February 11, 2015

expert reaction to BMJ investigation into sugar, industry and public health

The BMJ has published the results of its investigation into public health scientists and the sugar industry.

Prof. Susan Jebb, Professor of Diet and Population Health at the University of Oxford, said:

“The article by Jonathan Gornall implies that industry funding for research projects I led as part of my employment with the UK Medical Research Council has compromised my role as Chair of the Public Health Responsibility Deal, but fails to provide any evidence to support this.

“It refers to a series of studies in which I was involved which included funding from industry. None of these involve research into the effects of sugar on health. All these projects were complete by 2010 at the latest, pre-dating my role as Chair of the Responsibility Deal Food Network. I have received no personal remuneration from any of these projects. All have been conducted according to all the MRC governance arrangements for working with industry and the industry involvement has been declared.

“The following information was provided to the BMJ.

1. The research project funded by Coca-Cola was a clinical trial conducted in the UK and USA to test the effect on weight loss of a novel no sugar product being developed by the company. The investigators, not the company, developed a protocol to test this and we showed the product was ineffective and did not lead to additional weight loss.  We also used the trial to test the effectiveness of a web-based weight loss programme, which we found to be modestly effective. The funding for this project ended in 2010 and the results of this work have been published http://www.ncbi.nlm.nih.gov/pubmed/23920353.

2. The research linked to Unilever, Cereal Partners, RHM and Sainsbury’s was not industry-funded research, rather it represents the contribution of the companies to two publicly funded dietary intervention studies, supported by the Food Standards Agency. The funding for both of these projects finished in 2007 and the primary analyses for both studies were published in 2010 http://www.ncbi.nlm.nih.gov/pubmed/20739418 and http://www.ncbi.nlm.nih.gov/pubmed/20307353. The only involvement of these food companies was to provide specific food products for use in these dietary intervention studies which involved hundreds of participants over several months. In some cases they produced products to our specifications in plain packaging. They had no involvement in the design, conduct, analysis or interpretation of the studies. It would have been very difficult and more expensive for us to do these studies without the provision of these products direct from the companies.

3. There were two studies funded by WeightWatchers. The first, published in 2011 was an investigator led protocol, analysed and reported independently by the MRC and our academic partners in Australia and Germany to compare usual care for weight loss with referral to WeightWatchers http://www.ncbi.nlm.nih.gov/pubmed/21906798.

There was also a project funded by WeightWatchers to analyse data from the WeightWatchers UK NHS referral scheme, which has also been published http://www.ncbi.nlm.nih.gov/pubmed/21645343

The ongoing research at HNR supported by WeightWatchers involves the analysis of blood samples to investigate the effects of weight loss on cardio-metabolic risk factors. It will use samples collected as part of a trial funded by the National Prevention Research Initiative, a multi-agency funding scheme run by the MRC in which I am a co-applicant.

4. The study funded by Sanofi considered the impact on appetite and eating behaviour of a novel anti-obesity drug which was subsequently withdrawn from use.

5. The project funded by Tanita was to evaluate a new device to measure body composition, particularly intra-abdominal fat. The results from this work have also been published http://www.ncbi.nlm.nih.gov/pubmed/20360757.”

Catherine Collins RD FBDA, Spokesperson for The British Dietetic Association, said:

“As a dietitian I rely on high quality human nutrition research to ensure dietary advice to patients is optimal. This information is mainly obtained from clinical trials published in peer-reviewed clinical journals.

“So it is disconcerting to read Jonathan Gornall’s exposure of the link between industry and researchers – not that the link exists, but that a journalist feels it necessary to impugn good collaborative studies between industry and independent nutrition researchers based at the MRC and in UK universities. Science should deal in hard evidence, not insinuation.

“Similar to last year’s exposé on the UK alcohol industry and funded research (‘Under the Influence’, BMJ 2013), Gornall applies his focus to the machinations of the sugar industry. His citations extend to a Penguin book, a CBC news story, ‘Action on Sugar’ press releases, and media features from an ardent anti-sugar author. These citations are used to counter the hundreds of peer-reviewed clinical papers crafted into the public health documents he cites from the Department of Health, Public Health England and SACN.

“Despite being qualified to interpret medical and nutrition research, I remain as confused as the public will be to what Gornall is trying to say. Is it that the lure of money moulds researchers into compliant, complicit BigSugar agents willing to pervert good science for dosh? Is it that despite being open and transparent about funding links, plus registering your study prospectively with ClinicalTrials US/ EU and subsequent research, peer review is still inadequate for objectivity if your funding came from BigSugar?

“From a dietitian’s perspective, I would predict that the reason BigSugar has collaborated with researchers such as Jebb, Prentice, Macdonald et al is to ensure their research is conducted with those most knowledgeable in that field of investigation.

“As a science communicator I think it’s important to separate correlation from causation.  As an UK registered Dietitian I’ll continue to use objectivity, impartiality and my grounded knowledge in clinical nutrition to determine the relative merits of publications, whatever their funding source.”

Dr Frances Rawle, Head of Policy at the Medical Research Council, said:

“We ensure that all research we fund is free of any influence from those with whom we collaborate, be they a charity or a commercial organisation. We actively encourage researchers to work with industry and, where it’s appropriate, we jointly fund many projects with industry partners or provide independent scientific expertise. Nutrition research is a good example because working with food and diet industry can help to directly translate high quality research into public health benefit.”

“Any claims made for foods or for dietary products need to be backed by good, objective research evidence and, as with all MRC research, our work in this area is aimed at delivering the best science and is free from any commercial influence. We take the independence of our research extremely seriously and are open about all partners and organisations with whom we work.”

Prof. Richard Mithen, Acting Director of the Institute of Food Research, said:

“It is entirely appropriate that universities and publically supported research organisations such as the MRC HNR work in a constructive manner with industry for the public good.  As is current practice, there needs to be transparency of funding sources and declaration of any actual or perceived conflicts of interest.

“These research organisations provide a service to health professionals and consumers through conducting independent trials of new food products or ingredients with appropriate contractual agreements that all results will be published regardless of outcome, even if these studies are partly or entirely funded by industry. It would not be feasible or appropriate if the costs of these studies were to fall upon the public purse, or for these studies to be undertaken by the commercial sector themselves and not subject to external scrutiny.

“Furthermore it is entirely unjustified to imply lack of integrity of individual scientists that have accepted funding for their research programmes from industry and who have made appropriate declarations of funding sources.”

Prof. Tom Sanders, Emeritus Professor of Nutrition and Dietetics, King’s College London, said:

“The nutrition community consists of a relative small pool of scientists, whereas the food industry is among the largest sectors in business in the UK. It is not unreasonable to expect the food industry to seek advice from best nutritional scientists and to outsource research questions to them.

“The UK Scientific Advisory Committee on Nutrition (SACN) comprises experts in nutritional sciences who are all required to declare conflicts of interests in the working of the committee and to withdraw from discussions where there is deemed to be a conflict of interest in line with the Nolan principles. The members of these committees give up much of their time at little cost to the public purse. Their role is to produce reports, which are mainly risk assessments and not policy documents. These documents are open and transparent and their decisions can be verified by references to the peer reviewed literature.

“The implied alternative in the BMJ article is to have a committee made up of members who are not tainted by connection to the food industry. In my experience such individuals lack the required experience and expertise and are likely to be incompetent.

“Any suggestion that government advisers are ‘bent’ because of their relationships with the food industry (grants, advisory bodies) is toxic and plays into the hands of those with political motives for changing the food agenda which are not science based. Prof Susan Jebb is unfairly vilified in the context of sugar and health – especially as she was an author of papers suggesting a tax on sugar-sweetened beverages ^1,2.”

1: Jebb SA. Carbohydrates and obesity: from evidence to policy in the UK. Proc Nutr Soc. 2014 Dec 17:1-6.

2: Ng SW, Ni Mhurchu C, Jebb SA, Popkin BM. Patterns and trends of beverage consumption among children and adults in Great Britain, 1986-2009. Br J Nutr. 2012 Aug;108(3):536-51

Prof. Stephen O’Rahilly, Professor of Clinical Biochemistry and Medicine at the University of Cambridge, and Director of the MRC Metabolic Diseases Unit said:

“It would be a damaging blow to science and to public health if any contact between scientists in academia and those in the food industry was automatically seen as contaminated. There is a long history of collaboration between academic researchers and the food industry which has, over the years, resulted in some policies of benefit to international public health.

“In addition to financial contributions to the costs of research, nutritional researchers in academia have benefitted from access to data and expertise available in food companies which can complement and strengthen their work. However, this positive relationship relies on complete academic freedom to interpret and write up results. That freedom has been the norm and we must be vigilant to preserve it. It would be very harmful for society if academics could never collaborate with industry to investigate questions relevant to the advance of knowledge and/or public health.

“However, the direct involvement of the food industry in bodies concerned with government policy is a separate issue and in my view should be debated separately.”

Statement from the University of Oxford:

“Oxford University research is carried out independently of its funders. The  funders do not influence what research is done, how the academic carries out their research, or what conclusions they reach. Consumer brands frequently fund research relevant to their sectors, but have no influence on the outcomes. Whether or not the results are favourable to the industry, the situation is clear: the researchers will still seek to publish the results in the usual way in peer-reviewed publications.”

‘Sugar: spinning a web of influence’ published in the BMJ aon Wednesday 11 February. 

Declared interests

Prof O’Rahilly: “Acting as an agent of Cambridge Enterprise, the arm of the University of Cambridge that interacts with industry, I am reimbursed for the provision of independent scientific advice on drug development in metabolic diseases to AstraZeneca, Medimmune and Pfizer. I have no significant interactions or collaborations with the food industry.  I have, in the past, had preliminary discussion with Unilever that did not lead to any significant collaborative work and I have lectured at scientific meetings sponsored by Nestle.”

Prof Sanders: “I am a member of the Scientific Advisory Committee of the Natural Hydration Council which is an industry funded body that promotes the drinking of water.  I am also a Scientific Governor of the charity British Nutrition Foundation and honorary Nutritional Director of the charity HEART UK.”