Researcher weathers criticism over fish study

When it comes to medical studies, consumer spending and corporate profits can be a combustible mix for scientists and researchers.

That reality has become clear to Floyd "Ski" Chilton, a professor of physiology and pharmacology and the director of the Wake Forest Center for Botanical Lipids.

It's been about three weeks since Chilton and Wake Forest University School of Medicine released a report advising people with inflammatory issues to reduce or eliminate their consumption of tilapia, a popular, lower-cost fish.

Chilton said last week that he's been stunned by the aggressive "sound-bite criticism" from the National Fisheries Institute, an industry trade group. Other critics include a colleague at the medical school.

"I've published 110 medical articles, and I am incredibly surprised by the tone of the response by one or two organizations to a study in a very reputable, peer-reviewed journal," Chilton said.

The study appeared in this month's issue of Journal of the American Dietetic Association, which also featured a report that offered a mixed review of the Wake findings. Chilton will have the opportunity to respond to the critical report in a coming issue of the journal.

Dr. William Applegate, the dean of Wake Forest University School of Medicine, said that criticism, including from colleagues, is an inherent, and sometimes helpful, part of the advancement of science.

"The higher the financial stake involved in a study, the greater the level of industry criticism tends to be generated," Applegate said.

The fisheries institute said its goal in the debate is to inform consumers about health issues.

The institute features grilled tilapia tacos as the No. 3 recipe on its Web site -- www.aboutseafood.com.

A recent survey of area seafood restaurant owners and managers found mixed reactions to the tilapia study, with some reporting a decline in sales and others removing the fish as an entree special.

In its criticism of the Wake study, the fisheries institute particularly emphasized this statement in a July 17 press release about the study: "The types of fats in popular seafood have led to reports that bacon, hamburgers and doughnuts are a better choice than certain fish."

"In this letter (from independent researchers), we see doctors from schools in England, Germany, Korea and Australia teaming up with researchers from U.S. institutions, including Sanford School of Medicine, Penn State and Harvard School of Public Health, to say, ‘Wait a minute, what you are reading in the press is misleading,'" said Jennifer Wilmes, a registered dietitian with the institute.

The trouble with the institute's position is that the Wake study doesn't make that claim.

What the Wake study does say is that "Tilapia has higher levels of potentially detrimental long-chain omega-6 fatty acids than 80-percent-lean hamburger, doughnuts and even pork bacon."

"All other nutritional content aside, the inflammatory potential of hamburger and pork bacon is lower than the average serving of farmed tilapia."

The study found that farm-raised tilapia -- the fifth most popular fish consumed in the United States -- has very low levels of beneficial omega-3 fatty acids, primarily because the fish eat inexpensive corn-based feed.

"Perhaps worse, it contains very high levels of omega-6 fatty acids," researchers said.

The combination "could be a potentially dangerous food source for some patients with heart disease, arthritis, asthma and other allergic and auto-immune diseases that are particularly vulnerable to an ‘exaggerated inflammatory response.'"

"They have sound-bited the study, taking things out of context to take the study in a different direction than the science," Chilton said. "There is a vulnerable population not enhancing the quality of their health with the best source of omega-3 fatty acids, and they deserve the knowledge."

Chilton said that consumers should still eat at least two servings of fish a week but focus more on salmon, mackerel, albacore tuna and shrimp for better omega-3 benefits. He also recommended taking fish-oil supplements.

Chilton is not alone among Wake scientists and researchers in being at the center of industry criticism and backlash.

Dr. Mary Claire O'Brien drew the ire of some beverage-industry officials as the lead Wake researcher on a November study on caffeinated alcoholic beverages. O'Brien is a physician and professor at Wake's department of public-health sciences and emergency medicine.

O'Brien's report found that college students who consume energy drinks while also having alcohol are more likely to drink more, get hurt, ride with a driver who is drunk or sexually assault someone.

"The study generated a tremendous amount of national and international response when it first came out because these caffeinated alcoholic drinks are increasing in popularity, and we were the first to report the potential injury component to consumers," O'Brien said.

Because of the study and the efforts of 11 state attorneys general, Anheuser-Busch agreed in June to stop producing caffeinated alcoholic beverages. The attorneys general got involved because they were concerned that aggressive marketing campaigns had created a false impression, disproven in previous separate research, that the caffeine in the drinks would counteract the intoxicating effect of the alcohol.

"If you drink enough to become intoxicated, but don't know you're intoxicated, how dangerous is that?" O'Brien said.

But MillerCoors has plans to roll out new versions of its Sparks caffeinated alcoholic energy drink this fall.

In another study involving a Wake researcher, Dr. Curt Furberg spent years defending a 2002 report that found that lower-cost, diuretic drugs were more effective in the initial treatment of hypertension than a newer, highly profitable brand-name drug, Norvasc, which is made by Pfizer.

Furberg is a professor of public-health sciences at Wake.

Pfizer responded by starting a major marketing campaign that highlighted only the parts of the 2002 study that were positive for Norvasc.

"By and large, companies are only going to promote what earns them profits," Furberg said in a November 2003 article written by a producer of the PBS investigative news show Frontline. "And, sometimes, that's not good for your health and safety."

"Completeness and honesty is not the strength of industry when it comes to studies critical of their products," Furberg said in an interview with the Winston-Salem Journal last week. "They pick out the pieces they want to make an issue out of, and conveniently close their eyes to the rest."

Applegate, the dean of the Wake medical school, said that "we don't intervene in the criticism unless there is a gross disrespect for the university or the researcher's work and reputation."

"We stand by our academic faculty's ability to publish reports in academic journals. We don't try to suppress or censor their studies. We do have our public-relations department try to identify studies that may provoke a strong industry reaction so we can have a statement ready.

"We let the science and the report speak for itself, and over time, the truth of the evidence will come out," Applegate said.

The fisheries trade group also targeted Chilton's reputation by pointing to what the group says is a conflict-of-interest with his book, Inflammation Nation.

Chilton said that the tilapia study was cleared by a medical-school committee that reviews research for potential conflict of interest.

"I welcome that scrutiny with all my studies," Chilton said.

When asked whether he regrets the hamburger and bacon reference in the tilapia study, Chilton said "that to the point it created confusion, I do."

"But to the degree that the study has spurred debate about increased regulation of farm-raised tilapia and more attention to feeding better products to the fish, I don't regret it at all."

■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.