ANYTHING TO DECLARE?
Conflict of interest is about much more than money says Dr Arya Sharma. In a blog post in Obesity Notes
(a shortened version reprinted here with permission) he highlights the
conflicts and potential biases nutrition researchers should not hesitate
to acknowledge and disclose that John Ionnadis and John Trepanowski
raise in JAMA.
First, the authors focus on nutrition
research for good reasons. They say: “The totality of an individual’s
diet has important effects on health, [while] most nutrients and foods
individually have ambiguously tiny (or nonexistent) effects. Substantial
reliance on observational data for which causal inference is
notoriously difficult also limits the clarifying ability of nutrition
science. When the data are not clear, opinions and conflicts of interest
both financial and nonfinancial may influence research articles,
editorials, guidelines, and laws. Therefore, disclosure policies are an
important safeguard to help identify potential bias.”
While
the potential for financial conflict in relationship to the food
industry is well recognised and there are now well-established
disclosure norms, other conflicts, of which there are many, are not
routinely acknowledged, let alone, disclosed. For one, there are
significant financial conflicts that have nothing to do with taking
money from industry. For example: “Many nutrition scientists and experts
write books about their opinions and diet preferences. Given the
interest of the public in this topic, books about nutrition, diets, and
weight loss often appear on best-selling lists, even though most offer
little to no evidence to support their frequently bold claims.”
Furthermore: “Financial conflicts of interest can also
appear in unexpected places. For example, many not-for-profit nutrition
initiatives require considerable donor money to stay solvent. Public
visibility through the scientific literature and its reverberation
through press releases, other media coverage, and social media
magnification can be critical in this regard.”
But
conflicts can get even more complicated when they start reflecting
researchers’ own personal views and biases: “Allegiance bias and
preference for favorite theories are prevalent across science and can
affect any field of study. It is almost unavoidable that a scientist
eventually will form some opinion that goes beyond the data, and they
should. Scientists are likely to defend their work, their own
discoveries, and the theories that they proposed or espoused.” While
that is certainly true for any area of research, nutrition scientists
face an additional challenge.
“Every day they must make
numerous choices about what to eat while not allowing those choices to
affect their research. Most of them also have been exposed to various
dietary norms from their family, culture, or religion. These norms can
sometimes be intertwined with core values, absolutist metaphysical
beliefs, or both. For instance, could an author who is strongly adherent
to some religion conclude that a diet-related prescription of his or
her religion is so unhealthy as not to be worthwhile?”
The
authors propose that nutrition researchers: “disclose their advocacy or
activist work as well as their dietary preferences if any are relevant
to what is presented and discussed in their articles. This is even more
important for dietary preferences that are specific, circumscribed, and
adhered to strongly. For example, readers should know if an author is
strongly adherent to a vegan diet, the Atkins diet, a gluten-free diet, a
high animal protein diet, specific brands of supplements, and so forth
if these dietary choices are discussed in an article. The types of
articles in which relevant disclosure should be expected include
original research, reviews, and opinion pieces (such as editorials).”
Although the article focuses on nutrition research, the authors
acknowledge that similar biases may exist in other areas of research.
In
my own experience, ideological biases (although well-intended) are
pervasive through much of the research and publications on topics
ranging from physical activity to public health, where I often see
strong recommendations made based on evidence that is not even remotely
as robust or rigorous as the evidence that comes from, say a large
randomised clinical trials of a new prescription drug.
I
certainly agree with the authors’ recommendation that: “As a general
rule, if an author’s living example could be reasonably expected to
influence how some readers perceive an article, disclosure should be
encouraged. Authors who have strong beliefs and make highly committed
choices for diet or other behaviors should not hesitate to disclose
them. Doing so may help everyone understand who is promoting what and
why.”
Dr Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program.
Read more:
• John Ionnadis and John Trepanowski: Disclosures in Nutrition Research: Why It Is Different.
• Dr Arya Sharma: Conflict Disclosures in Nutrition Research
