Paul D Thacker: Unpicking food industry influence over what we eat

Here’s a hot tip for the physician wanting to write fewer prescriptions: next time a patient asks for the blue pill for his erectile dysfunction, suggest he drink more pomegranate juice instead. Beyond helping men get a lift in bedroom, an American manufacturer has funded clinical studies finding that pomegranate juice can “reduce the risk of, and treat heart disease, including by decreasing arterial plaque, lowering blood pressure, and improving blood flow to the heart.” Even better, according to the manufacturer, if you drink more pomegranate juice, you can even “cheat death.”

The particulars of this and other food research is examined in Unsavory Truth: How Food Companies Skew the Science of What We Eat, the latest book by Marion Nestle, emeritus professor of Nutrition, Food Studies, and Public Health at NYU. If you’re familiar with the ways that the pharmaceutical industry has influenced healthcare, then you won’t be surprised to learn that food companies do the same in nutrition. In fact, Nestle starts her book discussing the large body of literature on corporations manipulating drug prescribing practices.

In an interview, Nestle said she started with pharmaceuticals because the research on pharma company influence is so vast and rich. Studies on pharma corruption serve as her template to examine similar financial tactics that distort nutrition science. Here the studies are almost nonexistent. When Nestle did a literature review, she found only 11 studies that examined corporate influence on nutrition research. Yet, she cites one soon to be published paper that examined 4000 peer-reviewed studies (mostly funded by government or foundations) that appeared in the top nutrition journals in 2014. Researchers found that only 14 percent properly disclosed corporate financial ties. Of these more than 60 percent reported results favorable to the sponsor, while 3 percent has unfavorable results.

As for that pomegranate juice research, it was sponsored by POM Wonderful, a company which spent $20 million on research to promote pomegranate juice and supplements. In early 2010, the FDA warned the company about some of its more outrageous advertising and many months later Federal Trade Commission (FTC) told POM to stop making unproven claims in advertisements. POM responded in typical American fashion and sued the FTC for harming POM’s freedom of speech, its research programme, and the company’s “constitutional rights.” The courts upheld the FTC decision.

Just as in pharma, corporate research is not the only dilemma. Nestle documents how industry has captured the entire infrastructure of academic nutrition. Government boards that put out nutrition advice are often filled with scientists who have ties to corporate interests, and nutrition societies regularly hop into bed with industry. Meanwhile, universities often look the other way when their professors engage in questionable practices.

For example, in the 1970s the US federal government put together committees to evaluate hundreds of products that were already on the market and are now covered under GRAS (Generally Regarded as Safe). One example where financial interest seemed to skew committee advice is with sugar. In his 2016 book The Case Against Sugar journalist Gary Taubes wrote that the Sugar Association heavily influenced the sugar GRAS committee. Furthermore, the overall GRAS review process was chaired by George W. Irving Jr, a former head of the scientific advisory board of the International Sugar Research Foundation. Based on the evidence available at the time, the only problem that the 1976 GRAS review found with sugar is that it caused dental caries. A common current practice for agencies that advise on foods and dietary practices is to fill their panels with industry consultants which are then “balanced” with one consumer advocate.

Nestle also takes a hard look at many professional societies including the Academy of Nutrition and Dietetics which was founded in 1917 and launched a journal in 1925. In the past Nestle has written how the Academy’s position on food often favours food companies over the public, and how the Academy and its members have been found to have financial ties to industry. A 2013 report on the Academy found that the Academy’s ties to food products correlated with their policy statements on nutrition and health. Companies paid between $15,000 to $50,000 fees to exhibit at the Academy’s annual meeting.

In 2013, a group of dieticians formed Dietitians for Professional Integrity (DFPI) to get the Academy to sever some of those ties. They calculated that doing so would raise membership by only $8 a year. Over many years, the DFPI had some great successes in pushing for more acknowledgement of corporate influence on dietician’s practices and even changed some policies. For example, in 2016 Coca-Cola and McDonald’s stopped exhibiting at the Academy’s Food and Nutrition Conference and Expo.

In a final example, Nestle describes how Coca-Cola worked with professors at multiple academic centers to create a group called the Global Energy Balance Network (GEBN). The GEBN’s purpose was to shift the discussion around obesity away from diet and sugary drinks to lack of exercise. As Nestle recounts, several reporters contacted her because they were surprised that any university would take corporate money to help Coca-Cola market sugar drinks. I have previously written in The BMJ about how Coca-Cola secretly sponsored journalism programmes to get reporters on board with idea that obesity was caused by lack of exercise. Much of this programme was later shut down, but some of the academics involved in the programme published studies which still appear in the literature and support Coca-Cola’s original idea.

As someone who has spent over a decade investigating and writing about financial ties between industry and academia, I came away from this book feeling relieved and irritated. I have long believed that financial corruption exists in most areas of science and so I felt relieved to find the ties with the food industry so carefully documented in this book. But I was irritated to find the same excuses and denials by researchers who reject peer-reviewed literature which documents how corporations exert influence over science. We have precious little of this research when it come to food, but hopefully Nestle’s book will spur further discussion.

Paul D Thacker is a freelance journalist.

Competing interests: I have read and understood BMJ policy on declaration of interests and note that I am paid to write for various media outlets, consult part time for a nonprofit research institute that studies brain disorders, and have had universities provide expenses for talks on corruption in science and medicine.