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PHOTO: EDELMAR/ISTOCK.COM
By David Merritt Johns1
and Gerald M. Oppenheimer1,2
Over the past quarter-century, histori-
cal research has revealed how major
industries from tobacco to lead to pe-
troleum have meddled in science to
conceal the hazards of their products.
Drawing on secret industry docu-
ments, these studies hav e shown how special
interests have used financial incentives to in-
fluence scientists, fabricate doubt, and delay
regulation (1). Recently, similar allegations
have been made against the sugar industry,
with claims that prominent industry-backed
researchers in the 1960s downplayed or sup-
pressed evidence linking sugar and heart
disease. Building on a newly popular narra-
tive holding that the low-fat campaign of the
1980s was not based on solid science, these
allegations have suggested that if not for the
machinations of the sugar industry
and its cadre of sponsored research-
ers, the history of U.S. dietary policy
might have unfolded very differently.
In this article, we argue that the his-
torical evidence does not support
these claims. Although we do not
defend the sugar industry and can-
not address every aspect of this his-
tory, we believe recent high-profile
claims come from researchers who
have overextended the analogy of
the tobacco industry playbook and
failed to assess historical actors by
the norms and standards of their
time. Our analysis illustrates how
conspiratorial narratives in science
can distort the past in the service of
contemporary causes and obscure
genuine uncertainty that surrounds
aspects of research, impairing ef-
forts to formulate good evidence-
informed policies. In the absence of
very strong evidence, there is a seri-
ous danger in interpreting the in-
evitable twists and turns of research
and policy as the product of malevolent play-
books and historical derailments. Like scien-
tists, historians must focus on the evidence
and follow the data where they lead.
The current controversy over sugar has its
origins in the rise of obesity as a policy issue
near the turn of the 21st century and concom-
itant concerns that existing dietary guide-
lines were not achieving their intended ends.
As nutrition scientists increasingly acknowl-
edged benefits of “healthy fats” and possible
metabolic dangers of added sugars, critical
new accounts questioned whether the archi-
tects of the low-fat campaign had placed too
much faith in weak epidemiologic findings
and brushed aside countervailing evidence.
Some scientists particularly lamented the fate
of John Yudkin, a British nutrition scientist
from the 1960s who they noted had “preached
in the wilderness” about the dangers of
sugar, only to be sidelined and ignored (2).
One article called this historical failure by low-
fat enthusiasts to heed Yudkin’s Cassandra-
like warnings “the sugar conspiracy” (3).
The case for industrial malfeasance builds
on this revisionist foundation, expanding
and enlarging the size and seriousness of
the “sugar conspiracy.” In September 2016,
researchers with the University of Califor-
nia, San Francisco (UCSF), announced that
they had uncovered archival documents
showing that in the mid-1960s, the sugar
industry secretly paid nutrition scientists
at Harvard to write a key literature review
downplaying the evidence linking sugar
and coronary heart disease (CHD) (4). As
the UCSF authors recounted, “By the 1960s,
2 prominent physiologists were champion-
ing divergent causal hypotheses of CHD:
John Yudkin identified added sugars as the
primary agent, while Ancel Keys identified
total fat, saturated fat, and dietary choles-
terol.” But according to the authors,
after the sugar industry “paid off ” a
Harvard review team led by D. Mark
Hegsted, the effect was to “derail”
scientific discussions of sugar’s po-
tential role in heart disease, with the
dietary fat hypothesis subsequently
coming to dominate the field.
Marion Nestle, a nutrition pro-
fessor and authority on corporate
influence, suggested that the docu-
ments were a “smoking gun” (5).
The Harvard scientists “knew what
the funder expected, and produced
it,” she said, accepting a “bribe” that
may have shaped the field for years.
A New York Times report asserted
that, “five decades of research into
the role of nutrition and heart dis-
ease, including many of today’s di-
etary recommendations, may have
been largely shaped by the sugar in-
dustry.” Recently, a new study by the
UCSF group claimed that the sugar
industry “suppressed” damaging re-
search it had funded.
We believe that these narratives
are wrong. There was no “smok-
ing gun.” There was no “sugar con-
spiracy”—at least not one which we
have identified. Here, we offer a brief
HISTORY OF SCIENCE
Was there ever really a “sugar conspiracy”?
Twists and turns in science and policy are not necessarily products of malevolence
POLICY FORUM
1Department of Sociomedical Sciences, Columbia
Unive rsity, New York, NY, USA. 2School of Public
Health, City University of New York, New York, NY,
USA. Email: dmj2119@columbia.edu
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review of postwar nutrition research on fat
and sugar and attempt to explain the emer-
gence of these conspiratorial stories.
A NEW FOCUS ON NUTRITION
In the United States, a new movement to de-
velop knowledge about nutrition emerged in
the context of World War II, at a time when
health officials believed deficiency diseases
posed a threat to economic productivity and
military fitness. Concurrently in late 1941,
the Rockefeller Foundation gave $100,000
(~$1.6 million in 2018, adjusted for inflation)
to Harvard to create a nutrition unit, and 15
food firms amassed nearly $1 million (~$16
million in 2018) to launch a research orga-
nization called the Nutrition Foundation to
fund studies and prepare for rationing. At
the center of both was Frederick J. Stare, a
clinician and biochemist hired by Harvard to
chair its new department and by the Nutri-
tion Foundation to edit its journal.
Nutrition research thus began at Harvard
at a moment when the interests of nutrition-
ists and food executives seemed to be aligned;
deficiency diseases presumably would be ad-
dressed through fortified products or efforts
to increase distribution and consumption.
Initially, the department focused on war-
related research commissioned by the U.S.
Army and other federal agencies. But in the
years after the war, with circulatory diseases
accounting for roughly 40% of U.S. deaths,
Stare decided to focus on two conditions
commonly linked with the “rich” American
diet: obesity and heart disease (6).
By 1951, Stare had secured 27 funders, in-
cluding the U.S. Public Health Service, the
Nutrition Foundation, the American Meat
Institute, the National Dairy Council, the
American Cancer Society, the Eli Lilly Com-
pany, and the Sugar Research Foundation
(SRF). According to Bernard Lown, a cardi-
ologist hired by Stare in 1958, it was “natural”
and “proper” for Stare to turn to the food in-
dustry in accord with the mores of the time.
“There was no sense of ‘being bought,’” re-
called Lown, who later accepted, along with
a Soviet colleague, the 1985 Nobel Peace Prize
awarded to International Physicians for the
Prevention of Nuclear War. Nor were there
demands from journals that authors provide
financial disclosures, Lown said. “It wasn’t
required. It never entered my mind!” (7).
DEVELOPING THE LOW-FAT PARADIGM
As nutrition scientists at Harvard began
to examine the possible link between diet
and heart disease, the group initially looked
askance at the claims of researchers such as
Ancel Keys, an eminent physiologist, who
believed heart attack prevention should
begin with a diet low in fat. Such beliefs
threatened the “sound American diet,
where nutritional adequacy is built around
meat, milk and eggs.”
But within a few years, the Harvard team
became deeply engaged in research contrib-
uting to a new causal paradigm in which
heart attacks were the end result of a long-
term accumulation of fatty material in the
coronary arteries, suggesting possibilities
for prevention. Many heart disease suffer-
ers had high serum cholesterol levels, and
various investigators had produced arterial
disease in animals by feeding foods such
as eggs. Wartime data appeared to show
European populations deprived of fatty
animal foods experienced a decline in coro-
nary deaths. Influential early studies of this
emerging dietary fat hypothesis were sup-
ported by the U.S. dairy industry.
During the 1950s, Harvard nutritionists
participated extensively in collaborative field
investigations: a study involving four research
centers to test the predictive value of blood
lipid assays by examining 15,000 workers at
Chrysler, Kodak, Met Life, and two dozen
other organizations; international studies
examining the diets and cholesterol levels of
populations in Guatemala, Costa Rica, and
Nigeria. These investigations added to in-
sights gained from ambitious cohort studies
such as Framingham that would eventually
identify multiple “risk factors” (such as el-
evated blood cholesterol) by following thou-
sands of individuals prospectively over time.
Despite broad agreement that more evi-
dence was needed, the dietary fat hypoth-
esis seemed scientifically plausible to many
researchers. As the media queried experts
for guidance in the wake of U.S. President
Eisenhower’s heart attack in 1955, some ten-
tatively backed the low-fat diet. Stare himself
did so in a 1956 magazine column, joining
with the President’s eminent heart consul-
tant, Paul Dudley White, in recommending
that, “perhaps less fat in the American diet...
would be desirable.”
By 1960, a dominant paradigm was form-
ing around the belief that replacing satu-
rated “animal fats” with vegetable oils could
lower serum cholesterol levels and possibly
fight heart disease. Reflecting this view was
a new statement from the American Heart
Association (AHA), coauthored by Stare, rec-
ommending that the “coronary-prone” con-
sider limiting intake of foods such as whole
milk, butter, and meat (8). Hoping to demon-
strate causality, scientists began organizing a
pilot study for a large “definitive” trial.
THE SUGAR HYPOTHESIS
By the time John Yudkin emerged as an
outspoken critic of the fat theory, he was
well aware he was fighting an uphill battle.
Trained in medicine and biochemistry like
Stare, Yudkin had taught nutrition at Lon-
don University since 1946. Situated in a
college of household science, however, he
was initially unable to obtain funding from
the government’s Medical Research Coun-
cil (MRC). Yudkin thus turned to industry
for support. “I’ve always been a consultant
to the food industry,” said Yudkin in a 1979
interview, arguing that it would be “highly
illogical” for a nutrition scientist to refuse to
work with food companies.
Yudkin’s entry in the diet-heart debates
began with a 1957 paper challenging prevail-
ing interpretations of the widely discussed
hypothesis that countries that consumed
more fat had higher rates of coronary mor-
tality. He argued that several modern expo-
sures correlated with coronary deaths as well
or better than fat, including animal protein,
sugar, and access to radio and television. Fo-
cused on writing a popular diet book, Yudkin
did not initially implicate sugar in heart dis-
ease, seeking merely to establish that his rec-
ommended low-starch slimming regimen,
rich in meat and cheese, was not a recipe for
cardiac arrest. (He actually endorsed satu-
rated fat restriction for the coronary-prone.)
But after learning of a study that attrib-
uted elevated rates of heart disease among
some immigrants to their transition from a
meaty diet to more sugar-laden fare, and new
claims suggesting a sugar-sensitive constitu-
ent of the blood called triglycerides might
predict heart attacks better than serum cho-
lesterol, Yudkin sought to refine his hypoth-
esis. In 1964, he performed a case-control
study that used questionnaires to assess the
sugar intake of 25 men without known heart
disease, 20 coronary patients, and 25 men
with arterial disease. Finding a significant
difference in sugar intake between his cases
and controls, Yudkin proposed in the Lan-
cet that “people who take a lot of sugar—for
example in their tea or coffee—are far more
likely to have a heart attack than those who
take little” (9).
The publication stimulated 20 letters to
the editor, several of them with questions
about Yudkin’s failure to adjust for factors
such as smoking and body weight. MRC sci-
entists asked why Yudkin’s controls averaged
77 grams of sugar per day when his own data
suggested the typical Englishman ate 139.
But Yudkin’s sugar theory attracted wide
press attention, as well as new offers from
book publishers.
AN INDUSTRY-SPONSORED REVIEW
Despite Yudkin’s work, the central focus of
diet-heart research remained on fat. At Har-
vard in 1962, Stare’s top scientist, Mark Heg-
sted, launched a controlled feeding study at
Danvers State Hospital, a Massachusetts psy-
chiatric institution. Backed by a new dairy
industry fund created to give producers a
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firsthand look at the possible role of dairy
fats in disease, the Danvers study involved
feeding 20 schizophrenic men various diets
in which intake of vegetable oils, butterfat,
eggs, starch, sugar, and lactose were manipu-
lated so as to quantify their impact on blood
cholesterol levels.
Over his 20 years at Harvard, Hegsted had
earned a reputation as a data-driven scien-
tist. Among his first Harvard studies was
an analysis of adult protein requirements
that disappointed its sponsor, the Ameri-
can Meat Institute, by concluding that the
National Research Council’s recommended
daily allowance was much too high and that
even vegetarian diets could supply adequate
protein. Under the Reagan administration,
Hegsted would be fired from his job devel-
oping the first U.S. Dietary Guidelines after
his low-fat approach provoked the ire of the
beef industry.
The Danvers study would become another
example of Hegsted’s independence. In a talk
on 6 May 1965, at a meeting of the Nutrition
Foundation, Hegsted began by addressing re-
cent findings linking carbohydrates with heart
disease, acknowledging that Yudkin’s claims
were “worth considering” but hard to credit
“without controlled laboratory data” (10). He
expressed skepticism about new claims that
triglycerides might be a better risk indica-
tor than cholesterol. Moving to the Danvers
data, Hegsted said the results suggested that
the link between dietary carbohydrates such
as starch or sugar and serum cholesterol el-
evation was “rather minimal” compared with
the “abundant evidence implicating dietary
fat.” The Danvers data buttressed the case
against saturated fats, providing the basis for
a new formula relating fat intake to serum
cholesterol that came to be called the “Heg-
sted equation.” The findings helped nudge the
AHA to extend its warning about dietary fat
to the entire U.S. population.
It was a disaster for the dairy industry. But
for sugar executives—one attended Hegsted’s
talk—the findings appeared to constitute a
scientific basis for countering the claims of
Yudkin. One month after Hegsted’s presenta-
tion, an SRF executive reached him by phone
to discuss his research and the prospect that
SRF might hire him to conduct a review
of those articles “which find some special
metabolic peril in sucrose.” Hegsted agreed
to cover SRF’s “particular interest,” but only
within the context of a review “sufficiently
broad to make it worth doing.”
For Hegsted, the sugar review was but
one of several Danvers-related articles to
be written, including one that expanded on
his Nutrition Foundation talk—a draft of
which he shared with SRF. In it, he argued
that practical manipulations of the Ameri-
can diet should focus on dietary fat, not-
ing that the “potent role” of fats had been
“amply demonstrated,” but that such a role
for carbohydrates had “not yet been shown.”
The SRF-sponsored review, published in the
New England Journal of Medicine in 1967,
expanded on these themes and reviewed ad-
ditional studies but did not disclose that it
had been commissioned by SRF (11).
THE BATTLE OVER SUGAR AND FAT
Increasingly challenged by his scientific
peers, Yudkin continued to gather evidence
on sugar: examining national patterns in
diet and disease, refining his questionnaire-
based study linking sugar and heart disease,
and conducting clinical studies of the effect
of elevated sugar intake on insulin and plate-
let adhesiveness. Assisting him in amplifying
his ideas was a group of powerful commer-
cial entities whose interests aligned with his
beliefs. In 1966, Yudkin reported that he was
receiving ~£25,000 per year (~$530,000 in
2018) from “the big food manufacturers.”
Yudkin was an asset because he brought
scientific legitimacy to events such as the
high-protein breakfast promotion organized
in 1966 by the British Egg Marketing Board.
The next month, for International Milk Day,
he joined the National Dairy Council to pub-
licize its new “seventeen day milk diet.” He
conducted research showing the “value of
taking milk before alcoholic drinks”—an im-
plicit test of the “Drive Safely on Milk” slogan
the dairy industry had used since 1961. As a
dairy consultant, he toured the United States,
promoting his sugar theory and an industry
statement he had written titled “Sense and
Nonsense about Dairy Foods.” In one indus-
try meeting, Yudkin would later note that his
research on sugar could also be viewed as “di-
version tactics” that might “prove beneficial
by freeing butterfat from any ‘guilt.’”
By the eve of the 1970s, Yudkin had ac-
quired some critics. “I regard Yudkin as a
menace and a deterrent to good nutrition
policy,” wrote Hegsted to a colleague in 1969.
That year, the sugar industry convened a
panel of heart disease consultants, including
a National Institutes of Health (NIH) scien-
tist, which debated a possible “anti-Yudkin”
effort because “although British scientists
are critical of him and his flimsy data, he
does have the interest of the press.” Indeed,
British government scientists had become
sufficiently concerned about Yudkin’s sugar
hypothesis that they decided to put it to an
authoritative test. Multiple government re-
search teams, some of them part of a mul-
ticenter working party organized by MRC,
tried without success to replicate Yudkin’s
finding that heart attack sufferers tended
to be heavy sugar users. The eminent MRC
panel reported in 1970 that the evidence in
favor of the sugar hypothesis was “extremely
slender” (12).
These publicly funded studies, along
with other forceful critiques, marked the
beginning of the end for Yudkin’s sugar hy-
pothesis. In 1971, he retired and began sum-
marizing his case against sugar in a popular
book. Proponents of the fat hypothesis soon
faced disappointment as well: NIH declined
to fund the “definitive” trial, despite persis-
Enjoying ice cream in the 1960s, when battle lines were being drawn over the roles of dietary fat and sugar.
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tent exhortations that if strong trials could
not be mounted, then dietary advice would
have to be promulgated based on the best
existing evidence.
By the 1970s, nutrition had become a sub-
ject of heated public discussion, and a U.S.
Senate committee—after extensive expert
testimony and stern warnings from several
well-credentialed skeptics who simply did
not believe the evidence was sufficient to
warrant the issuance of high-profile congres-
sional recommendations for dietary change—
embraced the low-fat concept as one aspect
of a broad program of healthy eating (13).
The committee’s 1977 report Dietary Goals
for the United States, which set the model for
the low-fat policy paradigm, mentioned Yud-
kin’s theory only in passing. Written by com-
mittee staff but edited mainly by Hegsted,
the Dietary Goals did not, however, overlook
sugar. Taking note of sugar’s link with tooth
decay and possibly diabetes, the report rec-
ommended a 40% reduction in sugar intake.
CAUGHT IN THE CROSS FIRE
As we have shown, by the 1960s the para-
digm that dietary fat was a likely risk factor
for heart disease prevailed among a coali-
tion of scientists closely linked with NIH and
AHA and was based on extensive research.
By contrast, the sugar theory was developed
by a small number of researchers, was sup-
ported by limited evidence, and was not ac-
cepted by key authorities. Normal science
is a social project in which a community of
scientists develops consensus over theory.
Heart disease epidemiology, in adopting a
multifactorial model, could plausibly have
accommodated sugar if the theory had with-
stood testing. But Yudkin’s claims were seen
as weak and antagonistic, and his signature
finding could not be replicated. Moreover,
sugar did not appear to meaningfully affect
serum cholesterol—the only then-accepted
lipid pathway to coronary disease.
As we have also shown, the sugar industry
approached Hegsted only after learning of
the results of his dairy industry–backed study
suggesting that fat and not sugar was a fac-
tor in heart disease. “There was no, ‘We’ll get
money from them and make the results come
out this way,’” recalled Lown, who worked in
the department. “It didn’t happen that way,”
he said. “The sugar industry didn’t find re-
searchers at Harvard who would make up a
story they didn’t believe in order to cash in
on the sugar industry money,” asserted Gary
Taubes, author of The Case Against Sugar, a
2016 book that delves deeply into the sugar
industry’s involvement in nutrition research.
“What industry does is find people who al-
ready believe something that that industry
finds convenient, and then they pay those
people to make those beliefs known” (14).
During the period in question, food in-
dustry funding of nutrition research was
routine, and disclosures were “rarely re-
quired,” as Marion Nestle has written. When
NIH moved to defund Framingham in 1968,
its former director rescued it by soliciting
grants from the Oscar Mayer Foundation
and other private entities—none of which
were routinely disclosed in publications.
Today, food industry funding of research
remains common, although most journals
require disclosure of conflicts of interest.
Compliance is inconsistent, however, and
some argue existing policies do not address
important sources of bias such as investiga-
tors’ dietary habits and beliefs.
Our study raises questions about how to
assess the historical influence of special in-
terests on nutrition science and policy. Cer-
tainly, there is ample evidence that various
sectors have tried to influence scientists, and
we agree with those who suggest that food
companies fund research with an eye to-
ward marketing. (Indeed, an internal sugar
industry document states that SRF was cre-
ated “for the basic purpose of increasing the
consumption of sugar.”) We do not claim the
sugar industry had no influence on nutrition
work at Harvard, nor on the field in general.
But we believe that there is no good reason
to conclude that SRF’s sponsorship of a liter-
ature review meaningfully shaped the course
of dietary science and policy. Moreover, we
think it is an error to demonize, almost as
a reflex, scientists and their research when
there is evidence of private funding. Such a
response can create an intellectual template
that short-circuits a fuller investigation of
alternative explanations. For example, argu-
ments that the sugar industry “suppressed”
evidence should be tested against alterna-
tive hypotheses.
Our history also underscores the fallacy
of emphasizing the machinations of one
commodity sector when multiple food in-
dustries were deploying similar techniques
of influence in the battle for market share.
It is notable that during the low-fat era of
the 1980s, when suspicion fell heavily on
the meat and dairy industries, it was argued
that, “The ‘fat lobby’ has not only influenced
our nation’s food and nutrition policies, it
has determined those policies” [empha-
sis original] (15). Nearly 40 years later, at
a moment when some have said “butter is
back” and sugar is toxic, “Big Sugar” is the
behemoth accorded these dramatic powers.
Caught in the cross fire of these “diet wars”
have been the reputations of historical nu-
trition scientists, whose statures have risen
or fallen based on the extent of their contri-
bution to current theories.
Interpreting history requires attention to
the logic and tools of the period under study.
Over the course of the diet-heart debates,
the techniques of epidemiology and causal
inference evolved substantially. The random-
ized controlled trial had not yet attained the
hegemonic “gold standard” status it is often
accorded today. It is thus peculiar to reject as
unscientific the beliefs of those who pressed
for action on the basis of then cutting-edge
epidemiologic theory and research. As the
great historian of science Thomas Kuhn once
wrote, “Out-of-date theories are not in prin-
ciple unscientific because they have been
discarded.”
Historical investigations of “merchants of
doubt” have been invaluable in showing that
scientific uncertainty is sometimes the prod-
uct of deliberate acts of deception. Such stud-
ies underscore the essential insight that the
existing evidence base is powerfully shaped
by social forces and political choices, and
that had decisions unfolded differently, our
areas of knowledge (such as genomics) and
blind spots (such as obesity prevention or
gun violence) would be shifted. But ahistori-
cal accounts thwart our ability to critically
evaluate the often long and zigzag process
of scientific conjecture and refutation. They
provide spurious cover for changes to policy
by suggesting that old ideas are illegitimate.
And, they advance a false impression that
doing the “right” kind of science will some-
how avert the messy business of making
policy based on incomplete evidence, public
values, and democratic politics (16). j
REFERENCES AND NOTES
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The Cigarette Papers (University of California Press, 1998).
2. R. H. Lustig, in Pure, White, and Deadly: How Sugar Is Killing
Us, and What We Can Do to Stop It, J. Yudkin (Penguin, 2013),
p. 12.
3. I. Leslie, The Guardian, 7 April 2016;
www.theguardian.com/society/2016/apr/07/
the-sugar-conspiracy-robert-lustig-john-yudkin.
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176, 1680 (2016).
5. M. Nestle, JAMA Intern. Med. 176, 1685 (2016).
6. F. J. Stare, Adventures in Nutrition (Christopher Publishing
House, 1991).
7. D. M. Johns, Interview of B. Lown, Chestnut Hill, MA, 12
December 2016; https://www.mailman.columbia.edu/
sites/default/files/pdf/lown.pdf.
8. I. H. Page et al., Circulation 23, 133 (1961).
9. J. Yudkin, J. Roddy, Lancet 284, 6 (1964).
10. D. M. Hegsted, box 11, folder 14, D. Mark Hegsted Papers,
1952–1999 (inclusive), 1960–1978 (bulk), H MS c54,
Harvard Medical Library, Francis A. Countway Library of
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11 . R. B. M cGan dy, D. M. Hegs ted, F. J. Stare, New Engl. J. Med.
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12. L. Pl att, et al., Lancet 7686, 1265 (1970).
13. G. M. O ppen heime r, I. D. Benru bi, Am. J. Pub. Health 104, 59
(2014).
14. G. Taubes, The Livin’ La Vida Low-Carb Show (February
2017); http://bit.ly/2DU2JIc.
15. M. F. Jacob son, in , Jack Sprat’s Legacy: The Science and
Politics of Fat and Cholesterol, P. Hausman (Richard Marek
Publi sher s, 1981 ), p. 16.
16. Suggested further reading is provided in the supplementary
materials.
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