Good Calories, Bad Calories

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 potentially biased” as well 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 well, 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 still 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 will 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 still do. Since the 1940s, nutritionists in academia had been encouraged to work closely with industry. In the 1960s, this collaborative relationship deteriorated, at least in public perception, into what Ralph Nader and other advocacy groups would consider an “unholy alliance.” It wasn’t always.

As Robert Olson explained at the time, he had received over the course of his career perhaps $10 million 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 call 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. All scientists need funds.”

Scientists were believed to be free of conflicts if their only source of funding was a federal agency, but all 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 will 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 parallel 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 Kellogg, 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 alliance 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 successfully 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.

Once politics, the public, and the press had decided on the benefits of low-fat diets, science was left to catch up. In the early 1970s, when NIH administrators opted to forgo a $1 billion National Diet-Heart Study that might possibly be definitive and to concentrate instead on a half-dozen studies, at a third of the cost, they believed the results of these smaller studies would be sufficiently persuasive to conclude publicly that low-fat diets would prolong lives. The results of these studies were published between 1980 and 1984.

Four of these studies tried to establish relationships between dietary fat and health within populations—in Honolulu, Puerto Rico, Chicago (Stamler and Shekelle’s second Western Electric study), and Framingham, Massachusetts. None of them succeeded. In Honolulu, the researchers followed seventy-three hundred men of Japanese descent and concluded that the men who developed heart disease seemed to eat slightly more fat and saturated fat than those who didn’t, but the men who died seemed to eat slightly less fat and slightly less saturated fat than those who didn’t. This observation was made in Framingham and Puerto Rico as well. In 1981, investigators from the three studies published an article in the journal Circulation discussing the problem. They said it posed a dilemma for dietary advice, but not an insurmountable one. The fact that the men in Puerto Rico and Honolulu who remained free of heart disease seemed to eat more starches suggested that it might be a good idea to recommend that we all eat more starch, as McGovern’s Dietary Goals actually had. And because the advice should never be to eat more calories, we would have to eat less fat to avoid gaining weight.

When one is reading this report, it’s hard to avoid the suspicion that once the government began advocating fat reduction in the American diet it changed the way many investigators in this science perceived their obligations. Those who believed that dietary fat caused heart disease had always preferentially interpreted their data in the