Whole (38 page)

Big Pharma also funds medical journals in a more insidious way, through article reprints. When a study published in a prestigious journal
supports the claims of a drug manufacturer, that’s good news for sales, because one way the pharmaceutical company gets the word out to doctors who will prescribe the drug is through expensive, glossy reprints of the article that the drug rep delivers (generally accompanied by a box of donuts or fancier fare). The journals enjoy huge profit margins on these reprints, sometimes up to 80 percent, according to former
British Medical Journal
editor Richard Smith.
¹
And a study published in 2010
²
correlated high reprint sales with industry-funded studies. In other words, the published studies that pharmaceutical companies paid for were much more likely to generate big reprint profits for journals. How much money are we talking about? It’s not unusual for a single reprint order to cost millions of dollars.
³

Setting aside the obvious question of whether the peer review boards of medical journals prefer studies that show positive drug effects, we can see that wholistic research is unlikely to become a reprint profit center. In whose financial interest is it to spread the word that eating processed food and factory-farmed beef, dairy, and poultry increases disease risk? Even “natural foods” retailer Whole Foods profits from processed foods; the
Wall Street Journal
reported in 2009 that CEO John Mackey admitted, “We sell a bunch of junk.”
⁴

Medical journals, in short, are given a financial incentive, if not outright pressured by their pharmaceutical benefactors, to publish reductionist studies that promote the efficacy of pharmaceuticals and other profitable interventions. Other models and viewpoints are seriously underrepresented in the medical literature, leading those who read that literature—doctors, researchers, policy makers, and the public—to believe mistakenly that the biased sliver of data that passes through the medical journal filter actually represents a larger truth.

I’ve seen publication bias of medical research journals many times in my own career. Although we were able to publish our findings on the effect of animal protein in highly qualified journals, further commentary on the broader significance of these findings has been another matter (one I intend to push even more vigorously after this book is completed).

Earlier, in
chapter three
, I mentioned the conversation I had with my colleague Peter Magee, the editor in chief of
Cancer Research,
the leading cancer research journal in our field. I told him of the new experiment my lab was planning, which would compare the remarkable protein effect on
cancer growth with the well-accepted effect produced by a really potent chemical carcinogen, and which I suspected would show that a relatively modest change in nutrient consumption might be even more relevant for cancer development than exposure to the potent carcinogen. He was skeptical, but he agreed that, if we actually got such results, he would consider highlighting our findings on the cover of the journal.

Once we were ready to publish, however, my editor in chief colleague had retired. His replacement and the new editorial review board were inclined to dismiss nutritional effects on cancer. They wanted papers on ideas that were more “intellectually stimulating”—papers that looked at how cancer works in molecular terms, especially if these ideas concerned chemicals and genes and viruses. Despite our adhering strictly to reductionist experimental procedures, our investigation of nutrition’s effects on cancer growth was almost akin to nonscience. Needless to say,
Cancer Research
did not publish our paper.

I received another cold shoulder from medical journals after collaborating with the director and founder of the True North Health Center, Dr. Alan Goldhamer. We coauthored a retrospective analysis of the dramatic effects of his fasting program on his clients with hypertension.
⁵
Every one of the 176 successive patients who were analyzed for the paper experienced a drop in blood pressure, most of which began within a few days of beginning the fast. The effect occurred relatively rapidly, was more substantial than that produced by any antihypertensive drug ever tested, and was free of side effects. It proved to be an unusually effective intervention. But journals like
JAMA
and
NEJM
, whose income depends on heavy advertising from antihypertensive medicines, declined publication in spite of reviewer recommendations to publish. They chose their wealth over your health.

The most egregious case of bias and muzzling I’ve witnessed on the part of a scientific journal revolved around a deeply flawed study
⁶
that purportedly proved that the dangerous Atkins Diet was more effective in helping overweight and obese women lose weight than three other diets, including Dr. Dean Ornish’s low-fat diet. The study was published in
JAMA
in March 2007, despite the article grossly misrepresenting the study’s results. One example: the authors claimed that their subjects on the Ornish diet were limited to 10 percent fat, as the diet recommends. But a careful review of the data table showed that over twelve months,
participants supposedly on the Ornish plan actually consumed about 29 percent of their calories in fat. Yet the authors insisted that they had performed a fair comparison. In that deception they were aided by the
JAMA
Letters section editor, Dr. Robert Golub, who refused to publish a single critique calling attention to the study’s very serious shortcomings, including commentaries submitted independently by Dr. Ornish himself, Dr. John McDougall, Dr. Caldwell Esselstyn, and myself. After
JAMA
ignored these submissions, I wrote to Dr. Golub, complaining about his journal’s antiscientific actions, and urging him to publish at least one informed critique of this flawed study. His reply? A pithy:

Dear Prof. Campbell,

Your letter has been rejected, and we will not engage in further e-mail correspondence about it.

Dr. Golub should have been dismissed forthwith from his position with a reprimand. This is a lack of integrity of the highest order. But in the current system of medical publishing, it’s just business as usual. After all, the Atkins Foundation is more than a diet; it’s the propaganda arm of a billion-dollar business. They call the tune, in the form of funding grants totaling millions of dollars per year,
⁷
and the doctors and researchers who don’t mind prostituting their professional credibility dance merrily across the pages of the most trusted medical publications in the world.

Most people don’t read medical journals; instead, they get their health news from newspapers, television news, and news websites owned by large media corporations. Ideally, journalists who cover the health beat peruse the top medical journals, attend professional conferences, and interview scientists about new discoveries and ongoing research. They use their own scientific training and background (meager as it often is) to evaluate and interpret findings to a public that lacks scientific expertise—which includes most elected officials. One of the key contributions of health journalists is to set the context of new findings by showing how the new
information fits into existing knowledge. Does it confirm, contradict, expand, or add nuance to the current paradigm?

In short, the public-facing media is supposed to be fair, thorough, and knowledgeable on the subjects they report. But they are too often none of the above. Most media bow to the subtle power exerted by the conglomerates that own them (in the case of the major networks and print media outlets), advertisers and/or underwriters, government regulators, and even elected officials (in the case of public broadcasting and other government-supported public media).

Both for-profit and the vast majority of nonprofit media simply echo the industry and government line. That line reinforces the reductionist paradigm and, as an extra bonus, produces some wonderfully gripping and sensationalist news to keep titillating the public: “A scientific breakthrough in the War on Cancer!” “New anti-obesity pill based on Amazonian superfood!” “Can chocolate cure depression?” You’ve seen many similar headlines and teasers, I’m sure.

If the mainstream health media were better—more scientifically literate, independent, and thoughtful—then the research establishment couldn’t get away with the distortions of truth that come from shoddy study design and biased medical journals. The journalists, and the public they represent and educate, would demand more variety in study designs, clearer explanations of the limits of current knowledge, and more inquiry into questions that really matter. After all, we the people are the ultimate source of all the funding, whether through our federal taxes funneled through the NIH, or our health insurance premiums and co-pays going to pharmaceutical companies, or our charitable donations to disease societies and patient advocacy groups. If the media really were free and fair, they would represent our interests. Instead, they function, with little exception, as mouthpieces for industry, telling us the side of the story industry wants us to hear while pretending it’s the whole truth. They spin the evidence positively and negatively to legitimize our broken health system and make it appear to be the only way things could be.

As we’ve seen, reductionist research may produce “truths” out of context that serve only to mislead and befuddle us. When the media report these minutiae as if they mean something important, it contributes to the public’s sense of confusion. They share out-of-context details about
fiber in oatmeal, lycopene in tomatoes, and vitamin A in carrots. One day they tell us that a glass of red wine a day will help us live longer, and the next day we discover that even one glass is toxic to the liver. Low-fat diets are great today; tomorrow, full fats are in. The result of all this reporting? Most consumers throw up their hands and alternate between false hope (“Hey, sardines prevent heart attacks!”) and fatalism (“Looks like everything’s gonna kill you. Might as well stop worrying about it.”). This bipolar attitude toward nutrition serves the industrial profiteers who sell us these foods, as well as the ones who sell us the treatments for the diseases our poor food choices cause. All this confusion and noise also lets bad ideas sneak through and look good by comparison.

The reporting I’ve described here is unavoidably biased toward industry’s interests. Bias does not necessarily mean lying. It can also mean exactly this: spinning minor details into major revelations.

Another form of bias involves omitting inconvenient data. The media can report only a small percentage of the biomedical findings that are produced every year. A legitimate media function is to act as a filter, choosing and sharing what’s valid and most important while ignoring the rest. But some media outlets use this responsibility as an excuse for failing to report on some of the best and most important health information, because it doesn’t fit into the reductionist paradigm or undermines the goals of an advertiser or sponsor.

Bias can’t explain all the media’s failures to give us good nutrition and health information. Another problem is the appalling lack of scientific expertise that many of the most influential reporters covering the fields of health and nutrition demonstrate. Because they are unable to assess critically the quality of health information that industry, government, and academia produce, they typically act as mouthpieces for these institutions rather than advocates for the public’s right to know. Many articles consist of minimally rewritten corporate and government press releases, interspersed with expert interviews that corporate PR representatives conveniently hand them on silver platters. As a result, the reductionist half-truths that masquerade as scientific wisdom get passed on to us unquestioned and undigested. There’s nothing wrong with nonscientists writing about science; I have no interest in limiting debate or silencing freedom of speech. But I do wish that journalists would acknowledge
the limits of their expertise, rather than give the illusion of competence where none exists.

All in all, the story the media tells us about health and nutrition comes from a script written by the very people who profit from our pain and suffering. I’ve had far too many firsthand experiences of media manipulation, obfuscation, and suppression of the powerful connection between food and health to believe otherwise.

Around the same time I began working on this manuscript back in early 2007, there was an episode of the
PBS NewsHour
in which host Jim Lehrer reported an exciting news release from the ACS: cancer deaths in the United States decreased in 2004 for the second successive year.
⁸
Most notably, it was said to be a “big drop” from 2003. The way it was reported, it seemed that the tide in the War on Cancer, then thirty-six years old and counting, was finally about to turn. Later in the program,
NewsHour
correspondent Margaret Warner interviewed the chief medical officer of the ACS. Glowing with pride, he offered a few reasons for this big drop in cancer death rates, especially the decrease in cancers of the lung, breast, and prostate: better treatments, more screening, and less smoking. All in all, it was an upbeat report and interview that aired, coincidentally, just in time for the annual ACS fundraising campaign.

The next day, in my local Raleigh, North Carolina paper, the story dutifully made its appearance on the front page.
⁹
Shortly thereafter, President Bush was persuaded to go over to the nearby NIH laboratories and to declare that “the drop [in cancer rates] this year was the steepest ever recorded.”
¹⁰
What’s more, this “big” drop was all the more promising, the press regurgitated, because it followed what might be the beginning of a new trend that started the year before.

As someone who has spent most of his career seeking to eliminate cancer, I was fascinated by this wonderful announcement. Rather than depending on the TV and newspaper reports, I decided to dig a little and examine more closely the new figures in this report. Here they are:
for every 200 cancer deaths in 2003, there was one less cancer death in 2004, a drop of about a half of 1 percent.
¹¹
That’s not the “big drop” that I expected based on the way it was reported. Although any such evidence favoring less cancer, however small, is welcome news, I doubt anyone who watched
NewsHour
that day, saw the subsequent media reports, or caught the president’s speech would have estimated its magnitude at a measly half of 1 percent.