Despite that and despite the fact that that warning is printed on every package of cigarettes that is marketed in this country, I am told that the consumption of tobacco continues to rise. Do you have any observations on that phenomenon?

Mrs. WHELAN. You are asking me to comment on human nature. The tobacco-disease link, I think, it is important to recognize in terms of the spectrum of the strength of causation. Here we have something wherein there is a very, very strong increased risk of many different types of disease which are related to smoking.

In terms of the question of diet and heart, there is a lot of interesting evidence there, a lot of suggestive associations, but it is simply not in the same category.

With regard to the role of Government, I would suggest that our Government refrain from commenting or taking an educational role, or beyond that a legislative role, until we have more consensus from the scientific community on the cause-effect relationship.

Mr. WAMPLER. I certainly agree with your latter statement. That has been a bone of contention of mine for some time, that these types of decisions should be predicated on the best scientific information available to us. I think it was perhaps an understatement when you indicated that there is a genuine division of opinion among scientists on the subject matter before us today.

Again, I thank you for taking time to come and for sharing your thoughts with us.

Mrs. WHELAN. Thank you.

Mr. WAMPLER. I wish you well in your future work on the studies that you have underway.

Mr. RICHMOND. Thank you very much for coming, Dr. Whelan. This hearing is recessed until 10 tomorrow morning. Thank you, ladies and gentlemen.

[Whereupon, at 2 p.m., the subcommittee stood in recess to meet Thursday, June 19, 1980.]

NATIONAL ACADEMY OF SCIENCES REPORT ON

HEALTHFUL DIETS

THURSDAY, JUNE 19, 1980

HOUSE OF REPRESENTATIVES,

SUBCOMMITTER ON DOMESTIC MARKETING,
CONSUMER RELATIONS, AND NUTRITION

OF THE COMMITTEE ON AGRICULTURE,

Washington, D.C.

The subcommittee met, pursuant to recess, at 10 a.m., in room 1301, Longworth House Office Building, Hon. Frederick W. Richmond (chairman of the subcommittee) presiding.

Present: Representatives Panetta, Glickman, Harkin, Symms, Heckler, and Grassley.

Also present: Representatives Brown and Wampler of the full committee.

Staff present: Robert M. Bor, chief counsel; John R. Kramer, special counsel; John E. Hogan, counsel; Robert T. Lowerre and J. Robert Franks, associate counsels; Peggy L. Pecore, clerk; Bernard Brenner, Carolyn Cheney, Anita R. Brown, Gary Norton, Glenda Knight, Mary Jarratt, and Thomas E. Adams, Jr.

OPENING REMARKS OF HON. FREDERICK W. RICHMOND, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK

Mr. RICHMOND. Good morning, ladies and gentlemen.

This is a continuation of the hearings of the Subcommittee on Domestic Marketing, Consumer Relations, and Nutrition of the House Committee on Agriculture, public hearings on the National Academy of Sciences Food and Nutrition Board's publication entitled, "Toward Healthful Diets."

At the first session of this hearing on the Food and Nutrition Board's report, we heard testimony about several aspects of the current status of research into nutrition and about the process for which this report was compiled and about the impact of public policies on nutrition education.

Briefly, we were told that the preponderance of evidence viewed by a consensus of scientists working in this field is that diet has a very strong impact on health. In particular, we were told that diet affects serum cholesterol levels which, in turn, are related to heart disease and possibly cancer. This is the so-called diet heart hypothesis. We were also told that many, many scientists believe that important evidence about this relationship is found in epidemiological studies in which the diets and disease data of whole populations are compared.

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The Food and Nutrition Board's report did not address this kind of evidence. We were also told that this report was not based on any new evidence but that it did utilize some evidence on which the Government's public policy on dietary guidelines is based.

We also heard testimony to the effect that a sound public health policy should be based on preventative measures in which the advice to reduce cholesterol levels and the intake of saturated fats is significant in attempts to reduce the risk of heart disease and possibly cancer. This advice, of course, is contained in the present official policy of the Government's documents, but that advice is not given in the Food and Nutrition Board's report.

Now I would like to insert into the record a letter from Dr. Donald Kennedy, president-elect of Stanford University and, as we know, former Administrator of the Food and Drug Administration. Dr. Kennedy's other commitments, namely, a commencement, prevent him from being here today.

[The prepared statement of Dr. Donald Kennedy follows:]

PREPARED STATEMENT OF DONALD KENNEDY, VICE PRESIDENT AND PROVOST, STANFORD UNIVERSITY

I have been asked to comment on recent advice on diet given by the Food and Nutrition Board, National Academy of Sciences/National Research Council. As the sharp differences between the Food and Nutrition Board's recommendations and those issued earlier this year by HEW and USDA indicate, there is disagreement in the nutrition community about the advisability, for most people, of reducing dietary cholesterol and fat. I cannot provide expert scientific testimony on the merits of this controversy. I am, however, familiar-as an NAS member and a former officer of the NRC and its committees, and as a former health agency head-with some differences in procedure between the two kinds of organizations that have produced the conflicting advice.

The position set out by the Departments of Health, Education, and Welfare and of Agriculture were based on analysis of the available data by full-time, capable professional scientists. That published by NAS/NRC is based upon review by a somewhat smaller number of equally distinguished scientists who take time from other duties to provide advice to Government. The differences in the time and attention, or in the level of ability, supplied by the two groups is probably not significant. There is, however, a significant difference in their accountability to the public. Committee members as NAS/NRC are not subject to the same strict scrutiny for conflict of interest as are Government scientists, nor does the adequacy of that scrutiny enjoy the full protection of congressional oversight. That distinction may ordinarily be unimportant. When the matter is as controversial as the subject of this hearing, however, it may become critical. That is especially true when the more prudent advice offered by the public comes from the source with the better guarantee of objectivity.

Mr. RICHMOND. Mr. Brown, would you like to make an opening statement?

Mr. BROWN. No, thank you, Mr. Chairman.

Mr. RICHMOND. Mr. Wampler?

Mr. WAMPLER. No, thank you.

Mr. RICHMOND. Our first witness this morning is Dr. J. Michael McGinnis, Deputy Assistant Secretary for Health, Disease Prevention and Health Promotion, Department of Health and Human Services. Good morning, Dr. McGinnis.

STATEMENT OF DR. J. MICHAEL MCGINNIS, DEPUTY ASSISTANT SECRETARY FOR HEALTH (DISEASE PREVENTION AND HEALTH PROMOTION), DEPARTMENT OF HEALTH AND HUMAN SERVICES Dr. MCGINNIS. Good morning, Mr. Chairman and members of the subcommittee.

I would like to thank you for the opportunity to meet with you today to discuss our mutual concern with appropriate dietary guidelines for healthy Americans. I would like to begin by introducing Dr. Robert Levy, the Director of the National Heart, Lung, and Blood Institute. Dr. Levy will follow my presentation, and will discuss the evidence regarding relationships between diet, blood lipid concentrations, and atherosclerotic disease, especially atherosclerosis as manifested in heart attacks.

Also here and available for questions is Dr. Wayne Callaway, acting as Executive Secretary of our departmental Nutrition Coordinating Committee.

With the Chair's permission, I would like to submit my formal remarks for the record and speak somewhat less formally from charts and notes.

Mr. RICHMOND. Without objection, your entire testimony and charts will appear in the record.

[The statement of Dr. McGinnis may be found on p. 156.]

Mr. RICHMOND. We have allotted you 10 minutes to say anything you wish.

Dr. MCGINNIS. Mr. Chairman, as you know, the Department of Health and Human Services has, with the Department of Agriculture, developed a set of dietary guidelines for Americans. I think it is im portant to note that there is a substantial similarity between the guidelines which were developed by our two Departments and many of the elements of the report of the Food and Nutrition Board. There are, of course, some prominent differences related to the way the cholesterol issue is presented.

To give you an idea of how the dietary guidelines were developed by our two Departments, I would like to construct for you the analytic framework involved in our deliberations.

It should be stated at the outset that the fundamental issue for public nutrition policy is not the extent to which a solitary dietary factor has been proven to cause a solitary disease, but what, on balance, are sensible dietary recommendations to the public, given the relationship between dietary factors and a range of diseases, and given current aggregate dietary patterns.

The basic goals behind dietary recommendations relate to the assurance of dietary adequacy and the prevention of disease. So the first question we face is: What are the diet-related factors in diseases that are prominent for Americans?

On the first chart is a listing of the leading causes of death for Americans, as well as certain prominent diet-related causes of morbidity. Listed on the right are the prominent risk factors associated with these diseases.

You will note that there are diet-related factors prevalent throughout each of these diseases-virtually all of them for the purposes of this discussion. I would like to go through them individually, if I might.

For heart disease, the associated factors are high blood pressure and elevated blood cholesterol in addition to smoking, lack of exercise, diabetes, and stress.

For cancer, the associated factors are alcohol and diet, in addition to smoking, worksite carcinogens, and environmental carcinogens.