rgely aligned. Indeed, a side-by-side comparison of overlapping text from the ISRF submission to the NIDR, Dental Caries Research—1969 , and the 1971 NCP RFC, Opportunities for Participation in the National Caries Program , reveals that 78% of the ISRF submission to the NIDR was directly incorporated into the 1971 NCP RFC. (S1 Table provides the actual text from the ISRF submission and 1971 NCP RFC.) Of the 274 total lines in the 1971 NCP RFC describing research priorities, 110 lines, or 40%, were taken verbatim or closely paraphrased from the ISRF submission. Of these 110 lines, 34% were copied verbatim from the ISRF report, and 66% were paraphrased.
This study analyzes a series of papers discussing previously undocumented cane and beet sugar industry activities between 1959 and 1971 regarding strategies to influence the research priorities of the NIDR’s 1971 NCP. The documents show that the sugar industry knew that sugar caused dental caries as early as 1950 and did not attempt to deny the causative role of sucrose in tooth decay. Instead, through trade associations, the sugar industry adopted a strategy to deflect attention to public health interventions that would reduce the harm of sugar consumption, rather than restricting intake.
After the NIDR announced it was considering a research program to eradicate dental caries in 1966, the sugar industry used tactics designed to protect sucrose sales. In collaboration with the chocolate and confectionary industries, SRF funded research that supported the idea that enzymes and a tooth decay vaccine could be developed that could eradicate dental decay without requiring sugar restrictions. ISRF conducted reviews of the dental caries literature to identify potential interventions that might reduce the health harms of sugar consumption other than by restricting sugar intake. ISRF cultivated relationships with the NIDR leadership through meetings with the Caries Task Force chairman and through a consultation with members of the NCP steering committee charged with selecting research priorities. A sugar industry report submitted to the NIDR became the basis for the research priorities published in the first NCP RFC.
While not officially recognized as participating in the NIDR Caries Task Force, the sugar industry effectively contributed to the research priorities developed for the launch of the NCP. Research priorities identified in the first NIDR NCP RFC focused on sugar harm reduction strategies, as opposed to sugar restriction, and were strongly aligned with sugar industry research priorities. The NIDR, like ISRF, took the position that sugar restriction was impractical.
The first policies related to the declaration of conflicts of interest for federal advisory committees were implemented in the early 1960s . Prior to that, concern that industry interests were a threat to scientific integrity was not a majority view . Significant consumer concern about corporate influence on expert committees would not surface until the 1970s, after the launch of the NCP. By contrast, in 2015, the NIH had an entire program dedicated to ethical contact within its institutes  because of the greater awareness of industry conflicts of interest and how they can adversely impact the scientific enterprise.
The 1970s Missed Opportunity
The majority of the research priorities promoted by the sugar industry and those selected for the 1971 NCP RFC failed to lead to widespread application . By 1976, clinical studies of dextranase mouth rinses in humans had failed to duplicate the success of using dextranases to inhibit new dental caries in experimental animals . The NIDR found that the pharmaceutical industry had limited interest in research, development, and distribution of antimicrobial agents, because of the high cost of regulatory approval by the Food and Drug Administration (FDA) and doubts about identifying an agent that would be successful on a large scale . By 1977, NCP researchers had found that their plan to substitute sucrose with a mixture of glucose and fructose “would effect little reduction 