Michele Simon, a public health lawyer and advocate, recently published an expose of the ties between the American Society for Nutrition (ASN) and certain industries - you can find the full report here. The report caused quite the stir on twitter, getting play from the MotherJones, ScientificAmerican, and the accolades of a number of twitter celebs. Yoni Freedhoff kindly tweeted the report, suggesting that Ms Simon is only 'questioning' the ties between ASN and industry; alas, reading the report shows that much more than just 'questioning' is going on here - the title alone speaks to that': "Nutrition Scientists on the Take from Big Food - Has the American Society for Nutrition lost all credibility?" As Andrew Kniss pointed out on twitter, ASN being "on the take" is quite the accusation.
The report won't surprise anyone who has followed Ms Simon in the past. She wrote a similar report about the Academy of Nutrition and Dietetics a couple years ago. This new report similarly highlights the role that industry has in funding scientific research, our conferences and our researchers. The report offers no concrete evidence of industry detrimentally influencing the scientific process - it's just a series of observations highlighting facts, like editors of ASN journals (e.g. David Allison) are funded by industry, and the ASN scientific sessions at Experimental Biology are sponsored by individual industries or groups. The report is worth a read, but I would note the lack of tangible evidence that industry, or industry-funded researchers, is/are corrupting the science. It's mostly full of "what ifs" and "possibilities" that industry has this influence, based on perception of associations alone. The targeting of David Allison is basically beating a dead horse - Ms Simon is far from the first. FedUp did its best to make Alison seem like a bought out researcher (ironically giving voice to some of the most biased individuals, like Taubes and Lustig). Barry Popkin's threw Allison under the bus in his comments defending Susan Jebb in the BMJ series on food industry ties and sugar researchers -a perfect example of how these spurious correlations between funding and researchers can misrepresent the quality of a researcher and their research. For those concerned about industry influence, these sort of reports can be the ultimate confirmation bias (it's akin to how you can make basically any claim about Monsanto and most people won't critically evaluate it). Alison is, in reality, a great researcher, having done much to call out the limitations of nutrition research, and researchers increasing unwillingness to accept the limitations of observational evidence and data derived from self-reported dietary data. Popkin throws him under the bus in his comments citing an ABC story that critiques Alison for a number of ties, particularly highlighting his 'industry friendly' Obesity Reviews publication questioning the evidence underlying the WHO's claim that breastfeeding protects against obesity - indeed, many other 'independent' researchers have questioned this and arguably better study designs cast doubt on the relationship. Alas, calling out researchers/organizations for overstepping the conclusions able to be drawn from their research doesn't fit into our ideals (that breastfeeding has innumerable benefits - note: i'm super pro-breastfeeding) and can easily be painted as 'industry friendly'.
Ms Simon also misrepresents ASN's position statements in the report. She bangs the beaten drum accusing ASN's statement on food processing of being overly industry friendly, but as I've discussed previously, the statement was a scientific statement to try to define 'processed food', a truly value laden term that has no objective definition. Connie Weaver, the leader author of the paper, said it best at the time:
At the time of its publishing (and now again) many used this report to accuse ASN of industry influence, despite having little evidence for it. Their statement isn't industry friendly, it's just scientifically defining the word 'processed'. I said it in my original write-up of the ASN statement, and I'll say it again: almond milk, tofu and kale chips are still quite processed foods, whether public health advocates want to acknowledge it or not. They are just processed differently than twinkies and fruit loops, which is what people generally want to think of processed foods as. There is indeed a continuum of processing, and I'm still glad that ASN acknowledged ways that processing can be used for the better, and for the worse, as it will hopefully guide industry and research on this topic.
Ms Simon takes issue with ASN's statement on added sugars, using it as another avenue to convince readers that ASN is bought out by industry. In this section, she makes the following claim: "In contrast, ASN has never publicly state it is against the breakdown of saturated and trans fats on the Nutrition Facts label, which is no different from the breakdown of naturally occurring vs. added sugars." She seems to misunderstand basic nutrition science, seeing as fatty acids are chemically distinct from one another, and a molecule of sucrose is a molecule of sucrose, regardless of where it is found. Her analogy would make sense if ASN opposed the labeling of fructose compared to glucose. For anyone who hasn't read it, you can find ASN's statement here - you're welcome to take objection with their opinion, but, again, Ms Simon offers no concrete evidence that this position is bought out, nor does she give reason why we shouldn't believe that ASN doesn't support the added sugars label for the reasons they gave. Their statement notes the insufficient evidence for the effects of added sugars beyond excess calories (of which she provides no high quality evidence to the contrary), and they feel that the focus should be on a reduction in calories. They also note that there isn't enough evidence that this change would improve consumer food choices, urge the FDA to consider the effect this will have on how companies choose to formulate their products (possibly adding back in fat to make up for the taste), and note that since added sugars are chemically identical to endogenous ones, it would be quite difficult to determine how much is added and ensure compliance - those vehemently opposed to added sugars will surely see this as 'industry friendly' but I personally see it as reality. If Ms Simon were to present convincing evidence that this perspective were influenced by industry and were not valid (eg did ASN ignore quality research on the added sugar section of label influencing consumers? - note that recent evidence that's been generated doesn't suggest it'd be beneficial), the report would come off as more substantial. As of now, Ms Simon's just spins and selectively quotes the ASN statement to make it sound bad, so that it can be painted as industry-friendly (e.g. she states that she finds it egregious that ASN cites a lack of evidence for the adverse effects of sugar, when in reality they state that there is insufficient evidence for adverse effects of added sugars beyond contributing to total calories - an important distinction that acknowledges that added sugars can contribute to excess calorie intake, having detrimental health effects, and that these could be avoided by not over-consuming calories).
Despite the individual contents of the report that present little to no evidence of ASN being 'on the take', this isn't my biggest issue with it. I certainly understand concerns of 'perception' regarding industry funding, and have some of my own - that's why I'm particularly concerned when I see reports like this, that breed little more than conspiracy while offering no viable solutions for what to do about it. The report is lacking of genuine motive for being written - if one were truly concerned about the effect of industry funding on research, the message would focus heavily on how researchers and organizations can fund themselves without the help of industry money, not weave conspiracy with simple observations. How should ASN fund a successful conference without industry sponsorship? As a member of ASN, I personally can't afford to pay hundreds of dollars to attend the conference on a graduate student salary, but I do want to network with my peers/senior researchers, communicate science, and establish future collaborations that might ultimately produce results that benefit other scientists/the public. How should researchers fund their own research without the help of industry, when something like ten percent of grants are funded? (likely worse if you're in nutrition and not studying obesity/diabetes/cvd) These are the questions that need to be answered. If there's a clear source of funding for how all of this can occur, I'd love to know. Otherwise, shouting about industry associations from the rooftops of social media while offering no plan for what to do about it helps no one (except the author's popularity and bank account), and only furthers public distrust in science. Additionally, as a student pursuing a career in research, I find this perception that anyone who is associated with industry has a 'less than' opinion, or isn't welcome on editorial boards, as being quite disheartening. The notion that I have to choose the 'righteous' path of academia only funded by NIH/NSF (as if those researchers are free of bias #whitehatbias) or the shill path of industry/industry funding to do science because of a non-scientist's ideals about industry's role in research is quite disconcerting.
The irony of this whole report was stated best by Tamar Haspel on twitter. Ms Simon admitted that the report was funded by the Alliance for Natural Health. If you're not familiar with ANH, Colby Vorland made a nice list of things that they are openly opposed to here - it's a lengthy one but includes your typical anti-GMO/vaccination/gluten/artificial sweetener/pharmaceuticals/fluoridation alternative health sentiments. They're pretty much one of the woo-iest alternative health organizations out there. If we are to apply Ms Simon's same logic throughout the report to the fact that this report was funded by ANH, we'd see this report as nothing more than an alternative health organization bought out lawyer trying to discredit a scientific organization that doesn't share their fear-mongering health information.
As I said above, I understand those who see industry funding as a perception issue. I am always willing to engage in discussions about how research should be funded, and how we can better ensure scientific integrity. I'd encourage anyone interested in nutrition research funding and industry partnerships to read the recent AJCN piece, here, titled 'Achieving a transparent, actionable framework for public-private partnerships for food and nutrition research'. This article represents further discussion that ASN has continually had surrounding industry funding - they had a piece back in 2009 in AJCN here (and a commentary here), and in 2013 had a panel on the issue, which videos of can be found here. I'm happy these conversations are going on and the discussion continues to evolve; indeed, I might be more concerned if industry had infiltrated the scientific process and no one was talking about it. Notably, none of these discussions seem to suggest a viable system where there is no industry relations, allowing for those with a political agenda to continually paint nutritional scientists as being 'on the take' from industry, either until NIH gets an unlimited budget or we have no more conferences, and very little research.
Update: Random other thought - the concern about industry funding seems to be most heavily placed on areas of controversy in nutrition (nearly all of the focus seems to be on the issue of added sugars). It would benefit those opposed to industry funding to narrow the broad claims about industry funding to their areas of concern - many rely on industry funding across diverse fields of study in nutrition, and those, who don't perform nutrition research, telling researchers how to get funding continues to come off as disingenuous.
Update: Ms Simon did an interview over at PlosBlogs here. She continues to make the point that industry only supports research that it could potentially benefit from (this is basic economics 101 - not sure how we get around that, or what it says about the quality of the evidence being generated). Again, she lambastes the idea that industry funding is seen as okay, and continues to offer no solution for researchers. She even goes so far as to say that we can completely discount studies based on their funding, depicted below (as an fyi, no, soda does not cause obesity- this is exactly the overstated public health messages that fuel the careers of 'bought out' industry researchers, because they can just state this obvious fact). She cites Marion Nestle as an influence, which isn't surprising but even Dr Nestle noted in her most recent 'industry research roundup' post (Dr Nestle recently updated her blog with a post on industry funded studies not supporting the funder) that industry sponsorship doesn't mean that conclusions are wrong (screenshot below). As I've always said, we can't throw out industry research because of its sponsorship - it's worth a critical analysis, as is all research, and if there's a flaw to it, give researchers some credit because we tend to find these things, and weigh that research much less. If we're concerned about how things are being reported to the media (which is something I am highly concerned about and talk about on this blog frequently), let's crackdown on press offices and on inadequate peer review (again, this isn't a problem unique to industry funded research).
Andy Bellatti, founder of a group opposed to industry funding in the Academy of Nutrition and Dietetics (which questionably promotes alternative medicine), also worked with Ms Simon on the report, and recently talked with Aljazeera about the report here. His comments completely misrepresent ASN, and make them out to be Sugar Association sold out shills (not surprising, given his groups ties with Robert Lustig). He, like Ms Simon, cites ASN's statement that there is a lack of consensus on the effects of added sugars, contrasting it against other public health organizations, yet leaves off the ever so important 'beyond adding excess calories' portion of ASN's claim. He also cites that the WHO recommends 5 percent of calories from sugar, which is blatently false - the 5 percent level was a conditional recommendation based on very low quality evidence, particularly pointing out that the studies were from Japanese populations with low fluoride intake. If you actually read the report, they note the low to moderate quality evidence associating added sugars and body weight. You can see the full list of remarks below and read the full report here. As ASN notes, the data suggesting a reduction in added sugars is weak. If you actually read the WHO report, they note that added sugars add calories without adding other nutrients, and that "A high level of free sugars2
intake
is of concern, because of its association with poor dietary quality, obesity and risk of
NCD". ASN and the WHO actually have very similar opinions on sugars, ASN just doesn't suggest labeling them for a number of reasons that I listed above (which I still have yet to see a take down of how their reasoning is evidence of being bought out by industry - the reasons they cite are quite convincing, IMO).
To note, I have no financial conflicts of interest to disclose - I'm paid by my graduate student stipend at Cornell and was in no way paid by anyone to write this. Nothing I say here represents Cornell or ASN. I am a former ASN student blogger and an ASN student member.
The report won't surprise anyone who has followed Ms Simon in the past. She wrote a similar report about the Academy of Nutrition and Dietetics a couple years ago. This new report similarly highlights the role that industry has in funding scientific research, our conferences and our researchers. The report offers no concrete evidence of industry detrimentally influencing the scientific process - it's just a series of observations highlighting facts, like editors of ASN journals (e.g. David Allison) are funded by industry, and the ASN scientific sessions at Experimental Biology are sponsored by individual industries or groups. The report is worth a read, but I would note the lack of tangible evidence that industry, or industry-funded researchers, is/are corrupting the science. It's mostly full of "what ifs" and "possibilities" that industry has this influence, based on perception of associations alone. The targeting of David Allison is basically beating a dead horse - Ms Simon is far from the first. FedUp did its best to make Alison seem like a bought out researcher (ironically giving voice to some of the most biased individuals, like Taubes and Lustig). Barry Popkin's threw Allison under the bus in his comments defending Susan Jebb in the BMJ series on food industry ties and sugar researchers -a perfect example of how these spurious correlations between funding and researchers can misrepresent the quality of a researcher and their research. For those concerned about industry influence, these sort of reports can be the ultimate confirmation bias (it's akin to how you can make basically any claim about Monsanto and most people won't critically evaluate it). Alison is, in reality, a great researcher, having done much to call out the limitations of nutrition research, and researchers increasing unwillingness to accept the limitations of observational evidence and data derived from self-reported dietary data. Popkin throws him under the bus in his comments citing an ABC story that critiques Alison for a number of ties, particularly highlighting his 'industry friendly' Obesity Reviews publication questioning the evidence underlying the WHO's claim that breastfeeding protects against obesity - indeed, many other 'independent' researchers have questioned this and arguably better study designs cast doubt on the relationship. Alas, calling out researchers/organizations for overstepping the conclusions able to be drawn from their research doesn't fit into our ideals (that breastfeeding has innumerable benefits - note: i'm super pro-breastfeeding) and can easily be painted as 'industry friendly'.
Ms Simon also misrepresents ASN's position statements in the report. She bangs the beaten drum accusing ASN's statement on food processing of being overly industry friendly, but as I've discussed previously, the statement was a scientific statement to try to define 'processed food', a truly value laden term that has no objective definition. Connie Weaver, the leader author of the paper, said it best at the time:
At the time of its publishing (and now again) many used this report to accuse ASN of industry influence, despite having little evidence for it. Their statement isn't industry friendly, it's just scientifically defining the word 'processed'. I said it in my original write-up of the ASN statement, and I'll say it again: almond milk, tofu and kale chips are still quite processed foods, whether public health advocates want to acknowledge it or not. They are just processed differently than twinkies and fruit loops, which is what people generally want to think of processed foods as. There is indeed a continuum of processing, and I'm still glad that ASN acknowledged ways that processing can be used for the better, and for the worse, as it will hopefully guide industry and research on this topic.
Ms Simon takes issue with ASN's statement on added sugars, using it as another avenue to convince readers that ASN is bought out by industry. In this section, she makes the following claim: "In contrast, ASN has never publicly state it is against the breakdown of saturated and trans fats on the Nutrition Facts label, which is no different from the breakdown of naturally occurring vs. added sugars." She seems to misunderstand basic nutrition science, seeing as fatty acids are chemically distinct from one another, and a molecule of sucrose is a molecule of sucrose, regardless of where it is found. Her analogy would make sense if ASN opposed the labeling of fructose compared to glucose. For anyone who hasn't read it, you can find ASN's statement here - you're welcome to take objection with their opinion, but, again, Ms Simon offers no concrete evidence that this position is bought out, nor does she give reason why we shouldn't believe that ASN doesn't support the added sugars label for the reasons they gave. Their statement notes the insufficient evidence for the effects of added sugars beyond excess calories (of which she provides no high quality evidence to the contrary), and they feel that the focus should be on a reduction in calories. They also note that there isn't enough evidence that this change would improve consumer food choices, urge the FDA to consider the effect this will have on how companies choose to formulate their products (possibly adding back in fat to make up for the taste), and note that since added sugars are chemically identical to endogenous ones, it would be quite difficult to determine how much is added and ensure compliance - those vehemently opposed to added sugars will surely see this as 'industry friendly' but I personally see it as reality. If Ms Simon were to present convincing evidence that this perspective were influenced by industry and were not valid (eg did ASN ignore quality research on the added sugar section of label influencing consumers? - note that recent evidence that's been generated doesn't suggest it'd be beneficial), the report would come off as more substantial. As of now, Ms Simon's just spins and selectively quotes the ASN statement to make it sound bad, so that it can be painted as industry-friendly (e.g. she states that she finds it egregious that ASN cites a lack of evidence for the adverse effects of sugar, when in reality they state that there is insufficient evidence for adverse effects of added sugars beyond contributing to total calories - an important distinction that acknowledges that added sugars can contribute to excess calorie intake, having detrimental health effects, and that these could be avoided by not over-consuming calories).
Despite the individual contents of the report that present little to no evidence of ASN being 'on the take', this isn't my biggest issue with it. I certainly understand concerns of 'perception' regarding industry funding, and have some of my own - that's why I'm particularly concerned when I see reports like this, that breed little more than conspiracy while offering no viable solutions for what to do about it. The report is lacking of genuine motive for being written - if one were truly concerned about the effect of industry funding on research, the message would focus heavily on how researchers and organizations can fund themselves without the help of industry money, not weave conspiracy with simple observations. How should ASN fund a successful conference without industry sponsorship? As a member of ASN, I personally can't afford to pay hundreds of dollars to attend the conference on a graduate student salary, but I do want to network with my peers/senior researchers, communicate science, and establish future collaborations that might ultimately produce results that benefit other scientists/the public. How should researchers fund their own research without the help of industry, when something like ten percent of grants are funded? (likely worse if you're in nutrition and not studying obesity/diabetes/cvd) These are the questions that need to be answered. If there's a clear source of funding for how all of this can occur, I'd love to know. Otherwise, shouting about industry associations from the rooftops of social media while offering no plan for what to do about it helps no one (except the author's popularity and bank account), and only furthers public distrust in science. Additionally, as a student pursuing a career in research, I find this perception that anyone who is associated with industry has a 'less than' opinion, or isn't welcome on editorial boards, as being quite disheartening. The notion that I have to choose the 'righteous' path of academia only funded by NIH/NSF (as if those researchers are free of bias #whitehatbias) or the shill path of industry/industry funding to do science because of a non-scientist's ideals about industry's role in research is quite disconcerting.
The irony of this whole report was stated best by Tamar Haspel on twitter. Ms Simon admitted that the report was funded by the Alliance for Natural Health. If you're not familiar with ANH, Colby Vorland made a nice list of things that they are openly opposed to here - it's a lengthy one but includes your typical anti-GMO/vaccination/gluten/artificial sweetener/pharmaceuticals/fluoridation alternative health sentiments. They're pretty much one of the woo-iest alternative health organizations out there. If we are to apply Ms Simon's same logic throughout the report to the fact that this report was funded by ANH, we'd see this report as nothing more than an alternative health organization bought out lawyer trying to discredit a scientific organization that doesn't share their fear-mongering health information.As I said above, I understand those who see industry funding as a perception issue. I am always willing to engage in discussions about how research should be funded, and how we can better ensure scientific integrity. I'd encourage anyone interested in nutrition research funding and industry partnerships to read the recent AJCN piece, here, titled 'Achieving a transparent, actionable framework for public-private partnerships for food and nutrition research'. This article represents further discussion that ASN has continually had surrounding industry funding - they had a piece back in 2009 in AJCN here (and a commentary here), and in 2013 had a panel on the issue, which videos of can be found here. I'm happy these conversations are going on and the discussion continues to evolve; indeed, I might be more concerned if industry had infiltrated the scientific process and no one was talking about it. Notably, none of these discussions seem to suggest a viable system where there is no industry relations, allowing for those with a political agenda to continually paint nutritional scientists as being 'on the take' from industry, either until NIH gets an unlimited budget or we have no more conferences, and very little research.
Update: Random other thought - the concern about industry funding seems to be most heavily placed on areas of controversy in nutrition (nearly all of the focus seems to be on the issue of added sugars). It would benefit those opposed to industry funding to narrow the broad claims about industry funding to their areas of concern - many rely on industry funding across diverse fields of study in nutrition, and those, who don't perform nutrition research, telling researchers how to get funding continues to come off as disingenuous.
Update: Ms Simon did an interview over at PlosBlogs here. She continues to make the point that industry only supports research that it could potentially benefit from (this is basic economics 101 - not sure how we get around that, or what it says about the quality of the evidence being generated). Again, she lambastes the idea that industry funding is seen as okay, and continues to offer no solution for researchers. She even goes so far as to say that we can completely discount studies based on their funding, depicted below (as an fyi, no, soda does not cause obesity- this is exactly the overstated public health messages that fuel the careers of 'bought out' industry researchers, because they can just state this obvious fact). She cites Marion Nestle as an influence, which isn't surprising but even Dr Nestle noted in her most recent 'industry research roundup' post (Dr Nestle recently updated her blog with a post on industry funded studies not supporting the funder) that industry sponsorship doesn't mean that conclusions are wrong (screenshot below). As I've always said, we can't throw out industry research because of its sponsorship - it's worth a critical analysis, as is all research, and if there's a flaw to it, give researchers some credit because we tend to find these things, and weigh that research much less. If we're concerned about how things are being reported to the media (which is something I am highly concerned about and talk about on this blog frequently), let's crackdown on press offices and on inadequate peer review (again, this isn't a problem unique to industry funded research).
 |
| From Ms Simon's Plos interview |
 |
| http://www.foodpolitics.com/2015/06/industry-sponsored-research-this-weeks-collection-2/ |
 |
WHO remarks on added sugar intake.
Just to clarify - this post is not to say that one shouldn't be concerned about industry. Years of tobacco science taught us that industry can indeed influence the science. The point is to say that we need to be more critical thinkers than to simply draw associations between industry funding and position stances that we don't like. We need better evidence that just simple associations, lest we become nothing more than anti-vaxxers claiming that vaccines are a weapon of BigPharma. If we are to be so convinced by industry conspiracy theory, there is indeed very, very little evidence we could ever trust.
To note, I have no financial conflicts of interest to disclose - I'm paid by my graduate student stipend at Cornell and was in no way paid by anyone to write this. Nothing I say here represents Cornell or ASN. I am a former ASN student blogger and an ASN student member.
Great post Kevin. I'm mixed on industry funding. I understand the issues of perceived influence (whether there is or not is another issue) and how the public sees the credibility of nutrition research and nutrition organizations with such funding. But I also understand the reality that without industry funding much research may not get be conducted nor would nutrition orgs have that additional needed funds for their activities. Ideally, it would be awesome if organizations and researchers could be funded totally independent of industry but as you said the NIH doesn't have an unlimited (or adequate) budget. I think that instead of calling organizations, researchers, and nutrition professionals shills and industry stooges on the take we should be continually vigilant about potential bias examining the science first rather than the funding (as so many do not do) and keep the conversation going, as you show the ASN has been doing over the years. I think that will be more effective in the long run than calling out orgs for industry funded while being funded by a alternative medicine group that appears to ignore science in all areas of medicine and nutrition.
ReplyDeleteThanks for your comment David! I'm starting to see that people are mixing up where industry has a lot of influence - I have much more concern about their influence on policy due to lobbying than I do on their ability to affect results of a trial from an independent/university researcher that they've funded. Walt Willett and David Katz have all taken industry funding, but not surprisingly, they don't get thrown under the bus in these conversations.
DeleteAdditionally, the limitations of nutrition research make a lot of this difficult to assess, since it's quite easy for industry to note that there isn't causality between 'x' and 'y'.
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ReplyDeleteGreat blog, Kevin. I think you hit the nail on the head when you said that there is a "lack of evidence" for the assertions made by Ms. Simon. What she and her cronies fail to understand is organizations like the Academy of Nutrition and Dietetics and ASN partner with industry to amplify science-based nutrition messages and provide resources for members that they wouldn't be able to do otherwise without a significant dues increase. I consult with the food industry and, in contrast to what some seem to believe, I do not change my stand on science-based nutrition according to who is paying me. My last three new clients found me on social media. I was posting science-based information that supported their messaging so they asked if I would work for them. The Academy has strict guidelines for industry partnerships as I am sure ASN does too. Neva Cochran, MS, RDN, LD
ReplyDeleteOne of the other things worth noting about Alliance for Natural Health is the fact that their main purpose is lobbying and much of that has been directed at trying to eliminate state licensure for dietitians. We have seen this in many states including NC, VA and IL, They seem to have deep pockets and their supporters include alt med practioners and supplement industry.
ReplyDeleteI was recently remarking at just how much better quality industry-funded studies are, spurred to look at the sugar research more after funding the Mayo Clinic citing studies with 20 participants in a crossover trial as excellent evidence that sugar (well, like 30% of calories) kills you
ReplyDeleteI find myself having less issue with the 'industry' sugar science as well. Too many citing studies that are irrelevant to real world situations to suggest that sugar is 'toxic'. Activist science has arisen as one of my biggest concern. I have little doubt that most Americans overconsume calories, and that a portion of that can be attributed to excessive sugar consumption, but those trying to argue that sugar in and of itself is toxic (and comparing it to tobacco) are overstepping the data.
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