conflict of interest
Describing their findings as "particularly worrisome," the authors of a study published Monday in Public Health Nutrition noted that in the U.S., the Dietary Guidelines for Americans form "the foundation for all national nutrition programs," which amount to nearly $100 billion annually.

A study released Monday found 95% — 19 of the 20 members — of the U.S. government-run committee responsible for establishing dietary guidelines for Americans have one or more conflicts of interest (COIs) with industry actors in Big Food, Big Ag and Big Pharma.

The U.S. Dietary Guidelines for Americans Advisory Committee (DGAC) sets the guidelines used by U.S. policymakers, healthcare providers, nutrition educators and federal nutrition program operators, including those responsible for school lunch programs, on what foods and beverages "meet nutrient needs, promote health and prevent disease."

According to the study, 129 industry actors had relationships with the 20 DGAC members, based on the COI disclosures submitted by the members of the committee.

Describing their findings as "particularly worrisome," the authors of the study explained why this is a matter of public concern, noting that in the U.S., the Dietary Guidelines for Americans form "the foundation for all national nutrition programs," which amount to nearly $100 billion annually.

The DGA also offers guidance to state and local governments, as well as healthcare professionals, hospitals, and community groups, among others, as "overarching dietary recommendations."

The study's authors added:

"Trustworthy dietary guidelines result from a transparent, objective, and science-based, process. Our analysis has shown that the significant and widespread COI on the committee prevent the DGA from achieving the recommended standard for transparency without mechanisms in place to make this information publicly available.

"Our findings here are particularly worrisome, as industry influence and COI can result in diverting the scientific process underpinning the U.S. national dietary guidelines, to one that is responsive to profit-driven interests rather than the public health."

The study appeared in Public Health Nutrition, published by Cambridge University Press on behalf of The Nutrition Society, a UK-based nonprofit whose mission is to advance the scientific study of nutrition.

The DGAC, first convened in 1977, operates under the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS). The report, since its introduction in 1980, is revised and re-released every five years.

The DGAC's latest report, issued in July 2020, led to the publication in December 2020 of the ninth version of the Dietary Guidelines for Americans.

Did committee members influence policy on breastmilk substitutes to promote product sales?

In an example of the depth and extent of the conflicts of interest identified, the authors of the study highlighted examples such as the following, involving food and nutritional products produced for infants and young children:

"[T]he Pregnancy and Lactation Subcommittee of the DGAC had six members, four of whom, or two thirds, had COI involving manufacturers of breastmilk substitutes: SD, RK, KD, JS [referring to DGAC committee members] all had instances of COI with Mead Johnson, and SD had COI with Wyeth and Abbot [sic].

"The Birth to Age 24 Months Subcommittee, which also addressed infant and young child nutrition, had four of its six members having COI involving manufacturers of breastmilk substitutes: SD, RK, KD also served on the Pregnancy and Lactation Subcommittee, with the same COI mentioned above; and TD had at least one COI with Abbott.

"There is evidence that those companies producing breastmilk substitutes regularly use science and try to influence policy in order to protect and promote the sales of their products, and their relationships with DGAC members may have had a direct impact on the work of those members."

The study also highlighted the following findings:

"Our analysis found that 95% of the committee members had COI [conflicts of interest] with the food, and/or pharmaceutical industries and that particular actors, including Kellogg, Abbott, Kraft, Mead Johnson, General Mills, Dannon, and the International Life Sciences [Institute or ILSI] had connections with multiple members.

"Research funding and membership of an advisory/executive board jointly accounted for more than 60% of the total number of COI documented.

"We observed the existence of extensive, varied and long-standing relationships between some DGAC members and industry actors whose products are directly affected by the DGAC report ́s recommendations as well as the DGA themselves.

"[W]e can observe that Kellogg, Abbott, Kraft, Mead Johnson, ILSI, General Mills and Dannon are well-positioned to advance their interests within the DGAC given the existence of relationships (in some cases long-held) with several DGAC members.

"The most prevalent type of COI was research funding, followed by DGAC members being on a board/committee in a company, and consultant positions. Some industry actors, such as Mead Johnson, General Mills and Kellogg's and the industry-funded organization, ILSI, have interacted with an extensive number of DGAC members.

"Conversely, other industry actors have prolonged relationships with only a handful of DGAC members. Amongst the top 15 industry actors by overall number of COI are ILSI and three trade associations or programs funded by them (California Walnut Commission, Almond Board of California and Beef Checkoff). Each of these actors has diverse means and ends to potentially influence scientific research and the DGA process."

How 'revolving door' policies come into play

The apparent conflicts of interest also extend beyond the committee members themselves, as noted in the study:

"The use of what is called a 'revolving door' might also be problematic, with for example the Secretary of Agriculture, who spent much of his career in the agribusiness sector, having the ultimate say over the final content of the guidelines.

"In both cases, there seems to be an interplay between the strategic interests of industry actors, the professional interests of the researcher and, ultimately, the scientific work produced by the former."

The study's authors identified a possible "strategy by corporations to develop relationships that maximize their impact on science and policy," and stated:

"DGAC members appear to disclose relationships each with a different group of industry actors, which are largely a reflection of how their own research speaks to a different industry sector, albeit most of them exhibit ties to corporations both in the food and pharmaceutical sectors."

A fundamental lack of transparency?

Uncovering information about the 20 members of the DGAC, or even ascertaining who the members of the committee are, is challenging, in part, because the names of the members are buried in an appendix beginning on page 822 of the committee's 835-page report.

While the report states that it provides "brief biographical information for each member of the 2020 Dietary Guidelines Advisory Committee as it relates to the Committee's scope and charge," none of the information provided appears to provide any indication of the conflicts of interest for any of the committee members.

This is of particular significance in light of the study's finding that 95% of the committee members had at least one conflict of interest.

Indeed, according to the study, the top three committee members in terms of COIs identified were Sharon Donovan, Jamy Ard and Heather Leidy, with 152, 92 and 84 COIs identified, respectively, and identified connections to 31, 12 and 31 industry actors, respectively.

Another committee member, Richard Mattes, had 33 connections to industry actors, in addition to 65 COIs.

The authors of the study further noted the above figures may, in fact, understate the extent to which conflicts of interest actually exist, due to the criteria and time frame involved in the above determinations:

"Nonetheless, given that our method is also prone to underreporting, these percentages illustrate what are effectively the two main pillars underpinning long-term relationships between scientific experts and industry actors: (1) funding for research projects and (2) advisory roles in corporate boards.

"The current process for assessing COI, based on annually self-reported disclosures, does not capture the long-standing relationships between the DGAC and industry actors that we identified here.

"A 'COI timespan' of at least three-to-five years is normal, although our paper demonstrates that a longer timespan would be beneficial to understanding the breadth and depth of an expert's long-term relationships with industry.

"Moreover, to be as thorough as possible, COI declarations should include past positions, revolving door situations, and COI involving third parties, such as industry front groups (e.g., ILSI)."

The study's authors also questioned the transparency with which the members of the DGAC were selected in the first place, noting that the process was less than fully public:

"There is, in addition, a need for more transparency in the process for selecting DGAC members — a process where all pertinent information is made public (e.g., information contained in Form 450).

"The DGAC report states that Forms 450 were posted online, but we could not find them on the DGA website at the time of our data collection.

"It is this paper's contention that the USDA-HHS should publicly post all COI of appointed DGAC members, as recommended by the 2017 NASEM [National Academies of Science, Engineering, and Medicine] report permanently during and after completion of the DGA."

According to the study, members of the DGAC are considered temporary federal workers, thereby requiring them to follow USDA ethics rules, and to "place loyalty to the United States Constitution, Federal laws, and ethical principles above private gain," adding that they "may not 'participate personally and substantially in a 'particular matter' in which [they] have a financial interest."

Nevertheless, according to the study:

"In particular, the food industry has historically been observed to seek to influence the DGA process in its favor, for example by pushing for recommendations for particular foods or food groups, such as dairy products, grains or meat.

"For instance, of the comments submitted by organizations to the public consultation for selection of topics for the development of the 2020-25 DGA ... nearly 70% were from industry actors, particularly those in the food industry.

"Moreover, trade associations such as the American Beverage Association, the Grocery Manufacturers Association (now the Consumer Brands Association), and the National Potato Council, as well as companies like Unilever, nominated experts to be appointed to the DGAC through an informal step."

The study's methodology

The study was conducted between January and February 2022, with the purpose of measuring the "incidence of conflicts of interest (COI) with food and pharmaceutical industry actors on the advisory committee for the 2020-2025 U.S. Dietary Guidelines for Americans (DGA) and assess the adequacy of current mechanisms to disclose and manage COI among the committee's members."

Searches were conducted by the study's authors during the two-month period, utilizing publicly available data.

The authors defined a conflict of interest as any relationship "between a DGAC member and an industry actor in a given year."

Specifically, according to the authors:

"We documented the year in which the COI was disclosed as the year for which the COI existed, even if the relationship between the DGAC members and the organization might have been maintained for a longer period of time than that disclosed.

"Furthermore, lacking evidence to the contrary, we considered funding from industry to be a COI for any DGAC member who is a co-author on a study sponsored by industry.

"We argue that the time dimension is important in order to shed light on long-term relationships between industry and DGAC members. Therefore, we considered COI without date restrictions, allowing us to go as far back in time as information is publicly available.

"We focused on the COI of DGAC members with corporate actors from the food, drink and pharmaceutical industries, as well as third parties working with them such as trade associations or front groups.

"We included pharmaceutical companies, because some sell infant nutrition products and often offer devices or drugs that compete with food-based solutions to chronic diseases.

"We took a conservative approach using exclusively primary data to obtain evidence of a COI. We considered primary data sources as those platforms where information about COI is disclosed either directly by a DGAC member (e.g., scientific publication or a Curriculum Vitae), or by the institutions to which they were affiliated (e.g., bios on institutional websites).

"Primary data sources were excluded where a COI was discussed without a reference to the original information source."

Further remarking on the possibility that there are even more COIs that were not identified by the study, Nina Teicholz of The Nutrition Coalition, one of the study's authors, told The Defender in an email:

"It is true that some evidence of COI has disappeared from the Internet after various groups (including the Nutrition Coalition here and here) published articles on the committee's COIs.

If these were not on the internet at the time of this paper's search, then we did not include them."

In summarizing the significance of their findings, and the importance of the DGA's role in providing nutritional guidance to the American public, the authors did not mince words:

"It is critical to underscore the DGA's impact on public health, especially for communities who are most impacted by diet-related diseases.

"For Americans to be able to trust the guidance from the DGA as sound, objective, and science-based, it is imperative to ensure that each step of the process, from the selection and appointment of the DGAC to the final release of the DGA, is publicly accessible, transparently administered, and largely free of COI and influence from actors whose profit-driven interests are often at odds with those in public health.

"Our analysis of COI of DGAC members has shown that this is far from true."

Michael Nevradakis, Ph.D. is an independent journalist and researcher based in Athens, Greece.
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