My apologies to blog followers for dropping out for most of 2014. The two projects that have slowed postings to the blog were our 26-author review “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base” and my book The World Turned Upside Down. The Second Low-Carbohydrate Revolution. The first, we felt, was a kind of manifesto on carbohydrate restriction for diabetes. It received some attention from MedPage Today and it will be the focus of the ASBP-NMS (American Society of Bariatric Physicians — Nutrition and Metabolism Society) Conference in April. I will also discuss it at the EASD (European Association for the Study of Diabetes) meeting in Stockholm in September.
The book, somewhat delayed in printing is now available on Amazon and in Kindle format World Turned Upside Down covers a number of areas: I try to give a very basic introduction into organic chemistry and metabolism and I add my voice to the critiques of the low-fat hypothesis and the sorry state of nutritional science. I also provide specific strategies on how to analyze reports in the literature to find out whether the main point of the paper is valid or not. The deconstructions of traditional nutrition, the “also bought” on the Amazon page, are numerous and continuing to proliferate as more and more people become aware of how bad things are. To me, the “surprise” in Nina Teicholz’s “Big Fat Surprise” is that, after all the previous exposés and my own research, there were deceptive practices and poor science that even I didn’t know about. So, why doesn’t anybody do anything? Why doesn’t somebody blow the whistle on them? It’s not like we are dealing with military intelligence. What are they going to do? Not fund my grant, not publish my paper? Ha.
“When you go to work today, imagine having a tape recorder attached to your body, a second one in your briefcase, and a third one in a special notebook, knowing that you will be secretly taping your supervisors, coworkers, and in some cases, your friends.” These are the opening lines of Mark Whitacre’s remarkable confession/essay/exposé (later a movie with Matt Damon) describing his blowing the whistle on Archer Daniels Midland (ADM) one of the largest food companies in the world; their motto at the time “ADM. Supermarket to the world.”
It turned out that ADM had been colluding with its competitors to fix prices, in particular on the amino acid, lysine. Whitacre’s story is fascinating in detail. Although relatively young, he was high up in the company, a division manager (“I lived in a huge home, which had an eight car garage filled with eight cars, and indoor horse-riding stables for my children”). He travelled around the world to big corporate meetings. At some point, encouraged by his wife whose ethical standards were quite a bit higher than his own, he became an FBI informant. Accompanying him in his business trips was a green lamp, housing a video feed. ”It is a good thing that all of the co- conspirators were men. A woman would have immediately noticed that this green lamp did not match the five star décor of some of the finest hotels, such as the Four Seasons in Chicago.” Ultimately, the lysine trial resulted in fines and three-year prison sentences for three of the executives of ADM as well as criminal fine for foreign companies worth $105 million, a record at the time. At the trial, things really went down-hill for the company when Whitacre produced a tape recording of the President of ADM telling executives that the company’s competitors were their friends and their customers were the enemy. Wits at the time suggested a new motto “ADM. Super mark-up to the world.” In the end, in a remarkable twist in the story, his whistle-blowing was compromised by the fact that he was on the take himself.
“I concluded that I would steal my own severance pay, and decided upon $9.5 million, which amounted to several years of my total compensation. …And I also considered what would happen if ADM learned of this theft. If they accused me, I thought that I had the perfect answer. How can you prosecute me for stealing $9.5 million when you are stealing hundreds of millions of dollars each year in the price fixing scheme? …. I decided to submit several bogus invoices to ADM, until I accumulated $9.5 million, which was meant to be my family’s financial security when I would be fired at a future date for being a whistleblower.”
As it turned out, a number of food and beverage companies, who had won hundreds of millions in settlements against ADM were the ones who actually provided financial security for his family while Mark Whitacre spent nine years in prison.
Whistle blowing and imperial deshabillement
If it is not hidden, is it whistle-blowing? Did the kid “blow the whistle on the emperor’s new clothes?” If it is right out in the open, what is the scandal? Well, there is open and there is open. Leaving out information may be a sign of a cover-up. I described, in my book, the case of the paper by Foster, et al., the conclusion of which was that “neither dietary fat nor carbohydrate intake influenced weight loss.” I admitted, in the book, that:
“I had not read Foster’s paper very carefully before making the pronouncement that it was not very good. I was upbraided by a student for such a rush to judgment. I explained that that is what I do for a living. I explained that I usually don’t have to spend a lot of time on a paper to see the general drift…. but I was probably not totally convincing. So I read the paper, which is quite a bit longer than usual. The main thing that I was looking for was information on the nutrients that were actually consumed since it was their lack of effect that was the main point of the paper.…
In a diet experiment, the food consumed should be right up front but I couldn’t find it at all…. The data weren’t there. I was going to write to the authors when I found out…that this paper had been covered in a story in the Los Angeles Times. As reported by Bob Kaplan: ‘Of the 307 participants enrolled in the study, not one had their food intake recorded or analyzed by investigators. The authors did not monitor, chronicle or report any of the subjects’ diets. No meals were administered by the authors; no meals were eaten in front of investigators. There were no self‑reports, no questionnaires. The lead authors, Gary Foster and James Hill, explained in separate e-mails that self‑reported data are unreliable and therefore they didn’t collect or analyze any.’
I confess to feeling a bit shocked. I don’t like getting scientific information from the LA Times. How can you say “neither dietary fat nor carbohydrate intake influenced weight loss” if you haven’t measured fat or carbohydrate? …. in fact, the whole nutrition field runs on self‑reported data. Is all that stuff from the Harvard School of Public Health, all those epidemiology studies that rely on food records, to be chucked out?”
So was this a breach of research integrity? It might be considered simply an error of omission. If you didn’t measure food consumed, you don’t necessarily have to put it in the methods. Was it just dumb not to realize that if you write a study of a diet comparison, you can’t leave out what people ate or at least admit that you didn’t measure what they ate. So can you blow the whistle on them for not telling the whole truth? The authors were all well-known researchers, if party-liners.
The Office of Research Integrity is set up to police serious infractions in federally funded grants but it usually has to be clear cut and, sometimes, there is a whistle-blower. The Baltimore case is one of the better known if somewhat embarrassing cases for the agency — there was nothing to the whistle-blower’s allegations. In any case, there is a big gray area. If you falsify your data on a government research grant, you can go to jail. If you make a dumb interpretation, however, if you say the data mean X when they show not-X, well, research is about unknowns, and you may have slipped up. Even Einstein admitted to the need to offer “sacrifices at the altar of Stupidity.” The NIH is supposed to not fund stuff like that. Editors and reviewers are supposed to see through the omission. What if they fell down on the job too? What if you have a field like nutrition where the NIH study sections are on the same wavelength as the researchers. There is, however, the question of the total impact. A lot of stuff is never cited and never does any harm. I enquired with the ORI, in a general way, about Foster’s paper. They said that if it is widely quoted, it could be an infraction. It is cited as evidence against low-carb diets. So am I going to be a whistle-blower? I don’t think so.
The problem is that only an insider can blow the whistle and although cooperation and collegiality remain very weak in the nutrition field, it is still our own nest and whistle-blowing makes everybody look bad. The “long blue line” does not form because the police think that corruption is okay. The problem is not just that there can be retribution, as in Serpico, but that it makes everybody look bad. It is simply that it reflects poorly on the whole police force. And while it is probable that, as Mark Whitacre said, “almost all of their 30,000 employees went to work each day doing the right thing morally and ethically,” the statement that “ADM was not a bad company” does not ring true. If we call attention to what is tolerated in medical nutrition, we are all looking like fools. And, of course, Foster’s paper is one of the more egregious but there is a lot of competition for worst and it reflects badly on all of us in the field. “Is that what you do when you go to work?”
The parable of the big fish
I received an email from a physician in England. He has had consistently good results with low-carbohydrate diets.
“There is never a day when I don’t see the deleterious effects of too many carbs on those with the metabolic syndrome. And yet most doctors carry on as if it doesn’t exist !! …
Only yesterday I saw a man I have known for over 15 years. His GGT [gamma-glutamyl transferase; marker for liver disease] had always been about double normal. Embarrassingly I had assumed that he was a drinker, despite repeated denial, thinking his big belly was evidence! He chose low carb March 2013 and never looked back. Liver function normal now and an easy 7Kg weight loss.”
He said that the information had been used in the production of the ABC Catalyst TV documentary from Australia, but:
“I am a very, very small fish! As smaller fish we GPs specialise in getting ideas across to ordinary folk. The Internet is democratising medicine faster than some big fish realise. I wrote my practical diabetes piece partly for the educated general public and insisted on open access.
Big fish will scoff at my small numbers (70) and lack of double blindness anyway.”
I assured him that he was making an impact, that n = 70 was fine and not to worry about the big fish. I related a story told to me by one of my colleagues in graduate school: he had gone fishing in the Gulf of Mexico and they had caught a very big fish (I no longer remember the kind) which was thrashing around on the deck and they could not contain it. There happened to be a rifle on board and somebody shot the fish. The bullet went through the bottom of the boat which sank.