Obesity: Worlds Collide?

Conflict of Interest?

Would you believe a nutrition researcher working for Coca-Cola who said that restricting foods might backfire in preventing obesity because 'birds put on weight when food is scarce'? Would you choose him to be president of "The Obesity Society", if your club's mission was to "be the leader in understanding, preventing and treating obesity and in improving the lives of those affected"?

A recent New York Times article, "Conflict on the Menu", threw light on the "food fight among the nation's obesity experts". The New York State Restaurant Association hired the president-elect of the Obesity Society, Dr. David Allison, to support their suit against New York City's regulation requiring chain restaurants to list the kilocalorie values on menu items.

Allison submitted an affidavit warning that listing calories on menus might encourage overeating. According to the NYT he suggested the regulation would either tempt patrons with "the forbidden-fruit allure of high-calorie foods", or leave them so hungry they'd "later gorge themselves".

Somewhat less creatively, the American Medical Association, the American Academy of Pediatrics, the American Heart Association, the American Diabetes Association, the American Public Health Association, the California Center for Public Health Advocacy, the Medical Society of the State of New York, the Trust for America's Health, and many other organizations back the city's regulation.

Obesity & Personal Freedom

While the New York Times keeps the focus of the story on the skirmish within the Obesity Society, there are other stakeholders. One category of stakeholders are "consumer freedom and choice" advocates, who vehemently object to the city's plan.

The Center for Consumer Freedom (CCF) is a group that lobbies against government regulation. They wrote histrionically about New York City's calorie labeling plan in "Menu Labeling Meltdown", warning that "the food cop campaign will plaster our nation's menus with warning labels." They said that Dr. Allison provided "damning evidence" that labeling "might be harmful". CCF belabored the idea that Allison's affidavit dealt a "major blow" to the city's plan and that Burger King might not have to label their Whopper with its energy value: 670 kilocalories.

CCF claims to fight for Americans' right to "guilt free eating". Their stated mission is "promoting personal responsibility and protecting consumer choice" and they're especially belligerent towards individuals or groups like the Center for Science in the Public Interest (CSPI) -- "the food cops". While CSPI works for the public interest, Sourcewatch says CCF is "a front group for the restaurant, alcohol and tobacco industries". Indeed, Phillip Morris started the organization under the name "Guest Choice Network" years ago for the purpose of organizing restaurants against government smoking bans.

It probably comes as no surprise then, that CCF wields the same arguments that tobacco lobbyists used to oppose government smoking bans, saying the food labelig rules violate the First Amendment. However Sandra Wootan, director of nutrition policy at the Center for Science in the Public Interest (CSPI), says: "The restaurant industry isn't concerned about defending the First Amendment, as its lawsuit laughably claims. It just wants to keep its customers in the dark. People need nutrition information to exercise personal responsibility and to feed their children healthy diets." In other words choice is actually broaden with more information, like calorie labels.

So does "personal freedom" stand for "corporate freedom" in this context? Of course, personal freedom is important, but governments are also obliged to work on behalf of the community. New York city's regulation basically requires chain restaurants that already post caloric information elsewhere, like on websites, post the same information in their restaurants. This is hardly the cumbersome requirement that CCF makes it out to be, since the restaurants already have the information, and it's not too difficult to post a sign above a pastry that says "350 kcal" or "950 kcal".

Science & Policy

Despite the Center for Consumer Freedom's (CCF) approval of Allison's recent position they haven't always been so friendly to Dr. Allison, and in turn, Mr. Allison hasn't always been so friendly to industry positions. For instance, in 2001, CCF contested Dr. Allison's 1999 finding that obesity caused 300,000 deaths a year, calling the research "bogus". The organization accused him of "voicing support for an onerous and unnecessary 'Twinkie Tax'", and having "ties to the weight-loss industry". In 2004 and 2005 the group decried Dr. Allison's research conclusions in articles like "Hypocritical Food Cops Preach 'Integrity'", accusing him of conflict of interest and citing Allison's many industry affiliations to discredit his research.

In 2005 Allison was one of ten authors on a New England Journal of Medicine paper showing that the average lifespan in the US would decrease because of the obesity epidemic. (Olshansky et al, "A Potential Decline in Life Expectancy in the United States in the 21st Century", March 17, 2005 Vol. 352:1138-1145.) The accompanying editorial said the group's assumptions were "excessively gloomy".

Although this was a science research paper, the authors pointed out policy implications. There were possible up-sides to the research, they wrote, for instance: "the U.S. population may be inadvertently saving Social Security by becoming more obese". But policy interventions might reverse the death trends, they wrote: "Unless effective population-level interventions to reduce obesity are developed, the steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today may, on average, live less healthy and possibly even shorter lives than their parents."

An accompanying editorial gave more detail. "Deadweight? --The Influence of Obesity on Longevity", by Samuel Preston, Ph.D., mentioned other research showing that only "30 excess calories a day during an eight-year period for Americans 20 to 40 years of age" produced the obesity epidemic. (NEJM Volume 352:1135-1137). Given the morbidity and mortality implications of small increases in daily calories, Dr. Preston said: "reversing the increase in body mass might be accomplished through small behavioral changes...food and restaurant industries would be valuable allies in this effort..."

The authors recommended that government interventions were important to maintaining current longevity, as well as cooperation from restaurants in trying to influence calorie reduction. Which makes it particularly ironic that co-author Allison now chooses the role of a hired gun fighting calorie labeling on behalf of restaurants.

In contrast to their favorable opinion of Allison a few years ago, CCF now applauds Allison's position, with no mentions of his "conflicts of interest", which served as the meat and potatoes of their previous irate stories about his research.

News of Allison's affidavit supposedly caused a fracas among members of the Obesity Society, who got ''completely mad that a president-elect of [an] organization that cares about obesity and cares about healthy eating, wants to hold back information from people that helps them make healthy choices'', according to the NYT. The current president of The Obesity Society to put out a separate statement opposing Dr. Allison's and supporting the city's labeling rules.

When The "Truth" Pays in Gold

A professor at the University of Alabama, Dr. Allison is an obesity statistician with a background in psychology. He's more than just a statistician with an affidavit that appears to be a conflict of interest. He's has published over 300 papers and 5 books.

For his efforts and accomplishments Dr. Allison was honored by George Bush last year in a White House ceremony for recipients of the Presidential Award for Excellence in Science, Mathematics and Engineering". The award recognizes mentoring of women, minorities, and persons with disabilities.

Dr. Allison noted that the award was not just about mentoring but also about making sure the students "understand the ethical foundation on which science is based." It's a mission he apparently takes seriously, as The Birmingham News reported: ''In science, we are not just doing a job,'' he said. ''I was chosen. I think of it like a calling. It is a special and sacred profession. Our sacred duty is truth.''

When questioned by the New York Times about his support of the restaurant industry Allison said, "I'm happy to be involved in the pursuit for truth....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."

Speaking his truth, Allison remains agnostic in his choice of client. He has been consulted by government, industry and the media for his expertise in obesity, science and integrity. When University of Vermont obesity professor Eric Poehlman was accused of falsifying data on metabolism and aging in research papers and federal grant applications, Dr. Allison interviewed the media in his defense: "I believe he's innocent, and I believe that he is being broken financially to the point where he's ready to give up the fight because he has no more money to fight with, and that's the way the game works", (Boston Globe, March, 2005). Poehlman served a year in jail, paid fines and recieved penalties.

Dough Boy

The Center for Consumer Freedom historically discredited any research Allison was involved in except when it ran in their favor. They accused Allison repeatedly of conflict of interest especially with companies selling "weight control product and services". CCF's leader may be a "real bottom feeder" as CSPI puts it, but the organization doesn't exaggerate Allison's impressive industry ties. In the 2005 NEJM paper about obesity longevity, nine authors each disclosed zero financial interests or affiliations. Dr. Allison, however, listed 150 organizational affiliations in a three page single spaced PDF, attached to the paper.

Dr. Allison's list of grants, monetary donations, donations of product, payments for consultation, contracts, honoria and commitments include consulting assignments for numerous parties, like lawyers engaged in litigation, pharmaceutical companies including Pfizer, Eli Lily, Wyeth Ayerst, Glaxo, as well as Corning, Frito-Lay, Coca-Cola, the Wheat Council, Kraft Foods, Nabisco, the FDA and ILSI. He has impressive experience doing everything from serving on the United Soybean Panel's Nutrition Advisory Board, to being an expert witness for defendant Lockheed Martin at $350 an hour in a groundwater contamination lawsuit.

Much of this was listed in Allison's resume, which I assume the Obesity Society recieved prior to selecting him to their leadership council. If not it was summarized at the Integrity in Science project at CSPI, or in disclosure documents in his publications. His insouciant transparency, extensive network (I assume), precocious achievement. and ethically unencumbered attitudes to choosing clients no doubt secured him a Obesity Society leadership position.

In this sense, doesn't the indignation from The Obesity Society is fine make you wonder? If Allison's position is so disagreeable, why did the nominating committee and 2,000 members in the society select him to be their future president? His consulting positions were a significant piece of his resume. He has been a paid industry consultant for at least 15 years.

Hungry Scientists, Money

Pharmaceutical companies, lawyers, labs, product companies, insurance companies, NGO's, and governments all have an interest in obesity, which means there's a lot of funding at stake in research. Yet by accident or design, research can be wrong, with resulting policy implications.

Allison co-authored a study published in NEJM, and endorsed policies that are the opposite of the "expertise" he now sells.TVDinner.jpg.

Poehlman's false data of age related metabolic depreciation affected policy. Doctors and researchers based study and clinical practice on his results. Grants for Poehlman meant that other scientists were denied funding.

In 2004, the CDC released a study which overestimated the annual deaths from obesity. This created false public perceptions and had policy implications, as various stakeholders eyed the competitive pie of public health money and got nervous that the CDC's results would deprive other public health goal like anti-tobacco funding for the cause of obesity.

Some people think that science should remain separate from policy -- like an old TV dinner, the cut vegetables separate from meat product and the syrupy peaches, each one in its own plastic mold -- compartmentalized, never mixed. Combining "science and policy" confuses the public they say. Others say that science and policy are already mixed up, a big stew.

The news often blends everything together, the science, the policy, the personalities, the business, the lobbyists, but yet affects neutrality. The news is too often drained of color and interesting nutrients and doled out as an equally portioned product of pro and con, like symmetrical gray-brown freeze-dried blocks of frozen vegetable puree. We're fed an easily digested story with the predictable arch of a food fight and a neat two part conflict: "Scientists found this...but others found that".

Unfortunately, one of the largest problems resulting from this information processing by media and various lobbies, politicians, and interest groups, is that many of us -- citizens, reporters, politicians, scientists out of their field... have no clue who's the lobbyist, the "unbiased researcher", the expert, or the apostate. But our confusion not only a conflict of interest problem, or a media problem, scientists' fault, or some government agency's fault. It's a larger more thorny economic conundrum.

Update: The New York Times reported that David Allison resigned as the incomin.g president of the Obesity Society. (Oct. 26, 2009, corrected middle initial) He said in his email statement that "I stand behind the scientific statements I made, my right to make them, and the manner in which I made them", however he apologized for the "distress" he might have caused the Obesity Society. The economic tensions that interfere with frank science presentation and reporting remain.

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