Good Calories, Bad Calories (12 page)

Having held one set of hearings before publishing the Dietary Goals, McGovern responded to the ensuing uproar with eight fol ow-up hearings. Among those testifying was Robert Levy, director of the National Heart, Lung, and Blood Institute, who said that no one knew whether lowering cholesterol would prevent heart attacks, which was why the NHLBI was spending several hundred mil ion dol ars to study the question. (“Arguments for lowering cholesterol through diet,” Levy had written just a year earlier, even in those patients who were what physicians would cal coronary-prone, “remain primarily circumstantial.”)

Other prominent investigators, including Pete Ahrens and the University of London cardiologist Sir John McMichael, also testified that the guidelines were premature, if not irresponsible. The American Medical Association argued against the recommendations, saying in a letter to the committee that

“there is a potential for harmful effects for a radical long term dietary change as would occur through adoption of the proposed national goals.” These experts were sandwiched between representatives from the dairy, egg, and cattle industries, who also vigorously opposed the guidelines, for obvious reasons. This juxtaposition served to taint the legitimacy of the scientific criticisms.

The committee published a revised edition of Dietary Goals later that year, but with only minor revisions. Now the first recommendation was to avoid being overweight. The committee also succumbed to pressure from the livestock industry and changed the recommendation that Americans “decrease consumption of meat” to one that said to “decrease consumption of animal fat, and choose meats, poultry, and fish which wil reduce saturated fat intake.”

The revised edition also included a ten-page preface that attempted to justify the committee’s dietary recommendations in light of the uproar that had fol owed. It included a caveat that “some witnesses have claimed that physical harm could result from the diet modifications recommended in this report….” But McGovern and his col eagues considered that unlikely: “After further review, the Select Committee stil finds that no physical or mental harm could result from the dietary guidelines recommended for the general public.” The preface also included a list of five “important questions, which are currently being investigated.” The first was a familiar one: “Does lowering the plasma cholesterol level through dietary modification prevent or delay heart disease in man?”

This question would never be answered, but it no longer seemed to matter. McGovern’s Dietary Goals had turned the dietary-fat controversy into a political issue rather than a scientific one, and Keys and his hypothesis were the beneficiaries. Now administrators at the Department of Agriculture and the National Academy of Sciences felt it imperative to get on the record.

At the USDA, Carol Foreman was the driving force. Before her appointment in March 1977 as an assistant secretary of agriculture, Foreman had been a consumer advocate, executive director of the Consumer Federation of America. Her instructions from President Jimmy Carter at her swearing-in ceremony were to give consumers a “strong, forceful, competent” spokeswoman within the USDA. Foreman believed McGovern’s Dietary Goals supported her conviction that “people were getting sick and dying because we ate too much,” and she believed it was incumbent on the USDA to turn McGovern’s recommendations into official government policy. Like Mottern and Hegsted, Foreman was undeterred by the scientific controversy. She believed that scientists had an obligation to take their best guess about the diet-disease relationship, and then the public had to decide. “Tel us what you know, and tel us it’s not the final answer,” she would tel scientists. “I have to eat three times a day and feed my children three times a day, and I want you to tel me what your best sense of the data is right now.”

The “best sense of the data,” however, depends on whom you ask. The obvious candidate in this case was the Food and Nutrition Board of the National Academy of Sciences, which determines Recommended Dietary Al owances, the minimal amount of vitamins and minerals required in a healthy diet, and was established in 1940 to advise the government on nutrition issues. The NAS and USDA drafted a contract for the Food and Nutrition Board to evaluate the recommendations in the Dietary Goals, according to Science, but Foreman and her USDA col eagues “got wind” of a speech that Food and Nutrition Board Chairman Gilbert Leveil e had made to the American Farm Bureau Federation and pul ed back. “The American diet,” Leveil e had said,

“has been referred to as…‘disastrous’…. I submit that such a conclusion is erroneous and misleading. The American diet today is, in my opinion, better than ever before and is one of the best, if not the best, in the world today.” NAS President Philip Handler, an expert on human and animal metabolism, had also told Foreman that McGovern’s Dietary Goals were “nonsense,” and so Foreman turned instead to the NIH and the Food and Drug Administration, but the relevant administrators rejected her overtures. They considered the Dietary Goals a “political document rather than a scientific document,”

Foreman recal ed; NIH Director Donald Fredrickson told her “we shouldn’t touch it with a ten-foot pole; we should let the crazies on the hil say what they wanted.”

Final y, it was agreed that the USDA and the Surgeon General’s Office would draft official dietary guidelines. The USDA would be represented by Mark Hegsted, whom Foreman had hired to be the first head of the USDA’s Human Nutrition Center and to shepherd its dietary guidelines into existence.

Hegsted and J. Michael McGinnis from the Surgeon General’s Office relied almost exclusively on a report by a committee of the American Society of Clinical Nutrition that had assessed the state of the relevant science, although with the expressed charge “not to draw up a set of recommendations.”

Pete Ahrens chaired the committee, along with Wil iam Connors of the University of Oregon Health Sciences Center, and it included nine scientists covering a “ful range of convictions” in the various dietary controversies. The ASCN committee concluded that saturated-fat consumption was probably related to the formation of atherosclerotic plaques, but the evidence that disease could be prevented by dietary modification was stil unconvincing.*15 The report described the spread of opinions on these issues as “considerable.” “But the clear majority supported something like the McGovern committee report,” according to Hegsted. On that basis, Hegsted and McGinnis produced the USDA Dietary Guidelines for Americans , which was released to the public in February 1980.

The Dietary Guidelines also acknowledged the existence of a controversy, suggesting that a single dietary recommendation might not be appropriate for an entire diverse population. But it stil declared in bold letters on its cover that Americans should “Avoid Too Much Fat, Saturated Fat, and Cholesterol.” (The Dietary Guidelines did not define what was meant by “too much.”)

Three months later, Philip Handler’s Food and Nutrition Board released its own version of the guidelines—Toward Healthful Diets. It concluded that the only reliable dietary advice that could be given to healthy Americans was to watch their weight and that everything else, dietary fat included, would take care of itself. The Food and Nutrition Board promptly got “excoriated in the press,” as one board member described it. The first criticisms attacked the board for publishing recommendations that ran counter to those of the USDA, McGovern’s committee, and the American Heart Association, and so were seen to be irresponsible. They were fol owed by suggestions that the board members, in the words of Jane Brody, who covered the story for the New York Times, “were al in the pocket of the industries being hurt.” The board director, Alfred Harper, chairman of the University of Wisconsin nutrition department, consulted for the meat industry. The Washington University nutritionist Robert Olson, who had worked on fat and cholesterol metabolism since the 1940s, consulted for the Egg Board, which itself was a USDA creation to sponsor research, among other things, on the nutritional consequences of eating eggs. Funding for the Food and Nutrition Board came from industry donations to the National Academy of Sciences. These industry connections were first leaked to the press from the USDA, where Hegsted and Foreman suddenly found themselves vigorously defending their own report to their superiors, and from the Center for Science in the Public Interest, a consumer-advocacy group run by Michael Jacobson that was now dedicated to reducing the fat and sugar content of the American diet. (As the Los Angeles Times later observed, the CSPI “embraced a low-fat diet as if it was a holy writ.”)

The House Agriculture Subcommittee on Domestic Marketing promptly held hearings in which Henry Waxman, chairman of the Health Subcommittee, described Toward Healthful Diets as “inaccurate and potential y biased” as wel as “quite dangerous.” Hegsted was among those who testified, saying

“he failed to see how the Food and Nutrition Board had reached its conclusions.”

Philip Handler testified as wel , summarizing the situation memorably. When the hearings were concluded, he said, the committee members might find themselves confronted by a dilemma. They might conclude, “as some have,” that there exists a “thinly linked, if questionable, chain of observations”

connecting fat and cholesterol in the diet to cholesterol levels in the blood to heart disease:

However tenuous that linkage, however disappointing the various intervention trials, it stil seems prudent to propose to the American public that we not only maintain reasonable weights for our height, body structure and age, but also reduce our dietary fat intakes significantly, and keep cholesterol intake to a minimum. And, conceivably, you might conclude that it is proper for the federal government to so recommend.

On the other hand, you may instead argue: What right has the federal government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence that it wil do them any good?

Mr. Chairman, resolution of this dilemma turns on a value judgment. The dilemma so posed is not a scientific question; it is a question of ethics, morals, politics. Those who argue either position strongly are expressing their values; they are not making scientific judgments.

Though the conflict-of-interest accusations served to discredit the advice proffered in Toward Healthful Diets, the issue was not nearly as simple as the media made it out to be and often stil do. Since the 1940s, nutritionists in academia had been encouraged to work closely with industry. In the 1960s, this col aborative relationship deteriorated, at least in public perception, into what Ralph Nader and other advocacy groups would consider an “unholy al iance.” It wasn’t always.

As Robert Olson explained at the time, he had received over the course of his career perhaps $10 mil ion in grants from the USDA and NIH, and $250,000 from industry. He had also been on the American Heart Association Research Committee for two decades. But when he now disagreed with the AHA recommendations publicly, he was accused of being bought. “If people are going to say Olson’s corrupted by industry, they’d have far more reason to cal me a tool of government,” he said. “I think university professors should be talking to people beyond the university. I believe, also, that money is contaminated by the user rather than the source. Al scientists need funds.”

Scientists were believed to be free of conflicts if their only source of funding was a federal agency, but al nutritionists knew that if their research failed to support the government position on a particular subject, the funding would go instead to someone whose research did. “To be a dissenter was to be unfunded because the peer-review system rewards conformity and excludes criticism,” George Mann had written in The New England Journal of Medicine in 1977. The NIH expert panels that decide funding represent the orthodoxy and wil tend to perceive research interpreted in a contrarian manner as unworthy of funding. David Kritchevsky, a member of the Food and Nutrition Board when it released Toward Healthful Diets, put it this way:

“The U.S. government is as big a pusher as industry. If you say what the government says, then it’s okay. If you say something that isn’t what the government says, or that may be paral el to what industry says, that makes you suspect.”

Conflict of interest is an accusation invariably wielded to discredit those viewpoints with which one disagrees. Michael Jacobson’s Center for Science in the Public Interest had publicly exposed the industry connections of Fred Stare, founder and chair of the department of nutrition at Harvard, primarily because Stare had spent much of his career defending industry on food additives, sugar, and other issues. “In the three years after Stare told a Congressional hearing on the nutritional value of cereals that ‘breakfast cereals are good foods,’” Jacobson had written, “the Harvard School of Public Health received about $200,000 from Kel ogg, Nabisco, and their related corporate foundations.” Stare defended his industry funding with an aphorism he repeated often: “The important question is not who funds us but does the funding influence the support of truth.” This was reasonable, but it is always left to your critics to decide whether or not your pursuit of truth has indeed been compromised. Jeremiah Stamler and the CSPI held the same opinions on what was healthy and what was not, and Stamler consulted for CSPI, so Stamler’s al iance with industry—funding from corn-oil manufacturers—was not considered unholy. (By the same token, advocacy groups such as Jacobson’s CSPI are rarely if ever accused of conflicts of interest, even though their entire reason for existence is to argue one side of a controversy as though it were indisputable. Should that viewpoint turn out to be incorrect, it would negate any justification for the existence of the advocacy group and, with it, the paychecks of its employees.) When I interviewed Mark Hegsted in 1999, he defended the Food and Nutrition Board, although he hadn’t done so in 1979, when he was defending his own report and his own job to Congress. In 1981, when the Reagan administration closed down Hegsted’s Human Nutrition Center at the USDA and found no further use for his services, Hegsted returned to Harvard, where the research he conducted until his retirement was funded by Frito-Lay. By that time, the controversy over the Food and Nutrition Board’s conflicts of interest had successful y discredited Toward Healthful Diets, and Hegsted’s Dietary Guidelines for America had become the official government statement on the dangers of fat and cholesterol in our diet.