Currently browsing posts about: Conflicts-of-interest

The American Society of Nutrition (ASN) is not the only nutrition society raising issues of conflict of interest (see yesterday’s post).  The Academy of Nutrition and Dietetics (AND) is the subject of two recent analyses of this problem.

• The Food Ties that Bind
• And Now a Word From Our Sponsors

FoodNavigator-USA interviewed a number of people, including me, about the implications of these reports.  Opinions differ, to say the least.

But here’s what I said:

Sponsorship perverts science

However, Dr Marion Nestle, Paulette Goddard professor of nutrition, food studies, and public health at New York University, said it was wishful thinking to assume that companies that make their money selling soda and chips as well as water, juice and oatmeal could provide a “full” picture.

The issue, she said, was not whether FNCE delegates were capable of distinguishing facts from sponsored spin in conference handouts.

She told us: “That’s not the right question. Most people are unaware of how such things influence their opinions. Substantial research on sponsorship by tobacco, drug, and chemical companies provides such evidence. There is not yet as much research on the effects of food industry sponsorship but the few studies that exist are completely consistent with research on other industries.”

It’s stunningly easy to design studies that accomplish these goals

Asked whether it was unfair to automatically dismiss industry-funded research and information rather than judging it on its merits, Nestle said: “In my opinion, agriculture, food, nutrition, and health professionals should dismiss industry-sponsored research out of hand, and journals should not accept industry-sponsored papers. 

“There is only one reason for food companies to sponsor research—so they can use the results in their own interests. 

“Sponsorship perverts science.  Sponsored research is not about seeking truth or adding to public knowledge.  It is about obtaining evidence to defend or sell the sponsor’s product, to undermine research that might suggest that a product is unhealthy, to head off regulation, and to allow the product to be marketed with health claims. 

“It’s stunningly easy to design studies that accomplish these goals and to conduct them in ways that meet the scientific criteria of peer-reviewers.”

She added: “Peer reviewers, journal editors, and readers ought to be asking: Why did the sponsor fund this study?  Was the research question designed to permit an answer that might not meet the sponsor’s goal?  Was the study conducted in a way that permitted an answer against the sponsor’s interest?  Sponsored studies almost always fail these tests of independence.”

I think corporate sponsorship poses huge problems for the credibility of nutrition researchers and nutritionists in general.  The issue requires much more discussion than it has received to date.

Let the debates begin!

I am a member of the American Society for Nutrition (ASN), the organization that publishes the American Journal of Clinical Nutrition (AJCN) and the Journal of Nutrition.

I’ve become increasingly worried about food company influence on ASN.  Food companies fund sessions at ASN annual meetings.

But I’m even more concerned about food company sponsorship of scientific studies published in AJCN.

The results of sponsored studies almost invariably benefit the sponsor.  Exceptions are scarce.

The conflicts are so blatant that I can often guess from reading an abstract who the study’s sponsor must be.

A look at the conflicts of interest disclosed by the editorial board of AJCN suggests why this problem is occurring.

Of the 12 members of the editorial board, only 3 disclose no corporate conflicts of interest, and 2 others disclose minor conflicts.

But the majority—7 of the 12—list major corporate affiliations.  The list of food companies for which they consult or advise is too long to reproduce but it includes Coca-Cola, PepsiCo, The Sugar Association, The National Restaurant Association, ConAgra, McDonald’s, Kellogg, Mars, and many others.

This raises uncomfortable questions: How does this editorial board deal with papers suggesting harm to health from consuming products from these companies?  How does it deal with sponsored papers suggesting benefits of the products?

Affiliations with food companies may or may not lead to publication bias, but at the very least they give the appearance of serious conflicted interest.  This affects opinion not only of sponsored studies, but also of the overall credibility of research published in the journal.

For the results of papers published in the AJCN to be considered credible, the editorial board should:

• List the editor responsible for review of published papers in the conflict disclosures.
• Recuse individual members with conflicts from reviewing papers in their area of conflict.
• Phase out conflicted editors as quickly as possible.
• Appoint editors who have minimal or no conflicts.
• Give special editorial scrutiny to papers sponsored by food and beverage companies.

ASN is not the only nutrition society raising doubts about its conflicts of interest with food company sponsorship.  The Academy of Nutrition and Dietetics (AND) is the subject of two recent reports analyzing its conflicts of interest.

• The Food Ties that Bind
• And Now a Word From Our Sponsors

I will say more about these reports tomorrow, but it looks like a similar report could be written about ASN, alas.

I was invited to write the editorial to accompany a study published today in JAMA Internal Medicine looking at the highly conflicted process used to decide whether food additives are Generally Recognized as Safe (GRAS).

Here’s the study.

Here’s my editorial.

I know this sounds completely crazy, but here’s what the study found:

• Manufacturers get to decide whether food additives are safe or not.
• Manufacturers get to decide whether to bother to tell the FDA the additives are in the food supply.

And if they do volunteer to inform the FDA (and many do),

• Manufacturers get to decide who sits on the panels that review the evidence for safety.

In reading the study, it seemed to me that:

• As long as not too many people roll over dead after eating foods with new additives, nobody will ever have a clue whether the additive is safe.
• The regulatory gap has spawned an entire enterprise of GRAS consultants and GRAS consulting firms who are in the business—presumably lucrative—of providing the scientific documentation the FDA needs to determine additive safety.

Some of the consultants need to do a better job.  The FDA raises enough questions that about 15% (my estimate) of the requests would be denied.

The good news: If the FDA sees the safety documentation, it does its job.

But what happens to the rejected additives?  Or the ones that don’t get voluntarily sent to FDA?

Nobody really knows (think: caffeine in alcohol drinks–the FDA had no idea).

We need a better food safety system in this country and conflicts of interests in GRAS additive approvals are a good place to start.

Here’s what USA Today has to say about this (I’m quoted).

My post yesterday about Michele Simon’s report on food company sponsorship of the Academy of Nutrition and Dietetics (AND) elicited a wealth of thoughtful comments.  These are well worth careful consideration.

Many express disappointment that I would suggest that corporate sponsorship might influence their thinking or practice, that other nutrition professionals have equal or better education, that I singled out AND when other nutrition and health organizations also accept food industry funds, or that I am unsympathetic to their plight (they are required to be AND members whether or not they agree with its policies).

Let me clarify:

On the effects of corporate sponsorship: I don’t know a single individual who thinks that taking money from food companies influences personal opinion or practice, but research on the effects of drug—and food—company sponsorship demonstrates otherwise.    At the very least, sponsorship gives the appearance of conflict of interest.  Individuals and organizations who accept sponsorship from soda companies, for example, can hardly be expected to advise the public to drink less soda.

On education: my point here is not that dietetic education is inadequate but that other nutritionists without such training may be equally qualified to advise the public about diet and health.

On other organizations:  That other nutrition and health organizations accept funds from food companies has long been a point of discussion on this blog (click on Partnerships).  I am especially concerned  about the practices of the American Society of Nutrition, to which I belong.  Its embarrassing role in the Smart Choices fiasco was an example of why nutrition professional organizations should avoid getting involved in such alliances.

On sympathy: I have plenty.  Food company sponsorships create painful dilemmas for nutrition professionals and each of us must figure out our own way to deal with them.  I have written about my own struggles with this issue in Food Politics and elsewhere.

I especially appreciate the comments from those of you engaged in your own struggles with this issue within AND.  You have your work cut out for you.  Here, for example, is the response of your president, Dr. Ethan Bergman, to Simon’s report. He writes [and see addition below]:

There is one indisputable fact in the report about the Academy’s sponsorship program: We have one. And for the record, I support the Academy’s sponsorship program, as does the Board of Directors and our members.

Let me make it clear that the Academy does not tailor our messages or programs in any way due to influence by corporate sponsors and this report does not provide evidence to the contrary.

…As members of a science-based organization, I encourage you to not take all information you see at face value, always consider the source (in this case, an advocate who has previously shown her predisposition to find fault with the Academy) and seek out the facts.

My interpretation: ignore the message because the messenger is not one of us.

As nutrition professionals, we ignore such messages at our peril.  If we want the public to trust what we say, our views cannot be perceived as compromised by financial ties to food companies.

What you can do.  If, as some of you noted, you oppose corporate sponsorship and would like to do something about it, here are a few suggestions:

• Let your voice be heard: write letters, post blogs, send tweets.
• Make it clear to colleagues and clients that you oppose current policies on corporate sponsorship.
• Provide evidence that your organization can do just fine without the money.
• Join committees and groups within your organization; say what you think.
• Organize petition campaigns.
• Run for office; run a slate for office.

If you want the policy to change, work for it.

But don’t be discouraged if nothing much happens right away.  Change takes time.  Keep at it.

Thanks to all of you for taking this issue so seriously.  Let’s keep working together to find ways to keep food company money out of our professional lives.

Addition, January 25: a reader, Craig, points out that Coca-Cola gave Dr. Bergman the opportunity to carry the torch at last summer’s Olympic games.  A news story about this event quotes Dr. Bergman on the Academy’s partnership:

I think the philosophy that Coca Cola has through its Live Positively campaign, and our philosophy at the academy, is about trying to improve the nation’s health through better nutrition and fitness so this fits in well with our cause.

 

I’m always saying that food company donations and partnerships to health and environmental Good Causes end up doing more for the companies than the recipients.  Money always talks.  Accepting corporate donations comes with strings that create conflicts of interest.

The latest evidence for these assertions comes from the Grand Canyon’s efforts to get plastic water and soda bottles out of the park.  These account for a whopping 30% of its waste.

According to the account in today’s New York Times, Coca-Cola, one of the park’s big donors, convinced the National Park Service to block the bottle ban.

Stephen P. Martin, the architect of the plan and the top parks official at the Grand Canyon, said his superiors told him two weeks before its Jan. 1 start date that Coca-Cola, which distributes water under the Dasani brand and has donated more than $13 million to the parks, had registered its concerns about the bottle ban through the foundation, and that the project was being tabled.

The Times quotes Mr. Martin:

That was upsetting news because of what I felt were ethical issues surrounding the idea of being influenced unduly by business…It was even more of a concern because we had worked with all the people who would be truly affected in their sales and bottom line, and they accepted it.

It also quotes a Coca-Cola spokeswoman, Susan Stribling:

the company would rather help address the plastic litter problem by increasing the availability of recycling programs. “Banning anything is never the right answer…If you do that, you don’t necessarily address the problem…You’re not allowing people to decide what they want to eat and drink and consume.”

And throw plastic bottles into the park, I guess.

This sordid episode explains why Coke gives millions to the Grand Canyon.  In a word, greenwashing.

Oops.

Coke needs to change its position on this one.  And so does the Park Service.

Readers Robyn and Will sent me a link to an ABC News story about Yum! Brands efforts to get more states to authorize the use of food stamp (SNAP) benefits in fast food restaurants.

Michigan, California, Arizona, and Florida already do this.  Yum!, the parent company of KFC, Taco Bell, and Pizza Hut, wants it to go national.

They write:

We believe that food stamps should be used to buy nutritious food for kids and families, not junk food! This nonsense has to stop!  This is a government program–it should not be a means for corporations to sell products that will eventually lead to ever-increasing health problems–obesity, heart issues, diabetes, etc. What can we do to be heard?

USA Today did a story on this last week.  It elicited more than 1,000 comments.  I’m not surprised.

The issue thoroughly divides the food advocacy community.   Public health and anti-hunger advocates sharply disagree on this issue, as they do on the question of whether sodas should be taxed.

USA Today quoted Kelly Brownell, director of Yale’s anti-obesity Rudd Center:

It’s preposterous that a company like Yum! Brands would even be considered for inclusion in a program meant for supplemental nutrition.

But then the article quoted Ed Cooney, executive director of the Congressional Hunger Center and a long-time anti-hunger advocate:

They think going hungry is better?…I’m solidly behind what Yum! is doing.

Of course he is.  Want to take a guess at who funds the Congressional Hunger Center?

Yum! is listed as a “Sower,” meaning that its annual gift is in the range of $10,000.   I’m guessing Yum! is delighted that it is getting such good value at such low cost.

USA Today was negligent in not mentioning Mr. Cooney’s financial ties to Yum! and other food brands.  Such ties matter, and readers deserve to know about them.

But Mr. Cooney’s argument worries me on grounds beyond the evident conflict of interest.

For one thing, it smacks of elitism.  “Let them eat junk food” argues that it’s OK for the poor to eat unhealthfully.  I think the poor deserve to be treated better.

For another, promoting use of SNAP benefits for fast food and sodas makes it and other food assistance programs vulnerable to attack.

Rates of obesity are higher among low-income groups, including SNAP recipients, than in the general population.

Anti-hunger and public health advocates need to work a lot harder to find common ground if they want food assistance programs to continue to help low-income Americans.

Let’s be clear about what’s at stake here.  SNAP is an entitlement program, meaning that anyone who qualifies can get benefits.

In June 2011 alone, according to USDA, 45 million Americans received an average of $133 in benefits at a total cost to taxpayers of more than $6 billion.

That’s a lot of money to spend on fast food.  Yum!’s interest in getting some of that money is understandable.

If you think low-income Americans deserve better:

• Complain to Congress for permitting the legal loophole that allows this.
• Insist to USDA that SNAP benefits be permitted only for real food.
• Get your city to recruit farmers’ markets, grocery stores, and other sources of healthy food to low-income areas.
• Let your congressional representatives know that you want a safety net for people who are out of work that enables people to eat healthfully.
•  And tell the Congressional Hunger Center and similarly inclined anti-hunger groups that you think conflicts of interest interfere with their ability to help the clients they are supposedly trying to serve.

The latest issue of JAMA has a paper on a “portfolio” of dietary means to reduce blood cholesterol levels.

The paper is likely to get lots of press because it concludes that consuming the “portfolio”—a combination of plant sterols, soy protein, viscous fibers, and nuts—does a better job of lowering LDL-cholesterol (the “bad” kind) than does dietary advice to reduce saturated fat.

The paper is unusually difficult to read  (see the Abstract, for example).  But besides that, I interpret the study in part as a drug trial.

One look at the Abstract and I immediately suspected that this study must have been sponsored by a maker of plant sterol margarines.

Bingo!

Plant sterols are well established to reduce blood cholesterol levels.  Unilever, which makes Take Control margarines, is one of the sponsors.

As I interpret it, the study shows:

• Advising people who weigh an average of 76 kg (167 pounds) to consume a healthy diet doesn’t work.  Study subjects did not change their diets by much during the six months of the trial.  No news here.
• Advising people to add things to their diets has a better chance of succeeding than advising taking things away (like saturated fat).
• All of the portfolio items have been established to lower blood cholesterol in clinical trials, although the evidence for soy protein seems a bit iffy these days.
• The study does not distinguish between the relative effects of soy protein, fiber, or cholesterol lowering margarines. If soy is eliminated, that leaves fiber and margarines. I’m guessing the margarines were the critical factor. Hence: a partial drug trial.

And because my book on calories is coming out next March, I must point out that the study groups reported losing  losing small amounts of weight, which means they must also have reduced their calorie intake.  Weight loss alone should help with blood cholesterol.

The take-home message: if you really do substitute nuts, sources of fiber, and healthy foods for whatever less healthful foods you used to eat, you ought to get some health benefit, with or without plant sterol margarines.

QED: Healthy diets produce health benefits.

It’s always nice to see that confirmed.

Among the many thoughtful comments on yesterday’s post is one from the Director of Oxfam America’s Private Sector Department, Chris Jochnick, who writes that I did not “quite capture the scope and intent of this project.”

As part of our work, Oxfam has a responsibility to engage with global corporations, through both collaboration and campaigns, in order to have constructive dialog on their business practices.

….Throughout the work, Oxfam has maintained complete independence including the ability to undertake advocacy against either company if the situation warranted. The Coca-Cola Company and Oxfam America shared the costs of the collaboration roughly in the proportion of 2:1, with The Coca-Cola Company contributing two-thirds of the costs (US $400,000) and Oxfam America contributing one-third of the costs in kind including staff time.

Unrelated to the study, The Coca-Cola Company made an earlier donation of $2,500,000 to Oxfam between 2008-2010 for humanitarian work in Sudan, with an emphasis on work related to water, sanitation and hygiene.

….Our independent voice keeps Oxfam’s approach to private sector collaborations dynamic and honest.

Let me add a bit more about what I think is wrong with this picture.

The goal of Coca-Cola is to sell more Coca-Cola.  The goal of Oxfam is to address world poverty.  I’m having trouble understanding how these goals could be mutually compatible.

Coke sales in the United States are flagging.  Last year, three quarters of Coke’s revenue derived from sales outside of North America in emerging economies where rates of obesity are increasing rapidly.

Sugary beverages like Coke are increasingly associated with obesity and its health consequences, problems now rampant in developing economies.

In the past year, Coke has embarked on an aggressive campaign of contributions to potentially critical groups such as the American Academy of Family Physicians, the Children’s Hospital of Philadelphia, Save the Children, and now Oxfam.

These groups are now highly unlikely to advise their constituents to cut down on sugary sodas.  If nothing else, sponsorship buys silence.

Oxfam may have done the work of its Poverty Footprint Report without company interference.  It is what is not in the report that is so much in Coke’s interest.

For just under $3 million, Coke has purchased an endorsement from Oxfam of its “anti-poverty” practices and silence on the role of sugary drinks in obesity.  This kind of public relations is well worth the price.

What does Oxfam get in this bargain?  The money, of course, but at the cost of serious questions about the credibility of its report and its independence.  Perhaps these are tolerable, but what about loss of respect?

I score this as a win for Coca-Cola.