RitaRubinMAt ID: 838191
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1 MedicalNews&PerspectivesBacklashOverMeat
MedicalNews&PerspectivesBacklashOverMeatDietaryRecommendationsRaisesQuestionsAboutCorporateTiestoNutritionScientists RitaRubin,MAtsalmostunheardofformedicaljour-nalstogetblowbackforstudiesbeforethedataarepublished.ButthatswhathappenedtotheAnnalsofInternalMedi-lastfallaseditorswereabouttopost Downloaded From: https://jamanetwork.com/ by a Texas A&M University User on 01/15/2020 News&Analysis jama.com(Reprinted)JAMAPublishedonlineJanuary15,2020©2020AmericanMedicalAssociation.Allrightsreserved. evidence-basedmedicinetoproducenutritionalguidelinesthatarentham-peredbyconflictsofinterest.Besidessys-tematicreviewsabouttherelationshipbetweendietarypatterns,food,andnutri-entsandhealthoutcomes,NutriRECSsaiditconsiderspatientandcommunityval-ues,attitudes,andpreferencesinitsguidelinerecommendations.Inthepapers,NutriRECSmem-bersandtheircoauthorswrotethattheysoughttobringscientificrigortocurrentmeatintakeguidelinesbasedmostlyonob-servationalstudiesthatdontestablishcause-and-effectrelationships.Johnston,anassociateprofessorwithTexasA&MUniversitysnutritionandfoodsciencedepartment,andhiscoauthorsusedthe(GradingofRecommen-dations,Assessment,Development,andEvaluations)approachtoassessthequalityofevidenceuponwhichtheybasedtheirguideline.TheGRADEframeworkconsid-ersevidencefromrandomizedcontrolledtrials(RCTs)tobeofthehighestqualityandobservationaldatatobeoflowerqual-itybecauseofresidualconfounding.Apanelof14individualsfrom7countriesvotedonthefinalguidelinerecommenda-tions,and3dissented.Theauthors,whonotedthattheirrec-ommendationswereweakandbasedonlow-certaintyevidence,foundnostatisti-callysignificantlinkbetweenmeatconsump-tionandriskofheartdisease,diabetes,orcancerinadozenRCTsthathadenrolledabout54000participants.Theydidfindaverysmalldiseaseriskreductionamongpeoplewhoconsumed3fewerservingsofredmeatweeklyinepidemiologicalstudiesthatfollowedmillions,buttheassociationwasuncertain.Theauthorsacknowledgedthatotherreasonsbesideshealthnamelyconcernsabouttheenvironmentandanimalwelfaremightmotivatepeopletoreducetheirmeatintake,althoughthosefactorsdidnotbearontherecommendations.Thatwouldrequireasystematicre-viewoftherelevantevidence,whichwasbe-yondthescopeofourworkandindeed,ofourexpertise,Johnstonandhiscoauthorscommentedonthewebsiteinre-sponsetocriticismfornotconsideringen-vironmentalimpact.KatzandotherTHImembershavecriticizedtheauthorsuseofGRADEbe-cause,unlikepharmaceuticalresearch,somuchnutritionresearchisobserva-tionalandsolittleinvolvesRCTs.Wecantrandomlyassignpeopletodietsfordecades,KatztoldJAMA.Evenifwecouldwecouldntblindthemtowhattheyreeatingeverythingaboutnutri-tionalepidemiologycriesoutfortheuseofothermethods[besidesGRADE].KatzandcoauthorsincludingWillettanarticleaboutatooltheyconstructedthatdeemphasizestheimportanceofRCTsinevaluatingevidenceaboutwhattheycalllifestylemedicine,includingdiet.Werenotanti-meat,saidKatz,foundingdirectoroftheUSCentersforDiseaseControlandPrevention fundedPreventionResearchCenteratGriffinHospital,a160-bedacute-carecommunityhospitalinDerby,Connecticut,thatsaffiliatedwiththeFrankH.NetterMDSchoolofMedicineatQuinnipiacUni-versityandtheYaleSchoolofMedicine.Werejustpro-science.Theproblem,saidHarvardMedicalSchoolobesityspecialistDavidLudwig,MD,PhD,isthatthescienceisnotthatgood.Theaverageresearchstudyinnutritionisjustlowerquality.InarecentJAMA,Ludwigandhiscoauthorswrotethatcomparedwithpharmaceuticalresearch,dietarystud-iesarefarmorechallengingintermsofcon-sistency,qualitycontrol,confounding,andinterpretation,whichmakestranslatingthosefindingsintopublicpolicyexceed-inglydifficult.Insteadofcomingupwithtoolstogivemoreweighttoobservationalstudiesinguidelinedevelopment,nutritionscientistsneedtorethinkhowtheydesignstudies,JohnIoannidis,MD,DSc,oftheStanfordUni-versitySchoolofMedicine,wroteina2018JAMAThefieldneedsradicalreform,Ioannidisnoted.WordGetsAroundDemandstoretractthebeforetheywerepublishedsuggestthatthejournalsembargopolicyhadbeenvio-lated.(Embargoesprohibitreportersandpressofficersattheauthorsinstitutionsfromcirculatingarticlesbeforetheyrepublished.Breakinganembargoisaseri-ousbreach.)articleontheTHIwebsitestatesthattheorganizationhadobtainedthemeatar-ticles5daysbeforetheywerescheduledtobepublishedonline.LainesaidKatzwasonpressreleaselistbecausehewritesaweeklycolumnfortheNewHavenRegister,aConnecticutnewspaper.Katzsaidhecirculatedonlythepressre-leasethatsinthepublicdomainbutnottheembargoedarticles,amo
2 ngTHIcol-leagues,tellingthemthattheguide
ngTHIcol-leagues,tellingthemthattheguidelinelookslikeitsgoingtobeaseriousproblemforus.Actually,embargoesapplytopressre-leasesaswellasthearticlesthemselves,saidAngelaCollom,themediarelationsmanager.Theandmanyotherjour-nalspostreleasestoawebsiterunbytheAmericanAssociationfortheAdvance-mentofSciencethatrestrictsaccesstomembersofthemediawhoagreetoem-bargopolicies.Thosechannelsarenotpublicdomain,Collomsaid.BecauseKatzsharedthepressrelease,sheadded,thedroppedhimfromthelistofjournalistseli-gibletoreceiveembargoedreleasesorarticles.Fourdaysbeforethearticleswerepub-lished,Katzand11THImemberssentLaineletteraskinghertopre-emptivelyretractpublicationofthesepaperspendingfur-therreviewbyyouroffice.ThesignatoriesincludedTHIcouncilmembersHuandWillett;NeilBarnard,MD,presidentofthePhysiciansCommitteeforResponsibleMedi-cine(PCRM);formerUSSurgeonGeneralRichardCarmona,MD,MPHDavidJenkins,MD,PhD,anutritionprofessorattheUni-versityofTorontoFacultyofMedicine;andDariushMozaffarian,MD,DrPH,deanoftheFriedmanSchoolofNutritionScienceandPolicyatTuftsUniversity.Itsreallyfrighteningthatthisgroup,whichincludespeoplelikeWalterWillettandFrankHuattheHarvardSchoolofPublicHealth,whichhappenstobemyalmamater,wereawareofthisandassist-ingit,Lainesaid.Whatsmore,THImemberJohnSievenpiper,MD,PhD,alsosignedthelet-tertoLaineeventhoughhecoauthoredtheNutriRECSsystematicreviewtherelationshipbetweenmeatconsump-tionandall-causemortalityandtheriskofcardiovasculardisease,heartattack,andtype2diabetes.LainesaidshecontactedSievenpiper,anutritionscientistattheUniversityofToronto,afterreceivingtheletterandpointedoutthathehadsignedastandardNews&AnalysisE2JAMAPublishedonlineJanuary15,2020(Reprinted)jama.com©2020AmericanMedicalAssociation.Allrightsreserved. formaffirminghisagreementwithhispa-persconclusions.Thathadnotchanged,hetoldher,buthedidnotagreewiththeguide-linepaper,ofwhichhewasnotanauthor.Hoursbeforethemeatarticleswerepostedandtheembargolifted,BarnardsPCRMwentsofarastopetitiontheFederalTradeCommission(FTC)tocorrectfalsestatementsregardingconsumptionofredandprocessedmeatreleasedbytheofInternalMedicine.ButtheFTCdescribesitsroleasprotectingconsumersandpro-motingcompetitioninthemarketplace,soitsunclearwhatauthorityorinterestitwouldhaveinthiscase.DespitePCRMsname,lessthan10%ofits175000membersarephysicians,accord-ingtoitswebsite,whichdescribestheorga-nizationsmissionassavingandimprovinghumanandanimallivesthroughplant-baseddietsandethicalandeffectivescien-tificresearch.InformationTerrorismTherebukescontinuedforweeksafterpublicationofthemeatarticles,butKatzdidntcommentviathetypicalroutesofpostingcommentsonthejournalsweb-siteorwritingalettertotheeditor.Hesaidhedidneitherbecausehesabletoreactmuchmoreimmediatelyandgenerateamuchwiderawarenesswithmyownblogplatforms.InhisOctober6columnfortheNewHavenRegister,Katzcomparedthear-ticles,whichhecalledagreatdebacleofpublichealthtoinformationterrorismthatcanblowtosmithereensthelifesworkofinnumerablecarefulscientists.About3weekslater,PCRMaskeddistrictattorneyfortheCityofPhiladelphia,wheretheeditorialofficeislocated,toinvestigatepotentialrecklessendanger-mentresultingfromthepublicationofthemeatpapersandrecommendations.Anothersalvocameduringarecent1-daypreventivecardiologyconferencewherehalfthepresentationswereonplant-baseddiets.Duringhiskeynoteaddress,WillettshowedaentitledDisinforma-tionthatfaultedseveralorganizationsandindividuals:thesensationalistmedia,spe-cificallytheandlongtimeNewYorkTimessciencereporterGinaKolata,whowrotethenewspapersfirststoryaboutthemeatpapers;BigBeef,specificallyTexasA&MandnutritionscientistPatrickStover,PhD,vicechancellorattheschoolandaco-authoroftheNutriRECSmeatconsump-tionguideline;andevidence-basedaca-demics,namelyNutriRECSandGordonGuyatt,MD,MSc,chairofthepanelthatwrotethemeatconsumptionguidelines.Itwaspartofmytalkaddressingtheconfusionthatthepublicgetsfromtheme-diaaboutdietandhealth,WillettsaidinanemailtoJAMA.Someofthisrelatestothetriangleofdisinformationthatisfeedingintothis.Thesamestrategyisbeingusedtodiscreditscienceonsugarandsodacon-sumption,climatechange,airpollution,andotherenvironmentalhazards.Guyatt,adistinguishedprofessoratMcMasterUniversityinHamilton,Ontario,ledthedevelopment30yearsagooftheconceptofevidence-basedmedicine.IninterviewwiththeCanadianBroadcast-ingCompanyafewdaysafterthemeatarticleswereposted,Guyattcalledtheresponsetothemcompletelypredict-ableandhysterical.Tufts
3 UniversityprofessorSheldonKrimsky,PhD,de
UniversityprofessorSheldonKrimsky,PhD,describeditdifferently.Itsoundslikeapoliticalcampaign,saidKrimsky,whospokeonapanelaboutcor-porateinfluenceonpublichealthatthean-nualmeetingoftheAmericanPublicHealthAssociation.IveseenMonsantodothesamethingontheotherside.Krimsky,whostudieslinkagesbetweenscienceandtechnology,ethicsandvalues,andpublicpolicy,saidTHIispartofaplant-baseddietmovement.IfKatzwroteapaper,anditwaspublishedinoneofthejournals,Iwouldassumehewouldhavetodisclosehisrelation-shipwithhisorganization.StevenNovella,MD,founderandexecu-tiveeditoroftheScience-BasedMedicinewebsiteandalong-timecriticofKatz,wasmorepointedinhisassessmentoftheTHIcampaignagainstthemeatarticles.Itsatotalhitjob,Novella,aYaleneurologist,toldJAMA.Theyhaveacertainnumberofgo-tostrategiesinordertodismissanyscien-tificfindingstheydontlike.Onesuchstrat-egy,hesaid,istolodgeaccusationsoftenu-ousconflictsofinterest.ConfluenceorConflictofInterest?TheNewYorkTimeswasthefirstorganiza-tiontoraisetheissueofpotentialconflictsofinterestamongthemeatpapersauthors.AnOctober4articlenotedthatJohnston,whoreportedhavingnocon-flictsofinterestinthe3yearspriortopub-lication,coauthoredaDecember2016studythatwasfundedbythenon-profitInternationalLifeSciencesInstitute(ILSI),whichisprimarilysupportedbythefoodandagricultureindustry.Heandhiscoauthorsofthe2016articleusedGRADEtoconductaseparateandindependentreviewofthemethod-ologicalqualityofdietaryguidelinesthataddress(added)sugarrecommendations,JohnstontoldJAMA.Theyfoundthattheevidencetosupportrecommendationstocutbackonaddedsugarswaslowtoverylow,highlightingmethodologicaldefi-cienciesinnutritionalguidelines,Johnstonsaid.Thispaperdidnotsaysugarisokaytoconsume.HesaidhereceivedtheILSIfundingin2015,whichwasbeforethe3-yearperiodforwhichhewasrequiredtoreportcompetinginterestsforthemeatarticles.However,ac-cordingtoaDecember31correctioninthe,Johnstondidntincludeonhisper-sonaldisclosureformagrantfromTexasA&MAgriLifeResearchthathereceivedwithinthe36-monthreportingperiod.Thegrantfundedinvestigator-drivenresearchaboutsaturatedandpolyunsaturedfats,ac-cordingtothecorrection.JohnstonisnttheonlyonewhoshadILSIties.TrueHealthInitiativememberSievenpiperservedasascientificadvisorforILSIsCarbohydratesCommitteeasvicechairoftheILSINorthAmericaSci-entificSession2018.Andinlate2015,CanadasNationalPostreportedthattheCornRefinersAssociationretainedSievenpiperasanexpertwitnesstosup-portitscasethathigh-fructosecornsyrupisnolesshealthythansugar.Shortlyafterthemeatpaperswerepub-lished,THIDirectorJenniferLutzpostedanarticleentitledSteakHolderInterests:In-dustryFundingandNutritionReporting,ThearticlecalledoutStover,whocoauthoredtheNutriRECSmeatguideline,forhavinganundisclosedconflictofinter-estbecausehisschoolreceivesfundingfromthebeefindustry.Stoverisvicechan-celloranddeanfortheTexasA&MCollegeofAgricultureandLifeSciences,whichispartofTexasA&MAgriLife.Lutzsarticlenotedthat44Farms,thelargestTexasofBlackAnguscattle,establishedanendowmentatStoversschooltosupporttheInternationalBeefCattleAcademy.However,thebeefindustryprovidesonlyabout1.5%ofAgriLifesfunding,whichNews&Analysisjama.com(Reprinted)JAMAPublishedonlineJanuary15,2020©2020AmericanMedicalAssociation.Allrightsreserved. itposts,spokeswomanOlgaKuchmentsaid.Federalsources,suchastheUSDepartmentofAgriculture,accountforabouthalfofAgriLifesfunding,Kuchmentadded.Besidesanimalscience,AgriLiferesearchareasincludenutritionandfoodsci-ence,horticulturalscience,andsoilandcropsciences.AlthoughhehasreceivedAgriLifefunding,Johnstonsaid,Ipersonallyhaveneverhadtieswiththebeefindustry.Meanwhile,industrytiesandotherpo-tentialconflictsofinterestseemtobecom-monamongTHIcouncilmembersandtheorganizationitself.Amongthenot-for-profitpartnerslistedontheTHIwebsiteare,theOliveWellnessInstitute,whichdescribesit-selfasasciencerepositoryonthenutri-tion,health,andwellnessbenefitsofolivesandoliveproducts;andthePlantricianProj-ect,whosemissionistoeducate,equip,andempowerourphysicians,healthcarepracti-tionersandotherhealthinfluencerswithknowledgeabouttheindisputablebenefitsofplant-basednutrition.AmongTHIsfor-profitpartnersareWholesomeGoodness,whichsellsbetter-for-youfoodssuchaschips,breakfastce-reals,andgranolabarsdevelopedwithguid-ancefromrenownednutritionexpertDrDavidKatz;and,whichsellsmeat-lessproductsmadeofmycoprotein,orfer-mentedfungusmadeintodough.Katz,whoonhispersonalwebsitescribeshimselfasan,bristlesatthesuggesti
4 onthathe,hisorganization,oranyofhiscounc
onthathe,hisorganization,oranyofhiscouncilmembersmighthaveconflictsofinterest.Wewerenttellingpeople:Buyourkumquats,hesaid.Perhapsnotkumquats,butKatz,ac-cordingtohiscurriculumvitae(CV),andhavereceivedfundingfromtheCaliforniaWalnutCommission.AndtheT.H.ChanSchoolofPublicHealth,HusandWillettsacademichome,hasreceivedhundredsofthousandsofdollarsfromthewalnutgroup.IdontthinkthereisanybasisintheworldtoaccuseWalterWillettofconflictofinterest.HeandFrankHuhavegenuinein-terestinthehealtheffectsofnuts,Katzsaid.Theresnothingfundamentallywrong[with]industryfunding.And,KatztoldJAMA,Ithinktheresabigdifferencebetweenconflictofinterestvsconfluenceofinterest.TheworkyoudoiswhatyoucareaboutNooneseverpaidmetosayanythingIdontbelieve.Katzisapastpresidentofanorganiza-tioncalledtheAmericanCollegeofLife-styleMedicine(ACLM),whosewebsitestatesthatTHIwasbirthedfromunderACLMswingin2015,duringhis2-yearterm.TheACLMestablishedtheAmericanBoardofLifestyleMedicine,whichisntrecognizedbytheAmericanBoardofMedicalSpecial-ties.AmongACLMscorporatepartnersisPlantStrongbyEngine2,whichholdsre-treatsdesignedtofosterandcelebrateyourplant-basedpotential,andwhichdeliversready-to-eatwholefoodplant-basedmealswithnoBS(youknow,BadStuff).Carmona,theTHIcouncilmemberandformersurgeongeneral,servesontheboardofHerbalifeNutrition,thedietarysupple-mentscompany,andaschiefofhealthinnovationCanyonRanch,theworldsrecognizedleaderinluxuryspavacations.Ina2018commentaryentitledResist-inginfluencefromagri-foodindustriesonCanadasnewfoodguide,THIcouncilmem-berJenkinslistedunderhiscompetingin-terestsdozensofresearchgrantsfromcom-paniesandindustrygroups,includingthePulseResearchNetwork,theAlmondBoardofCalifornia,theInternationalNutandDriedFruitCouncil;SoyFoodsAssociationofNorthAmerica;thePeanutInstitute;KelloggsCanada;andQuakerOatsCanada.Katzs66-pageCVprovidesmuchfoodforthoughtaboutindustryfundingofnutri-tionresearch.Helists2grantsfromHersheyFoodstotaling$731000tostudytheef-fectsofcocoaonvascularfunctioninpeoplewithhypertensionandinthosewithobe-sity.Hereceived4grantstotaling$662000fromtheEggNutritionCenter,theresearchandeducationdivisionoftheAmericanEggBoard.OneoftheegggrantswasawardedinAugust2010,aroundthesametimehepublishedanarticleentitledRecentanthro-pologicandclinicalresearchraisesques-tionsaboutegg/cholesterolrelationship EggsonerationintheEggNutritionCentersNutritionCloseupnewsletter.Healsore-ceived$249701fromISOThrivetostudytheeffectsofitseponymousgastroenterolo-gistrecommendedmicroFoodinover-weightadults.KatzalsoisseniornutritionadvisorforKindHealthySnacksaTHIpartnerandhasreceived$153000inresearchgrantsfromthecompany.In2015,theyearKatzbe-cameanadvisortoKind,itreceivedawarningletterfromtheUSFoodandDrugAdministration(FDA)forfalsenutrientclaims,includingtheuseofthewordhealthy,onitslabels.ConsumerConfusionDoconsumerslosewhennutritionresearch-erscantplaynice?TimothyCaulfield,LLM,researchdirec-toroftheUniversityofAlbertasHealthLawInstituteandaTHIcouncilmember,gave3publiclecturesin1weeknotlongafterpublishedthemeatarticles.Thisis-suecameupatall3,Caulfieldsaid.Iunderstandboththeconcernaboutconflictofinterest,especiallyinnutritionre-search,andthevalueofadvocating[for]amoreplant-basedapproachtonutrition,hesaid.Butthereissomuchpublicconfusionsurroundingdiet.Iworryaboutanymessag-ingthatmightbeinterpretedasdogmatic.Caulfield,describedina2018profileTorontosGlobeandMailasoneofNorthAmericasmosthigh-profileskeptics,tak-ingontherisingtideofpseudoscienceandmisinformation,notedthatthe[THI]coun-cilhasmanyalternativemedicinepractition-ersandembracesintegrativehealth.Thiscanbedifficulttosquarewithascience-basedapproach.WhenaskedifheplannedtostepdownfromtheTHIcouncil,Caulfieldsaid,Illneedtoputmorethoughtintothis.IhaventaskedthemtoremovemynamebutIhaventbeenactivelyinvolved.Thecacophonythathaseruptedoverthemeatpapersisdrowningoutthevalidpointstheymade,Lainesaid.Thesadthingisthattheimportantmessageshavebeenlost,shesaid.Trust-worthyguidelinesusedtodependonwhoweretheorganizationsorthepeopletheycamefrom.Today,though,thepublicshouldknowwedonthavegreatinforma-tionondiet,Lainesaid.Weshouldntmakepeoplescaredtheyregoingtohaveaheartattackorcoloncanceriftheyeatredmeat. :Sourcereferencesareavailablethroughhyperlinksembeddedinthearticletextonline.News&AnalysisE4JAMAPublishedonlineJanuary15,2020(Reprinted)jama.com©2020AmericanMedicalAssociation.Allrightsreserved.