Prominent nutrition expert Marion Nestle is pulling an opinion piece she recently co-authored in the Journal of Public Health Policy following revelations that the piece contained multiple factual errors and failed to reveal her co-author’s ties to one of the subjects of the article.
The article, “The food industry and conflicts of interest in nutrition research: A Latin American perspective,” was published October 29 and raised concerns about the conflicts of interest that can occur when a food company pairs with a public health organization. Specifically, the article critiqued the supposed relationship between the biggest beverage distributor in Guatemala and the leading Guatemala-based public health organization, aligned to distribute a fortified supplement for undernourished children.
However, after the paper appeared, Nestle learned they had misrepresented the relationship between the key parties, and failed to disclose that her co-author, Joaquin Barnoya, received “a substantial portion of his salary” from INCAP. Retracting the opinion was the best solution, Nestle wrote on her blog today:
To correct and clarify these issues, we would need to revise the Viewpoint. Doing so, however, is not possible once a paper is published. That left us no choice but to request a retraction, which I believe is the right course of action in this situation.
The opinion stemmed from an advertorial that presented an alliance between the Central American Bottling Corporation (cbc), the Institute of Nutrition of Central America and Panama (INCAP), and the U.S.’s Shalom Christian Foundation, to distribute the food supplement Mani+. In the JPHP article, Nestle and Barnoya raised concerns about the conflicts of interest that can arise from such alliances:
Because one purpose of the partner companies is to sell sugar-sweetened beverages to anyone who will buy them, this alliance raises questions of conflict of interest and challenges INCAP’s credibility as a promoter of public health.
They closed the article with a strong recommendation that INCAP strengthen its stance regarding conflicts of interest:
At a minimum, INCAP should publicly disclose its relationship with cbc/PepsiCo while making it clear that it recognizes sugar-sweetened beverages as a leading cause of obesity and, therefore, supports policies to restrict their marketing and sales…INCAP’s board of trustees (or the equivalent governing body) should critically review its financial relationships for conflicts of interest with the organization’s primary mission. Failing to do so sends a message that sugar-sweetened beverage consumption is supported by an important health research organization, a misunderstanding that can have devastating public health consequences for a region already in dire need of evidence-based health practices and policies.
Then, they got a response from some readers, Nestle writes:
Shortly after publication of the Viewpoint, Carolina Siu Bermúdez, the director of INCAP who appears in the advertorial, wrote to object that our piece incorrectly implied a financial relationship with cbc, and that Dr. Barnoya had failed to disclose that INCAP paid a substantial portion of his salary via a grant from yet another organization. We also received letters from Dr. Edward Fischer, the founder of NutriPlus/Mani+, Professor of Anthropology and Director of the Center for Latin American Studies at Vanderbilt University, objecting to our statement that the alliance was responsible for manufacturing (rather than just distributing) the product. Both asked us to retract the Viewpoint.
The authors investigated, and found out the critics were correct.
Indeed, further investigation by us and by the editors of the JPHP exposed additional errors.
According to Nestle, the “clarifications and corrections” are:
— The alliance is involved only in the distribution of Mani+, not its manufacture (as we had asserted).
— The actual nature of the alliance between cbc, INCAP, and the Shalom Christian Foundation—who does what—is, in fact, unclear. The Viewpoint should have characterized the relationship with less certainty and specified that cbc has no financial relationship with either INCAP or the Foundation.
— Dr. Barnoya should have disclosed his financial relationship with INCAP, and I should have insisted that he do so.
— The Viewpoint was triggered by the advertorial, and we should have made this connection more explicit.
— The reference in the Viewpoint to the advertorial is incorrect. It is listed as (2015) cbc co. Unidos contra la desnutricion. INCAP, cbc y Fundacion Crisitiana Shalom Firman Convenio 23(July): 9. The correct reference is Alianza Contra la Desnutricion. elPeriódico. July 23, 2015;Advertorial: 9.
It’s unclear when the retraction notice itself will be posted. But already, her transparency is receiving praise:
Not sure I've ever read a more forthright and thorough retraction/apology than @MarionNestle's https://t.co/h2SMyocAVj cc @ivanoransky
— Yoni Freedhoff🎗️ (@YoniFreedhoff) November 25, 2015
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Um, um, maybe Nestle’s piece was so irresponsibly done from the start that praising her retraction is just powder in the eyes?
Nestle and I disagree on a lot of things. But I respect this outcome.
I only wish NEJM would realize the same thing on the Benbrook/Landrigan policy piece of late.
That said, I hope that this drama does not discount the outcome of this alliance. Does it reach vulnerable kids? Does it improve their nutritional status? I’m getting a little tired of the drama about who-pays-who when maybe we should be focusing on the actual impacted parties.
Show me the data.
I appreciated Nestle apologizing and publishing the blog post on her retraction.
BUT, in fact, this is a very mild retraction given the facts. The authors of this article committed three serious errors: (1) failed to report a serious competing interest, (2) misreported the key piece of evidence, and (3) misrepresented their primary source as a piece of journalism when it was in fact an advertisement. I assume Nestle did not read the Spanish language primary sources, so I suspect that her co-author (who failed to report his conflict of interest–that he works for the organization being criticized) is mostly responsible.
Starting with the very first sentence (the foundational assertion for the whole article), this piece is based on an assertion that is not backed up by the cited sources. That first sentence states that the Guatemalan Pepsi bottler is working with an international nutrition institute to produce a ready-to-use supplementary food Mani+ (this sentenced is then footnoted with reference #1)
This claim is false and the citation provided does not back up the claim. The Central American Bottling Corp. is not involved in the manufacture and distribution of Mani+ –never was, isn’t now. This assertion is simply untrue. No nuance, not difference of opinion: this is false. And the footnoted citation does not support what is reported in the sentence. And yet it harms our ability to carry out the Mani+ program in Guatemala, which is a locally sourced and ethically produced treatment for malnutrition.
Further, Reference #1 refers to an “advertorial” that the authors cited as though it were a newspaper report. Nowhere does it state that cbc or PepsiCo were involved in the development or manufacture or distribution of Mani+. This is not a subtle difference of interpretation. The advertorial does not state what the authors claimed in the footnoted sentence.
This accusation, published in a respected venue, does real damage to our reputation and our ability to do the important work that we do.
It is a VERY mild retraction given the circumstances.