March 26, 1984
Hold the Eggs and Butter!
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The Consensus Conference
If a large portion of middle-aged American adults are now cutting back on meat and taking statin pills, it is due almost entirely to the step that the NHLBI took next. Dispensing drugs and dietary advice to the entire US population is a huge responsibility, and the NHLBI decided it needed to create a scientific consensus, or at least the appearance of one, before moving forward. Also, the agency needed to define the exact cholesterol thresholds above which it could tell doctors to prescribe a low-fat diet or a statin. So once again, in 1984, NHLBI convened an expert group in Washington, DC, with a public meeting component attended by more than six hundred doctors and researchers. Their job—in an unrealistic two-and-a-half days—was to grapple with and debate the entire, massive stack of scientific literature on diet and disease, and then to come to a consensus about the recommended cholesterol targets for men and women of all ages.
The conference was described by various attendees as having preordained results from the start, and it’s hard not to conclude otherwise. The sheer number of people testifying in favor of cholesterol lowering was larger than the number of spaces allotted to challengers, and powerful diet-heart supporters controlled all the key posts: Basil Rifkind chaired the planning committee, Daniel Steinberg chaired the conference itself, and both men testified.
The conference “consensus” statement, which Steinberg read out on the last morning of the event, was not a measured assessment of the complicated role that diet might play in a little-understood disease. Instead, there was “no doubt,” he stated, that reducing cholesterol through a low-fat, low-saturated-fat diet would “afford significant protection against coronary heart disease” for every American over the age of two. Heart disease would now be the most important factor driving dietary choices for the entire nation.
After the conference, in March 1984, Time magazine ran an illustration on its cover of a face on a dinner plate, comprised of two fried-egg eyes over a bacon-strip frown. “Hold the Eggs and Butter!” stated the headline, and the story began: “Cholesterol is proved deadly, and our diet may never be the same.”
As we’ve seen, LRC had nothing to say about diet, and even its conclusions on cholesterol were only weakly supported by the data, but Rifkind had already demonstrated that he believed this extrapolation was fair. He told Time that the results “strongly indicate that the more you lower cholesterol and fat in your diet, the more you reduce the risk of heart disease.”