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Perspectives

Book
Fat and heart disease: challenging the dogma
Many readers will be incensed by this Part of the scientific process is health were also complicit in providing
book. If you think saturated fats and rigorous peer review and debate. advice based on the weak science of a
cholesterol are bad for you, you’ll be Many voices were raised against the few key opinion leaders. Promises of
incensed. If you think the fat story is interpretation of the Seven Countries massive funding, together with a lack
exaggerated, you’ll be incensed. If you Study. Dissent, however, was barely of rigorous evaluation of the strength
trust in the objectivity of science to tolerated and Teicholz describes how of the evidence, seem to have resulted
inform health policy, you’ll be incensed. the discussions degenerated into in entrenched positions on dietary fat
Stories of shocking scientific corruption personal attacks. Teicholz explains intake. On the basis of epidemiological
and culpability by government agencies how this came about in the second data, but ignoring the evidence from
are all to be found in Nina Teicholz’s half of the 20th century. direct scientific interventions with
bestseller The Big Fat Surprise. This is dietary saturated fats, the mantra
a disquieting book about scientific “Researchers, clinicians, and of low-fat diets became established.
incompetence, evangelical ambition, health policy advisers should Parallels can be found in other dietary The Big Fat Surprise
and ruthless silencing of dissent that read this provocative book that recommendations today where foods Nina Teicholz. Simon & Schuster.
Pp 496. US$17·00.
has shaped our lives for decades. are promoted, or condemned, on
reminds us about the ISBN 9781451624434
It is important that people trust the basis of absent or poor scientific
scientists. Despite the increasing importance of good science and evidence.
number of retracted papers, society the need to challenge dogma…” The Big Fat Surprise is a gripping
still puts scientists near the top of narrative, but readers might be
professions that are trusted. In the After his heart attacks, US President incredulous at some of Teicholz’s claims
UK’s 2016 Ipsos MORI Veracity Index, Dwight Eisenhower offered govern­ and want to check the references.
scientists were trusted by 80% of ment support for further scientific When many of those papers are read
the British public. Unfortunately, investigation into dietary fats and again from a more critical perspective,
this might be changed by Teicholz’s heart disease. Proponents of the link the angst and anger will rise. Teicholz
exposé that claims the public were between dietary fat and heart disease reminds us to critically question
misled into thinking that high levels of were therefore in the ascendancy and research and, more importantly,
dietary saturated fats are the cause of obtained positions as government challenge unjustified extrapolation;
heart disease. advisers, as editorial board members, remember that associations do not
Poor science was at the start of and on grant-giving bodies. From provide evidence of causality; and to
the problem, claims Teicholz. The these powerful positions they largely be alert for misrepresentation and
Big Fat Surprise tells us that the diet- silenced critics by making it difficult non-reporting of inconvenient results.
heart hypothesis was formulated and to publish papers that disagreed with Researchers, clinicians, and health
promoted by Ancel Keys. He embarked their views. Furthermore, as Teicholz policy advisers should read this
on an epidemiological study, the Seven documents, researchers who applied provocative book that reminds
Countries Study, that aimed to identify for grants for research that might us about the importance of good
a correlation between dietary saturated challenge the key opinion leaders science and the need to challenge
fats and heart disease. The first in the fat debate had their grant dogma—especially when (with the
published results of this study seemed applications rejected. Teicholz reports best of intentions) agencies might
to support the relation between fat that one grant applicant was told use scientific data to advocate societal
intake and heart disease, but Teicholz ”Your opposition to Keys is going to changes. The Big Fat Surprise also
tells us of bias in selecting countries cost you your grant.” In science today shows that the quest for scientific
and in selecting data (excluding it is still a criticism of peer review truth should not be subsumed to
much data from one country). Such that reviewers are not likely to look personal ambition. Furthermore,
limitations would make this study objectively at results that disagree with in providing a challenge to the
difficult to publish in a respectable their own work. When research grants demonisation of saturated fats, this
journal today. Furthermore, the follow- and publications are dependent on book should encourage us to challenge
up time was short, and when longer the goodwill of reviewers, science that other so-called facts.
term data were collected these did not challenges dogma can be stifled.
support the hypothesis—but often Teicholz goes on to report that Stuart Spencer
these results were not published. agencies with the job of protecting stuart.spencer@lancet.com

www.thelancet.com Vol 390 August 19, 2017 731

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