statement from abc managing director on catalyst ruling/media/broadcasting investig… · web...

Investigation Report No. 3244File no. ACMA2014/651

Broadcaster Australian Broadcasting Corporation

Station ABC1

Type of service ABC television

Name of program Catalyst

Dates of broadcast 24 and 31 October 2013

Relevant legislation/code

ABC Code of Practice 2011 (revised in 2013)

Date finalised 24 December 2014

Decision No breach of standard 2.1 [accuracy]No breach of standard 2.2 [materially mislead]No breach of standard 7.6 [appropriate steps to mitigate risk]

ACMA Investigation Report – Catalyst broadcast by the ABC on 24 and 31 October 2013

The complaintIn August 2014, the Australian Communications and Media Authority (the ACMA) commenced an investigation into two related episodes of the ABC’s Catalyst program:

1. ‘Heart of the Matter Part 1 – Dietary Villains’ broadcast on 24 October 2013 (the first broadcast)

2. ‘Heart of the Matter Part 2 – Cholesterol Drug War’ broadcast on 31 October 2013 (the second broadcast).

The ACMA commenced its investigation in response to receiving two complaints, one about the first broadcast (from Complainant 1), and the other about the second broadcast (from Complainant 2).

Based on the complaints received, the ACMA has assessed the ABC’s compliance with standards 2.1, 2.2 and 7.6 of the ABC Code of Practice 2011 (revised in 2013).

The programCatalyst is a science program broadcast by the ABC at 8pm on Thursdays. The ABC’s website describes the program as follows:

At Catalyst we know that science is a dynamic force for change.

Each week Catalyst brings you stories from Australia and around the world.

Our passion to meet scientists at the forefront of discovery is matched by our fascination with science breakthroughs however big or small.

Science changes all our lives.

For better or worse, we are committed to showing you what our future holds.1

The first broadcast examined the role of dietary fat in heart disease – ‘whether there is a causal link between dietary saturated fat intake, cholesterol and heart disease’.2 The second broadcast considered whether statins are over prescribed to people who may not benefit from them – ‘whether cholesterol-lowering drugs, known as statins, are an effective preventative treatment for heart disease’.3 Each broadcast was just over half an hour long.

The ABC’s response to complaints made about the broadcastsThe ABC received 91 Code complaints about the broadcasts. In response to the complaints the ABC took the following steps:

Its Audience and Consumer Affairs Unit conducted its own investigation into whether or not the broadcasts complied with the Code and set out its findings in an investigation report.4

1 http://www.abc.net.au/catalyst/team/about.htm.2 The ABC’s Catalyst ‘Heart of the Matter’ Investigation Report (the ABC’s investigation report) at

page 5.3 ABC’s investigation report at page 5.4 The ABC’s investigation report is available from the ABC’s website at http://about.abc.net.au/wp-

content/uploads/2014/05/Catalyst-Heart-of-the-Matter-ACA-Investigation-Report.pdf.

ACMA Investigation Report – Catalyst broadcast by the ABC on 24 and 31 October 2013 2

http://about.abc.net.au/wp-content/uploads/2014/05/Catalyst-Heart-of-the-Matter-ACA-Investigation-Report.pdf


http://www.abc.net.au/catalyst/team/about.htm

On 12 May 2014, the ABC’s Managing Director issued a statement on the ABC’s Catalyst ruling. The ABC also published statements on the Catalyst webpage and the ABC’s Corrections webpage, and published the report of the ABC’s investigation into the broadcasts.

The ABC removed the broadcasts from the ABC’s website and they are no longer available to view.

The Managing Director’s statement and the statements published on the Catalyst and ABC Corrections webpages are reproduced at Attachment A.

The ABC’s investigation report concluded that:

The broadcasts complied with the accuracy obligations in the Code (standards 2.1 and 2.2 of the Code).

The first broadcast did not unduly favour one perspective over another. However, the second broadcast unduly favoured the anti-statin perspective in its presentation of the evidence on the benefits and harms of statins, in breach of standard 4.5 of the Code.

The ABC took appropriate steps to mitigate the risk of serious threats to individual or public health with both broadcasts (standard 7.6 of the Code).

Part III of the Code (headed ‘Resolved Complaints) provides:

A failure to comply will not be a breach of the Code if the ABC has, prior to the complaint being made to the ACMA, taken steps which were adequate and appropriate in all the circumstances to redress the cause of the complaint.

The ACMA considers that, taken together, the steps the ABC took in response to complaints it received about the broadcasts - outlined above - ‘were adequate and appropriate in all the circumstances to redress the cause of the complaint[s]’.

In his complaint to the ACMA, Complainant 2 referred to the second broadcast’s ‘bias’ and ‘inaccuracies’. In view of the ABC’s thorough investigation, the steps the ABC took as a result of its investigation, and the lack of specificity of the complaint made by Complainant 2, in this case the ACMA has not investigated these aspects of his complaint.

AssessmentThis investigation is based on submissions from the complainants to the ABC and the ACMA, the ABC’s response to complainants (primarily its investigation report), and a copy of the broadcasts provided to the ACMA by the ABC. Other sources used have been identified where relevant.

In assessing content against the Codes, the ACMA considers the meaning conveyed by the relevant material. This is assessed according to the understanding of an ‘ordinary reasonable’ listener or viewer.

Australian courts have considered an ‘ordinary, reasonable’ listener or viewer to be:

A person of fair average intelligence, who is neither perverse, nor morbid or suspicious of mind, nor avid for scandal. That person does not live in an ivory tower, but can and does


read between the lines in the light of that person’s general knowledge and experience of worldly affairs.5

The ACMA considers the natural, ordinary meaning of the language, context, tenor, tone, visual images and any inferences that may be drawn. In the case of factual material which is presented, the ACMA will also consider relevant omissions (if any).

Once the ACMA has applied this test to ascertain the meaning of the material that was broadcast, it then assesses compliance with the Codes.

Issue 1: Accuracy

Relevant code provision Standard 2.1:

Make reasonable efforts to ensure that material facts are accurate and presented in context.

Standard 2.2:

Do not present factual content in a way that will materially mislead the audience. In some cases, this may require appropriate labels or other explanatory information.

The Code requires that standards are interpreted and applied in accordance with relevant Principles. In the case of factual accuracy, the relevant Principles include:

The ABC requires that reasonable efforts must be made to ensure accuracy in all fact-based content. The ABC gauges those efforts by reference to:

the type, subject and nature of the content;

the likely audience expectations of the content;

the likely impact of reliance by the audience on the accuracy of the content; and

the circumstances in which the content was made and presented.

The ABC accuracy standard applies to assertions of fact, not to expressions of opinion. An opinion, being a value judgement or conclusion, cannot be found to be accurate or inaccurate in the way facts can.

…

The efforts reasonably required to ensure accuracy will depend on the circumstances. Sources with relevant expertise may be relied on more heavily than those without. Eyewitness testimony usually carries more weight than second-hand accounts.

…

The ABC should make reasonable efforts, appropriate in the context, to signal to audiences gradations in accuracy, for example, by querying interviewees, qualifying bald assertions, supplementing the partly right and correcting the plainly wrong.

5 Amalgamated Television Services Pty Limited v Marsden (1998) 43 NSWLR 158 at pp 164–167.


Complainant’s submissionsComplainant 1 complained to the ABC about ‘significant errors and notable omissions’ in the first broadcast.

Complainant 1’s submissions to the ABC and the ACMA are set out at Attachment B.

In his complaint to the ACMA, Complainant 1 raised concerns with the accuracy of certain statements made in the broadcast about the Lyon Diet Heart Study and the Six Countries Study, and these are considered below as they formed part of his complaint to the ABC. However, Complainant 1’s complaint to the ACMA, also raised concerns in addition to those initially raised with the ABC, predominantly around the causes of heart disease, in particular the role of sugar. These additional concerns have not been considered as they did not form part of his complaint to the ABC.

ABC’s submissions In response to the 91 complaints the ABC received about the broadcasts, the ABC published on its website the material reproduced in Attachment A. Additionally, the ABC’s response to the complainants is at Attachment C.

Finding The ABC did not breach standards 2.1 or 2.2 of the Code.

ReasonsIn applying standard 2.1 of the Code, the ACMA usually adopts the following approach:

Was the particular content complained about factual in character?

Did it convey a material fact or facts in the context of the relevant segment?

If so, were those facts accurate?

If a material fact was not accurate (or its accuracy cannot be determined), did the ABC make reasonable efforts to ensure that the material fact was accurate and presented in context?

In applying standard 2.2 of the Code, the ACMA usually adopts the following approach:

Was the particular material (the subject of the complaint) factual in character?

Was that factual content presented in a way that would materially (that is, in a significant respect) mislead the audience?

The first consideration is whether the content complained about is factual. The considerations the ACMA uses in assessing whether or not broadcast material is factual are set out at Attachment D.

Lyon Diet Heart Study

Complainant 1 submitted that the first broadcast incorrectly ‘references the Lyon Diet Heart Study as evidence that cholesterol is not implicated in heart disease’. Complainant 1 then notes that the ‘Final Report of the Lyon Diet Heart Study … clearly states that cholesterol is indeed implicated in heart disease’ and that ‘the role of cholesterol in heart disease is noted in the abstract, in the conclusion and in the body of the Lyon Diet Heart Study report’.


Complainant 1 then contends that ‘this is clearly not the conclusion that the Catalyst program reached from this study’. As a result, the ACMA has considered the ABC’s compliance in this respect with standard 2.1 of the Code.

The first broadcast contained the following segments on the Lyon Diet Heart Study and Mediterranean diet:

Narration: There is one diet that stands out from the rest – the Lyon Diet Heart Study, which touted the benefits of a Mediterranean diet. Remarkably, after several years, those on the Mediterranean diet had a whopping 76% less deaths from heart attacks.

Presenter: So why did the Mediterranean diet get such a spectacular result when all the others had failed? I’ll explain why later. But one of the most interesting things to come from that study went virtually unnoticed.

Nutritionist: Here’s the part that nobody talks about. See, you think that in the group that had the double-digit reduction in heart disease, their cholesterol levels must have plummeted, right? Their cholesterol levels didn’t budge. Both groups had the same cholesterol levels, except one group just stopped dying. So, so much for the relationship between cholesterol and the risk for heart disease.

…

Narration: … The omega-3s, another type of polyunsaturated fats – found in fish, for example – are thought to counter the inflammatory effects of omega-6s.

Physician: The two of them are kind of like the accelerator and a brake pedal on a car, and if they’re in balance things operate smoothly. I mean, you don’t want too much anti-inflammatory, you don’t want too much pro-inflammatory. Because of the advent of vegetable oils, we now have tonnes of omega-6 fats, and really, very little omega-3 fats.

Narration: This is thought to be why the Mediterranean diet was so successful. It was high in omega-3 fats, not to mention it was low in refined carbohydrates like sugar, and rich in antioxidants.

The main import of the segment was the protective effect of omega-3 fats, explained by the physician and reinforced by the narration. The only statement on the link between cholesterol and heart disease was the nutritionist’s statement: ‘so much for the relationship between cholesterol and the risk for heart disease’.

Distinguishing between factual material and other material, such as opinion, can be a matter of fine judgment. In this case, given the contextual indicators, the ACMA considers that the statement was not factual material. The statement was preceded by ‘Here’s the part that nobody talks about’, ‘right?’ and ‘so much’, signalling that the content was contestable and was presented as an expression of opinion, a personal judgement or a critical comment on some findings of the study that were allegedly not reported on.

Six Countries Study (the Study)

Complainant 1 also submitted that the first broadcast incorrectly stated that ‘Keys “withheld data [for] 16 other countries”’ yet omitted to specify which six other countries would have resulted in different conclusions.

The relevant segment from the first broadcast is:


Narration: Aside from people with a genetic condition, like familiar hypercholesterolemia, diet has long been the focus of how we can lower our cholesterol. The idea that saturated fat clogs your arteries by raising cholesterol first gained traction in the ‘50s. American nutritionist Ancel Keys became intrigued with the soaring rates of heart disease after World War II.

Ancel Keys: The facts are simple. You know the chief killer of Americans is cardiovascular disease.

Narration: He compared the rates of heart disease and fat consumption in six countries. It was almost a perfect correlation – the more fat people ate, the higher the rates of heart disease. Except, there was just one problem. Keys withheld data for 16 other countries. Later, when researchers plotted all 22 countries, the correlation wasn’t so perfect. Dr Michael Eades is critical of the way Ancel Keys excluded countries that didn’t fit his hypothesis.

Physician: He more or less cherry-picked countries. You could show just the opposite. You could show that the more saturated fat people ate, the less heart disease they had, if you cherry-picked the right countries.

Narration: [Physician] says that even if fat consumption trends in the same direction as heart disease, it doesn’t prove anything.

Physician: Just because there’s a correlation, doesn’t mean that there’s causation. It’s like people who are fat have big belts, but that doesn’t mean that if you buy smaller belts, you won’t be fat. I mean, that’s not the causation. That’s what these observational studies show – it’s just a correlation.

Dr EC: The classic study by Ancel Keys is a textbook example of fudging the data to get the result that you want out of a study. And, unfortunately, there’s a lot of that that goes on.

Statement that ‘Keys withheld data for 16 other countries’

In this case, the ACMA has considered Complainant 1’s concern about the statement against Standard 2.1 of the Code.

The first broadcast examined the role of dietary fat in heart disease with this particular segment examining the basis on which the link between cholesterol and heart disease first received mainstream acceptance in the 1950s. While the segment was relatively brief, it made it clear that ‘[Ancel Keys] compared the rates of heart disease and fat consumption in six countries’ and drew conclusions from that analysis.

In the context of the first broadcast, the statement would have conveyed to an ordinary reasonable viewer that the Study was based on an analysis of the data for six countries and that 16 countries were excluded from the Study, a meaning that was accurate.

Omission to specify the six other countries

In this case, the ACMA has considered Complainant 1’s concern that the omission of material was ‘materially misleading’ against standard 2.2 of the Code.

While the ABC is not required to present all factual material available to it, a breach of Standard 2.2 would occur if the omission of particular material meant that the factual material actually broadcast was not presented accurately.

The segment did not set out to refute the study’s conclusions by reference to other countries, only to highlight that ‘the medical community’s initial acceptance of the link between


cholesterol and heart disease was based on methodologically questionable correlations and without proof of causality.’6 In the context of the segment, it was not necessary to specify any other six countries that would have yielded different results and omitting to do so did not materially mislead the audience.

The ACMA is of the view that the relevant material facts broadcast were accurate and that the factual content was not presented in a way that would have materially misled the audience.

Accordingly, the ABC did not breach standards 2.1 or 2.2 of the Code.

Issue 2: Harm and offence – appropriate steps to mitigate risks

Relevant code provision Standard 7.6:

Where there is editorial justification for content which may lead to dangerous imitation or exacerbate serious threats to individual or public health, safety or welfare, take appropriate steps to mitigate those risks, particularly by taking care with how content is expressed or presented.

Complainant’s submissionsComplainant 2 submitted to the ABC that ‘the adverse consequences of [the second broadcast] has (from my own experience) resulted in many patients staying off statin therapy with potential adverse health outcome.’

The complainant’s submissions are set out at Attachment B.

ABC’s submissions The ABC’s investigation report stated that:

A voice over prior to and at the conclusion of the episode advised viewers that the views expressed in the program were not intended as medical advice and that they should consult with their doctors regarding medications. The importance of seeking medical advice before discontinuing medication was also reiterated by Professor [S] in a grab that was included in the broadcast program.7

FindingThe ABC did not breach standard 7.6 of the Code.

ReasonsStandard 7.6 obliges the ABC to take appropriate steps to mitigate ‘serious threats to individual or public health, safety or welfare’.

The second broadcast critically examined the role of statins in both primary treatment and secondary treatment. In particular, it examined whether statins are effective in reducing the

6 ABC’s investigation report at page 11.7 ABC’s investigation report at page 4.


risk of developing heart disease and whether people are being prescribed statins unnecessarily.

The second broadcast focused on concerns that ‘the benefits of [statins] have been grossly exaggerated’8 and canvassed matters including the widespread use of statins, their potential side effects (including a real-life case study), and the behaviour and influence of pharmaceutical companies.

The following segment appeared in the second broadcast:

Presenter: Unless you’ve already been diagnosed with heart disease, then taking a statin won’t help you live longer. It may reduce your risk of a cardiovascular event, but it may also increase your risk of developing something else, like diabetes. Either way, taking a statin won’t extend your life span.

…

Presenter: Should women take cholesterol-lowering medication?

Professor BG: In general, no. Now there may be exceptions…

It also included an interview with Edward, a man who had been prescribed statins to reduce his cholesterol level. Edward claimed to have experienced side effects as a result of the medication he was prescribed, and explained that once he stopped taking his medication, he started feeling better within a month, and ‘100 per cent’ better after six months.

The ACMA considers that there was editorial justification for the content – the second broadcast examined:

Important issues with significant public health implications where opinions differ among highly qualified scientists and medical practitioners. The subject matter was a worthwhile subject for Catalyst to investigate and report on.9

Statins are widely prescribed in Australia and the second broadcast emphasised their potential side effects and queried their efficacy for many persons who are currently prescribed them. Given this, the ACMA considers that the ABC was obliged to take steps to mitigate the risk that people who are currently prescribed statins by their doctor would stop taking them without medical advice.

The ABC took the following steps to mitigate this risk:

It included the following voiceover at the start and end of the second broadcast:

The views expressed in this episode of Catalyst are not intended as medical advice. Please consult with your doctor regarding your medications.

The voiceover at the start of the second broadcast was accompanied by this visual message:

8 Statement made in the second broadcast – see the ABC’s investigation report at page 36.9 ABC’s investigation report at page 1.


The second broadcast included Associate Professor [DS]’s statement that:

I would certainly encourage people who are considering cessation of treatment for perceived side effects and so forth to discuss it with their doctor.

The ACMA considers that the ABC took appropriate steps to mitigate the risk by including the voiceover at the start and end of the second broadcast, the viewer advice at the start of the second broadcast, and the statement by Associate Professor [DS] urging people to talk to their doctor before making any decision to cease their statin medication.


Attachment A

The ABC’s response to complaints about the broadcasts

Statement from ABC Managing Director on Catalyst ruling10

Today, the ABC’s independent Audience and Consumer Affairs Unit [the A&CA] has released its findings regarding a controversial Catalyst program on statins and heart disease.

The detailed investigation was prompted by a number of complaints into two Catalyst programs, collectively titled Heart Of The Matter, aired in October last year. The report of the investigation is available here.

While acknowledging the importance of public health issues relating to the efficacy of heart disease treatment and the contrasting opinions of highly-qualified scientists, the A&CA has concluded that the second episode breaches ABC standards on impartiality.

Because of the interlocked nature of the two programs, both will be removed from the ABC website. Information will be added to the program website and the ABC Corrections page to advise of the steps that have been taken.

Additionally, the PM program has added an Editor’s Note to the transcript of its story ‘Backlash against ABC’s Catalyst program questioning heart disease-cholesterol links’, and an appropriate entry has been made on the ABC Corrections page. The note on the Catalyst website will also reinforce the advice made in the second Catalyst program, that viewers should not make any changes to their prescribed regimen of medications without seeking appropriate medical advice.

As the A&CA report shows, this has been a thorough investigation involving complex issues and a wide range of material.

The Catalyst programs were very engaging, attracted large audiences and clearly touched on an issue of importance to many Australians. The link between statins and heart disease is a matter warranting investigation and coverage on our programs. The issue has been extensively covered overseas and continues to be the subject of debate within medical circles. I would like to see our science programs on radio and TV work together to revisit it, whilst taking absolute care to comply with our rigorous editorial policies.

Statement published on the ABC Corrections webpage

Heart of the Matter

Posted 12 May 2014, 11:13amMon 12 May 2014, 11:13am | Updated 12 May 2014, 11:22amMon 12 May 2014, 11:22am

Catalyst, ABC1: In October 2013, Catalyst aired a two-part program dealing with statins, cholesterol and heart disease. Following a number of complaints, the ABC’s independent Audience and Consumer Affairs Unit investigated the programs. While acknowledging the importance of public health issues relating to the efficacy of heart disease treatment and the contrasting opinions of highly-qualified scientists, the A&CA has concluded that some parts of the program breached ABC standards on

10 Available from the ABC’s website at http://about.abc.net.au/press-releases/statement-from-abc-managing-director-on-catalyst-ruling/ [accessed 20 November 2014].


http://www.abc.net.au/news/2014-05-12/heart-of-the-matter/5446420

http://www.abc.net.au/corrections/


http://about.abc.net.au/press-releases/statement-from-abc-managing-director-on-catalyst-ruling/


impartiality. Accordingly, the programs have been removed from the ABC website. A statement from the Managing Director can be found here. The full investigation report can be viewed here.

Statement published on the Catalyst webpage

STORY ARCHIVE

Thursday, 24 October 2013

Heart of the Matter Part 1 - Dietary Villains

This Catalyst special has now been removed.

Catalyst, ABC1: In October 2013, Catalyst aired a two-part program dealing with statins, cholesterol and heart disease. Following a number of complaints, the ABC’s independent Audience and Consumer Affairs Unit investigated the programs.

While acknowledging the importance of public health issues relating to the efficacy of heart disease treatment and the contrasting opinions of highly-qualified scientists, the A&CA has concluded that some parts of the program breached ABC standards on impartiality. Accordingly, the programs have been removed from the ABC website.

A statement can be viewed here

The full investigation report can be viewed here

As was emphasised in the Heart of the Matter program, viewers should not make any changes to their prescribed regimen of medications without seeking appropriate medical advice.

STORY ARCHIVE

Thursday, 31 October 2013

Heart of the Matter Part 2 - Cholesterol Drug War

This video has now been removed

Catalyst, ABC1: In October 2013, Catalyst aired a two-part program dealing with statins, cholesterol and heart disease. Following a number of complaints, the ABC’s independent Audience and Consumer Affairs Unit investigated the programs.

While acknowledging the importance of public health issues relating to the efficacy of heart disease treatment and the contrasting opinions of highly-qualified scientists, the A&CA has concluded that some parts of the program breached ABC standards on impartiality. Accordingly, the programs have been removed from the ABC website.

A statement can be viewed here

The full investigation report can be viewed here

As was emphasised in the Heart of the Matter program, viewers should not make any changes to their prescribed regimen of medications without seeking appropriate medical advice.



http://about.abc.net.au/press-releases/statement-from-abc-managing-director-on-catalyst-ruling


http://about.abc.net.au/press-releases/statement-from-abc-managing-director-on-catalyst-ruling




Attachment B

Complainants’ submissions

Complainant 1’s submission to the ABC:

There are a number of significant errors and notable omissions in the above program.

Some of the errors are documented in an attached document. I have also included another document that gives a brief history of the issues that are covered in the above program.

The errors are significant and given that it can affect the lives and well-being of your viewers, I believe that corrections should be made on air.

Please, please, please respond to the questions that I have raised regarding the accuracy of comments made in your program.

…

Attachment to Complainant 1’s submission to the ABC:


The Catalyst program Heart of the Matter references the Lyon Diet Heart Study as evidence that cholesterol is not implicated in heart disease. If you actually read the Final Report of the Lyon Diet Heart Study [1], it clearly states that cholesterol is indeed implicated in heart disease.

The Lyon Diet Heart Study is a "randomized, single-blind secondary prevention trial aimed at testing whether a Mediterranean-type diet, compared with a prudent Western- type diet, may reduce recurrence after a first myocardial infarction."

The Final Report of the Lyon Diet Heart Study states, "the data confirm the impressive protective effect of the Mediterranean diet." It also states, “major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence.”

This report concludes, that “for each increase of 1 mmol/L of total cholesterol increased the risk of recurrence by 20% to 30%. Epidemiological studies have consistently shown a positive correlation between plasma cholesterol levels and the incidence of (and mortality from) CHD in various populations. Thus, our population does not appear to be different from other low-risk populations.”

This is not the conclusion that Catalyst managed to derive from the Lyon Diet Heart Study.

This report also states that an increased leukocyte count increased the risk of heart disease.

Other Risk Factors

Another important and independent risk factor for heart disease is homocysteine level greater than 9 mmol/L. Optimal level for homocysteine is 6 mmol/L. Homocysteine is a non-protein, sulphur containing amino acid. High levels indicate deficiency in B12, B9 (folic acid) or B6. It can also be raised from smoking, kidney disease and diabetes. Average homocysteine levels are higher in vegetarians and vegans than in the general population.


http://wisenutritioncoaching.com/wp-admin/post.php?post=613&action=edit#_ftn1

Six Countries Study

Ancel Keys’ paper Atherosclerosis: A Problem in Newer Public Health paper was presented in New York in January 1953. This paper is commonly referred to as the Six Countries Study. He stated that the present high rate of death from degenerative heart disease is not inevitable by showing comparisons with other countries. 11

Keys does state in this paper that “the high reliability with groups and the low reliability with individuals apply to all of the measurements so far studied: total cholesterol, cholesterol/phospholipids ratio, . . . .”.

Firstly, at this stage of his research, Keys implicated fat (% calories from fat) as an indicator of heart disease – not saturated fat.

Secondly, this paper does refer to his previous surveys and the works of others. He was not relying on only the statistics of the 6 selected countries to make his conclusions.

J Yerushalmy and H Hillboe criticised the paper Atherosclerosis: A Problem in Newer Public Health in the publication Fat In The Diet and Mortality From Heart Disease 12, claiming that Keys only choose 6 countries that supported his hypothesis. They state Keys did not give reasons for his selection. This is clearly incorrect. If you read Keys’ paper, Keys did give the reasons for choices.

The Scandinavian countries were excluded because of the effects of the World War II. The consumption of meat and eggs dropped during the war and so did the level of heart disease. However, two areas of Finland were included later in the Seven Countries Study.

The WHO data shows France as having little heart disease even though it has a high fat consumption, giving rise to the French Paradox myth. According to a paper in the Dialogues of Medicine – Vol 13 No 3 2008, 14 the French paradox is indeed a myth.

The clear conclusion, driven by the facts as summarized by Pierre Ducimetière, is that the rates of CHD are not so low in France, animal fat intake is not so high, and the diet-heart concept is not so unique that the existence of a “French paradox” can be sustained, except for satisfying cultural fantasy or for wine enthusiasm and marketing. Thus, the real paradox is why the French paradox continues to exist as a concept, when it should be replaced by the less mystifying view, namely, “the more Mediterranean, the better”.

11 A Problem in Newer Public Health Ancel Keys; Presented in New York 1953Download from http://wck.com.au/nutrition/KeysAtherosclerosis.pdf

12 Fat In The Diet and Mortality From Heart DiseaseDownload from Yerushalmy: Fat In The Diet & Mortality From Heart Disease

13 Strom A, Jensen RA. Mortality from Circulatory Diseases in Norway 1940-1945. The Lancet. 1951; 1(3): 126-129.http://www.epi.umn.edu/cvdepi/photo.asp?id=33

14 Dialogues in Cardiovascular Medicine – Vol 13 . No. 3 . 2008 – The French Paradox: Fact or Fiction?http://www.dialogues-cvm.com/document/DCVM49.pdf


http://www.dialogues-cvm.com/document/DCVM49.pdf

http://www.epi.umn.edu/cvdepi/photo.asp?id=33

http://www.wisenutritioncoaching.com/wp-content/uploads/2013/07/YerushalmyFatInTheDietMortalityFromHeartDisease.pdf

http://wck.com.au/nutrition/KeysAtherosclerosis.pdf

The Catalyst program stated that data from 22 countries was available to Ancel Keys but he chose the data that fitted his hypothesis. The Catalyst program does not state the source of this data from the 22 relevant countries.

Jacob Yerushalmy and Herman Hilleboe examined the data from all of the 22 countries in the WHO Epidemiological and Vital Statistics 1951-1953 publication. The results were published in their paper Fat in the diet and mortality from heart disease. Note that Keys’ paper was presented in January 1953. Yerushalmy and Hilleboe used World Health Organisation data from the years 1951-1953.

Is this the source of the data that Keys did not include in his study? If so, it was not available until after he presented his paper.

The Catalyst program states that you could have chosen six other countries and drawn different conclusions. What six countries?

Even if data from all the 22 countries are included, it still shows:

positive correlations between heart disease and calories consumed, fat consumption, animal fat consumption, animal protein consumption and

negative correlations with heart disease and carbohydrate consumption, vegetable protein consumption, vegetable fat consumption.

Hillboe later co-authored a paper Risk Factors in Ischemic Heart Disease in Vol 53 No 3 American Journal of Public Health showing that “high cholesterol was the greatest risk factor of any single variable in ischemic heart disease”. 15

In the conclusion of Atherosclerosis: A Problem in Newer Public Health paper, Keys states that there is sufficient evidence to “warrant a large extension of this type of epidemiological research”. His views were refined with later studies including the Seven Countries Study.

Seven Countries Study and the Mediterranean Diet

Ancel Keys and colleagues posed the hypothesis that differences among populations in the frequency of heart attacks and stroke would occur as a result of physical characteristics and lifestyle and diet.

Surveys were carried out 1958 - 1970 in populations of men aged 40-59, in 16 areas of seven countries. Follow-up surveys were continued until the 1990s.

Most of the areas were stable and rural and had wide contrasts in habitual diet. Women were excluded because cardiac disease was less common and because of the invasiveness of physical examinations.

15 Download Rank Correlation Coefficients table from Yerushalmy and Hillboe’s paper


http://www.wisenutritioncoaching.com/wp-content/uploads/2013/07/56.-Yerushalmy-and-Hillboe-Correlation-Table.jpg

B: Belgrade, Yugoslavia; C: Crevalcore, Italy; D: Dalmatia, Yugoslavia; E: East Finland; G: Corfu, Greece; J: Ushibuka, Japan; K: Crete, Greece; M: Montegiorgio, Italy; N: Zutphen, Netherlands; R: Rome, Italy; S: Slavonia, Yugoslavia; T: Tanushimaru, Japan; U: USA; V: Velika Krsna, Yugoslavia; W: West Finland; Z: Zrenjanin, Yugoslavia 16

Mediterranean Diet

Who coined the name and introduced the concept of Mediterranean diet? Catalyst is prepared to demonise Keys, but it was Keys who named and introduced the concept the Mediterranean diet as a key to good health. In 1975, Ancel Keys and his wife Margaret published the book How to Eat Well and Stay Well the Mediterranean Way (New York, NY: Doubleday & Co; 1975) based on the results of his studies.

According to Keys, “The heart of what we now consider the Mediterranean diet is mainly vegetarian: pasta in many forms, leaves sprinkled with olive oil, all kinds of vegetables in season, and often cheese, all finished off with fruit, and frequently washed down with wine.”

The conclusion of the Catalyst program - “Exercise and a Mediterranean-style diet is the best way to prevent heart disease.” How is this different from the conclusions of Ancel Keys?

16 The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part 2 Journal of Lipid Research. 2004. First Published on November 16, 2004.Originally published in Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease A Keys Published Harvard University Press 1980


Ancel Keys and his wife Margaret lived a village in southern Italy for 28 years. Keys lived to be 100 years old and his wife 97.

Cholesterol Recommendations

Dr Bill Roberts (previous long-time editor of the medical journal Cardiology), Dr Bill Castelli (director of the Framingham Heart Study), Dr Caldwell Esselstyn (surgeon at the Cleveland Clinic) have stated that they have never seen a heart disease fatality when cholesterol levels are below 150 mg/dL (3.9 mmol/L).17

Dr John Mcdougall recommends the same guidelines and recommends oat bran, garlic, vitamin C, vitamin E and niacin if there is difficulty in reaching this level. 18

He also states that HDL “Good” Cholesterol is Not Worth Your Attention because HDL cholesterol will fall as total and LDL cholesterol falls. 19

The China Project

The China Project involved Colin Campbell, professor of nutritional biochemistry at Cornell, Chen Junshi, Deputy Director of Institute of Nutrition and Food Hygiene at the Chinese Academy of Preventive Medicine, Richard Peto of the University of Oxford and Li Junyao of the China Cancer Institute. It is one of the most comprehensive studies ever of nutrition.

The study examined 360 different health, lifestyle and nutrition factors of 6,500 people in 65 different counties in China and found over 8,000 significant correlations.

According to Professor Campbell,

Lower blood cholesterol levels are linked to lower rates of heart disease, cancer and other Western diseases, even at levels far below those considered “safe” in the West.

At the outset of the China Study, no one could or would have predicted that there would be a relationship between cholesterol and any of the disease rates. What a surprise we got! As blood cholesterol levels decreased from 170 mg/dL to 90 mg/dL (4.4 mmol/L to 2.3 mmol/L), cancers of the liver, rectum, colon, male lung, female lung, breast, childhood leukemia, adult leukemia, childhood brain, adult brain, stomach and esophagus (throat) decreased.20

The Catalyst conclusion that a low-fat high carbohydrate Mediterranean style diet is the best way to avoid heart disease is completely consistent with Ancel Keys’ conclusion.

…

Even more effective than a Mediterranean-style diet is a whole-food, plant-based diet as advocated by Professor Colin Campbell, Dr Caldwell Esselstyn, Dr Dean Ornish, Dr Neal Barnard, Dr John McDougall and Dr Michael Greger.

According to Professor Campbell,

The vast majority of all cancers, cardiovascular diseases, and other forms of degenerative illness such as the auto-immune diseases, kidney disease and macular

17 The China Study Campbell TC, Campbell TM Benbella Books Dallas Texas18 Dr J Mcdougall – Newsletter September 2002: Cholesterol – When and How to Treat19 Dr J Mcdougall – Newsletter April 2004: HDL “Good” Cholesterol is Not Worth Your Attenti20 The China Study Campbell TC, Campbell TM Benbella Books Dallas Texas


degeneration can be prevented and often reversed, simply by adopting a whole-food, plant-based diet.

+ + + + +

The premise of Heart of the Matter – part 2 is that cholesterol-lowering drugs is an ineffective and expensive method to “cure” heart disease. YES. It does not exclude the role of serum cholesterol and the high fat, high protein, high animal source standard western diet in promoting not only heart disease but also other “diseases of affluence”.

Complainant 1’s submission to the ACMA:

The Heart of the Matter Part 1 - Dietary Villains –shown on Thursday 24 October 2013 is full of inaccuracies, some which I noted in my response.

I did provide evidence that the material is incorrect.

I suspect that the reason that most complaints regarding the second episode were raised by medical practitioners (and their organisations). These people are concerned with the welfare of their patients and are not in a position to evaluate the “evidence” presented.

I will reiterate some of the points raised in my initial letter plus some additional notes.


The Catalyst program Heart of the Matter references the Lyon Diet Heart Study as evidence that cholesterol is not implicated in heart disease.

If you actually read the Final Report of the Lyon Diet Heart Study, it clearly states that cholesterol is indeed implicated in heart disease.

The Final Report of the Lyon Diet Heart Study states,

Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown

to be independent and joint predictors of recurrence.

For each increase of 1 mmol/L of total cholesterol increased the risk of recurrence by 20% to

30%. Epidemiological studies have consistently shown a positive correlation between

plasma cholesterol levels and the incidence of (and mortality from) CHD in various

populations. Thus, our population does not appear to be different from other low-risk

populations

Mediterranean Diet

- Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial

Infarction

Final Report of the Lyon Diet Heart Study

The role of cholesterol in heart disease is noted in the abstract, in the conclusion and in the body of the Lyon Diet Heart Study report.

This is clearly not the conclusion that the Catalyst program reached from this study.

Sugar is the cause of Heart Disease

We learnt from the Catalyst program that sugar is the real cause of heart disease.


By the early 1970s, Ancel Keys was ridiculing John Yudkin and his theory in papers, and just on the

basis of that sort of personality and political struggle, the nutrition community embraced this idea that

saturated fat was the problem, working through dietary cholesterol, and began to think of the idea that

sugar could cause heart disease as akin to quackery, and Yudkin was eventually ridiculed.

[GT]

Heart of the Matter – Dietary Villains

The above statement is absurd and wrong. Ancel Keys’ paper Sucrose in the Diet and Coronary Heart

Disease of 1971 questions the validity of Yudkin’s hypothesis.

Read the paper and explain to me where the ridicule is in this paper. The assertion that Keys ridicules Yudkin is another blatant lie.

…

I feel that the proposal for sugar’s implication in heart as stated in the program is another fundamental error.

Six Countries Study

The Catalyst program stated that data from 22 countries was available to Ancel Keys but he chose the data that fitted his hypothesis.

Unfortunately, the Catalyst program does not state the source of this data from the 22 relevant countries but it is apparent that these figures are from WHO Epidemiological and Vital Statistics 1951-1953.

Note that Keys’ paper was presented in January 1953. This means that the paper was presented (not written but presented) over 12 months earlier than when the data referenced by the Catalyst program was actually available.

Jacob Yerushalmy and Herman Hilleboe examined the data from all of the 22 countries in the WHO Epidemiological and Vital Statistics 1951-1953 publication. The results were published in their paper Fat in the diet and mortality from heart disease.

In this article Yerushalmy and Hilleboe criticised Keys for stating that “no information is given by Keys on how or why the six countries were selected”. This view is reiterated by [GT] and [presenter] in the Catalyst program

[Presenter] states that Keys “withheld data from 16 other countries”. That is not only wrong but it is a lie. Keep in mind that data that that [presenter] refers to was not even published yet.

READ THE ORIGINAL PAPER BY KEYS (Atherosclerosis: A Problem in Newer County Health). Keys did list the data from 16 countries that were available at the time and does give reasons why he chose the six.

(That can be an exercise for the reader.)

This lie is endlessly perpetrated in popular books, magazines and websites by health commentators – not by medical researchers.

The Catalyst program states that you could have chosen six other countries and drawn different conclusions. What six countries?


Even if data from all the 22 countries are included, it still shows:

positive correlations between heart disease and calories consumed, fat consumption, animal fat consumption, animal protein consumption and

negative correlations with heart disease and carbohydrate consumption, vegetable protein consumption, vegetable fat consumption.

This same paper by Yerushalmy and Hilleboe has the following statement.

In all categories of heart disease, the association is strongest for animal protein expressed

in total calories.

Yerushalmy and Hilleboe

Fat in the diet and mortality from heart disease.

Why was this statement excluded from the Catalyst program?

Cholesterol is Protective After the Age of 47

Cholesterol did correlate with heart disease, but that disappeared by the time you reached your late

40’s.

After the age of 47, high cholesterol is probably protective. The people who had the highest

cholesterol lived the longest. Much to the amazement of a lot of researchers.

Heart of the Matter – Dietary Villains

WRONG, WRONG, WRONG.

Previous studies have stressed that a low blood cholesterol level and a decline in blood cholesterol

over time is often a manifestation of chronic disease, liver disease, infections and cancer. Suddenly,

investigators rediscovered low cholesterol levels. The adverse effects of low cholesterol levels

became a new research topic. Again, little new information has been generated over time and the

likelihood that lowering blood cholesterol causes people to be killed in an accident seems rather

remote. The basic problem with these studies is the lack of recognition of comorbidity, namely, the

associated chronic diseases and other health behaviours.

Lewis J Kuller

American Journal of Epidemiology Vol 150, No 9 1999

What really is happening is that as people get older, they get sicker and their cholesterol drops and they die.

Lack of Evidence in Dietary Studies

Catalyst highlighted the lack of evidence in dietary studies for blaming heart disease on

saturated fats and cholesterol.

Catalyst-Heart of the Matter ACA Investigation Report

I dispute the assertion that there is lack of evidence. There is a great deal of evidence – it just was not presented.

…


Legitimate Debate Cholesterol and Heart Disease

However, there is a legitimate debate about those conclusions. Reputable medical scientists

dispute the significance of the link between dietary fat intake, cholesterol and heart disease.

It is likely that many viewers would not have previously been aware of the debate about these

matters in scientific circles and that they would be hearing about the issue for the first time and

beginning to form their views on these debates based on the material presented in the Catalyst

program.

Catalyst-Heart of the Matter ACA Investigation Report

I dispute the contention that reputable medical scientists are still dispute the significance of the link between dietary fat intake, cholesterol and heart disease.

The people interviewed are not medical researchers. All of the participants in the Catalyst program believe that sugar is the cause of heart disease. This issue was addressed previously.

…

Complainant 2’s submission to the ABC:

I write to complain about the biased programme recently aired as a result of which patients at risk of serious further cardiovascular events have stopped their lipid lowering treatment.

I note the right of dissenting views to be aired, but the counter view should also be given (in this particular programme the scientific evidence from internationally recognised Australian experts was not given).

And:

I have already lodged my complaint re this programme; I wish to add that upon review of the ABC Editorial Policy, in my opinion this programme breached standards 1. independence, integrity and responsibility, 2. accuracy, 4. impartiality and diversity of perspectives (by ignoring Australian experts and randomised double blind clinical trial evidence) and 7. Harm and offence ( with 25% of patients on statin therapy ceasing their medication and exposing themselves to increased risk (as demonstrated in the Acacia Registry data (D Chew et al)).

Complainant 2’s submission to the ACMA:

The adverse consequences of this programme (much of the information was inaccurate or biased) has (from my own clinical experience) resulted in many patients staying off statin therapy with potential adverse health outcome, and required considerable additional time in counselling patients.


Attachment C

The ABC’s response to the complainants:

On 24 and 31 October 2013, ABC TV's Catalyst program broadcast two programs collectively titled 'The Heart of the Matter' which questioned whether a causal link exists between dietary saturated fat intake, cholesterol and heart disease and whether cholesterol-lowering drugs, known as statins, are an effective preventative treatment for heart disease.

Your correspondence was one of the 146 complaints the ABC received about the program, 91 of which raised editorial matters requiring response. These complaints have collectively been investigated by ABC Audience and Consumer Affairs, a unit which is separate to and independent of content making areas of the ABC. Our role is to investigate whether ABC content has complied with ABC editorial standards. Our investigation has considered the programs' compliance with editorial standards relating to accuracy, impartiality and harm and offence (as set out in sections 2, 4 and 7 of the ABC's Code of Practice - http://about.abc.net.au/reports-publications/code-of-practice-2014/ ).

The report of our investigation is available here - http://about.abc.net.au/wp-content/uploads/2014/05/Catalyst-Heart-of-the-Matter-ACA-Investigation-Report.pdf . We have concluded that while the first episode was in accordance with the Code of Practice, the second episode did not adhere to section 4.5 of the Code ('Do not unduly favour one perspective over others'). We have also concluded that corrective action is required to address an inaccurate statement made by [presenter] during an interview on PM.

The ABC Managing Director has today released a statement which can be found here - http://about.abc.net.au/press-releases/statement-from-abc-managing-director-on-catalyst-ruling/ . To address the problems identified in this investigation, the Managing Director has directed that when the Catalyst program returns to air in June 2014, the first episode will include a notice advising viewers of the Audience and Consumer Affairs findings. The programs will be removed from the ABC website. Information will be added to the program website and the ABC Corrections page (http://www.abc.net.au/corrections/ ) to advise of the steps that have been taken. Additionally, the PM program has added an Editor's Note to the transcript of its story 'Backlash against ABC's Catalyst program questioning heart disease-cholesterol links', and an appropriate entry has been made on the ABC Corrections page.

Please accept our sincere apologies for the time taken to respond to your complaint. This delay was due to the number of matters raised in relation to the programs, the volume of material considered in the review and the serious nature of the concerns raised.

Should you be dissatisfied with this response, you may be able to refer your complaint to the Australian Communications and Media Authority, www.acma.gov.au .


http://www.acma.gov.au/

http://www.abc.net.au/corrections/




http://about.abc.net.au/reports-publications/code-of-practice-2014/

Attachment D

Some considerations to which the ACMA has regard in assessing whether or not particular content is factual material for the purposes of broadcasting codes of practice

In practice, distinguishing between factual material and other material, such as opinion, can be a matter of fine judgement.

The ACMA will have regard to all contextual indications (including subject, language, tenor and tone and inferences that may be drawn) in making its assessment.

The ACMA will first look to the natural and ordinary meaning of the language used.

Factual material will usually be specific, unequivocal and capable of independent verification.

The use of language such as ‘it seems to me’ or ‘we consider/think/believe’ will tend to indicate that the content is contestable and presented as an expression of opinion or personal judgement. However, a common sense judgement is required and the form of words introducing the relevant content is not conclusive.

Statements in the nature of predictions as to future events will rarely be characterised as factual material.

Statements containing hyperbole will rarely be characterised as factual material.

The identity of the person making a statement (whether as interviewer or interviewee) will often be relevant but not determinative of whether a statement is factual material.

Where it is clear in the broadcast that an interviewee’s account is subjective and contestable, and it is not endorsed or corroborated, their allegations will not be considered as factual assertions.

Where an interviewee’s stance is separately asserted or reinforced by the reporter or presenter, or proof of an allegation is offered so that it becomes the foundation on which a program or a critical element of the program is built, it may be considered a factual assertion.21

Sources with expertise may be relied on more heavily than those without, in determining whether material is factual, but this will depend on:

o whether the statements are merely corroborative of ‘lay’ accounts given by other interviewees,

o the qualifications of the expert,

o whether their statements are described as opinion,

o whether their statements concern past or future events22 and

21 See investigation 2712; Channel Seven Adelaide Pty Limited v Australian Communications and Media Authority [2014] FCA 667.22 See investigations 3066, 2961.


o whether they are simply comments made on another person’s account of events or a separate assertion about matters within their expertise.


statement from abc managing director on catalyst ruling/media/broadcasting investig… · web...

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