by Marion Nestle

Currently browsing posts about: Conflicts-of-interest

Jul 29 2014

Last call for comments on proposed food label: more on Added Sugars

August 1 is the deadline for filing comments on FDA’s food label proposals.

Two were released yesterday, one for and one against.

The Union of Concerned Scientists (UCS) organized a statement in support of listing added sugars signed by 280 scientists, physicians, and public health officials (including me).

The press release says:

In a letter submitted as a public comment for the agency’s first label update since 1994, the signatories point out that sugar overconsumption contributes to diabetes, cardiovascular disease and other ailments….Many food and beverage manufacturers add excessive amounts of sugar to their products, including those that they market as healthy options. In our current food environment, many people are unknowingly and unavoidably consuming excess sugar. Given our soaring rates of chronic diseases and the link between sugar and these diseases, citizens have a right to know how much sugar has been added to their foods.

People who signed the letter include many from Healthy Food Action, a national network of health professionals founded by Dr. David Wallinga.  I am a co-author of the statement with UCS staff and Dr. Robert Lustig.

In contrast, the American Society for Nutrition (ASN), an organization of nutrition scientists to which I belong, produced a strong statement against labeling added sugars.

ASN also has concerns that the inclusion of added sugars on the label may divert attention away from total calories and other important contributors to weight gain. The inclusion of added sugars on the label may confuse consumers and create the perception that naturally occurring sugars are somehow more beneficial because they are “natural” and do not have health effects similar to added sugars…There is no supporting evidence that indicates that the inclusion of added sugars on the food label will translate into the American public reducing caloric intake from added or total sugars or total energy intake…it is important to consider potential unintended consequences of  reformulation as well. When sugar is removed from a solid food product…The replacement is often fat and/or starch which could lead to a product with higher calories per serving. ASN encourages FDA to carefully consider potential adverse consequences of this proposed determination, including gaining input from food scientists…An investment in consumer education… is likely to be most productive for consumer understanding relative to added sugars, and would assure that consumers do not experience increased confusion, which they may encounter if added sugars are declared on the Nutrition Facts label.

These comments, which read as though written by sugar trade association groups, were signed by the president of ASN.  Although the statement letter gives no indication of the process by which these comments were developed, I’m told it was prepared by ASN’s public policy committee.

If so, it would help to know whether members of the committee have financial ties to the sugar industry or to food companies that use sugar in their products.

I wonder how much of the ASN membership agrees with this position on Added Sugars.   I certainly don’t.

 

Jul 8 2014

Conflicts of interest in nutrition research:

Over the July 4th weekend, a reader sent a link to a paper about to be published in the American Journal of Clinical Nutrition titled Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis.

I took a look at the abstract:

Studies to date do not support the proposition that recommendations to increase F/V intake or the home delivery or provision of F/Vs will cause weight loss. On the basis of the current evidence, recommending increased F/V consumption to treat or prevent obesity without explicitly combining this approach with efforts to reduce intake of other energy sources is unwarranted.

This would seem to make some sense, no?  But the dismissal of recommendations to increase fruit-and-vegetable consumption sent up red flags.

My immediate question: who paid for this study?

Here’s the conflict of interest statement.

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Note the presence of companies making processed foods whose sales would decline if people ate more F&V.

A coincidence?  I don’t think so, alas.

More evidence: just today, Bettina Siegel sent me her post on a paper sponsored by the Corn Refiners Association, once again with a predictable outcome.

When it comes to nutrition research, “guess the sponsor” is a game that is all too easy to win.

Jun 4 2014

Guess who funded the contradictory fructose study?

Today, Michael Goran and his colleagues published an NIH-funded study demonstrating that the proportion of fructose in products made with high fructose corn syrup is often higher than 55%—as much as 60% to 67%.

This matters because of concerns that high intake of fructose might induce insulin resistance and other metabolic problems.

Today also, a different group of investigators published a study saying just the opposite.  Fructose in products, it says, is in close agreement with the amount expected.

Who funded this one?  The International Society of Beverage Technologists, whose executive board represents soda companies.

Really, these kinds of results are so predictable that all I have to do is see the results to guess who must have funded the study.

Coincidence?  I don’t think so.

 

May 23 2014

GMO labels cost families $800/year: Guess who paid for the study?

Yesterday, Food Navigator reported that Cornell economists calculated that GMO labels would cost the average family of four a whopping $800 per year.

This seemed so improbable that I immediately wondered:  Who paid for it?

I clicked on the link to the study: Bingo!

The work on this report was supported financially by the Council for Biotechnology Information.

You won’t find the list of companies and groups that support the Council on its website, but Source Watch fills the gap.

I am increasingly alarmed by the increasing extent of industry research sponsorship—it’s become a huge issue in  studies of nutrition, diet, and health.

The influence of funding source on research outcomes is so predictable—many studies have now shown that industry-funded studies almost invariably produce results that favor the sponsor—that I’m batting nearly 100% on conflict-of-interest  checks, of which this GMO study is a particularly blatant example.

It’s not that industry pays investigators to find the desired answers to questions.  It’s more complicated than that.  It has to do with the way investigators ask and try to answer the research questions.  The industry favored biases get built into the study’s assumptions and controls, often (I think) unconsciously.

This study, for example, is based on an elaborate set of assumptions leading to the $800 per family estimate.  Other assumptions might give different results.   The authors do not discuss the limitations of their estimates, nor are they required to in this type of report.

But I’m willing to hazard a guess that independently funded studies would come to considerably lower estimates.

Moral: if a study produces surprising results that favor an industry position, look hard to see who sponsored it.

Addition, May 24:

A reader sent in further information about the Council for Biotechnology Information:

Council for Biotechnology Information

1201 Maryland Avenue, SW., Suite 900, Washington, DC 20024 USA

Phone: 202-962-9200 web site: http://gmoanswers.com

(CBI: http://www.sourcewatch.org/index.php?title=Council_for_Biotechnology_Information.

http://www.powerbase.info/index.php/Council_for_Biotechnology_Information.

Experts: http://gmoanswers.com/experts. Founding members and supporting partners:

http://gmoanswers.com/about. There are also offices in Saskatoon (SK, Canada)

(http://whybiotech.ca)  and Mexico City (AgroBio Mexico: http://agrobiomexico.org.mx.)

Mar 11 2014

Betting on Herbalife and hedging the bet

Skeptic of the value of dietary supplements that I am, I cannot help feeling sorry for Herbalife.

The company sells protein shakes and snacks, vitamins and dietary supplements, and energy and fitness drinks which, it says, “combined with healthy eating and exercise, can help you lead a healthy, active life.”

Yes indeed, healthy eating and exercise will do that for you every time.

But Herbalife has become the victim of a bizarre hedge fund bet and its consequences.

In what is one of the most blatant conflicts of interest besetting a food product, a hedge fund manager, William Ackman, made a billion dollar “short” bet that Herbalife’s stock would fall.

When the stock did not do so immediately, Mr. Ackman set out to destroy the company’s reputation to force its stock down.

He even got members of Congress, including Senator Edward Markey (Dem-Massachusetts) to call for an investigation of the company’s marketing practices, an action that caused a 14-point drop in the stock.

This decidedly unsavory story was the subject of a New York Times investigative report yesterday: “Staking $1 Billion That Herbalife Will Fail, Then Lobbying to Bring It Down.”

The company has grown into a global powerhouse, with a worldwide team of more than three million so-called members and distributors who operate as independent contractors through a system that rewards many of them not only based on actual sales, but also on their ability to recruit more distributors.

The sales tactic, popular with many nutritional supplement companies, has frequently been the target of criticism. In 1986, California authorities issued an order prohibiting Herbalife from making false claims about the weight-loss powers of its nutritional drinks.

Herbalife reported sales of $4 billion in 2012 and is sold in more than 90 countries by distributors who earn profits on product sales and additional commissions from a “multi-level marketing” compensation structure.

Ackman argues that this is a pyramid scheme that particularly disadvantages Hispanic distributors and customers.  Other hedge funds disagree and have placed “long” bets on Herbalife.

This is food politics at a breathtaking level of income.  The Times story is well worth a look.

Nov 21 2013

More on food company sponsorship of nutrition research and practice

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.

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!

Nov 20 2013

Conflicts of interest in nutrition societies: American Society of Nutrition

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.

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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.

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

Aug 7 2013

You think the FDA gets to approve all food additives as safe? Not a chance.

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).

 

 

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