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SugarIndustrySecretlyPaidforFavorableHarvardResearchScientificAmerican

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Sugar Industry Secretly Paid for Favorable Harvard

Research
Newly uncovered documents reveal that a sugar industry trade group initiated and paid for the
studies, examined dras and laid out a clear objective to protect sugars public reputation
By Melissa Bailey, STAT on September 13, 2016

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Credit: GUNILLA G Flickr
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Asnutritiondebatesragedinthe1960s,prominentHarvardnutritionistspublished
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tworeviewsinatopmedicaljournaldownplayingtheroleofsugarincoronaryheart
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disease.Newlyuneartheddocumentsrevealwhattheydidntsay:Asugarindustry
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tradegroupinitiatedandpaidforthestudies,examineddrafts,andlaidoutaclear
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objectivetoprotectsugarsreputationinthepubliceye.

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Thatrevelation,publishedMondayinJAMAInternalMedicine,comesfromDr.
CristinKearnsattheUniversityofCalifornia,SanFrancisco,adentistturned

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researcherwhofoundthesugarindustrysfingerprintswhilediggingthroughboxes
oflettersinthebasementofaHarvardlibrary.

HerpaperrecountshowtwofamousHarvardnutritionists,Dr.FredrickStareand
MarkHegsted,whoarenowdeceased,workedcloselywithatradegroupcalledthe
SugarResearchFoundation,whichwastryingtoinfluencepublicunderstandingof
sugarsroleindisease.

ThetradegroupsolicitedHegsted,aprofessorofnutritionatHarvardspublichealth
school,towritealiteraturereviewaimedatcounteringearlyresearchlinkingsucrose
tocoronaryheartdisease.Thegrouppaidtheequivalentof$48,000in2016dollars
toHegstedandcolleagueDr.RobertMcGandy,thoughtheresearchersneverpublicly
disclosedthatfundingsource,Kearnsfound.

HegstedandStaretoreapartstudiesthatimplicatedsugarandconcludedthatthere
wasonlyonedietarymodificationchangingfatandcholesterolintakethatcould
preventcoronaryheartdisease.Theirreviewswerepublishedin1967intheNew
EnglandJournalofMedicine,whichbackthendidnotrequireresearcherstodisclose
conflictsofinterest.

Thatwasanerawhenresearcherswerebattlingoverwhichdietaryculpritsugaror
fatwascontributingtothedeathsofmanyAmericans,especiallymen,from
coronaryheartdisease,thebuildupofplaqueinarteriesoftheheart.Kearnssaidthe
papers,whichthetradegrouplatercitedinpamphletsprovidedtopolicymakers,
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aidedtheindustrysplantoincreasesugarsmarketsharebyconvincingAmericansto
eatalowfatdiet.

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Nearly50yearslater,somenutritionistsconsidersugarariskfactorforcoronary
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heartdisease,thoughtheresnoconsensus.Havingtwomajorreviewspublishedin
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aninfluentialjournalhelpedshifttheemphasisofthediscussionawayfromsugar
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ontofat,saidStantonGlantz,KearnsscoauthorandheradvisoratUCSF.Bydoing
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that,itdelayedthedevelopmentofascientificconsensusonsugarheartdiseasefor
decades.

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MarionNestle,anutritionexpertatNewYorkUniversitywhowasnotinvolvedinthe
paper,saidshesstillnotconvincedbythosewhoarguethatsugarispoisona
personstotalcalorieconsumptioncouldmattermore.ButshecalledtheUCSF
findingsasmokinggunrare,hardevidenceofthefoodindustrymeddlingin
science.

Scienceisnotsupposedtoworkthisway,shewroteinanaccompanying
commentary.Isitreallytruethatfoodcompaniesdeliberatelysetouttomanipulate
researchintheirfavor?Yes,itis,andthepracticecontinues,Nestleadded,noting
thatCocaColaandcandymakershavebothtriedrecentlytoinfluencenutrition
research.

Inastatement,thesugartradegroupsaidindustryfundedresearchhasbeenunfairly
criticized.

WeacknowledgethattheSugarResearchFoundationshouldhaveexercisedgreater
transparencyinallofitsresearchactivities,saidthetradegroup,whichnowgoesby
thenametheSugarAssociation.Beyondthat,itischallengingforustocommenton
eventsthatallegedlyoccurred60yearsago,andondocumentswehaveneverseen.

Sugardoesnothaveauniqueroleinheartdisease,thegroupmaintained.Were
disappointedtoseeajournalofJAMAsstatureusingheadlinebaitingarticlesto
trumpqualityscientificresearch.
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Athinframed,softspokenwomanwhoblushesoftenwhenshespeaks,Kearnsisan
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unlikelycrusaderagainstthesugarindustry.Trainedasadentist,Kearnssaidshe
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wasshockedtohearakeynotespeakerata2007dentistryconferenceondiabetes,
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nolesstellherthereisnoevidencelinkingsugartochronicdisease.Shequither
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jobanddevotedherselffulltimetouncoveringdocumentsthatshowthesugar

industrysinfluenceoverpublicpolicyandscience.

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Shehasnowamassed2,000pagesofinternaldocuments.Shekeepsthemintwo
bankersboxesinhercubicleatUCSF,alongwithphotosofdecayingteeth,andshow

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andtellboxesofsugaryCocoaPebblesandCinnamonToastCrunch.

Herpreviousworkhasshownhowthesugarindustryinfluencedafederaldental
researchprogramtoshiftattentiontoothereffortssuchasfindingavaccinefor
toothdecayinsteadofexploringthebenefitsofeatinglesssugar.

Forherlatestpaper,KearnsflewtoBostonin2011andspentseveraldaysinHarvard
MedicalSchoolsCountwaylibrary,thumbingthroughboxesoflettersthatHegsted
leftbehind.

Hegstedwas,inNestleswords,aheroofnutritionists:HehelpeddraftDietary
GoalsfortheUnitedStates,the1977Senatecommitteereportthatpavedthewayfor
thenationsfirstdietaryguidelines.Hewentontooverseethehumannutritionunit
attheDepartmentofAgriculture.

Pagingthroughtheletters,Kearnswasshockedbyhislevelofcooperationwiththe
sugarindustry,shesaid.

Hereswhatshefound:Inthe1950s,theSugarResearchFoundationidentifieda
strategicopeningtoincreasesugarsmarketsharebygettingAmericanstoeatalow
fatdiet,basedonresearchthatblamedfatandcholesterolforcausinghighblood
pressureandheartproblems,accordingtoa1954speechbythetradegroups
president.
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JohnHickson,theSugarResearchFoundationsvicepresidentanddirectorof
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research,wascloselymonitoringnutritionresearch.InaninternalmemoKearns
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uncoveredfrom1964,heproposedthatthetradegroupembarkonamajor
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programtocounteractnegativeattitudestowardssugar,inpartbyfundingitsown

researchtorefuteourdetractors.

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HicksonfirstrecruitedStare,chairoftheHarvardpublichealthschoolsnutrition
department,tojointhefoundationsscientificadvisoryboard.InJulyof1965,just
afterarticleslinkingsucroseordinarytablesugartocoronaryheartdisease

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appearedintheAnnalsofInternalMedicine,heapproachedHegstedforhelp.
HicksonstruckadealtopayHegstedandMcGandy,bothoverseenbyStare,$6,500
($48,000in2016dollars)forareviewarticleoftheseveralpaperswhichfindsome
specialmetabolicperilinsucroseKearnsfound.

HegstedaskedHicksontoprovidethearticlesforthereview.Hicksonsentatleast
fivearticlesthatthreatenedthesugarindustrywhichsuggestheaimedforthe
researcherstocritiquethem,Kearnsandhercoauthorsargue.

Hicksonsettheobjectiveforthereview:Ourparticularinteresthadtodowiththat
partofnutritioninwhichthereareclaimsthatcarbohydratesintheformofsucrose
makeaninordinatecontributiontothemetaboliccondition,hithertoascribedto
aberrationscalledfatmetabolism,hewrotetoHegsted.

Iwillbedisappointedifthisaspectisdrownedoutinacascadeofreviewandgeneral
interpretation,Hicksonwrote.

Wearewellawareofyourparticularinterestincarbohydrateandwillcoverthisas
wellaswecan,Hegstedreplied,accordingtoKearns.

Lettersshowthescientistcommunicatingwithhisfundernotjustattheoutset,but
whilewritingthereview,Kearnsfound.InApril1966,Hegstedwrotetothesugar
tradegrouptoreportthathisreviewhadbeendelayedbecauseresearchersinIowa
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hadproducednewevidencelinkingsugartocoronaryheartdisease.Everytimethe

Iowagrouppublishesapaperwehavetoreworkasectioninrebuttal,Hegsted
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wrote.

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LettersindicateHicksonrevieweddraftsofthepaper,thoughitsnotclearwhether

histradegroupmadeanyeditsorcomments.

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AmIgoingtogetanothercopyofthedraftshortly?HicksonaskedHegsted,
accordingtoKearns.

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Iexpecttogetitdowntoyouwithinaweekortwo,Hegstedreplied.

HicksongotafinaldraftafewdaysbeforeHegstedintendedtosubmititfor
publication.Thefunderwashappy:Letmeassureyouthisisquitewhatwehadin
mindandwelookforwardtoitsappearanceinprint,Hicksonwrote.

Whenthepaperswerepublishedthefollowingyear,authorsdisclosedotherindustry
funding,butmadenomentionoftheSugarResearchFoundation.

Hegstedsreviewsexaminedawiderangeofresearch.Hedownplayedanddismissed
papersthatarguedthatsugarwasacauseofcoronaryarterydisease.Hefoundmerit
onlyinthosethatsawfatandcholesterolasaculprit.

Glantz,Kearnsscoauthor,saidthemajorproblemwiththereviewisthatitwasnot
evenhanded:Inthecaseswheresugarwasimplicated,Hegstedandcolleagues
dismissedentireclassesofepidemiologicalevidence.Buttheydidntholdstudiesthat
implicatefattothesamestandard,Glantzsaid.

HesaidtheleveloftheHarvardresearcherscooperationisclear:Theindustrysays,
Herearesomepaperswerereallyunhappywith.Dealwiththem,Glantzsaid.
Theythendid.That,tome,wasthethingthatIfoundthemostamazing.

Glantzsaidthesugarindustryusedasimilarplaybooktothetobaccoindustry,whose
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internaldocumentshehaswrittenaboutextensively.Thelettersrevealhow
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sophisticatedthesugarexecutiveswereinswayingpublicopinion,hesaid.They
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closelytrackedtheresearchandwerecarefulaboutwhichinfluentialscientiststo

approach.

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Bydealingwiththemwithalighttouch,theygotwhattheywanted,Glantzsaid.
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Webtrends

Glantz,Kearns,andtheircoauthor,LauraSchmidt,acknowledgedthattheirresearch
waslimitedbythefactthattheycouldnotinterviewtheprotagonistsbecausetheyare

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dead.

Dr.WalterWillett,whoknewHegstedandnowrunsthenutritiondepartmentat
Harvardspublichealthschool,defendedhimasaprincipledscientist.

Hewasaveryhardnosed,datadrivenperson,whohadarecordforstandingupto
industryinterests,includinglosingajobattheUSDAforstandinguptothebeef
industry,Willettwroteinanemail.Iverymuchdoubtthathechangedwhathe
believedorwouldconcludebasedonindustryfunding.

Willettsaidtoday,researchhasbecomemoreclear,showingthatrefined
carbohydratesandespeciallysugarsweetenedbeveragesareriskfactorsfor
cardiovasculardisease,whilethetypeofdietaryfatisalsoveryimportant.Buthe
saidthatatthetimeHegstedandcolleagueswerewriting,evidenceforfatasarisk
factorforcoronaryheartdiseasewasconsiderablystrongerthanforsugar,andhe
wouldagreewithmostoftheinterpretationstheresearchersmade.

However,bytakingindustryfundingforthereview,andhavingregular
communicationsduringthereviewwiththesugarindustry,Willettacknowledged,it
puthim[Hegsted]inapositionwherehisconclusionscouldbequestioned.

Itisalsopossiblethattheserelationshipscouldinducesomesubtlebias,evenif
unconscious,headded.
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Willettcalledthehistoricalaccountausefulwarningthatindustryfundingisa
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concerninresearchasitmaybiaswhatispublished.Hesaiditisdoublyaconcern
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inreviewsbecausethisinevitablyinvolvessomejudgementabouttheinterpretation

ofdata.

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ButWillett,whoseprofessorshipisnamedafterFredrickStare,saidStareandhis
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fellowresearchersbrokenorules.Conflictofintereststandardshavechanged
dramaticallysincethe1960s,henoted.

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Since1984,theNewEnglandJournalofMedicinehasrequestedauthorstodisclose
conflicts.Andthejournalnowrequiresauthorsofreviewsnottohavemajor
researchsupportfromrelevantcompanies.

NEJMspokeswomanJenniferZeissaidthejournalnowasksauthorstoreportall
financialconflictsduringthe36monthspriortopublication,andalsoconductsa
rigorouspeerreviewthataidsusinguardingagainstpotentialconflictsofinterest.

Glantzsaidthejournalshouldattachaneditorialnotedescribingwhatactually
happenedwiththereview.Theprovenanceofthepaperisverymisleading,hesaid.

Zeissaidthejournalplanstotakenoaction.

Meanwhile,Kearnsiscontinuinghercampaigntorevealmoreinternaldocuments
fromthesugarindustry.

InarecentinterviewataUCSFfoodcourt,shesteeredclearofthegigante
chocolatechipcookiesandchoseachickensandwichandafruitcup.Shesaidshes
driveninpartbyherexperienceasadentist,whenshesawpatientswhosemouths
werewreckedbytoothdecayoneofwhomneededdenturesatage30.

ThefederalgovernmentisgettingonboardwithresearcherslikeKearnswhohave
beenwarningoftheperilsofsugarnewdietaryguidelinesrecommendlessthan10
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percentofapersonsdailycaloriescomefromaddedsugars.
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RepublishedwithpermissionfromSTAT.Thisarticleoriginallyappearedon
September12,2016

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ABOUT THE AUTHOR(S)

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Melissa Bailey
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Melissa Bailey

STAT
STAT delivers fast, deep, and toughminded journalism. We take you inside science labs and
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Scientic American is part of Springer Nature, which owns or has commercial relations with thousands of scientic publications
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2 016 S CI E N TI F I CA ME RI CA N , A DI V I S I ON OF N A TU RE A ME RI CA , I N C.
A LLRI GHTS RE S E RV E D.

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