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García G, Pérez-Ríos M, Ruano-Ravina A, Candal-Pedreira C. Assessing conflict of interest reporting and quality of clinical trials on infant formula: a systematic review. J Clin Epidemiol 2024; 169:111313. [PMID: 38432526 DOI: 10.1016/j.jclinepi.2024.111313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This study aims to assess the quality, risk of bias, and conflicts of interest (COIs) of clinical trials conducted on the effects of fortified infant formula. STUDY DESIGN AND SETTTING Systematic review including all randomized clinical trials targeting healthy children and using three arms: fortified infant formula; standard formula; and breastfeeding. We performed a descriptive analysis of the studies reviewed, assessed their quality using the "Risk of Bias 2- RoB 2" tool, and identified COIs. RESULTS A total of 40 studies were included. All showed a high overall risk of bias, with this being especially noteworthy in the "deviations from intention to treat" and "missing outcome data" domains. Of the total included studies, 29 reported conclusions in favor of the fortified formula; 15 studies reported multiple conclusions that were either contradictory or not in line with the results. COIs with industry were identified in 33 studies, and in 17 studies, these conflicts were not declared in the appropriate section. CONCLUSION From a methodological perspective, studies on fortified infant formula display low quality, made evident by the high risk of bias. Additionally, there are frequent COIs. These aspects must be considered by health professionals and the population when drawing up recommendations for the use of this product.
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Affiliation(s)
- Guadalupe García
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Galicia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Galicia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Galicia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
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Gallus S, Stival C, McKee M, Carreras G, Gorini G, Odone A, van den Brandt PA, Pacifici R, Lugo A. Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic. Tob Control 2024; 33:267-270. [PMID: 36207129 DOI: 10.1136/tc-2022-057368] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Debate continues about whether electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest. We undertook a longitudinal study in Italy. METHODS 3185 Italian participants aged 18-74 years provided baseline (April-May) and follow-up (November-December) responses in 2020, reporting smoking status and use of e-cigarettes and HTP. We tracked transitions over that period and reported risk ratios (RR) and corresponding 95% CIs for changes in smoking in relation to baseline use of e-cigarettes and HTPs. RESULTS Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking (compared with never users, RR 8.78; 95% CI: 5.65 to 13.65) and current HTP users (RR 5.80; 95% CI: 3.65 to 9.20). Among ex-smokers, relapse (17.2%) at follow-up was more likely among e-cigarette (RR 4.25; 95% CI: 2.40 to 7.52) and HTP users (RR 3.32; 95% CI: 2.05 to 5.37). Among current smokers at baseline, those who had continued smoking at follow-up were 85.4% overall. These were more frequently current novel product users (compared with non-users, RR 1.10; 95% CI: 1.02 to 1.19 for e-cigarette users; RR 1.17; 95% CI: 1.10 to 1.23 for HTP users). CONCLUSIONS Both e-cigarette and HTP use predict starting smoking and relapse, and appear to reduce smoking cessation. Due to the limited sample size within specific strata, the association with quitting smoking should be confirmed by larger prospective studies. These findings do not support the use of e-cigarettes and HTPs in tobacco control as a consumer product, at least in Italy.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute, Florence, Italy
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute, Florence, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Piet A van den Brandt
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Schäffer A, Groh KJ, Sigmund G, Azoulay D, Backhaus T, Bertram MG, Carney Almroth B, Cousins IT, Ford AT, Grimalt JO, Guida Y, Hansson MC, Jeong Y, Lohmann R, Michaels D, Mueller L, Muncke J, Öberg G, Orellana MA, Sanganyado E, Schäfer RB, Sheriff I, Sullivan RC, Suzuki N, Vandenberg LN, Venier M, Vlahos P, Wagner M, Wang F, Wang M, Soehl A, Ågerstrand M, Diamond ML, Scheringer M. Conflicts of Interest in the Assessment of Chemicals, Waste, and Pollution. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:19066-19077. [PMID: 37943968 DOI: 10.1021/acs.est.3c04213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity loss, in a triple planetary crisis. Consequently, in 2022, countries agreed to establish an intergovernmental science-policy panel (SPP) on chemicals, waste, and pollution prevention, complementary to the existing intergovernmental science-policy bodies on climate change and biodiversity. To ensure the SPP's success, it is imperative to protect it from conflicts of interest (COI). Here, we (i) define and review the implications of COI, and its relevance for the management of chemicals, waste, and pollution; (ii) summarize established tactics to manufacture doubt in favor of vested interests, i.e., to counter scientific evidence and/or to promote misleading narratives favorable to financial interests; and (iii) illustrate these with selected examples. This analysis leads to a review of arguments for and against chemical industry representation in the SPP's work. We further (iv) rebut an assertion voiced by some that the chemical industry should be directly involved in the panel's work because it possesses data on chemicals essential for the panel's activities. Finally, (v) we present steps that should be taken to prevent the detrimental impacts of COI in the work of the SPP. In particular, we propose to include an independent auditor's role in the SPP to ensure that participation and processes follow clear COI rules. Among others, the auditor should evaluate the content of the assessments produced to ensure unbiased representation of information that underpins the SPP's activities.
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Affiliation(s)
- Andreas Schäffer
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, 210023 Nanjing, China
- Key Laboratory of the Three Gorges Reservoir Region's Eco-Environment, Chongqing University, 400045 Chongqing, China
| | - Ksenia J Groh
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Gabriel Sigmund
- Environmental Technology, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - David Azoulay
- Center for International Environmental Law (CIEL), Washington, D.C. 20005, United States
| | - Thomas Backhaus
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biological and Environmental Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Michael G Bertram
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå 907 36, Sweden
- Department of Zoology, Stockholm University, Stockholm 114 18, Sweden
- School of Biological Sciences, Monash University, Melbourne 3800, Australia
| | - Bethanie Carney Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Ian T Cousins
- Department of Environmental Science, Stockholm University, 10691 Stockholm, Sweden
| | - Alex T Ford
- Institute of Marine Sciences, University of Portsmouth, Portsmouth PO4 9LY, United Kingdom
| | - Joan O Grimalt
- Department of Environmental Chemistry, IDAEA-CSIC, 08034 Barcelona, Catalonia, Spain
| | - Yago Guida
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Ibaraki, Japan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, 21941-902 Rio de Janeiro, RJ, Brazil
| | - Maria C Hansson
- The Centre for Environmental and Climate Science (CEC), Lund University, 22362 Lund, Sweden
| | - Yunsun Jeong
- Division of Environmental Health, Korea Environment Institute (KEI), 30147 Sejong, Republic of Korea
| | - Rainer Lohmann
- Graduate School of Oceanography, University of Rhode Island, Narragansett, Rhode Island 02881, United States
| | - David Michaels
- Department of Environmental & Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C. 20052, United States
| | - Leonie Mueller
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
| | - Jane Muncke
- Food Packaging Forum Foundation, 8045 Zurich, Switzerland
| | - Gunilla Öberg
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Marcos A Orellana
- Global Toxics and Human Rights Project, American University Washington College of Law, Washington, D.C. 20016, United States
| | - Edmond Sanganyado
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, United Kingdom
| | - Ralf Bernhard Schäfer
- Institute for Environmental Sciences Landau, RPTU Kaiserslautern-Landau, 76829 Landau, Germany
| | - Ishmail Sheriff
- School of Civil Engineering, Universiti Sains Malaysia, 14300 Nibong Tebal, Penang, Malaysia
| | - Ryan C Sullivan
- Department of Chemistry and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15217, United States
| | - Noriyuki Suzuki
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Ibaraki, Japan
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts 01003, United States
| | - Marta Venier
- Indiana University, Bloomington, Indiana 47405, United States
| | - Penny Vlahos
- Marine Sciences, University of Connecticut, Groton, Connecticut 06340, United States
| | - Martin Wagner
- Department of Biology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Fang Wang
- State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China
| | - Mengjiao Wang
- Greenpeace Research Laboratories, Department of Biosciences, University of Exeter, Exeter EX4 4RN, United Kingdom
| | - Anna Soehl
- International Panel on Chemical Pollution, 8044 Zürich, Switzerland
| | - Marlene Ågerstrand
- Department of Environmental Science, Stockholm University, 10691 Stockholm, Sweden
| | - Miriam L Diamond
- Department of Earth Sciences and School of the Environment, University of Toronto, Toronto M5S 3B1, Canada
| | - Martin Scheringer
- Institute of Biogeochemistry and Pollutant Dynamics, ETH Zürich, 8092 Zürich, Switzerland
- RECETOX, Masaryk University, 625 00 Brno, Czech Republic
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Hendlin YH, Vora M, Elias J, Ling PM. Financial Conflicts of Interest and Stance on Tobacco Harm Reduction: A Systematic Review. Am J Public Health 2019; 109:e1-e8. [PMID: 31095414 PMCID: PMC6603486 DOI: 10.2105/ajph.2019.305106] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 11/04/2022]
Abstract
Background. Tobacco companies have actively promoted the substitution of cigarettes with purportedly safer tobacco products (e.g., smokeless tobacco, e-cigarettes) as tobacco harm reduction (THR). Given the tobacco, e-cigarette, and pharmaceutical industries' substantial financial interests, we quantified industry influence on support for THR. Objectives. To analyze a comprehensive set of articles published in peer-reviewed journals assessing funding sources and support for or opposition to substitution of tobacco or nicotine products as harm reduction. Search Methods. We searched PubMed, Embase, Web of Science, and PsycINFO with a comprehensive search string including all articles, comments, and editorials published between January 1, 1992, and July 26, 2016. Selection Criteria. We included English-language publications published in peer-reviewed journals addressing THR in humans and excluded studies on modified cigarettes, on South Asian smokeless tobacco variants, on pregnant women, on animals, not mentioning a tobacco or nicotine product, on US Food and Drug Administration-approved nicotine replacement therapies, and on nicotine vaccines. Data Collection and Analysis. We double-coded all articles for article type; primary product type (e.g., snus, e-cigarettes); themes for and against THR; stance on THR; THR concepts; funding or affiliation with tobacco, e-cigarette, pharmaceutical industry, or multiple industries; and each author's country. We fit exact logistic regression models with stance on THR as the outcome (pro- vs anti-THR) and source of funding or industry affiliation as the predictor taking into account sparse data. Additional models included article type as the outcome (nonempirical or empirical) and industry funding or affiliation as predictor, and stratified analyses for empirical and nonempirical studies with stance on THR as outcome and funding source as predictor. Main Results. Searches retrieved 826 articles, including nonempirical articles (21%), letters or commentaries (34%), editorials (5%), cross-sectional studies (15%), systematic reviews and meta-analyses (3%), and randomized controlled trials (2%). Overall, 23.9% disclosed support by industry; 49% of articles endorsed THR, 42% opposed it, and 9% took neutral or mixed positions. Support from the e-cigarette industry (odds ratio [OR] = 20.9; 95% confidence interval [CI] = 5.3, 180.7), tobacco industry (OR = 59.4; 95% CI = 10.1, +infinity), or pharmaceutical industry (OR = 2.18; 95% CI = 1.3, 3.7) was significantly associated with supportive stance on THR in analyses accounting for sparse data. Authors' Conclusions. Non-industry-funded articles were evenly divided in stance, while industry-funded articles favored THR. Because of their quantity, letters and comments may influence perceptions of THR when empirical studies lack consensus. Public Health Implications. Public health practitioners and researchers need to account for industry funding when interpreting the evidence in THR debates.
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Affiliation(s)
- Yogi H Hendlin
- At the time of the study, all of the authors were affiliated with the Center for Tobacco Control Research and Education and Department of Medicine at the University of California San Francisco
| | - Manali Vora
- At the time of the study, all of the authors were affiliated with the Center for Tobacco Control Research and Education and Department of Medicine at the University of California San Francisco
| | - Jesse Elias
- At the time of the study, all of the authors were affiliated with the Center for Tobacco Control Research and Education and Department of Medicine at the University of California San Francisco
| | - Pamela M Ling
- At the time of the study, all of the authors were affiliated with the Center for Tobacco Control Research and Education and Department of Medicine at the University of California San Francisco
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