by Marion Nestle

Currently browsing posts about: Conflicts-of-interest

Oct 9 2023

Industry funded study of the week: Cheese prevents dementia!

It was hard to miss this headline in Dairy Reporter: “Cheese intake could lower risk of dementia, study suggests.”

No kidding?  I wonder who paid for this?

To its credit, the article did full disclosure:

The study was conducted as part of broader research commissioned by Japanese dairy major Meiji Co., Ltd. and part-funded by the company.

I went right to it.

The study: Kim H, Osuka Y, Kojima N, Sasai H, Nakamura K, Oba C, Sasaki M, Suzuki T. Inverse Association between Cheese Consumption and Lower Cognitive Function in Japanese Community-Dwelling Older Adults Based on a Cross-Sectional Study. Nutrients. 2023; 15(14):3181. https://doi.org/10.3390/nu15143181

Purpose: “We investigated whether cheese intake is associated with lower cognitive function (LCF) in community-dwelling older adults.”

Method: “This cross-sectional study included 1503 adults aged over 65 years. The analyzed data were obtained through face-to-face interviews and functional ability measurement.”

Results: Cheese intake, along with usual walking speed and calf circumference to be significant factors associated with LCF.

Conclusions: Cheese intake is inversely associated with lower cognitive function.

Funding: This study was funded by the Japan Agency for Medical Research and Development , the National Center for Geriatrics and Gerontology, and Meiji Co., Ltd.

Conflicts of Interest: “This study was conducted as a part of the ‘Epidemiology study of the relationship between dairy products intake and cognitive function’ commissioned by Meiji Co., Ltd. T.S. holds the position of Commissioned Research Chair, and H.K. is a member of the Commissioned Research group. K.N., C.O., and M.S. are employees of Meiji Co., Ltd. The other authors declare no conflict of interest. The funding sponsors had no role in the execution, analysis, or interpretation of the data or the writing of the manuscript.

Comment: Meiji Holdings Co Ltd (Meiji) 

is a manufacturer and distributor of dairy products, confectionery, and nutritional products. The company’s product portfolio comprises milk, yogurt, cheese, ice cream, chocolates, and gummy candies. The company also provides beauty supplements, protein products, nutritional products, vaccines, antibacterial agents, and generic drugs. The company markets its products under Meiji, Essel, Oishii Gyunyu, DepromeL, Reflex, Kaju Gummy, Kinoko no Yama, Galbo, Amino Collagen, Savas, Sycrest, Streptomycin, Kanamycin, Depromel, and Metact brand names…Meiji is headquartered in Chuo-Ku, Tokyo, Japan.

Five of the authors work for the company.

Does eating cheese reduce the risk of dementia?  You read the paper and decide.  I think you can’t make this stuff up.

Oct 4 2023

The Academy of Nutrition and Dietetics responds to the Washington Post

I was not going to bother to say anything about this letter addressed to the Washington Post from the President of the Academy of Nutrition and Dietetics (AND), Laurie Wright, which she sent to all members.  But at least five recipients sent it to me for comment, so here goes.

From: Commission on Dietetic Registration <cdr@eatright.org>
Date: September 29, 2023 at 3:19:42 PM EDT
To: [REDACTED]
Subject: Letter to the Editor of the Washington Post from Academy President Lauri Wright

The September 13 article “The food industry pays ‘influencer’ dietitians to shape your eating habits” does a disservice to the nation’s hundred thousand plus registered dietitian nutritionists by painting broad-stroke misrepresentations about the dietetics profession and its association, the Academy of Nutrition and Dietetics.

Using examples of only seven individuals, the authors imply it is common practice for RDNs to have undisclosed affiliations with food companies and sponsors. This could not be further from the truth. More than 90 percent of registered dietitian nutritionists work in clinical health care, such as hospitals, medical centers and long-term care facilities, as well as in private practice, public and community health, school nutrition and other foodservice operations.

A growing number of practitioners do share their knowledge and expert opinions through social platforms, engaging with online communities and correcting health misinformation (much of which comes from potentially harmful fads promoted by infinitely larger numbers of uncredentialed influencers with much larger followings). The Academy of Nutrition and Dietetics has a strict Code of Ethics — which includes adhering to disclosure rules and guidelines established by the Federal Trade Commission — and has published many articles over the years about the importance of disclosure.

The authors further implied that the Academy is funded by the food and beverage industry, citing a long-since debunked “investigation” conducted by a small group of activists that disbanded six years ago. The truth lies in the facts: The Academy uses an independent advisor to manage our financial investments in all sectors of the S&P 500, and less than 3 percent of the Academy’s and its Foundation’s investments are in the food sector. Further, only 7 percent of the Academy’s revenue comes from sponsorships. This information has always been fully transparent to the public through our annual reports.

All this information was provided to the Post reporters in advance of the story, but unfortunately the writers elected to mislead their readers with a false narrative implying that non-disclosure of sponsorships is rampant in our profession. Speaking for Academy members who abide by our Code of Ethics, we expected the Post to abide by a higher journalistic standard as well.

Oh dear.  The cozy relationship between AND members and food companies is something I’ve written about extensively in my books, Food Politics and, more recently, Unsavory Truth.  

I’ve also written about the Academy’s conflicted interests on this site, most recently here.

And then there is Michele Simon’s deep dive into the Academy’s relationships with sponsors from a decade ago.

Here’s what President Wright’s defensive letter does not say:

  • We apologize for the unethical behavior of some of our members and will immediately take steps to make sure no member does this again.
  • Non-disclosure of sponsorship is grounds for dismissal from the Academy.
  • We will strengthen our policies to make clear that the Academy will not tolerate such non-disclosure.
  • We will insist not only of disclosure of paid posts, but also disclosure of the name of the sponsor.
  • To make sure members fully understand what is at stake, we are providing guidelines for ethical disclosure and illustrations of what and what is not appropriate.

For your amusement, one reader sent me an Instagram example of full disclosure from Gwyneth Paltrow (who is not, to my knowledge, an AND member)—clearly labeled as a paid partnership with Copperfit.  You have to be logged in to Instagram to open the link.

Sep 25 2023

Industry-funded study of the week: a citrus and pomegranate supplement

When I saw this article—Study: Orange and pomegranate extract impacts major marker for healthy ageing—my first thought was “Who paid for this?”  Bingo.

The study: Ahles, S., Cuijpers, I., Hartgens, F. et al. The Effect of a Citrus and Pomegranate Complex on Physical Fitness and Mental Well-Being in Healthy Elderly: A Randomized Placebo-Controlled Trial. J Nutr Health Aging 26, 839–846 (2022). https://doi.org/10.1007/s12603-022-1834-4

  • Objectives: This study investigates whether a citrus and pomegranate complex (CPC) improves physical fitness, mental well-being, and blood biomarkers for oxidative stress and endothelial function in healthy elderly.
  • Design: A randomized placebo-controlled cross-over trial.
  • Participants: The study included 36 healthy elderly aged 60–75 years old.
  • Intervention and Measurements: Participants received four weeks of CPC supplementation and performed the handgrip strength and senior fitness test. Quality of life (QOL) was assessed and blood samples were analyzed for oxidative stress and endothelial function markers.
  • Results: After four weeks of CPC supplementation, handgrip strength significantly improved (p=0.019), compared to placebo. Moreover, the thinking, memory, learning, and concentration facets were improved (p=0.042), compared to placebo, and plasma malondialdehyde decreased, compared to placebo (p=0.033). The intervention did not affect senior fitness and the other QOL domains and blood parameters.
  • Conclusion: Four weeks of daily CPC supplementation significantly improves handgrip strength and self-evaluated measures of psychological function in healthy older adults. Further research should focus on mechanisms associated with physical performance.
  • Funding: Funding: Authors IC and FT are supported by the Province of Limburg, The Netherlands [grant number HEFI-2]. This research project was supported by BioActor B.V.
  • Ethics declarations: Conflict of interest: S.A. is an employee of BioActor BV. F.H. is a sports medicine consultant and owner of Sports Medicine Center Maastricht*Parkstad. All other authors declare no conflict of interest. The funders had no role in the design of the study, in the preparation of the manuscript, or in the decision to publish the results.

Comment: This is a classic example of a study nobody but the product maker would ever do.  The statement that the funders had nothing to do with the study design or anything else may or may not be true—there have been too many examples of its not being true to take any such statement seriously without much further discussion.  Even with that assurance, researchers who accept industry funding rarely recognize industry influence—it seems to occur at some unconscious level.

Sep 19 2023

Food companies pay dietitian-influencers to hawk their products

The Examination, a brand-new news outlet, and the Washington Post jointly published a jaw-dropping article last week about dietitians paid by food and supplement companies to defend and promote their products on Instagram and TikTok.

Why jaw-dropping?  Two reasons: the media—videos, posts—embedded in the article (these are amazing to see), and the non-disclosure of payment.

As the World Health Organization raised questions this summer about the risks of a popular artificial sweetener, a new hashtag began spreading on the social media accounts of health professionals: #safetyofaspartame….What these dietitians didn’t make clear was that they were paid to post the videos by American Beverage, a trade and lobbying group representing Coca-Cola, PepsiCo and other companies….The food, beverage, and dietary supplement industries are paying dozens of registered dietitians that collectively have millions of social media followers to help sell products and deliver industry-friendly messages on Instagram and TikTok, according to an analysis by The Examination and The Washington Post.

Here’s just one example:

Registered dietitian Lindsay Pleskot, of Vancouver, British Columbia, has posted videos of herself eating ice cream and peanut butter cups while telling people that denying themselves sugary food will only make cravings worse….These and other posts were paid for by the Canadian Sugar Institute.

You might think that embarrassing revelations like these would induce the Academy of Nutrition and Dietetics to set firm policies about conflicts of interest with food companies.  No such luck.
Instead, the president of the Academy issued a statement. She attacks one of the reporters on this story.

This same Post reporter has targeted registered dietitian nutritionists before. Last October, he published an article about a misleading report authored by anti-licensure activists seeking to undermine the important work of the Academy and our members and to demonize the industry without any regard for the truth. At that time, we responded strongly to rebut the report and to correct the news article with facts.

She also defends the Academy by saying it has rules in place, but “cannot police individual RDNs’ online activities or personal social media channels; we do have a Code of Ethics process to review and act on questionable practices that are brought to our attention.”

She did not say whether she considered these practices to be questionable or requiring action.  I think they do.

Instead, she says, “If the article seeks to malign or discredit the Academy or the more than 112,000 credentialed practitioners whom we proudly represent, we will reply swiftly and with purpose.”

In other words, take no responsibility, attack, and deny.

This is an important story.  Nutrition advice should not be tainted by commercial influence.

These reporters are not going to let this go, and should not.

  • If you have experience with nutrition influencers, share it with The Examination here.
  • I you want to sign up for The Examination, do so here.
Aug 28 2023

Industry-funded study of the week: Beer!

A reader, Emma Calvert, a Senior Food Policy Officerfor the European Union in Brussels, sent me “this article.  She also pointed me to the article Food Navigator wrote about it: “Review hails health benefits of beer-gut alliance.”

Eager to find out what the “beer-gut alliance” might be, I went right to it.

The study: Beer-gut microbiome alliance: a discussion of beer-mediated immunomodulation via the gut microbiome.” Silu Zhang, Shuo Jin, Cui Zhang, Shumin Hu, Huajun Li.  Front. Nutr., 25 July 2023.  Volume 10. https://doi.org/10.3389/fnut.2023.1186927

Background: “As a long-established fermented beverage, beer is rich in many essential amino acids, vitamins, trace elements, and bioactive substances that are involved in the regulation of many human physiological functions.  The polyphenols in the malt and hops of beer are also important active compounds that interact in both directions with the gut microbiome.”

Methods: “This review summarizes the mechanisms by which polyphenols, fiber, and other beneficial components of beer are fermentatively broken down by the intestinal microbiome to initiate the mucosal immune barrier and thus participate in immune regulation.”

Conclusion: “Beer degradation products have anti-inflammatory, anticoagulant, antioxidant, and glucolipid metabolism-modulating potential. ..The positive effects of bioactive substances in beer in cancer prevention, reduction of cardiovascular events, and modulation of metabolic syndrome make it one of the candidates for microecological modulators.”

Funding: “This study was supported by the Open Research Fund of State Key Laboratory of Biological Fermentation Engineering of Beer, under grant no. K202101.”

Conflict of interest: “CZ and SH were employed by Tsingtao Brewery Co. Ltd.  The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.”

Comment: This seems like a lot to claim for beer.  Vested interest?  Yes.  The State Key Beer Lab is part of the Tsingtao Brewery Co. Ltd, Qingdao, 266100, China and two of the authors work for the company.  Why do this study?  To distract attention from the harmful effects of alcohol consumption (where do I begin?) and from its calories, and instead give beer a health aura.

Beer, alas, is not a health food, best consumed in moderation if at all.

Sorry.

Aug 25 2023

Is WHO’s aspartame decision conflicted?

One of the most viewed articles in The Guardian last week was this one on possible conflicts of interest among WHO panelists dealing with the health effects of the artificial sweetener, aspartame.

The headline: Revealed: WHO aspartame safety panel linked to alleged Coca-Cola front group

The article refers to the release last month of two somewhat contradictory reports on the potential carcinogenicity of the artificial sweetener, aspartame, a situation I referred to in this space as crazy-making.

To review:

  • The WHO’s International Agency for Research on Cancer (IARC) classified aspartame as possibly carcinogenic to humans.
  • But in the same report, the WHO and FAO Joint Expert Committee on Food Additives (JECFA) said a daily aspartame intake of 40 mg/kg body weight was acceptable.

A  report from US Right to Know poses a possible explanation: “Did a Coca-Cola front group sway a WHO review of aspartame?

One possible answer: at least six out of 13 JECFA panel members have ties to ILSI, a longtime Coca-Cola front group. [In addition] Both the chair and vice chair of the JECFA panel have ties to ILSI.

I’ve written repeatedly about ILSI actions on behalf of the food industry, most recently about how it tracked responses to my book Unsavory Truth (in which I discuss the organization as a front group).

Just because committee members have affiliations with an industry front group does not mean they cannot be objective about the science of aspartame, and I have certainly heard arguments that anyone who has any stature in nutrition cannot avoid such ties (full disclosure: in the late 1980s, ILSI attempted—unsuccessfully, no surprise—to recruit me for a job).

But it is striking that 8 of 13 members had such an affiliation, a (perhaps) coincidence that got The Guardian’s attention.

At the very least, the membership gives the appearance of a conflict of interest, which is one reason why such things matter.

Aug 23 2023

Does industry involvement in research constitute a conflict of interest?

Last week, my industry-influenced study of the week involved kombucha, although the involvement appeared minimal.

All kombucha and placebo drinks were donated by Craft Kombucha. Craft Kombucha did not have any access to data reported in this study. No author has any financial ties with Craft Kombucha. SD was employed by MedStar Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

One of the authors of the study, Daniel Merenstein, wrote to object to the way I characterized it (quoted with his permission).

…But you do make it very clear in the article that all industry did was donate free drinks and had no access to data. Not sure how that really deserves being called influence. But my much larger point is this statement, ” It’s easy to find claims for its health benefits if you search for them, but much harder to find science to back them up.  IIf you can demonstrate benefits, you can sell more products.  Hence, this study.

I think it is exactly the opposite. It is much easier to just say your product works or even better yet to get an influencer to drink your product.

But to actually put your product into scientist’s hands and have no access to data or publication is a huge step forward in food science. Look at JAMA every week, almost all the drug studies are -. The kombucha maker should be applauded for their bravery.

We didn’t going looking for a + outcome but registered our trial and stated a priori exactly what we would be looking at and reporting. This study has many limitations but not the ones you mentioned.

Dan

I appreciate thoughtful and respectful letters like this .  This one especially deserves a response.  Dr. Merenstein implies that this is an investigator-initiated study designed to test an investigator-initiated hypothesis.  Such things do happen.  Unfortunately, they are not the norm.

Here’ what concerned me about the study:

  • It involved a kombucha company, even if lightly.  Much evidence demonstrates that company involvement in research ia highly correlated with positive outcomes, so much so that it has a name, the “funding effect.”
  • Funding influence is thorougly demonstrated to occur at an unconscious level; investigators do not intend to be influenced, are unaware of the influence, do not recognize it, and deny it (even in the face of much research to the contrary).  The unconscious influence usually shows up in the way the research question is asked or in the interpretation of the results.
  • Statements that funders have no involvement in the research have coften been shown to be false.  Exceptions do occur; this may well be one of them.
  • This is a one-food study.  It is impossible to control such studies for dietary and other lifestyle confounders unless done in a locked metabolic ward.

On this last point, I am always suspicious of one-food studies because I find it hard to believe that a single food can make a measureable difference in chronic disease outcome.

I would like to know a lot more about how the microbiome works before being convinced that kombucha has any special health benefits (I do think it is delicious).

To their great credit, these authors fully disclose the limitations of their study (it was small) .

Dr. Merenstein says this study is really about the science.  In this case then, the bias is one shared by all scientists—a belief and the desire to prove it,–in this case that kombucha has particular health benefits .  If scientists didn’t have such beliefs and desires, no science would ever get done.

Such personal biases are indeed quite different from bias induced by financial interests with a company making a product.

Perhaps I misjudged this one.  If so, I owe Dr. Merenstein and his colleagues a sincere apology, here offered.

I thank him for writing and giving me the opportunity to discuss these issues again.

(For detailed discussion and references on issues related to industry research funding, see my book, Unsavory Truth: How the Food Industry Skews the Science of What We Eat).

Aug 21 2023

Industry-funded study of the week: Pecans again

At least five readers recently sent me items about research funding by pecan trade associations and I especially thank Lisa Young and Matthew Rees.

But I will begin with Headline vs. Study from the weekly newsletter (invaluable) Obesity & Energetics Offerings (8-18-23).

Guess who funded this:

  • Funding: We acknowledge funding from the Texas Pecan Board and a grant from the Texas Department of Agriculture.
  • Conflicts of Interest: The authors declare no conflict of interest.

Comment: Acknowledged or not, the funding establishes a conflicted interest.  Industry funding influences the outcome of research, whether the researchers recognize it or not.  I will say more about that this week in response to a comment from a reader.

In the meantime, here is another one.

  • The study: McKay DL, Eliasziw M, Chen CYO, Blumberg JB. A Pecan-Rich Diet Improves Cardiometabolic Risk Factors in Overweight and Obese Adults: A Randomized Controlled Trial. Nutrients. 2018 Mar 11;10(3):339. doi: 10.3390/nu10030339.
  • Acknowledgments: This work was supported by the U.S. Department of Agriculture (USDA) Agricultural Research Service under Cooperative Agreement No. 58-1950-014 and the National Pecan Shellers Association. The National Pecan Shellers Association provided the pecans for the intervention.
  • Conflicts of Interest: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Comment:  The role of the National Pecan Sheller sAssociation is not clear (to me) from these acknowledgments.  Did the trade association initiate or fund the study, or was its involvement strictly in providing pecans?   Is there a difference?  Perhaps.  It is possible for studies involving vested financial interests to be done objectively, but studies of the “funding effect”—a higher probability of favorable outcomes—to be the norm.  Again, I will speak to this point later this week.

In the meantime, for detailed discussion and references of this issue, see my book, Unsavory Truth: How the Food Industry Skews the Science of What We Eat.