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feel terribly aggrieved that you did not sit down with Dr. Levy, Dr. McGinnis, and other people, and discuss the matter on the basis of an interagency task force, which is the way it should have been done when you have a definite contradictory report based on the same set of facts.
Dr. HANDLER. I repeat, neither the Department of Agriculture nor the National Institutes of Health turned to our Food and Nutrition Board for advice with respect to their statement; they did not ask our opinion or our permission to release their statement, nor did we take umbrage when they did that.
I do not understand, sir, this line of argument that somehow we are compelled to ask someone else's permission to say something.
Mr. RICHMOND. Dr. Handler, your charter makes you a research organization; policy is supposed to be made by either the Congress or executive organizations of the Government. You are not an executive organization of the Government.
Dr. HANDLER. That is correct, and we did not behave like one.
Mr. RICHMOND. Certainly you did by putting out this report without going back and talking to an agency of the Government.
Dr. HANDLER. No university in the United States asks your permission, sir, to publish those scholarly works of its professors.
Mr. RICHMOND. Yes, but universities in the United States are not supported 90 percent by Federal funds based on a Federal charter that goes back to 1863.
Dr. HANDLER. We did this with funds that were not Federal, sir. .
Mr. RICHMOND. You did it with industry funds? Do you think a report done with industry funds by a distinguished Government agency
Dr. HANDLER. We are not a Government agency.
Mr. RICHMOND. In that you are chartered by the Government, we could call you a Government-chartered organization. Is that correct!
Dr. HANDLER. At the time we were chartered, sir, there was no other way to get a charter in the District of Columbia.
Mr RICHMOND. Dr. Handler, you are chartered, and you are financed basically by the U.S. Government. You are an official adviser to the U.S. Government.
Dr HANDLER. With that, sir, I would agree.
Mr. RICHMOND. Now, we have established you are an official adviser to the U.S. Government.
Dr. HANDLER. And we are hamstrung. You deny our right to speak on any other subject unless
Mr RICHMOND. As an adviser to the U.S. Government, your obligation was to go to USDA and HEW and put together a task force and work this out so that the American people would not now be totally confused.
Dr. HANDLER. It would be one rotten country if that were true. I deny that, sir.
Mr. RICHMOND. Dr. Handler, do you mean to tell me that you do not think it would be a lot better idea for you to form a task force
Dr. HANDLER. I say it was ungracious, and it may even have been
impolitic; but it was neither improper nor immoral. It did not defy our charter.
Mr. RICHMOND. You do not personally feel that this whole matter could have been taken care of in a much more efficient and proper fashion if you had dealt with the other two Departments without going straight to the American public with your findings!
Dr. HANDLER. What would have happened if we had done that, sir? Would they have asked us not to publish it, and should we have then not done so? Is that what you are proposing? The opinions of our Board would not have changed.
Mr. RICHMOND. My time is up, Dr. Handler. Mr. Panetta?
Dr. Handler, I do believe that goal of the report, which is stated in the report, which was to try to alleviate the confusion in the public mind with regard to conflicting recommendations in this area, frankly, was not achieved here.
What comes out of the questioning and, I think, the presentation is, that like so many other reports and agencies, the biggest problem becomes: “Whose turf are you on? Whose area are you in? Whose feet are you stepping on?” as opposed to what the goal of these efforts is supposed to be. The goal here was to try to clear up conflicting statements.
It seems to me that it would have been in the interests of the Board to really deal with the other agencies, to really deal with the reports, to try to develop some kind of comprehensive advice for the American public. That has not happened here. We essentially have the same old confusion.
Your report has generated opposing viewpoints that I think, if I were a member of the public, I would be more confused about than ever—as to what I ought to do.
Frankly, I would fall back on my basic commonsense—to eat what I think is correct and to go to my doctor and probably seek out his guidance. And I think that is where we are at as a result of the testimony that has been presented here.
The fact is that there is confusion here over what I think is a very small area of difference.
Dr. HANDLER, Agreed.
Mr. PANETTA. And I think what is happening is that what is being presented is actually making the differences much greater than they really are.
The specific area of difference, as far as I can determine, relates to the question: What kind of guidance or advice should we give to healthy persons ?
Dr. HANDLER. That is correct.
Mr. PANETTA. As far as the ot areas are concerned, as far as I can see, there really is not much difference. With regard to the question of risk factors, with regard to those who have hypertension, there is basically a consensus that in those instances there ought to be a lower cholesterol intake.
Dr. HANDLER. Mr. Panetta, even with respect to healthy persons, the difference between this statement and the NIH/USDA statement is
Mr. PANETTA. Then let us try to pinpoint that difference. What do you see is the basic difference with regard to the recommendation to healthy persons ?
Dr. HANDLER. That is my interpretation, and I am willing to do that. But, sir, my colleagues who wrote it are here, and I think they really are the persons who should speak to that.
Mr. PANETTA. At least with regard to your viewpoint on the report, the specific area of difference relates to that particular point?
Dr. HANDLER. Yes. It is simply how hard you should work at avoiding cholesterol in your diet.
Mr. PANETTA. I take it there is the other question, and it is really a question more of emphasis, which is: Does it, in fact, benefit the healthy person to reduce cholesterol intake?
Dr. HANDLER. I agree with Dr. Levy: We do not know that, and, in fact, we have no supporting evidence to say it. And when you do not have evidence, I do not understand how you advise it.
Mr. PANETTA. Having set that aside and we will deal with those specific questions—basically, on the dietary guidelines, as far as I can determine, most of the seven dietary guidelines that are issued by USDA and the Department of HEW-which I guess is now Health and Human Services
do you disagree with any of them! Dr. HANDLER. No, sir. Mr. PANETTA. You do not!
Dr. HANDLER. No. They all say, “Do not do too much of this, that, and the other.” And, by definition, you should not do too much of anything. Moderation and diversity—that was the line before, and we fully
Mr. PANETTA. So there really is no basic disagreement with regard to the general dietary guidelines that are issued to the American public?
Dr. HANDLER. I think that is correct, sir.
Dr. Handler, you might have known that many of the witnesses yesterday were extremely supportive of the work of the National Academy of Sciences and of the prior reports, and of the caliber of work which this panel represents as well. Even those who disagree with your contradictory findings—many had kind words for the National Academy of Sciences.
Nonetheless, the departure from what was accepted thinking in nutritional circles—according to the statements of the U.S. Surgeon General and USDA, Health and Human Services, international experts and other groups-is, it seems, a serious departure from traditional nutritional advice
Dr. HANDLER. Traditional? No; recent.
Mrs. HECKLER [continuing]. Contained in your report. That has been the source of the controversy.
I would agree with Mr. Panetta that, rather than resolving nutritional questions and removing the contradictions from the public consciousness, the report has raised new questions and possibly can lead one to more erroneous conduct than the earlier publications which prompted your study, as you have reported.
I just wonder, first of all, if your panel realized that this would be interpreted and perceived as a very substantial departure from prior advice.
Dr. HANDLER. I am afraid, ma'am, you will have to ask my colleagues what they realized; I cannot tell you what they realized. I can tell you what I said.
Dr. HANDLER. I told them that if their report departed significantly from conventional wisdom, they could be assured that it would be bathed in controversy. Those are the very words I used, and since that is, indeed, the way science progresses, if our panel, examining all the available information, thinks that the emperor has no clothes, it should say so. If that causes controversy, fine, and that controversy occurs out in the open where everyone can see it; we debate where truth lies and where ignorance really begins and let everyone know about that.
The concern of our panel—if concern is the right word—was that for several decades the American people have been told to eschew cholesterol to the best of their ability, and that statement-we submit-rests on no evidence in the literature that we can find to support it, to indicate that if, indeed, we all do that we will benefit thereby. That is where matters stand.
Mr. HECKLER. Obviously, Dr. Handler, there is the lack of proof in terms of linkage in almost all areas of diet.
Dr. HANDLER. But may one invent a hypothesis and tell the entire American people how to eat because we have a hypothesis?
Mrs. HECKLER. Obviously, if you listen to the earlier witnesses, the hypothesis exists and is based on a consensus of expert opinion, and there is what is considered to be a fairly slight deviation
Dr. HANDLER. Then, please, if you do that, you must tell the American people, “We hope that this will benefit you, but we do not know that it will." That is honesty, and in this case that has not been done. That is essentially all we have added to the debate.
Mrs. HECKLER. In terms of the exact recommendations that you have made, I think you have added a great controversy to the debate.
For example—and I would like to go back to your earlier statement on the question of your recommendation on the reduction of caloric intake-"If one reduces calories, we automatically reduce cholesterol.”
Dr. HANDLER. To some degree.
Mrs. HECKLER. Having the usual preoccupation of the American woman with diets, I can assure you that that is not the case. I am sure you are familiar with the famous Mayo Clinic diet, which was an egg-oriented diet in which you eat eggs three times a day, and
you have to really accelerate your
Dr. HANDLER. Any diet that is that bizarre and moves into extreme directions is a mistake. Moderation and diversity has been the recipe for good nutrition forever.
Mrs. HECKLER. Nonetheless, limiting caloric intake does not
Dr. HANDLER. If you do it by bizarre means rather than just eating a fraction of the normal diet, then that is what happens.
Mrs. HECKLER. But your statement was that any reduction of caloric intake would have that result.
Dr. HANDLER. I meant a rational one, ma'am, rather than an irrational or bizarre one.
Mrs. HECKLER. That just happens to be one of the diet programs that hundreds of thousands have used, and there are a considerable number of others which orient their diet totally to protein, beef intake, et cetera.
Dr. HANDLER. I call your attention to our report which tells you how to eat generously among several categories of foods as a guide to doing that, and it also tells you to watch your total calories. If you do that, you have almost no choice but to reduce your fat consumption and, with it, some of the cholesterol.
Mrs. HECKLER. I understand your total report, but I am referring to your personal statement here today in which you made the reference.
However, to go on to something more serious and more important, there is the question of your definition of the healthy person. How do you define the healthy person, over 40, for example?
Dr. HANDLER. I do not know that I can do that, Mrs. Heckler, but I certainly can say that, for the sake of the report, it meant individuals with no overt signs of cardiovascular disease; that is what it was talking about in this one limited area-and whose serum cholesterols were within what we call the normal range, although what is normal has been lowered considerably, but by what I heard Dr. Levy say, he has it down to 210-milligram percent. When I taught medical students, it was about 250; so it has come down.
Mrs. HECKLER. Then, obviously, the healthy person who was to read your report and follow its guidance, would have to first go to his or her doctor and have the serum cholesterol level measured.
Dr. HANDLER. I do not know how else to know whether you have risk factors than to find out.
Mrs. HECKLER. But this kind of procedure was not mentioned in the report.
Dr. HANDLER. Yes, it is.
Mrs. HECKLER. In your final recommendations, looking at the overview of what you have suggested, you feel that no limitation on cholesterol intake is necessary in terms of the healthy individual.
Dr. HANDLER. No; no; you are putting words into my mouth. Mrs. HECKLER. Dr. Handler, may I just ask you this specific question? Now that you have defined healthy in a very precise medical way, I would like to know what percentage of the population over 40 would fall within that category.
Dr. HANDLER. I guess I do not really know, I think it would be much more than half; but, as we get older and older, since half of us die of cardiovascular disease, the fraction goes down further, and further, and further. I had my coronary 6 years ago.
Mrs. HECKLER. Many of the witnesses yesterday suggested that 30 to 40 percent of the population over 40
Dr. HANDLER. Half of us die of this, more or less. Maleness is a risk factor, and not quite half of us are male. You can play that game, but the fact is, if you want to turn that around and ask what advice you can give to people whose physicians think they are really healthy, regardless of sex, then that is what this report is speaking to.
Mrs. HECKLER. Does it disturb you that this report could affect half of the population-half which would die of cardiovascular diseaseand that they might be reassured by the report to feel that no caution is necessary, despite prior medical and nutritional facts ?