Review Of Sugar-Sweetened Beverage Studies Supports Suggestion Of A 'Master Plan' Developed By This Industry To Instil Doubt In Their Adverse Effects

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Article Date: 14 May 2013 - 0:00 PDT Current ratings for:
Review Of Sugar-Sweetened Beverage Studies Supports Suggestion Of A 'Master Plan' Developed By This Industry To Instil Doubt In Their Adverse Effects

A review of multiple other reviews investigating links between sugar-sweetened beverages and obesity supports the suggestion that there is a 'master plan' by the industry manufacturing these drinks to instil doubt in consumers as regards their adverse effects. The review is being presented at this year's European Congress on Obesity in Liverpool, UK, and is by Dr Philippe De Wals, Laval University, Quebec City, Canada, and colleagues.

"The role of sugar-sweetened beverages (SSBs) on the increasing prevalence of obesity is a matter of great interest," says Professor de Wals. "In recent years, reviews have been published on this topic with very different conclusions."

In this review, De Wals and colleagues identified the characteristics of reviews that were associated with the authors' position on evidence supporting a causal relationship between SSBs and body weight. They looked at reviews published in English in peer-reviewed journals during the 2006-2011 period. The methodological quality of these studies was assessed by two judges using two scoring systems:? A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the American Dietetic Association Quality Criteria Checklist (ADA-QCC). The authors' final position was blindly assessed by 11 experts using a standard tool called the Likert scale ranging from 0='no evidence of a causal relationship' to 5='strong evidence of a causal relationship'.

The researchers identified 17 reviews in total, including 3 meta-analyses, 3 qualitative systematic reviews and 11 qualitative non-systematic reviews. Four of these reviews were funded by the food industry. Quality scores (the scientific quality of the reviews) were not correlated with the source of funding. However, reviews funded by the industry concluded that evidence supporting a causal relationship was weak (mean position score = 1.78 on the 1 to 5 scale) whereas evidence of a link was generally considered to be well founded in the other reviews (mean position score = 3.29).

Dr De Wals concludes: "Results support the hypothesis of a master plan, based on subtle intervention, that has been developed by the food industry to instil doubt regarding the adverse effects of SBB and to prevent the implementation of public health interventions and policies aiming to reduce their consumption."

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Doctors’ Lucrative Industry Ties

Viktor Koen

Dr. Alfred J. Tria is the chief of orthopedic surgery at St. Peter’s University Hospital, a 478-bed facility in New Brunswick, N.J., and to the medical technology company Smith & Nephew, his good word is worth a million bucks. Well, $940,857, to be precise.

That’s how much the company paid Dr. Tria in fees for promoting its products and training doctors in Asia to use them from 2009 to 2011, according to disclosures required by the state of Massachusetts, where Dr. Tria is licensed. In 2010, Dr. Tria earned $421,905 from private industry — more than any other Massachusetts-licensed physician that year.

Dr. Tria may be an outlier, but gifts and payments to physicians from drug and medical device companies have been rampant in medicine for decades. Over a two-and-a-half-year period, device and drug companies shelled out over $76 million just to physicians licensed in Massachusetts, according to a study published online this month in The New England Journal of Medicine. That amount does not include outlays of less than $50, which are exempt from disclosure.

The companies treat doctors to dinner, pay them to attend lectures, and underwrite conferences and continuing medical education courses. Asked whether such payments could pose a conflict of interest for physicians, Dr. Tria said, “It’s a legitimate concern.”

A spokesman for St. Peter’s said Dr. Tria had disclosed his financial relationships with industry to the hospital and refused to elaborate on the hospital’s policy.

Information about these sorts of payments to physicians is available for the first time now in a handful of states that have passed laws requiring corporations to disclose payments to health providers. Next year, the data should be available nationwide when the federal Physician Payment Sunshine Act goes into effect. Corporations were supposed to start collecting the information last year.

“For many decades, we had no information — these were closely held industry secrets,” said Susan Chimonas, of Columbia University, who has researched industry payments to physicians. “We are just starting to get a sense of how much money companies are spending on the marketing and consulting arrangements.”

The data will be a treasure trove for researchers. For patients, the question is what to make of this information and whether to seek it out when choosing a physician or making an important medical decision. Orthopedic surgeons, cardiologists and psychiatrists received the most lucrative payments, the new study found. Primary care physicians — such as internists and pediatricians — were least likely to receive payments.

In Massachusetts, companies are required only to broadly categorize the purpose of the payments, and nearly 90 percent of them were described as “compensation for bona fide services.” Dr. Aaron S. Kesselheim, an assistant professor at Harvard and the lead author of the new study, says that though the reported information can be vague, it can still be useful.

“It’s another piece of data for patients to examine as they consider treatment options,” he said. “If they go to an orthopedic surgeon who recommends a knee transplant, and they go to another who recommends watching and physical therapy, it might be interesting for the patient to wonder to what extent those two physicians have relationships with industry.”

The question may also be appropriate if a physician changes a patient’s prescription for no apparent reason, or prescribes a new or more expensive drug instead an older, tried-and-true alternative, said Dr. Joseph S. Ross, an internist and assistant professor of medicine at Yale.

“We know physicians are more likely to overprescribe or potentially prescribe inappropriately when they have a financial relationship with industry,” Dr. Ross said. His own research has found that many physicians do not think there is anything inappropriate about industry gifts as long as they’re not too lavish.

The size of the gift is not a determinant of its influence, experts say. Even a small gift can generate positive feelings and influence attitudes and behavior. “I don’t think doctors ever set out to make decisions that are not in the best interest of their patients,” said Dr. Deborah R. Korenstein, associate professor at Mount Sinai and a co-author of the study by Dr. Ross.

“But there are subconscious influences that people can’t control, and that’s why patients, and doctors, need to be concerned,” she said.

A paper Dr. Korenstein published in 2011 found that more than a dozen expert panels that developed national clinical practice guidelines for managing diabetes and high cholesterol were dominated by physicians with financial conflicts of interest — that is, they were receiving payments from companies with an interest in how these diseases are managed.

Physicians often do not realize that they are being manipulated when drug companies offer to pay them consulting fees — for example, for listening to pharmaceutical representatives describe new medications and evaluating their performance. The real purpose “is just to get the doctor to listen to the reps over and over again,” said Dr. Adriane Fugh-Berman, director of PharmedOut, a project at Georgetown University Medical Center that focuses on the influence of drug company marketing.

Dr. Fugh-Berman advises patients to avoid physicians who see drug reps and dispense samples. “Ask, ‘Could I have a tried-and-true drug?’ ‘Could I have a generic version?’?”

Although many schools and hospitals have adopted new policies that guide interactions with industry, they exempt physicians who are not staff employees and do not restrict the doctors’ income. Tufts University Medical Center adopted a policy in 2010 that required physicians to get approval and review if they were paid more than $25,000 in a year by a private company. But a Tufts associate professor, Dr. Yoav Golan, an infectious disease specialist, was paid $340,754 by drug companies in 2011, including $100,000 from Forest Laboratories, $73,918 from Merck and $42,109 from Pfizer, according to disclosures filed in Massachusetts.

A Tufts spokeswoman, Julie Jette, said the payments were approved by the university. “The policy wasn’t intended to be a cap,” she said. Dr. Golan did not respond to an e-mail requesting comment.

Dr. Chimonas said she would encourage physicians and their professional groups “to think about how all the information that is coming out is going to be interpreted or understood by the public.”

“It’s so important for patients to be able to trust their physicians,” she said.

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