it’s time to retract the 2019 global burden of disease risk factor study

An open letter to Professor Richard Horton, Editor, The Lancet

Dear Professor Horton,

In an era of global malnutrition, food insecurity, and a misinformation, there’s a growing need for evidence-based solutions. The public relies on accurate information regarding nutrient-rich foods, especially when it comes to the critical role red meat plays in the diet, and the ideological bias many have against consuming it.

The Global Food Justice Alliance is incredibly concerned about the response to questions recently raised about the 2019 Global Burden of Disease (GBD) Risk Factors study, published in The Lancet.

A published letter from a group of highly respected health and nutrition academics asked why the study showed a 36-fold increase in global deaths attributed to eating red meat. The response to this letter from the GBD collaborators included as admissions of errors, inaccuracies and unreliability.

Additionally, in their letter, the academics asked for clarification that the evidence published in The Lancet satisfies both the PRISMA (Transparent Reporting of Systematic Reviews and Meta-Analyses) and GATHER (Guidelines for Accurate and Transparent Health Estimates Reporting) protocols and that all supporting data were published on a peer review basis. To date, no such evidence has been presented to justify the nearly 36-fold increase in deaths attributed to “diets high in red meat”.

Furthermore, the 2019 GBD authors reduced the TMREL (Theoretical Minimum Risk Exposure Level) from 22.5g of red meat per day to 0g of red meat per day. As stated in the recently Lancet published letter of concern from representatives of the World Cancer Research Fund (WCRF) International and the Academy of Nutrition Sciences, “We support Stanton and colleagues’ call for further clarification, justification, or reconsideration of the TMREL of zero for unprocessed red meat selected by GBD in their latest estimates.” They also state that “Neither WCRF nor other international organisations recommend complete avoidance of meat” and that “The absence of an explicit rationale for the assumptions underlying the GBD estimates is troublesome, unsupported by the evidence, and unrealistic.”

The very authors of the study acknowledged there is a clear protective relationship between red meat intake and haemorrhagic stroke, which will be reflected in the findings of a soon to be published 2020 update, and they have also admitted zero deaths can be attributable to anyone below the age of 25.

Red meat also plays a key role in protecting people from additional deaths and illnesses, from iron deficiency anaemia, sarcopenia, and child and maternal malnutrition.

The Lancet has a responsibility to ensure that the global health estimates are error free and are rigorously and transparently evidence-based. But the existing, incorrect data can – and has already begun to – have an impact on the formation of food policies and cause reputational damage to meat and its role in human nutrition for millions of families around the world who require the nutrients in red meat.

According to The Lancet’s guidelines, the Committee on Publication Ethics (COPE), and the Committee of Medial Journal Editors (ICMJE), immediate correction of the errors is required. Additionally, the GBD 2019 risk factor study authors are either unwilling or unable to provide peer-reviewed evidence to substantiate the conclusions of their paper. Therefore, in accordance with COPE and ICMJE guidelines, an immediate retraction of the publication should occur.

If retraction of the GBD 2019 publication does not rapidly occur, it certainly would give the impression that The Lancet applies different standards to GBD manuscripts than it applies to other submissions, ignoring the need for transparency, justification, and PRISMA compliance? Given the acknowledgement of inaccuracies, absence of evidence, and the authors’ commitment to publishing an updated version, we are surprised and concerned that the old, incorrect study is still published on The Lancet website. We strongly urge you to please consider retracting it with the upmost urgency. Failure to do so undermines not only the GBD but the entire editorial team at The Lancet.

Yours sincerely,

Diana Rodgers, Registered Dietitian

Executive Director, Global Food Justice Alliance