BMJ 2015;350:h215 doi: 10.1136/bmj.

h215 (Published 11 February 2015)

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Feature

FEATURE
SUGAR

Sugars web of influence 2: Biasing the science

The sugar industry is increasingly making efforts to buy into the science on nutrition, reports Jonathan
Gornall
Jonathan Gornall freelance journalist, Suffolk, UK
Industry funding of research that shows sugar in a good light is
nothing new. In 2009, US dental administrator Cristin Couzens
unearthed the files of a bankrupt sugar company and discovered
a cache of revelatory documents spanning decades.
Couzens found that back in the 1960s, when diet drinks were
seen as a threat to manufacturers of sugary drinks, the industry
had funded research in an attempt to show that cyclamate
sweeteners were bad for health. In the 1970s, efforts were made
to distance sugar from diabetes, and between 1975 and 1980
the Sugar Association in the US had funded 17 studies to
maintain research as a main prop of the industrys defense.1

As recently as 2003, a Sugar Association newsletter showed it

was trying to secure seats for unbiased experts on the US
Department of Agricultures dietary guidelines advisory panel
and made this pledge to its members: the association was
committed to the protection and promotion of sucrose
consumption. Any disparagement of sugar will be met with
forceful, strategic public comments and the supporting science.2
This document, Couzens said in a 2013 interview, showed the
sugar industry was still very active in nominating scientists to
serve on the dietary guidelines advisory committee, and it is
still publishing research through connections with the World
Sugar Research Organisation, based in London.3

The World Sugar Research Organisation (WSRO) did not

respond to several attempts to contact it. However, according
to its website, it is an international scientific research
organisation globally supported by the sugar industry, dedicated
to encouraging a better appreciation of the direct and indirect
contribution made by sugar to the nutrition, health and wellbeing
of all the populations of the world.
The evidence, it says, suggests that a high-fat, high-energy
diet, combined with inactive sedentary lifestyles, are the two
principle [sic] factors increasing the risk of obesity.
Furthermore, A combination of high-carbohydrate diets and
regular physical activity can assist in the maintenance of an
ideal body weight.4

In 1979, after publication of John Yudkins book Pure, White

and Deadly, which was highly critical of sugar and the sugar
industry, the organisation published a critique in its members

bulletin under the headline For your dustbin. Yudkin took

exception to the description of his work as science fiction and
began a four year libel action which, according to the account
in the updated version of his book, ended in a published apology
and WRSO paying costs.5
WSROs supporters today still include British Sugar and Tate
and Lyle in the UK, and Coca-Cola and the Sugar Association
in the US. The organisation is headed by Richard Cottrell, a
biochemist who is a former director of the Sugar Bureau (which
changed its name to Sugar Nutrition UK in 2012).

Among other contentious claims on the WRSOs website are

that high sugar consumers are more likely to be slim, sugar
can make it easier to follow a low fat diet, and sugar may be
more satiating [than fat]. The site lists several published papers
to support these claims but does not say whether the studies
were funded by the organisation.

Influence of sponsored research

It is, of course, difficult to judge whether individual pieces of

published research funded by organisations such as WSRO, or
companies such as Mars and Coca-Cola, influence public
opinion or the decisions of those in power.

However, a paper published on PLoS Medicine last year reported

evidence that systematic reviews examining the relation of sugar
sweetened beverages with weight gain or obesity were five
times more likely to present a conclusion of no positive
association if the research had been funded by industry.6
An earlier study that examined 206 papers on the health effects
of milk, soft drinks, and fruit juices had also concluded that
Industry funding of nutrition-related scientific articles may
bias conclusions in favour of sponsors products, with potentially
significant implications for public health.7
The sugar industry, says David Stuckler, professor of political
economy and sociology at Oxford University, is increasingly
making efforts to buy into the science on nutrition, echoing
tactics used by the tobacco industry: Diverting the agenda and
biasing science are two industry tactics that we see at play.
Sugar Nutrition UK, an industry funded body devoted to
researching the science of sugar, is one organisation that funds

[email protected]
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BMJ 2015;350:h215 doi: 10.1136/bmj.h215 (Published 11 February 2015)

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FEATURE

sugar related research. A spokesperson said the organisation

was completely transparent about the nature of our research
programme and that all the research projects it funded were
registered on ClinicalTrials.gov, the global registry and results
database of clinical studies. However, only two trials supported
by Sugar Nutrition UK are listed on the website because the
organisation did not sign up to the initiative until last year.
It was, added the spokesperson, nevertheless a policy of Sugar
Nutrition UK to publish the results of all funded projects,
regardless of the outcome. However, despite several requests
to do so, the organisation did not provide a list or give any
details of all the research work it had funded.
Sugar Nutrition UK also monitors more than 90 journals and
maintains on its website a selection of summaries of recent
papers on the subject of carbohydrates and health.

This year the Union of Concerned Scientists in the US published

a report highlighting how food and beverage manufacturers
along with industry supported organisations such as trade
associations, front groups, and public relations firms have
actively sought to deceive the public and ensure that Americans
continue to consume high amounts of sugar.8
One tactic was to exert . . . influence in academic spaces by
supporting seemingly independent scientists and through
participation in scientific meetings.

Although industry funding does not necessarily lead to biased

results in a given study, the report concluded, industry-funded
studies are as a group biased toward results favourable to
industry and, as such, do raise serious concerns about impact
of industry funding on the objectivity of scientific literature.
This funding effect could produce systematic biases in nutrition
research, including studies on sugar, and ultimately affect public
health.
Evidence of industry funding does not, of course, amount to
evidence of research malpractice by funded researchers, but
examples of industry funded research that favours industry are
not hard to find.
A 2013 paper published in Nutrition Journal reached the
potentially controversial conclusion that increased frequency
of candy consumption among adults in the United States was
not associated with objective measures of adiposity or select
cardiovascular risk factors, despite associated dietary
differences.9

The research was funded by the National Confectioners

Association, which, according to an acknowledgment at the end
of the paper, developed the research question, though did not
contribute to the design of the study, analysis, interpretation of
data, or drafting of the manuscript. It had, however, reviewed
the manuscript prior to submission and provided minor editorial
suggestions for consideration by the authors who retained the
authority to accept or reject them.9

Corresponding author, Mary Murphy, a registered dietitian and

senior scientist with the US based scientific consulting company
Exponent, told The BMJ she believed it was possible to produce
unbiased findings despite the financial support of an
organisation with a clear interest in the outcomes, and we believe
those findings are credible.
She and her colleagues had been engaged by the National
Confectioners Association to conduct this work because there
is limited research on the relationship of candy consumption on
diet and health. As part of the acceptance process, the
manuscript underwent an objective, open peer review.
Disclosure of the funding source was provided to reviewers in
the submission.
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Sponsorship defended
In April last year an article in Diabetes Care contested a claim
elsewhere in the journal that we need to reconsider
consumption of dietary sugar based on the growing concern of
obesity and type 2 diabetes.10

Not so, wrote Richard Khan of the University of North Carolina

School of Medicine and John Sievenpiper of the Clinical
Nutrition and Risk Factor Modification Centre at St Michaels
Hospital, Toronto. The pox on sugar was overwrought and
overworked. At the foot of the article Sievenpiper disclosed
he received funding from Coca-Cola and speakers fees and
honorariums from Coca-Cola and the Dr Pepper Snapple
Group.11
Sievenpiper told The BMJ that his departments sugar related
research programme was funded by the Canadian Institutes of
Health Research and the Calorie Control Council, which
represents the low and reduced calorie food and beverage
industry. They had applied to Coca-Cola and Dr Pepper Snaffle
Group for educational grants after the research had been
designed and conducted and had used the money only for
knowledge translation.

Nevertheless, he believed it was wrong automatically to dismiss

research funded by industry. Although he recognised that direct
industry funding could be perceived by some as harming
credibility, I do not think this view is shared by all, especially
critical thinkers. It is a very easy way to dismiss research one
does not like without having to look carefully at it.
A crucial question when considering financial conflicts of
interest was do they matter?

Where industry decides on the research questions then industry

funding may lead to a distortion of the research question,
[making] it more likely that a result will favour the product or
position of the sponsor, he said.
But while industry funding could influence conclusions drawn
from research, that does not necessarily mean that it affects
the actual results. The issue was easily overcome by
systematic reviews and meta-analyses that pool the totality of
the evidence . . . as these are based on the data and not the
authors conclusions.
Intellectual conflicts, such as how long investigators had been
wedded to a hypothesis or whether they had developed a
personal brand around a position, could represent a more
relevant conflict of interest.

Many of the strongest voices in the anti-sugar movement have

popular books from which they profit directly, he said. It is
hard to imagine that they might readily change their views when
presented with evidence that refutes their position.

Funding research isnt the only way the sugar industry might
seek to influence policy makers. UK based AB Sugar, one of
the largest sugar producers in the world, recently funded a report
by the think tank 2020Health called Careless Eating Costs Lives.
The report reached a conclusion that echoed the message at the
heart of industrys rejection of claims that sugar is a key cause
of obesity. Despite attempts to tackle obesity by focusing on
the populations intake of energy dense, high calorie ingredients
such as fat, sugar and alcohol the problem really lies with
people consuming too much of everything, and there is no
single cause for the observed rise in obesity.12
Competing interests: I have read and understood BMJ policy on
declaration of interests and declare I am in receipt of funds from the
European Union co-financed project ALICE RAP (www.alicerap.eu).
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BMJ 2015;350:h215 doi: 10.1136/bmj.h215 (Published 11 February 2015)

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FEATURE

Provenance and peer review: Commissioned; not externally peer

reviewed.
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Cite this as: BMJ 2015;350:h215

BMJ Publishing Group Ltd 2015

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