Lobbyists for the sports drink industry: an example of the rise of “contrarianism” in modern scientific debate

We welcome any discussion of our article which traces the emergence, especially in the United States of America, of exercise‐associated hyponatraemia (EAH) as a novel disease, even though its aetiology had already been established by us. We appreciate that some may wish to distance themselves from involvement in this affair. But this is not a sound basis for an objective scientific debate. We choose to respond first to Dr Murray's letter.

In his position as Director of the Gatorade Sports Science Institute (GSSI), Dr Murray is a full‐time employee of PepsiCo, which is a publicly listed company in the USA. The principal accountability of a publicly listed company like PepsiCo and its subsidiary, Gatorade, is to increase the wealth of its shareholders. This follows from the landmark case of Ford versus the Dodge Brothers heard in the Michigan Supreme Court in 1916.¹

In his otherwise uncritical review of the Gatorade phenomenon, Rovell² touches on this legal accountability: “This lack of change (in the Gatorade formulation) has caused some people to be sceptical as to the true function of the Gatorade Sports Science Institute (GSSI) which has funded more than 120 studies in the past 17 years. Is GSSI there to develop the latest and greatest sports drink formula for the masses, or is it there to use science to best defend the status quo? Is it really possible that nothing substantial has come along in sports drink science in the past four decades that would make Gatorade a better drink? There are, after all, very few product categories that fail to evolve over four decades” (pp 194–195). “…..But it is undeniable that GSSI was also created to be part of Gatorade's powerful marketing arm” (p 195). “…..Having the Gatorade Sports Science Institute does mean walking a fine line between educating the public on hydration and perhaps using GSSI to sell product. Gatorade brand managers will tell you that educating the public is the number‐one goal, but it's impossible to ignore the fact that GSSI is a part of Gatorade, which is part of Pepsi, which is a public company that is expected to make money” (p 206).

Thus although the publicly stated objectives of the GSSI may indeed be to “maintain the longstanding and extensive commitment to sports science research and education that we proudly support” as claimed by Dr Murray, the bottom line reality is that, if the GSSI does not increase the wealth of the shareholders of PepsiCo, it acts in contravention of the laws of the USA. For it is both “immoral” and illegal for a publicly listed company in the USA (and presumably elsewhere) to act charitably unless its philanthropic actions increase shareholders' wealth.¹

The content of the advertising material produced by the GSSI suggests that its identified commercial function is to maximise the sales of Gatorade by promoting any science which proves (1) that ingesting “more” Gatorade is better than drinking less, and (2) that Gatorade is superior especially to water (but also to all other sports drinks) for ingestion by athletes before, during and after exercise.

This legal requirement to pursue profit poses the greatest ethical challenge to those with scientific training employed by for‐profit companies. For their defining responsibility becomes the defence of the company's profitability and not to seek the truth. In this position, each of them must replace the skepticism he or she has imbibed as a scientist with an attitude of “contrarianism”, presenting only that evidence which supports the company's commercial objectives.³ To do this, Hansen concludes that the contrarian must act as a lobbyist ignoring the defining characteristic of the scientist as described by Nobel Laureate Richard Feynman: “The only way to have real success in science is to describe the evidence very carefully without regard to the way you feel it should be. If you have a theory, you must try to explain what's good about it and what's bad about it equally. In science you learn a sort of standard integrity and honesty”.

The way in which lobbyists deal with such moral ambiguity is brilliantly caricatured by the actions of the charming Nick Naylor in the recent Hollywood production Thank you for smoking, based on the novel by Christopher Buckley.⁴ In his position as chief lobbyist for the fictitious Academy of Tobacco Studies, Naylor represents the interests of the tobacco industry in the USA. Naylor is successful because he understands that his duty is to “win” arguments, not to present or advance the truth.

The point is that lobbyists like Naylor cannot act as usual scientists, according to the Feynman dictum. Rather, they must present, in the guise of an established scientific truth, a contrary position which is permanent and predetermined, and which has but one function—the advancement of the financial interests of the companies to whom they are accountable. To disguise their condition of compromise, lobbyists will usually assert that their exclusive interests are especially magnanimous, including, for example, the “welfare of athletes” and the “advancement of science”, both of which they “proudly support”. In fact, lobbyists should rather stick to their chosen jobs and leave benevolent actions to those who choose to be employed (at substantially more meagre salaries) specifically to serve humanity.

As the covert goal of the contrarian scientist‐turned‐lobbyists is neither humanitarian nor the advancement of scientific truth, it is pointless for scientists to engage with them in scientific debate. Indeed, lobbyists retain their influence over the general public and the conduct of science, only for as long as their mission and mode of operation are not universally understood.⁴

As Dr Murray's response to our article does not fall within the scope of conventional scientific discourse, conducted respectfully and with dignity, according to venerated scientific traditions which aim to advance truth, we will restrict our response solely to the exposure of his most obvious distortions.

To begin with, we did not “manufacture” the three arguments which he has now created on our behalf. We presented a singular theory: that the evidence that EAH is owing to overdrinking was already established in 1986, and proved by us in 1991, but that this proof was not accepted for 20 years because, in our view, it “conflicted with the prevalent message that was being driven by the sports drink industry”.

Were this purely a scientific debate, Dr Murray's duty would be to present the contrary evidence showing that the industry for which he acts as the principal lobbyist has, since 1986, done everything in its power to ensure that athletes do not overdrink during exercise. But his response fails to contest our core disputation. His silence proves that our contention is correct. Rather, using the skilful lobbyist's classic tactic, he creates three diversionary arguments which he claims we, not he, “manufactured”. Thus, he changes the focus of the debate from one which his silence acknowledges he cannot win to another which he might “win” if he can distort the argument sufficiently to confuse those readers who are unaware of his tactics.

He is reluctant to enter into that debate as he knows that, as recently as January/February 2002 (ie, 11 years after EAH was proved to be due to overdrinking), the GSSI placed an advertisement in the New York Runner magazine, and presumably elsewhere, with the banner statement: “Research shows your body needs at least 40 oz. of fluid every hour (ie, 1200 ml per hour) or your performance could suffer”. This conclusion is allegedly based on the results of “thousands of tests” conducted by the “scientists of the Gatorade Sports Science Institute” who have “studied it for over 15 years in research facilities all across the country”.

But the advertisement fails to warn that this advice conflicts with the fluid replacement guidelines of the American College of Sports Medicine (ACSM), which states that athletes should drink “as much as tolerable” and not >1.2 l/h. Nor does that advertisement warn that such high rates of fluid intake are safe only for those athletes who have very high sweat rates because they are either very large or can run very fast in hot conditions. Rather, the athlete depicted in the advertisement appears to be a lean, light and small female runner, exactly the athlete at the greatest risk for developing EAH⁵ if she were to follow the command of the GSSI.

This advertisement certainly does not support Dr Murray's claim that the GSSI accepts the “widespread agreement that over‐drinking is the root cause of most cases of exercise‐associated hyponatraemia”. Rather, in another classic sleight of the contrarian's keyboard, he makes Noakes the villain by accusing him of misrepresenting the ACSM guidelines. Perhaps if Dr Murray was more inclined to personal introspection, he and indeed Dr Roberts would more easily identify the GSSI as the true villain in this distortion.

Perhaps it is not surprising that a few months after the publication of that advertisement encouraging all athletes to drink “at least” 1200 ml/h “or your performance could suffer”, the 2002 Boston Marathon, a race for which Gatorade was the official sports drink, “suffered” the world's leading distinction of a 13% incidence of EAH at a marathon,⁶ including the death of Dr Cynthia Lucero apparently because she had “ingested too much Gatorade” according to a report of the official autopsy findings.⁷ One would presume that if the GSSI had been committed to avoiding EAH by warning runners in the USA not to overdrink, the incidence of EAH would have been nil in the Boston and other marathons, as is the case in marathons held in our respective countries, South Africa and New Zealand, and in which, for more than a decade, athletes have been specifically warned of the potentially fatal dangers of drinking “at least 40 oz of fluid every hour”.⁸,⁹,¹⁰

Indeed, given the resources available to the GSSI, it is remarkable how ineffective their educational programme has been, which has “annually produced and distributed educational materials that have gone directly to hundreds of thousands of marathoners, Ironman‐distance triathletes, and ultradistance competitors, the athletes most at risk of hyponatraemia”. Unless of course the focus of that material was not really to discourage athletes from overdrinking, Dr Murray cannot distort one decisive statistic: that only in the USA did the incidence of EAH reach epidemic proportions.⁹ Thus, any preventive interventions that the GSSI now wish to claim were utterly useless.

Dr Murray's next distortion is to state that one of us (TDN) cannot now criticise the 1996 ACSM drinking guidelines as he acted as a consultant to those guidelines. The reality, as described above, is that it was the GSSI that first distorted the ACSM message by encouraging athletes to drink “at least” 1200 ml/h (or according to the information provided by the GSSI to competitors at the 1999 Hawaiian Ironman Triathlon at rates of up to 2000 ml/h for “heavy sweaters”) without mentioning the provisos included in the ACSM guidelines and which TDN had approved. Perhaps TDN's sole error was that he incorrectly blamed the ACSM for a distortion perpetuated by the GSSI.

Elsewhere,¹¹,¹²,¹³,¹⁴ TDN has detailed the full extent of his current criticisms of the failings of the ACSM guidelines and of which he was unaware when he first reviewed those guidelines more than 10 years ago. In the context of this response, the major failing of the ACSM was that it did not discipline the GSSI when it began to distort their guidelines, including the erroneous claim⁵ that the ingestion of sports drinks can prevent the development of EAH. Nor did the ACSM do enough to aggressively warn the athletes of the dangers of overdrinking during exercise.

In his next distortion, Dr Murray accuses us of “unsubstantiated insinuations of impropriety”. We apparently implied that “members of the ACSM writing committee of the 1996 position stand were either duped or willingly forsook their professional integrity to please a corporate interest. This is a serious inference (etc)”. We have read and re‐read the article (as, obviously, did the legal advisors to the British Journal of Sports Medicine before its publication), and we are completely unable to find anything in the article that remotely supports Dr Murray's distortion. We merely pointed out that the ACSM had (until recently) only two platinum sponsors, Gatorade and the GSSI, and that the GSSI was very active in promoting the concept that athletes should drink “as much as tolerable” (as evidenced by their 2002 New York Runner advertisement and their advice to competitors in the 1999 Hawaiian Ironman Triathlon and presumably to competitors in other races as well). We also pointed out that a novel theory of thermoregulation during exercise has emerged in the period since Dr Cade developed Gatorade in 1965. Dr Murray's claim that we implied that all these resulted from the influence of the sports drink industry solely on a small cadre of scientists who advise the ACSM is a figment of his own highly creative thinking.

Of course, Dr Murray is one of the few people who knows the full extent (if any) of the financial interaction between Gatorade and the GSSI and those sports physicians and exercise scientists who serve those companies in a variety of roles and some of whom have occupied important leadership roles in the ACSM. Thus, it is only he, not we, who could ever provide that information. Given (1) the current concerns about the potential control that the pharmaceutical industry exerts over many influential scientists who compose guidelines influencing drug‐prescribing patterns which directly benefit the companies exerting those covert controls¹⁵,¹⁶,¹⁷ and (2) Dr Murray's assurance that the sports drink industry exerts no such covert influence, we believe that, in the interests of transparency, it would be desirable for the GSSI to indicate the extent to which those individuals, listed on the GSSI website as members of one or more of the seven GSSI advisory boards, as well as any others with whom the Institute works, benefit in any way from this relationship. As this group potentially forms one of the most influential groupings in the science of exercise, this information would be especially helpful in confirming publicly that its objectivity is beyond reproach. We are sure that Dr Murray, the GSSI and indeed the ACSM would welcome actions to effect this “burden of proof”, as DrMurray calls it or, as we prefer, the “burden of transparency”.

Finally, we are sincerely flattered that such an influential lobbyist should consider us so threatening to the interests of his company that, before the scientific community and all those with access to the internet, we must be dismissed as “painfully uninformed” scientists, who “stumble over basic thermoregulatory physiology”, who ignore “over 50 years of scientific endeavor”, who “enthusiastically manufacture” a “self‐professed claim of ‘case proven'” in an article which suffers from “an absence of novel finding (and) does not qualify as science”, which is also “rife with factual errors and unfounded inferences”, and which includes “blatant misrepresentation” and “unsubstantiated insinuations of impropriety” while presenting claims that are “ludicrous and without basis”. We especially appreciate his claims that it was our erroneous idea that dehydration makes “heat illness inevitable” and that the GSSI, not ourselves,⁵ was the creative force that developed the global consensus of the factors causing EAH. In the process, he skillfully projects us as two psychotic imposters who act without concern for either science or the welfare of athletes. Those who know us personally or who have studied our work⁸,⁹,¹⁰,¹¹,¹²,¹³,¹⁴,¹⁸,¹⁹,²⁰,²¹,²²,²³ will find all these claims absurd.

We are left to conclude that even Nick Naylor at his very best⁴ could not have crafted a more extraordinary work of fiction.