Bias in medical & nutritional research

We often assume that conclusions about foods and medications from research studies are honest and accurate. Historically, most nutrition research was government-funded, with key organizations like the NIH in the US and NIN in India. However, budget cuts in the 21st century have led to private industries, particularly food and pharma, filling the funding gap. Medical and nutritional research can be categorized as follows

(1) Primary research

Traditionally funded by the NIH, it focuses on broad public benefits like laboratory studies and randomized trials. Projects like the Human Genome and Human Proteome are still NIH-funded. However, a decrease in government funding has made this research less common.

(2) Applied research

Applied research uses science to prevent and treat diseases. While some still receive NIH funding, much is now backed by pharma, food, and the supplement industries. It can be divided into research supporting various foods, justifying supplements, or showing harm in certain foods or lifestyles.

(3) Public health research

This aims to improve public health at a population level, ideally government-funded, though private industries are increasingly stepping in.

(4) Clinical research

Focused on testing medications, this research is primarily funded by pharmaceutical companies. Variability in how people respond to treatments (e.g., due to gut microbiomes) complicates results. For instance, if a drug helps 30% of participants in a placebo group and 70% in an experimental group, it’s deemed effective, leading to its prescription for all, even though 60% who either were not cured or cured only due to placebo effect, are still exposed to side effects without gaining any benefit.

(5) Pharmacological research

This field explores how chemicals interact with biological systems, playing a central role in pharmaceutical development. Some key points worth noting are:

5.1 The goal is not necessarily to cure diseases, as doing so could conflict with the long-term profitability of pharmaceutical companies.

5.2 Pharmaceutical companies often focus on managing health markers such as blood pressure, blood sugar, or cholesterol, which usually require increasing dosages over time.

5.3 These companies emphasize early detection, claiming it saves lives. While this is true for certain conditions like cancer, for most lifestyle diseases, it often leads to starting medication earlier. Additionally, they lobby to lower the thresholds for starting treatment, as seen with medications for blood pressure, blood sugar, and cholesterol.

5.4 Pharmaceutical companies promote tighter control of these markers, often suggesting higher or more frequent dosages. For example, increasing the dosage from two to three pills a day represents a 50% increase in business. This approach influenced the ACCORD study (2001-2009). However, the study backfired, as it showed increased mortality rates in the experimental group, leading to its early termination.

Bias in research

When we read research papers, we expect them to be honest and objective. However, various factors can distort this objectivity. Numerous studies have shown how research can be manipulated to favor the organization funding it. Some of these biases are summarized below.

(1) Funding bias

In the US, government funding for research has significantly declined over the past five decades. By 2021, private sources contributed $633 billion to research and development (R&D), while government funding amounted to just $76 billion. Private funding often comes with specific interests or conditions, and studies show that research funded by private sources rarely contradicts the interests of the sponsor. This can happen for several reasons:

– Research may be designed to avoid negative outcomes. For example, using the Standard American Diet (SAD) as a control can make almost any alternative diet seem healthier by comparison.

– In some cases, research design can obscure significant negative outcomes. For instance, one study asked college students to consume large amounts of white bread, and their health appeared to improve. However, concluding that white bread is healthy would be misleading, as the students had to reduce their intake of more harmful foods like eggs, sausages, and bacon.

-Funders may cancel research midway if they realize the results will not favor them. To prevent this, a law was enacted requiring that research be registered with government authorities before it begins, ensuring it cannot be canceled midstream. However, this law is not always strictly enforced by bureaucrats who are hoping for a cozy consulting career upon retirement.

– Before any research is published, a synopsis must be provided. Funders often manipulate this summary to downplay negative findings. A notable example is when Senator Bob Dole altered the language of George McGovern’s 1977 dietary guidelines. Originally recommending reduced meat consumption, the guidelines were changed to encourage the consumption of lean meat. The two statements have entirely different implications.

(2) Myth bias

Myths can skew researchers’ judgment. For example, high protein intake was long recommended, despite evidence that excessive protein harms kidneys and liver. Similarly, the myth that plant protein is incomplete has been debunked, yet it persisted for years.

The dairy industry perpetuated the idea that milk is the best calcium source, even when evidence suggested it could contribute to osteoporosis.

(3) Scholarly pride bias

Respected experts may distort findings to defend earlier positions. An example is Dr. Ancel Keys, whose *Seven Countries Study* promoted low-fat diets by excluding data from 15 countries that contradicted his hypothesis.

(4) Publication bias

Positive outcomes are more likely to be published, skewing perceptions. Negative results often face reluctance in publication, leading to a distorted understanding of certain therapies.

For example, if three studies find that egg white therapy cures second-stage breast cancer, all three studies will likely get published. However, if seven subsequent studies show it does not, only one or two may be published. Future researchers may then mistakenly conclude the therapy is effective, leading to further studies based on flawed premises.

(5) Media bias

Media prefers sensational stories, which can lead to biased reporting. The food and pharma industries, significant advertisers, influence the coverage, leading to overexposure of certain diet trends while scientifically sound approaches are underreported. For example, Dr. Atkins’ high-protein, high-fat diet received more media coverage than Pritikin’s low-fat, high-carb approach, despite the latter being scientifically sounder. Sensational books like *Grain Brain* and *Wheat Belly* also received more coverage, influenced by powerful Food industry lobbies that support such narratives. Additionally, since the media relies heavily on advertising revenue from the food and pharmaceutical industries, they often hesitate to publish studies critical of these sectors.

(6) Government bias

Government agencies often face conflicts of interest, as bureaucrats seek consulting jobs post-retirement, and elected officials raise funds from industries they regulate.

The public relies on Government agencies like the Food & Drug Administration (FDA) to ensure that medical devices are safe.

There is an inherent conflict of interest within the drug and device approval process, as the FDA primarily depends on clinical trials conducted by the very companies that manufacture these products. Research findings are often ambiguous and open to debate. The FDA has, at times, approved drugs and devices despite objections from its own staff. This recently came to light on a device called MitraClip made by Abbott Labs to fix leaky heart valves that was approved by the FDA in 2013. Over 17,000 reports have been filed complaining about this device.

(7) Other conflicts of interest

Political, personal ambitions, and other conflicts can further complicate the research landscape.

Conclusion

It’s crucial to approach research with caution. Understanding potential biases, especially the source of funding, helps reveal the full story behind the findings. Always scrutinize before accepting conclusions.

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