consideration of that in any serious way. They withdraw from a serious consideration of the problem of the dietary fiber and human health.

They narrowed their focus to the set of considerations to which you have heard this morning. The report, rather than being the kind of report characteristic of the work we do at the Academy-full, scholarly, detailed presentation of a data base and analysis-was limited to this abstract, as I termed it awhile ago, for lack of funds.

The Academy has an endowment. It does not yield nearly enough money to permit us to do this sort of thing. I have to point out to the chairman we do have an endowment. We have the right to use it, I do believe.

Mr. WAMPLER. Thank you. Mr. Chairman, I am deeply concerned about these allegations that these negotiations in the Department were terminated, for whatever reason, might be true.

But I would like to ask that the record be kept open for a reasonable period of time. I would like to make some independent inquiries of the Department to see what the circumstances were.

It seems to me that in this particular case, if the Academy had had sufficient funding, through this grant or a similar one, I think we would have had a more thorough study.

Now, apparently, they are going to do what they intended to do earlier and did not because of lack of a grant.

I would ask unanimous consent. I do not know what the chairman's plan is by way of additional hearings.

Mr. RICHMOND. Mr. Wampler, I advised the panel that our hearing record will be open for 2 weeks for any additional comments and material.

Mr. WAMPLER. That will be fine.

Mr. RICHMOND. Also, I think our committee will have a meeting promptly after these hearings to discuss what further actions we would take.

Mr. WAMPLER. That would certainly be satisfactory for me.
Thank you, Dr. Handler.

Mr. RICHMOND. Dr. Handler, I am sorry you cannot stay for the balance of the hearings. We will have a closing statement. I am just telling you, unfortunately, it will not be what I consider a pleasant statement. But I feel I have to make it.

I really believe that you are a great National Academy of Sciences, which has such a prestigious reputation, which has been somewhat sullied.

I would like to straighten it out again, if we possibly can. Thank you.

Our next witness is Dr. Olson.

STATEMENT OF DR. ROBERT E. OLSON, ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO.

Mr. OLSON. Thank you, Mr. Chairman.

It is a privilege for me to participate in these hearings. I have submitted for the record a complete statement which I would like to have entered to the proceedings.

Mr. RICHMOND. Without objection, so ordered.

[The prepared statement of Dr. Olson may be found on p. 228.] Dr. OLSON. I should like to begin by saying something about the mode of action of the task force of the Board that prepared this report. As you heard from Dr. Harper, it was a group of the Board. There were six of us. I function as chairman.

Dr. Handler has commented about the fact that it is not fully documented, but I want to assure you that the study was comprehensive, deliberate, and long-involving a review of some 400 references in the medical literature on the issue of diet and heart disease.

Only 60 of these are quoted in the report, and as he properly said, this report, as published, represents an abstract of a much more serious and scholarly effort than is reflected by the report itself in its 20 pages.

It is the intention of the Academy to now prepare an encyclopedic background for these recommendations. I do not think it will change the sense of the recommendations in terms of current knowledge. But nonetheless that will be done.

I think also it is important to point out that the Food and Nutrition Board and the task force that prepared this report were motivated by three considerations in developing these recommendations. The first was that diet is an important part, but only a part, of preventive medicine. In the conclusions and recommendations, the other aspects are delineated. Diet is an important part, but a sound program of preventive medicine involves immunization, improvement of physical fitness, prevention of accidents, avoidance of cigarette smoking and alcohol abuse, and health surveillance so that an increasing proportion of our population will, in fact, understand what risk factors they have with respect to various diseases.

The second consideration that motivated the task force was the view that epidemiology, which relates factors in the host and the environment, the disease processes, cannot be the sole basis for making public health recommendations.

That is not to say that the Board did not scrutinize exhaustively the epidemiological reports that have been prepared and that are in the literature relating diet to disease. This we did.

But on the other hand it is clear from the writings of eminent epidemiologists, like Sir Austin Bradford Hill of the University of London, that single observations about association of an event or a factor with a disease process have not established cause and effect. There has to be an additional exploration of features of this association, some of which were mentioned by Dr. McGinnis today, that entered into the deliberations of the task force of the American Society for Clinic Nutrition, such as strength of association, specificity of association, consistency of association, temporality of association. Does the purported event bear a proper time relationship to the appearance of the disease? Ingredient in the biological observations about a disease is a dose-response curve.

Then there are other points which I think are very important. The plausibility of the purported cause and effect is one; coherence of the data as it relates to animal experimentation and clinical trials; the very great importance of intervention to see whether the purported event or factor, if removed, will alter disease rates; and, finally, a syn

thesis based on analogy with other observations. The Board did take all these criteria into account in developing its recommendations.

The third point that motivated the Board was the idea that has come up repeatedly today in the the testimony; that the proof of benefit should be demonstrated before one makes a recommendation to the public.

The philosophy about proof of benefit you have heard discussed today. The Public Health Service is more or less taking the view that without proof of benefit they are going to proceed under the assumption that it will eventually be demonstrated.

I think the Board took a more conservative view and said if proof of benefit has not been demonstrated, then it is important not to make a recommendation. I think on that philosophic issue the difference in the report really hinges.

The report has been called a procholesterol report. It is not a procholesterol report. The Board does not pronounce on increasing cholesterol intake. It simply says with the current data available, we cannot really, in good conscience, make a recommendation on cholesterol.

The actual data show that since 1900 the cholesterol intake in the American population has been almost constant at about 550 milligrams percent. It has not fluctuated in any respect to follow the curve of heart disease, which as you know, began to increase in 1920 and peaked in 1963. It has been declining since at the rate of 1 to 2 percent per year.

In the studies done in this country, in Massachusetts and in Michigan, there has been no correlation made between any component of diet, including cholesterol intake, and risk. The Board reviewed, in great detail, the lipid hypothesis vis-a-vis the importance of LDL cholesterol increasing the probability of events of coronary disease.

They also could not ignore this important information in our own country which shows that dietary cholesterol intake of this essential metabolite does not correlate with risk, or, for that matter, with serum cholesterol values.

Finally, we reviewed a great deal of evidence in metabolic units which have shown that if one begins with a basal diet of 300 milligrams per day of cholesterol, which is the Public Health action level at the present time, and adds additional cholesterol, the effect on serum cholesterol is very modest, if at all detectable.

There are increasing numbers of new studies that show that adding meat or eggs to an otherwise balanced diet containing 300 milligrams of cholesterol will not, in fact, appreciably affect the serum cholesterol level.

So, on the basis of these data, we simply fail to pronounce. We did not urge people to go out and have an omelet orgy or in any way change prudent dietary habits.

The report has been characterized as a profat report. It is not a profat report. In fact, the constraints which are put on fat intake are really greater than those recommended by the USDA in the sense that the USDA does not suggest a number.

The Food Nutrition Board has been very impressed with the need for balance in diet. Variety and moderation is the key phrase that you have heard repeated here oftentimes.

In fact, if one follows the basic four food groups and selects portions in proportion to that recommended by the USDA, which has had this

document now for some 30 years, with decreasing caloric intake, in order to get the recommended dietary allowances, in the essence of a sound diet, fat intake has to go below 35 percent.

So, as calories shrink, fat must shrink. This is clearly indicated in one of the recommendations which, as you know, said for low-energy expenders, which we as a Nation are becoming, you must reduce fat, alcohol, and sugar.

In my full testimony I have discussed what I consider eminent authorities which have expressed divergent views on the lipid hypothesis as applied to dietary modification. There are many of them, including Sir John McMichael, perhaps the leading cardiologist of Britain.

Most recently, there is the American Heart Association's statement, which is ratified by the delegates of that organization, which essentially makes the same recommendations of the Food and Nutrition Board.

Finally, Mr. Chairman, I would like to point out that among the expert national committees around the world, four or five of them have not pronounced on dietary cholesterol. This includes the Canadians, the Australians, the British, the Norwegians, and the New Zealanders. They have specifically avoided making a recommendation on dietary cholesterol.

So, the Board feels we are not so out of step with very deliberate bodies who have considered similar evidence.

Finally, Dr. Levy talked briefly about the decline in coronary heart disease in this country since 1963. He also mentioned that a conference was held by NIH to study and try to explain this decline, which concluded by saying that it could not be explained.

I think it is clear to observers of the rates of change of heart disease in this country, which has had this great rise up to 1960 and then a decline, that no single variable can explain either the rise or the fall.

Dietary habits have not changed that much since sometime before 1963, which we have to allow for in terms of cause and effect, to make diet a major determinant of the rise and fall in coronary heart disease. In final conclusion, Mr. Chairman, it is our view that this is a sensible, prudent, and important statement for the American people that reiterates advice given many years ago about moderation and variety, adding an issue of salt restriction, and particularly urging people to maintain normal weight by increasing exercise and by reducing food intake.

Thank you.

Mr. RICHMOND. Thank you, Dr. Olson.

Mr. Panetta has a speaking engagement. I delight to allow him to ask a few questions now.

Mr. PANETTA. Thank you, Mr. Chairman.

First of all, let me say to you, Dr. Harper, that indeed there is no problem with confusion and there is no problem with dissent; but I think the main goal, as stated in your report, was not to add to the confusion, but try to clarify it.

I think that was the basic intent that was stated. In an effort to reduce the confusion in the mind that has resulted from the conflicting recommendations, the Board has prepared the following statements. I do not think it was your intent, certainly, to add to the confusion. but to try to clarify it.

In that context, it seems to me that the conclusions we can draw are these. I really want your concurrence, or at least your objection, to what I am going to say.

First of all, with regard, and speaking specifically on the cholesterol issue, to people who risk factors present-and I think in the statement of the report it is persons with a positive family history of heart disease, risk factors such as obesity, hypertension, diabetes, concentration of blood lipids, and liproprotein fractions-that in those instances there is agreement that there should be a reduction in terms of cholesterol intake.

Is that correct?

Dr. HARPER. Yes.

Mr. PANETTA. With regard to individuals who do not reflect those risk factors, I would take it that it is still your advice not to eat too much cholesterol. In that sense you are probably concurring with the general guidelines on the diet.

Is that a fair statement? In other words, you are not saying to people that do not have these risk factors that they are to go out and gorge themselves on cholesterol?

Dr. HARPER. We certainly are not saying that. We are still saying moderation.

I would like to point out one difference we are not saying. We are not saying that if you follow these guidelines there is the implication that you may reduce the incidence of chronic degenerative diseases, which a number of other organizations are saying.

If those other organizations were selling a product and put that claim on the label, the Food and Drug Administration would immediately make them cease and desist doing that. This seems to me incongruous. That is an agency of the Government.

Mr. PANETTA. Again, though, to the extent that there is agreement that a person who goes out and eats nothing but cholesterol or eats too much cholesterol, there seems to some general agreement that that ought not happen.

Dr. HARPER. The Board certainly supports the idea that no one should eat too much of any one food or any one nutrient. We have a panel on misinformation that prepares small publications on the topic. Mr. PANETTA. Then I guess my point is this. I think the agreement is that you are looking for a prudent diet, then, with regard to the healthy individual.

The question I would then pose is this. Rather than saying that the Board makes no specific recommendation about dietary cholesterol for the healthy person, in effect, what you are recommending is that people engage in a prudent diet which may mean some restraint and some balancing with regard to all foods, including cholesterol. Would that not have been a more appropriate recommendation so the public has some kind of guideline?

Dr. HARPER. You must admit that we did not put that in the conclusions of the report or in the final group of recommendations. That was in the center of the report in the discussion. It was the one point that the newspaper reporters, the television people, all seem to focus on. They pulled it out of the report.

There are some of us, at least, who feel that was a distinct disservice to the American people in that that is what truly created the confusion.