Wallowing with Willett

By Steven Milloy

September 22, 2002

 

In my Sep. 9 Wall Street Journal op-ed, “McJunk Science,” I criticized McDonald’s recent decision to switch cooking oils.  My op-ed attributed McDonald’s move to the junk science of Harvard University’s Walter Willett.

 

Willett responded to my op-ed with a letter (Wall Street Journal, Sep. 19), basically claiming that I lied. Willett is partially correct - somebody is lying.

 

Below is his letter. My responses are in bold.

 

I respond, you decide.

 

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Trans Fat, Heart Disease,
And McDonald's Scientists

On your Sept. 9 editorial page, Steven Milloy of the Cato Institute repeats his claim that trans fatty acids pose no risk for heart disease. [SM: My claim, first made in 1997, is that the relevant epidemiologic studies do not support a link between consumption of trans fats and increased heart disease risk.]

First, Mr. Milloy casts doubt on a causal relation between blood cholesterol and heart disease and refers to my "acknowledgment that the cholesterol-heart disease link is more myth than fact." [SM: I wrote, “Moreover, it's not even clear that elevated cholesterol necessarily leads to heart disease and death. In the much-vaunted Framingham Heart Study -- where 5,200 men and women in Framingham, Mass., have been extensively studied in over 1,000 published reports since 1948 -- high cholesterol was not associated with increased heart disease risk after age 47. After age 47, in fact, those whose cholesterol went down had the highest risk of a heart attack. "For each 1 mg/dl drop of cholesterol there was an 11 percent increase in coronary and total mortality," reported the study's authors.”]

This relation has been established beyond doubt by multiple lines of scientific evidence, including many randomized trials of cholesterol reduction, [SM: What about the above-quoted Framingham Heart Study? Epidemiological surveys often report positive relationships between cholesterol intakes and cardiovascular disease based on simple regression analyses; however, when multiple regression analyses account for the colinearity of dietary cholesterol and saturated fat calories, there is no relationship between dietary cholesterol and coronary heart disease morbidity and mortality. Further, a report from a 1993 British Medical Journal meta-analysis for cholesterol reduction randomized trials reports, “In the pooled analysis, net benefit in terms of total mortality from cholesterol lowering was seen only for trials including patients at very high initial risk of coronary heart disease (odds ratio 0.74; 95% confidence interval 0.60 to 0.92). In a medium risk group no net effect was seen, and in the low risk group there were adverse treatment effects (1.22; 1.06 to 1.42).”]

… and I have not ever suggested anything to the contrary. [SM: Willett’s denial conflicts with statements attributed to him in Gary Taubes’ July 7 article in The New York Times Magazine. The article reads “Our levels have been declining, and we have been smoking less, and yet the incidence of heart disease has not declined as would be expected. ‘That is very disconcerting,’Willett says. ‘It suggests that something else bad is happening.’”]

As proven in randomized experiments, trans fatty acids increase total cholesterol and the atherogenic LDL cholesterol fraction, and reduce levels of HDL (the good cholesterol). [SM: So what? Trans fats consumption would only increase LDL cholesterol temporarily in healthy individuals. The more cholesterol in the diet, the less cholesterol the body makes.]

Second, Mr. Milloy falsely claims that I co-authored every study that claims to link trans fat consumption with heart disease. [SM: Willet sort of has me here. My statement was true until March 2001. Pardon me for overlooking the two studies Willett cites - but even the Institute of Medicine ignored them in its July 2002 report. Such is their importance. Keep in mind that Willet has been carping about trans fats since at least 1993. Moreover, his defense amounts to form over substance as discussed in my next comment.] 

Oomen and colleagues in the Netherlands have found an increased risk of coronary heart disease mortality among men consuming higher intakes of trans fatty acids, [SM: Oomen admits at the outset of his in his study that “Evidence on the relation between trans fatty acid intake and coronary heart disease is limited.” Oomen’s study consists of only 98 cases of heart disease and reports a weak statistical association based on dietary data that were not verified. Oomen’s study is obviously not dispositive on anything and only reaffirms his own opening assessment.]

…and Siscovick at the University of Washington in Seattle found higher risk of sudden cardiac death among those with higher intakes, measured by concentrations of trans fatty acids in red blood cells. [SM: Siscovick opens his February 2002 study saying, “The relation of trans-fatty acid intake to life-threatening arrhythmias and primary cardiac arrest in unknown.” His research is based on only 179 cases and reports a weak statistical association that is not statistically significant. As with Oomem, Siscovick’s study only reaffirms his opening statement about the weakness of the epidemiology.]

Third, Mr. Milloy claims that studies of trans fat and heart disease invariably report no or weak associations. Wrong again. [SM: Sorry, Wally. Check out “Fear of Margarine.”]

The evidence of increased risk is remarkably consistent, as summarized in a meta-analysis by Oomen and colleagues. [SM: I’m not aware of Oomen’s meta-analysis and could not find it through PubMed. The Institute of Medicine report doesn’t cite this study either. Secret science?] In particular, Mr. Milloy claims that our own study of 90,000 women "fails to link trans fats with heart disease." In fact, we reported a 50% greater risk of heart disease among women with the highest intake of trans fat, which was highly statistically significant after controlling for standard cardiovascular risk factors and other lifestyle variables. Thus, the epidemiologic evidence is consistent with the results of controlled studies of trans fat consumption and blood cholesterol fractions. [SM: A reported 50 percent increase in an epidemiologic study is meaningless - that’s basic Junk Science Judo. For more on Willett’s study, check out my write-ups, “Fear of Margarine,” “Fatheads?”, and pages 163-65 in Junk Science Judo: Self-defense Against Health Scares and Scams.]

Mr. Milloy misrepresents the scientific evidence and insults the corporate management and scientists of McDonald's Corp. by implying that their decision to reduce and ultimately eliminate trans fat from their products was made without a careful review of the scientific evidence. [SM: I have not misrepresented the science. But I plead guilty to insulting McDonald’s and Willett. One is intellectually bankrupt while the other is morally bankrupt. You figure out which is which.] Although ironic, I find myself defending a fast food giant that, in this instance, has made a decision that will have immediate and important benefits for consumers throughout this country and world-wide. [SM: Wally, baby, you’re not defending McDonald’s. You’re defending your own junk science-fueled career.]

Walter Willett, M.D., Dr.P.H.
Chair, Department of Nutrition
Harvard School of Public Health
Cambridge, Mass