by Marion Nestle

Currently browsing posts about: American-Diabetes-Association

May 5 2016

More on corporate funding of nutrition research: exchange of letters

In January this year, JAMA Internal Medicine published my Viewpoint on corporate funding of nutrition research: science or marketing.

Richard Kahn, former chief scientist and medical officer of the American Diabetes Association, wrote a letter in reply (see below for more about him**).  The journal published his letter, along with my response, in its current issue.  Here’s what I said.

In Reply Dr Kahn requests evidence that nutrition research funded by food companies is of lesser quality than studies funded by independent agencies or performed by investigators with nonfinancial conflicts of interest. Concerns about such issues are relatively recent; few published studies address them directly. Instead, concerns about industry sponsorship of nutrition research derive from comparisons with the results of studies of funding by tobacco, chemical, drug, or medical device companies. This research typically finds industry-sponsored studies to report results more favorable to the products of the sponsor than studies not funded by industry. It identifies subtle rather than substantive differences in the quality of this research; industry-funded studies are more likely to underreport unfavorable results and interpret neutral results more positively.1 When results are negative, they are less likely to be published.2

Between March 2015 and March 2016, I identified 166 industry-funded nutrition research studies and posted and discussed them on my blog.3 Of these, 154 reported results favorable to the interest of the sponsor; only 12 reported contrary results. The few studies systematically examining the influence of industry funding on nutrition research tend to confirm results obtained from other industries. For example, a systematic review comparing industry-funded and nonindustry-funded trials of probiotics in infant formula reported no association of funding source with research quality. Industry-funded studies, however, seemed more likely to report favorable conclusions unsupported by the data.4

Dr Kahn states that sponsored studies often specify that the funder had no role in the study. Only recently have some journals required such statements, and I am unaware of research on the extent of this practice or authors’ adherence to it. Among the 166 industry-funded studies that I reviewed, few disclosed involvement of a sponsor.

Dr Kahn asks whether industry funding is any more biasing than career self-interest or intellectual passion. Unlike industry funding, self-interest and passions are intrinsic to every scientist who conducts research, are a matter of public record, cannot be eliminated, and have not been shown to consistently bias research results in the same ways as industry funding.5 Fortunately, nutrition societies and research institutions are developing policies to manage financial relationships with industry.6 Such policies hold promise for preventing financial conflicts of research in nutrition research.

1. Lundh  A, Sismondo  S, Lexchin  J, Busuioc  OA, Bero  L.  Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2012;12:MR000033. PubMed

2. Rising  K, Bacchetti  P, Bero  L.  Reporting bias in drug trials submitted to the Food and Drug Administration: review of publication and presentation. PLoS Med. 2008;5(11):e217. PubMed   |  Link to Article

3. Nestle  M. Food Politics Blog. http://www.foodpolitics.com/. Accessed March 2, 2016.

4. Mugambi  MN, Musekiwa  A, Lombard  M, Young  T, Blaauw  R.  Association between funding source, methodological quality and research outcomes in randomized controlled trials of synbiotics, probiotics and prebiotics added to infant formula: a systematic review. BMC Med Res Methodol. 2013;13:137. PubMed   |  Link to Article
5. Bero  L.  What is in a name? Nonfinancial influences on the outcomes of systematic reviews and guidelines. J Clin Epidemiol. 2014;67(11):1239-1241. PubMed   |  Link to Article 
6. Charles Perkins Centre. Engagement with Industry Guidelines 2015. University of Sydney, 2015. https://intranet.sydney.edu.au/perkins/research-support/engaging-with-industry.html. Accessed March 2, 2016.
**Richard Kahn is infamous in my circles for supporting the positions of the sugar and soda industries while with the American Diabetes Association and now.  I wrote about what he said in an interview with Corporate Crime Reporter in my book What to Eat (pages 355-356).  Recently, The Russells (of CrossFit) had a lot more to say about Kahn’s ongoing opposition to public health measures.
Jan 19 2012

Weighing in on Paula Deen

The huge fuss over Paula Deen’s type 2 diabetes is understandable.   She is, after all, the queen of high-calorie Southern cooking.  And diabetes rates are especially high in the South.

Perhaps less understandable is the reaction of the American Diabetes Association.  As reported in the New York Times,

Heredity, according to the American Diabetes Association, always plays some part. “You can’t just eat your way to Type 2 diabetes,” said Geralyn Spollett, the group’s director of education.

Wrong.  You most definitely can eat your way to type 2 diabetes.

Type 2 diabetes is closely linked to overweight and obesity.  No, not everyone who is overweight develops type 2 diabetes.  But most people who have type 2 diabetes are overweight.

The first line of defense?  Lose a few pounds.  Even a relatively small reversal of calorie balance can make symptoms of type 2 diabetes disappear and reduce or eliminate the need for drugs.

Mrs. Deen does not mention weight as a factor in her disease, or losing weight as an effective treatment.

Instead, she is now a spokesperson for the drug Victoza.

According to the Times’ account, Mrs. Dean says that it is elitist to criticize her food:

You know, not everybody can afford to pay $58 for prime rib or $650 for a bottle of wine. My friends and I cook for regular families who worry about feeding their kids and paying the bills.

Really?  Does Mrs. Deen think those families can afford to pay the $500 a month drug companies charge for Victoza?

Victoza costs in other ways too.  It has to be injected and is not exactly benign.

Victoza® is not recommended as the first medication to treat diabetes. Victoza® is not insulin and has not been studied in combination with insulin…It is not known if Victoza® is safe and effective in children. Victoza® is not recommended for use in children

In animal studies, Victoza® caused thyroid tumors—including thyroid cancer—in some rats and mice.  It is not known whether Victoza® causes thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people which may be fatal if not detected and treated early…Inflammation of the pancreas (pancreatitis) may be severe and lead to death.

The company also advises:

Victoza® is an injectable prescription medicine that may improve blood sugar (glucose) in adults with type 2 diabetes when used along with diet and exercise.

Diet and exercise?  Why not just do that in the first place?

As for the American Diabetes Association: its disinterest in promoting diet and exercise is easily explained.  It is funded by drug companies.

I gave a talk at an annual meeting of the Association a few years ago and was astounded by the number of drug companies giving things—writing pads, pens, and tape holders, but also lab coats and stethoscopes—at the trade exhibit.  Much of the scientific meeting was devoted to drug studies.  I spoke at the only session that year on dietary issues.  And Coca-Cola sponsored a session on sugars in diabetes.

Mrs. Deen’s food is best eaten in moderation.  She would do more for her own health and that of her fans if she used her television presence to promote healthier lifestyles.

Update, January 30: Brad Jacobson interviews drug reps on AlterNet (I’m quoted).