Sugar review: Rewriting history to expose a non-existent conspiracy

Sugar review: Rewriting history to expose a non-existent conspiracy
Last week, the Journal of the American Medical Association (JAMA) published an historical analysis of internal sugar industry documents.

In it, academics from the University of California, San Francisco accused the forerunner of the American Sugar Association of paying three Harvard scientists in the 1960s to downplay any connection between sugar consumption and heart disease by conducting a literature review of the science of the time.

Katherine Rich
Katherine Rich

In “Sugar Industry and Coronary Heart Research: A Historical Analysis of Internal Industry Documents​”, Cristin Kearns, Laura Schmidt and Stanton Glantz claimed they had proof that the Harvard nutrition professors had been doing the bidding of sugar companies and published biased research.

I see their findings as an attempt to rewrite nutrition history and create a narrative that 60 years of low-fat nutrition advice is somehow a grand industry conspiracy. 

The Harvard professors had cited “major evidence​” to suggest that “only one avenue​” existed by which diet might precipitate hardening of the arteries “by influencing the levels of serum lipids, especially serum cholesterol​”.

There can be no doubt that levels of serum cholesterol can be substantially modified by manipulation of the fat and cholesterol of the diet​,” they wrote.

We conclude, on the basis of epidemiologic, experimental and clinical evidence, that a lowering of the proportion of dietary saturated fats, increasing the proportion of polyunsaturated acids and reducing the level of dietary cholesterol are the dietary changes most likely to be of benefit​”

The Harvard review was in no way earth-shattering, and its authors’ conclusions were completely in line with the thinking of most academics at the time.

But the fact that the paper had been published without disclosing payment—not a requirement of the New England Journal of Medicine​ until 1984—was sufficient proof for Dr Kearns et al to make their claims of bias at the behest of the sugar industry.

Predictably, media reports of Dr Kearns’s work spread quickly around the globe because the story had all the components of a great food industry conspiracy: money changing hands, allegations of undue influence, the manipulation of respected academics—and even a glamorous Ivy League university thrown in for good measure. 

Some of the headlines and coverage have been hysterical: “How the sugar industry distorted health science for more than 50 years​”; “Behind the sugar industry’s 50-year mission to axe its link to heart disease​”; and the patently untrue headline: “Sugar lobby paid scientists to blur sugar’s role in heart disease​”. All of these imply that writing out cheques to the three Harvard academics was all it took to get the desired research result. 

The headlines and criticisms this piece of work has unleashed around the world have been inflammatory, as well as defamatory of the three men (if they were alive and here to defend themselves), particularly of Mark Hegsted, who was previously described by fellow nutrition expert Marian Nestle as a “hero of nutritionists​”. 

I’m sure his family members would be appalled to read online headlines such as “Drafter of U.S. Dietary Goals Was Bribed by Big Sugar to Demonize Fat​”. This is the man who the current head of Harvard’s nutrition department, Walter Willett, described as a principled scientist. 

[Prof. Hegsted] was a very hard-nosed, data-driven person, who had a record for standing up to industry interests​,” including losing a job at the US Department of Agriculture for standing up to the beef industry, Dr Willett said in an interview after the JAMA​ paper’s release. “I very much doubt that he changed what he believed or would conclude based on industry funding​.”

Having recently read Nina Teicholz’s excellent book “The Big Fat Surprise​”, which details the work of the most dominant scientific figures in the fat debate in the 1960s, the idea that a single industry-funded literature review could be accused of swaying academic thought for the past 50 years just didn’t stack up to me. 

But rather than rely on online coverage, I thought I’d go back to the sources and read the three studies in question—two from the NEJM​ and the recently published JAMA paper​. Like a lot of anti-industry stories I’ve seen over the years, what was online and what the papers actually said were quite different. 

What I did find was that what Dr Kearns discovered in a few musty letters doesn’t warrant the reputational trashing of three Harvard nutrition professors (Robert McGandy, Frank Stare and Hegsted), or the Sugar Association for that matter. 

In terms of a great conspiracy theory, the story that these three academics could be paid to manipulate their research just to support the sugar industry is on very shaky ground indeed. 

Here are some of the facts and key points left out of most of the global coverage: 

1. It was just a literature review.

Though it was no more than a review of literature, from the hail of criticism and widely reported comments of Prof. Glantz, one of the authors, accusing the Harvard professors of “behaving badly​” and implying they were somehow compromised or conflicted, I assumed the work in question must have been a major piece of research that changed the course of academic debate. Not so. All the Sugar Research Foundation appears to have done is merely commission a literature review of the science at the time. 

Literature reviews, no matter how thorough, seldom change the course of academic discussion. The literature review covered major works of American nutritionist Ancel Keys, his British counterpart John Yudkin, and others of the day. It was just a summary of research completed, not new work. Claims that commissioning such a review could derail academic debate for 50 years is nonsense. 

Despite being presented as an influential piece of research, the review (published in two parts in the NEJM​) was not remarkable and does not seem to have created many ripples; certainly not enough to support a theory that funding a literature review was so significant that it changed the course of academic discussion. 

For a piece of research that Prof. Glantz alleges “delayed the development of a scientific consensus on sugar-heart disease for decades​,” it’s noteworthy that the Harvard paper’s lead-author, Prof. McGandy, isn’t mentioned once in Teicholz’s exhaustive research of the history of low-fat nutrition theory. 

The NEJM​ is mentioned 60 times, with coverage of a number of “landmark​” papers from the journal, but the McGandy literature review isn’t mentioned or listed in her vast number of references of research papers of historical significance. It could be that Teicholz overlooked this literature review, which apparently was such a roadblock to academic discussion, but I doubt it. It’s just not credible to suggest that the Sugar Research Foundation funding one literature review was the critical factor in tipping the balance in the Keys vs Yudkin debate. 

The critical charge by Prof. Glantz could be made only in the absence of any analysis or recognition of all other activities at the time. Kearns et al freely admit in the paper that they did not analyse the role of other organisations or nutrition leaders. Not viewing the correspondence and the literature review in a 1960s context, where nutrition leaders such as Dr Keys and the American Heart Association so dominated nutrition thinking, has to be a major flaw. 

2. Kearns et al admit there’s no evidence of influence.

It appears that the correspondence between the Sugar Research Foundation and the academics has been interpreted 50 years later through a rather dark lens. 

Communications from the academics to the foundation’s research director were professional and relatively innocuous. The comment by Hegsted picked out by Dr Kearns—“We are well aware of your particular interest in carbohydrate and will cover this as well as we can​”—is bland and hardly a smoking gun. 

Dr Kearns presents no evidence that McGandy, Stare and Hegsted did anything dishonest. Buried towards the end of her paper is the comment: “There is no direct evidence that the sugar industry wrote or changed the NEJM review manuscript, the evidence that the industry shaped the review’s conclusions is circumstantial​”. The fact that the so-called “evidence​” of alleged dishonest processes is only “circumstantial​” (actually there’s no evidence of any wrongdoing) is a point completely lost in almost all the media coverage where the three professors have been completely slammed. 

3. Does anyone seriously believe Robert McGandy would risk his job and reputation for US$500? 

While the professors did not disclose that they had received payment for doing the literature review, which they’d be required to do if the work was done today, they complied with the rules of the day. 

Combined, they received US$6,500 to do the work. Even in today’s dollars that’s not a large amount of funding, and certainly not enough to risk their reputations or their prestigious jobs at Harvard. 

Dr Kearns has presented not one piece of hard evidence that the three Harvard professors approached their work with anything other than professionalism, which makes their reputational crucifixion all the more unfair. 

4. There’s no evidence that the academics were reflecting anything other than their own professional views in their review. 

There is no evidence that the academics were swayed in their views at all. If the three men were still alive and here to defend themselves, it’s likely, given their lifetimes of academic service and research, the suggestion that being paid for their time might change their academic view would be abhorrent to them. 

The only (so-called) circumstantial evidence is relatively innocuous correspondence between the Sugar Association and Prof. Hegsted. Most notably, there was no correspondence at all between the lead author, Robert McGandy (who probably did the bulk of the work), or Fred Stare and the Sugar Research Foundation. So it is particularly unfair to besmirch the reputations of these respected academics who don’t appear to have had any correspondence with the industry body at all. 

5. It doesn’t appear that Dr Kearns approached this academic research with an open mind. 

Questions should be asked about whether the strong views of Dr Kearns, who is part of, a campaigning anti-sugar science group, could have introduced bias to her approach to reviewing the documents.

Moreover, Dr Kearns’s Twitter handle is revealing: “@Sugarpolitics—“Pushing the conversation on the PR practices of the sugar industry”. Likewise, some of her Facebook posts asking whether people are concerned about “Big Food? Big Pharma? Big Insurance? Big Banks?”—a conspiracy theory perfect storm. 

She also runs a website and is the co-author of a 2012 article, “Big Sugar's Sweet Little Lies: How the industry kept scientists from asking: Does sugar kill​?”

She is clearly driven in her field of interest. CBCNews in 2013 describes how Dr Kearns “went on the hunt for evidence that Big Sugar had manipulated public opinion​”, how it became an “obsession​” and how she “quit her job, exhausted her savings and spent 15 months scouring library archives​” in search of information about industry influence in the sugar debate. 

While the story at the time was framed in a positive light, this and her other campaigning does little to create the impression that she would have approached the Sugar Association documents with an open mind about her hypothesis. 

When she and her colleagues have such well-publicised firm views about sugar (and the industry) was there ever any chance that she could have reviewed the Sugar Research Foundation correspondence and drawn a different conclusion? I suggest that would be doubtful. 

When her criticism of the academics is that that they were not sufficiently transparent, it is particularly ironic that Dr Kearns chose not to disclose her involvement in

With the correspondence exchanged between the Sugar Research Foundation and Prof. Hegsted so relatively bland and professional, Dr Kearns seems to have worked hard to infer a darker meaning that supports the theory that the foundation’s money somehow could have manipulated three Harvard nutrition professors and the outcome of the literature review. 

My own disclosure 

My criticisms of this paper will no doubt be dismissed because I am the chief executive of an industry association that has grocery suppliers as members, and one of them is even a sugar refinery. 

I’ve taken the time to look into this paper not because I am concerned about its effect on any of our members (who are, after all, to be found in a small island nation at the bottom of the globe) but because I see it as trying to rewrite nutrition history and create a narrative that 60 years of low-fat nutrition advice is not the responsibility of Dr Keys, the American Heart Association and others, but rather somehow a grand sugar industry conspiracy. 

The second reason is that a major concern here has to be the complete trashing of the reputations of three people (now deceased) who dedicated their lives to academia and nutrition. More than 100 years of service appears to be up in smoke due to a relatively light paper that set out to find a conspiracy and created one. 

Prof. Hegsted’s Wikipedia page has already been updated since the publication of the paper by someone keen to share this modern day negative perspective of his career. 

All of this reminds me of a visit I made to Harvard in the early Nineties. Massachusetts in the autumn is a sight to behold and a special memory. Being only a short drive away, I also took the opportunity to visit Salem, best known for the mass hysteria that resulted in the Salem Witch Trials in 1692. 

It could be argued that the online coverage of the JAMA​ paper in news and social media, and the treatment of the academics involved and the Sugar Association, has all the hallmarks of a modern-day witch hunt. Of course, no one involved has been burnt at any stake as part of such anti-sugar hysteria, but their Google histories and reputations have certainly suffered fire damage. 

I feel sorry for the surviving families of Hegsted, McGandy, Stare and Sugar Research Foundation research director John Hickson. It must be deeply upsetting to see their relatives’ reputations so unfairly besmirched due to such blatant sugar politics.

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