How the sugar industry paid for a Harvard study on the dangers of fats
Dr. Cristin Kearns Finds Papers That Show The Sugar Industry Sponsored Research That Diminishes the Role of Sugar in Heart Disease
In the 1960s, during a heated debate over nutrition, Harvard nutritionists published two studies in the largest medical journal that diminish the role of sugar in the occurrence of coronary heart disease. But recently leaked documents reveal new details: A sugar industry trade group launched the study, paid for it, reviewed drafts, and set a goal to protect the sugar's reputation in front of public opinion.
This discovery published on Mondayin JAMA Internal Medicine, by Dr. Christine Kearns of the University of California, San Francisco. She retrained from dentist to researcher, and discovered traces of the sugar industry by digging through boxes of letters in the basement of a Harvard lab.
In her work, she details the story of how two famous Harvard nutritionists, Dr. Fredrick Stare and Mark Hegsted, now deceased, worked closely with the Sugar Research Foundation trading group. trying to influence public opinion about the role of sugar in disease.
A trade group persuaded Hegsted, a professor of nutritional science at Harvard Public School of Medicine, to write a review rejecting the findings of early research linking sucrose and coronary heart disease. The group paid the equivalent of $ 48,000 today to Hegsted and his colleague Dr. Robert McGandy, and the researchers did not publicize the source of the funding.
Hegsted and Steer left no stone unturned in the research that exposed sugar, and concluded that only dietary fat and cholesterol intake should be changed to prevent disease. These reviews were published in 1967 in the New England Journal of Medicine, whose rules at the time did not require scientists to disclose possible conflicts of interest.
At the time, researchers debated which food, sugar or fat, was to blame for the deaths of many Americans, especially men, from coronary heart disease, a buildup of plaque in the heart arteries. Kearns says the work, which the trade group subsequently cited in booklets targeted at regulators, helped increase sugar's market share by convincing Americans of the benefits of a low-fat diet.
Kearns calls these documents stored in her office "sugar papers."
Nearly 50 years later, sugar is considered a risk factor for heart disease by some nutritionists, although there is no consensus among them. Two major studies, published in an influential journal, "helped move the controversy away from sugar to fat," says Stanton Glantz, Kearns' co-author and director at UCSF. "It delayed the development of a scientific consensus on sugar and heart disease by decades."
Marion Nestle, a nutritionist at New York University who was not involved in the work, says she has not yet been convinced by the arguments of those who believe that "sugar is poison." The total calories a person consumes may matter more. But she called the find a "smoking gun" - a rare example of irrefutable evidence of food industry machinations in science.
“Science shouldn't do this,” she wrote in a comment . “Is it true that food companies are deliberately trying to manipulate research to their advantage? Yes, it is - and the process continues, ”Nestlé added, noting that Coca-Cola and the candy industry have recently tried to influence nutritional research.
In a statement, the sugar trading group argues that the same study has received unfair criticism. “We recognize that the Sugar Research Foundation needed to be more transparent in its work with research,” writes the group now known as the Sugar Association. But "it is very difficult for us to comment on the events that took place 60 years ago and the documents that we have not seen at all."
"Sugar is not critical to heart disease," the group says. "We are disappointed that a JAMA-grade magazine is using high-profile headlines to disprove quality scientific research."
Kearns, a fragile and quiet woman who often blushes when she talks, is not suited to the role of a crusader in the fight against the sugar industry. She was studying to be a dentist and described how shocked she was when a diabetes speaker at a 2007 dentist conference claimed that there was no evidence linking sugar to chronic disease. She resigned and dedicated herself to uncovering documents showing the impact of the sugar industry on public opinion and science.
Now she has managed to collect 2000 pages of internal documentation. She stores them in two fireproof cabinets at her UCSF workstation, along with photos of crumbling teeth and boxes of Cocoa Pebbles and Cinnamon Toast Crunch.
Her previous work demonstrated how the sugar industry influenced the government's dental research program to look for a cure for tooth decay instead of researching the benefits of reducing sugar intake.
For her new research, Kearns flew to Boston in 2011 and spent several days in the County Library of Harvard Medical School, rummaging through the boxes of letters left there by Hegsted.
Hegsted, according to Nestlé, was a "nutritional hero." He helped draft the US Diet Goals, a 1977 Senate report that paved the way for the country's first dietary rules. He oversaw the food department at the Ministry of Agriculture.
Looking through his letters, Kearns was "shocked" by the level of his collaboration with the sugar industry.
She found that in the 1950s, the Sugar Research Foundation set a strategy to increase sugar market share by placing Americans on a low-fat diet based on research blaming fat and cholesterol for high blood pressure and heart problems. This was all described in a 1954 speech delivered by the president of the trade group.
John Hickson, Vice President of the Foundation and Director of Research, carefully monitored progress in nutritional research. In a 1964 internal memo found by Kearns, he suggested that the group "launch a big campaign" to "counter negative attitudes towards sugar", in part by funding their own research to "refute our detractors."
Hickson hired Star, chairman of the nutritional department at Harvard Medical School, to join the foundation's panel of experts. In July 1965, just after the Annals of Internal Medicine articles linking sucrose - common table sugar - to coronary heart disease, he turned to Hegsted for help. Hickson agreed to pay $ 6,500 for the services of Hegsted and McGandy, overseen by Steer (adjusted for inflation, this is $ 48,000 today). The service included writing "an article reviewing several articles describing a metabolic threat found in sucrose."
Hegsted asked Hickson for the articles. Hickson posted at least five articles that threatened the sugar industry - suggesting that he intended to criticize them. So, at least, says Kearns and colleagues.
Kearns stores sugar-sweetened foods in his office
Hickson 's purpose of the review is: “We are particularly interested in the part about nutrition that says carbohydrates in the form of sucrose contribute excessively to metabolism and lead to abnormalities called fat metabolism. I will be disappointed if this aspect gets lost in review and overall interpretation. "
Kearns states that Hegsted responded, "We are well aware of your carbohydrate interests and will review as closely as possible."
Kearns found that scientists communicated with the sponsor not only before starting work, but also in the process. In April 1966, Hegsted wrote to the trade group to report a delay in the review due to a new study in which Iowa scientists found new evidence linking sugar to coronary disease. “Every time the Iowa Group publishes a paper, we have to re-write the rebuttal,” he wrote.
It follows from the letters that Hickson reviewed the drafts of the works, although it is not known whether any comments or corrections came from him.
“Will I get another draft copy soon?” Higson asked Hegsted, according to Kearns. “I think I can do it for you in a couple of weeks,” Hegsted replied.
Hickson received the final draft of the work a few days before Hegsted was about to publish it. The sponsor was pleased: “I hasten to assure you that this is the kind of work we had in mind, and we look forward to seeing it appear in print,” Hickson wrote. When the work was published the following year, the authors mentioned that it had received funding from other sponsors, but had not given a word to the Sugar Research Foundation.
Hegsted's reviews covered a wide range of studies. He refuted the work in which sugar was called the cause of coronary disease. He found merits only in those works that blamed fats and cholesterol for everything.
Glantz, a co-author of Kearns, says the main problem with the reviews is that they were unfair: when sugar was blamed, Hegsted and his colleagues brushed aside whole classes of epidemiological data. But they didn’t criticize the articles that blamed fat.
He says the level of cooperation among Harvard researchers is clear: “The industry says, 'These are the jobs that we don't like. Deal with them, 'says Glantz. - And they figured it out. This is what impressed me the most. "
Glantz says that the sugar industry in its actions copied the tobacco industry, about whose internal documents he wrote a lot. The letters show the tricky moves the sugar industry has taken to change public opinion, he says. They carefully tracked the research and carefully chose which scientists to turn to. “They treated them with care, and as a result they got what they wanted,” says Glantz.
Glantz, Kearns and their co-author, Laura Schmidt, acknowledge that their research was limited by the inability to interview already deceased participants in the events.
Dr. Walter Willett, who knew Hegsted and is now the head of the nutrition department at Harvard Medical School, defends him as a scientist with principles. “He was a very purposeful person who trusted only the data, and in his life he used to oppose the interests of the industry,” Willett wrote in a letter. For example, Hegsted lost his job at the USDA because he got in the way of the meat industry. "I very much doubt that he changed his principles, or made conclusions based on receiving funding from the industry."
Willett says it has become clearer today that refined carbohydrates and sugary drinks "are risk factors for heart disease," and that "the type of fat consumed is also very important." But he says that at the time of Hegsted's work, the evidence that fat was a risk factor for coronary heart disease "was much stronger" than the evidence for sugar. He claims he would agree with "most of the interpretations" made by researchers.
“However, because he [Hegsted] received funding from the sugar industry and was in constant contact with them,” Willett admits, “he found himself in a position where his conclusions could be questioned. It is also possible that such a relationship could lead to a slight bias, albeit subconscious. "
Willett called the historic report "a useful warning that getting industry funding is a research problem because it could lead to biased work being published." He says that “in the case of reviews, this is doubly problematic, as they involve value judgments in interpreting the data.”
But Willett, whose professorship bears the name of Frederick Steer, says Steer and his colleagues did not break any rules. Conflict of interest standards have changed dramatically since the 1960s. Since 1984, the New England Journal of Medicine has required authors to report controversy. The journal also requires reviewers to "support research" from relevant companies.
NEJM spokeswoman Jennifer Zeiss said the magazine now requires authors to publish information on all financial controversies that arose in the 36 months preceding publication, and also conducts thorough peer review to help prevent potential conflicts of interest.
Glantz says the magazine should have done an editorial about what “really happened” with that review. “The origins of this work are highly misleading,” he says. Zeiss says the magazine has no such plans. And Keynes is continuing his campaign to reveal more internal documents to the sugar industry.
In a recent interview at a food court at UCSF, she ditched chocolate chip cookies in favor of a chicken sandwich and fruit salad. She says she is partly based on her experience as a dentist - she has seen patients with teeth decayed, including a man who needed a denture at the age of 30.
The government supports such researchers as Keynes, speaking about the dangers of sugar - new recommendations on nutrition suggest that people receiving less than 10% of calories from sugar in foods.