The Former Dentist Uncovering Sugar's Rotten Secrets
Wednesday, February 3, 2016
For Cristin Kearns, it happened like all great Google finds: late at night, after clicking through every link on 10 pages of search results. That’s when she first saw the name of famed nutritionist Ancel Keys inside an unlikely book, Zoology Reprints and Separata, etc., Vol. 166.
Zoology Reprints is one of the tens of millions of books Google has scanned, uploaded to the Internet, and made word-searchable. The volume’s contents are varied and obscure. There’s a list of tree species living in forests in the United States; a course catalog for Sul Ross State Teachers College in Texas; and a number of sugar-company pamphlets from the 1940s, including “Sugar Is the Foundation of All Life” and “Some Facts About the Sugar Research Foundation, Inc. and its Prize Award Program.”
It was in the latter that Kearns learned that trade associations for sugar manufacturers even existed, and that they funded research. From there, she found library catalog listings of other papers, hidden in plain sight in university collections. Kearns has been using these papers to determine how corporations influenced American research on sugar’s adverse health effects.
One of her more fruitful finds was the correspondence of Roger Adams, a professor emeritus of organic chemistry at the University of Illinois and an advisory board member for the Sugar Research Foundation. When he died, Adams left the university his letters, including memos and reports he had exchanged with the Sugar Research Foundation. Based on those documents, Kearns published a study inPLoS Medicine last year showing that the foundation and other groups attempted to deflect federal researchers’ interest away from studying how to decrease Americans’ consumption of sugar to prevent cavities. The groups—supported by fees from cane- and beet-sugar manufacturers—funded research into improbable alternatives to consuming less sugar, including a vaccine against cavities. The International Sugar Research Foundation, the successor to the Sugar Research Foundation, invited federal scientists to serve on a panel during the same month the scientists were deciding what dental studies the government should fund. Afterward, the foundation sent research recommendations to what was then called the National Institute of Dental Research, downplaying the importance of eating less sugar to remaining cavity-free. Kearns found that the National Institute of Dental Research took 78 percent of the sugar groups’ recommendations.
Now, Kearns is re-analyzing the Rogers papers, as well as the many others she’s uncovered, to evaluate how far the sugar industry’s reach extends. In the late 1970s, nutritionists fiercely debated the main causes of heart disease and diabetes: Were Americans eating too much fat, cholesterol, sugar, or some combination of all three? A growing body of science shows that excess sugar contributes to obesity and diabetes, but, for many years, nutritionists focused elsewhere. Kearns is now using the Rogers papers to test the hypothesis that scientists funded by industry steered the consensus research toward putting all of the blame on fat and cholesterol. Ultimately, she wants to see closer scrutiny of food industry-backed scientists who advise governmental groups that issue dietary recommendations.
The 1940s Sugar Research Foundation agenda was a find Kearns could never have managed 20 years ago. Who would think to look in a book advertising itself as a zoology text?
“When I found it, I was relieved,” she says. More than a year before, she had quit her job as a dental operations manager for the Kaiser Permanente Dental Care Program of the Northwest after a surprising encounter at a dental conference. A doctor there handed her a booklet with suggestions for what dentists could tell their patients who had diabetes. “It was, ‘Increase fiber, reduce fat, reduce salt, reduce calories,’ and it didn’t say anything about reducing sugar,” she says. She was bent on determining why a government-published handout would leave out what seemed, to her, an obvious piece of advice. The industry’s influence gradually came into view.
If sugar industry efforts skewed research about sugar’s harmful health effects, then national and international guidelines about sugar consumption are, in fact, based on flawed science. Until recently, federal organizations such as the Department of Agriculture and the Food and Drug Administration had never officially recommended caps on the amount of sugar a person should eat, even though caps for nutrients such as fat and sodium have existed for more than 20 years. Kearns and others have attributed this delay to the science and lobbying efforts of sugar, soda, and other food companies. Meanwhile, Americans’ average consumption of sugar grew by 10 percent between 1980 and 2010. It’s only recently that consumption of sugary drinks, at least, has started to fall.
Even after finding her first stash of papers, Kearns still had plenty of work left to do. She had to read and analyze more than 1,500 pages. And she had to figure out a way to bring them to the attention of policymakers.
But before the then-unemployed dentist could begin uprooting the industry’s effects on health recommendations, Kearns—a slim, blonde woman whose soft-spoken manner made me feel I was yelling at her when we spoke—had to figure out how to get somebody to listen.
It can take a moment to wrap your mind around exactly what Kearns is trying to do. She’s hoping to use her analysis to understand, quantitatively, what influence, if any, sugar companies have exerted on nutritional science that’s favorable to the industry. This kind of work isn’t new, of course. It’s how fields like history and investigative journalism operate.
Kearns joins recent efforts by various journalists to document how the activities of food and beverage companies have contributed to the country’s high rates of obesity and chronic disease. New York Times reporter Michael Moss has written about how food manufacturers engineered their chips and soda to keep people wanting more, for example, while his colleague, Anahad O’Connor, has reported on a Coca-Cola-funded research program that emphasized exercise—not calorie-cutting—for weight loss, even though the science indicates that most people find it hard to shed pounds through exercise alone. Kearns herself co-authored aninvestigative magazine story, along with journalist Gary Taubes, about sugar companies’ efforts to create a body of research that questions the links between sugar consumption, diabetes, and heart disease.
Kearns is one of the only people who have found evidence that cane- and beet-sugar manufacturers contributed to public-health problems. That’s thanks in part to her having worked as a dentist both in private practice and in a low- income clinic, which helped her realize something was amiss when conversations about dental health rarely included considerations of sugar. But it’s more a tribute to her doggedness, her willingness to comb through even the most obscure corners of library archives, and her persistence even in the face of a large and well-funded target.
She’s also unusual in the world of academia, where she’s settled for now as a research fellow at the University of California–San Francisco. Most folks who study sugar and health at universities are chemists, biologists, or epidemiologists. They examine sugar’s effects on the body, or they analyze data about whether people who eat more sugar are more likely to be in poor health. No other academic researchers study the secret workings of sugar refiners’ science campaigns.
But companies’ activities—including how they formulate their food, how their advertising and marketing affect what people buy, and their scientists’ roles in crafting nutritional guidelines—could help explain a number of major public-health problems. They could be especially important to understanding so-called non-communicable diseases, such as cancer, diabetes, and heart disease, which don’t spread from person to person the way cholera or the flu do.
“Most non-communicable diseases are spread by big corporations,” says Stanton Glantz, a public-health researcher famed for his analysis of tobacco industry documents in the 1990s, “because profit-maximizing behavior leads them to be out pushing products which end up causing disease.” Glantz is Kearns’ mentor at UCSF. “If you’re interested in disease control, in addition to understanding the detailed mechanics of how smoking causes heart disease or how smoking causes cancer at a molecular level, you’ve got to be looking up at what forces are out there that are promoting the disease because they’re making a lot of money doing it.”
Evidence of corporations’ influence on science can lead to certain policy changes that biological and epidemiological evidence alone cannot. “This kind of research is very useful to make the point that, yeah, you simply can’t have these guys at the table,” says Richard Daynard, an expert on public health law at Northeastern University School of Law in Boston. Simply knowing that a product can be bad for people’s health isn’t enough to convince the governmental organizations to remove industry folks from policy discussions. There must be evidence of company wrongdoing too.
There’s plenty of evidence of wrongdoing among tobacco companies, which is why the World Health Organization’s Framework Convention on Tobacco Control includes a clause restricting entities with a monetary stake in tobacco from participating in tobacco-control efforts. Daynard and Kearns want to see a similar rule considered for food company participation in the nutritional-guidelines drafting process.
Kearns’ work may also open more sugar industry papers to the public’s purview. “Maybe, for some creative attorney down the road, some of [Kearns’] research or research like that could help in crafting discovery requests,” says Julie Ralston Aoki, a staff attorney at the Public Health Law Center at the William Mitchell College of Law in St. Paul, Minnesota. Clever discovery requests by the Minnesota attorney general in the 1990s led to the release of around 70 million pages of secret documents from the tobacco companies, including Philip Morris and British American Tobacco. Researchers have been analyzing those documents ever since. The WHO mined them for further evidence that companies interfered with international tobacco-control efforts. One advocacy group used them to reveal that a University of Geneva scientist didn’t disclose his relationship with Philip Morris International in his published studies about second-hand smoke. If analogous papers from the sugar industry become public, researchers like Kearns could run their own analyses, and perhaps stumble onto more projects like the cavity one.
Kearns has one major precedent for her work: Glantz. In May 1994, an anonymous “Mr. Butts” mailed him a package of letters, memos, and other materials from Brown & Williamson. The package contained evidence that company executives long knew nicotine was addictive and that smoking caused cancer. Just one month before, CEOs from American tobacco companies had claimed they didn’t believe nicotine was addictive in testimony before Congress.
Glantz and his colleagues made their discovery public in 1995, when they published a series of articles about the Mr. Butts documents in the Journal of the American Medical Association. Eventually, the team wrote a book called The Cigarette Papers. The leaked documents helped spur President Clinton’s administration to ask for tobacco-control proposals from the FDA. Many scientific journals started refusing to publish any research funded by the tobacco industry.
After Kearns found Roger Adams’ old correspondence, she looked to books likeThe Cigarette Papers as a model for what to do with it. Eventually, she settled on getting help from a journalist. She zeroed in on Taubes, whose book Good Calories, Bad Calories argues that calories from refined grains and sugars are uniquely fattening compared to calories from fat or protein. Scientists are still debating whether that hypothesis is true, but, at the very least, it was clear Taubes was well-versed on both biochemistry and the last century of nutrition science.
Taubes’ book both inspired Kearns and galvanized her. In it, Taubes argues that confirmation bias led researchers and agencies to interpret the science about fat and carbohydrates incorrectly. The scientists meant well but were too attached to pet theories, Taubes writes.
Kearns doesn’t believe that scientists were pursuing their theories out of vanity; she thinks industry-funded scientists deliberately muddled the issue. How? One idea she’s exploring is whether they published scientific papers that favorably but inaccurately summarized the results of experiments on whether eating too much sugar leads to disease. Scientists often rely on such summaries, called reviews, as a starting point for their own work. Policymakers often read reviews, too, to get a big-picture look at what the consensus science says. If an influential review is biased, it has the power to warp other researchers’ work and conclusions.
At the time these reviews were published, no one would have questioned their accuracy, Glantz says. When it comes to working with industry, scientists, as Glantz sees them, are but babes in the wood. “Most scientists are pretty nai?ve and think ‘right will out,’ and in science, they teach you, you should focus on the ideas, not the people,” Glantz says. “These are strong and appropriate values, but then you have these companies and their lawyers and their PR people, who know how to manipulate those good values and use them to really stand in the way of the development of knowledge.”
In December 2010, Kearns sent Taubes a message using the submission form on garytaubes.com. She didn’t get a reply. She spent months toying with the idea of sending a query letter to magazines on her own, a venture with a low probability of success for an unknown writer. Then, she saw that Taubes planned to visit her local independent bookstore in Denver in February 2011, to promote his book Why We Get Fat. She got there early, stayed late, and finally got to talk to him.
Taubes hadn’t seen her first message, but was immediately interested in her work after hearing from her in person. “In the course of doing the research for my previous books, I could feel the influence of the sugar industry in determining public policy, but I couldn’t nail it down,” he recalls. But Kearns had: “The material she accumulated was unprecedented. It was exactly what was necessary to document the sugar industry’s program.”
“I think I scared her a little bit with how excited I got,” he says.
After some back and forth, they decided to submit, together, a proposal to Mother Jones. They worked on the article for more than a year. It was published as a cover story in late 2012.
One of the industry-funded scientists the piece took on was the late Frederick Stare, the founder of the nutrition department at Harvard University’s School of Public Health. As Kearns and Taubes reported, the International Sugar Research Foundation funded 30 studies in Stare’s department between 1952 and 1956 alone. Then, in the 1970s, Stare led a review called “Sugar in the Diet of Man,” which FDA officials later used to help them decide whether to regulate how much sugar manufacturers could put in food. In addition to independent studies, the review cited many industry-funded studies that found “conflicting” or zero links between eating too much sugar and heart disease and diabetes. The FDA ended up classifying sugar in a way that wouldn’t require regulation.
The International Sugar Research Foundation still exists today; in 1978, it re-organized and re-branded itself as the World Sugar Research Organization. Roberta Re, the organization’s director general designate since August, didn’t have much to say about her group’s history. “It’s difficult for me to comment on things that might have happened or not in the past before I was even born,” she says. “I don’t think you can design science to look like something because I don’t think scientists would do that.”
Stare died in 2002, but Stanley Gershoff, who started working as a nutrition researcher at Harvard under Stare in 1951, offers a glimpse into how scientists like him thought about asking food companies to fund their work. Stare was in charge of raising most of the money for a new, cash-strapped department that didn’t have a large endowment to support it, Gershoff says. Asking for money from industry seemed like a natural choice. “There was a food business. That’s why you turned to them,” Gershoff says. He later became the founding dean of Tufts University’s nutrition department and was charged with raising money in much the same way.
At Tufts, Gershoff sometimes turned down industry money, if it came with strings that bound too tightly. Kellogg’s once offered a contract that would have required Tufts scientists to run their papers by the company before publishing them in a journal. “I said, ‘No, we don’t do things that way,’” Gershoff says. “I turned down $200,000. And then I went to General Mills in Minneapolis and I got $300,000 from them without any strings attached.”
As for sugar’s influence in particular, Gershoff is skeptical. “Nobody I knew ever wrote great things about sugar or sugar companies,” he says.
Not long after she first found her papers, Kearns decided she wanted to study at UCSF’s Center for Tobacco Control Research and Education, which Glantz directs. To her, the parallels between sugar and tobacco were obvious, and she thought the center might find her work a good fit. Before contacting Glantz, though, she wanted something to impress him with. After the Mother Jones story published online, she reached out to him in an email.
Meanwhile, Glantz had already found the story on his own. “The timing was perfect,” Kearns says. “I think we talked on the phone either that day or the next, and he invited me to come out and give a talk about what I’d found.”
After Kearns’ talk, Glantz started calling colleagues to see if they had any leftover funds they could use to bring Kearns on as a research fellow. “By Monday I had a fellowship pieced together,” he says.
Kearns is small of body and quiet of presence. She doesn’t make it immediately clear what sacrifices she’s made to get where she is. But there’s a reason why—when so many journalists are covering the sugar industry now— she was the one who found the papers.
She has no journalism training. She went to dental school, worked in private practice for a year, and then spent four years as a dentist at a health center serving low-income patients in Denver. At the center, her clients were quite different from the ones she saw as a private dentist. “The burden of oral disease that those patients have is just extreme. I would have patients come in and I would have to tell them, ‘I have to take out all your teeth,’” she says. She made dentures, or, for some folks, placed a filling in every tooth. She spent so much time craning over patients’ mouths that she injured her neck and couldn’t practice as a dentist any longer, even if she had wanted to. Burned out, she turned to an administrative position at Kaiser.
While she was there, she attended a conference for dentists, where she received the booklet that described advice dentists could give their diabetic patients. She knew about the evidence that suggested both tooth decay and diabetes were likely caused by eating too much sugar; her Inner City Health Center patients in Denver often had both, exacerbated by their inability to pay for regular teeth cleanings and check-ups. But the booklet didn’t even mention sugar.
“When I saw this, I was like, ‘Here I am, working so hard’—I worked so hard as a dentist,” Kearns says. “That was some of the hardest work, physical work, I’ve ever done, and mental work too. And meanwhile, this is what is being promoted from a level much higher than me.”
That’s when she started poking around and found the industry’s cache of papers.
“Her background in dental science, and her fascination with this link between cavities and tooth decay and diabetes, and her refusal to accept the conventional thinking on this, which is that we don’t know what causes the link,” Taubes says, “gave her the perspective to ask the right question: Why is it that no one is pinpointing sugar here?” Ultimately, Kearns’ search was about finding the right names and the right documents—and being willing to keep searching, without aid or a steady income. She spent a year doing exactly that.
Kearns originally left private practice for the inner-city center because she found it distressing when she saw patients in private practice who needed several follow-ups, but couldn’t afford them and so “just sort of drifted away.” At Kaiser, she hoped to make a bigger difference than she could seeing low-income patients, by attempting to make dental insurance cheaper and more accessible. She became disillusioned, however, by the bureaucracy she encountered at the organization. The idea to look into industry influence came at the right time, when she was ready for a change and ready to pursue a bigger goal.
“I really feel like understanding what the sugar industry is doing, that’s the root cause,” Kearns says. As an inner-city dentist, she couldn’t even begin to address it. “For every 10 people I patch up, I’ve got 10 more. It’s this endless cycle.” She’s hoping to break that cycle, by revealing the forces that have kept health organizations from telling the public the truth.
Source: Pacific Standard