Why Is This Prestigious Medical Journal Encouraging People to Eat as Much Meat as They Want?
Alternate guidelines are a reversal of the findings of the global public health community
On Monday afternoon, the journal Annals of Internal Medicine lifted an embargo on a controversial series of reviews that encourages adults to continue to eat current average consumption levels of red and processed meat — three to four times a week.
Conducted by researchers from Dalhousie University and McMaster University in Canada, along with the Spanish and Polish Cochrane Centers, the reviews and nutrition guidelines comprise a series of articles that the journal revealed to select members of the medical community and journalists under embargo last week.
While the information was embargoed, many heads of research institutes, chief physicians, professors, and others in the field have been trying to intervene regarding the publication of the material: They are alarmed that a self-appointed group can issue dietary “guidelines” to the public in a prominent medical journal. And they are concerned that the so-called guidelines are at odds not only with those of the global public health community and the Eat Lancet Commission Report — but with the researchers’ own data.
The authors say they did not consider ethical or environmental reasons for abstaining from meat in their recommendations. They ignored the obvious interest in reducing meat intake, as evidenced by the rapid growth of Beyond Meat and Impossible. Many relevant studies appear to have been overlooked and ignored.
I caught up with our regular contributor, Dr. David L. Katz, to give us some context.
MB: Can you explain to us what’s happening with the Monday release of the guidelines in the current Annals of Internal Medicine?
DK: The journal Annals of Internal Medicine, for reasons that are unclear, is devoting almost an entire issue to multiple articles from the same authors who, for the most part, are statisticians with particular expertise in aggregating and scoring data from prior studies. Here, they conducted a series of reviews of existing studies to look at the health effects of eating fresh and processed meat. They found what is commonly known: That higher intake of meat and processed meat leads to higher rates of premature death, cancer, heart disease, and diabetes.
But they then applied a statistical method to score the evidence and reached the conclusion that they had very low certainty in its reliability.
If they’d simply said, “Here’s what we found. We have limited confidence in the data,” I think it would evoke a shrug of the shoulders from both professionals and the general public. Instead, this group is issuing “guidelines” that essentially encourage the public to continue eating as much meat and processed meat as they want. These guidelines are at odds with public health, planetary health, and a vast aggregation of evidence — including the very reviews on which they claim to be based.
MB: Who are the people behind the Annals of Internal Medicine? Who reads it? Is there a board?
DK: This is the official journal of the American College of Physicians, the largest medical college in the country, with roughly 160,000 members. Essentially, it represents everybody trained in internal medicine — I’m a member and a fellow. The journal is linked to an extremely large, influential, and prestigious medical organization.
While the information was embargoed, journalists asked my colleagues and me whether these guidelines are officially endorsed by the American College of Physicians — because that would be a big deal. They’re not. In fact, we have an email correspondence directly from the president of the American College of Physicians saying they are entirely uninvolved. Sadly, that may not suffice to correct the appearance of endorsement by the college.
Some of us reached out directly to the president and executive director of the American College of Physicians to ask them to look into this because we have such grave concerns about the impact these publications will have on public understanding and public health. If these so-called guidelines seem to represent the official imprimatur of the American College of Physicians but do not, that’s a matter of direct concern to the college beyond the interests of the journal.
MB: In talking to your colleagues over the weekend, do you have any insight as to why the journal went in this direction?
DK: We have no information on that matter; we’ve corresponded with their editorial office, but they have provided no clarification. All we can do is speculate. Everyone’s speculation points to the obvious: notoriety. It’s hard to garner attention in this noisy world, and everyone craves and needs it. For example, the signature credential of any journal is their “impact factor,” which has to do with how often their publications are cited by others. The more widely known papers are, the more they will be cited. These papers will certainly dominate the health news for a while, and get worldwide attention. And even if they cited mostly to refute them, they will — inevitably — be cited a lot.
MB: What does publishing this mean for the average American?
DK: The real concern I have here actually isn’t about any short-term understanding of what’s true regarding meat or processed meat. After all, the people who have already decided they don’t want to eat meat are not likely to start again because of this. And the people who were carnivorous all along will love this story, but they’re eating meat anyway. And everybody in between who was curious about trying the Impossible Burger or Beyond will probably still be curious about trying those.
I have a much, much bigger concern: This will further undermine trust in nutrition science. Nutrition science has been assaulted in inappropriate ways as is; a number of people have made careers out of refuting fundamental truths in nutrition and implying there is contention and doubt where there really is none. These publications will effectively say at an extremely high volume to the public: Even the most settled, cardinal elements of nutritional understanding are up for debate. And therefore you can trust nothing. And therefore you can trust no one. And therefore there are no experts. And therefore anything goes — eat whatever the heck you want.
None of that is true, and there are — literally — lives at stake; diet quality is the leading cause of premature death in the U.S. today. My colleagues and I did not get this stirred up for nothing. This is a big deal.
MB: What does this mean for the credibility of medical journals and the research they publish?
DK: This publication is shaking the very foundation we need under us to have an influence on public dietary patterns in the first place. If the public trusts none of us, we cannot lead. The result will be that people get diseases they could have avoided, and die prematurely, unnecessarily.
This would be like, at the very moment the Surgeon General’s report on smoking and health was issued, the New England Journal of Medicine or JAMA published alternative guidelines claiming, stop the presses, we have reviewed and scored the data and recommend that everybody just go on smoking. That might have had an immediate impact on smoking rates, but more importantly, it would have caused the public to say, “The experts themselves can’t agree with one another, so we don’t know what’s what.” That would have delayed agreement on the truth about smoking, and during that delay, people would have died. Today, diet quality kills far more people every year in the U.S. than tobacco — so the comparison is justified.
This is a tragedy of public health. It is a violation of the public trust. It’s why we scrambled to prevent the publication of these reviews. Putting out the fire after it is ablaze — after these papers publish the reviews, and the media hype them up, and the public is confused and disgusted — will never be as good as if they hadn’t been published in the first place. I am a preventive medicine specialist — that’s what my whole career has been based on: better to prevent a calamity than treat one.
The publication of these reviews mean our efforts at prevention failed. An ounce of prevention here would have been worth all the pounds of cure we can muster.
Mark Bittman is the author of more than 20 acclaimed books, including the “How to Cook Everything” series. He wrote for The New York Times for more than two decades, and became the country’s first food-focused op-ed columnist for a major news publication. He has hosted two television series and been featured in two others, including the Emmy-winning “Years of Living Dangerously.” Bittman is currently the special adviser on food policy at Columbia’s Mailman School of Public Health and the editor-in-chief of Heated.