Thursday, March 06, 2008

Fat Chance: Conflicts of Interest and Calorie Counting

Stephanie Saul in the New York Times, and Karl Stark in the Philadelphia Inquirer have covered the curious story of the downfall of the president-elect of the Obesity Society. Last month, Ms Saul set the stage,

New York City’s new rules for menu labels at chain restaurants have set off a food fight among the nation’s obesity experts.

Most support the theory of the city’s health commissioner that forcing chain restaurants to list the calories alongside menu items — flagging that a Double Whopper With Cheese has 990 calories, for example — will make patrons think twice about ordering one. The rules are set to take effect at the end of March.

There is a countertheory, however, set forth by Dr. David B. Allison, the incoming president of the Obesity Society, a leading organization of obesity doctors and scientists. An affidavit he recently submitted to the United States District Court for the Southern District of New York has ignited a controversy within his organization.

In the filing, Dr. Allison argues that the new rules could backfire — whether by adding to the forbidden-fruit allure of high-calorie foods or by sending patrons away hungry enough that they will later gorge themselves even more.

It might be only a scientific debate among nutrition experts, except for the fact that Dr. Allison was paid to write the document on behalf of the New York State Restaurant Association, which is suing to block the new rules.

Dr. Allison’s role in the debate has angered some members of the Obesity Society, setting off an e-mail fury since word of his court filing began to circulate. Some have pointed to Dr. Allison’s other industry ties, which have included advisory roles for Coca-Cola, Kraft Foods and Frito-Lay.

Many of the group’s 1,800 members are “completely mad that a president-elect of the Obesity Society, an organization that cares about obesity and cares about healthy eating, wants to hold back information from people that helps them make healthy choices,” said Dr. Barry M. Popkin, a member of the organization, who is director of the Interdisciplinary Obesity Center at the University of North Carolina, Chapel Hill.

Dr. Allison, a professor of biostatistics and nutrition at the University of Alabama, Birmingham, is scheduled to start a one-year term as president of the Obesity Society in October. He has defended his affidavit. In a telephone interview, he said he did not take a position for or against menu labeling in the document but merely presented the scientific evidence that the labeling might deter over-eating but might not and, in fact, might be harmful.

He also defended his work for the restaurant industry, but would not disclose how much he was paid for his efforts.

“I’m happy to be involved in the pursuit for truth,” Dr. Allison said. “Sometimes, when I’m involved in the pursuit for truth, I’m hired by the Federal Trade Commission. Sometimes I help them. Sometimes I help a group like the restaurant industry. I’m honored that people think my opinion is sufficiently valued and expert.”

The executive vice president for the restaurant association’s metropolitan New York chapters, E. Charles Hunt, said that Dr. Allison was retained by the association’s lawyers. “Obviously, a lot of it was in favor of our position,” Mr. Hunt said, “although he didn’t come right out and say that.”

So this sounds like yet another story about conflicts of interest, and their possible effects influencing the publicly expressed opinions of a prominent academic. As usual, the conflicted party angrily denied that his financial relationships could have affected his scientific judgment. As we have noted before, this is undoubtedly a sincere belief, but psychological evidence and common sense suggests that having financial ties to organization x may influence one to take positions in line with organization x's interests, even if these influences do not reach conscious thought.

The variant here seems to be that the academic had a financial relationship not with a drug, biotechnology or device company, the usual suspects, but with an association of restauranteurs.

But wait, Mr Stark added more in his story in the Philadelphia Inquirer,

The relationship between academic researchers and industry is a front-burner issue in many fields. Several congressional inquiries are looking at drug-firm support for the American College of Cardiology, the national cardiology group, and the American Heart Association.

Compared with those groups, the Obesity Society, based in Silver Spring, Md., would seem like a tiny outpost with its $2.1 million budget. But the group's 1,800 members include many influential researchers, physicians and dietitians.

The society relies heavily on industry money, raising about $1 million in the last year from various companies, said Morgan Downey, the group's executive vice president. The biggest corporate donors were drugmakers sanofi aventis, GlaxoSmithKline and Allergan as well as the health-care conglomerate Covidien, he said.

About $230,000 of the corporate money funded a conference in September for health advisers to presidential candidates, Downey said.

Fast forward to this week, when Ms Saul reported in the New York Times that Dr Allison is giving up his leadership position for the Obesity Society,

A dispute over food industry influence has resulted in the resignation of the incoming president of the Obesity Society.

Dr. David B. Allison, who was to take over the society, a national group of obesity doctors and researchers later this year, submitted his resignation from that position on Friday.

So what happened? Did the Obesity Society cast out a leader because he had conflicts of interest that interfered with his ability to advance science, education and clinical practice? Or did the Obesity Society cast out a leader because he was aligned with commercial interests opposed to the commercial interests that provide most of the society's support? That is, was he cast out not because he had conflicts of interest, but because he did not have the same conflicts of interest as the society?

Who can tell?

Once again, this case is an illustration of the pervasiveness of conflicts of interest affecting health care organizations. It also shows how the pervasiveness of such conflicts sometimes makes it impossible to discriminate debates about science and health policy from the claims of conflicting pitchmen.

Full disclosure of these conflicts beforehand would at least have given warning that the nature of the debate was ambiguous.

But to figure out the best answer in the current policy debate, that is, whether it really is a good idea to have legislation to put calorie counts on restaurant menus, would really require the input from people who are not paid by either restauranteurs, or those selling obesity treatments. Fat chance that will happen soon.


Anonymous said...

So what happened? Your second answer.

Anonymous said...

The economics of food choices are complex, especially for the poor. This point was made clear to me many years ago. Issues such as food cost, you can buy more fast food calories than you can take home from the grocery. Prestige and socialization, it is nice to say you went out, even if it was for fast food, play a vital role in choice. Besides, removing trans-fats from our food eliminated obesity, or so I have been told.

I fly commercially once a year and returning from that trip recently I was struck by a negative comment of a person standing outside a clearly defined smoking area complaining that people were being allowed to enjoy themselves. One has to wonder: Have legitimate health issues been hijacked to provide some type of Puritan sense of superiority?

To claim that one is not influenced by financial incentives is also open to question. One need only look at the excerpt from the below AP story to see how seriously fiduciary duty is taken in some areas of business.

Posted: 2008-03-05 22:32:36
BOSTON (March 5) - Federal regulators on Wednesday fined Fidelity Investments $8 million and brought civil charges against former star money manager Peter Lynch and 12 others for receiving improper gifts from outside brokers vying to win Fidelity's lucrative trading business

Taken collectively, there appears to be a desire on the part of some, to control all aspects of our lives, and a willingness on the part of others to benefit financially from this desire. Like recent study results we appear to be trying to treat the symptoms of the disease, not the root cause. Obesity is often due to real health and economic issues. The willingness to accept, or be involved in finical conflicts, points to a larger societal problem.

Steve Lucas

Shelayne said...

Would it really make a difference? There was a lot of fuss in the UK news recently about how few people realise that a Starbucks coffee, with cream, chocolate, etc, is massively laden with calories. But even after seeing it on the news, people were still buying the things. Surely it's common sense that a big mac or Whopper is high in calories? If you want to lose weight, then you need to make sustainablelifestyle changes for weight loss and not just eat what you fancy all the time and blame other people.