Good Calories, Bad Calories by Gary Taubes Page B

blame lay solely with those medical authorities who, for numerous reasons, including “a misguided attempt to do good, advocate ‘preventive’ maneuvers that have never been validated in rigorous randomized trials. Not only do they abuse their positions by advocating unproven ‘preventives,’ they also stifle dissent.”

    From 1960 onward, those involved in the diet-heart controversy had intended to conduct precisely the kind of study that three decades later would reverse the common wisdom about the long-term benefits of hormone-replacement therapy. This was the enormous National Diet-Heart Study that Jeremiah Stamler in 1961 had predicted would take five or ten years of hard work to complete. In August 1962, the National Heart Institute awarded research grants to six investigators—including Stamler, Keys, and Ivan Frantz, Jr.—to explore the feasibility of inducing a hundred thousand Americans to change the fat content of their diet.*12 In 1968, the National Institutes of Health assembled a committee led by Pete Ahrens of Rockefel er University to review the evidence for and against the diet-heart hypothesis and recommend how to proceed. The committee published its conclusions in June 1969. Even though the American Heart Association had been recommending low-fat diets for almost a decade already, Ahrens and his col eagues reported, the salient points remained at issue. “The essential reason for conducting a study,” they noted, “is because it is not known whether dietary manipulation has any effect whatsoever on coronary heart disease.” And so they recommended that the government proceed with the trial, even though, Ahrens recal ed, the committee members came to believe that any trial large enough and sufficiently wel control ed to provide a reliable conclusion “would be so expensive and so impractical that it would never get done.”
    Two years later, the NIH assembled a Task Force on Arteriosclerosis, and it came to similar conclusions in its four-hundred-page, two-volume report.
    The task force agreed that a “definitive test” of Keys’s dietary-fat hypothesis “in the general population is urgently needed.” But these assembled experts also did not believe such a study was practical. They worried about the “formidable” costs—perhaps $1 bil ion—and recommended instead that the NIH
    proceed with smal er, wel -control ed studies that might demonstrate that it was possible to lessen the risk of coronary heart disease without necessarily relying on diet to do it.
    As a result, the NIH agreed to spend only $250 mil ion on two smal er trials that would stil constitute the largest, most ambitious clinical trials ever attempted. One would test the hypothesis that heart attacks could be prevented by the use of cholesterol-lowering drugs. The other would attempt to prevent heart disease with a combination of cholesterol-lowering diets, smoking-cessation programs, and drugs to reduce blood pressure. Neither of these trials would actual y constitute a test of Keys’s hypothesis or of the benefits of low-fat diets. Moreover, the two trials would take a decade to complete, which was longer than the public, the press, or the government was wil ing to wait.

Chapter Three
    CREATION OF CONSENSUS
    In sciences that are based on supposition and opinion…the object is to command assent, not to master the thing itself.
    FRANCIS BACON, Novum Organum, 1620
    BY 1977, WHEN THE NOTION THAT dietary fat causes heart disease began its transformation from speculative hypothesis to nutritional dogma, no compel ing new scientific evidence had been published. What had changed was the public attitude toward the subject. Belief in saturated fat and cholesterol as kil ers achieved a kind of critical mass when an anti-fat, anti-meat movement evolved independent of the science.
    The roots of this movement can be found in the counterculture of the 1960s, and its moral shift away from the excessive consumption represented by