Clearing Away the Rubbish

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue”
~Richard Horton, editor in chief of The Lancet

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor”
~Dr. Marcia Angell, former editor in chief of NEJM

Back in September, there was a scientific paper published in Clinical Cardiology, a peer reviewed medical journal that is “an official journal of the American Society for Preventive Cardiology” (Wikipedia). It got a ton of attention from news media, social media, and the blogosphere. The reason for all the attention is that, in the conclusion, the authors claimed that low-carb diets had proven the least healthy over a year period:

“One-year lowered-carbohydrate diet significantly increases cardiovascular risks, while a low-to-moderate-fat diet significantly reduces cardiovascular risk factors. Vegan diets were intermediate. Lowered-carbohydrate dieters were least inclined to continue dieting after conclusion of the study. Reductions in coronary blood flow reversed with appropriate dietary intervention. The major dietary effect on atherosclerotic coronary artery disease is inflammation and not weight loss.”

It has recently been retracted and it has come out that the lead author, Richard M. Fleming, has a long history of fraud going back to 2002 with two FBI convictions of fraud in 2009, following his self-confession. He has also since been debarred by the U.S. Food and Drug Administration. (But his closest brush with fame or infamy was his leaking the medical records of Dr. Robert Atkins, a leak that was behind a smear campaign.) As for his co-authors: “Three of the authors work at Fleming’s medical imaging company in California, one is a deceased psychologist from Iowa, another is a pediatric nutritionist from New York and one is a Kellogg’s employee from Illinois. How this group was able to run a 12-month diet trial in 120 subjects is something of a mystery” (George Henderson). Even before the retraction, many wondered how it ever passed peer-review considering the low quality of the study: “This study has so many methodological holes in it that it has no real value.” (Low Carb Studies BLOG).

But of course, none of that has been reported as widely as the paper originally was. So, most people who read about it still assume it is valid evidence. This is related to the replication crisis, as even researchers are often unaware of retractions, that is when journals will allow retractions to be published at all, something they are reluctant to do because it delegitimizes their authority. So, a lot of low quality or in some cases deceptive research goes unchallenged and unverified, neither confirmed nor disconfirmed. It’s rare when any study falls under the scrutiny of replication. If not for the lead author’s criminal background in the Fleming case, this probably would have been another paper that could have slipped past and been forgotten or else, without replication, repeatedly cited in future research. As such, bad research builds on bad research, creating the appearance of mounting evidence, but in reality it is a house of cards (consider the takedown of Ancel Keys and gang in the work by numerous authors: Gary Taubes’ Good Calories, Bad Calories; Nina Tiecholz’s The Big Fat Surprise; Sally Fallon Morrell’s Nourishing Diets; et cetera).

This is why the systemic problem and failure is referred to as a crisis. Fairly or unfairly, the legitimacy of entire fields of science are being questioned. Even scientists no longer are certain which research is valid or not. The few attempts at determining the seriousness of the situation by replicating studies has found a surprisingly low replication rate. And this problem is worse in the medical field than in many other fields, partly because of the kind of funding involved and more importantly because of how few doctors are educated in statistics or trained in research methodology. It is even worse with nutrition, as the average doctor gets about half the questions wrong when asked about this topic, and keep in mind that so much of the nutritional research is done by doctors. An example of problematic dietary study is that of Dr. Fleming himself. We’d be better off letting physicists and geologists do nutritional research.

There is more than a half century of research that conventional medical and dietary opinions are based upon. In some major cases, re-analysis of data has shown completely opposite conclusions. For example, the most famous study by Ancel Keys blamed saturated fat for heart disease, while recent reappraisal has shown the data actually shows a stronger link to sugar as the culprit. Meanwhile, no study has ever directly linked saturated fat to heart disease. The confusion has come because, in the Standard American Diet (SAD), saturated fat and sugar have been conflated in the population under study. Yet, even in cases like that of Keys when we now know what the data shows, Keys’ original misleading conclusions are still referenced as authoritative.

The only time this crisis comes to attention is when the researcher gets attention. If Keys wasn’t famous and Fleming wasn’t criminal, no one would have bothered with their research. Lots of research gets continually cited without much thought, as the authority of research accumulates over time by being cited which encourages further citation. It’s similar to how legal precedents can get set, even when the initial precedent was intentionally misinterpreted for that very purpose.

To dig through the original data, assuming it is available and one knows where to find it, is more work than most are willing to do. There is no glory or praise to be gained in doing it, nor will it promote one’s career or profit one’s bank account. If anything, there are plenty of disincentives in place, as academic careers in science are dependent on original research. Furthermore, private researchers working in corporations, for obvious reasons, tend to be even less open about their data and that makes scrutiny even more difficult. If a company found their own research didn’t replicate, they would be the last in line to announce it to the world and instead would likely bury it where it never would be found.

There is no system put into place to guard against the flaws of the system itself. And the news media is in an almost continual state of failure when it comes to scientific reporting. The crisis has been stewing for decades, occasionally being mentioned, but mostly suppressed, until now when it has gotten so bad as to be undeniable. The internet has created alternative flows of information and so much of the scrutiny, delayed for too long, is now coming from below. If this had happened at an earlier time, Fleming might have gotten away with it. But times have changed. And in crisis, there is opportunity or at very least there is hope for open debate. So bring on the debate, just as soon as we clear away some of the rubbish.

* * *

Retracted: Long‐term health effects of the three major diets under self‐management with advice, yields high adherence and equal weight loss, but very different long‐term cardiovascular health effects as measured by myocardial perfusion imaging and specific markers of inflammatory coronary artery disease

The above article, published online on 27 September 2018 in Wiley Online Library (, has been withdrawn by agreement between the journal Editor in Chief, A. John Camm and Wiley Periodicals, Inc. The article has been withdrawn due to concerns with data integrity and an undisclosed conflict of interest by the lead author.

A convicted felon writes a paper on hotly debated diets. What could go wrong?
by Ivan Oransky, Retraction Watch

Pro-tip for journals and publishers: When you decide to publish a paper about a subject — say, diets — that you know will draw a great deal of scrutiny from vocal proponents of alternatives, make sure it’s as close to airtight as possible.

And in the event that the paper turns out not to be so airtight, write a retraction notice that’s not vague and useless.

Oh, and make sure the lead author of said study isn’t a convicted felon who pleaded guilty to healthcare fraud.

“If only we were describing a hypothetical.

On second thought: A man of many talents — with a spotty scientific record
by Adam Marcus, Boston Globe

Richard M. Fleming may be a man of many talents, but his record as a scientist has been spotty. Fleming, who bills himself on Twitter as “PhD, MD, JD AND NOW Actor-Singer!!!”, was a co-author of short-lived paper in the journal Clinical Cardiology purporting to find health benefits from a diet with low or modest amounts of fat. The paper came out in late September — just a day before the Food and Drug Administration banned Fleming from participating in any drug studies. Why? Two prior convictions for fraud in 2009.

It didn’t take long for others to begin poking holes in the new article. One researcher found multiple errors in the data and noted that the study evidently had been completed in 2002. The journal ultimately retracted the article, citing “concerns with data integrity and an undisclosed conflict of interest by the lead author.” But Fleming, who objected to the retraction, persevered. On Nov. 5, he republished the study in another journal — proving that grit, determination, and a receptive publisher are more important than a spotless resume.

10 thoughts on “Clearing Away the Rubbish

  1. A response to a post at another blog:

    “The causes of this anger come easily to mind; loved ones lost through the denial of adequate medical care caused by the pursuit of quack remedies, and the crushing despair that follows false hope… The people who promote the claims we skeptics oppose sometimes get angry as well, but with much less real moral justification – they are angry because skeptics are… reducing their clientele for whatever untested or failed “alternative” medical modalities they promote.”

    There is that. My grandmother died from cancer. It’s uncertain what might have been the outcome had it been treated, but we’ll never know. She instead chose to do a macrobiotic diet and new age practices, specifically Science of Mind “mind treatments”. My dad talks about how much faith she had that she could overcome her illness and how the failure put her in a bad place for the brief time she had left. That demonstrates what you’re talking about. On the other hand, the mainstream medical field has had many areas of failure that have caused many to mistrust it, often because lack of skepticism among defenders of the status quo or else defenders of what is profitable. Consider antidepressants that have been pushed for longer than I’ve been alive, but recent meta-analysis shows that they are unhelpful for most people they are being prescribed to (and with serious side effects that can actually harm health). There is immense money to be made in doling out drugs to the mentally ill. Other methods of treatment aren’t nearly as profitable because they are not as easily made into a marketable product. There has been much reporting on the influence of pharmaceutical lobbyists and representatives.

    Diet and nutrition is another contested area. One survey showed that most doctors lacked basic knowledge about nutrition. That is unsurprising as it hasn’t been a priority in medical schools. Yet doctors regularly act as experts on nutrition and many people trust their supposed expertise. The problem goes much deeper than this, though. The official dietary recommendations was largely based on speculation and low-quality research that came to be treated as fact, even though there was other research at the time that pointed to entirely different conclusions. There is a number of contributing factors. For some decades now, it has been known that a replication crisis is plaguing diverse fields of scientific research. Nutrition research has been a major victim of this scientific failure, not that it is alone in this. The problem for this field is that much of the research is done by doctors, but as with education in nutrition most doctors never received much education in statistics and research methodology. Few doctors are trained researchers and so the field is rife with badly designed studies and poorly analyzed data.

    This has allowed for particular dietary ideologies to dominate for the past few generations. Some insightful and detailed science journalism about this has been done by Nina Teicholz and Gary Taubes. What went wrong with this field goes beyond mere strong opinions. There were some charismatic and influential figures in the field, e.g., Ancel Keys, who came to have outsized influence over public debate and public policy. Many critics, even when they had the science on their side, were silenced or became excluded, such as not being invited to speak at scientific conferences, not being able to get funding for research, and not being published in the best journals. This failure was made possible partly because of the limitation of early nutrition research. It heavily depended on epidemiological studies which look for associations but can’t easily control for confounding factors. So, for example, Ancel Keys began with the hypothesis that saturated fat was to blame for heart disease, went looking for information that confirmed his beliefs while ignoring what contradicted it, but even then his own data (as later re-analyzed) always had shown that sugar was the stronger correlation than saturated fat. Nutrition research still largely relies on this weak form of evidence that easily falls prey to bias.

    It’s not limited to dietary issues either, but I would point to another area that overlaps with nutrition research. There has been a contentious debate over statins, involving side effects and overprescription. After decades of the pro-statin camp controlling the conventional views in medicine, two respected peer-reviewed British medical Journals, the Lancet and BMJ, are now in the middle of a fight over this issue. Teicholz was drawn into it when she published an article in the BMJ. The disagreement is not only about statins themselves but also about what we scientifically know about cholesterol and its role in health. Because of the replication crisis, there has been much muddying of the water. In 2005, the standards for research were improved and that seems to have been the turning point, as most studies since then have supported the position of the statin skeptics. Yet the older and more well-established research, although lower quality, continues to hold powerful sway in the research community.

    On a positive note, after about a half century of suppression of alternative views within these areas of research, lively debate has been reawakened. A large part of this had to do with the internet which has given a platform for dissenting and skeptical voices. It’s much more difficult to silence scientific researchers and academic experts who refuse to toe the line. Also, the evidence in support of the alternative views keeps accumulating and has come to a point where it is harder to ignore, even though much of the evidence has been around since the early 20th century and in some cases earlier than that. An example of this is the ketogenic diet. It was originally researched for epileptic seizures back in the 1920s. Then studies looked into its use for diabetes shortly after that. But when medications were discovered and marketed for both conditions, the funding for research dried up. This is in spite of the fact that the medications were never as effective in comparison. To this day, the ketogenic diet remains one of the most effective treatments for both of these conditions, but there simply is no profit to be made in it. What helped turn the tide was when a Hollywood filmmaker got involved because of his son’s epilepsy. He discovered the ketogenic diet in the medical literature and, after successfully treating his son, started the Charlie Foundation in 1994. His advocacy jumpstarted ketogenic research after decades of barely getting any attention. It has since grown into a major area of medical knowledge, having been studied with numerous physical and mental conditions.

    The challenge is that no one has sole rights to skepticism. Those defending the status quo often claim to be the skeptics and they simultaneously often have the most influence over public perception of how views are perceived. The most skeptical voices sometimes get portrayed as the complete opposite for anyone who advocates an alternative view is easily painted as an ideologue, whereas those defending mainstream ideology are of course merely being reasonable or that is how they perceive themselves. To understand genuine skepticism requires taking the long view. Also, it’s important that we be skeptical, even of our own self-identified skepticism. Skepticism isn’t a single position but a contested battleground. And the fight isn’t always fair. Future generations will probably be better judges of this.

    • As seen in the below pingback, Troythulu finally got around to replying to my comment. He wouldn’t allow my skepticism of his skepticism, the original comment above, to be posted on his blog and so I put it here. His response is what I expected. He sounds defensive and I could respond in kind, but I don’t feel like it, as that kind of engagement sounds depressing and tiresome. I’ve known him for a number of years now and I know he is a good person and means well. It’s understandable that he would be defensive, as my original comment was highly critical. Even though the criticisms I made were general, it would be natural for him to take them as personal.

      I admit that I grow tiresome of selective skepticism, specifically that which is consistently a knee-jerk defense of mainstream conventional thought. To my mind, that is groupthink, not skepticism. It’s not that, in reaction, I automatically fall into the opposite camp. I follow the evidence where it leads. But no well informed person could talk about psychiatric meds, diet/nutrition, conspiracies, etc without realizing the establishment view is often far off from the evidence. Troythulu is well versed in logic and cognitive biases, but he doesn’t come across as widely informed beyond a few areas such as his study of languages. That is fine, since no one knows everything. The irritating part is that he doesn’t admit to what he doesn’t know in these other areas. His ideological identity as a ‘skeptic’ sometimes trumps basic intellectual humility and curiosity. In theory, he admits that no one is perfect, but that theory doesn’t always apply to actual disagreements when he feels polarized into a strong position for whatever reason.

      Let me bring up my own radical variety of skepticism, as discussed in my original comment. I mentioned the example of the ketogenic diet, something that has been widely researched for a century and yet many doctors still ignorantly speak of ketoacidosis and fear-monger about long-term dangers, which is simply inexcusable. Most doctors never learned much about diet and nutrition. Being mainstream doesn’t give them magical access to knowledge they never learned. Sadly, that doesn’t stop them from acting as expert authorities on diet and nutrition. Sure, trust doctors in the areas they are educated and informed, but realize that might be rather narrow. The things is, if you read authors like Gary Taube and Nina Teicholz, Tim Noakes and Richard David Feinman, you quickly realize that the dominant paradigm in nutritional science was never based on science itself, as the ideology preceded the research and the research never showed what it claimed to have proven. It wasn’t so much science as government policy that pre-empted science, shut down debate, and silenced opposition.

      I noticed an example of pseudo-skepticism on the so-called “Rational Wiki”, as similarly found on Wikipedia as well. There is an automatic dismissal of any dietary and nutritional views that don’t fall in line with government policy, as if government is the final arbiter of science and skepticism. If they truly believe that, they are naive and gullible beyond belief. Otherwise, I must assume they are serving some kind of agenda, either personal or in working for some organization that benefits from the business of big ag, big food, etc. There has been a concerted effort to put out disinformation and muddy the water, whatever is motivating the people behind it.

      Take the hit piece titled “Statin denialism”:
      The piece was dismantled on the talk page. Listed on the main page are professors and scientific researchers who are leading experts in their respective scientific fields, along with award-winning science journalists, who are collectively dismissed by the anonymous wiki editors as “statin denialists”, a false and misleading straw man argument and ad hominem attack. The article demonstrates a profound dishonesty that is breath-taking. The Rational Wiki presents itself as a leading source of skepticism on the internet. Yet how easily such things become co-opted for ulterior motives. If you look at the talk page, you’ll see this simple comment and reference that undermines the entire article:

      If cholesterol truly caused heart disease, the cholesterol lowering drugs should reduce mortality rates. A review of 29 randomized controlled trials, showed that 93% of the trials showed no benefit in mortality.
      “The table summarizes 29 major RCTs of cholesterol reduction reported after the publication of these regulations (Table). Notably, only 2 of these 29 studies reported a mortality benefit, while nearly two-thirds reported no cardiovascular benefit at all. These unfavorable outcomes and inconsistent results suggest that the lipid hypothesis has failed the test of time. ”

      As another example, there is the article about James DiNicolantonio:
      Although not listed on the “Statin denialism” article, he is described as a “cholesterol denialist” with a hyperlink to the other article. This conflation of language and willful ignorance was pointed out on the talk page of the “Statin denialism” piece. Consider who is being so casually dismissed by these internet trolls portraying themselves as ‘skeptics’.

      DiNocoloantonio is the author of several popular books about the scientific field that is his area of professional expertise. As a cardiovascular research scientist and doctor of pharmacy at Saint Luke’s Mid America Heart Institute, he is the author or co-author of over 200 medical publications and serves as the Associate Editor of British Medical Journal’s (BMJ) Open Heart, a journal published in partnership with the British Cardiovascular Society. In case you didn’t know, the British Medical Journal is one of the leading medical journals in the world. Driven by newer and better quality research, there is a still ongoing scientific debate about cholesterol and statins in the BMJ and The Lancet that is shaking up the earlier consensus. DiNicolantonio isn’t a random person writing about his opinions. He is a respectable and well known expert in this field.

      Here are some other examples of this pseudo-skepticism about low-carb diets and the cholesterol debate:

      Yet to Troythulu, this questioning of conventional thought and its egregiously biased defenders makes me an anti-intellectual conspiracy theorist, in what he portrays as a silly obsession with “ebil conspiraciez” to be dismissed out of hand because he simply knows what is true without having to research it. He misdirects with childish talk about not getting his payment for being a ‘shill’. I never called him a shill, as I have never thought of him that way nor would I ever imply such a thing. That is plain bizarre and not the kind of lazy rhetoric I would have ever expected from him. It makes me feel sad because I thought he was the kind of person who would put his skepticism above the personal, but his response came across as yet more pseudo-skeptical dismissiveness in seeing me as an adversary to be dealt with, not as a fellow human being with a mutual interest in skepticism. All I was looking for was honest dialogue, but maybe I shouldn’t be surprised. This isn’t the first time I’ve disagreed with Troythulu. And it isn’t the first time I’ve been skeptical of his skepticism. I did a thorough analysis of his views on conspiracy theories a while back:

      He never acknowledged that I demonstrated his position was unjustified according to the evidence, of which I provided a wide survey. He never admitted he was wrong in that particular case nor attempted a counter-argument if he wished to stand by his original position, although he was honest enough to allow my pingback to be posted on his blog. I won’t claim his skepticism in general is without merit as most of the time his skepticism is reasonable and fair-minded, but like any of us he has his blind spots. As it seems to me, he too often assumes the dominant paradigm is true until proven false, as if scientific reality were mandated by a real or perceived ‘consensus’, even when the dominant paradigm never proved itself to be true in the first place. To put it simply, he gives the benefit of the doubt to establishment thought and the status quo. But why should we accept conventional thought as true simply because that is what is believed by those with power or influence to enforce their views and to shape public perception? An appeal to authority is not skeptical, especially when one cherry picks the authorities who conform to one’s beliefs while dismissing all other authorities that are inconveniently challenging.

      Yes, there are areas of strong consensus that are undeniable, such as in climate change, but there are other areas that are highly contested and that was the focus of my concern. As a self-proclaimed skeptic, that should also be a concern to Troythulu. So, why does he portray me as being anti-science in my being skeptical of low quality scientific research and contested areas of scientific debate? Why attack my person rather than engage with my arguments and the evidence I present? Despite all of that, I agree with much of what he said in his response to me. The main problem is it is mostly irrelevant to my original comment. It’s as if he thought I needed to be chided and put back in my place. I would have rather had a friendly conversation, one human being to another, as we surely agree about more than we disagree.

    • Some defenders of science believe that consensus among experts is always the result of well functioning scientific method and scientific debate. Or if it isn’t always, the rare cases when its not are temporary glitches in an otherwise rational process. In line with diet and health, let me throw some doubt on that fantasy.

      Science may be self-correcting, but when a paradigm dominates that self-correction might take generations or longer. Bad science and practices can have a way of persisting, even when the supposed experts should know better:

      Dietary ideology dogmatically was enforced on the fields of nutrition and medicine for about a half century. There was little self-correction going on during that period. Even now, other views are dismissed as fringe or as fad diets, despite the accumulating evidence in their favor (even the ketogenic diet gets dismissed, a diet that has been medically studied and clinically used for a century). Also, we know that there were powerful and wealthy interests that helped cause this. Government involvement helped to control and determine this field of science. Corporations and lobbyist groups also had immense sway.

      As one example among many, consider the link of the sugar industry and Harvard researchers that shifted blame to saturated fat:
      We know from more recent examples that scientists paid by corporations will promote their products and sometimes even edit their research papers at the request of same corporate interests:
      View at

      If you want to see more examples of corporate and other influences in this areas of science, read Gary Taubes, Nina Teicholz, Joanna Blythman, Marion Nestle, etc. But none of this should be surprising. There is a long and well-documented history of this kind of thing. No skeptic worthy of the name has an excuse to be ignorant of this kind of thing. But if one does find oneself ignorant, let me offer an opportunity for education — below is a passage from a book about this exact topic, a passage that I previously shared in another post (the author, by the way, advocates a different dietary approach than I follow, but we both agree on the problems of nutritional science):

      Unsavory Truth
      by Marion Nestle
      pp. 108-113

      [US senator William] Proxmire was right about the [National Academy of Science’s Food and Nutrition] board’s ties to industry. Those were revealed in 1980 during a dispute over the first edition of the US dietary guidelines, which advised reductions in intake of fat, saturated fat, and cholesterol (meaning, in effect, meat, dairy, and eggs) to reduce the risk of heart disease. The board opposed the guideline so vehemently that it issued a counter-report, Toward Healthful Diets, arguing that fat restrictions were unnecessary for healthy people. This infuriated health advocates, who charged that at least six board members had financial ties to industries most affected by the guidelines. Sheldon Margen, a professor of public health at the University of California, for example, objected that “the board’s range of expertise is too narrow, its ties with industry too close to avoid the suspicions of bias, its mandate is too ill-defined, and its mode of operation too secret.” Others criticized the board’s support by an industry liaison committee whose members represented eighty food companies. The furor over the report so embarrassed the academy that it eliminated the industry panel, removed board members with strong ties to food companies, and appointed new members with fewer industry ties.

      That was not the only instance of early concerns about conflicted committees. I asked Ken Fisher, who in the 1970s had directed the nongovernmental Life Sciences Research Office (LSRO), about his experience appointing committees to review the safety of food additives. In 1958, Congress had defined two categories of food additives: new chemicals that needed to be proven safe before they could go into the food supply and substances with a history of common use—sugar, salt, flavorings, and the like—that could be considered generally recognized as safe (GRAS). In the early 1970s, questions about the safety of GRAS additives led President Richard Nixon to direct the FDA to evaluate them, and the FDA commissioned the LSRO to conduct the reviews. The LSRO appointed committees to do this work and was immediately confronted with the problem of what to do about candidates with ties to companies making or using the additive under consideration.

      The review committees eventually issued 151 evaluations of more than four hundred GRAS additives. In a report on this work, Fisher said that the LSRO required candidates to report grants, contracts, and consultancies, as well as investments and holdings. It did not permit members with such ties to participate in discussions or vote on final decisions. Fisher told me that all members “were made aware of these conditions and all agreed—after some back and forth.” He recalled “one conflicted member, who of his own volition, absented himself from the vote on the decision.” He also recalled that committees “rejected several of the monographs on substances because they were incomplete and clearly biased in coverage of published positive or negative studies on certain substances.”

      Fisher’s comments suggested that conflicts of interest only rarely caused problems with GRAS reviews. But in The Case Against Sugar (2016) the journalist Gary Taubes presented the GRAS review of sugar (sucrose) as highly conflicted. His book notes that the chair of the overall GRAS review process was George W. Irving Jr., a former head of the scientific advisory board of the International Sugar Research Foundation, and that the GRAS committee relied heavily on materials provided by the Sugar Association. The 1976 GRAS review concluded that “other than the contribution made to dental caries, there is no clear evidence in the available information on sucrose that demonstrates a hazard to the public when used at the levels that are now current and in the manner now practiced.” According to Taubes, the Sugar Association took that to mean that “there is no substantiated scientific evidence indicating that sugar causes diabetes, heart disease, or any other malady.” He has harsh words for critics of the idea that sugars are harmful. “If you get a chance,” He advises, “ask about the GRAS Review Report. Odds are you won’t get an answer. Nothing stings in a nutritional liar like scientific facts.”

      The FDA’s GRAS reviews still elicit concerns about conflicted interests. A 2013 analysis of the GRAS review process concludes that the industry ties of committee members not only threaten the integrity of GRAS reviews but also the integrity of the FDA’s entire scientific enterprise. In a commentary on that analysis, I pointed out that without independent review of GRAS additives, it is difficult to be confident that the ones in use are sage.

      My question to Fisher about GRAS review committees had induced him to search through notes packed away for decades. Among them, he found memos indicating that Mike Jacobson had asked to have consumer representatives appointed to GRAS review committees, but, he said, “We opted not to do so as it would imply the other members of the [committees] were not consumers.” Fisher was referring to Michale Jacobson, director of the Center for Science in the Public Interest (CSPI), whose concerns about conflicted advisory committee members also date back to the 1970s. Jacobson was arguing that if federal agencies insisted on permitting members with industry ties to serve on advisory committees, they should balance viewpoints with an equivalent number of consumer representatives.

      Jacobson holds a doctorate in microbiology. He began his career working for Ralph Nader, cofounded CSPI in 1971, and retired as its director in 2017. CSPI’s purpose is to improve the American diet, and it continues to be the largest nonprofit organization engaged in advocacy for a broad range of nutrition issues, among them conflicts of interest caused by food industry sponsorship. I served on the CSPI board for about five years in the early 1990s, remain a member, and subscribe to its monthly Nutrition Action Health letter.

      In 1976, Jacobson asked a member of Congress with a strong record of consumer advocacy, New York Democrat Benjamin Rosenthal, to help him survey the heads of university nutrition departments about their faculty’s ties to food corporations. Jacobson told me why he had done this: “It was so obvious to me that professors were touting their academic affiliations while shilling for food manufacturers and trade associations. I thought it would be interesting and possibly useful to collect information about the matter.” Rosenthal introduced their report of the survey results, titled “Feeding at the Company Trough,” into the Congressional Record, with this blunt statement:

      Nutritional and food science professors at Harvard, at the Universities of Wisconsin, Iowa and Massachusetts, and at many other prominent universities work closely and often secretly with food and chemical companies. Professors sit on the boards of directors, act as consultants, testify on behalf of industry at congressional hearings, and receive industry research grants. Many professors with corporate links also serve as “university” representatives on Federal advisory committees. . . . One can only come to the conclusion that industry grants, consulting fees and directorships are muzzling, if not prostituting nutrition and food science professors.

      The report named names: it characterized Fred Stare, the head of Harvard’s Department of Nutrition, as a “food-industry apologist,” but it also listed the industry ties to sixteen other eminent scientists, nearly all members of prestigious national committees issuing advice about nutrition and health. It proposed three strategies for countering conflicted interests: balance, disclosure, and new funding mechanisms. All merit comment from today’s perspective.

      To achieve balance, they wanted consumer representatives to be appointed to nutrition advisory committees. This seems entirely rational, but in my experience federal agencies view experts who avoid industry ties on principle as too biased to appoint, especially if they state those principles publicly. I was a member of the Dietary Guidelines Advisory of Committee in 1995, but only because I had previously worked with the assistant secretary of health, Philip R. Lee, who insisted on my appointment. I served a s a consumer representative on two FDA advisory committees in the 1990s, Food Advisory and Science Advisory, but have not been asked to join another federal committee since the publication of Food Politics in 2002. The FDA’s current practice is to appoint one consumer representative to its committees, hardly enough to have much influence on decisions.

      With respect to disclosure, the report comments on the failure of the named professors to state the full extent of their industry ties: “As long as collaboration with industry continues to be viewed by the academic community as ethical and respectable, it is important that the public know about potential sources of bias. . . . In such matters, respect for individual privacy must yield to society’s right to know.”

      To help accomplish the third strategy, funding, the report raised the idea of a nonprofit, public interest group to “launder” industry contributions before they reach universities. But I doubt that such a group could maintain its objectivity if it depended on ongoing donations. I also doubt that companies would be willing provide ongoing support for research that might risk producing unfavorable results.

      p. 193

      [Founder of Harvard Department of Nutrition Fred] Stare ran into precisely the same difficulty faced by the Nutrition Foundation: the need to please donors to get ongoing support. For this reason, or perhaps because his personal beliefs coincided with those of his donors, eh was widely recognized as a nutrition scientist working on behalf of the food industry. His public statements consistently defended the American diet against suggestions that it might increase the risk of heart or other chronic disease. He, like officials of the Nutrition Foundation, could be counted on to state the industry position on matters of diet and health and to assure reporters and Congress that no scientific justification existed for advice to avoid food additives or eat less sugar.

      We now know much more about the depth of Stare’s food-industry ties from documents that came to light in 2016 when Cristin Kearns and colleagues at the University of California, San Francisco published an analysis of internal documents of the Sugar Research Foundation (SRF), the forerunner of today’s Sugar Association. The documents included letters between the SRF and Mark Hegsted, a faculty member in Stare’s Harvard department, about the SRF’s sponsorship of a research review on the effects of dietary carbohydrartes and fats on cardiovascular disease. The review, written by Stare, Hegsted, and antoher colleague, appeared in two parts in the New England Journal of Medicine in 1967. The letters show that the SRF not only commissioned and paid for the review but also pressured the Harvard authors to exonerate sugar as a factor in heart disease, then and now the leading cause of death among Americans. Other documents from the mid-1960s demonstrate that the SRF withheld funding from studies suggesting that sugar might be harmful.

    • Let me point to another area of scientific failure. A similar figure to Ancel Keys in diet/nutrition is Noam Chomsky in linguistics. Both dominated their respective fields through a similar force of personality and understanding of the politics of academia.

      Despite a lack of strongly supporting evidence, Chomsky’s unproven hypothesis of recursion and modularity dominated the field and shut down debate for an even longer period than Keys was ever to accomplish. Those like Edward Sapir and Benjamin Lee Whorf were effectively silenced because such views didn’t conform to the paradigm that came to dominate. This state of affairs, as with diet and nutrition, was only recently changed. Playing a role like that of Gary Taubes with fat and sugar, Daniel Everett overturned the scientific consensus about linguistics. But more than a half century of scientific inquiry was suppressed and much money wasted on dead-end hypotheses.

      So, yeah, self-correction can and does happen, at least some of the times (we know when it happens, not when it doesn’t happen). But as seen with such examples, many people died still in ignorance before that happened. And in the case of diet and nutrition, consider the hundreds of millions of people who were harmed and had their lives cut short because of scientific and medical failure. Who knows what other areas of failure exist such as these. What dominant paradigms shut down our ability to question and doubt? What is it that seems true to us that will seem bizarre or idiotic to future generations?

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