7. The many critical scientists
An excerpt from my previous book
The Cholesterol Myths (out of print).
Mary Enig is an international expert in the field of lipid biochemistry, a nutritionist and a Consulting Editor to a number of scientific publications, among others the Journal of the American College of Nutrition. She is also the President of the Maryland Nutritionists Association. She has published many scientific papers on the subject of food, nutrition topics, food fats and oils, several chapters on nutrition for books and a book about dietary fats, oils and cholesterol (90a). Her main research has concerned the hazards associated with eating too much trans fatty acids. In an interview she was asked if saturated fats cause heart disease: The idea that saturated fats cause heart disease is completely wrong, but the statement has been “published” so many times over the last three or more decades that it is very difficult to convince people otherwise unless they are willing to take the time to read and learn what all the economic and political factors were that produced the anti-saturated fat agenda. Read also hers and Sally Fallons paper The Oiling of America
Michael Gurr is an associate professor of biochemistry at the School of Biological & Molecular Sciences in Oxford, editor-in-chief of Nutrition Research Reviews and editor of three other scientific journals.Wrote Professor Gurr in his conclusion of a large review on the diet-heart idea (91): The arguments and discussion of the scientific evidence presented in this review will not convince those "experts" who have already made up their minds, for whatever reason, be it truly scientific or political, that a fatty diet is the cause of CHD [coronary heart disease]. However, I hope that some readers, who were, perhaps, unaware that the lipid hypothesis had any shortcomings, will have been persuaded that the relationships between the fats we eat and the likelihood that we may die from a heart attack is by no means as simple as these simplistic statements imply.
George Mann, now retired, was previously a professor in medicine and biochemistry at Vanderbilt University in Tennessee. From his studies of the Masai people (see section 3) he realized that diet couldn't possibly be the main cause of high cholesterol and coronary heart disease. As long ago as 1977, in The New England Journal of Medicine he published a strong argument against the diet-heart idea citing the lack of relationship between dietary habits and blood cholesterol, the lack of correlation between this century's trends in fat consumption and death rates in the United States, and the disappointing outcome of the cholesterol lowering trials (92).
After the start of the cholesterol campaign eight years later Mann summarized his criticism of the diet-heart idea in Nutrition Today (93). According to Mann, the diet-heart idea is the greatest scientific deception of our times. Mann is especially critical of the cholesterol-lowering trials. Never in the history of science have so many costly experiments failed so consistently, he declared.
Professor Mann also criticized the directors of the Lipid Research Clinics trial (LRC), the fundament of the cholesterol campaign. The unsupportive results from the LRC trial have not prevented them from bragging about this cataclysmic break-through, he wrote. And, he continued: The managers at the National Institutes of Health have used Madison Avenue hype to sell this failed trial in the way the media people sell an underarm deodorant. The Bethesda Consensus Panel ... has failed to acknowledge that the LRC trial, like so many before it, is saying firmly and loudly 'No, the diet you used is not an effective way to manage cholesterolemia or prevent coronary heart disease and the drug you so generously tested for a pharmaceutical house does not work either.
People who are faced with the many distorted facts about diet, cholesterol and heart disease often ask me why so many scientists unquestioningly accept the diet-heart idea. Here is Professor Mann's comment: Fearing to lose their soft money funding, the academicians who should speak up and stop this wasteful anti science are strangely quiet. Their silence has delayed a solution for coronary heart disease by a generation.
Professor Mann offers a little glimpse of hope at the end of his article in Nutrition Today (93): Those who manipulate data do not appreciate that understanding the nature of things cannot be permanently distorted - the true explanations cannot be permanently ignored. Inexorably, truth is revealed and deception is exposed. ...In due time truth will come out. This is the relieving grace in this sorry sequence.
Michael F. Oliver, a former professor and director of the Wynn Institute for Metabolic Research, London was one of the first to demonstrate that, on average, patients with coronary heart disease more often had abnomal levels of various fats in the blood than control individuals did. Professor Oliver still thinks that those with inherited diseases of cholesterol metabolism, or those at a very high risk for cardiovascular risk may benefit from cholesterol lowering, but in several papers he has warned against campaigns for cholesterol lowering in the general population: Doubts about the promotional nature of these campaigns are not popular. Doubters are scorned, although this does not matter. But the issue is a very serious one if vast sums are spent and widespread changes are made in the lifestyle of normal people when the accumulated evidence is that total mortality is unchanged or possibly even increased (94).
Again and again, Professor Oliver has criticized those who think that the increased mortality from non-medical causes seen in many trials is an effect of chance. Rather, he thinks, the very lowering of blood cholesterol may be dangerous: Very little is known about the long-term effects of lowering cholesterol concentrations on the composition of cell membranes (95).
According to Oliver our bodies may regulate attempts to lower blood cholesterol in most cases, but
...would such homoeostatic [regulatory] mechanisms be effective in all patients, at all times, and in all cells--particular cells in which biologic function is impaired for other reasons? These doubts will not go away for several more years? (95)
Edward R. Pinckney is an editor of four medical journals and former co-editor of JAMA, the Journal of the American Medical Association. In 1973, together with his wife, he published a book, called ”The Cholesterol Controversy” (97) which summarized all the inconsistencies of the cholesterol idea. Dr. Pinckney describes all the factors that influence blood cholesterol in healthy people and how difficult it is to get a reliable measure of the cholesterol level because of the uncertainties of the analysis: The level of one's blood cholesterol is, at best, nothing more than an extremely rough indication of a great many different disease conditions. At worst, it can be more the cause of stress and the diseases that stress brings on. To alter one's life style as a consequence of this particular laboratory test may well cause more trouble than it could relieve.
The start of chapter 1 in Pinckney´s book is worth citing: Your fear of dying--if you happen to be one of the great many people who suffer from this morbid preoccupation- may well have made you a victim of the cholesterol controversy. For, if you have come to believe that you can ward off death from heart disease by altering the amount of cholesterol in your blood, whether by diet or by drugs, you are following a regime that still has no basis in fact. Rather, you as a consumer, have been taken in by certain commercial interests and health groups who are more interested in your money than your life.
Raymond Reiser is a former professor of biochemistry at Texas A&M university. In 1973 he criticized the recommendations for dietary treatment of high cholesterol by declaring: The authority quoted by these authors for the recommendation is not a primary source but another review similar to their own. It is this practice of referring to secondary or tertiary sources, each taking the last on faith, which has led to the matter-of-fact acceptance of a phenomenon that may not exist. (98)
Here is another citation from Professor Reiser´s papers (99): One must be bold indeed to attempt to persuade large segments of the populations of the world to change their accustomed diets and to threaten important branches of agriculture and agribusiness with the results of such uncontrolled, primitive, trial and error type explorations. Certainly modern science is capable of better research when so much is at stake.
Paul Rosch is President of The American
Institute of Stress, Clinical Professor of Medicine and Psychiatry at New York
Medical College, Honorary Vice President of the International Stress Management
Association and Chairman of its U.S. branch. He is the editor or subeditor of
three well-known medical journals, he has been a member of the board of several
other journals, and has served as President of the New York State Society of
Internal Medicine, as Chairman of the International Foundation for
Biopsychosocial Development and Human Health, and has been an Expert Consultant
on Stress to the United States Center for Disease Control. He has written
extensively over the past forty-five years on the role of stress in health and
illness, with particular reference to cardiovascular disease and cancer.
He has appeared on numerous national and international television programs such
as The Today Show, Good Morning America, 60 Minutes, Nova, CBS, NBC, PBS, BBC
and CBC network presentations. His editorials and comments have been
published in every major medical journal. Professor Rosch has also been
interviewed and widely quoted in numerous major American newspapers and
As the author of the
Newsletter of the American Institute of Stress Professor Rosch has published
several articles about the cholesterol hypothesis and the diet-heart idea. His
conclusions are close to those presented in this book: A massive crusade has
been conceived to “lower your cholesterol count” by rigidly restricting
dietary fat, coupled with aggressive drug treatment. Much of the impetus for
this comes from speculation, rather than any solid scientific proof."
The result is
well-known, says Professor Rosch: The public is so brainwashed, that many
people believe that the lower your cholesterol, the healthier you will be or the
longer you will live. Nothing could be further from the truth.
How can this go on year after year? Professor Rosch has several explanations: The cholesterol cartel of drug companies, manufacturers of low fat foods, blood testing devices, and others with huge vested financial interests have waged a highly successful promotional campaign. Their power is so great that they have infiltrated medical and governmental regulatory agencies that would normally protect us from such unsubstantiated dogma.
Professor Rosch reminds us that
practicing physicians get most of their information from the drug companies. But
compared to their peers a half century ago, most doctors don’t have the time
or skills to critically evaluate reports, very few know anything about research,
nor did the generation that taught them.
Ray Rosenman is the retired Director of Cardiovascular Research in the Health Sciences Program at SRI International in Menlo Park, California, and associate chief of medicine, Mt Zion Hospital and Medical Center in San Francisco. Since 1950 he has been a cardiologist and a researcher. He has published four books and many text chapters and journal articles about cardiovascular diseases. His main interest has been the influence of neurogenic and psychological factors on the blood lipids (100), but he has also written reviews critical of the diet-heart idea.
Here is the conclusion from his most recent review: These data lead to a conclusion that neither diet, serum lipids, or their changes can explain wide national and regional differences of IHD [coronary heart disease] rates, or the variable 20th century rises and declines of CHD mortality. This conclusion is supported by the results of many clinical trials which fail to provide adequate evidence that lowering serum cholesterol, particularly by dietary changes, is associated with a significant reduction of IHD mortality or improved longevity. It is variously stated that the preventive effects of dietary and drug treatments have been exaggerated by a tendency in trial reports, reviews, and other papers to cite and inflate supportive results, while suppressing discordant data, and many such examples are cited (101).
Russell Smith was an American experimental psychologist with a strong background in physiology, mathematics and engineering. No review written by the proponents of the diet-heart idea are remotely comparable with Smith's books and papers (102) when it comes to scientific depth and completeness. Smith's summation is devastating for the diet-heart proponents: Although the public generally perceives medical research as the highest order of precision, much of the epidemiologic research is, in fact, rather imprecise and understandably so because it has been conducted principally by individuals with no formal education and little on-the-job training in the scientific method. Consequently, studies are often poorly designed and data are often imappropriately analyzed and interpreted. Moreover, biases are so commonplace, they appear to be the rule, rather than the exception. It is virtually impossible not to recognize that many researchers routinely manipulate and/or interpret their data to fit preconceived hypotheses, rather than manipulate hypotheses to fit their data. Much of the literature, therefore, is nothing less than an affront to the discipline of science.
Dr. Smith concludes: The current campaign to convince every American to change his or her diet and, in many cases, to initiate drug "therapy" for life is based on fabrications, erroneous interpretations and/or gross exaggerations of findings and, very importantly, the ignoring of massive amounts of unsupportive data...It does not seem possible that objective scientists without vested interests could ever interpret the literature as supportive.
Dr. Smith is aware that he is up against some extremely powerful institutions: The political and financial power of the NHLBI and AHA team...is enormous and without equal. And because the alliance has substantial credibility in the eyes of the public and most practicing physicians, it has become a juggernaut, able to use its power and prestige to suppress a great body of unsupportive evidence and even defy the most fundamental tool of scientists, logic.
The scientists who have produced the misleading papers and reviews are, of course, the first whom Smith faults. But he adds: Equally culpable are the editors of the many journals who publish articles without regard to their quality or scientific import. It is depressing to know that billions of dollars and a highly sophisticated medical research system are being wasted chasing windmills.
William E. Stehbens is a professor at the Department of Pathology, Wellington School of Medicine, and director of the Malaghan Institute of Medical Research in Wellington, New Zealand. Based on his own studies and on extensive reviews of the literature he has effectively demonstrated the many fallacies of the diet heart-idea. In a thorough review of the experimental studies he concluded: Upon examination of this evidence and consideration of the specific criteria for the experimental production of atherosclerosis, any pathologist of independent mind and free from preconceived ideas would conclude that human atherosclerosis and the lesions induced by the dietary overload of cholesterol and fats are not one and the same disease (103).
Professor Stehbens has also pointed out the weaknesses of the epidemiologic studies that have used mortality statistics as proof for causality: Continued, unquestioned use of unreliable data has led to premature conclusions and the sacrifice of truth. The degree of inaccuracy of vital statistics for CHD is of such uncertain magnitude that, when superimposed on other deficiencies already indicated, the concept of an epidemic rise and decline of CHD in many countries must be regarded as unproven, and governmental or health policies based on unreliable data become untenable (104).
According to Professor Stehbens atherosclerosis is due to wear and tear of the arteries, not to too much cholesterol in the blood, and he has many good arguments for this idea. The following words from a 1988 paper (105) summarize Stehbens' view on the diet-heart idea:
The perpetuation of the cholesterol myth and the alleged preventive measures are doing the dairy and meat industries of this and other countries much harm quite apart from their potential to endanger optimum nutrition levels and the health of the populace at large...It is essential to adhere to hard scientific facts and logic. Scientific evidence for the role of dietary fat and hypercholesterolemia in the causation of atherosclerosis is seriously lacking...The lipid hypothesis has enjoyed undeserved longevity and respectability. Readers should be aware of the unscientific nature of claims used to support it and see it as little more than a pernicious bum steer.
Lars Werkö was a professor of medicine at Sahlgren's Hospital, Gothenburg, Sweden, when he moved to become scientific director at the Astra Compagny. Later on he became head of the Swedish Council on Technology Assessment in Health Care, a governmental agency. Professor Werkö has been an opponent of diet-heart for many years. In 1976 he criticized the design in the large epidemiologic studies aimed at preventing coronary heart disease, most of all the Framingham study.
According to Professor Werkö (107) the dogm is based on questionable
"facts" rooted in hopes, wishful thinking and studies using selected materials:
No studies have proved anything, but instead of formulating new hypotheses diet-heart supporters call the current one the most probable truth, and they have intervened in people's lives because they will not wait for the final proof.
These were some of the most important criticists, but there are many more. Go to THINCS, The International Network of Cholesterol Skeptics
Some of my scientific papers about this and similar issues:
questionable role of saturated and polyunsaturated fatty acids in
cardiovascular disease. J Clin Epidemiol 1998;51:443-460.
Read also a dissent to the paper: Golomb BA. Dietary fats and heart
disease-dogma challenged? and my answer; same journal and same issue.
This paper won the Skrabanek award 1999
popular-scientific books, where you can read much more: