Taking Aim at Doctors' Dire Warnings, Thomas Moore Triggers a Cholesterol Debate

updated 11/13/1989 AT 01:00 AM EST

originally published 11/13/1989 AT 01:00 AM EST

Thomas J. Moore's first book, Heart Failure, has all the intrigue of a good thriller: a conspiracy theory, dangerous drugs, forced behavior modification and the threat of death. There's no spy in Moore's 308-page work, a nonfictional investigation of heart care. But its lengthy section on a national obsession—cholesterol—has become more controversial than any international whodunit. Armed with four years of research, Moore, 45, challenges conventional medical thinking by claiming that reducing cholesterol levels is difficult with diet, risky with drugs—and may not even do much to lower the risk of a heart attack.

Moore, a Cornell-educated investigative reporter who is now a visiting fellow at George Washington University, doesn't stop there. The anticholesterol movement, he further charges, is mainly the result of a coalition between an elite group of doctors, government health officials and the drug companies that contribute to cholesterol research. "They've oversold the role of cholesterol as if it were the only cause of heart attacks," he insists. Coming at a time when oat bran is haute and fried eggs daring, Moore's book has left many readers smacking their lips in anticipation. His critics, however, say that it would be foolish to go back to the steakhouse.

"His conclusions are unfounded," argues Dr. James Cleeman, coordinator of the National Cholesterol Education Program (NCEP), one of Moore's prime targets. "Evidence of the benefits from reducing cholesterol is very powerful."

Indeed the heart of the cholesterol controversy lies in how you crunch the numbers. When Moore, who has training in statistical analysis but not in medicine, looks at the figures from the major cholesterol studies, he sees "millions of dollars spent putting thousands of people on special diets and drugs, but with little significant reduction in cholesterol levels—or deaths from heart attacks." When those whom Moore calls cholesterol crusaders look at the same modest gains, they conclude that even small improvements will eventually save lives.

What makes Moore's blood boil are two fundamental NCEP recommendations, affecting about a third of the adult population. First, that everyone with serum-cholesterol levels of 240 milligrams or more be treated with a restricted diet or cholesterol-lowering drugs or both. Second, that people with cholesterol counts between 200 and 239 milligrams be considered for treatment if two other risk factors (including smoking, obesity, diabetes, high blood pressure or a family history of heart disease) exist.

Casting the net so wide, Moore says, "results in the treatment of millions of people who will show little gain from it." He is particularly concerned about the side effects of cholesterol-lowering drugs, such as liver damage, cataracts and gastro-intestinal disturbances.

Moore approached his cholesterol investigation with the same tenacity he has exhibited as a reporter. Raised in Wheaton, Ill., the son of a lawyer and an architect, Moore started his career at the Chicago Sun-Times in 1969, where a series of pieces he wrote helped bring down a number of corrupt public officials. In 1975 he joined Sen. Gary Hart's staff and in 1977 began investigating CIA activities for the Senate intelligence committee. He returned to investigative reporting in 1979 and in 1986 won three national press awards for a series on heart-bypass surgery for the Knight-Ridder chain of newspapers.

Alarmed by the number of heart-attack deaths he saw, Moore wanted to focus on prevention. "That's why I looked at cholesterol. I expected to come up with a different story," he says. What he found was that the cholesterol question was being hotly debated among medical professionals, and he felt the public was only getting part of the story. In his book Moore chastises top doctors in the cholesterol field, likening them to a "medical version of the military-industrial complex," and criticizes their multiple roles as researchers, policymakers and drug company consultants: "The danger of such a closed loop is that important and basic questions are neither asked nor answered."

Still, when the rhetoric is stripped away, Moore and his targets may not be that far apart. Everyone agrees, for example, that high cholesterol levels pose health risks for young and middle-aged men—the group most at risk for premature heart attacks and heart disease, and the group most often studied. But should the results of those studies determine how everyone else eats? Moore and the experts all applaud the recent decision by the National Heart, Lung and Blood Institute to study the effects of lowering cholesterol in such previously neglected groups as women and the elderly. Where the two sides disagree is on the benefit of spending what Moore estimates to be between $20 billion and $40 billion on tests, treatments and drugs to lower the nation's cholesterol level.

"Cardiac disability takes a greater economic toll on the country than testing cholesterol," insists Dr. Daniel Steinberg, a professor of medicine at the University of California at San Diego, who chaired the 1984 conference that targeted cholesterol as a main cause of heart disease. "If you prevent somebody's heart attack, you give him a lot of good years."

In the event that Steinberg and others are right, Moore, whose own cholesterol level is 220 milligrams, follows a regimen that's on the safe side of the statistics. The reporter, who shares a Washington, D.C., town house with his wife, Barbara, an editor, jogs three to five miles four times a week. He eats a light breakfast (cereal and milk) and a "very light" lunch (salad or pasta) before joining Barbara for a home-cooked dinner, often of French or Italian specialties. "I'm not a scientific dieter, but I'm careful about health and nutrition," says Moore. "It's a matter of moderation and common sense versus some magic diet that promises to prevent heart attacks or make you live longer."

—Mary H.J. Farrell, Jim Castelli in Washington, D. C.

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