nutrients. 2022; 14(15):3002. https://doi.org/10.3390/nu14153002
³ Wolfe KL, et al. Cellular Antioxidant Activity (CAA) Assay for Assessing Antioxidants, Foods, and Dietary Supplements. J Agric. Food Chem. 2007, 55, 8896–8907.
⁴ Song W, et al. Cellular Antioxidant Activity of Common Vegetables. J. Agric. Food Chem. 2010, 58, 6621–6629. DOI:10.1021/jf9035832
⁵ Wolfe, K., Kang, X., He, X., Dong, M., Zhang, Q., and Liu, R.H. Cellular antioxidant activity of common fruits. J. Agric. Food Chem. 56 (18): 8418-8426, 2008.

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The Alliance for Potato Research & Education is explicitly “Dedicated to advancing the scientific understanding of the role potatoes play in promoting the health of all people.”

As the Alliance explains:

Potatoes are a nutrient-rich vegetable and one of the top sources of potassium in Americans’ diets, yet they are often singled out as a food to limit. This recommendation is often based on misperceptions that eating potatoes is linked to increased cardiometabolic disease risk, even though potatoes contribute to overall fruit and vegetable consumption.  However, a newly published study in the Journal of Nutritional Science finds that advice may be unwarranted

Guess who sponsored that study.

• The study:  Potato consumption is not associated with cardiometabolic health outcomes in Framingham Offspring Study adults

• Conclusion: In this prospective cohort, there was no adverse association between fried or non-fried potato consumption and risks of T2DM/IFG, hypertension or elevated triglycerides.

• Funding: This work was supported by the National Heart, Lung and Blood Institute …with additional support from the Alliance for Potato Research and Education. The funders had no role in the design, analysis or writing of this article…The authors have declared that no conflict of interest.

Comment: We can argue about the effects of potatoes on insulin and blood sugar levels, a contentious issue because the ways they are cooked and prepared influence digestion of their starches to sugars and how quickly those sugars are absorbed.  But industry funding confuses the arguments, as it has a high probbility of inducing more than the usual level of bias into the results.  Much industry influence occurs at an unconscious level where it is unrecognized by rsearchers, so much so that they do not see it as a conflict of interest.  I think it is.

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The study: Health Functions of Egg Protein.  Ryosuke Matsuoka, Michihiro Sugano.  Foods 2022, 11, 2309. https://doi.org/10.3390/foods11152309.

Purpose: “In this review, we have summarized the available information regarding the health benefits of egg proteins based on human studies.”

Conclusion: “This review summarizes the health effects of egg proteins, especially EWP, as reported in human studies. Two major functions have been clearly identified: (1) they improve muscle mass and have muscle-strengthening and antifatigue effects when
consumed during exercise; (2) they can improve lipid metabolism by reducing visceral fat and lowering serum cholesterol levels. The intake of egg protein may, thus, contribute to the prevention of physical frailty and metabolic syndrome.”

Conflicts of Interest: M.S. declares no conflict of interest. R.M. is an employee of Kewpie Corporation. There are no other patents, products in development, or marketed products to declare.

Comment: M.S. declares no conflict but is Chair of the Japan Egg Science Society, Tokyo, respectively.  The purpose of this study was to examine the benefits of egg proteins, not to evaluate them in comparison to any other proteins or to assess the role of eggs in diets.  Studies that look for benefits invariably find them.  The Kewpie Corporation sells products using eggs.  It can now advertise them as health foods.

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The study:  Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies.  Glenn A.Gaesser.  Trends in Cardiovascular Medicine, Available online 6 September 2022.  https://doi.org/10.1016/j.tcm.2022.08.002

Conclusions:  Meta-analyses of prospective cohort studies demonstrate that refined grain intake is not associated with risk of CVD, stroke, or heart failure. This conclusion holds for studies that restricted analyses to staple grain foods only, as well as for studies that included both staple and indulgent grain foods as a single refined grains category. Although refined grains are included as a component of the Western dietary pattern, the present findings suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.

Declaration of Competing Interest:  The author is a scientific advisory board member of the Grain Foods Foundation and the Wheat Foods Council.

Funding: Preparation of this manuscript was supported in part by a grant from the Grain Foods Foundation.

Comment: Refining of grains removes the outer bran and germ and most of the fiber and nutrients along with them, leaving some nutrients along with teh starch and protein.  Refined starch is quickly digested to sugars and rapidly absorbed.  The Wheat Foods Council wants to reassure you that you can eat as much refined grain as you like without raising disease risk.  Much independently funded research argues otherwise, alas.  If nothing else, refined grains contribute calories relatively low in nutrients and constitute major components of ultra-processed foods.  This study did not look at dietary patterns.

And thanks to David Ludwig for alerting me to this one.

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The New York Times article on drug industry user fee payments to the FDA reminded me of my first meeting as a newly appointed member of the FDA’s Science Board in the late 1990s.  Here’s how it went:

FDA staff: We want to get your advice on user fees for inspection of food production facilties.

Me, appalled (oh no.  Not this at my very first meeting):  You mean food companies would pay the FDA’s expenses for inspecting their facilities?

FDA: Yes, what’s wrong with that?

Me: It’s causes a conflict of interest.  It puts the FDA under financial pressure to stay on good terms with the companies and not find problems.

FDA: But NIH does it.

Me: NIH is not a regulatory agency; FDA is.

I did not last long on that committee.  I was nominated for it again a year or so ago but never heard another word about it.

The Times article is about the drug industry.  Here are some excerpts:

• The pharmaceutical industry funding alone has become so dominant that last year it accounted for three-quarters — or $1.1 billion — of the agency’s drug division budget.
• Senator Bernie Sanders,…suggested that the pharmaceutical companies’ tendency to charge “outrageous” prices was related to their significant role in funding and advancing policy goals of the F.D.A.’s drug division. “So the industry, in a sense, is regulating itself,” Mr. Sanders said…May make sense to somebody — but not to me.”
• …the high costs of the program limit opportunity for small businesses; new-drug application fees are $1.5 million to $3.1 million.
• Over the years, the program’s scope and funding grew. Annual “performance reports” detail the F.D.A.’s efforts to make quick decisions, hold routine meetings with drug companies and approve products under fast-track pathways.
• …user fee negotiations in 1997 led to reducing the number of clinical trials for drug approval to one, from the longtime standard of two trials.

So does the FDA charge food companies for regulating them?  Yes.

The FDA can charge user fees for:

• The cost of reinspecting domestic food facilities, U.S. agents for foreign facilities, and food importers.  Fees cover “all expenses, including administrative expenses incurred in connection with arranging, conducting, and evaluating the results of the reinspection.”
• Expenses related to companies that do not comply with food recall orders, “including technical assistance, follow-up effectiveness checks, and public notifications. “
• Expedited review and import entry of human and animal food into the United States for participating importers.”

Food user fees are less conflicted than for drugs, and only about 1% of the cost of FDA’s food inspections comes from user fees.

But this is a bad system overall.  FDA is a regulatory agency.  It requires absolute independence in order to do its work honestly.  It should be taxpayer supported entirely so it can work entirely in the public interrest.

See:

• FDA User Fee Programs
• Fees under FSMA
• Guidance for industry on user fees under FSMA
• Why is the FDA Funded in Part by the Companies It Regulates?

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I was interested to see this article in Hoard’s Dairyman: Bringing dairy research to thought leaders.

It explains how food trade associations build relationships with nutrition scientists.

The article discusses the role of the  National Dairy Council (NDC) , in getting research on the benefits of dairy products “into the hands of our science-based colleagues around the country and even globally.”

This is why NDC circles various conferences and meetings on our calendar where we present dairy research and continue establishing relationships with credible third-party organizations.

One of the most important groups is the American Society for Nutrition (ASN)…ASN is the world’s largest nutrition science organization with about 7,000 members from more than 100 countries representing the academic, government, and private business sectors. Many ASN members embody the next generation of scientists and it’s critical we get to know each other.

The article goes on to explain how the NDC:

• Worked to ensure that the latest dairy science was part of this year’s ASN agenda.
• Led a symposium on dairy’s components and cardiovascular health and diabetes.
• Presented on dairy’s unique nutrient package
• Holds leadership positions within ASN.

But:

ASN is just one stop for NDC. We’ll also be involved with conferences hosted by other key organizations, such as the Mayo Clinic, Institute of Food Technologists, International Dairy Federation’s World Dairy Summit, Institute for the Advancement of Food and Nutrition Sciences, and others.

I am a member of ASN and have long been concerned about its too cozy relationships with food companies and their trade associations.  I eat dairy foods and think they have a reasonable place in healthy diets, but they are not essential to human health.  Research debates on dairy products continue, and the close involvement of the NDC in a nutrition professional association compromises the independence of that association.

When I complained about the inherent conflicts of interest in such relationships, ASN officials explained that they want the association to be inclusive, a “big tent.”

Inclusivity is nice, but in this case the benefit goes more to the NDC than to the ASN.

Hoard’s Dairyman is not something I usually see, so I thank Lynn Ripley for sending.

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