We tend look back at the 1950s and ’60s when smoking was ubiquitous with, at best, bemusement, and at worst, alarm. The glamorous adverts showcasing smoking, the blatant product placement in film and the sponsorship of public events are now something of an enigma to the modern-day consumer; a world away from our health warnings, “Quit” campaigns and plain packaging.
Apart from deliberately misleading the public in marketing campaigns, perhaps the more sinister moves by “Big Tobacco” were made in the realm of science. More specifically, in how research was manipulated to discredit the negative impacts of nicotine and tobacco, in an attempt to drown out dissent in a well-funded, smoke-covered cloud.
As shocking as these revelations were (and indeed, still are) there is an element of predictability; an expectation that manufacturers of a product that aims to hook a user, with death a likely side effect, would be inclined to resort to such low measures in their aim to deceive the public.
What is more disturbing, then, is that such practices are sadly not an antiquated practice of a bygone era, conducted only by a sinister few. New information has come to light documenting that similar methods have been, and continue to be, adopted by corporations today. But it is not the tobacco industry. It’s food.
A BitterSweet History
At around the same time that scientists were investigating the health implications of tobacco use, another group were looking at heart disease. Specifically, their focus was on what was causing the disease and how it could be prevented.
A study published in The New England Journal of Medicine was undertaken by a group of scientists in 1967 at Harvard University. It involved a literature review, which examined a variety of experiments. The conclusion drawn by the group was that the best way for Americans to beat coronary heart disease was to cut fat out of their diets, finding insufficient evidence to rely on the studies that examined sugar. What was not disclosed at the time of publication was that the study was sponsored by the Sugar Research Foundation (SRF), the main industry body for sugar in the United States.
An article published last year (almost 50 years after the fact) in JAMA Internal Medicine, reveals internal SRF documents stating a clear objective that they wished to “refute” any connection between sugar and heart disease. The Harvard study achieved that goal.
Co-author of the JAMA paper Stanton Glantz concedes the move by the sugar industry was a smart one. “Review papers, especially if you get them published in a very prominent journal, tend to shape the overall scientific discussion,” Glantz says.
Glantz and his co-authors Kearns and Schmidt concede that while there is no evidence of direct involvement of the SRF in the 1967 study, the circumstantial evidence that the SRF shaped the study’s outcome is inescapable. An internal SRF document shows how the industry was becoming increasingly concerned about the rising reports showing sugar as
a “less desirable dietary source of calories”. The recommendation by the then vice president and director of research at SRF, John Hickson, was that the industry fund its own studies into the health impacts of sugar. “Then we can publish the data and refute our detractors,” the document reveals.
Aside from this financial influence, many of the articles in the 1967 Havard review were hand-picked by the SRF. The outcome was that the review downplayed the significance of research that sugar could play in coronary heart disease. The JAMA authors also note that the authors of the Harvard review “applied a different standard to different studies”, being highly critical of any study that involved sugar, while overlooking flaws in research that implicated fats.
The worth of the consumer market for sugar shouldn’t be underestimated. In 1955, Forbes magazine noted: “If every American could be induced to tip just one extra teaspoon of sugar into his breakfast coffee alone, US consumption would rise two billion pounds annually.”
The SRF has been replaced by the Sugar Association, which released a statement in relation to the JAMA findings: “We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities, however, when the studies in question were published, funding disclosures and transparency standards were not the norm they are today.” In its statement, the Sugar Association also laments the immediate assumption that all industry-led research is “tainted”. “What is often missing from the dialogue is that industry-funded research has been informative in addressing key issues,” it said.
A Worrying Trend
Although the Harvard study is now 50 years old, it is, unfortunately, not an isolated incident. Rather, it demonstrates the beginning of a trend of the sugar industry’s attempts to influence scientific debate about sugar and fat.
As the US scientist Ancel Keys was developing his hypothesis in the late 1960s that excess saturated fats in a diet raise cholesterol and thus cause heart disease, a small movement of dissent existed in the UK. Its main voice was British professor of nutrition John Yudkin, who published a book outlining the dangers of sugar called Pure, White and Deadly. In it, Yudkin outlines how sugar, not fat, was the more likely cause of illnesses such as obesity, heart disease and diabetes.
However, Yudkin and other dissenters would be drowned out as Keys’ lipid hypothesis became increasingly accepted as dogma among the medical profession. This was only entrenched further when the US Government issued its first Dietary Guidelines in 1980, recommending a low-fat diet as a healthy diet. The guidelines would be mirrored in those eventually adopted in the UK, Australian and New Zealand.
A Modern-Day Problem
What is the most worrisome about these discoveries is that the practice of the food industry influencing scientific research is continuing to this day. In 2016, research conducted by the Charles Perkins Centre at The University of Sydney found that there is bias in industry-funded research studies, though its full extent is unknown.
Professor Lisa Bero led the study and, with her team, conducted a systematic review of medical literature that looked at nutritional studies sponsored by the industry. Out of 775 reports, Bero and her team analysed 12 reports that fit the analysis criteria. The results of the study were published in JAMA Internal Medicine. What they found was that those studies that were sponsored by the food industry were more likely to have a conclusion that favoured that sponsor. This means that there was a direct correlation between whether the studies were influenced by the food industry and having that study produce a positive conclusion for that food product.
While it might seem incredible that such practices can still be happening today, Professor Bero says that this is more commonplace that we might think, “It happens all the time. We have looked at this with pharmaceutical studies and you would think that the peer review process would have control about this, but clearly the data shows over and over that they don’t.”
So how is this happening? From her review, Professor Bero believes that it is the conclusions, not necessarily the data that is being influenced in these studies. “Industry sponsorship didn’t really seem to be associated with the quality [of the study],” she explains, “So what that tells us is that it is not the detailed methods or the internal validity of the study, but more likely these other factors like how they frame the research question or whether all the results are getting published or not, that is influencing the outcomes.”
Influence over conclusions is key in scientific research, as it is the conclusion that is often examined when studies are covered in the media, or what is cited in future research. Consequently, not only do these studies have a direct impact on present science, but their findings can shape the direction of future research, as was seen in the result of Ancel Key’s studies. Bero herself is no stranger to scientific controversy, having studied corporate influence on research for the past 20 years.
Bero has also been a staunch opponent of tobacco-funded research, and says that there are parallels to be drawn between the practices adopted by “Big Tobacco” and “Big Food”. “Clearly the food industry, just like the tobacco industry does its own internal research, some of which it may publish and some of which maybe it doesn’t publish. These companies aren’t particularly transparent about what they are doing, so we don’t have that level of understanding about the food companies.”
Bero’s findings are echoed by New York University Professor Marion Nestle, PhD, who is the leading US authority on nutrition funding, and author of bestseller Food Politics. Nestle argues that whether it is tobacco, drugs or food, all corporations are motivated to sell a product. “Co-opting experts – especially academic experts – is an explicit corporate strategy,” she says. Having a journal-backed result that is favourable to a company’s product is a powerful advertising tool, one which companies are willing to pay for.
A 1996 survey published in The New England Journal of Medicine found that nearly 30 per cent of American university faculty members accept industry funding. “Researchers on such relationships do not suggest that industry-sponsored research is always biased, just that there is a higher probability that it will draw favourable conclusions,” argues Nestle.
In fact, Nestle has been monitoring studies funded by industry sponsors. In 2015 alone, her research found that out of 168 studies, 156 produced results that were favourable to the sponsor. So even if researchers do not believe that funding influences their results, the data is increasingly showing that it does.
Can there be a place for industry?
On the face of it, it would appear that the aims of industry are directly opposed to the aims of science. How can a corporation which has a legislated duty to its shareholders to maintain profit margins be actively involved in scientific research that may produce an unfavourable result?
It is true that not all industry-funded research is tainted with bias. However, as the data increasingly shows, and as we have learned from tobacco in the past, the practice lends itself to being exploited time and again. Given the risk involved, it would appear that there needs to be greater regulation with how such practices are adopted.
Currently regulation is twofold between the universities conducting the research and the journals that later publish it. A university may have strict regulations over what funding it will accept and how a sponsor may be involved in a research project, but there is no uniformity between universities as to what these regulations are. Similarly, a journal may require strict disclosure of any funding or involvement by a sponsor before it will publish a study, but standards vary between publications and are not strictly applied.
Moving forward, it is clear that transparency is key. One method advocated by academics such as Professor Bero is for studies to be registered before they can be published. This would require explicit disclosure about what a study aims to look at, how the data will be collected, and what role a sponsor will play in that study. This practice was widely adopted in relation to journals publishing results with drug trials, and effectively changed the way such trials were reported.
Another avenue for industry to sponsor research, would be for them to go into consortia with other funders, who would then act as a check against any undue influence. “If they have a genuine interest in research they shouldn’t be concerned about pooling their funds together and having it administered by an independent peer review panel,” argues Bero. However, such practice is currently very rare, as sponsors seem reluctant to adopt such a model.
A Role for Government?
A further question raised is whether there is any role for governments to play in maintaining the integrity of research, particularly in nutrition science, where results can go on to inform government policies such as dietary guidelines. Professor Bero believes the topic is an interesting one, but fraught with practical difficulties. “Historically, governments have only been able to regulate the integrity of their own research and the source of their own funding. They have not had much control,” she explains. “It would be hard to regulate the flooding of the medical literature with all of these industry-sponsored studies.”
To combat the health problems associated with a high sugar diet, the World Health Organisation has formulated new guidelines. Released in 2015, these recommend adults and children limit their daily intake of free sugars to less than 10 per cent of their total energy intake. A further reduction to below 5 per cent – or roughly six teaspoons
per day – would provide additional health benefits.
The Marriage of Sugar & Tobacco
The relationship between sugar and tobacco goes beyond adopting similar research practices. Indeed, blended cigarettes actually had sugar added to them. In his 2016 book, The Case Against Sugar, Gary Taubes notes that this practice was adopted by cigarette companies as early as the 1920s to change the acidity level of the tobacco. The more acidic the tobacco, the easier it was to inhale and to emit the maximum amount of nicotine into the smoker’s system. The sugars in the tobacco also caramelise as they burn, and provides for the sweet flavour and smell that was marketed to make cigarettes more attractive to women and adolescents.