Studies regarding nutritional recommendations are notoriously difficult. As there are so many variables that need to be factored in, including lifestyle, environment, and genetics, it’s challenging to tease out any dietary habit as having a direct relationship to good health or bad. Many try to do it, but most of these seemingly absolute recommendations are buried in an advertisement for what’s being studied. Blueberries anyone? Just ask the makers of “blueberry extract.” A general rule is to steer clear of any dietary recommendation from a source that sells said food, supplement, diet plan, or powder. In those situations, it’s pretty easy to see the conflict of interest, so buyer beware.
But when a peer-reviewed study is published in a highly acclaimed academic journal such as the Annals of Internal Medicine, which certainly doesn’t have a side gig promoting juice cleanses, rosemary-sage lotion, or turmeric tea, even the most discerning skeptic will take it as real. A peer-reviewed journal is one that only publishes articles that have been vetted by multiple unpaid reviewers who are considered to be experts in the article’s specific area of study, and each article must be reviewed and approved by at least one major editor on the journal’s editorial board. Very large studies also need to be carefully scrutinized by the Editor-in-chief.
The Annals of Internal Medicine has over 150,000 subscribers, which is one of the highest numbers for an academic journal. They have one of the highest ‘impact factors’ of any academic journal, a metric of how often articles published in a particular journal are cited in other journals. Over 18,000 reviewers contribute their input to the peer review process of the Annals. This review process is rigorous, as less than 8% of articles submitted actually make it to publication.
One of the requirements of all reviewers and editors on any academic journal board is that they disclose any conflict of interest they have, each time they review any article. This includes describing any connection to commercial entities related (or even unrelated) to the article reviewed, or any personal or professional connection to the authors. Perhaps even more critical is that authors need to disclose any financial relationship to companies that may be even remotely related to their work.
And more important than reviewers and editors disclosing any commercial relationships indicating conflict of interest, the authors’ relationships absolutely need to be disclosed to any reader in a specified section of the article. Commercial and/or financial relationship does not necessarily negate the value of the study altogether, nor does it mean that it shouldn’t be published. However, it provides transparency to the reader regarding any potential bias in the work.
On October 1, 2019, the Annals of Internal Medicine published updated clinical guidelines regarding red meat and processed meat consumption. In essence, the authors found no health benefits to reducing either processed or unprocessed meat consumption. This was contrary to nearly all study recommendations and national dietary recommendations put forth in the prior several decades. Cue the red flags.
As mentioned above, nutritional studies are notoriously challenging, as there are so many confounding factors, including self-reporting bias, lifestyle variables, difficulty with follow-up measures, genetics, and environmental factors altering veracity of the data. One factor that shouldn’t be a factor at all is the veracity of the authors’ words, especially when it comes to disclosure statements. In this study, suggesting that reducing red meat consumption is not necessarily beneficial for health, the authors did not disclose any conflicts of interest. As this study was counter to nearly every nutritional study in the recent past, all of which showed some degree of evidence that red meat consumption is harmful to cardiovascular health, and additives to processed meat are potentially carcinogenic, not to mention extremely high in sodium, this study was what some would call groundbreaking. Others would call it suspect.
And so began a little digging on the authors’ relationships. It didn’t take long to find that, indeed, some of the authors, notably the lead author, did not disclose relationships to organizations connected to the meat industry. For one, the research consortium responsible for work on the study is supported by a section of Texas A&M University which is partially funded by the beef industry. Dr. Michael Wilkes, host of NPR Sunday’s “Second Opinion,” discussed other conflicting relationships not disclosed by the authors, including support by the International Life Sciences Institute, which is funded by some little-known companies such as McDonald’s, Coca-Cola, and Nestle. He also voiced concern that not only was it unethical that the authors did not disclose relationships to the meat industry, it was irresponsible of the editors to gloss over the authors’ lack of disclosing such relationships.
In this day and age of click bait by celebrity endorsements, wellness products, diet scams, and weight loss promises, the last vestige of integrity remained academic publications. The public (and those in academia) are rightly perturbed by this sudden flip flop, as they should be.
Just when we’ve begun to get wise to health scams from folks hawking their wares, we are now faced with questioning some of the highest quality academic journals, which, to date, had been the last bastion of unbiased presentation of new information.
Forbes – Healthcare