The review of the historical documents, which was published yesterday in JAMA, raises questions over the legitimacy of industry-funded scientific research, and suggests that national dietary guidelines over the past 50 years may have been based on skewed science.
According to the report's authors, led by Cristin Kearns of the University of California in San Francisco, early warnings of the link between coronary heart disease (CHD) risk and sugar consumption, which emerged in the 1950s, were downplayed by the Sugar Research Foundation (SRF), a Washington DC-based industry trade association, now known as the Sugar Association.
The SRF sponsored its first research project into coronary heart disease in 1965 in which it singled out fat and cholesterol as the dietary causes of heart disease.
Internal documents and correspondence shows how the SRF set the agenda for the study and reviewed drafts before publication in the New England Journal of Medicine, which only brought in a policy of disclosing conflicts of interest in 1984.
'Give less weight to industry-funded studies'
“Policymaking committees should consider giving less weight to food industry–funded studies, and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development,” conclude the authors.
In an editorial accompanying the JAMA report, professor at the department of nutrition and food studies at New York University, Marion Nestle, said the practice of food companies deliberately setting out to manipulate research in their favour continues today.
She pointed to Coca-Cola’s funding of an anti-obesity group which said there was “virtually no compelling evidence” to suggest sugary drinks were linked with obesity, and was eventually disbanded due to allegations of industry bias.
Last year it was brought to light how the US sugar industry interfered and influenced research looking at the role of sucrose in dental caries, resulting in public health policy that was heavily skewed in industry’s favour throughout the 60s and 70s.
“Today, it is almost impossible to keep up with the range of food companies sponsoring research — from makers of the most highly processed foods, drinks, and supplements to producers of dairy foods, meats, fruits, and nuts — typically yielding results favourable to the sponsor’s interests,” writes Nestle.
“Food company sponsorship, whether or not intentionally manipulative, undermines public trust in nutrition science, contributes to public confusion about what to eat, and compromises dietary guidelines in ways that are not in the best interest of public health.
Bad science?
Unsurprisingly, industry has rejected the suggestion it is pushing bad science to promote its own interests.
The Sugar Association said in a statement published on its website: “We question this author’s continued attempts to reframe historical occurrences to conveniently align with the currently trending anti-sugar narrative, particularly when the last several decades of research have concluded that sugar does not have a unique role in heart disease.
“Most concerning is the growing use of headline-baiting articles to trump quality scientific research—we’re disappointed to see a journal of JAMA’s stature being drawn into this trend.”
Florence Ranson, communications director at FoodDrinkEurope, the group that represents the interests of the European food industry, said: “It would be totally irresponsible to promote bad science. The very idea that industry is trying to damage the health of its customers is unjustifiable.
"We all know that CHD and obesity have multiple causes, linked to diets, lifestyle, physical activity, education, choices, etc. Scientific studies support the work of industry and help industry reformulate its products and offer alternatives to consumers,” said Ranson.
Ranson rejected lead author Kearns’ conclusion to treat industry-sponsored research with scepticism (This is “excellent advice” according to Nestle).
“It reduces the merits of the scientists who carry out these studies, although they are subject to the same ethical rules as any other scientist,” said Ranson. “In fact, since studies results are published in peer reviewed journals and they are judged on the quality of the contents.”
Sponsored science: Keeping it clean
But with shrinking public funds an increasing amount of research that is used as the basis for public health policymaking is linked to industry.
According to head of food and health at consumer rights group BEUC Ilaria Passanari, this could take the form of direct funding - in-house or via consultancies – or indirectly through funding to universities.
For her, transparency is crucial.
“Stories about the food industry influencing scientists with funding, in some cases also trying to hide this, reached the news quite often over the last years. Policy makers should be more aware of the influence of the industry in the production of evidence and in generating bias that lead to bad science. Moreover, both the industry and the scientists receiving funding, should be fully transparent and disclose the potential conflict of interests.”
This extends to scientific publications but also academics speaking at public conferences and examples of indirect funding, she added.
Last year FDE published a set of guiding principles for industry that are intended to ensure robust and transparent research when industry collaborates with scientists.
These include complete transparency of all sources of funding and publishing all research – regardless of results – in independent peer-reviewed journals.
But in addition to being voluntary, the principles are further limited by the fact that adherence is not monitored.
“We are of course not in a position to monitor or check every study carried out, we rely on trust,” said Ranson. “At this stage, we are also in the process of further promoting the principles, so that a growing number of companies adopt them and they become common to absolutely all in the industry. We also rely on the scientific community and their ethical commitments.”
But this may not be enough to keep industry at a safe arm's length or restore consumer trust.
Passanari said: "To ensure [the principles] are not merely symbolic FDE should ensure that they are effectively implemented and put in place a system of monitoring, sanctioning those not complying. This is also necessary if they want to have consumers trusts in the food industry."
Source: JAMA Intern Med.
Published online 12 September 2016, doi:10.1001/jamainternmed.2016.5394
“Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents”
Authors: Cristin E. Kearns, Laura A. Schmidt, Stanton A. Glantz