It is important for the public It is important to recognize this. and for policy makers in particular. has resulted in inappropriate conclusions being drawn from the results of the critical evaluation of scientific information about relationships between diet and chronic degenerative diseases conducted and published by the American Society for Clinical Nutrition. The society published its analysis and then polled the nine members of the panel who served as chairmen of task forces as to their judgement about the strength of the relationshop between dietary cholesterol intake and heart disease. The average score for the panel was 62 out of a possible 100. That score indicates that agreement on this issue has not been achieyed, This is clear from the background paper on the subject. It raises many unanswered questions that require answers before the issue can be resolved. The danger for science and for public policy is that some interpretations of the Society's statement imply that some given level of concensus constitutes resolution of the scientific issue. This stems, in my view, from confusing the approach used in resolving public policy issues with that used to resolve scientific issues. For public policy issues on which there are differences of opinion we often poll the public and the issue is resolved by majority vote. Depending on the nature of the issue, there may be a requirement for a two-thirds majority or even higher. In deciding certain legal issues, we require unanimity. In using this procedure we acknowledge that we do not know the correct answer but are willing, in order to resolve an impasse, to take a chance that the majority view will be better than that of the This approach has no place in assessing the reliability of minority. scientific information. Scientific hypotheses and conjectures are acknowledged as being unresolved if substantial well-grounded criticisms of them cannot be answered. The reason the Food and Nutrition Board did not draw a conclusion about the relationship between cholesterol consumption and heart disease is that there are too many unanswered questions about the subject. When we deal with public policy issues the approach, as I have indicated, is usually quite different, although it need not be. Scientific information is used as the basis for establishing many food and health policies but it is by no means the only consideration. Political considerations, emotional reactions, pressures from groups who may profit from the policies, moral and ethical beliefs, a desire to create the appearance of doing something about a difficult problem that is not understood, are just a few of the factors that enter into public policy decisions. Such factors may completely over-ride consideration of scientific knowledge that clearly supports a specific decision. We have examples of public policy decisions regarding nutrition and health that are based on soundly established scientific evidence. We have others in which the scientific evidence has been disregarded. When, after more than 20 years of research, pellagra, a disease that was a serious public health problem during the early part of this century, was discovered to be a nutritional deficiency disease and the specific agent that prevented the disease had been identified, public policy was established to combat the disease. Cereal grain products were fortified with niacin, the specific curative factor. Whether this action alone solved the problem can be debated; nevertheless, it was an action based on thorough scientific investigation and, since that time, pellagra has ceased to be a public health problem. On the other hand, public policy with respect to fluoridation of the water supply to prevent dental caries has varied from community to community despite the consistency of the accumlated scientific evidence showing that it is the most effective method developed to date to reduce the incidence of tooth decay. Many communities have instituted fluoridation of the water supply on the basis of the scientific evidence. This has been accepted publicly and the population has benefitted. In other communities, however, fluoridation has not been instituted because a majority of the voters have opposed it. Opposition to fluoridation has often been marshalled through distribution of false information about the effects of fluoride. It has also been opposed on the basis of political or religious views about the appropriateness of this approach to the resolution of public health problems. The consensus approach to institution of fluoridation as a public policy does not affect the reliability of the scientific information on which fluoridation is proposed. It merely indicates that in some communities reliable scientific information is the major factor influencing public decisions, whereas, in others it is not. I should now like to consider, in the light of these distinctions the reasons for the intensity of the reaction to publication of a report that, in essence, recommends moderation as a guideline for sound nutrition. It has been nothing less than astonishing. Insofar as I can see, there has been no criticism of the specific recommendations included in the report. Most of the adverse reaction has been against the failure of the Board to endorse public policy-type recommendations on fat and cholesteral consumption that paralleled the dietary recommendations of several organizations for reducing the incidence of heart disease. For failing to conform with the views of these organizations, the Board has been condemned and Board members have been maligned by innuendo, even in some highly regarded newspapers. Others have taken a supportive stand. As a result a thoughtful and useful report has been misconstrued. Other groups without scientific credentials that are recognized in the field of nutrition have released statements condemning the Board and its report "Toward Healthful Diets", and have impugned the integrity of Board members. Some members of public health organizations have expressed concern that their recommendations have not been endorsed. A serious question must be raised about the reasons for the intensity of these reactions. appear to represent an effort to coerce the Board into conformity. They The few specific scientific criticisms that have been made of the report were considered by the Board as Dr. Olson has pointed out in his written testimony. The Board found the scientific evidence to be inadequate to permit it to make a general recommendation on fat and cholesterol consumption as outlined and documented in the report "Toward Healthful Diets". Much of this evidence was included 66-408 0 - 80 15 previously in the publication "Research Needs for Establishing Dietary Guidelines for the U.S. Population", which was released by the Board last year. That publication was ignored by those who criticized the recent one, presumably because it was considered to be only a scientific statement that was unlikely to affect public policy. The disagreement of members of recognized public health associations is not difficult to understand. Their recommendations have been widely publicized for many years and have become the accepted wisdom. They have been adopted by many organizations but not by either the American Medical Association or the Food and Nutrition Board. The presumed revolutionary nature of "Toward Healthful Diets", was not in its content, which represents scientific doubts long held by a substantial segment of the nutrition community. It was in the fact that this view point was accorded a public airing, for the first time. Vigorous reaction can be expected when an orthodox position is first challenged. Contrary views have received little attention or publicity despite the fact that proponents of diet modification as a disease prevention measure concede that cause and effect relationships between diet and Understanding of heart disease have not been established. science changes and it would seem to be more appropriate strategy to focus on the need for research to solve this problem rather than to adopt the adversary approach to counter those who question a hypothesis, and thereby divert energy that could be used productively. |