Dietary Guidelines and the conflict of interest

It appears that we finally have something that we can agree upon with the Center for Science in the Public Interest (CSPI). According to a recent article prepared by Merrill Goozner of the Integrity in Science project at CSPI, and repeated by Marion Nestle in her blog, nearly half the new 2010 Dietary Guidelines Advisory Committee's 13 members have taken funding from the food and pharmaceutical industries. Of common interest is the Chairperson of the Committee, Dr. Linda van Horn, professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago. We are not aware of any conflict of interest involving research funding, however, during the first public meeting of the DGAC, Dr. van Horn recalled an experiment that she had done as a graduate student, which she stated proved without doubt that children who were fed reduced salt diets ended up abhorring the typical salt levels in many foods. Thus, she revealed the personal bias she brings with her as she assumes the chair of a committee tasked with the 'objective' evaluation of all the data on salt and health to be used as a base for future recommendations.

It is interesting to note that CSPI, Marion Nestle, and the preponderance of professionals in the medical community choose to define conflict of interest almost exclusively in terms of funding received from outside (particularly industry) sources. What they seem to totally ignore is the overwhelming bias resulting from personal ego, and a lifelong investment in a particular point of view on a subject. Such an all-consuming passion usually results in a conflict of interest greater than any motivated by research funding. Clinical researchers who have promoted a particular theory for decades are very unlikely to change their minds easily. Many brazenly belong to advocacy groups that publicly espouse their positions. How can they be expected to objectively evaluate data that may make decades of their investment worthless? Yet, there they are - fully prejudiced by preconceived positions - and placed in a position of public trust to make objective evaluations.

Thus, we have one of the greatest hypocrisies in modern medicine - biased researchers sanctimoniously pointing their fingers at the 'conflicts of interest' of others.

Physician, heal thyself!

As we pointed out in an earlier article, the chairman of the sub-committee for Fluid and Electrolytes for the 2010 Guidelines is Larry Appel. Dr. Appel is one of the world's most outspoken anti-salt advocates and is listed as a member of World Action on Salt and Health (WASH) - an advocacy group whose singular aim is: "to achieve a reduction in dietary salt intake around the world." In their justification for salt reduction, WASH focuses almost exclusively on hypertension to the virtual exclusion of all other risk factors and biomarkers responsible for overall health outcomes. They systematically ignore all data (including the Cochrane review and its latest reissue - ) as well as the most recent evidence that demonstrates the net negative health outcomes from reduced salt diets. How any member of such an advocacy group could possibly be selected (much less lead) what is supposed to be an objective advisory group is quite astonishing and a black mark on the Institute of Medicine as well as our National Academy of Sciences under which it operates. It is not as if the IOM were unaware of this conflict of interest. They simply choose to ignore it, confident in the belief that they can pass anything off as legitimate science.

And why not? When has the medical establishment ever been called out, no matter how egregious their behavior or advice has been? How many people marched on the IOM or the AMA offices to protest the countless deaths resulting from the hormone replacement therapy fiasco. When it comes to medicine, people suffer silently - and the establishment gets a free pass.

Such hypocrisy does not bode well for the future of objective medical science in this country.