Nutrition Support Blog: Scientific Misconduct, Conflicts of Interest, and Guidelines for Nutrition Support
The past year has witnessed several sensational stories about scientific and research misconduct, and there is ongoing controversy about the role of scientific journals and guidelines committees in policing misconduct, and how “tweaking data” may result in the deaths of patients1-3. A new article in Science details how a researcher who was the lead author on two influential studies of β-blocker medications given to patients undergoing surgery, was fired for misconduct after an investigation concluded that he had fabricated data (in a different study)1. The β-blocker research in question was used in developing the European Society of Cardiology guidelines, and although there is substantial controversy about how many people were harmed, it is possible that thousands (perhaps hundreds of thousands) of deaths resulted.
The journal that originally published the suspect data and the cardiology guidelines committee have also been criticized for being slow to retract the article and alter the guidelines1.
In the world of nutrition, the journal Heart retracted a meta-analysis published online in 2012, which reported that a strict sodium restriction in systolic heart failure resulted in significantly increased mortality2,3. The meta-analysis and a follow-up editorial were one of the most read papers in Heart in March 2013, but the papers were retracted after it was revealed that there was duplication of data in one of the papers central to the meta-analysis3. When the journal requested an independent analysis of the original data, the researchers reported that all of the raw data was “lost as a result of a computer failure”3.
It is extremely unsettling to consider how one suspect study can have such a corrosive effect on guidelines for clinical practice, with the potential to affect so many patients. In large fields with large numbers of clinicians and researchers, there tends to be more eyes on the research, and I think a greater likelihood of instigators willing to ask questions of suspect data. Nutrition support has a smaller number of practitioners compared to fields like cardiology, with far more potential for a single study or one individual on a guideline committee to alter practice. There has been increased scrutiny of corruption of clinical research and the undermining of evidence-based guidelines in the interests of enhancing industry profits4,5. It is increasing apparent that a simple disclosure of potential conflicts of interest is inadequate. I think it is time that nutrition support organizations mandate that any participant on a guideline committee be free of conflicts of interest (not just declare potential conflict). Additionally, guidelines should be subject to a wider peer review process and made available to general professional scrutiny and feedback prior to publication4,5. I imagine that there will be those who say that I am a dreamer for wanting a higher level of ethical accountability, but I am not the only one that is concerned about the introduction of corporate interests into research, guidelines and presentations*.
"Quis custodiet ipos custodies” (“Who watches the watchmen?”)
“All it takes for evil to succeed is for a few good men [people] to do nothing...”
― Edmund Burke
1. Vogel G. Suspect Drug Research Blamed for Massive Death Toll. Science. 2014;343 (6170):473-474.
2. DiNicolantonio JJ, Di Pasquale P, Taylor RS, Hackam DG. Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart. 2013 Mar 12.
3. [No authors listed] Retraction. Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart. 2013 Jun;99(11):820.
4. Guallar E, Laine C. Controversy Over Clinical Guidelines: Listen to the Evidence, Not the Noise. Ann Intern Med. 2014 Jan 28.
5. Spence D. Evidence based medicine is broken. BMJ 2014;348:g22 (Published 03 January 2014)
*(borrowed/paraphrased from Mr. Lennon)