Two years later, the NIH assembled a Task Force on Arteriosclerosis, and it came to similar conclusions in its four-hundred-page, two-volume report. The task force agreed that a “definitive test” of Keys’s dietary-fat hypothesis “in the general population is urgently needed.” But these assembled experts also did not believe such a study was practical. They worried about the “formidable” costs—perhaps $1 billion—and recommended instead that the NIH proceed with smaller, well-controlled studies that might demonstrate that it was possible to lessen the risk of coronary heart disease without necessarily relying on diet to do it.

As a result, the NIH agreed to spend only $250 million on two smaller trials that would still constitute the largest, most ambitious clinical trials ever attempted. One would test the hypothesis that heart attacks could be prevented by the use of cholesterol-lowering drugs. The other would attempt to prevent heart disease with a combination of cholesterol-lowering diets, smoking-cessation programs, and drugs to reduce blood pressure. Neither of these trials would actually constitute a test of Keys’s hypothesis or of the benefits of low-fat diets. Moreover, the two trials would take a decade to complete, which was longer than the public, the press, or the government was willing to wait.

Chapter 3

Chapter Three

CREATION OF CONSENSUS

In sciences that are based on supposition and opinion…the object is to command assent, not to master the thing itself.

FRANCIS BACON, Novum Organum, 1620

BY 1977, WHEN THE NOTION THAT dietary fat causes heart disease began its transformation from speculative hypothesis to nutritional dogma, no compelling new scientific evidence had been published. What had changed was the public attitude toward the subject. Belief in saturated fat and cholesterol as killers achieved a kind of critical mass when an anti-fat, anti-meat movement evolved independent of the science.

The roots of this movement can be found in the counterculture of the 1960s, and its moral shift away from the excessive consumption represented by fat-laden foods. The subject of famine in the third world was a constant presence in the news: in China and the Congo in 1960, then Kenya, Brazil, and West Africa—where “Villagers in Dahomey Crawl to Town to Seek Food,” as a New York Times headline read—followed by Somalia, Nepal, South Korea, Java, and India; in 1968, Tanzania, Bechuanaland, and Biafra; then Bangladesh, Ethiopia, and much of sub-Saharan Africa in the early 1970s. Within a decade, the Stanford University biologist Paul Ehrlich predicted in his 1968 best-seller, The Population Bomb, “hundreds of millions of people are going to starve to death in spite of any crash programs embarked upon now.”