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Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis
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  • Published on:
    BMJ Open response to Prof Marcora

    The editors would like to thank Prof Marcora for his comments.

    We agree that Prof Noakes should have declared his involvement in the original conception and design of this study as a competing interest, and hence we invited Prof Noakes to submit a response on the article to explain his position as one of the three reviewers of the completed study. As stated in our previous response, we do not feel that Professor Noakes' involvement with the protocol has compromised the integrity of the peer review process.

    Professor Noakes has also commented further on his role in the protocol, which you can view at http://bmjopen.bmj.com/content/6/1/e009301.responses#my-contribution-to-....

    As an expert in the field, Professor Noakes has made a valuable contribution as a reviewer on this paper. We do not feel that the value of the review would be diminished had Professor Noakes mentioned his prior involvement with the study protocol.

    Conflict of Interest:
    I am the Editor of BMJ Open.
  • Published on:
    Clarification needed
    • Samuele M Marcora, Director of Research School of Sport and Exercise Sciences, University of Kent

    According to the publication record, Professor Noakes 1) drafted the manuscript describing the aims and protocol of the study, 2) contributed to the development of the selection criteria, the risk of bias assessment strategy and data extraction criteria, 3) read, provided feedback and approved the final manuscript. This is why he was included as an author in the first manuscript related to this study.

    Whether Professor Noakes requested not to contribute to the final manuscript reporting the results of this study, or he was not invited to contribute by his previous co-authors is totally irrelevant to the ethical issue raised in my initial response.

    Given how important this ethical issue is, it is quite discouraging that Professor Noakes thinks that there is no conflict of interest. So I ask the Editors of BMJ Open to clarify further their position in order to provide guidance for future reviewers reading this exchange:

    1) Do you think it was appropriate for Professor Noakes to accept to review the current manuscript despite being involved in significant components of the study, even if only "peripherally"?

    2) Although you have already made clear your position that Professor Noakes did (contrary to his response) have a conflict of interest, do you think that disclosing it would have made his contribution as a reviewer ethical and thus acceptable?

    Thank you

    Conflict of Interest:
    None declared.
  • Published on:
    I was not "withdrawn" as an author and there was no conflict of interest

    Dr Marcora writes that "withdrawing authorship from the manuscript reporting the results of the systematic review/meta-analysis is not enough to eliminate this conflict of interest... it seems that Professor Tim Noakes has not declared this potential conflict of interest".

    The facts of the matter are the following: I do not believe that I have any conflicts of interest as I was involved very peripherally in advising the authors about the original design of the study. I reviewed the original protocol and offered some comments of minor relevance, none of which materially altered the designed of the study.

    From that moment on I had nothing more to do with the study and no contact with the authors. Importantly I did not know the paper was being written and did not see the manuscript at any time until I was asked by the BMJ to act as a reviewer. The point is that I was not "withdrawn" as an author of this paper, nor did I voluntarily withdraw myself from the authorship. (Dr Marcora's less than subtle implication also implied rather more directly on social media (Twitter - @SamueleMarcora), might be that when the paper made a finding with which I disagreed, I asked to be "withdrawn" as an author). I simply never was considered to be an author of the work that was reported. In addition as I show below, despite disagreeing to some extent with the findings of the study, in the review process I welcome and supported its publication....

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    Conflict of Interest:
    I advocate the use of a low carbohydrate high fat diet for the management of insulin resistance/obesity/Type 2 diabetes mellitus. I have written 3 books on this topic - Real Meal Revolution; Raising Superheroes; and Lore of Nutrition. All explain why I believe as I do in the value of low carbohydrate diets for the management of conditions linked to insulin resistance.
  • Published on:
    Note from the Editor

    BMJ Open acknowledges the above response received from Prof Marcora. Having looked into the peer review history of the manuscript, we agree that Prof Noakes should have declared his involvement in the original conception and design of this study as a competing interest. We have invited Prof Noakes to submit a response on the article to explain his position. However we do not believe that this undisclosed competing interest has compromised the integrity of the peer review process, which involved two other reviewers.

    Conflict of Interest:
    I am an Assistant Editor for BMJ Open
  • Published on:
    Potential reviewer undeclared conflict of interest
    • Samuele M Marcora, Director of Research, School of Sport and Exercise Sciences University of Kent

    I am no expert in these matters, but I would think that being one of the original authors of this systematic review/meta-analysis

    (see Sartorius, B., Sartorius, K., Aldous, C., Madiba, T. E., Stefan, C., & Noakes, T. (2016). Carbohydrate intake, obesity, metabolic syndrome and cancer risk? A two-part systematic review and meta-analysis protocol to estimate attributability. BMJ open, 6(1), e009301 )

    is a conflict of interest when it comes to serve as a reviewer for the very same systematic review/meta-analysis. I feel that withdrawing authorship from the manuscript reporting the results of the systematic review/meta-analysis is not enough to eliminate this conflict of interest. In the documents available via the article info on the BMJ Open website, it seems that Professor Tim Noakes has not declared this potential conflict of interest.

    I would like the Editors of BMJ Open to provide some clarifications on this matter.

    Conflict of Interest:
    None declared.