(05-05-2017) Conflict of Interest and the Role of the Food Industry in Nutrition Research

Dariush Mozaffarian, MD, DrPH1
Author Affiliations Article Information


cross medical and scientific research, few areas are as relevant to health as food and nutrition. Suboptimal diet is associated with more deaths and disability worldwide than any other modifiable factor; in the United States alone, poor diet is linked to almost 1000 cardiovascular and diabetes deaths per day.1 The direct and indirect costs of diet-related chronic diseases are astonishing and in the United States are estimated to be as much as $1 trillion annually.2

Compared with the scope of these burdens, limited resources are available for research about the health effects of foods and nutrients. In constant dollars, total National Institutes of Health funding decreased by 22% from 2003 to 2013, with only a small fraction of this budget supporting nutritional research. The US Department of Agriculture provides additional important research funding through the National Institute of Food and Agriculture and also through its Agricultural Research Service, yet much of this funding is dedicated to agricultural and food technology research. Thus, total federal spending for nutrition research across all agencies was only about $1.5 billion3 per year in 2009, compared with more than $60 billion spent per year for industry research on drugs, biotechnology, and medical devices.

In this landscape, the food industry plays a major role supporting nutrition research within company-based research and development and at academic institutions. One report estimated that spending for private sector food and agriculture research was approximately $12.4 billion in 2013.4 Yet concerns have been raised about bias in such research, with skewing of findings toward industry benefit. For example, evidence for substantial bias has been identified in conclusions of industry-sponsored systematic reviews regarding the health effects of sugar-sweetened beverages5 and artificial sweeteners.6 Evidence for industry-sponsored bias in research on a range of other nutritional topics is weaker, with a nonsignificant trend toward an approximate 30% higher likelihood of favorable conclusions.7 Although not statistically significant, this magnitude is similar to analyses of industry-sponsored studies of drugs or medical devices, which suggest an approximate 30% higher likelihood of efficacy and favorable conclusions, and an approximate 15% lower likelihood of agreement between the actual results and stated author conclusions.8

Many activities by the food industry have been considered highly problematic. Documented tactics include promotion of harmful products, misleading marketing campaigns, targeting of children and other susceptible groups, corporate lobbying, coopting of organizations and social media with financial support, and attacks against science and scientists.9 This has drawn comparisons, at times, with tactics of the tobacco industry. Conversely, the food industry is not monolithic, and substantial heterogeneity exists within and across companies and their products. Different agricultural producers, manufacturers, retailers, and restaurants can have widely varying interests in and commitments to rigorous science, health, and public welfare. Also, within companies, they can have substantial variation in these interests and commitments according to the specific nutritional issue in question. Some companies rely on a small number of unhealthy products for profits or focus largely on short-term monetary gain, while others are highly diversified, with evidence for commitments to values outside short-term profits alone. The food industry’s expertise, reach, and innovation are also relevant in helping surmount challenges in food production, formulation, and distribution. As a corollary, by collaborating with companies, academics, other nonprofit groups, and government can also positively influence the food industry’s perspectives by sharing of expertise on health, sustainability, policy, and public good—including the potential market advantages of incorporating these aims into business strategy.

Faced with these realities—the substantial global burden of diet-related diseases, scarce federal funding for nutrition research, and evidence for bias in industry-supported studies, but with great heterogeneity, significant expertise, and potential for positive influence in food industry—how should scientists, health professionals, and government, academic, and other nonprofit institutions view research support from the food industry? Several key actions, adapted from the Centers for Disease Control and Prevention (CDC)10 and other academic principles for industry funding, appear prudent (Box). To start, decisions regarding industry funding must be guided by defined and transparent principles. Recognizing substantial heterogeneity within and across food companies, the suitability of the industry partner for the specific project of interest must be assessed. The public good and mission alignment must also be evaluated and compared with potential benefit for the industry partner; projects that could be exploited against the public good or the organizational mission should be avoided.

Box.
Recommended Actions for Industry Funding in Nutrition Researcha

Develop and follow clear transparent principles for industry collaborations, consistently implemented for all potential partners

Assess suitability of the industry partner for the specific project of interest, including “areas of interest, image and motivation for partnering, track record for social and environmental responsibility, and financial soundness”10

Assess the public good and mission alignment of the project and also the feasible benefit for the industry partner and potential for exploitation

Develop a prespecified plan for project design, implementation, analysis, and interpretation, with efforts to maximize academic independence in each of these areas

Ensure full academic independence to report and publish the findings

Ensure that industry funding is transparent, acknowledged, and appropriately recognized throughout all stages of design, implementation, and reporting

Consider the balance of benefits vs harms from real or perceived conflicts of interest, including perspectives of all relevant internal and external stakeholders

Advocate for increased federal funding (eg, National Institutes of Health, Centers for Disease Control and Prevention [CDC], US Department of Agriculture, National Science Foundation, US Department of Defense) for nutritional research as an essential complement to industry funding

a Adapted and modified from the CDC and other academic principles for industry funding (http://www.childobesity180.org/funding-principles).

If these considerations are met, the research plan can be developed. Ideally, the industry sponsor should have no role in project design, implementation, analysis, or interpretation; this independence greatly minimizes the potential for bias. In many cases, however, the industry partner may wish to provide input to the study design, as well as additional project features; the acceptability of this input should be balanced against the principles summarized previously, with all roles documented in advance. Conversely, the decision to report and publish the findings must be fully retained by the academic partner, and the industry funding must be transparent and fully acknowledged—these principles must not be negotiable.

Once these considerations are met, among the most difficult challenges is the estimation of the overall benefits of the project vs the harms from real or perceived conflicts of interest. Compared with research funding from pharmaceutical, biotech, or medical device companies, industry sponsorship of nutritional research appears to raise far greater public and media concern and attention. The potential harms for diminished acceptance of the findings as well as individual and institutional reputation must be balanced against advancement of science, production of net societal good, and availability of other funding options. Related to the latter, increased federal support for nutritional research is crucial. Although this may seem impractical in the current budgetary climate, such funding represents an essential investment to improve health and reduce national health care spending.

The challenges involving the role of the food industry in research are profound and not easily dismissed. As the CDC concluded, the benefits of public-private partnerships include increasing the support and reach of good work, facilitating innovation for the public good, positively affecting industry, and building internal capacity.10 Yet, the potential for biased science and reputational harm are also clear. Given the scale of nutritional challenges worldwide, the scope of industry’s expertise and reach, the diversity across companies and their employees, and the potential to create products that are healthier and more profitable, the food industry is a necessary partner for important research and translational solutions to help address the global nutrition crisis. Still, public partners must remain vigilant and cautious about the potential for bias and soberly assess the pros and cons of each opportunity for collaboration.


Source: JAMA. 2017;317(17):1755-1756. doi:10.1001/jama.2017.3456

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