Sunday, May 01, 2016

Research Forum Claiming that Moderate Drinking Improves Health is Deliberately Hiding Its Conflicts of Interest with Big Alcohol

An organization calling itself the "International Scientific Forum on Alcohol Research" (ISFAR) has published on its web site a scathing review of a recent meta-analysis which concluded that moderate alcohol consumption does not reduce mortality as previously thought. The review contains statements from 14 members of ISFAR, and every one of the 14 blasts the study, with the review concluding that the study "markedly distorts the accumulated scientific evidence on alcohol and CVD [cardiovascular disease]."

The International Scientific Forum on Alcohol Research claims to be committed to providing a "balanced" analysis regarding alcohol and health. A co-director of the Forum asserts that: "Serious scientists should focus on the content and quality of research and their findings without bias in the interest of furthering our knowledge of alcohol and its effects on the human body."

The 14 Forum members (scientists) who provided the reviews of the paper were:
  • Elizabeth Barrett-Connor, MD,
  • Giovanni de Gaetano, MD, PhD
  • R. Curtis Ellison, MD
  • Ramon Estruch, MD, PhD
  • Harvey Finkel, MD
  • Tedd Goldfinger, DO, FACC
  • Ulrich Keil, MD, PhD
  • Dominique Lanzmann-Petithory, MD, PhD
  • Fulvio Mattivi, MSc
  • Erik Skovenborg, MD
  • Creina Stockley, PhD, MSc
  • Pierre-Louis Teissedre, PhD
  • Fulvio Ursini, MD
  • Andrew L. Waterhouse, PhD
Dr. Ellison is a co-director of the Forum and director of the Institute on Lifestyle and Health at Boston University Medical Center, which is the scientific center for the Forum. He claims that: "Our chief goal is to make it possible for the Institute to serve as a balanced, scientifically sound, and unbiased source of information on alcohol and health, making up-to-date information readily available to all who are interested."

The Rest of the Story

While the Institute on Lifestyle & Health and the International Scientific Forum on Alcohol Research would like the public to think that they are "unbiased" and presenting "balanced" critiques, especially as they read this recent review on the health effects of moderate drinking, the truth is that the review is hiding from readers critical information which renders it highly biased and wholly unbalanced.

Most importantly, the review does not reveal to the public that far from being an "unbiased" source of information, the Institute on Lifestyle & Health and the International Scientific Forum on Alcohol Research are alcohol industry-funded entities. Nowhere on the web page where the review is published is this information revealed. That is quite an important piece of information to fail to disclose to readers of this review.

Moreover, it appears to be a deliberate attempt to hide this information from readers of the review, since the Institute and ISFAR do disclose this information on the home page for the Institute and Forum. Even that disclosure is in some respects hidden, because you have to click to another page to see it; the Institute does not reveal its alcohol industry funding on the home page itself, and anyone who does not click through will have no idea that Big Alcohol is funding this project.

But the deception does not end there.

It turns out that five of the Forum members who reviewed the article have conflicts of interest by virtue of either their having received research funding from the alcohol industry or serving on advisory boards of alcohol industry-funded organizations, yet none of these conflicts are disclosed.

One reviewer - Dr. Ramon Estruch - is on the board of or receives money from three different research foundations, each of which is funded by alcohol companies. According to a published article: "Dr. Estruch reports serving on the board of and receiving lecture fees from the Research Foundation on Wine and Nutrition (FIVIN); serving on the boards of the Beer and Health Foundation and the European Foundation for Alcohol Research (ERAB)."

Well, it turns out that the Research Foundation on Wine and Nutrition is funded by alcohol companies.

And the Beer and Health Foundation is funded by the Spanish beer industry.

And the European Foundation for Alcohol Research acknowledges that it: "is supported by The Brewers of Europe, the voice of the brewing industry in Europe, whose members are the national brewing trade associations, representing more than 90% of European beer production."

A second reviewer - Dr. Creina Stockley - is listed as being with the Australian Wine Research Institute, which is also an alcohol industry institute.

A third reviewer - Dr. Pierre-Louis Teissedre - elsewhere acknowledges that his research team has received financial and in-kind support from a wine manufacturer (the maker of Perrin et Fils).

A fourth reviewer - Dr. Andrew Waterhouse - has received research funding from E & J Gallo Winery.

A fifth reviewer - Dr. Erik Skovenborg - is listed as being on the Board of ERAB, which is funded by the alcohol industry.

Unfortunately, that's not the end of the deception either.

The other co-director of the Forum is Helena Conibear, the Executive Director of Alcohol-in-Moderation (AIM) in the UK. BeamSuntory (manufacturer of Jim Beam bourbon and several other alcohol brands) states that it provides financial support to AIM.

Also, six of the Forum reviewers are listed as Alcohol in Moderation (AIM) Council Members:
  • Curtis Ellison
  • Harvey Finkel
  • Giovanni de Gaetano
  • Tedd Goldfinger
  • Erik Skovenborg
  • Creina Stockley
While the Council Members are not paid, their association with a foundation that apparently receives "financial support" from alcohol companies represents a conflict of interest that should have been disclosed.

Because of its alcohol industry funding and the fact that at least four of its members have financial conflicts of interest with Big Alcohol, the so-called "balanced" and "unbiased" International Scientific Forum on Alcohol Research is neither balanced nor unbiased. Stating that ISFAR is unbiased is like claiming that research on global warming funded by ExxonMobil is unbiased or that research on the health effects of smoking funded by Philip Morris was unbiased.

But while bias is simply a natural and unavoidable consequence of the corporate funding of research, hiding these conflicts of interest from the public is neither natural nor unavoidable. It represents, in my view, a deliberate attempt to deceive the public by hiding critical information.

If the Forum were so committed to transparency and full disclosure, why wouldn't it disclose, on the review page itself, that the Forum is alcohol industry-funded and that four of the article reviewers have received alcohol industry funding and a fifth is on a Board of a foundation that is funded by the alcohol industry? The failure to disclose is in some ways more problematic than the acceptance of alcohol industry money because it represents deception.

The Institute on Lifestyle & Health's deception of the public is even more evident in the biographies it provides of its Forum members. These biographies actively hide from readers the alcohol funding of several of these Forum members.

For example, Dr. Estruth's biography states that he is a member of the Advisory Board for "ERAB." The reader is not told what ERAB stands for, but that's of little consequence. What is of consequence is that the biography hides from the public the fact that ERAB is "supported by The Brewers of Europe, the voice of the brewing industry in Europe, whose members are the national brewing trade associations, representing more than 90% of European beer production."

Dr. Stockley's biography states that she works for the Australian Wine Research Institute. But it hides the fact that this Institute is funded by the alcohol industry.

Dr. Teissedre's biography fails to disclose that his research group received alcohol industry funding.

Dr. Waterhouse's biography hides the fact that he has received alcohol industry research funding.

Dr. Skovenborg's biography fails to disclose that he is on the Board of ERAB, which is funded by the alcohol industry.

Believe it or not, the deception goes even further.

While ISFAR claims that it is presenting a "balanced" review of the meta-analysis study, guess how many of the 14 reviewers are scientists who had a vested personal interest in the issue because they had published research that reported positive effects of moderate alcohol consumption and presumably had a pre-existing belief that moderate alcohol use improves health?

The answer, absurdly, is all 14!

The following Forum reviewers have previously published articles reporting positive health effects of moderate alcohol use:
  • Elizabeth Barrett-Connor
  • Giovanni de Gaetano
  • Curtis Ellison
  • Ramon Estruch
  • Harvey Finkel
  • Tedd Goldfinger 
  • Ulrich Keil
  • Dominique Lanzmann-Petithory
  • Fulvio Mattivi
  • Erik Skovenborg
  • Creina Stockley
  • Pierre-Louis Teissedre
  • Fulvio Ursini
  • Andrew L. Waterhouse
Sample articles documenting all of the above authors are:
Paper 1
Paper 2
Paper 3
Paper 4
Paper 5
Paper 6
Paper 7
Paper 8
Paper 9
Paper 10
Paper 11

It is absolutely ludicrous to attempt to provide a "balanced" review of a scientific question by having that review conducted by 14 people, all of whom have published research drawing a conclusion in the same direction. If there was any serious intent in providing balance, you would think that perhaps they could have asked one, even just one, scientist who had not published on this issue to provide a review. Talk about stacking the deck!

The issue of ISFAR hiding its conflicts of interest is not restricted just to its web site. In an October 2014 Medscape article in which Dr. Ellison was interviewed about research on the health effects of moderate alcohol consumption, he discusses the work of the International Scientific Forum on Alcohol Research. He is asked specifically to describe what the Forum is. However, nowhere on the web page or in the interview does he disclose that the Forum receives funding from alcohol companies.

Moreover, in the disclosure that Dr. Ellison provides, he also hides the fact that his project is alcohol industry-funded. All he discloses is that he: "Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: International Scientific Forum on Alcohol Research." But the reader or listener has no way of knowing that ISFAR is an alcohol industry-funded project. This is yet another aspect of ISFAR's deception.

Before closing, let me make two points very clear. First, I am not arguing that any member of the Forum is intentionally biasing his or her interpretation of the scientific literature. Conflict of interest has nothing to do with intentional bias. It has everything to do with subconscious bias that is simply unavoidable when one is receiving corporate funding (or any type of funding for that matter). And further, there is nothing unnatural about this bias. We are programmed - our brains are wired - to engage in reciprocity. This is a well-demonstrated psychological phenomenon which has been documented to occur in situations even less obvious than the receipt of corporate funding for research. Nor is there anything inherently wrong with having a conflict of interest. Failing to disclose a significant conflict is a different story.

Second, I am not arguing that accepting corporate funding for research is inherently wrong. It is not that "black and white." In this case, however, since the declared purpose of the Forum and the Institute is to provide a balanced and unbiased summary of research literature, it is completely unacceptable and inappropriate to be funded by corporations that have a huge, vested interest in the result of those reviews. It sacrifices the scientific integrity of such an organization when many of its members have individual conflicts of interest with the corporations whose financial interests are at stake.

And it is ludicrous - almost hilarious in a dark sense - that such a "balanced" review would be obtained by stacking the deck and soliciting a review only from scientists who have previously expressed their disagreement with the views expressed in the reviewed article. That is about as strong a systematic bias as one could imagine, even if one were trying to explain the concept by giving an extreme example. 

The rest of the story is that far from being a "balanced" and "unbiased" forum for review of scientific research on alcohol and health, the Institute for Lifestyle & Medicine and the International Scientific Forum on Alcohol Research are heavily conflicted entities that have strong ties to the alcohol industry. These ties occur not only through the Institute receiving alcohol funding, but through several of the Forum members having received alcohol industry funding or serving on Boards of organizations that are alcohol industry-funded.

But what makes the actions of these organizations even more inappropriate and scientifically dishonest and deceptive is the fact that they are largely hiding these immense conflicts of interest from the public.

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