Aseem Malhotra: Lessons in Public Health Advocacy

Dr. Aseem Malhotra is a best-selling author, researcher, and one of the most well-known cardiologists in the U.K. His views on cholesterol and sugar, controversial primarily among those who choose to promote special interests at the expense of public health, have landed him in numerous front-page news articles and on primetime television shows.

On Dec. 15, 2019, Malhotra was a featured speaker at a CrossFit Health event in Scotts Valley, California. In the presentation, he discusses his experiences moving from clinical practice into the public eye and shares the lessons he has learned about public health advocacy along the way.

Malhotra begins by invoking the Seven Nolan Principles, created by the U.K. Committee for Standards in Public Life to guide those whose job it is to serve others — e.g., politicians, teachers, police officers, doctors. Those principles are: selflessness, objectivity, integrity, accountability, honesty, openness, and leadership.

The ability of doctors to adhere to these principles, Malhotra argues, has been compromised by a crisis in the Western health-care system. To elucidate that crisis, he cites Gerd Gigerenzer, the Director of Health Literacy in Berlin, Max Planck Institute, and Muir Gray’s seven sins that contribute to inefficient health care: biased funding of research, biased reporting in medical journals, biased patient pamphlets, biased reporting in the media, commercial conflicts of interest, defensive medicine, and medical curricula that failed to teach doctors how to comprehend and communicate health statistics.

Malhotra shares a case study that demonstrates the stakes of these seven sins against health, the case of 55-year-old international airline pilot Tony Royle. Royle was living a very active lifestyle but was informed during a routine checkup that he was overweight, had a high total cholesterol-to-HDL ratio, and his 10-year risk assessment for heart attack and stroke had come back high.

Unfortunately, a few months later, Royle had a heart attack and was “prescribed the usual cocktail of drugs,” Malhotra explains. A year after that, Royle began feeling ill, and having a strong background in statistics — after being grounded due to the heart attack, he had reverted to a previous career teaching math and physics — Royle began looking into the data on the drugs he was taking. Considering absolute rather than relative benefit, he determined he should stop taking his beta blockers and statins. Within weeks, his symptoms had resolved. He then began looking at research on nutrition, discovered the work of Tim Noakes and Gary Taubes, and started reducing his carbohydrates. Within three months, he had lost nearly 50 lb. and his health markers improved. Now in his 60s, he is a top-20 amateur Ironman competitor.

Royle’s story demonstrates to Malhotra that there is something fundamentally wrong with the scientific literature upon which doctors base their decisions regarding patients. Malhotra has done a considerable amount of work to correct the research record on sugar and cholesterol and to expose the corruption that led to its distortion. He has written articles with Malcolm Kendrick, Uffe Ravnskov, David Diamond, and others, reanalyzing the data from Framingham Heart Study and finding “there was no association with coronary artery disease if your LDL was high, and in fact, there was an inverse association with all-cause mortality. In other words,” he explains, “the higher your LDL, if you’re over 60, [you’re] statistically less likely to die.”

In 2013, Malhotra wrote a peer-reviewed editorial for the BMJ that garnered much media attention and eventually left him embroiled in controversy. “In it I try to really put all of the jigsaw together to explain the obesity epidemic,” he explains. After spending two to three years studying saturated fat, cholesterol, and statins, he says, “I had concluded that our obsession with lowering cholesterol through LDL had led to the whole low-fat diet, low-saturated-fat diet movement, and it was clear that we’d increased our consumption of refined carbohydrates. We’d had this explosion of Type 2 diabetes and obesity.” In his editorial, he argued saturated fat is not a major contributor to heart disease, which conflicts with the diet-heart and lipid hypotheses as well as the multibillion-dollar statin industry based upon them.

Responses to the editorial were mixed. The BMJ issued a press release. News of the article appeared on the front page of The Times, in headlines on BBC news, and beyond. Professor Sir Rory Collins of Oxford, who, Malhotra notes, “got his knighthood from his work on statins,” was not happy. Collins demanded the BMJ retract the article. The journal’s editor, Fiona Godlee, refused, and the controversies escalated from there. Malhotra recounts the stages of his battle with Collins and what it taught him about harnessing mass media for public health advocacy.

Malhotra entered a similar battle when he turned his energies toward sugar. He wrote another editorial for the BMJ, this time declaring “Dietary advice on added sugar needs emergency surgery.” He soon began receiving messages from like-minded scientists, and together they formed Action on Sugar, an advocacy group that highlights the sugar problem and seeks policy change. But while he and his cohort exposed the ways in which Big Sugar functions like Big Tobacco, Andrew Lansley, the U.K.’s former Secretary of State for Health and Leader of the House of Commons, came to sugar’s defense. Lansley claimed, “Sugar is essential to food.” Malhotra claims, “He would have been more accurate in saying ‘sugar is essential to food industry profits and lining the pockets of his co-opted partners.’” “Lansley,” Malhotra points out, “was a paid director to marketing company Profero til the end of 2009. Profero clients have included Pepsi, Mars, Pizza Hut, and Diageo’s Guinness.” After these affiliations were brought to light, they “didn’t hear from Andrew Lansley again,” Malhotra says. “Sunlight is a very powerful disinfectant.”

“This is what’s going on right now in health care,” Malhotra concludes. “Whether it’s a food industry or the pharmaceutical industry, it’s a gross injustice. It’s a gross injustice on the public, on our relatives, on our friends, on our families … because people are being misled and deliberately misled for profit.”

“If there’s a gross injustice going on, if you want to revolutionize things, what do you do?” he asks. “You make the injustice visible. That’s what you’re doing, and the best way to do that — that ideal platform is mass media, and when mass media gets behind it … everything changes.”

To read a complete transcription of the presentation, click here.