Dietary Guidelines and Confluence of Interest
In a journalistic article that has stimulated a plethora of posts (Newsmax, World Food News, Mother Jones, and MinnPost), Nina Teicholz expresses concern about bias and the US Dietary Guidelines Advisory Committee Scientific Report.
In anticipation of a public hearing of the 2015 Dietary Guidelines for Americans in the House Committee on Agriculture on October 7, Elizabeth Nolan Brown writes that US Dietary Guidelines are based on the wisdom of “don’t eat anything your ancestors wouldn’t have eaten while watching Cheers on network television”.
Others may reach back further in time to glorify an era when people ate foods obtained by their own hand or that of someone they knew. The reality is that in a world of >7 billion people, modern agri-food production, enrichment/fortification, and distribution systems are reducing the prevalence of nutrient deficiencies and proportion of income spent on food.
Retraction Watch notes that conflicts of interest even permeate volunteer participation in randomized controlled trials (RCTs) – the gold standard of drug testing. People exhibit deceptive behaviors to participate. Seventy-five percent of subjects report concealing some health information from researchers to avoid exclusion from enrolment in a study. The Physicians’ Health Study provides evidence that RCT participants are not representative of the greater population.
Financial gain, fame, influence, and career aspirations drive individual actions to varying extents. Cappola and FitzGerald discuss the pejorative nature of the term ‘conflict of interest’ because it is confrontational and presumptive of inappropriate behavior, especially around financial gain. They make several recommendations:
- Replace the ‘conflict of interest’ with the term ‘confluence of interest’.
- Adopt terrain-mapping approaches to identify sources of bias, i.e. prospect of fame and influence, which have influence as financial gain among individuals, institutions, funders, and journals.
- Permit engagement of inventors in clinical development, with proper oversight, to advance translation of science from bench to bedside.
Transparency helps circumnavigate complexity and minimize bias to benefit individuals and society.
Teicholz, N. The scientific report guiding the US dietary guidelines: Is it scientific? 2015 BMJ doi: 10.1136/bmj.h4962
Cappola AR, FitzGerald GA. Confluence, not conflict of interest: Name change necessary. 2015 JAMA doi: 10.1001/jama.2015.12020
Dwyer JT, Woteki C, Bailey R, Britten P, Carriquiry A, Gaine PC, Miller D, Moshfegh A, Murphy MM, Smith Edge M. Fortification: new finds and implications. 2014 Nutr Rev doi: 10.1111/nure.12086
Devine EG, Waters ME, Putnam M, Surprise C, O’Malley K, Richambault C, Fishman RL, Knapp CM, Patterson EH, Sarid-Segal O, Streeter C, Colanari L, Ciraulo DA. Concealment and fabrication by experienced research subjects. 2013 Clin Trials doi: 10.1177/174077451342917
Sesso HD, Gaziano JM, VanDenburgh M, Hennekens CH, Glynn RJ, Buring JE. Comparison of baseline characteristics and mortality experience of participants and nonparticipants in a randomized clinical trial: the Physicians’ Health Study. 2002 Contr Clin Trials doi: 10.1016/S0197-2456(02)00235-0