Obesity Analysis Is Larded with Potential Conflict of Interest

An article published last month in the New England Journal of Medicine (NEJM) about obesity research prompted a lot of health journalists to respond, but their interest wasn’t about this growing (sorry) health problem-it was about the possible conflict of interest that the otherwise prestigious journal might have sidestepped.

Both Gary Schwitzer, editor of HealthNewsReview.org and Kevin Lomangino, a contributor to that site as well as editor-in-chief of Clinical Nutrition Insight, were moved to comment. As Lomangino wrote, the NEJM article “was a ‘mythbusting’ paper designed to separate fact from fiction and expose nonsense masquerading as truth. … as the authors point out, … clinging to unsupported beliefs can ‘yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.’

“But can we trust this particular team of mythbusters?” Lomangino asked after reviewing the disclosure at the end of the article listing all of the companies that paid the authors for a variety of things, including board membership, consulting and lecture fees, licensing agreements and to conduct research. It’s such a hefty catalog-Lomangino calls it “epic”-that you want to laugh at the way it concludes: “No other potential conflict of interest relevant to this article was reported.”

Among the various interests listed with, as Lomangino said, “considerable skin in the obesity game,” are Coca Cola, Pepsi, Kraft, National Cattlemen’s Association, World Sugar Research Organisation, Jenny Craig and drug companies that make weight-loss medications.

“I don’t think there is much doubt,” Lomangino said, “that these relationships influenced the content of the paper, and not for the better. How else to explain the choice of ‘facts’ that the authors chose to highlight in the paper, and those they inexplicably left out?”

Yeah, that’s pretty telling-good science doesn’t pick and choose the data it reports.

Lomangino discussed three interventions the authors say are “suited to clinical settings” in the “facts” section of the paper. Two of them – meal replacements such as low-calorie drinks and bars and weight-loss drugs-are well represented in the list of disclosures. But not represented on the list nor in the article is another intervention-counseling and behavioral therapy. It’s curious, Lomangino wrote, that the authors didn’t think it worthwhile to discuss the benefits of that approach.

Especially when you consider that such an intervention can be successful. The U.S. Preventive Services Task Force (see our blog about this agency) reviewed nearly 40 trials using counseling/therapy for weight loss and deemed it of sufficient value to warrant reimbursing qualified counselors. “But,” wrote Lomangino, “the disclosure list doesn’t indicate any obvious financial stake in this approach for the authors. Could that have had anything to do with their decision not to mention it?”

Everyone knows that a huge contributor to this country’s obesity problem is our fondness for soda and other sugary drinks. Then you realize that the authors say nothing in the paper about soft drinks or sugar and obesity, you look at the inclusion of Coke, Pepsi and the sugar research organization in the disclosure club and you say ‘what’s wrong with this picture?’

“I’m not saying it’s an undisputed fact that cutting out soda reduces obesity (although the evidence from clinical trials seems to be close to erasing any doubts…),” Lomangino wrote. “But considering the huge implications and obvious widespread confusion related to this issue, I think it’s strange that the authors didn’t include some kind of evidence-based discussion.”

“Strange”? He’s being kind. We’re thinking it’s more like “deficient,” or maybe “disingenuous.” “Deceitful,” even. The authors believed that the myth of sex as a big calorie burner deserved their analysis more than the effects of consuming Coke. They believed sex-as-exercise deserved their analysis more than examining whether you can lose weight with the help of dietary supplements, on which Americans spend billions of dollars each year; more than a discussion of the “myth” that eating dairy products can help you lose weight.

“I’m a little surprised,” Lomangino wrote, “that the article didn’t have more to say on these topics, and I can’t help but wonder if their decision-making had anything to do with ties to Basic Research, which according to WikiPedia makes the Zantrex-3 weight loss supplement, or multiple relationships with global dairy interests.”

Lomangino didn’t suggest that these relationships directly compromised the information the authors included, or that they consciously tailored the content to benefit their funders. He acknowledged that they provided a lot of useful, evidence-based information, and, like he, want to see better research in nutrition.

But no thinking person can ignore the possibility that their business relationships have the potential to influence the data and information they choose to present, and how they present it. And when you tiptoe down that path, you add to what the article authors describe as “poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources.”
Conflicts of interests abound in medicine and medical research. But it’s pretty unusual when those on its front lines make its potential harms so easy to see.

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