Andrew Creamer core medical trainee, Barnet Hospital, London, UK, Katharine Creamer final year medical student, University of Oxford, Oxford, UK
Creamer A, Creamer K.
Educating future doctors on industry pressure
BMJ 2015; 351 :h3915
doi:10.1136/bmj.h3915
Re: Educating future doctors on industry pressure-Big Pharma, Tobacco, Booze AND Food
Congratulations on an excellent piece.
The same principles apply to all vested interests, including Big Pharma, Big Tobacco, Big Booze, Big Food and Big Soda.
The key issue is to remain alert to the high likelihood of conflicts of interest.
And the need to actively manage these.
Gornall’s superb BMJ article on the Sugar Web 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 “nudge” strategies or Responsibility Deals widely recognised as ineffective.5,6 Furthermore, some nutrition scientists appear stuck in the denial phase. Some might claim scientific objectivity. More seriously, 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 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 be 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?
Some of these points were made previously in our BMJ letter published earlier this year
Simon Capewell
Alex Newton
Helen Bromley
Ffion-Lloyd Williams
References
1. Gornall J. The Sugar Web. BMJ 2015 350 h231.
2. Rob Moodie, David Stuckler, Carlos Monteiro, Nick Sheron, Bruce Neal, Thaksaphon Thamarangsi, Paul Lincoln, Sally Casswell, on behalf of The Lancet NCD Action Group Profits & Pandemics: prevention of harmful effects of tobacco, alcohol, & ultra-processed food & drink industries. Non-Communicable Diseases 4. Lancet February 2013
3. Bes-Rastrollo M, Schulze MB, Ruiz-Canela M, Martinez-Gonzalez MA (2013) 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 where Ian McDonald advocated 10% and rubbished 5%. http://www.telegraph.co.uk/news/health/news/10686201/Britain-will-not-ac...
5. Lang & Rayner. Nudge Ineffective, Responsibility Deal will fail BMJ 2011;342:d2177 doi: 10.1136/bmj.d2177
6. Panjwani, C. and Caraher, M. (Feb 2014). The Public Health Responsibility Deal: Brokering a deal for public health, but on whose terms?. Health Policy, 114(2-3), 163-173. doi: 10.1016/j.healthpol.2013.11.002
7. Feb 12th 2015: headline from TELEGRAPH http://www.telegraph.co.uk/news/health/11407141/Government-obesity-advis...
Competing interests: No competing interests