Food Industry Research Funding: Is This Conflict of Interest Too Large?

A historical analysis suggests that sugar control policies inconsistently cite coronary heart disease as a health risk.
TOPIC SERIES: CVD PREVENTION IN RHEUMATIC DISEASE

The Sugar Research Foundation (SRF) funded a coronary heart disease (CHD) research project in the 1960s, where they collaborated with Harvard researchers to make dietary fat the focus of a literature review on CHD risk while also downplaying the risk of sugar, according to a new report from JAMA Internal Medicine.1

Stanton A. Glantz, PhD, from the University of California, San Francisco, and colleagues examined internal documents from the SRF and correspondence between the foundation and Roger Adams, an SRF scientific advisory board member between 1959 and 1971, as well correspondence between SRF and D. Mark Hegsted, a co-director of the SRF’s first CHD research project between 1965 and 1966 and a professor of nutrition at the Harvard School of Public Health, Boston, Massachusetts.

In the 1960s, the SRF had a “very sophisticated understanding for the time” of the effects of sugar on health, Dr Glantz said in an audio interview with JAMA Internal Medicine. They asked researchers at Harvard University to perform a review of dietary determinants of heart disease. In the 2-part literature review, published in the New England Journal of Medicine in 1967, the SRF’s funding and role in the review were not disclosed.2,3

“In the review, the Harvard authors really downplayed the evidence linking sugar and triglycerides and heart disease and emphasized the evidence linking fat intake with heart disease,” Dr Glantz said.. “Now, having a high-fat diet is bad for you in terms of heart disease, but the thing that was quite striking in the review these people from Harvard wrote was that all of the evidence linking sugar and triglycerides and heart disease was really discounted and downplayed no matter how good it was, and the evidence linking fat with heart disease was extolled no matter how bad it was.”

Specifically, the SRF was worried about 7 papers that provided evidence of the link between sugar and CHD, according to Dr Glantz. The publication of the Harvard review was delayed due to emerging research, where the Harvard authors discounted the SRF-identified studies by questioning data, interpretation, and “entire classes of evidence,” the researchers noted.1 Dr Glantz said the correspondence between the SRF and the Harvard researchers showed a “very cozy relationship.”

“The authors took pains to trash each one of these papers that the Sugar Research Foundation was concerned about,” Dr Glantz said.

In a related commentary published in JAMA Internal Medicine, Marion Nestle, PhD, MPH, of New York University, said that while it is well-established that research sponsored by the tobacco, pharmaceutical, and chemical industries “almost invariably produces results that confirm the benefits or lack of harm of the sponsor’s products, even when independently sponsored research comes to opposite conclusions,” there is not much known about the food industry’s influence in industry-funded research.4

“The Sugar Association paid these investigators the equivalent of nearly $50 000 in today’s money to do this, so the idea that sugar or any other food company might actually buy the results of research is something that I think most researchers and most people who are in the nutrition field would just find incredible,” Dr Nestle said in a JAMA Internal Medicine audio interview. “Nobody would believe this. It seems so absolutely beyond comprehension, and yet there it is.”

The researchers found that the SRF continued to fund CHD research to influence public policy, including recommending the National Institute of Dental Research’s National Caries Program focus on cavity treatment instead of reducing sugar consumption and funding a review, “Sugar in the Diet of Man,” that influenced a 1976 US Food and Drug Administration (FDA) decision on the safety of sugar.1

“I think the sugar industry was very successful in derailing the earlier discussion, and had they not been so strategic in their funding, their selection of who they funded, and working with them to get a favorable — from their point of view — review, you never really know what would have happened,” Dr Glantz said. “But my guess is the consensus around sugar and heart disease would have developed much, much more quickly than it actually did.”

Dr Glantz and colleagues noted that even today, sugar control policies inconsistently cite CHD as a health risk.

“It’s been well-established that review papers are immensely influential in shaping the scientific debate, and by downplaying and really dismissing sugar’s connection to heart disease through triglycerides in this editorial, it really helped to derail discussion of that issue for decades,” he said.

Dr Glantz and colleagues emphasized that their research was only a “narrow window” into a single industry’s influence on the New England Journal of Medicine article and that there is no direct evidence that the SRF wrote or changed the review.1 Further, the researchers noted that it was difficult to validate the weight of each document they reviewed and they were unable to interview the authors of these documents because they had died.1 

They also did not evaluate any other organizations, leaders, or industries that were proponents of saturated fat and dietary cholesterol causing CHD.1

Dr Nestle said she hopes that nutrition research adopts a similar mindset to medical research that combats industry influence and close relationships between funders and researchers.

“I’m extraordinarily concerned about what this is doing to the field of nutrition in particular because people don’t have much confidence in what nutrition professionals are telling them is useful to eat, and they are correct in being skeptical about it,” Dr Nestle said.

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References

  1. Kearns C, Schmidt LA, Glantz SA. Sugar industry and coronary heart disease research: A historical analysis of internal industry documents. JAMA Intern Med. 2016. doi:10.1001/jamainternmed.2016.5394.
  2. McGandy RB, Hegsted DM, Stare FJ.  Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med. 1967;277(4):186-192. doi:10.1056/NEJM196707272770405.
  3. McGandy RB, Hegsted DM, Stare FJ.  Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med. 1967;277(5):242-247. doi:10.1056/NEJM196708032770505.
  4. Nestle M. Food industry funding of nutrition research. JAMA Intern Med. 2016.  doi:10.1001/jamainternmed.2016.5400.

This article originally appeared on Endocrinology Advisor