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We agree with Braillon that the health of the public is well served by attending to the social determinants of health,[1] but diet is an important plank in the public’s health and promotion of healthy eating is a global issue.[2 3]
We welcome suggestions for removing healthcare providers from a market society. As discussed in our paper,[4] substantial evidence shows that financial conflicts of interest are a greater concern than personal experiences and beliefs on guideline committees because of the multiplying or ‘megaphone’ effect that occurs when many people have similar conflicts that deliver a risk of biased decision-making in the same direction.[5] Global corporations with deep pockets influence the evidence base, advocacy groups AND guideline committee experts in the SAME direction. In contrast, if peoples’ experiences and beliefs exert meaningful cognitive biases such that they influence research, advocacy and evidence-informed decision making they are likely to act in a myriad of different directions.[6]
Braillon rightly laments the lack of robust evidence in all scenarios, however healthcare decisions still need to be made even when evidence is absent or poor quality. While we agree that having high quality evidence for all health-related questions would be ideal, our paper suggests a method for dealing with the real-world limitations of evidence-informed healthcare. In situations where evidence is absent or limited, the door is wide open for corporations to influence healthcare decisions through commercially backed amplification of industry-friendly opinion. Guidelines may not be a perfect solution but are certainly useful for individuals and communities if the financial conflicts of interest amongst committee members are eliminated or minimised. Our proposed method promotes accountability (through its transparency) as well as quality in guideline development.
Our risk-based model for dietary guidelines is not going to solve all the problems of poverty, inequity and low quality evidence, but it can go some way towards ameliorating the grosser outrages of financial conflicts of interest and surely that is worth striving for.
References
1. Braillon A. A risk based model for managing conflicts of interest in clinical guidelines can’t fix a broken system. BMJ 2023;380:p249. doi: 10.1136/bmj.p249
2. World Health Organization. Obestiy and overweight, Fact sheet. 2021 9 June. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
3. Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The lancet 2013;381(9867):670-79.
4. Parker L, Bero L. Managing risk from conflicts of interest in guideline development committees. BMJ 2022;379:e072252. doi: 10.1136/bmj-2022-072252
5. Ludwig DS, Kushi LH, Heymsfield SB. Conflicts of interest in nutrition research. JAMA 2018;320(1):93.
6. Ralston R, Hill SE, Gomes FDS, et al. Towards preventing and managing conflict of interest in nutrition policy? an analysis of submissions to a consultation on a draft WHO tool. Int J Health Policy 2021;10(5):255-65.
Competing interests:
No competing interests
16 February 2023
Lisa Parker
Honorary Senior Lecturer
Lisa Bero
University of Sydney
School of Pharmacy, Charles Perkins Centre, University of Sydney, NSW, Australia
Authors' response: Reducing commercial influence over guidelines won't fix poverty but is still worth striving for
Dear Editor
We agree with Braillon that the health of the public is well served by attending to the social determinants of health,[1] but diet is an important plank in the public’s health and promotion of healthy eating is a global issue.[2 3]
We welcome suggestions for removing healthcare providers from a market society. As discussed in our paper,[4] substantial evidence shows that financial conflicts of interest are a greater concern than personal experiences and beliefs on guideline committees because of the multiplying or ‘megaphone’ effect that occurs when many people have similar conflicts that deliver a risk of biased decision-making in the same direction.[5] Global corporations with deep pockets influence the evidence base, advocacy groups AND guideline committee experts in the SAME direction. In contrast, if peoples’ experiences and beliefs exert meaningful cognitive biases such that they influence research, advocacy and evidence-informed decision making they are likely to act in a myriad of different directions.[6]
Braillon rightly laments the lack of robust evidence in all scenarios, however healthcare decisions still need to be made even when evidence is absent or poor quality. While we agree that having high quality evidence for all health-related questions would be ideal, our paper suggests a method for dealing with the real-world limitations of evidence-informed healthcare. In situations where evidence is absent or limited, the door is wide open for corporations to influence healthcare decisions through commercially backed amplification of industry-friendly opinion. Guidelines may not be a perfect solution but are certainly useful for individuals and communities if the financial conflicts of interest amongst committee members are eliminated or minimised. Our proposed method promotes accountability (through its transparency) as well as quality in guideline development.
Our risk-based model for dietary guidelines is not going to solve all the problems of poverty, inequity and low quality evidence, but it can go some way towards ameliorating the grosser outrages of financial conflicts of interest and surely that is worth striving for.
References
1. Braillon A. A risk based model for managing conflicts of interest in clinical guidelines can’t fix a broken system. BMJ 2023;380:p249. doi: 10.1136/bmj.p249
2. World Health Organization. Obestiy and overweight, Fact sheet. 2021 9 June. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
3. Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The lancet 2013;381(9867):670-79.
4. Parker L, Bero L. Managing risk from conflicts of interest in guideline development committees. BMJ 2022;379:e072252. doi: 10.1136/bmj-2022-072252
5. Ludwig DS, Kushi LH, Heymsfield SB. Conflicts of interest in nutrition research. JAMA 2018;320(1):93.
6. Ralston R, Hill SE, Gomes FDS, et al. Towards preventing and managing conflict of interest in nutrition policy? an analysis of submissions to a consultation on a draft WHO tool. Int J Health Policy 2021;10(5):255-65.
Competing interests: No competing interests