Stopping the rot in nutrition science
22nd May 2006
Barrie Margetts, Editor-in-Chief of the scientific journal Public Health Nutrition, examines the issue of commercially motivated and sometime fraudulent nutrition research.
In 2005, huge media attention surrounded the revelation that a leading researcher, Hwang Woo-Suk from South Korea, had fabricated scientific data. Hwang published fraudulent research results in the peer-reviewed journal Science claiming that his team had cloned the world’s first human embryonic stem cells tailored to match the DNA of individual patients.
Nutrition scientists reacted to the publicity with a sense not so much of outrage, as of 'There but for the grace of God goes nutrition'.
We have reason to feel uneasy. Beginning in 2002, letters in Nutrition and the Lancet, a news story followed by correspondence in the British Medical Journal questioned the veracity of papers published in two of those journals and elsewhere. In response the author pointed out some mistakes in the criticisms and made a case for his results. He said he could not provide his data for new analysis because he had left his university for another country, data were in store and some had been mislaid.
The individual whose work was questioned is not an ordinary nutrition scientist. Since the early 1970s he has been exceptionally productive. In 1974 his papers began to be published in the respected medical journal the Lancet which, in 1983, asked him to summarise knowledge in his field. He has also been powerful.
Between 1980 and December 2003 he was chief editor of an international nutrition journal. From 1991 to 1994 he was founding head of a WHO Centre for Nutritional Immunology. In 1997 he was president of the 16th International Congress on Nutrition in Montréal, Canada. In 1999 he advised the US government how to improve the nutrition and immune function of combat soldiers. He has been said to have been twice recommended for a Nobel Prize.
The papers identified as troublesome are also extraordinary. They conclude that nutritional supplementation can, for elderly people, protect against infection and greatly improve memory and ability to learn, and so delay or even reverse dementia. However, the formulation for the supplement used is patented by the scientist and marketed by a company founded by him or his daughter.
Another paper by him with similar results appeared in 2002 in the journal he edited. The paper was stated to have been submitted and accepted on the same day. A supportive paper by another author was stated to have been submitted on that same day and accepted the next.
In 2005, not having had sight of any original data and because of the accumulated evidence of implausibility, Nutrition retracted the paper it had published in 2001. The British Medical Journal decided this was a prima facie case of fraud and wondered if other published papers by the scientist also included fabricated data.
At the end of January this year the Canadian Broadcasting Corporation (CBC) broadcast a three-part investigation. This disclosed attempts to 'blow the whistle' on the scientist beginning in the early 1990s. CBC found that his university took no action on the findings of a committee of enquiry that agreed with the whistle-blower, concluding that the scientist had fabricated data.
Certainly since July 2002 he has been styled at scientific and other meetings as Provost and Vice-Chancellor of the Université International des Sciences de la Santé, based in the ski resort of Crans-sur-Sierre in Switzerland which, as far as the CBC investigation could tell, is a PO box.
The evidence presented indicated he had indeed fabricated more data, for another study published in the British Medical Journal as well as his and another journal, concluding that some types of baby formula are less likely to cause allergic conditions such as eczema and asthma. The study was funded by manufacturers to test their brands of 'hypoallergenic' formula. Later he published a paper in his own journal whose conclusions supported his own study.
Epidemic misconduct
So the 'rough justice' of a media investigation has exposed a major case of fraud in nutrition science. Here the matter begins. The scientist’s name is Professor Ranjit Chandra, but this is not a story about an individual. It is about a system and a culture that makes the thought of misconduct too tempting and actual misconduct too easy.
In the 17th Century, Samuel Butler mocked the pomp of the founders of the Royal Society in his satirical poem Hudibras. He wrote: ‘What makes all doctrines plain and clear? About 200 pounds a year. And that which was prov'd true before, prov’d false again? 200 more!’ It is often said that nutrition is mostly fad and fashion; a worse charge is that the judgements of too many nutrition scientists are for sale.
The governance of nutrition science is in question. How is its funding, practice and publication controlled? How can fraud remain undisclosed for so long, and what does this imply for other misconduct? How can anybody now take the findings of nutrition scientists on trust? Nobody can say 'this is an isolated case'. It can't be said that 'nobody suspected' because some people knew a decade ago, and the whole issue has been in the public domain for three years.
Fabrication and ghosts
Indeed, we can't say 'this won't happen again' because it will, and it does. In his early life Robert Clive pillaged vast areas of India. Later in the 18th Century, as governor of Bengal, he audaciously observed: 'It is no wonder that corruption should find its way to a spot so well prepared to receive it'.
Fraud in research science is not rare, particularly when patentable substances, such as drugs, and also nutrition supplements, branded foods and drinks, food formulae and genetically manipulated foodstuffs, are involved.
An informal survey published in 1988 carried out by Stephen Lock, a former editor of the British Medical Journal, of 80 senior UK research scientists, found that half knew of studies they believed to be fraudulent, of which over half had been published. Of these, only six cases had led to any form of retraction.
The Committee on Publication Ethics (COPE) was set up in 1997 by a group of journal editors. By 2000 COPE had examined 103 cases of alleged misconduct by researchers of published papers, of which 80 showed evidence of misconduct: of these, 15 involved falsification and eight fabrication.
Another form of fraud is research using phoney authors. In 2003 an investigation carried out by a UK newspaper guesstimated that up to half of all papers published in medical journals on drugs are ghost-written, often with minimal contributions from the ‘authors’. The response from Richard Smith, Stephen Lock's successor as editor of the British Medical Journal, was: 'We are being hoodwinked by the drug companies'.
After leaving the British Medical Journal Richard Smith went further. In 2005 he said that between two-thirds and three-quarters of all clinical trials of drugs are funded by industry; that industry is able to manipulate the questions asked by such trials and their study designs so as to produce results favourable to the drug; that one-third of such trials published in the British Medical Journal are so funded, and that medical journals are 'an extension of the marketing arm of pharmaceutical companies'.
Richard Horton, editor of the Lancet, said the previous year: 'Journals have devolved into information laundering operations for the pharmaceutical industry'. This February, the New York Times reported that journalists are now more sceptical of findings published in scientific journals.
Rent-a-profs, industry fronts, conflicts of interest
Many scientists see no problem with accepting money from commercially or ideologically interested parties, whether or not disclosed, and some are prepared to 'speak for the product'. In either case, if questioned, they are likely to say that their integrity is not in question and their judgement is not affected. Such competing or conflicting interests may be considered so common as not to be worth mentioning.
Observers are likely to think differently; to quote an old saying: 'Whose bread I eat, his song I sing'. In courts of law, evidence is given less or even no weight when a witness is known to have an emotional, financial or other interest in the case. The same applies, or should apply, in science.
A remarkable example of conflicted interest exposed in the UK press in February is that of the Association for Research into the Science of Enjoyment (ARISE). Founded in 1988, ARISE is described as 'a worldwide association of eminent scientists', with a mission to show that 'everyday pleasures such as eating chocolate, smoking, drinking tea, coffee and alcohol contribute to the quality of life' and that deprivation of such pleasures, also including consumption of cream cheese, butter, cakes, ice cream and red meat, could cause a series of ailments, even brain damage.
The media enjoyed this hedonistic message: it seems that 195 print and broadcast stories appeared between September 1993 and March 1994, and continued certainly until 2004. Details of ARISE emerged as documents were disclosed after legal actions. These show that in 1994-95 its proposed budget was $773,750, almost all from cigarette manufacturers, with small amounts from food and drink companies. Originally the Association for Research in Substance Enjoyment, ARISE is also a front for Big Tobacco and its food and drink interests.
Undisclosed hiring of the facilities; knowledge and reputations of universities, research institutes, scientific departments and of individual scientists (known as the 'rent-a-prof' phenomenon) is well-known in the public health field; as is systematic funding of research in sensitive areas by interested parties, the dependence of congresses on support from transnational food manufacturers, and the influence of not-for-profit entities mainly funded and controlled by food, drink, agrochemical and/or pharmaceutical companies. These are reasons why nutrition science is not taken as seriously as we would wish, either by people in the know or by government, the media or the public.
What is to be done?
The funders, administrators, practitioners and publishers of nutrition science have a duty to make our profession candid. We can start by accepting that we are human. There is no reason to believe that scientists are by background or training any more or less likely to be corrupt or become corrupted than members of any other profession.
We should also accept that nothing can stop all fraud. In business, cases like Enron in the US, Robert Maxwell in the UK and Parmalat in Italy will happen again. The same is so in science. The most we can do is to help make fraud rare. Also, action designed to prevent outrage can, in treating one disease, cause others. Laws designed to prevent terrorism that have reduced civil liberties have proved to be troublesome.
Nor can we realistically expect science to be free from influence by ideologically and commercially interested parties. The good old days when science was completely independent never existed. The most we can do is to help make honesty the best policy.
As editor of the journal Public Health Nutrition, my conclusion is that the opportunities for venality, corruption and fraud in nutrition science are now too manifest, and the guards against them too casual. To repeat, the indictment is less of individuals, more of a culture that puts much temptation in the way of researchers who, seeing the rewards of greed all around, think of cooking their books, padding their bank accounts or modifying their opinions, do so once and have reason to believe that the risk of discovery or even of criticism is slight.
As the former President of Harvard has pointed out, there is a limit to what any one university or research centre can do in a climate of pressure to support industry, and also government, with useful research results. Individual journal editors can tighten up review systems, and lay media editors can tell reporters to insist on being told the source of funding of scientific findings, but there is a limit to what even those with substantial salaries and staff can do. The only effective action will be concerted.
This article is a condensed version of an editorial first published in Public Health Nutrition in April 2006, published by CABI Publishing. The article remains the copyright of the author 2006. A fully referenced copy of the full article is available at www.foodcomm.org.uk/margetts.htm
Science policy for sale?
It is often enlightening to look to America to see where a ‘free market’ approach can lead. In the US a sister organisation to the Food Commission runs a campaign to expose industry influence on scientific research.
Entitled Integrity in Science, the campaign is run by the Center for Science in the Public Interest (CSPI). Campaign investigations conclude that there is strong evidence that researchers’ financial ties to chemical, pharmaceutical or tobacco manufacturers directly influence their published positions in supporting the benefit, or downplaying the harm, of the manufacturer’s product.
Integrity in Science advocates full disclosure of funding sources, with information published in a way that can be scrutinised (e.g. websites); a review of who sits on government advisory committees; and for journalists to ask routinely about possible conflicts of interest and to provide this information to the public.
Another US campaign called The Revolving Door also tracks how corporate interests influence government decision-making.
In light of concerns raised by Professor Barrie Margetts (see above) and Professor Erik Millstone (see related aspartame article May 2006), the Food Commission believes that just such a campaign is needed in the UK. If Food Magazine readers know of anyone who might be interested in financing or contributing to an investigation and campaign to secure the scientific independence and integrity in UK food, agriculture and nutrition policy, please get in touch with the Food Commission.
Further information
CSPI’s website is at: www.cspinet.org/integrity/about.html
The Revolving Door website is at: http://www.revolvingdoor.info/
Useful resources
Public Health Nutrition: http://journals.cambridge.org/action/displayJournal?jid=phn The journal Public Health Nutrition focuses on the promotion of good health through nutrition and the primary prevention of nutrition related illness in the population.