The CDC’s deadly cocktail of conflicted industry partnerships, misleading statements, and cover-ups threatens the health of all Americans.
The CDC’s Diabetes Prevention Program is negligent at best. Furthermore, the CDC directly violated its own policy to partner with Coca-Cola and seems to have significantly understated the growth rate of diabetes. A group of CDC scientists alleges that the CDC intentionally misled Congress and preferentially treated Coca-Cola-funded employees. This behavior has real consequences. CDC’s unethical actions raise Americans’ risk of death from diabetes, heart disease, cancer and a host of other chronic diseases linked to insulin resistance.
CDC Prediabetes Material Ignores Diet
Sugar-sweetened beverages significantly increase the risk for Type 2 diabetes, even controlling for obesity. And while important, sugary drinks are just one dietary factor among many. Combine them with excessive consumption of sugary foods and other processed carbohydrates, as well as junk food generally, and you get what America is currently suffering from: ~85 million prediabetics. For more on this topic, watch the CrossFit Foundation’s conference on diet and cardiometabolic health from last week.
Yet the CDC’s diabetes-prevention campaign does not mention a single dietary factor as a risk for prediabetes:
Even if you assume that energy imbalance is the sole cause of diabetes, why does the CDC emphasize one side of the energy balance equation (physical activity), and completely ignore the other (food and beverage intake)?
And as Andy Bellatti of Dietitians for Professional Integrity commented, “It’s inaccurate and fatalistic to make it seem like being over the age of 45 indicates a higher risk of T2D independent of lifestyle.”
Surely 78-year-old CrossFit athlete Jacinto Bonilla would disagree with the CDC’s portrayal.
This CDC material is not an aberration. CDC has partnered with the American Diabetes Association to produce prediabetes public service announcements, such as the one below. This “prediabetes risk test” also completely ignores dietary risk factors. Instead, the first question it asks is, “Are you a man?”
Given the CDC’s conflicted and misleading approach to diabetes prevention, it’s no surprise that the CDC also seems to dramatically understate the scope of the diabetes epidemic, as compared to independent sources.
CDC May Dramatically Understate the Diabetes Rate
The CDC estimates that “30.2 million adults aged 18 years or older (12.2% of all U.S. adults), of which 7.2 million (23.8%) were not aware of or did not report having diabetes.” This comes out to roughly 23.1 million cases of adult, diagnosed diabetes, or 9.3 percent of the adult population.
On the other hand, Gallup recently polled 177,000 Americans and reached a much higher figure than the CDC: “11.6% of U.S. adults reported having been diagnosed with diabetes.” That comes out to 28.8 million adult, diagnosed cases.
So Gallup estimates the true number of adult Americans with diagnosed diabetes is 25 percent higher than the CDC figure. That’s a difference of 5.7 million Americans. And if you apply CDC’s conclusion that 23.8 percent of diabetics are undiagnosed to Gallup’s data, you reach a total of 37.8 million adult diabetics in America. This is 7.6 million higher than CDC’s estimate.
Why might the CDC have reached such a dramatically lower diabetes estimate than independent researchers? Well, if you read beyond the CDC’s press release and into its research methodology, the agency,
… assumes that the prevalence of diabetes in 2015 was the same as it was in earlier periods (2011–2014) …
This is a strange assumption. The CDC itself often warned that diabetes is spreading at a consistent rate. And yet somehow now it’s assuming that the prevalence did not change in a five-year period?
Besides Gallup, other independent sources differ from the CDC’s relatively sanguine assessment. This January, NPR reported,
“Claims for Type 2 diabetes — formerly known as adult-onset diabetes — among people younger than 23 years old more than doubled between 2011 and 2015, according to the analysis of a large national database of health claims paid by about 60 insurers.”
So youth diabetes claims doubled during the exact period that the CDC assumes the overall diabetes rate remained constant. The private insurers also found,
“the number of claims tied to an obesity diagnosis jumped 94 percent among infants and toddlers, and as much as 154 percent among people ages 19 to 22.”
It’s hard to square the private insurance data with what the CDC’s claiming. As NPR noted, that data,
“… contrasts with CDC findings that the prevalence of obesity among children and youth ages 2 to 19 years old remained relatively stable from 2011 to 2014.”
Besides assuming that the diabetes rate did not change between 2011 and 2015, the CDC data explicitly assumes that the “prevalence of diabetes in the resident population was identical to those in the civilian, noninstitutionalized population.”
The non-institutionalized population happens to exclude nursing homes, which have extremely high diabetes rates.
The CDC warns, “Deviations from these assumptions may result in overestimated or underestimated numbers and rates.”
Indeed. But you don’t see these strange assumptions or obvious caveats when the CDC issues its public statements and press releases.
Is it outlandish to suggest that the CDC would intentionally mislead the public by manipulating chronic disease numbers? Not if you look at the agency’s record. An internal ethical complaint alleges that the CDC lied to Congress about its WiseWoman heart disease prevention data and then covered up their lie. More on this later. And USA Today discovered that CDC,
“… is keeping secret large swaths of information about dozens of recent incidents involving some of the world’s most dangerous bacteria and viruses.”
The Center for Public Integrity reported that,
“… the Centers for Disease Control … failed to properly inactivate a sample of the Ebola virus before moving it from a high-security lab to another one in December 2014.”
Consider yourself lucky there’s no Big Ebola lobby.
The CDC Prediabetes Food Guidelines are Ineffective, Likely Harmful
The CDC’s and ADA’s inaccurate prediabetes messaging covered earlier is part of the agency’s Diabetes Prevention Program.
This program focuses on fat reduction while ignoring or even absolving sugar and processed carbohydrates. In Session 2 of the “Lifestyle Coach Facilitation Guide, the “Eating Less Fat” section seems to promote sugar as a healthier alternative to fat for diabetics:
“Our goal is to help you learn to make healthy food choices. Healthy eating involves eating less fat for several reasons: Fat contains more than twice as many calories as the same amount of carbohydrate (starch or sugar) or protein …”
Session 3, “Three Ways to Eat Less Fat and Fewer Calories,” mentions fat 143 times and sugar only twice. Session 4, “Healthy Eating,” mentions fat 77 times and sugar just thrice. None of these nutrition sessions mentions the word “insulin” a single time.
The Diabetes Prevention Program material lumps foods like nuts in the “high-fat foods” category with potato chips and pound cake. This is ridiculous since nuts contain no added sugar and in fact “improve blood sugar control.” And if fat in general is such a problem for diabetes, why do low-carb high-fat ketogenic diets reverse diabetes?
Granted, this material was released in 2012. The CDC’s more recently developed Prevent T2 program does include sugar reduction. Nevertheless, the CDC is still promoting its fat-reducing, sugar-ignoring 2012 material on its website, and it states the material is “still valid.”
CDC has doubled down on the fat-targeting, sugar ignoring approach to diabetes prevention in 2017. The newest CDC diabetes prevention campaign’s “Eat Healthier” section recommends “keeping track of your daily fat grams” but does not mention reducing sugar intake. Its “Food and Activity Tracker” tracks fat grams and calories, but does not mention sugar or even carbohydrates in general.
I asked Dr. Arne Astrup of the University of Copenhagen about the Diabetes Prevention Program’s dietary guidelines at the CrossFit Foundation’s nutrition conference. Dr. Astrup’s data suggests that low-fat recommendations like the CDC’s may contribute to the diabetes epidemic:
“I completely agree with you that the recommendations for diabetics today, I think at the global level, are probably not optimal … I didn’t show you all the data but actually we could see that the diabetics on the low-fat, high carbohydrate diet … gained weight and also with a deterioration in their glucose control.”
The CDC is the Problem and Fitzgerald’s Not the Solution
When President Donald Trump appointed Brenda Fitzgerald to direct the CDC, we discovered her Coca-Cola blog post. Then we found the Coca-Cola partnership she oversaw while leading the Georgia Department of Public Health. Since we broke the story, the New York Times, journalist Rob Waters, the Intercept, and other outlets have uncovered further evidence of Fitzgerald’s Coca-Cola collaboration. As the Times covered,
A series of emails, most from 2013, obtained under the Freedom of Information Act by U.S. Right to Know, illustrated a friendly relationship between Dr. Fitzgerald and Dr. Applebaum of Coke. When Dr. Applebaum was named president of the International Life Sciences Institute, the food industry’s premier research center, Dr. Fitzgerald wrote back, “Yea team.” …
If Fitzgerald, Coca-Cola and industry front group ILSI are playing on the same team, who’s the opposition? Certainly not sugar.
While Fitzgerald’s Coca-Cola ties are certainly concerning, it is only the most recent episode in a long series of successful industry efforts to undermine public health and manipulate the CDC.
First off, the CDC Foundation partnered with Coca-Cola and accepted more than US$1 million from the soda company. These donations violated the CDC Foundation’s policy, which bans “Partnership with an organization that represents any product that exacerbates morbidity or mortality when used as directed.” Does anyone disagree that 20-oz. Coke bottles exacerbate the risk of diabetes and obesity?
Even if CDC Foundation policy did permit Coca-Cola donations, the relationship raises major red flags. As UC San Francisco Pediatric Endocrinologist Dr. Robert Lustig asked,
“Why is Coke talking to CDC at all? Why is there any line of communication?….The contact is completely inappropriate and they’re obviously trying to use it to exert influence on a government agency.”
Obama-appointed former CDC director Tom Frieden claims he “basically canceled” Coca-Cola’s obesity-related projects at the CDC. This should not reassure anyone.
First of all, Coca-Cola continued to influence the agency through its personnel, many of whom either work simultaneously at industry front groups like ILSI, or accept industry research funding. Second, Brenda Fitzgerald has stated she would welcome renewing CDC’s Coca-Cola partnership following a “review process.” That Fitzgerald would even consider Coca-Cola funding given its express violation of the CDC Foundation’s policy indicates how seriously we should take her commitment to a “review process.”
Here’s some other unethical behavior CDC’s own scientists alleged last August in an internal ethical complaint, published by US Right To Know:
1. The CDC scientists alleged that CDC lied to Congress to make a chronic disease program seem more effective than it actually was, then covered up the lie:
“Recently, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has been implicated in a ‘cover up’ of inaccurate screening data for the Wise Woman (WW) Program. There was a coordinated effort by that Center to ‘bury’ the fact that screening numbers for the WW program were misrepresented in documents sent to Congress; screening numbers for 2014 and 2015 did not meet expectations despite a multimillion dollar investment; and definitions were changed and data ‘cooked’ to make the results look better than they were … An ‘internal review’ that involved staff across CDC occurred and its findings were essentially suppressed so media and/or Congressional staff would not become aware of the problems.”
2. And they allege that Coca-Cola-funded CDC officials enjoy preferential treatment:
“Another troubling issue at the NCCDPHP are the adventures of Drs. Barbara Bowman and Michael Pratt (also detailed in national media outlets). Both seemed to have irregular (if not questionable) relationships with Coca-Cola and ILSI representatives … Apparently Dr. Pratt’s position at Emory University has ended and he has accepted another position at the University of California San Diego? Again, how is this possible while he is still an active duty USPHS Officer. Did he retire and leave government service? Is UCSD paying for his time via an IPA? … It is rumored that Dr. Pratt will occupy this position while on Annual Leave? Really? Will Dr. Pratt be spending time in Atlanta when not on Annual Leave? Will he make an appearance at NCCDPHP (where he hasn’t been seen for months). Most staff do not enjoy such unique positions supported and approved by a Center Director (Dr. Bauer). Dr. Pratt has scored a sweet deal (not available to most other scientists at CDC).”
While Bowman resigned last year after emails emerged showing her advising Coca-Cola on lobbying the World Health Organization, Michael Pratt remains a CDC employee according to the CDC’s information desk. And this October Pratt is speaking at an incoming event hosted by the industry front group ILSI. Clearly, the CDC can’t object to its employees partnering with industry and promoting industry-friendly propaganda when it does so itself.
Earlier we joked that there’s no Big Ebola lobby to magnify the CDC’s reckless incompetence with deadly diseases. But how much worse could things really get at the CDC?