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Mr. RICHMOND. Without objection, it will be included.
[The two above-mentioned submissions are held in the subcommittee file.]
Dr. HANDLER. Mr. Chairman, my colleagues and I are very pleased to be here to discuss with you this report which has occasioned so much interest and confusion.
In a sense, I would think it would be possible for me to simply rest our case and say that the gentlemen who preceded us have already made it and that we have very little to add to what they have already said by way of substance or what it comes to.
As Dr. McGinnis pointed out, the difference between the report of our Food and Nutrition Board and the advice given to the American public by the Department of Agriculture and the National Institutes of Health relates only to the position of cholesterol and nothing else. Moreover, even that is only a half-truth because, were one to follow the prescriptions for reasonable behavior by our panel, necessarily as one sought to reduce one's caloric intake by rational and convenient means, one would reduce one's fat intake and with it the cholesterol intake as well; it would simply go hand in hand, although perhaps not as effectively as if one deliberately attempted to restrain one's intake of cholesterol.
So the problem which is before you and which we will discuss is cholesterol itself.
Let me make a few introductory comments, if I may, before I turn to my colleagues.
First, Mr. Chairman, I rather take umbrage at the letter which you introduced from Dr. Kennedy-not your right to introduce it but with what Dr. Kennedy said.
Mr. RICHMOND. Excuse me, Dr. Handler. As you know, your colleagues are on a panel directly following you. Each of them will have 10 minutes to make their own presentation.
Dr. HANDLER. I will not try to cover what they will say.
It is remarkable that Dr. Kennedy, who did such a good job of bringing external advisers into the Food and Drug Administration, denies that external persons might have something to contribute to this discussion of the points of human nutrition as compared with full-time Federal employees. I think it is remarkable since that is not the way he ran the Food and Drug Administration. I think it even more remarkable that in the light of the fact that Dr. McGinnis, quite properly, introduced to you a study by a group of people outside the National Institutes of Health, the cochairman of whom is sitting on my left, he [Dr. Kennedy) did that. I do not understand Dr. Kennedy's point, and I take great umbrage with his raising the issue of conflict, which I think is an utter irrelevance and should not belong in these discussions.
I should say a word about the way the National Academy of Sciences works in this regard. Back in the early 1970's I introduced two sets of procedures which are still in place. The first of those relates to the fact that every time a committee is brought into being—and we have a large number—each of the appointees is asked to submit to us a completed form entitled, "On Potential Sources of Bias," which, to my knowledge, remains unique. No agency of the U.S. Government requires such; no external body known to me requires such.
Each of the people on our Food and Nutrition Board had, indeed, submitted such a statement as part of the terms of their appointment; and I submit also, Mr. Chairman, that the problem about bias is not so much that it does not exist but that it not be concealed. In our procedures, as such, at the first meeting of any committee they go once around the table and each tells all the others just what it is that is in their bias forms. That relates not only to stockholdings or directorships; it also includes where they get their research money, if they have research money; and it includes a statement of what public statements relevant to the topic before that committee they have ever put into the public domain from which they might be reluctant to retreat, for example.
Once a year, each such committee is asked to once again review the content of those forms.
I know of no other organization that works as assiduously at this matter of bias as do we; and, at the other end, once a report is available, it is subject to review by independent reviewers, not appointed by those who wrote the article. Again, I know of no other system that works quite that assiduously, getting independent opinions before a report may be released to the public.
In that regard, with respect to releasing reports to the public, Mr. Chairman, you have raised the question of whether the National Academy of Sciences should make policy. Sir, only those bodies that can implement policy can make policy; the rest of us only talk about it. We cannot make policy. And our right to talk, I think, is still guaranteed by the first amendment; it was not suspended in the charter that Congress gave to the Academy.
I think we have, over the years, thoroughly and carefully and well served the Nation by calling attention to many problems, in the past, on our own initiative. I trust that we will continue to do so as such matters become necessary.
In the present instance, I started all this, Mr. Chairman. Well before the National Institutes of Health and the Department of Agriculture issued their guidelines, I went to a meeting of our Food and Nutrition Board, and I pointed out that the American people were getting advice from many quarters with respect to patterns of food consumption and the reasons therefor, that the advice was conflicting. The one that really upset me and happened to bring me to that meeting was a book entitled "Everything You Ever Wanted To Know About Nutrition,” which was so replete with obvious errors that I went to the Board and said, “You are the most authoritative body I know that can deal with this subject. Would you address it and then say whatever you find ?" That is the beginnings of all this.
They intended to do a very large and complete study and to provide a report that would be fully documented, as this one surely is not. They were well along in their negotiations with the Department of Agriculture to secure a contract which would help them do that job when, suddenly, quite inexplicably at the time, the Department of Agriculture simply terminated those discussions.
We never knew why until our self-appointed Consumer Liaison Panel resigned. In the letter sent to me by its Chairman, Jaines Turner, who was before you yesterday, they took credit for having politically intervened in some way to stop that process. I have no idea how they
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did that; but, Mr. Chairman, I submit that that is somehow some kind of a cross between book burning and a terrorist organization's taking credit for a bombing attack.
You would have had a much more thorough, complete statement, fully documented, had that not happened. As it is, the Board, itself, did undertake the examination of data, but you do not have a report that shows it. That was for lack of funds. The funds which were available to them were the meager sum which is available from the contributions of 80 different companies in the food industry, each of which gives us about $1,000 a year and for the general support of the Food and Nutrition Board. That has been going on since 1942 or 1943.
I submit, sir, that that does not place them in any kind of conflict. There are as many companies in that group anxious to sell low cholesterol products, or corn oil, or safflower oil, as there are others who would like to sell eggs or meat. That is just a wash, and it just is not a problem. There has been no contact between those industrial people and this committee as it prepared its report.
The problem before you, namely, Is it wise and is it possible to intervene in American nutritional or dietary practices in order to affect the incidence and mortality rate from vascular disease? is an old one. It came to the fore, sir, in the period, more or less, between 1925 or 1930 and 1960 when there occurred a dramatic change in the pattern of mortality in the United States.
Nutritional diseases, the infectious diseases, the endocrine diseases stopped being the great killers of mankind, and as that happened cancer and heart diseases vascular diseases came to the fore.
It was natural for one to wonder whether or not one could do anything about that. The first clues that it might be possible came from the results of World War II when the survivors of the siege of Leningrad, like Americans who came out of Japanese prisoner-of-war camps, were terribly undernourished and very susceptible to infection, but they had no diabetes; they had no hypertension; and they had no coronary artery disease.
Acute malnutrition is hardly the way to go in order to protect us against those, but the fact that diet in some way could affect that circumstance spoke for itself out of those findings.
The next big contribution was that of Prof. Ancel Keys of the University of Minnesota, who did a very large study, in which, particularly, he compared the populations of north and south Europe. That is, sort of, he compared the butter eaters as against the olive oil eaters, more or less, in the crudest sense.
He did, indeed, find correlations or thought he did-among the composition of the diet, the level of serum lipids—the analytical procedures were not very good in those days, and the numbers themselves as absolute numbers are not trustworthy, but the general terms were there and the incidence of vascular disease. And that really started the modern ball.
Anyone who cares to reexamine those data will discover that those data are flawed in the sense that the correlation hangs very badly on one data point; namely, the behavior of the east Finnsnot the west Finns. The east Finns are the lumberjacking Finns, and I do not know what that is about, but if you remove the east Finns from all his data, the correlation coefficient drops from 0.82 to 0.45; 0.45 means no correlation whatever. Yet, that is the beginning of this story. I do not know what it is about the population of east Finland.
Since then, there has been a huge body of literature-study after study—all hopeful, all thinking that we might be able to intervene. All of us hope that it is still possible; but, in fact, with dietary cholesterol itself, as I think my colleagues will tell you, the correlations have proved to be extremely weak. As many people die with so-called normal serum cholesterols as those who die with elevated serum cholesterols. The ability of dietary restriction to reduce serum cholesterol markedly or to avert cardiovascular damage has not been demonstrated; it has been rather disappointing; it is a hope rather than a demonstration, as you have heard from the previous witnesses.
That does not mean we should not go on studying; we very much should, but it does indeed leave you with a dilemma, sir. If you will look to it, I speak to that at the very end of my statement, and I would like to read just that. It says, “Mr. Chairman, when these hearings have concluded, your committee may well find itself confronted by a dilemma.” Indeed, you have already pointed it out among yourselves.
On the one hand, you may conclude, as some have, that: Well, there still remains a thinly linked, if questionable, chain of observations that connect dietary cholesterol to serum cholesterol to vascular disease. However tenuous that linkage, however disappointing the various intervention trials, it still seems prudent to propose to the American public that we not only maintain reasonable weights for our height, body structure, and age, but also reduce our dietary fat intakes significantly, and keep cholesterol intake ito a minimum.
Conceivably, you might conclude that it is proper for the Federal Government to so recommend. On the other hand, you may instead argue:
What right has the Federal Government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence that it will do them any good ?
Mr. Chairman, resolution of that dilemma turns on a value judgment. The dilemma so posed is not a scientific question; it is a question of ethics, morals, politics. Those who argue either position strongly are expressing their values; they are not making scientific judgments. In contrast, the Food and Nutrition Board has offered a rational, scientifically defensible position that avoids either of these horns of a dilemma. All of us can live with and easily benefit by their recommendations and I hope you will agree.
Mr. Chairman, I would now like to turn to my colleagues, unless you prefer to address me directly; it is up to you.
Mr. RICHMOND. Thank you, Dr. Handler.
Your colleagues will be on the panel right after we question you. and I would prefer to question you directly.
Dr. HANDLER. Very well.
Mr. RICHMOND. As you are all aware, the National Academy of Sciences was established on March 3, 1863, based on the following charter And in the charter it says:
The Academy shall, whenever called upon by any department of the Government, investigate, examine, and report upon any subject of science and art.
Based on this charter, is it not true that the Academy's function is to provide public policymakers with sound, objective, scientific analysis ?
Dr. HANDLER. When called upon. It does not say we are not free to speak when we wish, on our own.
Mr. RICHMOND. But basically your charter is to provide other agencies with scientific research.
Dr. HANDLER. That is true, and that is what we do for the overwelming bulk of our activities, sir.
Mr. RICHMOND. It appears, Dr. Handler, that your publication, "Toward Healthful Diets,” goes far beyond your charter authority. In fact, the introduction to your own report contains the following paragraph:
The Food and Nutrition Board is concerned about the flood of dietary rerommendations currently being made to the American public in the hope that a variety of chronic degenerative diseases may be prevented in some persons. These recommendations which have come from various agencies in Government, voluntary health groups, consumer advocates, and health food interests, often lack a sound scientific foundation. And some are contradictory to one another. In an effort to reduce the confusion in the minds of the public that has resulted from these many conflicting recommendations, the Board has prepared the following statement.
Dr. Handler, that is a statement of public policy. Of course, the report does make dietary recommendations to the American public.
Dr. HANDLER. Perhaps you use the word, “policy," differently than I do, sir. I do not see that that is a statement of policy. Policy governs program, and this is advice to individuals, to the best of my knowledge.
Mr. RicHMOND. Do you think it was proper, Dr. Handler, for you to do this report
Dr. HANDLER. Absolutely.
Mr. RICHMOND [continuing]. Which is in direct contradiction to the multimillion-dollar report which the USDA and HEW have been working on for years?
Dr. HANDLER. Sir, that does not make them right.
Mr. RICHMOND. No; but do you think it was right for you to announce this report at a public press conference without even going back and discussing the matter with HEW and USDA?
Dr. HANDLER. I think that was ungracious, and I regret that. But it was ungracious; it was not illegal, nor immoral, nor improper. .
Mr. RICHMOND. Also, do you think you might have discussed this report with our committee or Senator McGovern's Committee on Nutrition over in the Senate?
Dr. HANDLER. They did not discuss their report with us, sir. The U.S. Senate Select Committee on Nutrition issued a report and never came near us to ask what we thought of their advice to the United States.
Mr. RICHMOND. Dr. Handler, the National Academy of Sciences, as we have already established, was ordered by President Lincoln, on March 3, 1863, to advise Government agencies, to advise the Congress.
First of all, I am glad that you admit that you should not have had a public press conference on this report. Dr. HANDLER. I did not admit that; I said it was ungracious.
Mr. RICHMOND. Second, I feel aggrieved that you did not come before our committee or Senator McGovern's committee. And, third, I