New England Journal of Medicine ignored Chuck Benbrook's failure to disclose organic conflicts of interests

The New England Journal of Medicine, frequently referenced as NEJM, has a long history and important place in the sphere of American medical practice.

During the recent 200th anniversary celebration, a special issue highlighted the changes in the challenges that patients and medical practitioners have faced over the centuries. Some threats, like smallpox, had completely been vanquished during this time thanks to vaccines. Other issues have changed in proportion, as so many of us live longer and our world has changed in remarkable ways. This piece, The Burden of Disease and the Changing Task of Medicine, offers a fascinating interactive graphic of the causes of death today versus those in the past.

Access to new technology has certainly played a part in reducing the threats that used to plague us. Nobody calls for us to return to a time when diabetes killed children. Production of insulin by genetically modified bacteria has changed the course of this disease completely. And there is also hope that new technology and strategies can continue to prevent and reduce the impact of this condition going forward.

A journal with such prestige and position also has great responsibility to influence the practice of and the policies of the medical community and government regulators. As noted in the anniversary collection, the roles of medical journals remains crucial:

Journals don't simply disseminate new knowledge about medical theory and practice. They also define the scope of medical concerns and articulate norms for physicians' professional and social roles. Simultaneously, they work to preserve their reputation, financial stability, and editorial independence in a constantly changing publishing environment, amid an avalanche of medical information.

In an age of changing media, especially, a medical journal must maintain basic principles of adherence to quality scientific information and navigate the minefields of potential conflicts of interest that practitioners of science or influencers of policy might have in order to remain a trustworthy source of information and policy guidance. For example, if a new treatment for Ebola was developed, it would be important to disclose if funding for the studies was provided by the treatment developer. The science should still be evaluated on its merits, but journal editors require this information to accompany the published work in their journals. The International Committee of Medical Journal Editors (ICMJE) provides guidance and forms for this purpose for all authors in this sphere. Responsibly, NEJM discussed and formulated policies for dealing with conflicts of interest many years ago. Presciently, It stated in 1984:

We will therefore suggest to our authors that they routinely acknowledge in a footnote all funding sources supporting their submitted work. Likewise, any relevant direct business associations should also be acknowledged, such as employment by a corporation that has a financial interest in the work being reported.

Despite having clear policy guidelines in place, a recent opinion piece published in the NEJM by a physician and an economist focusing on the controversial issue of GMOs and pesticides escaped the proper scrutiny. The perspective piece, published on August 20, 2015 attempted to guide public policy but it failed to disclose the possible influencers or conflicts of interests of the authors. Attempts to address this with the journal’s editor, and inquiries to the ICMJE, were unsuccessful. The refusal to examine the evidence and to rectify this undermines the credibility of the journal and would be a perplexing precedent.

No conflicts acknowledged

GMOs, Herbicides, and Public Health” by Philip J. Landrigan, M.D., and Charles Benbrook, Ph.D., asked for the FDA to alter its policy on genetically modified food labeling because of what they say are two significant new developments.

First, there have been sharp increases in the amounts and numbers of chemical herbicides applied to GM crops, and still further increases—the largest in a generation—are scheduled to occur in the next few years. Second, the International Agency for Research on Cancer (IARC) has classified glyphosate, the herbicide most widely used on GM crops, as a “probable human carcinogen” and classified a second herbicide, 2,4-dichlorophenoxyacetic acid (2,4-D), as a “possible human carcinogen.

Numerous researchers with experience in this arena have challenged the factual contentions in the article. That's not the focus on this article; everyone has a right to express their opinion, and the authors are well known in their fields. My concern is disclosing potential conflicts of interest so the reader is fully informed about potential biases and can therefore better evaluate both the substance and context of the arguments.

Original disclosure documents filed by the authors on July 1 2015 were provided. Benbrook responded to a series of questions:

Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)? 

Answer NO                

Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the “Add +” box. You should report relationships that were present during the 36 months prior to publication. 

Answer NO

Just to make sure there was no confusion about the COI request, ICMJE has a summary question:

Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work? 

Ben brook's original filing is reproduced below:

Screen Shot 2015-10-19 at 2.10.15 PM

But his answers did not appear to be candid. From 2012-May 2014 — well before the publication date of this opinion piece — Benbrook had been an adjunct "research" professor at the Center for Sustaining Agriculture and Natural Resources (CSANR) at Washington State University (WSU). He served as the leader of the CSANR program called Measure to Manage (M2M): Farm and Food Diagnostics for Sustainability and Health (M2M). The stated goal of M2M was to "develop, refine, validate, and apply analytical systems quantifying the impacts of farming systems, technology, and policy on food nutritional quality, food safety, agricultural productivity, economic performance along food value chains, and on natural resources and the environment."

According to this document from the CSANR website — since removed by the university [but available here] — Benbrook's entire salary and his M2M research program was funded by the organic industry with no funding support from any independent or university sources. Screen Shot 2015-10-19 at 2.21.40 PM

Benbrook apparently had concluded that these relationships did not merit a mention to the question about his "relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work."

But that was not the entirety of Benbrook's conflicts of interest. Soon after the New York Times published additional evidence of undisclosed relationships of both authors. Reporter Eric Lipton used the Washington state Freedom of Information Act (FOIA) to obtain emails from Benbrook, which further demonstrate the close ties to the organic industry for both writers. Other emails obtained by a separate FOIA request reveal an even more elaborate web of influence and conflicts.

FOIA'd documents show that Benbrook received more than $128,000 in 2013 from Washington University, with all the funding coming from industry sources.2015-08-29_17-27-40 salary Benbrook 2013

There are a number of other curious features of Benbrook's claims that had “nothing to disclose”. First, emails suggest that as of no later than May 28, 2015, Benbrook had separated from his position at Washington State University (NYTimes emails, page 49) (Further revelations indicate Benbrook had been severed from his position on May 15.)JessicaShade_moveWSU

So it is not clear if Benbrook was still affiliated with WSU, as the NEJM article represents, when the opinion piece was initially submitted; but he was well aware that he was no longer at WSU during the evaluation process and before publication. There is no indication he took any action to correct what ended up being an erroneous claim of employment.

There were also more details disclosed about the funding sources for his M2M program. All the funders who provided Benbrook's salary are key players in the organic industry. The “Now Task” email sent on Sept 4, 2014 includes an attachment with funding details of this program (Funder_2012-2013_Update.docx). Funding sources include a number of organic industry sources, including Stonyfield, Whole Foods, Organic Valley, Clif Bar, The Organic Center (TOC), Organic Trade Association (OTA), and Chipotle, among others. Much of this would fall within the time period specified in the disclosure forms: “You should report relationships that were present during the 36 months prior to publication”. [emphasis ICMJE]M2M_funding

Further, this document describes some other relationships relevant to this arena but not disclosed. Benbrook had run Benbrook Consulting Services for more than 20 years, serving on a board certifying “ecolabels” and another for non-GMO products, and acting as an advisor to Whole Foods Market — an outspoken critic of the use of glyphosate (Whole Foods includes glyphosate on its Prohibited and Restricted pesticide list). Benbrook also did not disclose his involvement with an eco-label certification organization and another business relationship that he maintained with Pesticide Data Central, selling data, advice, and services associated with this topic.Benbrook_other_activities

If these boards and consultancies were pharmaceutical relationships linked to a researcher, certainly NEJM would find them valid conflicts.

There are other relationships that are not disclosed for both Benbrook and Landrigan. Here we see that Gary Hirshberg of Stonyfield farms, a producer of organic foods and active funder of mandatory GMO labeling campaigns, coordinated with both Landrigan and Benbrook on May 26, 2015 for travel and content to a July 8 Washington meeting with Wal-Mart coinciding with debate over a House vote on labeling. The agenda: a discussion titled, “Conclusions, Proposals, and Next Steps —Why a Mandatory GMO Labeling Policy can contribute to positive change and increased consumer confidence.” [NYT collection, pages 7-9]

Shown here is a sample of the email documents:landrigan_benbrook_stonyfield

The DC event appeared to be an attempt, in part orchestrated by Benbrook, to influence WalMart’s future purchasing policies in favor of organic producers. In addition to the Walmart event, Agri-Pulse reported on a Washington DC breakfast the same day [NYTimes collection, page 14]:DC_lobbying

This evidence of direct and coincident involvement with this industry and lobbying was not disclosed by either Benbrook or Landrigan, as evidence by the forms they submitted. And yet it would seem to violate the policy guidelines of the ICMJE, which includes:

When authors submit a manuscript of any type or format they are responsible for disclosing all financial and personal relationships that might bias or be seen to bias their work.

After the Times emails were posted, and after NEJM had been approached by numerous people, Benbrook did submit a revised answer to one question--whether he had any relationships or activities that readers could perceive as a conflict.Screen Shot 2015-10-19 at 2.56.38 PM

The only additional disclosures: he was a member of a USDA crop biotech advisory committee and was a Principal in Benbrook consulting. He did not disclose the two clients most relevant to his opinion: Whole Foods, which has an anti-glyphosate policy and the Pesticide Data Center. In fact there is no acknowledgement of any of his extensive connections to the organic industry. As Benbrook's CV on display at the Pesticide Data Center, Benbrook is also a consultant to the Organic Center, a research and lobbying arm of the Organic Trade Association — a direct and unmentioned conflict.

When the NEJM editorial team was approached with this evidence, Steven Morrissey PhD, managing editor of NEJM, declined to evaluate this public evidence. ICMJE responded that they “do not, however, have any ability to investigate or authority over its use by or the practices of other journals”, so paths for how to address this with normal channels remain unclear.

What if researchers and physicians associated with a statin drug were taking trips to Washington with a lobbying group, and attempting to influence major pharmacy chains’ purchasing policies and FDA treatment recommendation? Would we expect this to be disclosed by authors in the NEJM? Of course. The science should still be evaluated on its merits, but disclosure of the relationship would be required. This situation is no different. Here Landrigan and Benbrook failed to disclose their relationships. And NEJM should insist on corrections to their disclosure forms, so that physicians, journalists, and general public readers understand this influence.

If the editors of the prestigious New England Journal of Medicine intends to be a credible voice among the noise of nonsense on many medical and public policy issues, they need to adhere to the principles of scientific evidence and disclosure on all fronts. It’s difficult enough to find credible information in these days of dubious scientific publishers and free-range social media. Undermining the confidence in reputable scientific publications could only make things worse.

Mary Mangan, Ph.D., received her education in microbiology, immunology, plant cell biology, and mammalian cell, developmental, and molecular biology. She co-founded OpenHelix, a company providing training on open source software associated with the burgeoning genomics arena, over a decade ago. All comments here are her own, and do not represent her company or any other company. You can contact Mary via twitter: @mem_somerville

  • Julie Kelly

    Good work as always, Mary. But sadly this is another example why the public is leery about what they hear from scientists, even published in respected pubs like NEJM, because they suspect it’s tainted somehow.

    • mem_somerville

      After my email exchanges with a couple of journals lately, I’m finding it hard to maintain confidence in them, too. But I think it’s still worth fighting for, so I’ll keep at it.

      • RobertWager

        When the facts become more important than the fear “fact”or click-bait we will see better coverage of agbiotech. Been waiting for some time but still hold out hope as things are slowly changing for the better.

      • Wackes Seppi

        A battle like this is only lost when we stop fighting.

  • Good4U

    Chuck Benbrook has been railing against agricultural technology for at least 3 decades. He has always been promoting some sort of airy-fairy alternative to feeding vast numbers of people on this planet. He’s never been honest about the costs, both in environmental destruction and in human health, that would come from adopting his flimsy ideas that distinctly favor the “organic” industry. This recent slam by he and Landrigan against technology is just one more in a long litany of hit pieces, and its publication in NEJM is just a “gimme” by the good old boys in the medical community, mostly in deference to Landrigan’s old age and self-ascribed “stature”. Julie Kelly is right, though. Many readers can’t parse science from diatribe, and sadly the NEJM editors didn’t help the situation.

  • Cairenn Day

    And the organic/anti GMO folks like him are celebrated as ‘whistleblowers’ and such, by the same folks that demonized Dr Folta for allowing Monsanto to contribute $25,000 to a education program, where every penny went to costs and none to Dr Folta.

    I am sick of the lies and the hypocrisy coming from one side of this debate. They scream about being transparent and they they HIDE their funding sources.

    It is past time that the media started pointing out that.

    • agscienceliterate

      It’s incredible hubris and arrogance. The media need to have their feet held to the fire for their own credibility. Actually, this hypocrisy in the reporting of organic and biotech is a great story in itself …. wonder if it could be pitched to mainstream media.

      Folta is a scientist of the highest degree, and Benbrook is a slime.

      • Cairenn Day

        Did you see the BuzzFeed trashing of Dr Folta? A biased ‘journalist’ ignoring facts and spinning the story up, like a Texas tornado.

        Disgusting !

  • Bill Anderson

    Do we have Ms Mangan’s declaration of interests on this issue anywhere?

    • mem_somerville

      That’s Dr Mangan, Bill. My interest in this issue is science. I have no financial interests ag biotech or the pesticide industry. I have never worked for any of the players, nor have I received even a dime from them for any reason. Industry has never paid for my travel to lobby in DC, as Benbrook has. They have never paid any of my salary, as Benbrook. I have never received any food industry grants, as Benbrook. I am not on any boards, especially of organizations associated with labeling, as Benbrook. I have never received $120,000 and media training for manipulating the press, as Benbrook. I have no consulting or expert witness gigs, as Benbrook. I have no stock in any of the players, unless they are in the index funds that I have in my retirement account, but I don’t know what stocks they hold, I never look, I just buy and hold the indexes sometimes in my retirement accounts. I have no books or videos to peddle, like GMO haters. I have no affiliate marketing, like FoodBabe. I make no money from activism from any source, like Just Label It, or any other.

      Anything else you are concerned about? How about you, Bill?

      • Bill Anderson

        Hi
        Well that is all right then!
        Me- I confess I do eat food.
        GLP? Neither you not I know but it does not have the look and feel of a disinterested academically inclined disseminator of information does it? Best Wishes

        Bill

        • mem_somerville

          Care to talk about the Benbrook evidence at all? You know, the stuff we see in his own words and email?

          • Bill Anderson

            No. As McLuhan pointed out many years ago. The medium is the message. Think about it.

        • ChadwicktheJones

          I suppose you just want to keep moving the goal posts until you get something to chew on? Do you actually have anything to add to the discussion?

  • Roy Williams

    Essays like this need to find their way into mainstream media – not just occasionally, but all the time.

  • Looking at the nature of Dr. Mangan’s education and deep involvement with OpenHelix, it is clear that this article is a very biased attempt to discredit any criticism of GMO’s, by throwing unjustified mud at scientists and their publishers. It is like Go Go GMOers can not stand any criticism–that they really don’t believe that they even have to be careful about how they effect all the people and other living things on Earth.

    • mem_somerville

      Yes, open source software is inherently…wait, what are you talking about? Or are you just “throwing unjustified mud”?

      Your complete lack of self awareness is giggle-worthy, though, thanks for stopping by.

  • Wackes Seppi

    Translated into French with great pleasure and published here:

    http://seppi.over-blog.com/2015/10/le-new-england-journal-of-medicine-chuck-benbrook-et-les-conflits-d-interets.html

    The Benbrook case can be dealt with in the “he said, she said” or “he did, (an other) he did”. This should of course be done. But with measure and to show the uggly methods of the militant segment of organic agriculture.

    The demonstration of the lack of reaction from NEJM will hopefully spread and raise the awareness of journal editors of the urgent task of better policing conflicts of interest and, beyond that, reducing the opportunitis for junk science to come on the forefront.

    I take it that in the recent case of Seralini’s article in PLOSone, it is the editorial staff who protested and caused amendments — quite insufficient ones, but nevertheless — to be made to the article, particularly the declarations on financing and interests.

    May I also draw your attention to the fact that Benbrook participated in a Greenpeace campaign against GM crops in October 2012 (thus within the 36 months period). He toured Europe endel Lutz and Wes Shomyer.

    Lutz, by the way, was quoted saying that he decided to stop GMOs in 2011. Lutz was also quoted in the Wall Street Journal in February 2015. His statement means that he continues to grow GM corn. For more (in Frenche:

    http://seppi.over-blog.com/2015/06/greenpeace-s-etait-paye-le-lutz-de-l-enfumage.html

    Back to Benbrook: he produced a “report” for Greenpeace, dated October 2012:

    http://www.greenpeace.org/international/Global/international/publications/agriculture/2012/438-Benbrook-Report-Summary.pdf

    That report is not mentioned in (most of, some of?) his resumes. In particular, it is not mentioned in his statement to the US District Court for the District of Vermont in the labeling case:

    http://ago.vermont.gov/assets/files/Consumer/GE_Food/63-3%20Exh%20C%20Benbrook%20Declaration.pdf

    That statement, dated November 14, 2014, is also not acknowledged in the NEJM declaration. But we may consider that this is a minor sin to the omission to disclose an important and relevant fact to the Court.

    • mem_somerville

      Yeah, there are many layers of issues here. But even the basic disclosure of his own board membership on those organizations would be completely required if this was a pharmaceutical story.

      It’s also bugging me that Landrigan is getting away with failure to disclose travel paid by industry, and nobody is noticing.

      Thanks for the work on the translation!

  • Klaas van Dijk

    See https://pubpeer.com/publications/623F78B233DA1523FF16616E5D5B32#fb42571 for backgrounds about undisclosed conflicts of interest of an author of a recent paper in NEJM.

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