In 1900, John D. Rockefeller controlled approximately 90 percent of all petroleum refining in the United States. He was, by some calculations, the richest private individual who had ever lived.
He had a problem. Scientists were discovering that compounds derived from coal tar, a petroleum byproduct, could be used as synthetic medicines. Aspirin, derived from coal tar, had been launched by Bayer in 1899. The petroleum waste stream Rockefeller had previously had to dispose of could now be sold back to the public as medicine at a markup of roughly 10,000 percent.
He had another problem. American medicine in 1900 was a competitive ecosystem of homeopaths, herbalists, naturopaths, osteopaths, midwives, and traditional doctors who used food, plants, water, and lifestyle as the primary tools of healing. Approximately half of all American medical schools taught some form of natural or alternative medicine.
Rockefeller bought into the German pharmaceutical industry, eventually taking a substantial stake in IG Farben, the conglomerate that included Bayer, BASF, and Hoechst. He then commissioned a report.
The report was written by Abraham Flexner, an educator with no medical training, funded by the Rockefeller and Carnegie Foundations, and published in 1910. It declared that natural and alternative medical schools were unscientific quackery. It recommended the closure of more than half of all American medical schools and the standardisation of the rest around medicine based on synthetic patented drugs.
Congress acted. Half of American medical schools closed within a decade. The remainder accepted Rockefeller and Carnegie funding on the condition that their curricula be reorganised around pharmaceutical treatment. Nutrition was removed. Herbal medicine was removed. Lifestyle intervention was removed. The doctor's job was redefined: diagnose the symptom, prescribe the drug.
The drugs were petroleum-derived. The petroleum was supplied by Rockefeller-controlled refineries. The medical schools were funded by Rockefeller. The journals were funded by Rockefeller. The AMA was supported by Rockefeller. The hospitals were funded by Rockefeller.
By 1925, the American medical system was a vertically integrated extension of the petroleum industry, operating under the marketing slogan that it was scientific.
This is the system that exists today.
The pharmaceutical industry generates approximately $1.5 trillion in annual revenue. The American population, 4 percent of the global total, consumes approximately 50 percent of all pharmaceuticals manufactured.
The system was not designed to make people healthy. The system was designed to manage symptoms in a way that produces lifetime customers. A healthy patient is a former customer. A managed patient, who takes the pill every day for the rest of their life, is an annuity.
The objective has always been to keep you in that profitable corridor between healthy and dead.
Long enough to keep buying. Not so well that you stop.
The doctor who advises you to fix your metabolism by changing your diet is, from the point of view of the system that trained him, a defective product. The doctor who prescribes you a statin, a metformin, an antidepressant, and a blood pressure medication for life is performing exactly as designed.
The system was designed by an oil baron who needed to sell the waste products of his refineries.
It still functions, 116 years after the Flexner Report, exactly the way he designed it.
You are the customer.
The corridor is where you live.
A pharmaceutical company that cures a disease loses a customer.
A pharmaceutical company that manages a disease gains an annuity.
The business model of chronic disease management is structurally incompatible with the goal of resolving chronic disease.
The financial structure produces the incentive.
The incentive produces the research agenda.
The research agenda produces the guidelines.
The guidelines produce the prescription.
The prescription produces the revenue.
The revenue funds the next round of research.
At no point in this loop does anyone need to intend harm.
The loop produces the harm regardless.
Seed Oils
In 1900, heart disease was a medical rarity. The first description of a myocardial infarction in the medical literature was published in 1912. The cardiologist Paul Dudley White, who would later treat President Eisenhower, reported that in his early career in the 1920s he might see one or two heart attacks per year.
By 1950, heart disease was the leading cause of death in America.
Something happened between 1900 and 1950 that transformed a rare clinical curiosity into the number one killer of the wealthiest nation on earth.
That something was not saturated fat. Americans had been eating saturated fat for their entire history. Butter consumption peaked in the 1930s. Lard was the default cooking fat in every kitchen. Beef tallow was universal. Heart disease was rare.
That something was not cholesterol. Eggs had been a dietary staple for centuries. Organ meats were consumed weekly. Cholesterol intake had not meaningfully changed.
That something was not red meat. Per capita red meat consumption was broadly stable from 1900 to 1960.
The one dietary variable that tracks, almost perfectly, onto the rise of heart disease in America is the introduction and rapid scaling of industrially processed seed oils.
Crisco, the first commercially available hydrogenated vegetable oil, was launched in 1911. It was made from cottonseed oil, which had previously been classified as industrial waste. Procter & Gamble, who manufactured it, had been using cottonseed oil to make soap and candles. They discovered that the hydrogenation process could turn the liquid oil into a solid fat that resembled lard. They patented it, marketed it as modern and scientific, and placed it in American kitchens.
By 1950, seed oil consumption in America had risen from near zero to approximately 10 percent of total caloric intake. By 2010, it had risen to approximately 20 percent. Americans now consume, on average, 80 grams of seed oil per day. Their great-grandparents consumed approximately zero.
Heart disease tracks this curve. Diabetes tracks this curve. Obesity tracks this curve. Alzheimer's, which some researchers now call type 3 diabetes, tracks this curve.
Saturated fat consumption has declined continuously since the 1960s. Heart disease has not declined at the same rate. Cholesterol intake has declined. Heart disease has not followed it down. Red meat consumption has declined since the 1970s. Heart disease has not followed it down.
Seed oil consumption has risen continuously, and heart disease has risen with it.
The correlation is not proof of causation. But the correlation between saturated fat and heart disease, which the entire Western dietary framework was built on, was never proof of causation either. It was a hypothesis.
The hypothesis has been tested, repeatedly, in randomised controlled trials, and it has failed every time.
The seed oil correlation has not been tested at scale, because nobody who funds dietary research has any financial interest in testing it.
The companies that make the seed oils fund the research.
The research does not investigate the seed oils.
The seed oils remain in the food supply.
Your grandmother cooked with lard. Her heart was fine.
You cook with rapeseed oil. Your cardiologist is busy.
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