Feature Sugar

Sugar: spinning a web of influence

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h231 (Published 11 February 2015) Cite this as: BMJ 2015;350:h231

Comment on Sugar: spinning a web of influence

Dear BMJ:

As a scholar who has been actively fighting to reduce added sugar in our diet for several decades and as one who has not only published extensively on the topic but actively worked with governments to tax sugar-sweetened beverages,1-4 I thought the BMJ article missed the key elements for when industry influences scholars.5-7 Furthermore, I felt that Dr. Jebb, with whom I wrote one paper on beverage consumption plans and was working with her on planning to tax SSB’s in the UK, was quite incorrectly impugned.8 I should note that I also have interacted with, evaluated their practices, and worked with the food industry. This has involved private discussions with other noted scholars and the food industry on nutrition topics, public negotiations on many key issues related to program implementation in a number of low or middle income countries and I have received gifts from industry that were unfettered to undertake diet studies. Also I worked with very respected scholars on several random-controlled trials, where industry funding was involved. But few would call me a friend of the food industry. However, I do feel we must reform them, cannot just ignore them, and must use regulatory changes to push this process. I use this background of mine as a basis for pointing where we need to look for scholars whose work is truly affected by their industry-funded efforts.

Consultation and active helping is absolutely a no-no. First, there are a number of scholars who consult and aid the sugar industry globally. We have a number in my country and one of our major network news programs actually had 5 minutes to discuss one scholar suspected of such bias who received funding and consultancies from this sector.9 And there are the scholars who were funded by the big sugar and beverage industries that paid for their salaries and offered handsome consulting arrangements who continue to work to obfuscate the research on sugar and health. I will not name any of them but some are quite known and others are just on boards of industry groups, hired to give speeches in other countries (e.g., when an eminent Colombian endocrinologist was paid to go to Mexico City a day before a government SSB tax to give a talk that stated that soft drinks and sugar were fine to consume and did not affect diabetes). This is the most blatant use of industry funding to pervert science, but more subtle cases are usually found. Those are the scholars the BMJ should have sought out and they are the ones who have created the biased literature noted in a few reviews.10 11

Second, there are few scholars who have not attended conferences with industry sponsorship or worked at one time or another on projects that received industry funding who work in the food and nutrition area. But few of them are actively promoting and working with industry in the manner ascribed in this BMJ article and certainly from my many conversations with Dr. Jebb, she is not one of them. This is certainly the case with respect to sugar.

Big tobacco provides the best example of the harmful effect of industry funding. But certainly the sugar and food industry have also worked in a similar manner.12 To me the major issue is that first and foremost, the food industry has paid prominent scientists to conduct studies which blatantly are designed to give answers questioning other science that goes against the industry and also these individuals usually act as advisers and consultants with the intent of countering potentially damaging scientific evidence. But this is based on funding studies directly relevant to that industry and then having the scholars speak up for the industry. There are clear cases where the industry has bought scientists and science as noted above and the big sugar and big beverage area is absolutely filled with such scholars. But I think the article did not undertake the due diligence to find where personal gain and where scientists as well as just as often professional organizations are bought. Then industry does use its funding to mislead and obfuscate public knowledge. And big beverage has been using spokespersons and scientists like this for decades. But I do feel that the wrong individuals were singled out. I certainly know that a person that pushed for an SSB tax like Dr. Jebb does not fit this bill.

In summary, I felt this set of BMJ articles5-7on the influence of sugar was not only naïve but misguided and missed the people in the UK funded by the industry to help them directly and actively to obfuscate science around key policy issues. And there were and remain many who actively continue to keep the public health agencies from undertaking further actions in the tobacco area. Now we are seeing an increasing number of those in many other medical areas and certainly now in the food arena work actively to stop regulatory actions which are essential if we are to improve our diets and reduce our risks of a vast array of diet-related noncommunicable diseases. At the same time it is almost impossible not to have some interactions with the food industry if one wishes to make changes at a time when for half of the low and middle income countries and most of the higher income countries significant proportions of our food intake comes from package food purchases, most processed minimally or ultraprocessed.13.

Barry M. Popkin

References

1. Ng SW, Slining MM, Popkin BM. Use of caloric and noncaloric sweeteners in US consumer packaged foods, 2005-2009. J Acad Nutr Diet 2012;112(11):1828-34.e6.
2. Popkin BM. Sugary beverages represent a threat to global health. Trends Endocrinol Metab 2012;23(12):591-93.
3. Brownell KD, Farley T, Willett WC, et al. The public health and economic benefits of taxing sugar-sweetened beverages. New Eng J Med 2009;361(16):1599-605.
4. Popkin BM, Nielsen S. The sweetening of the world's diet. Obes Res 2003;11(11):1325-32.
5. Gornall J. Sugar’s web of influence 3: Why the responsibility deal is a “dead duck” for sugar reduction. BMJ 2015;350.
6. Gornall J. Sugar’s web of influence 2: Biasing the science. BMJ 2015;350.
7. Gornall J. Sugar: spinning a web of influence. BMJ 2015;350.
8. Ng SW, Ni MC, Jebb S, et al. Patterns and trends of beverage consumption among children and adults in Great Britain, 1986–2009. Br J Nutr 2012;108:536-51.
9. Harris D, Patrick M. Is 'Big Food's' Big Money Influencing the Science of Nutrition? Secondary Is 'Big Food's' Big Money Influencing the Science of Nutrition? 2011. http://abcnews.go.com/US/big-food-money-accused-influencing-science/stor....
10. Lesser LI, Ebbeling CB, Goozner M, et al. Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med 2007;4(1):e5.
11. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. Am J Public Health 2007;97(4):667-75.
12. Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q 2009;87(1):259-94.
13. Popkin BM. Nutrition, agriculture and the global food system in low and middle income countries. Food Policy 2014;47:91-96.

Competing interests: B. Popkin in the past 3 years has been funded once to speak on beverage consumption patterns and trends at the British Nutrition Association by Danone Water Research Center. Also he assisted a SSB vs water random controlled trial funded by Danone Water Research Center to the National Institute of Public Health, Cuernavaca, Mexico. At other times in his career for 4-5 years his SPH received gifts from Kellogg Corporation for his group to conduct diet studies with the understanding one paper each year would be on any topic and one would be on a topic related to breakfast.

06 March 2015
Barry Popkin
Professor
University of North Carolina at Chapel Hill
137 E. Franklin St., Chapel Hill, NC 27516