Currently browsing posts about: Conflicts-of-interest

Last week, I posted correspondence regarding the American Society of Nutrition’s (ASN) partnership with the industry-sponsored Smart Choices program.  This program places a check mark on food products that meet its nutrient standards.  I am concerned about ASN’s involvement in this project as it puts the society in conflict of interest.  Several other food rating systems are under development, among them the traffic-light system used in Great Britain.  How can the ASN objectively evaluate the relative merits of these systems if it is paid for administering – and, therefore, endorsing – Smart Choices?  I much prefer the traffic light system, have concerns about the entire approach, and think some of the standards overly generous, particularly the upper limits of 25% of calories from added sugars and 480 mg sodium per serving.  Several people who commented on my post asked to see the ASN’s response.  Here it is:

From: John E. Courtney, Ph.D., Executive Officer, American Society of Nutrition
Sent: Tuesday, May 12, 2009 10:24 AM
Subject: Sunday, May 10, 2009 10:36 AM email to Katrina Dunn

Importance: High

Dear Dr. Nestle,

Thank you for your comments on ASN and the Smart Choices program. We value feedback from our members and I’d like to take this opportunity to address some of your concerns and amend a few of the points you made. First, The Smart Choices Program is not an industry-initiated plan. The Smart Choices idea was facilitated by the Keystone Center, which works with a broad array of stakeholders to develop solutions to complex health and social problems. The Smart Choices front-of-pack symbol was developed through a series of plenary meetings over two years and intensive work groups with academics, food manufacturers, public health organizations, and with observers from federal agencies.  This unique process with a broad array of stakeholders along with the fact that the program is completely transparent sets it apart from other programs that have been developed. In the fall of 2008, Keystone Center issued a RFP for organizations interested in administering the program. The ASN Executive Board was briefed on the program, discussed and evaluated it, and approved moving forward. ASN partnered with NSF to administer the program and was selected. ASN’s role will primarily be one of oversight and facilitation of the program governance, and the Society will be responsible for maintaining the scientific integrity in the Smart Choices program. This program was discussed at the ASN Volunteer Member Leadership Summit in January and most recently at the ASN Scientific Sessions and Annual Meeting at Experimental Biology in New Orleans, LA in April, 2009.

Perhaps most exciting for the Society and consistent with its mission is that ASN will be coordinating a rigorous evaluation of the program as well as consumer research to determine the effectiveness of the program. Perhaps most importantly, ASN neither “owns” the program nor are we making any profit from the program. The funds generated from company participants will be reinvested into the program.  ASN is the pre-eminent society for nutrition researchers and practitioners and encourages scientific debate and transparency and is looking forward to evaluating the effectiveness of this program in helping consumers.

Thank you again for your comments and for your commitment to advancing nutrition research and practice.

Over the weekend, I received a letter from the American Society of Nutrition (ASN) nominating me to join the Board of Directors of the Smart Choices program.  Smart Choices, you may recall from my previous posts on this program as well as on other such systems, is a food industry-initiated plan to put a check mark – a stamp of approval – on processed food products that meet certain nutritional criteria.  Apparently, the ASN Board agreed to administer (and, implicitly, endorse) this program without discussing the matter with the membership.  I think involvement of independent nutrition researchers with Smart Choices represents a conflict of interest and the ASN should not be involved in this effort.  Here is what I told Katrina Dunn, the ASN Program Coordinator:

Dear Katrina—

Thank you for inviting me to join the Board of Directors of the Smart Choices program.  I regret that I cannot accept.  Participating in Smart Choices represents a serious conflict of interest for nutrition educators who wish to maintain independence from the influence of the food industry on nutrition advice.

But participation also represents a serious conflict of interest for the American Society of Nutrition (ASN).  I am dismayed that the ASN—an organization devoted to the highest standards of nutrition research–is involved in this project.  I think the ASN should reconsider this involvement and withdraw immediately.

The ostensible purpose of Smart Choices is to guide the public to select more healthful foods.  I am unaware of a research basis indicating that the program is likely to succeed in this goal.

Evidence does, however, support two additional goals of the program.  The first is to provide a basis for marketing highly processed food products.  I think we would all agree that highly processed foods are, in general, demonstrably nutritionally inferior to whole or minimally processed foods.

The second is to stave off federal regulations requiring a traffic-light food rating system such as that in use in the United Kingdom.   Preliminary research indicates that consumers prefer this system to numerical scores and understand the colors to mean that they should choose green-lighted foods and avoid red-lighted foods.

The cut points selected for the Smart Choices program may meet criteria of the Dietary Guidelines, but their health benefits are debatable (the sodium cut point is particularly generous).  Surely, a great deal more research is needed before ASN directly or indirectly endorses specific processed foods simply because they meet arbitrary nutrient cut points.

These concerns all address questions of intellectual conflict of interest.  But I am also concerned about financial conflicts of interest.  If ASN receives payment for its endorsement and administration of this program, the organization—and its members—risk losing intellectual independence.

I appreciate the invitation but I believe the entire program is ill advised and I urge ASN to extricate as quickly as possible.

Sincerely yours,

Marion Nestle
Paulette Goddard Professor of Nutrition, Food Studies, and Public Health
New York University

If it’s one thing the food industry does really well, it’s surely to pat itself on the back.  Something called The Ethisphere Institute (motto: “Good.  Smart.  Business. Profit.”) has produced a list of the world’s most ethical companies, among them Kellogg’s, Danone, PepsiCo, and Unilever.  How did Ethisphere do this?  It analyzed data from the companies.  I’m guessing it didn’t include marketing to children or misleading health claims as ethical criteria.

And food company representatives have gotten together to establish guidelines for funding food and nutrition research so as to prevent conflicts of interest.  The guidelines make sense – keep everything transparent and stay out of the way of research and publication – but do not address what I see as the most serious consequence of food industry sponsorship: setting up research studies to  inevitably yield results that favor the sponsor’s products.

This, I can assure you, is remarkably easy to do and happens all the time (see, for example, my post on Açaí).

Yes, food and nutrition research is difficult to do and interpret.  That is why independent funding is essential.  At least that’s how I see it.  You?

My e-mail inbox is flooded with copies of an op-ed from today’s New York Times arguing that pigs running around outside have “higher rates” of Salmonella, toxoplasma, and, most alarming, trichina than pigs raised in factory farms. The writer,  James McWilliams, is a prize-winning historian at Texas State San Marcos whose forthcoming book is about the dangers of the locavore movement to the future of food.

I put “higher rates” in quotation marks because that is not what the study measured.  The study on which McWilliams based his op-ed is published in Foodborne Pathogens and Disease. The investigators actually measured “seropositivity” (antibodies) in the pigs’ blood.  But the presence of antibodies does not necessarily mean that the animals – or their meat – are infected.  It means that the free-range pigs were exposed to the organisms at some point and developed immunity to them.  The industrial pigs were not exposed and did not develop immunity to these microorganisms.  But you would never know that from reading the op-ed.   How come?

Guess who paid for the study?  The National Pork Board, of course.

The Center for a Livable Future at Johns Hopkins has much to say about all this.  My point, as always, is that sponsored studies are invariably designed in ways that produce results favorable to the sponsor.    In this case, the sponsor represents industrial pork producers.

April 14 update:  the editors of the New York Times have added a note to the electronic version of Professor McWilliams’ op-ed pointing out the National Pork Board sponsorship of the study on which he based his piece.  And McWilliams rebuts arguments against his piece on the Atlantic Food Channel, while conceding that he may have gotten the science wrong.

The Rudd Center at Yale is devoted to establishing a firm research basis for obesity interventions.  Its latest contribution is a paper in the Milbank Quarterly from its director, Kelly Brownell, and co-author Kenneth Warner, an equally distinguished anti-smoking researcher from the University of Michigan.  Its provocative title: The perils of ignoring history: Big Tobacco played dirty and millions died.  How similar is Big Food?

The paper is getting much attention.  A spokesman for the American Dietetic Association, a group well known for its close ties to food companies, emphasizes that food is not tobacco.  Of course it’s not.  But food companies often behave like tobacco companies, and not always in the public interest.  The Milbank paper provides plenty of documentation to back up the similarity.  Worth a look, no?

April 3 update: Evidently, FoodNavigator.com thinks so.  It is asking readers to file 100 word comments on issues raised by the paper by April 8.   And here are the comments.

How serious a problem is Bisphenol A, the hormone-like substance that leaches from some plastic water bottles?  The answer: how would we know?  According to investigative reporter, David Case, most of the studies of bisphenol A toxicity are sponsored by corporations that spin the results.  Take a look at his most interesting January 14 report, The real story behind bisphenol A.

In theory, whoever is paying for a study should not matter.  In practice, the sponsor matters a lot.  It’s not that scientific investigators are corrupt; most aren’t.  But sponsorship – perhaps unconsciously – influences the design of studies as well as their interpretation.   According to Case, the bisphenol A studies are a good example of this phenomenon.  You can find other examples filed under Sponsorship.

At the request (and expense) of Kellogg’s, the Life Science Research Organization convened an expert panel to evaluate studies linking consumption of whole grains – as defined by FDA – to reduced risk of cardiovascular disease and diabetes.  Using the FDA’s definition, the panel judged the studies insufficient to support a claim that whole grains reduce the risk of cardiovascular disease or diabetes.  The FDA defines whole grains as whole: grains that are ground, cracked, or flaked but include all the parts in their original proportions.  When the panel expanded the definition of whole grains to include supplements of bran, germ, or fiber, the results came out better.   Supplements work better than the real thing!  Kellogg’s must be pleased with the results of its investment.

Oh no, not again!  Merrill Goozner of the Integrity in Science project at Center for Science in the Public Interest (CSPI) writes that six of the 13 members of the 2010 Dietary Guidelines committee, including the chair, get research support  or consulting fees from food or drug companies with vested interests in what the guidelines say.  CSPI had to dig up this information, as the sponsoring agencies did not disclose these potential conflicts of interest.