Intended for healthcare professionals

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

The Sugar Web: Potential conflicts of interest need to be managed robustly

Gornall’s superb article1 and the subsequent responses highlight some potentially generic issues around Conflicts of Interest. These include partial advice, altered behaviour, disclosure and, crucially, how best to mitigate future harms.

Can we profit from Gornall’s case studies to generate some generic messages?

There is a long history of industry funded research in nutrition science, and widely acknowledged. But what happens when those same scientists are then elevated from the laboratory to the ministry to advise on national public health policy? Will anyone believe their assertions that substantial and prolonged industry funding does not bias their advice, nor impair their “scientific objectivity and impartiality”? Such claims contradict common sense and deny an extensive literature spanning the tobacco, alcohol, drug and food industries.2,3 Nutrition scientists are also human, and humans rarely bite the hand that feeds them.

Behaviour is clearly altered. Conflicts of Interests can manifest through the mere perception of bias, or through partial advice or altered behaviour. A committee chairman might leak a confidential preliminary conclusion favourable to industry4; or a Government advisor might energetically champion industry-friendly partnerships or “nudge” strategies widely seen as ineffective.5,6 Others might take substantial industry funding for research and multiple Scientific Advisory Board roles while consistently not disclosing these in scientific publications, lectures or broadcasts.1 Some nutrition scientists appear stuck in the denial phase. The public has not been impressed.1,7

Gornall demonstrates that the recent disclosure of food industry interests has clearly been inadequate. Yet, we are probably all conflicted financially, scientifically or personally. So how can potential conflicts of interest in food policy be better managed? The literature offers three alternative strategies: Conservative (do nothing), Descriptive (simply record potential conflicts) or Prescriptive (try and eliminate them). Thus, local and national government have for many years successfully operated clear policies for managing potential conflicts of interest - the Nolan Principles of Public Office.7

Can the UK food policy machine now develop and mature?

Clearly, the same individual scientists who are researching with industry support (however ethical) should not also be leading the formulation of public policy. A solution already exists to capture their expertise while minimising potential influence from industry. The Nolan Principles are already applied very effectively to scientists potentially entangled with the tobacco, alcohol or pharmaceutical industries. Will nutrition science catch up before the British public lose patience?

References
1. Gornall J. Sugar: spinning a web of influence BMJ 2015; 350 :h231
2. Moodie R et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet doi: 10.1016/S0140-6736(12)62089-3
3. Bes-Rastrollo M, Schulze MB, Ruiz-Canela M, et al. Financial Conflicts of Interest and Reporting Bias Regarding the Association between Sugar-Sweetened Beverages and Weight Gain: A Systematic Review of Systematic Reviews. PLoS Med 10(12): e1001578. doi:10.1371/journal.pmed.1001578
4. Telegraph 9 March 2015: http://www.telegraph.co.uk/news/health/news/10686201/Britain-will-not-ac...
5. G. Rayner, T. Lang. Is nudge an effective public health strategy to tackle obesity? No. BMJ doi: 10.1136/bmj.d2177
6. Panjwani C, Caraher M. (Feb 2014). The Public Health Responsibility Deal: Brokering a deal for public health, but on whose terms?. Health Policy doi:10.1016/j.healthpol.2013.11.002
7. Telegraph 12th Feb 2015: http://www.telegraph.co.uk/news/health/11407141/Government-obesity-advis...

Competing interests: No competing interests

17 April 2015
Alex W Newton
Student
Helen Bromley, Ffion-Lloyd Williams, Simon Capewell
University of Liverpool
Liverpool