Beyond Reasonable Doubt: Avoiding conflict of interest in nutrition research
Stuart Gillespie 28 September 2023
Beyond Resonable Doubt (CDoH)


Tobacco industry tactics

In the late 1950s, as evidence of the harms of smoking continued to grow, the tobacco industry became very nervous. In December 1953, the CEOs of the top five companies came together at the Plaza Hotel in New York City to map a strategy. They couldn’t stand each other, but something had to be done. Also in the room was John W. Hill, the president of the nation’s leading public relations firm.

After long discussions, a consensus emerged through the blue haze. They could no longer ignore the science, so they resolved to ‘secure’ it. To do this, they identified, supported and amplified the views of sceptical scientists. Hill formed the Tobacco Industry Research Committee (TIRC) to support this research. No one was interested in answering scientific questions – the goal was to control the science. So long as doubt and controversy prevailed, the industry could fight off regulation and litigation. Scientific uncertainty facilitated the attribution of risks to the smoker, not the cigarette.

Doubt is our product since it is the best means of competing with the ‘body of fact’ that exists in the mind of the general public. It is also the means of establishing a controversy.’

Hill then realized he needed a second unit, separate from the TIRC, to act as a trade association and lobby for Big Tobacco, the largest companies in the tobacco industry. Within a few years, the Tobacco Institute became the most powerful political lobby in Washington DC and set about developing and refining its tactics, the 21st-century version of which can be found here.

Big Tobacco effectively invented the modern conflicts of interest that now play out across the interface between people and business in multiple domains including climate, environment, public health and more recently, the potential harms caused by ultra-processed food (UPF) consumption.


Big Tobacco and Big Food links

Seventy years later, the links between Big Tobacco and Big Food are again in the news. A study by University of Kansas researchers published in the journal Addiction shows "substantial tobacco-related influence on the U.S. food system". Foods produced by tobacco-owned companies (like Kraft-General Foods and Nabisco) between 1988-2001 were 29% more likely to be classified as hyper-palatable (having a certain mix of ingredients designed to be addictive) due to fat and sodium, and 80% more likely to be ultra-high in carbohydrates and sodium than foods produced by other companies. Tobacco companies pulled out of the US food system in the early 2000s but their hyper-palatable food products remained.

Hyper-palatability is a big deal as it is likely to be one of the main factors driving compulsive over-consumption of UPFs. In the US, as the share of dietary calories deriving from UPFs grew, so did obesity. Adult obesity prevalence has almost tripled in the last four decades, – from 15% in 1980 to 42% in 2020.

The UPF industry has adopted and adapted the tobacco industry playbook and developed new tricks of its own. Like the tobacco cabal before it, Big Food seeks to change the narrative – to sow doubt and uncertainty. This is done by funding research, publishing it, criticising or suppressing research that highlights UPF harms, and disseminating selected industry data to media and directly to policy makers. Among the multiple tools in the playbook, several are employed to shape research, communications and advocacy efforts, including:

  • Redirecting research priorities: Steering research agendas away from questions that are most relevant for public health and towards products and activities that can be commercialised.
  • Framing research questions: Set up questions in ways that avoid conclusions about product harms and risks.
  • Invoking personal freedom while blaming individuals: Arguing that food is the responsibility of the individual alone, and any regulation would infringe personal freedom.
  • Attacking scientists: Denigrating scientists who publish studies that highlight harms associated with UPF consumption using derogatory labels (non-experts, nanny-state-lovers, even ‘food fascists’).
  • Promoting physical activity above diet: Emphasizing physical activity over diet as the main researchable policy option for maintaining a healthy weight.
  • Denying the existence of harmful foods: Arguing that there are no bad foods, just unhealthy diets that derive from bad individual choices.
  • Creating “straw man” arguments: Introducing misleading arguments, such as conflating ultra-processing with processing, to divert attention from the core issues.
  • Endless calls for more research: Continuously stating that additional research is needed before any meaningful action is taken.


Addressing conflicts of interest

A conflict of interest (CoI) is a situation in which professional judgement concerning a primary interest (research validity) may be unduly influenced by a secondary interest (such as financial gain). CoIs are a big deal for researchers in food, nutrition and health. Many recent studies and reviews – including Besancon et al (2023),  Sacks et al (2020), Lundh et al (2017), Fabbri et al (2015), Flacco et al (2015), Bes-Rastrollo et al (2013)Stamatakis et al (2013) and Lesser et al (2007) – have clearly shown the effects of corporate influence on research.

And then, beyond studies, we have scientific academies and advisory committees.

In the US in 2022, an investigation revealed that the US Academy of Nutrition and Dietetics (AND) was investing in the stocks of Nestle and PepsiCo who were also funding it. – a novel circular form of conflicted interest by an agency supposed to be working to reduce the harms caused, in large part, by its own funders. AND was also investing in Abbott and Johnson & Johnson – two companies that regularly violate the International Code on the Marketing of Breast-milk Substitutes established by the World Health Organization.

In the UK in 2023, Erik Millstone and Tim Lang – food policy experts with ninety years of experience between them – investigated conflicts of interest in nine food regulatory institutions. They discovered that every committee had several members who were paid up by the food industry.  The most ‘conflicted’ was the Scientific Advisory Committee on Nutrition (SACN) with nine of 15 members funded by the ultra-processed food industry (likely an underestimate as declarations are voluntary and several were ambiguous).

In recent months – since the publication of Chris van Tulleken’s Ultra-Processed People and Henry Dimbleby and Jemima Lewis’s Ravenous – the industry has gone into overdrive, as media coverage of UPFs continues to grow.

In July 2023, the SACN released a noteworthy statement which concluded: ‘The observed associations between higher consumption of (ultra-) processed foods and adverse health outcomes are concerning, however…the evidence to date needs to be treated with caution.”

Shortly afterwards, Rob Percival, Head of Food Policy of the Soil Association, questioned why the committee had not referred to the way in which UPFs have displaced recommended foods and dietary practices. Two-thirds of the calories in the diets of many children are now ultra-processed. Why didn’t SACN address this displacement effect?

Percival then looked into the committee members.  Of the sixteen members, most receive/d funding from the ultra-processed food industry and/or are members of organisations like the American Society of Nutrition and the British Nutrition Foundation (BNF) who are funded by the ultra-processed food industry.

The BNF had earlier (April 2023) stated its position on UPFs that: ‘due to the lack of agreed definition, the need for better understanding of mechanisms involved and concern about its usefulness as a tool to identify healthier products, UPF does not warrant inclusion within policy.’

The European Food Information Council (EUFIC) – most of whose full members are UPF companies – has also planted doubt on recent studies highlighting an association between UPF consumption and heart disease.


Recognizing the impact and the need for change

The big issue for food and nutrition research (or any other discipline) is not the integrity of one individual researcher but whether industry funding confers a systematic bias. The answer to this question, as the studies above show, is unequivocal. The bias is systematic and significant. Conflict of interest is not good for the integrity of the research community and its ability to engender trust, and it’s not good for the public whose health will be affected by governmental failure to act on the basis of pro-industry findings.

Disclosure is not enough to solve this – the conflict doesn’t magically disappear if a researcher chooses to declare it. In 2021, the UN Human Rights Council released a report addressing the role of science on toxic substances which stated: ‘In order for the science that forms the basis of policy to be trusted, conflicts should be avoided rather than simply managed through disclosure processes.’

Another UN agency is now leading the way in the nutrition space. This year, UNICEF brought out programme guidance on engaging with the food and beverage industry. The guidance affirmed it would avoid all future partnerships with UPF industries. No room for doubt in this.

The same principle should apply to researchers. Going beyond disclosure, action is needed to increase funding for independent research and to develop, and monitor adherence with, effective guidelines to regulate the interaction of research institutes with commercial bodies.

Another principle is relevant here too, and this one is for governments. The precautionary principle, enshrined in international treaties and national legislation in many countries, states that: ‘if a product, an action or a policy has a suspected risk of causing harm to the public or to the environment, protective action should be supported before there is complete scientific proof of a risk.’

With the current situation of widespread global consumption of ultra-processed foods and rising levels of child and adult obesity in most countries, we need to invoke this principle. This does not, of course, change the need to continue to research the mechanisms involved behind the harms associated with UPFs – whether they relate to energy density, hyper-palatability, the effects of certain additives, or whatever else.

But it does mean that governments should act now. Sitting on their hands is no longer an option. A range of public action can be taken now to begin to turn the tide and shift the balance towards healthier diets for all.



Interested in the impact of commercial determinants on human and planetary health? Join the conversation! Between September and December, we are welcoming blogs from around the world on the commercial determinants of health in agriculture-food systems. Blog length can vary from 200 to 1000 words. Read out our blog writing guidelines for tips on crafting a compelling piece.

Your insights could be the spark that drives positive change. Submit a blog idea, we're open to suggestions! More information here.
 “Commercial activities shape the physical and social environments in which people are born, grow, work, live and age – both positively and negatively.” World Health Organization.

Beyond Resonable Doubt (CDoH)


Great blog Stuart!

Angela Carriedo

21 Oct 2023
Login or Join ANH Academy to be part of the conversation