On conflicts of interest

Science is far from being a fact-finding enterprise that somehow manages to rise above the tumult of everyday life

Declaration: Half a dozen ballpoint pens, a couple of keyrings, and a dinky notebook.

Those are the gifts I received during a 30-year career in diagnostic virology. I wasn’t wary of accepting them as they weren’t borne by Greeks, but by medical representatives. Their largesse, however, was wasted on me since my involvement in corporate affairs was limited to getting tea and custard creams for the reps while they waited for my boss.

Was I somehow compromised by accepting these offerings? As Ralph Waldo Emerson observes in his essay ‘Gifts’ (1844): “The law of benefits is a difficult channel, which requires careful sailing or rude boats.” And when gifts elide into conflicts of interest (COI), difficult channels might become dangerous rapids, as may be inferred from the UK’s National Food Strategy (2021, p48), where Dimbleby et al state that “[f]or sound commercial reasons… companies invest more money into researching, developing, and marketing unhealthy foods”. This bleak perspective is sharpened by Slater et al in Agriculture and Human Values (published online 11 June 2024), who mapped global multi-stakeholder institutions (MIs) involving the ultra-processed food (UPF) industry, finding that executives from Unilever, Nestlé, PepsiCo Inc, and Coca-Cola “held the most board seat positions…”. Unsurprisingly, “[s]cholars and advocates have raised several concerns about the proliferation of MIs in global food governance, relating to commercial COI….”

And Mialon et al in Globalisation and Health (2021; 17:37) suggest that “the food industry, like the alcohol and  tobacco industries, tries to influence science’s very principles, such as scientific integrity and the good conduct of research”. Further considering the relationship between COI and scientific integrity, Rebecca Coombes in the BMJ (2023;383: p2514) describes how in September 2023, the Science Media Centre (SMC) in London held a briefing for specialist journalists in which five professors working in nutrition addressed the topic of UPFs and diet-related disease. Afterwards, The Guardian published a story with the headline ‘Scientists on panel defending ultra-processed foods linked to food firms’ and Coombes cites the SMC’s industry links, with its annual report declaring funding from Nestlé and that previous funders included Tate and Lyle, Northern Foods, Kraft Foods, and Coca-Cola. Should such an influential organisation as the SMC, asks Coombes, “be taking funding from food manufacturers and showcasing scientists with their own conflicts?”

One of the five professors addressing the SMC meeting is now Chair of the UK’s Scientific Advisory Committee on Nutrition (SACN), formed in 2001 to provide independent scientific advice to the Department of Health and the Food Standards Agency. On 29 April 2024 he told the House of Lords food, diet, and obesity committee: “If we consider that an individual member has too much of a conflict of interest on a particular topic, I, as chair, in consultation with the secretariat, will exclude that individual from participation in the SACN discussion on that topic.” SACN’s February 2024 declarations of interest show that the Chair has no COI, but in 2014, while a member of the SACN’s carbohydrates working group he declared connections to Unilever and the Sugar Bureau (https://assets.publishing.service.gov.uk/media/5a807c0bed915d74e33fab19/SACN_annual_report_2014.pdf). Did those connections constitute “too much of a conflict of interest on a particular topic”?

…the food industry, like the alcohol and tobacco industries, tries to influence science’s very principles…

My own brush with COI occurred several years ago, when Dr X wrote an angry letter to the editor of a newspaper that had published a piece of mine noting that the side-effects of drug Y, manufactured by company Z, included confusion and memory loss. Dr X wrote: “It is also complete nonsense that drug Y causes confusion and memory loss – in fact drug Y has recently been shown to be associated with improved sleep quality.” I pondered this assertion at length.

In my reply to the editor, I cited the United States Food and Drug Administration, which stated: “Memory loss and confusion have been reported with drug Y use.” Further, a patient information leaflet for drug Y explained that possible side-effects include “sleep disturbances, including nightmares; memory loss…”. I also commented that in their letter Dr X had failed to declare a COI, namely that in a consensus document published in a medical journal they declared: “Travel grant and advisory board for company Z.”

My letter was not published.

Science is far from being a fact-finding enterprise that somehow manages to rise above the tumult of everyday life, working in isolation where the air is pure. In her Science as Salvation (1992) the philosopher Mary Midgley asks a pertinent question: “Are scientists, unlike people in the Arts Faculty, never biased in their work by irrelevant considerations?”

Amended declaration: All right… two dinky notebooks.