Conflicts of interest rife in those setting diabetes and cholesterol guidelines

One of my aims with this site is to expose health-related misinformation. There’s usually no shortage of material here. Many of the things we’re encouraged to do, like eat margarine, cut back on saturated fat, eat ‘healthy’ wholegrains, have no evidence base for them. So, how come we have this sort of ‘education’ rammed down our throats. Well, these ideas mean big business.

Last Sunday night I was asked by a national radio station here in the UK (Radio 5 live) to comment on a milk that is being touted as healthier than ordinary milk on the basis that it is low in saturated fat. During the interview (available to listen to below) I felt compelled to make two basic points:

  1. Just because something is low in saturated fat does not make it inherently healthy. Methylated spirits is contains no saturated fat at all, but it’s still not good to drink.
  2. There really is no good evidence linking saturated fat to heart disease, and neither has eating less of it been shown to benefit health.

The interviewer suggested many doctors would disagree with my second point. It’s a fair point, but then it would be up to those who disagree to produce the relevant science to back up their claims. The thing is, when you ask for the science, it’s never forthcoming. As an example, take a look at this exchange I had with the heart surgeon (with links to Unilever) who went on a seeming one-man crusade against butter.

What is it that can cause there to be a yawning abyss between official recommendations and what the science shows? Sometimes, the answer lies in conflicts of interest. It’s not uncommon for doctors, scientists and ‘key opinion leaders’ to have financial or other interests in industry. Imagine, say, you were sitting on a panel considering what the upper limit of ‘normal’ cholesterol levels should be. How imagine you were paid consultancy fees by one or more company that makes cholesterol-reducing drugs. Or perhaps drug companies fund your department or professorial chair. Heck, maybe you even own shares (stock) in these companies. Do you think that might influence your judgement at all?

The issue of conflicts of interests was a subject of a recent piece of research published in the British Medical Journal [1]. Researchers in the US looked at the potential conflicts of interest in panel members setting guidelines regarding the management of diabetes or cholesterol.

Of 14 sets of guidelines, five had no declaration of conflicts of interest at all. Taken as a whole, about half (48 per cent) of the 288 panel members reported conflicts of interest at the time the guidelines were published. 73 panel members reported no conflicts of interest, but it turns out this was not true for 8 (11 per cent) of them. Overall, more than half (52 per cent) of panel members had conflicts of interest. In short, conflicts of interest are very common in guideline panels, and these can go undeclared.

This piece of research reminded me of an episode some years ago concerning a group known as the National Cholesterol Education Program (NCEP) – an ‘expert panel’ in the US responsible for setting cholesterol policy. In 2004, the NCEP made recommendations for cholesterol norms to be lowered to the levels recommended by many doctors today. It subsequently transpired that 8 out of 9 members of the panel had financial links with drug companies making statin drugs. By the way, an independent review of the NCEPs guidelines concluded that: ‘we found no high-quality clinical evidence to support current treatment goals for [LDL] cholesterol’ [2].

If you want to understand how health policy can be out-of-step with the science, it pays to follow the money.

References:

1. Neuman J, et al. Prevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and United States: cross sectional study. BMJ 2011;343:doi:10.1136/bmj.d5621

2. Hayward RA, et al. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Int Med 2006;145:520-530

12 Responses to Conflicts of interest rife in those setting diabetes and cholesterol guidelines

  1. Zoe Harcombe 21 October 2011 at 10:20 am #

    Great interview – really concise & logical.
    M&S’s home turf is bras – they should leave milk to the cows!

  2. Micky Oliver 21 October 2011 at 11:09 am #

    Well done, quality article illuminates the inherent ignorance not just throughout the UK but around the world. They got it ‘stitched up like a kipper’. Makes us even more determined to fight this cause and show the world how their being misled with inaccurate propaganda.
    Careless Talk Cost’s Lives they used to say, well indeed!
    Keep up the good work.

  3. John Walker 21 October 2011 at 11:15 am #

    Dr. Briffa,
    I think you could have a go at the producers/writers of ‘Doc Martin’. Even that program is now pushing the ‘Healthy eating’ low calorie, low fat message. it’s just impossible to convince anyone. Day after day there are messages on-line, promoting, ‘five-a-day’, pushing the the calories in to calories out garbage; claiming that fat is the cause of obesity, when it is clearly wheat, starch and sugar that are the cause of the epidemic. What chance does the supporter of low carb have of seeing real change in entrenched thinking? It won’t alter my new found way of eating, which has seen me lose 1.5 stones in seven weeks. But it angers me when I hear Doctors like Dr. Christian, and his colleagues on ‘Embarrassing Bodies’ pushing the false message, which they believe to be true. Even my own doctor refuses to read ‘The Great Cholesterol Con’. if Doctors won’t read this, do they also skip over the relevant articles in their Medical Journals?
    In their ignorance, some The Medical Professionals are advising their patients to kill themselves. It’s just not on is it?

  4. Peter Brown 21 October 2011 at 12:50 pm #

    Dr Briffa,

    Thank you for pointing this out.this is something that has increasingly concerned me, as a health professional seeking to provide good, scientifically accurate information for my corporate fitness clients.

    The evidence for bias is very convincing and sadly, makes it very difficult to trust the medical profession when it comes to the huge drug market. The same industry bias is very obvious in the food industry (NB high fructose corn syrup).Once trust is gone, it is gone forever.

    Your readers may be interested in two paperback books that I have just read on this issue:
    “Overdosed America” by John Abramson MD and “The Great Cholesterol Con” by Dr Malcolm Kendrick, both available from Amazon.Highly recommended.

    There is a third book that I would like to recommend: “Adrenal Fatigue” by Dr James L. Wilson, which is a very important topic, but then rapidly degenerates into a selling tool for his “Adrenal Fatigue” tablets! This is a very good example of what you are talking about.

    The medical profession does itself no good by such a blatant “snouts in the trough” participation with the drug companies and confusing new medical “research” news which, increasingly, no-one believes!

    Peter Brown.

  5. Trish Cherry 21 October 2011 at 1:05 pm #

    Indeed we are right up against it. I get angry too when I hear the five a day, and high cholesterol thing in ordinary programmes. We sure are fighting a battle! This is even more important than the Global warming theory! We must fight on for the sake of our children and grandchildren. I wonder how long it will take. On The Food Programme on Sunday on radio four there is a dicussion on Calories. Zoe Harcombe will be on this. Lets hope that she and others like you are making an impact! I keep thinking about the comment my son made to me, he has a degree in Social Research, he also like me has Familial Hypercholesterolemia. I have chosen not to take statins, he does take them. But he said “At the end of the Day Mum NOBODY KNOWS” We just have to make informed choices. And fight for those who are not being given informed information.

  6. Valey 21 October 2011 at 5:41 pm #

    Wow, what an interview, it’s precise backed up with scientific evidence. I am grateful for your stand and approach. More than a year now I have been eating meat rich in fat and I’m in perfect health. Doc keep up with the good work, much appreciated.

  7. Gary 22 October 2011 at 11:00 am #

    Dr John,
    Great interview – was able to catch it live on my weekly commuting drive on Sunday night. It was so nice to hear you, the voice of reason, suddenly there on my car radio!
    It is really clear though, that not only has the “general public” been hood-winked by the consensus opinion, even though it has no evidence to back it up, but also they have been hood-winked into believing that the evidence is out there. I talk with people at work all the time, trying to encourage them that they may not be doing the right things to lose weight as they eat bowl after bowl of low fat cereal with skimmed milk…and virtually nothing else…and pour scorn on the very fit, very slim guy who has a protein shake and/or a “primal” meal. When I suggest there are clear studies that show no correlation between eg saturated fat and heart disease, their response is “yeah right, and what about all the other studies that prove a link that Dr Briffa doesn’t look at?” in the honest but deluded belief these studies are out there and you and like-minded people have cherry picked the studies that support your views. How very ironic, given that’s exactly what the sat fat busters do.
    One classic example in every day life that annoys me…my company orders 2 types of milk for everyone to use. I believe the order is split 60/40. Yep, you guessed it, 60% skimmed and 40% semi-skimmed! Where’s the choice for those of us that just want proper milk as it’s supposed to be?
    I saw a great suggestion on Twitter the other day that might help…and that was to rebrand “saturated fat” as “liquid gold”.

  8. A gap in the market 22 October 2011 at 2:22 pm #

    prompted by #7
    The dairy industry has contributed quite a lot to a shift in public perceptions upon fat and low fat. Skimmed and semi-skimmed milk represent the bulk of sales while sales of whole-milk have been in decline.
    Public perception is that low fat is the healthy choice despite that this is far from the full picture. * Both marketing and consumer choices play off this perception – which deserves to be referred to as a mis-perception, IMHO, BTW.
    Cream and milk are separated in the process dairy by a high-tech centrifuge. Modern dairies are plants on industrial scales. i could be mistaken but I believe this results in all milk being skimmed then cream is added back to result in products of various but very specific butterfat content.
    This approach gives high levels of control in process but the main benefit of the capacity for efficient skimming is the creation of a second valuable and marketable product – cream.
    In the UK margins on milk processing are adequate, just, but are under constant erosion from rises in oil-backed costs. Prior to the banking crisis whose nemesis befell us in the fall of 2008 UK processing dairies enjoyed a healthy export market for cream that contributed to improved operating margins for the business.
    After the crisis and in the austere conditions that ensue the UKs European neighbours are no longer importing UK cream in the volumes they were. Sales have fallen and so has the price.

    The marketing of milk Gary, involves a conflict of interest. Dairies have jumped on the low-fat health bandwagon out or commercial expediency. For a while they were ‘creaming it’.

    I have a conflict of interest. I owe my own living to milk, but I am not someone who consumes a lot of it as I have some concern about lactose and casein. But I also have interest in cholesterol and concern about oxidation of cholesterol during the dairy process. Organic, whole, and non-homogenised milk sits in my fridge. Sometimes it sits there longer than it should.

    * Incidentally with milk processing fat content alone should not be considered without thought and regard for how process may alter the attributes and properties of the fats themselves.

  9. John Smith 28 October 2011 at 4:55 pm #

    Surely this is fraud – plain and simple. If I don’t follow recommendations set by my doctor – my health insurance is rendered invalid. Additionally, insurance charges e.g. life insurance is set by these guidelines. High cholesterol? Increase in premium. If this is later proved to be wrong, can someone pay me the difference if it can be shown they acted improperly i.e. conflict of interest. What about these people’s character? Surely if they have even a slight concern that what they say is wrong – they shouldn’t say it.

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