Conflict Disclosures In Nutrition ResearchTuesday, January 30, 2018
As someone who has often engaged in research projects, consultation, or speaking engagements sponsored or otherwise supported by industry (all of which I happily acknowledge and declare), I am a keen observer of the ongoing discussion about when and how researchers need to be wary of potential biases and conflicts.
As I pointed out in previous posts, among all of the potential conflicts, the financial one is perhaps the easiest to declare and otherwise manage.
A recent article by John Ionnadis and John Trepanowski, published in JAMA, discusses the wide range of conflicts (most of which may be non-financial), that one may wish to have declared and exposed, especially when it comes to nutrition research.
The authors single our nutrition research for good reasons:
“…the totality of an individual’s diet has important effects on health, 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:
“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.”
“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.”
Even these financial conflicts can perhaps be dealt with through established disclosure norms.
But conflicts can get even more complicated when it starts 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 are faced with 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?”
“Advocacy and activism have become larger aspects of the work done by many nutrition researchers, and also should be viewed as conflicts of interest that need to be disclosed. These endeavors often spring from some of the noblest intentions and can lead to invaluable contributions to society and public health in particular. However, advocacy and activism are also orthogonal to a key aspect of the scientific method, which is to not take sides preemptively or based on belief or partisanship. Examples of white-hat bias (bias that distorts scientific evidence in support of a perceived righteous end such as better human health) have been reported.”
The authors therefore propose that,
“…it is important for nutrition researchers to 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).”
As with financial disclosures,
“Such disclosure should not be seen as an admission of lack of integrity. To the contrary, disclosure strengthens the perceived integrity of the author. Moreover, some disclosures may end up being advantageous depending on future research findings. For example, if at some point strict vegan diets are shown definitively to confer unmatched health benefits, an author who previously disclosed strong adherence to that diet may receive extra recognition and acclaim for his or her prescient wisdom….Availability of these disclosures would allow readers to be either more skeptical or more inspired (depending on how they view the presented evidence and arguments).”
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.”