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Conflicted Advisory Committees: Then and Now

SHOULD EXPERTS BE PERMITTED TO SERVE ON DIETARY ADVISORY committees when they have financial ties to companies that might profit from the committee’s advice? Of course not, but they often do. The UK Health Forum provided evidence for this contention in its collection of examples of inappropriate food-industry influence over the deliberations of government and professional advisory committees in such countries as Mexico, Chile, Guatemala, and Fiji, among others.1

Concerns about undue industry influence on committees are anything but new. In the 1970s, conflicts of interest among nutrition committee members came to the attention of no less than a US senator, Wisconsin Democrat William Proxmire. In 1974, Proxmire complained that the National Academy of Sciences’ Food and Nutrition Board, the group responsible for setting Recommended Dietary Allowances (RDAs) for daily nutrient intake, was in the pocket of the food industry. Proxmire was infamous for his annual Golden Fleece Awards ridiculing taxpayer-funded research he viewed as frivolous (much of it was not). He also held scientifically questionable beliefs about vitamins: if some were good, more were better. In his view, the RDAs were too low, “arbitrary, unscientific, and tainted” and amounted to “one of the most scandalous conflicts of interest in the Federal Government.” As he saw it, the board was “both the creature of the food industry and heavily financed by the food industry.” Furthermore, he said it was in “the narrow economic interest of the industry to establish low official RDAs because the lower the RDAs the more nutritional their food products appear.”2

In reality, the board was trying to stop the supplement industry from promoting large amounts of nutrients as beneficial when the science showed that excess intake was useless or harmful, but Proxmire was not especially interested in evidence. When the FDA proposed to set an upper limit of 150 percent of the RDA for over-the-counter nutritional supplements, he induced Congress to pass his Proxmire Amendment, which blocked the FDA from classifying “any natural or synthetic vitamin or mineral (or combination thereof) as a drug solely because it exceeds the level of potency which the Secretary determines is nutritionally rational or useful.”3

Proxmire may have misjudged the science, but he knew his politics. As he wrote at the time, “Let’s face it. The orthodox nutritional community is off base in supporting the FDA’s attempt to regulate vitamins as drugs. It’s foolish, wrong, and bad policy. It’s so typical of the FDA—go after the little guy, the harmless vitamins… but overlook aspartame, DES [diethylstilbestrol], and thalidomide.”4 In this, he was mostly in error. The FDA had issued a warning about DES, and to this day its refusal to approve thalidomide is considered the agency’s finest hour.

But Proxmire was right about the board’s ties to industry. Those were revealed in 1980 during a dispute over the first edition of the US dietary guidelines, which advised reductions in intake of fat, saturated fat, and cholesterol (meaning, in effect, meat, dairy, and eggs) to reduce the risk of heart disease. The board opposed the guidelines so vehemently that it issued a counter-report, Toward Healthful Diets, arguing that fat restrictions were unnecessary for healthy people. This infuriated health advocates, who charged that at least six board members had financial ties to industries most affected by the guidelines. Sheldon Margen, a professor of public health at the University of California, Berkeley, for example, objected that “the board’s range of expertise is too narrow, its ties with industry too close to avoid the suspicions of bias, its mandate is too ill-defined, and its mode of operation is too secret.” Others criticized the board’s support by an industry liaison committee whose members represented eighty food companies. The furor over the report so embarrassed the academy that it eliminated the industry panel, removed board members with strong ties to food companies, and appointed new members with fewer industry ties.5

That was not the only instance of early concerns about conflicted committees. I asked Ken Fisher, who in the 1970s had directed the nongovernmental Life Sciences Research Office (LSRO), about his experience appointing committees to review the safety of food additives. In 1958, Congress had defined two categories of food additives: new chemicals that needed to be proven safe before they could go into the food supply and substances with a history of common use—sugar, salt, flavorings, and the like—that could be considered generally recognized as safe (GRAS). In the early 1970s, questions about the safety of GRAS additives led President Richard Nixon to direct the FDA to evaluate them, and the FDA commissioned the LSRO to conduct the reviews. The LSRO appointed committees to do this work and was immediately confronted with the problem of what to do about candidates with ties to companies making or using the additive under consideration.

The review committees eventually issued 151 evaluations of more than four hundred GRAS additives. In a report on this work, Fisher said that the LSRO’s policies on conflicts of interest were more rigorous than those of the government. The LSRO required candidates to report grants, contracts, and consultancies, as well as investments and holdings. It did not permit members with such ties to participate in discussions or vote on final decisions. Fisher told me that all members “were made aware of these conditions and all agreed—after some back and forth.” He recalled “one conflicted member, who of his own volition, absented himself from the vote on the decision.” He also recalled that committees “rejected several of the monographs on substances because they were incomplete and clearly biased in coverage of published positive or negative studies on certain substances.”6

Fisher’s comments suggested that conflicts of interest only rarely caused problems with GRAS reviews. But in The Case Against Sugar (2016), the journalist Gary Taubes presented the GRAS review of sugar (sucrose) as highly conflicted. His book notes that the chair of the overall GRAS review process was George W. Irving Jr., a former head of the scientific advisory board of the International Sugar Research Foundation, and that the GRAS committee relied heavily on materials provided by the Sugar Association. The 1976 GRAS review concluded that “other than the contribution made to dental caries, there is no clear evidence in the available information on sucrose that demonstrates a hazard to the public when used at the levels that are now current and in the manner now practiced.”7 According to Taubes, the Sugar Association took that to mean that “there is no substantiated scientific evidence indicating that sugar causes diabetes, heart disease, or any other malady.” He has harsh words for critics of the idea that sugars are harmful. “If you get a chance,” he advises, “ask about the GRAS Review Report. Odds are you won’t get an answer. Nothing stings a nutritional liar like scientific facts.”

The FDA’s GRAS reviews still elicit concerns about conflicted interests. A 2013 analysis of the GRAS review process concludes that the industry ties of committee members not only threaten the integrity of GRAS reviews but also the integrity of the FDA’s entire scientific enterprise. In a commentary on that analysis, I pointed out that without independent review of GRAS additives, it is difficult to be confident that the ones in use are safe.8

My questions to Fisher about GRAS review committees had induced him to search through notes packed away for decades. Among them, he found memos indicating that Mike Jacobson had asked to have consumer representatives appointed to GRAS review committees, but, he said, “We opted not to do so as it would imply the other members of the [committees] were not consumers.” Fisher was referring to Michael Jacobson, director of the Center for Science in the Public Interest (CSPI), whose concerns about conflicted advisory committee members also date back to the 1970s. Jacobson was arguing that if federal agencies insisted on permitting members with industry ties to serve on advisory committees, they should balance viewpoints with an equivalent number of consumer representatives.

Jacobson holds a doctorate in microbiology. He began his career working for Ralph Nader, cofounded CSPI in 1971, and retired as its director in 2017. CSPI’s purpose is to improve the American diet, and it continues to be the largest nonprofit organization engaged in advocacy for a broad range of nutrition issues, among them conflicts of interest caused by food industry sponsorship. I served on the CSPI board for about five years in the early 1990s, remain a member, and subscribe to its monthly Nutrition Action Healthletter.

In 1976, Jacobson asked a member of Congress with a strong record of consumer advocacy, New York Democrat Benjamin Rosenthal, to help him survey the heads of university nutrition departments about their faculty’s ties to food corporations. Jacobson told me why he had done this: “It was so obvious to me that professors were touting their academic affiliations while shilling for food manufacturers and trade associations. I thought it would be interesting and possibly useful to collect information about the matter.”9 Rosenthal introduced their report of the survey results, titled “Feeding at the Company Trough,” into the Congressional Record, with this blunt statement:

Nutrition and food science professors at Harvard, at the Universities of Wisconsin, Iowa, and Massachusetts, and at many other prominent universities work closely and often secretly with food and chemical companies. Professors sit on the boards of directors, act as consultants, testify on behalf of industry at congressional hearings, and receive industry research grants. Many professors with corporate links also serve as “university” representatives on Federal advisory committees.… One can only come to the conclusion that industry grants, consulting fees and directorships are muzzling, if not prostituting nutrition and food science professors.10

The report named names: it characterized Fred Stare, the head of Harvard’s Department of Nutrition, as a “food-industry apologist,” but it also listed the industry ties of sixteen other eminent scientists, nearly all members of prestigious national committees issuing advice about nutrition and health. It proposed three strategies for countering conflicted interests: balance, disclosure, and new funding mechanisms. All merit comment from today’s perspective.

To achieve balance, they wanted consumer representatives to be appointed to nutrition advisory committees. This seems entirely rational, but in my experience federal agencies view experts who avoid industry ties on principle as too biased to appoint, especially if they state those principles publicly. I was a member of the Dietary Guidelines Advisory Committee in 1995, but only because I had previously worked with the assistant secretary for health, Philip R. Lee, who insisted on my appointment. I served as a consumer representative on two FDA advisory committees in the 1990s, Food Advisory and Science Advisory, but have not been asked to join another federal committee since the publication of Food Politics in 2002. The FDA’s current practice is to appoint one consumer representative to its committees, hardly enough to have much influence on decisions.

With respect to disclosure, the report comments on the failure of the named professors to state the full extent of their industry ties: “As long as collaboration with industry continues to be viewed by the academic community as ethical and respectable, it is important that the public know about potential sources of bias.… In such matters, respect for individual privacy must yield to society’s right to know.”

To help accomplish the third strategy, funding, the report raised the idea of a nonprofit, public interest group to “launder” industry contributions before they reach universities. But I doubt that such a group could maintain its objectivity if it depended on ongoing donations. I also doubt that companies would be willing to provide ongoing support for research that might risk producing unfavorable results.

CSPI has continued to view researchers’ ties to industry as a threat to science. In 2003, it initiated its Integrity in Science project to demonstrate how investigators’ financial ties to the chemical, pharmaceutical, and cigarette industries (not necessarily those making foods and beverages) affect research results and interpretation and to advocate for balance on advisory committees, full disclosure, and journalists’ attention to conflicted scientific interests.11 As part of this project, CSPI constructed a conflict-of-interest database listing about four thousand researchers identified through journal disclosure statements and other public sources as having accepted funding from industry. Conservative critics complained that the database unfairly implied that industry funding is necessarily corrupting and that CSPI’s Integrity in Science project was “in reality, a platform for bashing science it doesn’t like.”12

To discuss such issues, CSPI hosted four conferences (see Figure 8.1). I spoke at the 2003 conference on food-industry influence, but food issues were never the primary focus of this project and seemed peripheral to it, perhaps because the effects of sponsorship were—and continue to be—better documented for other industries. Nevertheless, many investigators on CSPI’s database were engaged in nutrition research, but they are not easy to locate without knowing what to look for. When I searched for “vitamin” as a research topic, up popped the names of 171 scientists, many of whose studies were funded by supplement companies.

CSPI ended this project in 2009, ironically for lack of funding, but continues to advocate for advisory committees free of industry influence. This group has been especially concerned about committees advising on treatment for high blood cholesterol, a risk factor for coronary heart disease. Such committees typically recommend the widespread use of statin drugs. But dietary approaches—reduced intake of foods highest in saturated fat, trans fat, sodium, and added sugars—also work, cost less, and have fewer side effects.13 Questions about who needs to take statins remain hotly debated, not least because when advisory committees are packed with members with financial ties to statin companies, they are more likely to recommend statins over dietary approaches and to advise these drugs for increasingly wide swaths of the population.14

In 2004, CSPI organized several dozen physicians and scientists (including me) to sign a letter calling for the appointment of independent panels to reevaluate the evidence for statin drugs versus dietary approaches. This concern remains highly relevant. In 2017, the editors of JAMA Internal Medicine, noting that clinical trials sponsored by statin companies report greater benefits and fewer adverse effects than non-industry-sponsored trials of the same drugs, urged physicians to “refocus efforts on promoting a heart-healthy diet, regular physical activity, and not smoking.”15

Conflicts of interest are a constant concern about drug advisory committees, but what about committees issuing the dietary guidelines? This too has a history. The guidelines have been issued jointly by the USDA and the Department of Health and Human Services (HHS) every five years since 1980. They constitute the official statement of federal nutrition policy. Because they influence the rules governing nutrition education, school meals, food assistance, and food labels, every word of them is the target of intense food industry lobbying.16

To understand how conflicts of interest might affect the guidelines, it helps to understand how they are created. The process begins with appointment of a Dietary Guidelines Advisory Committee (DGAC). When I was on the DGAC in 1995, the agencies instructed us to review the research published since the previous edition and provide the best advice we could on that basis. We wrote a report summarizing that research and then wrote dietary guidelines based on our interpretation of what it meant. In 2005, the industry-friendly administration of President George W. Bush changed that process. The DGAC would continue to review and summarize the science, but the agencies would now write the actual guidelines. This took the guidelines out of the hands of scientists and put them into the hands of agency political appointees.

Conflicted interests among DGAC members can also make that process subject to industry influence. As special government employees, members must disclose conflicts of interest to the agencies. The agencies, however, are not required to make the disclosures public and usually do not. Candidates for committee membership who consult, do research, or work for food companies are not necessarily disqualified from serving. They are eligible for waivers, which the agencies often grant on the grounds—debatable, in my opinion—that qualified members who have no ties to industry are too difficult to identify.

These days, the White House itself grants waivers related to dietary guidelines. In 2017, White House Counsel Donald McGahn issued a waiver for Kailee Tkacz, a former lobbyist for the Snack Food Association and for the Corn Refiners Association, for which she was also director of food policy. The Corn Refiners Association, you will recall, represents producers of high-fructose corn syrup. McGahn explained that this waiver would allow Tkacz to advise the USDA about the dietary guidelines process. He said he had “determined that it is in the public interest to grant this limited waiver because of Ms. Tkacz’s expertise in the process by which the Dietary Guidelines for Americans are issued every five years.”17

Citizens who want to know about DGAC members’ arrangements with food companies must file Freedom of Information Act (FOIA) requests or look up members’ disclosure statements in published papers. Doing so reveals that in 1995, when I was on the DGAC, only three of the eleven members had ties to food companies, but the balance soon shifted: to seven of eleven members in 2000, eleven of thirteen in 2005, and nine of thirteen in 2010. Members of the 2000 DGAC, for example, reported financial ties “to two meat associations, four dairy associations and five dairy companies; one egg association; one sugar association; one grain association; five other food companies; six other industry-sponsored associations; two pharmaceutical associations; and 28 pharmaceutical companies.”18 Zara Abrams, a journalism student at the University of Southern California, looked up disclosure statements in published papers by members of the 2015 DGAC. By her tally, ten of the fourteen had consulting arrangements or research grants with companies producing meat, dairy, or processed foods.19 Did such conflicts affect this DGAC’s interpretation of the science? Several critics argue that they most definitely did.

Nina Teicholz’s Critique: The DGAC’s Nonrigorous Science

In 2015, the BMJ published what it called an “investigation”—what later appeared to be a commissioned editorial—by the journalist Nina Teicholz, sharply critical of the DGAC for weaknesses in its scientific review. Teicholz is the author of The Big Fat Surprise (2014), a book promoting the health benefits of fats and foods derived from animals. Her article objected to the DGAC’s recommendation to reduce intake of saturated fats and, therefore, meat, arguing that it was largely based on reviews by heart and cardiology associations that receive substantial funding from food companies. “This reliance on industry backed groups,” she wrote, “clearly undermines the credibility of the government report.” She added, “It is surprising that unlike authors in most major medical journals, guideline committee members are not required to list their potential conflicts of interest. A cursory investigation shows several such possible conflicts: one member has received research funding from the California Walnut Commission and the Tree Nut Council, as well as vegetable oil giants Bunge and Unilever.”20

As I noted earlier, the agencies do collect information about conflicted interests; they just do not release it publicly. CSPI identified eleven more errors of fact or interpretation in Teicholz’s article and organized a letter signed by 180 scientists demanding its retraction (I did not sign it; although I viewed her analysis as scientifically flawed, I thought she was entitled to her opinion).21 To deal with CSPI’s letter, the BMJ asked two academics for independent reviews: Mark Helfand at the Oregon Health & Science University and Lisa Bero, with whom I had worked at the University of Sydney earlier that year. Both concluded that the Teicholz article had numerous factual errors but agreed with her contention that the DGAC process was insufficiently rigorous.

In Bero’s view, “Teicholz’s criticisms of the methods used by DGAC are within the realm of scientific debate.” Helfand noted that the Arnold Foundation (which promotes evidence-based policy) had supported Teicholz’s work; Teicholz had disclosed this funding, and the foundation’s website lists a payment of $4,000 to the BMJ “to produce a report that analyzes the scientific research used to inform the Dietary Guidelines Advisory Committee recommendations” (the payment went for open access to her article). Helfand stated that “compared with other BMJ investigations and most investigative journalism, this article is poorly researched and poorly documented.” He said the BMJ’s decision to publish the article was “regrettable” and “[The] article is better described as an opinion piece, editorial, or even an example of lobbying literature than an independent investigation.” Nevertheless, he advised against retraction, in part because “it is clear that further investigation of the composition of the committee, as well as its conflict of interest policies and work group structure, are warranted.” In response to complaints, the BMJ had earlier corrected Teicholz’s statement of conflicted interests. It later corrected one of her statements about the science. Finally, the BMJ chose not to retract but instead published further corrections and clarifications that CSPI believes largely supported the points detailed in its complaint.22

Beyond the BMJ article, the Arnold Foundation also funded a group organized by Teicholz, the Nutrition Coalition.23 This group lobbied Congress and succeeded in getting it to agree that the “entire process used to formulate and establish the guidelines needs to be reviewed before future guidelines are issued.… At a minimum, the process should include: full transparency, a lack of bias, and the inclusion and consideration of all of the latest available research and scientific evidence, even that which challenges current dietary recommendations.”24 On that basis, Congress granted a million dollars to the National Academy of Medicine to evaluate the guidelines process.

The academy dealt with this challenge by appointing a review committee, which released a report on the DGAC selection process early in 2017. The committee suggested that DGAC members be nominated by third parties, nominations be open to public comment, and members fully disclose conflicted interests. The committee’s second report later that year recommended ways to strengthen scientific credibility and make the DGAC’s decisions more transparent.25 Whether or how the agencies might use these recommendations to develop the 2020 guidelines was not public at the time this book went to press.

Neal Barnard’s Critique: The DGAC’s Cholesterol Advice

Breaking with precedent, the 2015 DGAC omitted advice to limit cholesterol to three hundred milligrams per day as a means of reducing heart-disease risk: “The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.… Cholesterol is not a nutrient of concern for overconsumption.”26 Eggs are the largest source of dietary cholesterol (one egg contains about two hundred milligrams). This change meant that Americans no longer needed to worry about the cholesterol in eggs.

As evidence, the DGAC report cited two review articles, both funded by independent sources. One found insufficient evidence to decide whether lowering dietary cholesterol reduces blood cholesterol. The second, a meta-analysis, found no association of eggs with heart disease risk or mortality but did find an association of eggs with an increased risk of type 2 diabetes and of heart disease in patients with diabetes.27 “Insufficient evidence” is not surprising. Studies on eggs and cholesterol are particularly difficult to interpret because saturated fat raises blood cholesterol levels more than does dietary cholesterol, blood cholesterol levels in the general population are already so high that adding an egg or two makes little difference, and so many people take statins that the effects of dietary cholesterol are blunted. Nevertheless, the dropping of the cholesterol guideline seemed so gratuitous that Neal Barnard, president of the Physicians Committee for Responsible Medicine (PCRM), wondered whether DGAC members’ ties to the egg industry might have influenced this decision.

PCRM advocates for plant-based diets and animal welfare. It and other such groups filed a lawsuit arguing that elimination of the cholesterol guideline violated the Federal Advisory Committee Act, which prohibits special interests from influencing committee members. They charged that the egg industry, through its Egg Nutrition Center (the education and research arm of the USDA-sponsored American Egg Board) deliberately organized research to cast doubt on a linkage between eggs and high blood cholesterol levels: “The Egg Nutrition Center’s funding establishes financial relationships with key researchers at major universities and supports studies designed to portray eggs in a favorable light. These research funds… are used to fund studies designed in pursuit of the American Egg Board’s mission ‘to increase demand for eggs and egg products.’”28

The lawsuit noted that studies funded by the egg industry dominate research on dietary cholesterol. It pointed to a 2013 review concluding that the effect of dietary cholesterol on blood cholesterol “is modest and appears to be limited to population subgroups.”29 Of the studies reviewed in that paper, 92 percent were supported by the egg industry. Because one of the review’s authors, Alice Lichtenstein, was vice-chair of the 2015 DGAC, the lawsuit suggested that Lichtenstein was in a position of particular influence over the cholesterol issue. She denies such influence: “The committee reviews the evidence, assesses current dietary intakes, and draws conclusions. This was not smoke and mirrors.”30

The lawsuit also charged that four other members of the DGAC had direct ties to the Egg Nutrition Center, were nominated by it, or held positions at a Tufts University research center that actively sought egg-industry funding to evaluate support for the new cholesterol nonrecommendation. It quoted press comments to demonstrate the effect of the DGAC’s decision: “Think of all those eggs you missed,” and “Eggs are back.”31

The legal brief may have been sparked by commitments to vegan diets and animal rights, but it is well worth reading for its lucid explanation of how easily egg studies can be manipulated to produce desired results. For example, if your study compares the effects of eating eggs to eating foods high in saturated fat or cholesterol, you won’t see a difference. If your dietary intervention adds eggs but cuts calories or saturated fat, the effects will cancel each other. If you divide study participants into groups based on how strongly they react to dietary cholesterol, only hyper-responders will appear to be at risk. If you use a small study sample so results are not statistically significant, you can interpret them as showing no effect. And if you mainly include industry-funded studies in your meta-analysis, you will have a better chance of showing that eggs have no effect on blood cholesterol levels.

I can think of one more: do the obvious. A study funded by the Egg Nutrition Center demonstrates that eating eggs along with raw vegetables increases absorption of vitamin E. Of course it does; vitamin E is fat-soluble and requires fat for absorption. This study is especially relevant because its senior author was a member of the 2015 DGAC.32 Shortly before release of the 2015 dietary guidelines, Barnard ran a billboard campaign pressing for reinstatement of the eat-less-cholesterol recommendation (Figure 8.2).

I was a reviewer on an early draft of the 2015 dietary guidelines, but that experience did not prepare me for what the guidelines said about cholesterol when they appeared early in 2016. To quote: “The Key Recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but… individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.… Eating patterns that include lower intake of dietary cholesterol are associated with reduced risk of CVD [cardiovascular disease].”33 This is head-spinning advice. If I am reading the guidelines correctly, they are saying that you don’t need to limit cholesterol but should eat as little as possible. No wonder dietary advice seems confusing.

To return to the PCRM lawsuit: the judge threw it out of court in October 2016. On what grounds? “Undue influence,” it seems, has no legal definition. The court ruled that it could find “no meaningful standard for deciding whether certain scientists exercised, or whether the USDA and HHS sufficiently guarded against, inappropriate influence in the DGAC.”34 In writing about this decision, Business Insider quoted Nina Teicholz, Neal Barnard, and me, the three of us in rare agreement about the absurdity of the ruling.35

Industry’s Critique: Sugar Guidelines Are Not Science-Based

In 2015, WHO advised consuming no more than 10 percent of calories from added sugars.36 So did the 2015 US guidelines. The guidelines have always advised eating less sugar, from the straightforward “avoid too much sugar” in 1980 and 1985, to the more complicated and obfuscating “choose beverages and foods to moderate your intake of sugars” in 2000 and “reduce the intake of calories from solid fats and added sugars” in 2010. Ten percent of calories translates to about fifty grams of added sugars a day, or twelve teaspoons, which is not exactly abstemious, but it takes only one sixteen-ounce soft drink to reach that limit. The Sugar Association immediately invoked the playbook to cast doubt on the science. It accused WHO of basing its advice on poor-quality evidence, and it called the US guideline “agenda based, not science based.”37

Taking up this theme, ILSI sponsored a study concluding that “guidelines on dietary sugar do not meet criteria for trustworthy recommendations and are based on low-quality evidence.”38 Of the study’s five authors, two disclosed grants from ILSI; one of the two was on the scientific advisory board of Tate & Lyle, a British supplier of sugar and sweeteners. Why the Annals of Internal Medicine chose to publish this ILSI-funded review is beyond me, but it hedged its bets by commissioning an editorial from two prominent advocates for sugar reduction, Dean Schillinger and Cristin Kearns of the University of California, San Francisco (UCSF). Their editorial demolished the review’s arguments point by point, and chastised the journal: “When it comes to added sugars, there are clear conflicts between public health interests and the interests of the food and beverage (F&B) industry.… High quality journals could refrain from publishing studies on health effects of added sugars funded by entities with commercial interests in the outcome.”39

This dispute was covered by the New York Times (which quoted me) as well as other publications. The AP’s Candice Choi interviewed ILSI’s executive director, who admitted that his group had initiated this study. Choi obtained emails revealing that ILSI had requested revisions of the review and that one author had failed to disclose grants from Coca-Cola and other companies with interests in making sugar appear harmless. The Annals had to correct the authors’ disclosure statements and publish a clarification that ILSI had, in fact, reviewed and approved the review. All of this convinced Mars, Incorporated, a member of ILSI, to tell Choi that this study “undermines the work of public health officials and makes all industry-funded research look bad.”40 Soon after, as noted in Chapter 4, Mars withdrew from ILSI.

The authors’ disclosure statement warned readers, “Given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully.” Yes, readers should. Unless ILSI and its commissioned authors believe that dietary guidelines ought to encourage eating more sugar, their review is pointless. ILSI-sponsored guidelines for selection of advisory committee members argue that financial biases are immaterial unless candidates for membership derive a direct benefit from the committee’s work. In ILSI’s view, keeping members with conflicted interests off advisory committees bars “the most experienced and knowledgeable nutrition and food scientists from contributing their expertise on the panels informing public policy.”41 I think this is a hypothesis that has yet to be tested. ILSI’s efforts, along with the others reviewed here, should make it clear that debates about the dietary guidelines are far more about politics than they are about science.