Historical analysis examines sugar industry role in heart disease research
Using archival documents, a new report published online by JAMA Internal Medicine examines the sugar industry's role in coronary heart disease research and suggests the industry sponsored research to influence the scientific debate to cast doubt on the hazards of sugar and to promote dietary fat as the culprit in heart disease.
Stanton A. Glantz, Ph.D., of the University of California, San Francisco, and coauthors examined internal documents from the Sugar Research Foundation (SRF), which later evolved into the Sugar Association, historical reports and other material to create a chronological case study. The documents included correspondence between the SRF and a Harvard University professor of nutrition who was codirector of the SRF's first coronary heart disease research program in the 1960s.
The SRF initiated coronary heart disease research in 1965 and its first project was a literature review published in the New England Journal of Medicine in 1967. The review focused on fat and cholesterol as the dietary causes of coronary heart disease and downplayed sugar consumption as also a risk factor. SRF set the review's objective, contributed articles to be included and received drafts, while the SRF's funding and role were not disclosed, according to the article.
"This historical account of industry efforts demonstrates the importance of having reviews written by people without conflicts of interest and the need for financial disclosure," note the authors, who point out the NEJM has required authors to disclose all conflicts of interest since 1984. There also is no direct evidence that the sugar industry wrote or changed the NEJM review manuscript and evidence that that the industry shaped its conclusions is circumstantial, the authors acknowledge.
Limitations of the article include that the papers and documents used in the research provide only a small view into the activities of one sugar industry trade group. The authors did not analyze the role of other organizations, nutrition leaders or food industries. Key figures in the historical episode detailed in this article could not be interviewed because they have died.
"This study suggests that the sugar industry sponsored its first CHD [coronary heart disease] research project in 1965 to downplay early warning signs that sucrose consumption was a risk factor in CHD. As of 2016, sugar control policies are being promulgated in international, federal, state and local venues. Yet CHD risk is inconsistently cited as a health consequence of added sugars consumption. Because CHD is the leading cause of death globally, the health community should ensure that CHD risk is evaluated in future risk assessments of added sugars. Policymaking committees should consider giving less weight to food industry-funded studies, and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development," the article concludes.
"This 50-year-old incident may seem like ancient history, but it is quite relevant, not least because it answers some questions germane to our current era. ... The authors have done the nutrition science community a great public service by bringing this historical example to light. May it serve as a warning not only to policymakers, but also to researchers, clinicians, peer reviewers, journal editors, and journalists of the need to consider the harm to scientific credibility and public health when dealing with studies funded by food companies with vested interests in the results - and to find better ways to fund such studies and to prevent, disclose and manage potentially conflicted interests," writes Marion Nestle, Ph.D., M.P.H., of New York University, in a related commentary.
JAMA Intern Med. Published online September 12, 2016. DOI: 10.1001/jamainternmed.2016.5400