Industry Funding may Bias Nutritional Health Research

Byoliveridley

Not a truly surprising finding, given the enormous profits at stake for the Nestle’s of the world.

PLoS Medicine – Relationship between Funding Source and Conclusion among Nutrition-Related Scientific Articles

Funding source was significantly related to conclusions when considering all article types (p = 0.037). For interventional studies, the proportion with unfavorable conclusions was 0% for all industry funding versus 37% for no industry funding (p = 0.009). The odds ratio of a favorable versus unfavorable conclusion was 7.61 (95% confidence interval 1.27 to 45.73), comparing articles with all industry funding to no industry funding. Conclusions: Industry funding of nutrition-related scientific articles may bias conclusions in favor of sponsors’ products, with potentially significant implications for public health.

Note the zero, as in, the number of unfavorable conclusions in wholly industry funded interventional studies.

interventional study—if humans consumed, or if human tissue was exposed to, a food or food component with the intention of measuring a biological response

Well, not surprising. You can exert much tighter control on an interventional study where you control most of the variables. Seems like there’s some predestination going on here!

What do the authors think is going on here?

(1) Industrial sponsors may fund only those studies that they believe will present their products in a favorable light, or their competitors’ products in an unfavorable light. In support of this possibility, all studies funded entirely by industry were characterized as “benefit” or “antagonism” with regard to the product under study (none were characterized as “no relationship”). That is, industrial organizations do not seem to sponsor articles about products in which they have no financial interest. (2) Investigators might formulate hypotheses, design studies, or analyze data in ways that are consistent with the financial interests of their industrial sponsors. (3) Industrial sponsors or investigators may choose to delay or not publish findings that have negative implications to the sponsor’s product. (4) Authors of scientific reviews may search and interpret the literature selectively, in ways consistent with the sponsor’s interests. (5) Scientific reviews arising from industry-supported scientific symposia, often published as journal supplements, may over- or under-represent certain viewpoints, if presenters whose opinions conflict with the sponsor’s financial interests are not invited to participate.

All good points. Remember next time you read an article in the paper about how exercise is much more important in determining obesity compared to your average sugary drink. Remember that a 12 Oz can of coke contains 39 grams of sugar, or 8 teaspoons worth!

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    Shaming People into Pooping Indoors

    Byoliveridley

    Meanwhile, in the other India, people still poop outdoors…

    Using shame to change sanitary habits – Los Angeles Times

    Every morning before sunrise, Ravi Shankar Singh, a cheerful man known to his neighbors as “Luv” Singh, sets out to patrol the potholed roads and rice fields of this north Indian village. He carries a whistle and a flashlight. He sings while he walks. The village’s self-appointed sanitation guardian, Singh is on the lookout for anyone squatting in the fields or alleys, using the cover of darkness to do what millions of people have always done across India: defecate outdoors. After years of programs to increase the number of latrines in villages, the government still has not managed to eradicate a practice that is cited in the spread of water-borne illnesses and parasites, such as diarrhea and hookworms. Critics say the obstacle is not so much the shortage of latrines, though that, too, remains a problem for nearly half of India’s rural population. The main challenge is getting people to use the facilities they have. Singh says he’s found a way. When he spots someone squatting, he lets loose with a blast on his whistle. Or shines his light on the offender. Or both.

    This is clearly a serious public health issue and one that is linked to many avoidable deaths from disease. I am not sure if blowing whistles at people is an ethical way to do it. In a country where actual toilet facilities are still rare, and the people who grew up in this scarcity have internalized the fact that they have to “externalize” their poop, just providing facilities and shaming them is not enough.

    Just as with most things in India, no easy answers, I guess the right combination of education (especially targeting the young), enforcement through fines, and most importantly, saturation coverage of clean and easily available toilets would eventually work.  But it will take time, and of course, public urination is a completely  different beast!

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    Black Lung – Miners pay so you can get more coal

    Byoliveridley

    The Pump Handle alerts us to a special report on coal miners and their lungs, not for the faint of heart, but something to keep in mind when you hear the phrases “Cheap Energy” and “coal” in one sentence, it’s not so cheap for these people.

    Black Lung: Dust Hasn’t Settled on Deadly Disease « The Pump Handle

    Louisville-Courier Journal reporters Laura Unger and Ralph Dunlop offer us the voices and faces of miners who are suffering from coal workers’ pneumoconiosis. Their special report, Black Lung: Dust Hasn’t Settled on Deadly Disease, includes an on-line version which features five compelling videos featuring 40- and 50-year old coal miners who are now suffering with the disabling lung disease. Mr. Danny Hall, 56, for example, who is still severely impaired despite receiving a lung transplant says “if I had to do over, I wouldn’t ever go into coal mining.”

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    Small California Study Finds Correlational Link Between Organochlorine Pesticides and Autism

    Byoliveridley

    That would have been my headline! It was a study of 29 women, and the results show a six-fold increase in the incidence of autism in children whose mothers were close to fields being sprayed with organochlorine pesticides. A factor of 6 is a big number, which is why they found statistical significance at such a low sample size.

    Most organochlorine pesticides (the most famous being DDT) are already banned in the first world. The ones suspected here, endosulfan and dicofol are banned in quite a few countries including Belize, Singapore. Cambodia and Germany. The Stockholm convention (international treaty to identify and restrict the use of persistent organic pollutants) has identified endosulfan as a possible addition to its list of POPs.

    Of course, the US has not even ratified the Stockholm convention thanks to the pesticide lobbies. So, nothing the Stockholm convention decides about endosulfan will  carry any legal weight. In this country, pesticides and most other chemicals in current use are “innocent until proven guilty”, meaning harm must be conclusively proven in a manner that will withstand court challenge. With industry sponsored research and lobbying, such a burden of proof is often insurmountable and therefore, hazardous pollutants are used in the US well beyond their sell-by dates.

    Pesticide link to autism suspected – Los Angeles Times

    Women who live near California farm fields sprayed with organochlorine pesticides may be more likely to give birth to children with autism, according to a study by state health officials to be published today. The rate of autism among the children of 29 women who lived near the fields was extremely high, suggesting that exposure to the insecticides in the womb might have played a role. The study is the first to report a link between pesticides and the neurological disorder, which affects one in every 150 children. But the state scientists cautioned that their finding is highly preliminary because of the small number of women and children involved and lack of evidence from other studies.

    Clearly, the increase in autism incidence has many more factors linked to it than environmental chemical exposure, but this is interesting and good work. This study will doubtless be severely criticized by the pesticide lobby. After all, it’s only a correlation, no mechanism has been proposed, and the sample size is very small. But, as I mentioned before, you don’t normally see six-fold increases in disease incidences with ambient environmental exposure, so there is definitely something going on here.

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    Lasers shooting into irises

    Byoliveridley

    I did not think my first minor surgery would involve someone shooting lasers to make holes in my iris. It sounds like more fun than it actually was, but was mostly painless and here I am, looking at a computer screen 3 hours later. My eyes feel like they’ve had about 5 hours of sleep, which is good considering they’re now sporting two brand new drain holes.

    Laser iridotomy is also performed prophylactically(preventively) on asymptomatic individuals with narrow angles and those with pigment dispersion. Individuals with a narrow angle are at higher risk of an acute angle closure, especially upon dilation of the eye

    http://www.surgeryencyclopedia.com/La-Pa/Laser-Iridotomy.html

    I also just started reading Bad Science by Ben Goldacre, which is about the use and misuse of the banner of science by a large group of people including nutritionists, pharmaceutical companies and “alternative” treatment specialists. It has a great chapter on the “placebo” effect, how much of it is culturally mediated, and how much doctor demeanour and confidence in their skills and outcome affects results. The doctor shooting holes in my eye was extremely confident in their skills and their results, and normally, my brain would be sending off all kinds of hubris warnings. In this case, their confidence reassured me a bit, and Bad Science definitely helped. It was also interesting to see a large section on homeopathy in the book, since I’ve written about my contact with homeopathy and felt that the cultural practices of a good homeopath can be of some use to people as long as they don’t go too far. The book confirmed some of that.

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    Soda = Fat

    Byoliveridley

    Sodat Fat

    From The New York Department of Health

    Try this experiment at home: Take two and a half cups of water, add 15-20 teaspoons of sugar and stir to dissolve. If you haven’t broken your wrist with all this action, take a sip or two, or gulp it down. No worries, you’ve just had all the nutrition in a typical soda!

    That’s the message the NY Department of health is sending out with its new PR campaign against soda. Pretty gross and effective, I must say, though I would go one further and put it on every label of Coke, now wouldn’t that be nice!

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    Sugar Pills, now more effective!

    Byoliveridley

    Well, all sugar is not bad for you. Apparently, when given to you in pill form by someone wearing a white coat with a pleasant demeanour, it can cure all kinds of ills.

    It’s not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.

    Via Wired

    An interesting article that takes the reader through a recent history of placebos, why they seem to work better now than they used to, and tangentially, why the competitive research paradigm of the pharmaceutical industry delayed recognition, and continues to delay possible fixes and therapies.

    A few things about the placebo effect:

    1. There appears to be a physiological and neurological basis to the effect, something that can actually be turned off by deactivating the body’s natural production of opioids.
    2. This effect is triggered by various patient stimuli, including exposure to advertising, faith in the medicine, doctor bedside manner, etc. It appears that for minor ailments, these effects could be as strong as the medication prescribed.
    3. It is not short lived, the effects can linger well after consumption of sugar pills.
    4. Despite all this, the article states that we are no closer to finding the most appropriate way to administer placebos (Hmm, or are we? Read on!).

    Pharmaceutical companies conduct hundreds of clinical trials every year. They are not required to publish them in most countries, so negative results, failures, etc. which reflect badly on the company’s stock price are routinely hushed up. This means that the mounds of data that show tested drugs as no better than placebo are not accessible for research. This is one of the greatest drawbacks of competitive research paradigms, the lack of cooperation, the inefficiency that comes from duplication of negative results, and the lack of statistical power that comes from inability to use all the data available. In a milieu where knowledge = stock price, this is the logical approach, but something to note next time an Ayn Rand acolyte comes bleating to you about the beauty and perfection of the market. You might ask “What are some options to the current patent exclusivity driven regime”? My favourite economist Dean Baker of the Center for Economics and Policy Research has written extensively about the drug development process and alternatives in his excellent (and free to download) book The Conservative Nanny State, I suggest reading at least the chapter on drug development and patents!

    Anyway, back to placebos, what to do? How to administer sugar pills in a quasi-official setting for minor ailments. It’s almost like you need a parallel paradigm of medicine that dispenses sugar pills that did not have to go through double blind randomised clinical trials. it would help if this paradigm uses vaguely scientific terminology while doing very little harm. It would work in conjunction with the conventional approach, not in competition so there is little danger of people taking sugar pills for malaria!

    I give you, Homeopathy!!! This blog(ger) is no stranger to this wonderful form of medicine, involving concepts such as the memory of water, similars, dilution, etc. When I wrote about homeopathy last year, it was more in relation to the psychological aspects of my experience with it. I (and I assume you did not click through to read!) wrote about my parents’ great and enduring relationship with their homeopath, and the benefits it brought them. Back in India this time around, it was suggested that I take some homeopathy for a cold I was developing, which I did (yum, sugar!). The cold went away in a few days 🙂 There was some swine flu medicine being passed around as well (I did not partake), which worked too, nobody at home got swine flu 🙂

    So, how to make it work? It already works in India because belief in the efficacy of homeopathy is well established. As long as the homeopath is well qualified in basic diagnosis, and crucially, knows when to punt the patient into conventional therapy, the system works to a certain extent. But what about a society with no such foundation? Do you go to a clinic with both an allopath and a homeopath, and if your ailment is one where placebo works about as well, let the homeopath make some well diluted similars for you to consume? How to settle turf wars? Would it be better for the allopath to feign develop an expertise in homeopathy and make that work for her in treating the patient? Would they apply the most important lessons in homeopathic treatment, Listen, Empathise, Soothe?

    I don’t know. It is not my nature to believe in sugar pills, faith, or advertising. So it is hard for me to say what would work. But given that sugar pills work well, it is vital for society to find a way.