Currently browsing posts about: Conflicts-of-interest

Thanks to everyone who flooded my mailbox with this piece from The Guardian: She was fired after not endorsing Splenda-filled salads to people with diabetes. Why?

According to a lawsuit {Elizabeth] Hanna recently filed against the ADA, the organization – which endorses recipes and food plans on its websiteand on the websites of “partner” food brands – tried to get her to greenlight recipes that she believedflew in the face of the ADA’s mission. These included recipes like a “cucumber and onion salad” made with a third of a cup of Splenda granulated artificial sweetener, “autumnal sheet-pan veggies” with a quarter cup of Splenda monk fruit sweetener and a “cranberry almond spinach salad” with a quarter cup of Splenda monkfruit sweetener.

Guess which company gave more than $1m to the ADA in 2022? Splenda.

I also was sent an email from Georgia Warren, the  Guardian’s Interim membership editor: The link between investigative reporting, some nightmarish recipes and the diabetes epidemic.

Why would a public health charity promote a product that its own science shows contributes to the disease it is fighting? Well, as Neil Barsky reported for us this week, the ADA took more than $1m from Splenda in 2022 – and then fired their chief nutritionist when, according to a lawsuit she recently filed, she refused to sign-off on the Splenda-based recipes that her bosses wanted the ADA to publicly endorse.

Neil – creator of our new series ‘Death by diabetes: America’s preventable epidemic’ – told me…“The ADA has bought into a system that requires them to raise money from corporations to fund their research. I don’t for a second doubt that every single person who works there cares about people with diabetes and wants to do the right thing, but being beholden to these groups distorts your judgment.”

..And what else is pharma funding? The ADA. The organization – whose guidance doctors rely on when treating their diabetes patients – boasts a $100m annual budget. Between 2017 and 2024, pharmaceutical and device manufacturers contributed over $134m to the organization – or roughly 20% of its total funding.

Comment: The ADA has long appeared to be in thrall the the drug industry.  I well remember the talk I gave at one of its annual conventions years ago.  I was one of two speakers about diet and diabetes (the other was a session on the role of sugar in diabetes sponsored by Coca-Cola—truly you can’t make this stuff up).  The other talks, hundreds of them, were about drugs.  At that time, the ADA said virtually nothing about diet on its website.

It’s gotten much better.  Here’s what it says about carbohydrates:

• Try to eat less of these: refined, highly processed carbohydrate foods and those with added sugar. These include sugary drinks like soda, sweet tea and juice, refined grains like white bread, white rice and sugary cereal, and sweets and snack foods like cake, cookies, candy and chips.

And here’s what the ADA says about artificial sweeteners:

It’s also important to know that at this time, there is no clear evidence to suggest that using sugar substitutes will help with managing blood sugar or weight or improving cardiometabolic health in the long run. So here’s the bottom line:

• Sugar substitutes are effective alternatives to sugar for some people, but not a perfect fit for all—it’s a personal choice.
• If you’re looking to reduce your intake of sugar or sugar substitutes, start slowly. For example, start by replacing one soda or juice with water or a no-calorie drink at a time.
• Water will always be a great choice! If you start feeling yourself get bored with just water, you can always spruce it up with fruits or herbs like this sparkling strawberry mint infused water.

And, finally for now, here are the ADA’s corporate sponsors, and its national sponsors.

Conflicted?  Sure looks like it.

I learned about this one from this article:  Prune consumption may prevent bone loss for postmenopausal women.  Dietary supplementation with prunes can have a broad range of effects on immune, inflammatory and oxidative stress markers in postmenopausal women, according to a recent study…. Read more

When I see a headline like this, my first question is , as always, who would pay for something like this?

I went right to the study:  De Souza MJ, Strock NCA, Williams NI, Lee H, Koltun KJ, Rogers C, Ferruzzi MG, Nakatsu CH, Weaver C. Prunes preserve hip bone mineral density in a 12-month randomized controlled trial in postmenopausal women: the Prune Study. Am J Clin Nutr. 2022 Oct 6;116(4):897-910. doi: 10.1093/ajcn/nqac189.

Conclusion: “The results of this investigation provide compelling evidence of the long-term efficacy of daily prune consumption.”

Funding: We thank the California Prune Board (Award Number: 180215) for the funding and prunes and the participants in this study.

Author disclosures: CW and CR are members of the Nutritional Advisory Panel for the California Prune Board. All other authors report no conflict of interest.

Comment: Bingo on this one.  Wouldn’t it be wonderful if all you had to do to prevent bone loss was to eat 5 prunes a day?   Go for it!

I’ve posted several studies sponsored by the blueberry industry , most recently on their effects on menopausal symptoms.  Blueberry trade associations, as I discuss in my book Unsavory Truth: How the Food Industry Skews the Science of What We Eat, led the way in promoting research suggesting this fruit is a “superfood.”

If only.

They are still at it, apparently, but sponsorship does not always guarantee the desired outcome.  Here is a rare exception to the rule that industry-sponsored studies almost invariably give results favorable to the sponsor’s marketing interest.  Let’s give credit where it is due.

• The study:  Chronic and postprandial effect of blueberries on cognitive function, alertness, and mood in participants with metabolic syndrome – results from a six-month, double-blind, randomized controlled trial.  The American Journal of Clinical Nutrition.  Available online 6 February 2024, https://doi.org/10.1016/j.ajcnut.2023.12.006
• Methods: “A double-blind, randomized controlled trial was conducted, assessing the primary effect of consuming freeze-dried blueberry powder, compared against an isocaloric placebo, on cardiometabolic health >6 mo and a 24 h postprandial period (at baseline).”
• Results: “Postprandial self-rated calmness significantly improved after 1 cup of blueberries (P = 0.01; q = 0.04; with an 11.6% improvement compared with baseline between 0 and 24 h for the 1 cup group), but all other mood, sleep, and cognitive function parameters were unaffected after postprandial and 6-mo blueberries.”
• Conclusion: “Although self-rated calmness improved postprandially, and significant cognition-metabolite associations were identified, our data did not support strong cognitive, mood, alertness, or sleep quality improvements in MetS participants after blueberry intervention.”
• Conflict of interest: “AC reports financial support provided by the US Highbush Blueberry Council (USHBC) and Biotechnology and Biological Sciences Research Council (BBSRC, UK). AC and EBR both act as advisors and consultants to the United States Highbush Blueberry Council grant committee. All other authors report no conflicts of interest.”
• Funding: “This work was supported by the United States Highbush Blueberry Council with oversight from the USDA and the Biotechnology and Biological Sciences Research Council (United Kingdom). The funders of this research had no involvement in this publication and have placed no restrictions on the publication of these data.”

Comment: In this instance, the last statement could well be correct (it isn’t always, alas).  I like blueberries but they are not a superfood.  There is no such thing as a superfood.  If you want to eat healthfully, by all means eat fruit—and enjoy the ones you like best.

I learned about this one from a commentary from Yoni Freedhoff, MD: Kimchi: Not Magically Protective Against Weight Gain.

• The study: Association between kimchi consumption and obesity based on BMI and abdominal obesity in Korean adults: a cross-sectional analysis of the Health Examinees study.  BMJ Open.  2024 Jan 30;14(2):e076650.  doi: 10.1136/bmjopen-2023-076650.
• Participants: “This study analysed 115 726 participants aged 40-69 years enrolled in the Health Examinees study in Korea.”
• Results: “In men, total kimchi consumption of 1-3 servings/day was related to a lower prevalence of obesity (OR: 0.875 in 1-2 servings/day and OR: 0.893 in 2-3 servings/day) compared with total kimchi consumption of <1 serving/day. Also, men with the highest baechu kimchi (cabbage kimchi) consumption had 10% lower odds of obesity and abdominal obesity. Participants who consumed kkakdugi (radish kimchi) ≥median were inversely associated with 8% in men and 11% in women with lower odds of abdominal obesity compared with non-consumers, respectively.”
• Conclusions:  “This large cross-sectional study described the association between kimchi consumption and obesity. In conclusion, total kimchi consumption of 1–3 servings/day was shown to be reversely associated with obesity in men. Regarding the type of kimchi, baechu kimchi was associated with a lower prevalence of obesity in men, and kkakdugi was associated with a lower prevalence of abdominal obesity in both men and women. However, since all results showed a ‘J-shaped’ association, excessive consumption suggests the potential for an increase in obesity prevalence. As kimchi is one of the major sources of sodium intake, a moderate amount of kimchi should be recommended for the health benefits of its other components. In addition, further investigation and prospective studies are needed to confirm the relationship between kimchi consumption and obesity.”
• Competing interests: “HJ and SS have no conflicts of interest to declare for this study. Y-RY and SWH are members of the staff at the World Institute of Kimchi.”
• Funding: “This research was supported by grants from the World Institute of Kimchi (KE2201-1) funded by the Ministry of Science and ICT, Republic of Korea.”

Dr. Freedhoff ‘s analysis of the data:

According to the paper, men who reported eating two to three servings of kimchi per day were found to have lower rates of obesity, whereas men who reported eating three to five servings of kimchi per day were not. But these are overlapping groups! Also found was that men consuming more than five servings of kimchi per day have higher rates of obesity. When taken together, these findings do not demonstrate a statistically significant trend of kimchi intake on obesity in men. Whereas in women, things are worse in that the more kimchi reportedly consumed, the more obesity, in a trend that did (just) reach statistical significance.

Comment: Why anyone would expect kimchi (spicy fermented vegetables such as cabbage) to affect obesity one way or the other is beyond me, but the World Institute of Kimchi must want more people to eat it.  Does anyone need an excuse to eat kimchi?  It’s great on its own without needing this kind of claim.  This study is about marketing, not science.

Dr Katie Pereira-Kotze, a part time Senior Nutritionist at First Steps Nutrition Trust wrote me to ask if I might comment on the conflicts of interest displayed at a conference sponsored by the British Journal of Midwifery (BJM).  This journal accepts sponsorship for its annual conference from breastmilk substitute companies (Nutricia, Kendamil, Nestle).

Groups concerned about the historic role of infant formula compnanies in discouraging breastfeeding in new mothers, have asked the BJM not to permit this funding.

For example, the Baby Feeding Law Group UK wrote a letter to the conference organisers in 2022.

We would also like to share with you our perceptions of the motivations of companies such as Kendamil and Nutricia for sponsoring events such as your conference. It is against the law in many countries including the UK for companies to promote infant formula. By partnering with organisations or sponsoring events, these companies avoid workplace controls on advertising and gain direct access to health care workers, including in the case of the BJM conference, midwives, and in doing so create a valuable link to pregnant and post-partum women.

The British Medical Journal (BMJ) also commented on these conflicted interests: Midwifery conference is criticised over formula milk sponsors.

Three companies that market formula milk (Aptamil, Kendamil, and Nestlé) are sponsoring the conference and have each been given a 40 minute slot during the one day conference programme.

This journal contrasted its own position on infant formula complany sponsorship with that of the midwifery jounral:

In 2019 The BMJ announced that it would no longer carry advertisements for breastmilk substitutes,4 and after pressure from clinicians and campaigners the Royal College of Paediatrics and Child Health also said that it would stop accepting funding from formula milk companies. Robert Boyle, a clinical reader in paediatric allergy at Imperial College London, told The BMJ, “Formula company marketing aims to disrupt breastfeeding, their main competitor, so that the companies can sell more formula.

Comment: The role of the commercial infant formula industry in pushing its products and discouraging breastfeeding has been well documented for decades, most recently in a series of Lancet Commission reports.  Conferences are expensive to run and the  British Journal of Midwifery undoubtedly can use the infant formula company money—but at some cost to its reputation.  The optics do not look good.  Sometimes, the money isn’t worth it.  Infant formula companies have joined cigarette and opioid companies in being viewed as producing products with great capability of doing more harm than good.  The sooner the BJM stops taking their funding, the better.

Lately, I have been asked repeatedly to explain just how the food industry exerts influence to protect and promote product sales.  This week’s posts address that question, starting with the usual Monday industry-funded study of the week, in this case an opinion piece sponsored by the potato industry.

Potato trade associations work hard to overcome concerns about this food’s rapidly absorbable starch content.

I received an email from the Alliance for Potato Research & Education telling me that if I don’t eat potatoes, I might become nutritionally deficient.

New publication alert: swapping out starchy vegetables may lead to unintended nutrition consequences.

A new perspective paper published in Frontiers in Nutrition underscores starchy vegetables are more than just carbs – they’re a vital vehicle for essential nutrients. Yet, as confusion around “good versus bad carbs” persists among consumers, there is a risk of starchy vegetable avoidance in favor of other carbohydrate foods perceived as equally or more nutritious – or even carbohydrate avoidance all together.

The press release cited a paper with this conclusion:

Replacing starchy vegetables with grain-based alternatives, including whole-grain foods, for one day led to a 21% decrease in potassium, a 17% decrease in vitamin B6, an 11% drop in vitamin C and a 10% reduction in fiber.

This called for a look at the actual paper.

The paper: Carbohydrate confusion and dietary patterns: unintended public health consequences of “food swapping.”   Ayoob, K.  Front. Nutr., 28 September 2023. Volume 10 – 2023 |

Rationale: “Nutrient-dense dietary patterns include both grain foods and starchy vegetables. These food groups are currently considered separately [by the Dietary Guidelines for Americana], and they must remain separate to ensure people are encouraged to consume complementary nutrients from each of these food groups.”

Conclusion: “Using complex carbohydrate foods, specifically starchy vegetables (e.g., potatoes) and grains, interchangeably is at best, not a useful strategy, but at worst, may increase the risk of micronutrient inadequacy and/or dietary imbalances.”

Funding: “The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Funding for this perspective was provided by Potatoes USA.”

Conflict of interest: “This study received funding from Potatoes USA. The funder had the following involvement with the study: composition and data analysis of the menu modeling. KA was compensated by Potatoes USA for preparation and revision of the manuscript.  The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.”

Comment: I like potatoes, think they have nutritional value (especially when baked rather than fried), and do not view them as poison.  But: this paper is an opinion piece commissioned, developed, and paid for by a potato trade association.  And sent to me in a press release.

Every now and then, someone sends me something about industry-funded research that does my work for me.  Here is an example.

I received this e-mailed message from John Andrews (reproduced with permission).

I’m sure others will have shared this with you, but as someone primed by reading your work to dig into authors’ backgrounds, I couldn’t help but notice some aspects of a new special issue of Animal Frontiers on ‘The Societal Role of Meat’ (link) that you might be interested to see. There are 36 authors across the special issue, but to highlight just a handful:

• Peer Ederer, guest editor and co-author of the introduction article, has his affiliation listed as ‘GOALScience at Global Food And Agriculture Network’ in Switzerland. However, the website of GOALScience describes themselves as an initiative of the ‘Global Food and Agribusiness Network’ (my italics), and describes itself as a commercial entity that operates as a “service to the global livestock stakeholder community” (link). The paper Ederer et al in the special issue (link) has a conflict of interest statement: “None declared.”
• Thompson et al (link) lists among its authors Jason Rowntree. Rowntree is described in his biography as having worked with the Savory Institute to develop its ‘Ecological Outcome Verification’ scheme for livestock farming. Rowntree’s biography on his university page describes him as an ‘advisor and educator’ to the Savory Institute. Savory’s website indicates that Rowntree’s university is what’s called a ‘Savory Hub’, and that Rowntree has at some point been ‘Hub leader’ (link). Rowntree is also co-lead on a $19mn research project in which Savory is a partner (link). The conflicts of interest statement for the article: “None declared”.
• Rod Polkinghorne, co-author of the perspective article (link), describes himself on his LinkedIn as “actively involved with the beef industry”. In fairness, his biography in the special issue does not disguise this, and the perspective article does not contain a conflict of interest statement of any kind.

I don’t want to suggest that this is particularly surprising in a journal that has a longstanding partnership with the American Meat Science Association, which partnership is not at all hidden (e.g. the journal’s ‘about’ page and Dilger, 2020). But the special issue is noteworthy as the claimed evidence base to support the ‘Dublin Declaration’ on the ‘societal role of livestock’, reported in the press in classic fashion (a Daily Telegraph headline in the UK reads ‘Meat is crucial for human health, scientists warn’), and actively being used as part of the current lobbying battles around EU environmental legislation (see e.g. here).

Perhaps I just don’t understand the subtleties of the term ‘conflict of interest’ well enough…

Comment: Thanks for all this.  Yes, industry connections like these pose conflicts.  These authors—and the journal in which they publish—have financial ties to an industry with an economic stake in the results of studies and the opinions of authors.

Indeed, these particular conflicts of interest are so evident that The Guardian did an article about them:  Revealed: The livestock consultants behind the Dublin Declaration of Scientists.

While I’m at it, let me toss in one more as an example of how meat industry funding works.

The study: Higher muscle protein synthesis rates following ingestion of an omnivorous meal compared with an isocaloric and isonitrogenous vegan meal in healthy, older adults (thanks to Charles Platkin for sending this one).

Conclusion: “Ingestion of a whole-food omnivorous meal containing beef results in greater postprandial muscle protein synthesis rates when compared with the ingestion of an isonitrogenous whole-food vegan meal in healthy, older adults.”

Funding: “This study was funded in part by The Beef Checkoff, Denver, USA, and Vion Food Group, Boxtel, The Netherlands.”

When I see a title like this, I can guess who paid for the study.  Not good.

The study:  Lactobacillus paragasseri OLL2809 Improves Premenstrual Psychological Symptoms in Healthy Women: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients. 2023; 15(23):4985. https://doi.org/10.3390/nu15234985

Methods: “This study employed a randomized, placebo-controlled, double-blind, parallel-group design to assess the efficacy of continuous ingestion of OLL2809 [the supplement] for managing menstrual symptoms in healthy women.”

Conclusion: “This study suggests that the consumption of OLL2809 over three menstrual cycles in healthy women can alleviate premenstrual ‘decline in activity’ and ‘irritability’, thereby indicating the potential of OLL2809 to enhance women’s QOL [Quality of Life].

Conflicts of Interest:  All authors are employees of Meiji Co., Ltd. The company funded this research. All authors are the inventors of pending patent (Japanese Patent Application No. 2023-182470).

Comment: The supplement is a bacterial probiotic.  The authors are employed by its maker and hold a patent for it, which they fully disclose.  Just as a reminder, industry-funded studies tend to come out with results favoring the sponsor’s interest, as is certainly the case here.

I need to say something about the journal, Nutrients, since many of the studies I post on industry-funded Mondays appear in that journal.  It charges authors €2900 (about $3300) to publish their articles.  It’s an open-access journal, so all authors have to pay to publish their articles.  More rigorous journals do not usually require page charges from authors unless they want open access.  Nutrients gives me the impression of pay to play.