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Breakfast in an age of commercial science

An article published in 1917 in Good Health, the self-proclaimed ‘oldest health magazine in the world’, reiterated that ‘breakfast is the most important meal of the day,’¹ and Good Health was edited by Dr John Kellogg. So here’s the worry. Type the popular mantras into Google today, and you discover that many of the studies asserting them are supported and funded by the manufacturers of breakfast cereals.

As a simple experiment, on 24 October 2015 I typed ‘breakfast’ into Google Scholar and downloaded the first ten papers that were medical or biological and which were fully accessible online. Of those ten papers, would you like to guess how many were funded, at least in part, by Kellogg, General Mills, Nestlé or some other food company? The answer is given in the footnote.^fn1

Breakfast is big business: global breakfast cereal sales are expected to reach $43.2 billion annually by 2019, up from $32.5 billion in 2012, and the North American market alone was worth $13.9 billion in 2012. But that North American market is now mature, which is why manufacturers now target the emerging world.² Of course they do: the breakfast cereal business is a great business; the raw product (grain or rice) is cheap but the final product on the supermarket shelves is not so cheap.

The fast food breakfast market is also big and growing. Dominated by McDonald’s, it was worth $31.7 billion in 2012 in North America, and between 2007 and 2012 its sales increased by 4.8 per cent annually.³ Fast food = meat = protein, and that message is now so strong that Kellogg’s has entered that market, to sell Kellogg’s Special K Flatbread Breakfast Sandwich Sausage, Egg and Cheese.⁴ These sandwiches, which are designed to be microwaved at home, look to English eyes like hamburgers. They are so small as to each deliver only 240 calories, but each sandwich also delivers 820 mg sodium (over 2 g of actual salt) which is a third of the daily recommended intake, and as most people would eat two Flatbread Sandwiches for breakfast, they will not only have consumed a gratuitous meal, they will also have consumed two-thirds of their daily allowance for salt before leaving the house in the morning.⁵ Still, the packet boasts a pretty photograph of two slices of orange placed alongside the Kellogg’s Special K Flatbread Breakfast Sandwich Sausage, Egg and Cheese.

Research funded by companies tends to produce results that are favourable to those companies: there will rarely be actual dishonesty on the part of the scientists, but nonetheless a bias can creep into the published findings. Consider the pharmaceutical industry. There is a class of drugs known as ‘calcium-channel antagonists’ that are prescribed for heart disease, and over the years at least seventy clinical studies on these drugs have been published by university professors and practising doctors. Some of those studies were funded by the manufacturers, while others were funded by independent sources including charities, government research agencies and hospitals, and in 1998 a group of investigators from the University of Toronto found: ‘A strong association between scientists’ opinions about safety and their financial relationships with the manufacturers. Supportive scientists were much more likely than critical scientists to have financial associations with the manufacturers.’⁶

University professors and practising doctors, therefore, publish findings that support their sources of research money. Repeated surveys of scientists’ publications have confirmed this finding, which is why journals now require the authors of papers to list their sources of research income and consultancies. Yet such listings can still leave the reader adrift: does an industrial association negate a researcher’s work, or can they be trusted anyway?

The food and drinks companies will also manipulate publication. David Ludwig is a hero in the battle against obesity. He is a professor of paediatrics at Harvard and an author of the 2007 book Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World. He is also an author of a study that found that research papers that have been funded, at least in part, by the drinks manufacturers are four to eight times more likely to report good news about commercial drinks than those that were funded independently. No research paper, moreover, that was funded wholly by the drinks manufacturers reported any bad news.^fn2 Since so many papers on drinks are funded by the manufacturers, Ludwig concluded that the whole field of study has been biased.⁷

So we have to be careful: breakfast studies have been infused by industrially funded science, and we may be at the same stage in their development as cigarette studies were before 1950, when Richard Doll and Bradford Hill discovered the link between smoking and lung cancer. Before 1950, and even for a time afterwards, that field was dominated by academic papers, sponsored by the tobacco companies, that proclaimed the health benefits of cigarettes and which then supported the subsequent advertising (‘More doctors smoke Camels than any other cigarette’, ‘L&M Filters are just what the doctor ordered’, ‘Reach for a Lucky instead of a sweet’).

Industrial money gets into surprising places. Even the great charities accept commercial funding: so Diabetes UK charges companies between £10,000 and £25,000 p.a. for using the Diabetes UK logo and name, while in 2013 at least twelve companies gave the American Diabetes Association more than $500,000. The charities do invaluable work, so they need support, and though it is perhaps a shame they solicit money from industry, they are nonetheless sensible of the risks and they implement scrupulous ethical policies. Which can be very effective. In 2013, for example, Dr Heather Leidy and her colleagues from the University of Missouri published a paper with a convoluted title: ‘Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast skipping,” late-adolescent girls’.⁸

And though Dr Leidy acknowledged that her study was supported by the beef and egg producer associations, she also wrote that they ‘were not involved in the design, implementation, analysis or interpretation of data’, and I believe her because Dr Leidy had actually shown that a high-protein breakfast is … bad for you! Although such a breakfast may lower your appetite later in the day, that does not compensate for the extra calories of the breakfast itself, and in Dr Leidy’s own words the net effect of eating a high-protein breakfast is that the daily intake of energy: ‘was greater ( ~ 120 kcal [calories]) compared with when breakfast was skipped’.

That effect did not reach statistical significance but the trend was sinister. For all their efforts, the beef and egg producers had funded research that showed that the healthiest breakfast option of all is to skip it! But we got there only because Dr Leidy is transparently an honest person.

The state, too, promotes breakfast. Agricultural producer groups in the USA go by unusual names such as the ‘Beef Checkoff’ or the ‘Egg Checkoff’ because they are not funded by membership subscriptions but, rather, by units sold. So every head of cattle, for example, that is sold or imported in America is ‘checked off’ for a $1 tariff.⁹ This is the corporate state by which the producers have harnessed legislation to tax consumers to fund, among other activities, the producers’ marketing.

The British state is as corporate. On 24 October 2015 I typed ‘Breakfast is the most important meal of the day’ into Google, and the first item came from a friendly-looking body called Shake Up Your Wake Up. SUYWU is very keen on breakfast, opening its page with ‘Apart from providing us with energy, breakfast foods are good sources of important nutrients such as … [words in bold in the original].’ But Shake Up Your Wake Up comes from the Agriculture and Horticulture Development Board, which is a statutory levy board (annual budget £56 million) that promotes the interests of farmers.

To conclude, Big Business has big interests in breakfast, Big Business has the resources to fund big research, Big Business has a friend in big government, and Big Business need not descend to publishing falsities: it need only publish selectively to provide a false impression of the health value of breakfast.

In a letter to his friend John Reynolds, John Keats wrote on 3 February 1818 that ‘We hate poetry that has palpable design upon us’, but the problem with industrial science is that it can have impalpable designs on us. Caveat emptor.

Industrially funded research: an alternative view

I’ve presented a bleak view of industrially funded research, yet industry may sometimes be the only source of money for the investigation of unconventional truths. As Nina Teicholz chronicled in her 2014 book The Big Fat Surprise,¹⁰ by the 1960s the governmental and charitable funding agencies were so convinced that dietary fat was the cause of atherosclerosis that a heroic dissenter like John Yudkin, the author of the anti-sugar pro-fat 1972 book Pure, White and Deadly, was cornered into asking industry to support his heterodox research because no one else would.¹¹ The ruthless leader of the dietary fat consensus, Ancel Keys, could then use that industrial support to smear ‘Yudkin and his commercial backers’.¹²

In his 1776 Wealth of Nations Adam Smith argued that markets tend to be more open to new ideas than are universities or government agencies, which was echoed by Friedrich Hayek in his 1944 Road to Serfdom, where he showed how new entrants fructify markets with innovative ideas. My own 2008 book Sex, Science and Profits re-emphasised the innovative value of commercial science in challenging received wisdoms.¹³

In his recent book Pharmaphobia, moreover, Thomas Stossel, a Harvard University professor of medicine, argues that only if university medical scientists work closely with industry – a closeness that will inevitably be rewarded with consultancy fees – will medical innovation be optimised.¹⁴

Ultimately it is for the readers of a scientific paper to determine for themselves if they believe it has been biased by its funding source, and such matters of judgement cannot easily be codified.