The JASMINE trial was designed as a multicenter, randomized Phase III registration trial, registered as jRCT2031210384 and conducted under the Japanese Good Clinical Practice framework. Its purpose was to evaluate the safety and efficacy of an exclusive human milk diet, a nutritional strategy in which very low birth weight infants receive human milk-based fortification rather than products derived from bovine milk. The population under study, infants born weighing very little, is among the most fragile in medicine, and nutritional decisions made in the first weeks of life can influence growth, feeding tolerance, and vulnerability to serious gastrointestinal disease. Because the intervention involved distinct nutritional products requiring different preparation and administration procedures, the investigators state that blinding of the treating clinicians was not practically feasible, a constraint that shaped the entire evidentiary architecture of the study.

Recognizing that an open-label design invites the possibility of observer bias, the trial incorporated a series of structural safeguards. Randomization was performed centrally using a permuted-block scheme stratified by study site and birth weight, with allocation concealment maintained until the moment of assignment. Clinical management across the participating neonatal intensive care units followed predefined protocols, and the major outcomes, including body weight, time to full enteral feeding, and adverse events, were prospectively defined before the trial began. Although blinded endpoint adjudication was not incorporated into the design, the trial operated under GCP-compliant monitoring that included on-site source data verification, a process in which monitors check that recorded data match the original clinical records. Mizuno’s response is explicit that the open-label design and the absence of blinded endpoint adjudication are genuine limitations of the trial and should be considered when interpreting outcomes that may be influenced by clinical management decisions.

The sharpest questions in the correspondence concerned the involvement of Prolacta Bioscience, the company that funded the trial and whose product was under evaluation. Mizuno’s response draws a distinction that he argues is essential for readers: the fact of sponsor funding is separate from the question of the sponsor’s role in the analysis and interpretation of the results. Industry sponsorship, he notes, is a standard model for pivotal Phase III trials intended to support regulatory approval, because such trials demand substantial resources for multicenter conduct, data management, pharmacovigilance, quality assurance, statistical analysis, and the preparation of regulatory submissions. As disclosed in the published article, Prolacta funded the study and contributed to its statistical design, but the statistical analyses of the trial data were performed by a third-party contract research organization, Innovative Analytics, working to a prespecified statistical analysis plan rather than by Prolacta personnel.

The statistical workflow described in the response is unusually detailed for a journal correspondence. The protocol and the statistical analysis plan were finalized before database lock and before any unblinded efficacy analysis, and the plan prespecified the primary endpoint of weight gain velocity, the non-inferiority margin, the sample size calculation, the intent-to-treat and per-protocol analysis sets, and a testing hierarchy in which claims of superiority could be tested only after non-inferiority had been established. Data management and monitoring were conducted through the contract research organization in accordance with GCP, including source data verification at participating sites. The analyses themselves were executed in SAS version 9.4 by Innovative Analytics. Sponsor personnel did provide data checking and statistical support during manuscript development, but, according to the response, Dr. Lee did not determine the primary endpoint, perform the primary or secondary analyses, alter the prespecified plan after examining the results, or select alternative analyses for publication; his involvement occurred after the trial analyses had been completed, and scientific interpretation and the decision to submit remained with the named authors.

Two admissions in the response stand out for their candor. First, the statistical analyses were not performed with the analysts masked to treatment groups, a limitation that the prespecification of methods, endpoints, analysis populations, and testing hierarchy was intended to mitigate but could not eliminate. Second, and stated with unusual directness, there was no separate replication of the primary statistical analyses by an external academic statistical group. Mizuno writes that the team wishes to be explicit about this point. In partial compensation, the trial was subject to a form of external scrutiny that few academic studies undergo: as a Phase III registration trial under Japanese GCP, JASMINE was inspected by the Pharmaceuticals and Medical Devices Agency, and the trial data, clinical study report, and statistical evidence were evaluated by the agency as part of the regulatory review supporting marketing authorization in Japan. Mizuno acknowledges that regulatory oversight and independent academic reanalysis are distinct things, but argues that the inspection and review provided meaningful external checks on the conduct, data integrity, and reporting of the trial.

The response also addresses a subtle disclosure question raised by the correspondents: the competing-interest statement in the published article referred to the individual competing interests of the named authors, while the sponsor’s financial and operational roles were reported separately in the Funding and Acknowledgments sections. Those separate disclosures covered the sponsor’s funding of the trial, Prolacta’s contribution to the statistical design, and the involvement of sponsor personnel during manuscript development. Mizuno agrees that these roles should be considered together when readers assess the independence of the evidence, and he frames the entire response as an opportunity to make the respective roles of the sponsor, the contract research organization, and the academic investigators more explicit. The episode illustrates a recurring tension in biomedical publishing: formal compliance with disclosure conventions can still leave readers uncertain about who did what, and correspondence of this kind often does the work of clarifying the division of labor that the original paper left implicit.

The second front of the dispute concerns a subsequent cost-utility analysis of the exclusive human milk diet in Japan, authored by Igarashi, Reyes, and Mizuno. The correspondents correctly noted that JASMINE observed only a single case of necrotizing enterocolitis, a devastating inflammatory bowel disease of prematurity, making it statistically inappropriate to derive a robust treatment-effect estimate for that condition from the trial alone. The health economic model therefore relied on external published evidence: the relative risks for the modeled complications, including the necrotizing enterocolitis relative risk used in the base-case analysis, were drawn from a published modeling study by Scholz and colleagues, with assumptions and data sources reported in the publication. Mizuno emphasizes that the necrotizing enterocolitis estimate in the model was an external modeling input, not an efficacy estimate derived from JASMINE, and that the economic analysis should therefore not be interpreted as demonstrating a treatment effect for that condition from the trial. The authors of the economic analysis also disclosed their financial relationships, with two authors reporting payments from Prolacta Biosciences to participate in the independent research and one reporting no disclosures.

The correspondents further observed that the necrotizing enterocolitis relative risk used in the base-case model differed from the estimate reported in the 2019 Cochrane review of human milk fortification. Mizuno attributes this difference to the use of different evidence sources rather than any trial-derived claim, and points to the uncertainty analysis built into the economic model: the robustness of the economic conclusions was tested through deterministic and probabilistic sensitivity analyses, including 10,000 Monte Carlo simulations, and through a scenario analysis using relative risk estimates from the largest meta-analysis of exclusive human milk diets available at the time, a 2024 meta-analysis published in Nutrients. Sensitivity analyses of this kind are the standard toolkit of health economics, allowing modelers to show whether a cost-effectiveness conclusion survives when uncertain inputs are varied across plausible ranges, and their presence here is offered as evidence that the economic findings were not hostage to any single assumption about necrotizing enterocolitis risk.

The broader significance of this exchange lies in what it reveals about the anatomy of trust in industry-funded clinical research. The primary objective of JASMINE was to evaluate the efficacy and safety of an exclusive human milk diet in Japanese very low birth weight infants within a regulatory framework, and the trial was randomized, conducted under GCP, monitored with source data verification, analyzed to a prespecified plan by a third-party organization, inspected and reviewed by the national regulator, and subsequently peer reviewed. Yet Mizuno concedes the open-label limitations, the unblinded analysts, and the absence of independent academic reanalysis, and argues that transparency about the respective roles of sponsor, contractor, and investigators is what allows readers to judge the evidence for themselves. Whether that standard of transparency satisfies critics will shape not only the reception of this trial but the ongoing scientific discussion about optimal nutritional strategies for vulnerable preterm infants, a debate in which every assumption, disclosure, and statistical choice is scrutinized by clinicians, regulators, and the families whose children stand to benefit or be harmed by the answer.

Subject of Research: Methodological and conflict-of-interest defenses of the JASMINE Phase III trial of exclusive human milk diets in very low birth weight infants

Article Title: Response to “Trial design, conflict of interest, and evidence independence in the JASMINE trial and its economic evaluations”

Article References: Mizuno, K. (2026). Response to “Trial design, conflict of interest, and evidence independence in the JASMINE trial and its economic evaluations”. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02929-x

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02929-x

Keywords: JASMINE trial, exclusive human milk diet, very low birth weight infants, necrotizing enterocolitis, conflict of interest, open-label trial, Good Clinical Practice, PMDA, cost-utility analysis, Prolacta Bioscience, neonatal nutrition, statistical analysis plan

The review, published in the Cochrane Database of Systematic Reviews under the title Pharmaceutical industry information and promotional strategies aimed at prescribers, compiled observational data on prescribers who had received various forms of industry contact, including advertising and education, gifts and payments, and free samples. The technical strength of a Cochrane review lies in its systematic approach: the authors searched, appraised and synthesized studies according to predefined criteria, allowing patterns to emerge across heterogeneous settings rather than relying on any single investigation. What emerged was a coherent signal that exposure to industry promotion changes behavior in measurable ways, shifting prescribing toward promoted products and, in a substantial share of cases, away from prescribing that best serves patients clinically or economically.

Grundy, who also directs the WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector at the University of Toronto and is one of two Canadian authors on the review, emphasizes that these marketing tactics are not confined to any single country or regulatory environment. The same multi-national companies market their drugs worldwide, meaning the dynamics documented in the review likely apply broadly across health systems. In the United States, where the Open Payments system requires companies to publicly report transfers of value to physicians, just over half of all licensed physicians have accepted a payment of some kind, including something as ordinary as a free meal. That figure, Grundy notes, cuts two ways. It shows that companies concentrate their marketing resources on physicians expected to deliver the highest return on investment and to prescribe more of the promoted drug, but it also reveals that a large number of physicians deliberately choose not to interact with pharmaceutical companies at all and remain independent of these influences.

The economics of this influence deserve particular scrutiny. When physicians accept payments or meals, the data show they subsequently prescribe more of the promoted drug, and when that drug is a brand-name product with cost-effective alternatives available, the consequences ripple outward through the health system. Patients face higher co-pays and greater out-of-pocket costs, while payers and public programs absorb inflated drug expenditures that may deliver no additional clinical benefit. In this sense, the review frames industry promotion not merely as an ethical concern about professional independence but as a measurable driver of health system costs and of inequities in what patients pay at the pharmacy counter.

Canada occupies a revealing position in this evidence base. No Canadian studies were included in the review, largely because the country lacks a mechanism to track how much pharmaceutical companies pay physicians and nurse practitioners, or why those payments are made. Unlike the United States, which maintains its public Open Payments database, Canada has no comparable transparency infrastructure at the national level. Grundy points out that surveys and qualitative research outside this review suggest free meals and payments are nonetheless likely common among Canadian prescribers, meaning the absence of Canadian data reflects a gap in transparency rather than an absence of the phenomenon itself. For policymakers, this is a concrete and actionable finding: a country cannot manage or evaluate influences it does not measure.

The review did not stop at documenting the problem. A subset of the included studies examined what happens when institutions adopt conflict-of-interest policies or restrict physician interactions with industry within practice settings such as medical schools and teaching hospitals. The results were encouraging. In environments where such policies were in place, physicians tended to prescribe less overall, or to prescribe more appropriate treatments, suggesting that structural safeguards can meaningfully mitigate the effects of promotional exposure. The review authors argue that more robust conflict-of-interest policies represent an important way forward, shifting the burden of independence from the individual conscience of each clinician to the systems in which care is delivered.

Grundy frames this as a matter of institutional responsibility rather than personal blame. Prescribers, she argues, need independent, evidence-based sources of drug information to maintain their independence in practice and to remain trustworthy and accountable to the people they serve. The studies included in the review demonstrate that practice environments can be deliberately designed to promote and preserve that independence, and that this is best achieved collectively, within health systems and institutions, rather than leaving individual clinicians to resist sophisticated, well-resourced marketing campaigns on their own. This reframing matters, because decades of research on professional behavior suggest that relying solely on individual willpower against systematic commercial pressure is a weak intervention compared with changing the environment itself.

There is also an important scope question raised by the findings. While most of the available research focused on physicians, physicians are no longer the only prescribers in many health systems, including Canada. Descriptive studies using the United States Open Payments data, which were not part of this review, have found that advanced practice nurses, including nurse practitioners and clinical nurse specialists, are also targets of industry promotion. As scope-of-practice expansions place more prescribing authority in the hands of nurses and other non-physician clinicians, the reach of pharmaceutical marketing expands with it. Grundy is explicit on this point: this is not just a problem for medicine, it affects the entire healthcare team, and the goal should be to create healthcare environments that safeguard the independence and integrity of care for every prescriber within them.

For readers weighing the practical implications, the review offers a clear evidence-based agenda. Health professional schools, hospitals, professional societies and health systems can adopt and enforce conflict-of-interest policies that limit promotional contact, particularly during training when prescribing habits are formed. Jurisdictions without transparency mechanisms, Canada among them, can establish mandatory disclosure of industry payments to all prescribers, not only physicians. Clinicians and educators can prioritize independent sources of therapeutic information. And patients, whose co-pays and out-of-pocket costs absorb much of the financial consequence, have a stake in demanding that prescribing decisions rest on clinical evidence rather than commercial relationships. The Cochrane evidence indicates that none of these changes requires a scientific breakthrough, only the institutional will to act on what the data already show.

What makes this review resonate beyond academic circles is its scale and its consistency. With evidence from more than 93 studies and the observed practices of millions of prescribers, the association between industry payments and prescribing behavior is no longer a contested curiosity of health services research; it is a documented, repeatable pattern across health systems and regulatory regimes. The finding that conflict-of-interest policies measurably improve prescribing adds a constructive counterweight, demonstrating that the influence of promotion is neither inevitable nor irreversible. As Grundy and her colleagues make clear, the task now is to translate that evidence into policy, so that the environments in which clinicians train and practice actively protect the independence on which safe, appropriate and affordable prescribing depends.

Subject of Research: The influence of pharmaceutical industry marketing and payments on physician prescribing behavior

Article Title: Study links pharmaceutical industry payments to changes in physicians’ prescribing practices

Article References: Study links pharmaceutical industry payments to changes in physicians’ prescribing practices. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: pharmaceutical industry, prescribing practices, Cochrane review, conflict of interest, Open Payments, physician payments, drug marketing, health policy, inappropriate prescribing, healthcare costs, Quinn Grundy, University of Toronto

Pharmaceutical companies deploy a wide arsenal of strategies to promote their products to the people who write prescriptions. These include one-on-one visits by sales representatives to doctors’ offices and hospitals, paid meals, coverage of travel costs to conferences, entertainment, consulting fees, honoraria for serving on advisory boards, and direct advertising. For every new medicine brought to market, companies target prescribers with offers of free meals and other payments, and the review confirms that these interactions translate into prescribing of the promoted drug, even when that drug may not be needed or may not be the most suitable or affordable option for a particular patient.

The evidence base behind the review is notable for its scale and its real-world grounding. The 93 included studies spanned several different study designs, but almost all of them observed actual prescribing patterns in clinical practice rather than relying on controlled experiments. The overwhelming majority of the studies, 88 percent, came from the United States, a concentration the authors attribute in part to the Physician Payments Sunshine Act of 2010. That legislation requires pharmaceutical companies to publicly report all payments made to doctors, and the resulting data is compiled in a searchable, analyzable database that has made it possible for researchers to link industry spending to prescribing behavior at an unprecedented level of detail.

To bring order to this vast body of data, the review authors grouped industry interactions into three distinct categories: advertising and education, gifts and payments, and free drug samples. They also examined conflict-of-interest policies as a potential mitigation strategy. The evidence was strongest and most consistent for gifts and payments, which were linked to less appropriate prescribing, a higher volume of prescriptions, and probably increased costs. Advertising and education, including sales representative visits, appeared to be associated with prescribing that was less clinically suitable and more expensive, with fairly strong evidence that these activities also drove up the overall number of prescriptions written. For free drug samples, and for the question of whether promotion influences hospital formulary decisions, the available evidence was too sparse or weak to support firm conclusions, although the limited data that does exist hints at possible effects.

One of the most striking patterns the review uncovered is a clear dose-response relationship between paid meals and inappropriate prescribing. The more meals a doctor received from a particular company, the more of that company’s drug the doctor prescribed. Crucially, this relationship held across a wide range of drug classes, from medications for high blood pressure and high cholesterol to antidepressants and opioid painkillers. A dose-response relationship is considered a hallmark of a genuine causal effect in epidemiological research, because it is difficult to explain by confounding factors why increasing exposure should predict increasing outcome so consistently across unrelated therapeutic areas.

Dr. Lisa Bero of the University of Colorado Anschutz, a study author, summarized the central finding bluntly: overall, when doctors have more contact with drug company promotion, prescribing tends to become less appropriate, more frequent, and more expensive. She emphasized that this matters because it directly affects patient care, noting that less appropriate and more expensive drugs can offer fewer benefits or cause more side effects than the alternatives, or may simply be unnecessary in the clinical context. In other words, the harms are not abstract financial ones; they can translate into worse outcomes for the individual patients sitting in the exam room.

No example illustrates the potential consequences of pharmaceutical promotion more starkly than the opioid crisis. The review found that even inexpensive meals were associated with increased opioid prescribing, and that the more payments a doctor received from opioid manufacturers, the more likely that doctor was to prescribe dangerously high opioid doses. The widespread inappropriate overprescribing of opioids, driven in part by marketing that exaggerated benefits and minimized harms, contributed to an epidemic of addiction and overdose deaths in North America. Dr. Bero described the opioid crisis as perhaps the most egregious example of inappropriate over-prescribing, but stressed that it was not an isolated incident. It attracted attention because the harms were so visible and severe, yet she argued that the systems which enabled it are still considered business as usual within the industry, and that interactions between pharmaceutical companies and prescribing physicians remain widespread while the harms they cause are rarely so apparent.

The normalization of these practices within medicine itself is a recurring theme in the research. Dr. Barbara Mintzes of the University of Sydney, the lead author, pointed out that receiving free meals from companies is very common for doctors, and that many physicians regard the practice as trivial and personally non-influential. Doctors often believe they cannot be bought for the price of a sandwich, she observed, but the data tells a different story: the more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs. From a marketing standpoint, the evidence suggests that small, routine gestures are an effective and efficient strategy, precisely because prescribers underestimate their own susceptibility.

There is, however, an encouraging counterpoint in the findings. Some hospitals and medical centers have adopted institutional restrictions, commonly known as conflict-of-interest policies, that limit how much contact industry representatives can have with doctors or what gifts and samples they are permitted to provide. The review found that these policies can mitigate the negative impact of pharmaceutical marketing on prescribing habits. According to Dr. Mintzes, robust conflict-of-interest policies tended to be effective, with the data indicating that they probably improve prescribing appropriateness and possibly reduce the overall number of prescriptions. This gives policymakers, hospital administrators, and professional bodies a concrete, evidence-supported lever for reform.

The authors are careful to frame the problem as one of systems rather than individuals. The review’s message, they emphasize, is not that a few bad apples are corrupting the profession, but that the structure of industry-prescriber interaction itself skews clinical decisions in ways that conflict with patient interests. With evidence now spanning millions of prescribers, multiple drug classes, and a dose-response gradient linking meals to prescriptions, the case for stricter institutional policies has grown considerably stronger. For patients, the practical takeaway is that the most appropriate treatment should be chosen on the basis of clinical evidence rather than industry marketing, and for the medical profession, the review suggests that the price of a sandwich may be higher than anyone imagined.

Subject of Research: The influence of pharmaceutical industry marketing on physician prescribing behavior

Article Title: Pharmaceutical company marketing negatively influences prescribing

Article References: Pharmaceutical company marketing negatively influences prescribing. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: pharmaceutical marketing, prescribing behavior, Cochrane review, conflict of interest, opioid crisis, free meals, Sunshine Act, drug promotion, systematic review, health policy, sales representatives, patient safety

Nova, a food classification system developed by researchers at the University of São Paulo, categorizes foods not by their nutrient content but by the degree and purpose of the industrial processing they undergo. The system’s fourth and most scrutinized category, ultra-processed foods, includes many packaged snacks, candy, sweetened beverages, and ready-to-eat products — foods manufactured with industrial ingredients and additives that consumers rarely use in home cooking. Over the past decade, Nova has become the backbone of a growing body of research linking higher consumption of ultra-processed foods to poorer health outcomes, including weight gain, cardiovascular disease, and other chronic conditions. That evidence base has, in turn, informed dietary recommendations and policy debates from Brazil to the United Kingdom, making Nova one of the most consequential frameworks in modern nutrition science.

But Nova has also attracted sustained criticism. Some researchers argue that the system lumps together nutritionally dissimilar products, that it overemphasizes processing at the expense of nutrient profiles, and that its categories are too vague to support sound policy. These critiques are not fringe positions; they appear in peer-reviewed journals and shape how policymakers interpret the evidence on ultra-processed foods. What has been far less clear is whether the researchers making these arguments bring independent perspectives — or undisclosed commercial interests — to the debate. LaFata and her colleagues set out to answer precisely that question using a systematic review, one of the most rigorous tools available for synthesizing a body of literature.

The team systematically identified 69 academic articles published between 2009 and 2025 that either criticized Nova or described potential benefits of ultra-processed foods. They then examined the industry relationships of the 232 authors across those articles, drawing on two sources: conflicts of interest disclosed within the articles themselves and additional relationships identified exclusively through publicly available information, such as corporate advisory roles, consulting arrangements, and funding records. This dual approach was designed to capture ties that authors may not have reported to journals, a persistent problem across biomedical research.

The results were striking. Fully 91.3 percent of the articles included at least one author with an identified food industry relationship. At the individual level, more than two-thirds of the authors — 68.5 percent — had some form of industry tie. Even more revealing was the disclosure gap: for 71.1 percent of the authors with identified industry relationships, those ties were found only through publicly available sources rather than through the formal conflict-of-interest disclosures attached to the articles. In other words, in most cases a reader of the original article would have had no way of knowing, from the article itself, that the authors had commercial relationships relevant to the topic at hand.

The analysis also uncovered a pattern in the content of the articles themselves. Articles involving authors with industry relationships were more likely to defend the food industry’s position or promote potential benefits of ultra-processed foods than articles written by authors with no identified industry ties. While the study’s design does not establish that industry relationships caused the critical positions — it is possible that companies seek out academics who already hold skeptical views — the association is difficult to dismiss in a field whose findings feed directly into regulatory decisions. The systematic review’s methodology, which included clearly defined criteria for identifying and classifying both the articles and the industry relationships, lends considerable weight to the pattern it documents.

LaFata is careful to frame the findings as a call for transparency rather than a wholesale dismissal of Nova’s critics. “This study is not saying that criticism of Nova is illegitimate,” she said, noting that “some of those criticisms identify real ways the system can be improved.” Any classification scheme as ambitious as Nova — one that attempts to sort the entire food supply by industrial processing rather than nutrients — is fair game for scientific scrutiny, and legitimate methodological critiques can strengthen the science. The concern, she argued, is not criticism itself but the possibility that readers, journalists, and policymakers cannot see who is behind it. “But readers should know who is shaping that debate,” she said. “When most of the published criticism involves authors with food industry relationships, and many of those relationships are not disclosed, transparency becomes especially important.”

The implications extend well beyond academic circles. Dietary guidelines, front-of-package labeling schemes, tax policies on sugary drinks, and school food standards are all increasingly informed by research on ultra-processed foods, and Nova sits at the center of that evidence base. If a substantial share of the published criticism of that framework comes from authors with undisclosed industry relationships, the apparent scientific controversy around Nova may look different once the affiliations behind it are visible. This dynamic — in which commercial interests shape scientific debate through apparently legitimate academic channels — echoes patterns documented in earlier public health fights over tobacco, sugar, and alcohol, where industry-funded research and industry-connected experts played measurable roles in delaying or diluting policy responses.

The study’s authors argue that the findings underscore the need for stronger transparency practices across nutrition research. Journals could tighten conflict-of-interest disclosure requirements and verify author statements against public records. Readers and journalists evaluating claims about ultra-processed foods could weigh the industry relationships of the researchers making those claims. Policymakers relying on the scientific literature to craft dietary guidance could ask not only what the evidence says, but who produced it and under what financial arrangements. None of these steps requires assuming bad faith on the part of any individual researcher; they simply acknowledge that financial relationships are relevant context for evaluating scientific arguments, particularly when those arguments concern the products of the companies involved.

As the debate over ultra-processed foods intensifies — with regulatory agencies, legislatures, and international health bodies all taking a closer look at the science — this systematic review provides a rare empirical window into that debate’s structure. Its central message is straightforward: criticism of Nova, like any scientific argument, deserves engagement on its merits, but the terms of that engagement change when the affiliations of its proponents remain hidden. With more than two-thirds of the field’s Nova critics holding food industry ties and most of those ties absent from formal disclosures, the study makes the case that transparency is not a bureaucratic nicety in nutrition science. It is a prerequisite for an honest public conversation about one of the most pressing questions in modern diet and health.

Subject of Research: A systematic review of food industry affiliations among researchers who criticize the Nova food classification system.

Article Title: Who’s shaping the debate over ultra-processed foods?

Article References: Who’s shaping the debate over ultra-processed foods?. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: ultra-processed foods, Nova classification, food industry ties, conflict of interest, nutrition research, systematic review, public health, transparency, disclosure, American Journal of Public Health, Oregon Research Institute, food policy