Sugar-coating the objectivity of medical research

Although we have all come to expect that the science of medicine might occasionally reach a blind alley or take a wrong turn on the road to truth, we trust in the integrity of the medical establishment to make the appropriate corrections and proceed on investigative and therapeutic journeys determined primarily by objective scientific evidence.

That was certainly the belief I held as a medical student in the ‘80s and throughout my career as a physician, despite the free lunches sponsored by cheerful and ebullient pharmaceutical representatives who pitched the drug du jour. We students and interns and residents and attendings may have eaten their pizza and hoagies, but we were secure that our clinical judgments would remain unbiased when it came to treating our patients.

But then again, as we all know, there really is no free lunch—or free pens or flashlights or god knows what else you may find at most medical conventions where drug companies pitch tent. Eventually something starts eating away at your firm and unbiased principles and the drug samples become a bit too easy to hand out gratis, and the prescribing hand a bit too familiar with the proprietary rather than generic names. This is why from the outset of my career I refused to see drug reps: I knew enough about myself to know that influences like these can’t be easily rebuffed.

However, I hardly imagined that vested pecuniary interests could ever have affected so many millions of patients by misdirecting the management of the coronary heart disease (CHD) over the past six decades. Believe it or not, such appears to be the case, as the recent publication in JAMA on the sugar industry shows. This fascinating and critical article demonstrates convincingly that the industry not only attempted but actually succeeded in shifting the medical approach to CHD away from sugar to fats.

In 1972, John Yudkin published Pure, White and Deadly, arguing that sugar was the real culprit in the obesity epidemic and the major factor in associated coronary disease. His findings were marginalised, thanks in large part to the sugar lobby. Instead, the position advocated by physiologist Ancel Keys, which advocated the role of fats and dietary cholesterol won the day and became the mainstay for treatment strategies—not because of intrinsic scientific merit, however.

The Sugar Research Foundation, today known as the Sugar Association, went so far as to pay three Harvard researchers to conduct a literature review, published in the prestigious New England Journal of Medicine in 1967, which refuted the link between sugar consumption and CHD.

Thanks in part to the advocacy of physicians like Dr. Robert Lustig, whose 2009 YouTube lecture “Sugar: The Bitter Truth” has been viewed by more than six and a half million people, and to researchers like him who have persevered in their pursuits to understand the physiology of CHD, the tide has begun to turn.

As someone once said somewhere, the truth will set us free; but he failed to mention that the road to the truth may be a long and hazardous one and that the power of special interests and money may create profound detours and, in some cases, lead us to points of no return. Medicine, like every other human activity, is not immune to the blandishments of lucre.

Fortunately Yudkin—and medical science—have been vindicated, as we are now finding out. Although I mourn the passage of so many decades spent in unnecessary error, and so many lives that might otherwise have benefited from an actually objective approach, I also take heart that these findings will keep us ever more vigilant about science, that ostensibly most ‘objective’ of human endeavours, and the non-scientific factors that may influence its course.

Dr. Garcia is a poet, novelist and physician who now resides in New Zealand. He may be contacted at emanuelegarcia@gmail.com.