Delivered as Ordered
Fancy a crime story? How about one with footnotes, for a change?
As a way into the world of scientific papers, I would like to recommend one that, as this article goes live on 12 September 2026, is celebrating its tenth anniversary. On 12 September 2016, “Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents"(1) appeared, by Cristin E. Kearns, Laura A. Schmidt and Stanton A. Glantz.
You do not need a medical background to find your way around it: this is less a medical paper than a piece of historical detective work. The authors dug through old correspondence from the 1960s and used it to demonstrate that the American sugar industry exerted influence on medical research. The paper carries extracts from that correspondence and puts it in context: letters between Harvard scientists and representatives of the “Sugar Research Foundation” (SRF), a trade body of the sugar industry.
$6,500
For anyone who would rather not work through the whole paper, there is an article from the University of California, San Francisco(2). And here is a criminally short summary of my own:
The Harvard researchers appear to have coordinated their findings closely with their clients at a sugar trade body, whose verdict on the result was that it was “quite what we had in mind"(3). They were paid $6,500, worth roughly $48,900 in 2016 purchasing power. In return, their literature review pinned the sole blame for raised cholesterol levels, and in consequence for heart disease, on dietary fat, and let sugar off the hook.
At the time there were two schools of thought on coronary heart disease: one blamed fat, the other sugar. Since - and in part because of - the publication described by Kearns et al., the hypothesis has prevailed that fat is the sole cause of heart disease, signalled above all by cholesterol.
Hypothesis is exactly the right word here: in that absolute form, it has never been established.
Conveniently, the resulting advice to avoid fat “freed up” a great many calories that had to be covered some other way - a task the sugar and food industries were happy to take on. Back then, and especially after the first US dietary guidelines in 1980, low-fat products arrived on the shelves. And food you strip the fat out of does not taste all that good to begin with…
Add sugar, though, and that changes.
The paper is a good read, and it leaves an uneasy feeling behind: how much research is bought? Is that still common practice?
The good news: since 1984 it has been standard (and required) practice to declare conflicts of interest in studies, payments of this kind included. Funding sources are now stated clearly as well.
Even that is overshadowed by the bad news. Gripping and vivid as the account in the paper is, Kearns et al. write explicitly:
There is no direct evidence that the sugar industry wrote or changed the NEJM review manuscript; the evidence that the industry shaped the review’s conclusions is circumstantial.
The correspondence of the day holds indications of the discussion between the SRF and the researchers, but no explicit instructions. Those can only be inferred indirectly, which leaves strong circumstantial evidence and nothing firmer. The payment, by contrast, counts as documented.
And the further outlook…
Even a clearly fact-based publication did not go without replies and letters of protest (letters to the editor)(4,5), which I will not summarise here as well. Some homework has to be left to you…
Set that against current research on fats, and on saturated fats in particular(6), as well as on cholesterol, and it becomes clear how deeply the old work has dug itself into public awareness, even though a far more nuanced view has seemed advisable for a long time:
Back then, up into the 1970s, only “total cholesterol” was measured: a figure that lumps together the “good” and “bad” kinds of cholesterol, already recognised at the time but not easily measurable. Only afterwards were the two reported separately - at first by the cheapest method available: calculating(7) LDL, which is now known to produce wildly wrong results at very high or very low triglyceride levels, among other cases.
Today even LDL(8) is split again into “good” and “bad”, and stand-ins such as ApoB get measured. That distinction has not reached everyday clinical practice everywhere yet (and is definitely material for another article(9)).
On the strength of that clear refinement in analytical methods alone, the old views would already be due to go overboard. What actually happened instead is that the views once published set hard in the collective memory: “fat is bad”, lately joined by “we know sugar is not particularly good either, unless it comes straight from fruit, and besides, we do not want to talk anyone into going without, so it is all fine really(10)”. The upshot is that the Deutsche Gesellschaft für Ernährung - German Nutritional Society, a largely government funded NGO, designated as appointed authority on nutritional matters allows us more sugar than meat and calls that a balanced diet.
A balanced diet, or 'ausgewogen' in German
A Balanced Diet - But on Which Scale?
‘You should eat a balanced diet’ - but what does that even mean?
Read more →Conclusion
The good news first, once more: conflicts of interest in studies, and their sources of funding, are normally declared these days. And the spoilsport right behind it: that is unfortunately no cure-all, as we have seen in various other articles here.
The uneasy feeling stays: if everything is as this paper makes it look, the collective health of the world was sold for the price of a car. Only very gradually is the view gaining ground that fat may not be quite so bad after all, and sugar a good deal more harmful than what was published back then.
