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Right. Out of the blue. Out of the blue. And what does he say? He says, Dr. France, I've heard the possibility that there might be some very interesting data in your father's basement. I'm talking to Robert France, a cardiologist at the Mayo Clinic in Rochester, Minnesota, about a phone call he got not long ago from a man named Chris Ramsden.
He had a question for Robert France about his father. My parents lived in the same house for over 50 years and essentially my father passed and then my mother was living in assisted living. The house was empty. The family hadn't gotten around to selling it. So we just sort of left it. Nobody was necessarily living in it, but it was there. And so when Chris said there might be something in the basement of interest,
I feel like every great Midwestern detective story begins with the line, "There might be something in the basement of interest." I had some concern because the joke in our family was that if we ever need to sell that house, we should just call the Air Force and call in a napalm strike.
There were files that had every paper that my father had ever published and every PhD thesis that he'd ever reviewed. And he was also an amateur radio operator, and he built his own radios, hand-wound his own coils, and built his own receivers. And so there's all this radio stuff down there. So there was a lot of stuff in that basement when Chris called.
My name is Malcolm Gladwell. You're listening to Revisionist History, my podcast about things overlooked and misunderstood. This episode is the final episode of the season, season two. It's a medical mystery, a detective story about a long-forgotten scientific study, a study with a crucial clue.
I left this episode to the last for a reason, because it is also, in many ways, the most personal of this year's stories. And it was Robert France who got me thinking about all this. I didn't meet Robert France in person. I was just calling him to clarify a few questions from another story I was working on. The previous episode, in fact. The one about french fries. It wasn't worth flying all the way to Minnesota for this one interview, I thought.
I was at my parents' home in Canada and preoccupied. I actually conducted the interview with France in my rental car on my cell phone with my little tape recorder on the dashboard with someone in Minnesota recording Robert France's end of the conversation. But now I wish I'd met him face to face.
How hard was it for you to find what he was looking for? Well, their home is about 90 miles from where I live down here in Rochester at the Mayo Clinic.
And so what I did is I would drive up there after work and spend a couple hours in the evening looking around and going through files. And I did that three or four times before I actually found the files that were of interest. And on that third or fourth time, I really came to truly one of the back corners of the basement, and there was a moldering old house.
cardboard box there that I opened up and I just immediately thought to myself, Eureka, I have found it. Robert France's father, the man who left the box in the basement, was Ivan France Jr., born in Smithville, West Virginia in 1916. He was slender and upright with a magnificent head of hair which he kept all his life.
He flew planes, tinkered with radios, played the clarinet. He wrote his scientific papers longhand, sitting at the dining room table in immaculate handwriting on yellow legal pads. Pencil, eraser, pencil sharpener, all just so. He was precise, punctual. Neither of his parents had finished high school. He ended up getting a degree from Harvard Medical School and then taught for 34 years at the University of Minnesota.
Ivan France was one of those unstoppable smart kids from the provinces. Not long before his death, Ivan France was interviewed for the university's archives. I made the final decision to go to medical school when I was a freshman in high school. That's a story I'd like to hear. And how did I decide to do that? Well, I noticed how my parents felt about people.
And the only people that I could see that they really respected were the Baptist preacher and the physician that took care of them. I knew I would never make it as a preacher. I'd run this whole interview if I could. I had another decision at that point, too, that I was offered a chance to play in a band in a...
cruise ship going between New York and Livermore. And at the same time, the chemistry department asked me to do a little research project in the summer. So there again, I made the wrong decision. And
and went with the chemistry department. I see. You never got to play the clarinet then for rich people on the luxury ship? No. What a loss to music. Ivan France did not end up on cruise ships. He chose instead to devote his life to studying heart disease, specifically to understanding the role of cholesterol and blood lipids in heart attacks.
He took his research seriously. Robert Franz says that his father raised his five boys according to the best practices of nutritional science. My dad would occasionally come home and say, let's look at the lipids in the family, and we'd line up and my mom would...
draw our blood because she felt she was better at it than my father. And he'd bring it down to the lab and look at our lipid profiles. You don't remember your lipid profile, do you? Well, they're always pretty good, you know, because I think from an early stage, my family tended to eat a low saturated fat diet. I remember a day when my dad brought back
a piece of something that was the first efforts at making something like, supposed to taste like steak or hamburger, but was actually, had no meat in it. And so these early efforts were foisted upon us and we did our best to help my father to understand that making something that tastes like meat that isn't meat is not going to be an easy thing to do.
You were his guinea pigs. Well, in a way we were. And I think it's true that he would have these ideas about things and say, well, let's try this. It's not really meat, but it's supposed to taste like meat. And maybe this is a way we can try to reduce our saturated fat intake. Yeah. Did he weigh in on, he sounds like he must have weighed in on what the family should be eating.
We basically ate a lot of vegetables, you know, like lightly steamed broccoli with some lemon and pepper on it or something, and maybe a little bit of margarine. In the 1960s, Robert's father decided he'd gone as far as he could in answering technical questions about the way in which cholesterol was synthesized by the body. He wanted to do something more practical, more useful. So he ran an idea by the head of the Heart Institute at the National Institutes of Health.
This guy that was ahead of that down there used to come up and visit me once in a while to see if I was doing what I was supposed to do with the NIH money. He always, he wanted to play chess so every time he would come up here we'd have to get together in the evening and play chess.
Fair enough. So it was starting to become a kind of an old boys network and I told him that I thought that that was something that the NIH should do, was to organize a big study in the general population to find out if there really was a relationship between diet, cholesterol, and heart disease.
Let's take a step backwards for a moment, because you can't understand the importance of what France was suggesting and why the basement tapes would ultimately matter so much until you understand how scientists usually study diet. There are lots of ways to analyze the effect that diet has on health.
You can do an observational study, for example. Identify tens of thousands of people. Have them fill out a questionnaire on their diet at regular intervals over many years. Then keep track of when they die and what they die of and look for patterns. That's what an epidemiological study is.
France had a colleague at the University of Minnesota named Ancel Keys, who conducted maybe the most famous epidemiological study of diet and health in history. For 25 years, Keys collected data on about 12,000 middle-aged men in Italy, Greece, Yugoslavia, Finland, the Netherlands, Japan, and the United States.
And he came to the conclusion that the people eating what he called a Mediterranean diet, lots of fish, vegetables, olive oil, and very little saturated fat, those people had the fewest heart attacks. Keyes was massively influential. The problem is, epidemiological studies are really tricky. For example, in France, people eat lots of butter and cheese and things cooked in fat, yet they have really low rates of heart disease. France was not included in the seven-country study.
Would Ancel Keys' results have been different if he'd added France and done an eight-country study? With epidemiological studies, you can get in real trouble if you pick the wrong populations. And how does Keys know that it's all the olive oil and fish and vegetables of the Mediterranean diet that make people from those places live so long? He's noticed an association between that diet and good health. But an epidemiological study can't prove causation.
Many years later, another researcher went back and reanalyzed Keyes' data and showed that people's consumption of sugar was a much better predictor of their health than their consumption of saturated fat.
The only way around these problems is to do a controlled clinical trial, a study where you gather together two large groups of people who you think are identical on every variable you can imagine. Age, weight, lifestyle, social class. Have one group eat their normal diet and have the other eat something you think is way healthier, and then follow them for years and see what happens. That's what Ivan Franz suggests to his friend from the National Institutes of Health.
And he said, well, that's very interesting because I had a similar message from a couple of other people. Maybe we'll just do that. The result was the National Diet Heart Study, a massive undertaking starting in the early 1960s. 100,000 people. Baltimore, Boston, Chicago, Oakland, and eventually Minnesota. France faced a challenge, though. Even clinical trials are not perfect.
Because how can you be sure that the group chosen to eat the normal diet doesn't start to eat healthier on their own over time? Or that the people chosen to eat healthy keep to their diet? How do you know they aren't sneaking big slices of chocolate cake every night?
So, alone among the participants in the National Diet Heart Study, Ivan France goes one step further, because he's Mr. Meticulous. He says, for my portion of the study in Minnesota, I'm going to use people who are living in an institution, so I know exactly what they're eating. Well, what I finally decided on was the school for...
people with low IQs at Downs Faribault. Oh yes. So everybody else wanted to do it in the open population. And I said, "Well, you'd get a lot better control if you do it in the closed population." And so what they finally did was to let me do it the way I wanted to, and the other five people do it in the open population.
The patients in France's study would go for their meals in the cafeteria and get one of two trays. They'd look completely identical, so nobody knew what side of the experiment they were on. The term researchers use for that is "double-blind." But one tray was food cooked with vegetable oil and everything low-fat. The other had everything cooked in saturated fat. One side got butter, one side got margarine. And even that little detail France made perfect.
At that time, there was a law in Minnesota that margin had to be cut in triangles. I remember that. You remember that? Sure. So it wouldn't look as good as the little butter. That was a big problem for me in my institutional study because that would have wrecked my double blind. Uh-huh. And so what do you think I did about that? Yeah.
We're a bright fellow. What did you do? I got a new law passed in the legislature. Let me cut my margin in squares. Like I said, Mr. Meticulous. This was a beautifully organized study. There was lots of money and nothing, no holes were barred to try to do a good job.
The Minnesota portion of the Heart Study took years to set up. It involved six different mental hospitals around Minnesota and one nursing home for a total of more than 9,000 research subjects. It ran for five years, from 1968 to 1973, with a long follow-up period. To this day, it stands as one of the most rigorous diet trials ever conducted.
The different state hospitals where this project was conducted were scattered around Minnesota. And so my father, he actually had a small airplane. It was a private pilot and would just puddle jump around from one little place to another, troubleshooting these issues. It consumed his life, and he sort of rarely took vacation and was always working on something. And it was just what he wanted to do, really. So what does the Minnesota study show?
Well, that was the problem. The patients on the vegetable oil diet did end up with lower cholesterol than the people who ate food cooked with animal fats. That part worked according to expectation. But the vegetable oil people didn't live longer, which made no sense. They were eating the kind of diet everyone believed should help you live longer.
Ivan France brought in a graduate student named Steve Broste to help crunch the data. Broste remembers everyone just being baffled. And they were hoping that with some new statistical techniques that had just come out, that they might be able to either understand why the results came out the way they did, or perhaps after some adjustments for various explanatory factors, that maybe the results would change. The results didn't change.
When Broste talked to Ivan France, France just shook his head. I remember him just expressing his bewilderment at how this could possibly have happened. Broste wrote up his results for his master's thesis, but he never published it. In 1989, 15 years after the Minnesota experiment ended, Ivan France finally published his results.
But the paper was vague and didn't really go into detail, as if after thinking it over for 15 years, he still couldn't make sense of what happened. This was a man who never ate butter, who regularly checked the lipid levels of his children's blood. This was what he believed in. To test that belief, he spent years and millions of dollars designing the perfect clinical trial, perfect, one step beyond everyone else in the National Diet Heart Study.
And after all that, the results were equivocal. He put a box full of all of his old data in his basement because he didn't believe in throwing anything out. He retired. He died in 2009. And his study was all but forgotten for a quarter century.
Until Ivan France's son, Robert, got a call out of the blue from Christopher Ramsden. It's pretty fun to try and track down missing data. So one clue led to another. Christopher Ramsden is a researcher at the National Institutes of Health. For seven years, he served as a lieutenant commander in the commissioned corps of the U.S. Public Health Service. He comes to the field of diet research from a different perspective than the majority of his peers.
People like Ivan Francer and Silky's were interested in the effects of saturated fats. If you eat lots of butter, what happens to you?
Ramsden is interested in the effects of the thing we are replacing butter with. Vegetable oils, corn oil, sunflower oil, grapeseed oil, canola oil, margarine. These are polyunsaturated fats, and they're all rich in something called linoleic acid. So for perspective, if you were to eat corn, corn is about 1% of it by weight is fat. Whereas if you eat corn oil...
It's 100% fat, and about 55% to 60% of that is one compound, linoleic acid. So I kind of view things like corn oil as kind of a cross between a food and a dietary supplement. Human beings need at least some linoleic acid for nutritional purposes. But in our attempt to keep our hearts healthier, we've essentially started to put vegetable oils in everything.
Ramsden estimates that up until 100 years ago, human beings would have gotten roughly 2-3% of their calories from linoleic acid. Now we're eating 3, 4, even 5 times that much. And the thing about linoleic acid is, it's not benign. It builds up in certain tissues. It may play a role in inflammation. So what does it mean that we've suddenly decided to consume large quantities of something so problematic?
Yeah, I think it's fair to say we're, you know, performing sort of an uncontrolled human experiment. Ramsden wanted some way to compare the health of people who eat lots of linoleic acid with people who eat a traditional diet of almost no linoleic acid. But what was he going to do? Somehow convince the government to give him hundreds of millions of dollars for the study? And then find thousands of people willing to turn their diets upside down? Then he realizes, wait, those studies have already been done.
In all of the mountains of data collected half a century ago in the name of studying cholesterol, there should be an answer to the linoleic acid question. Ramson first comes across something called the Sydney Diet Heart Study, the Australian counterpart to the big heart studies that were going on in the United States at the same time. He needs the raw data, but the study's main authors are long dead. One of the research assistants on the project, though, is still alive. Ramson tracks him down. I think you know what happens next.
So these data were actually in the house, I believe in the attic of Boonsing Leelarthapen, who was a research assistant at the time of the study, who went on to have a prominent career and got his PhD and luckily had the foresight to hold on to this nine-track magnetic tape. The attic tapes are exactly what Ramsden is looking for. But the Sydney study is small.
458 people, all middle-aged men. And it wasn't done in a controlled environment. That's when Ramsden calls Robert France and asks him to go rooting through his father's files to get his hands on the Minnesota experiment, the mother of all diet studies.
You know, at a certain point, universities make a decision to throw things out that they think are just taking up space and nobody's going to do anything with them anymore. And what's the value in preserving all these old things? And so it turns out that my father felt that was just a huge mistake. Why would you ever throw away the raw data? And sure enough, there they were, on magnetic tapes in a moldering box in the back of the friend's basement.
Chris must have been sharing with you the results as they were doing the work. How actively engaged with you was he when he was working through the data? Well, when they started getting to a point where they had kind of dug this hole
sub-analysis of the people who had been on the diet for more than a year and who were over 65, which was then showing a trend towards this finding that the more their cholesterol was lowered, the higher the risk of an adverse outcome. Adverse outcome, the great medical euphemism for death. Then he called me up and says, Bob, this is a little...
controversial, perhaps, because it's suggesting that there might actually be an adverse effect in some of these people of this diet. With the basement tapes, Ramsden could now drill down into the specifics of the trial. And what he found was that people over 65, the most vulnerable people in the experiment, were dying faster if they ate a so-called healthy diet.
The reanalysis of the Sydney trial, by the way, reached the same conclusion. Vegetable oil lowers your cholesterol, which is of course a good thing, but now Ramsden had two bits of evidence showing that all that extra linoleic acid seemed to be doing something else, something that more than cancelled out all the other benefits of vegetable oil. If you listened to the previous episode of Revisionist History, you heard me complaining about how McDonald's ruined french fries.
They used to cook them in animal fat and they were divine. But then, in 1990, they switched to frying them in vegetable oils and that's why they now taste like cardboard. We had to give up on one of the most delicious foods ever because we were told it was better for us, healthier. Saturated fats were bad. Look in your kitchen. Look at how much vegetable oil you have in your cupboard. Your ancestors did not have big bottles of corn oil lying around.
But now Ramsden comes along and says, wait a minute, the basement tape suggests that stuff is not so healthy after all. Linoleic acid might be a real problem. Let me just read to you from the conclusion of Ramsden's research article on the Minnesota study. It's in the British Medical Journal.
And remember that this is a super cautious scientist speaking in the final paragraphs of a peer-reviewed research paper that was probably rewritten and rewritten ten times to tone it down as much as possible. It concludes.
He's saying, The best clinical trials we have reach the opposite conclusion.
That's why Ramsden calls up Ivan France's son before he publishes his findings. He has to. So he said, how do you feel about that? This could be a little bit sensitive for you because this is your father's life work, and maybe in some situations it didn't actually have a neutral effect. Perhaps it wasn't even good for people. It's not a trivial issue for either man, is it? Ramsden is challenging 50 years of medical orthodoxy.
and he'd enlisted the son of the very man who helped create that orthodoxy. Ramsden tells Robert France, "I am about to call into question your father's life's work, to show that something he believed in his whole career perhaps wasn't that good for people. How do you feel about that?" Which means, "Have I made you complicit in the betrayal of your own father?" And what does France say? This is the heart of it. France says, "No, I'm not betraying my father.
If my father were alive, he would have done the same thing. Rummaged through his basement and given you the same computer tapes. I think my father would be very pleased because that's science, right? You have a hypothesis, you try to test it. Maybe it's diagram breaking, maybe it's not. And if things go a different direction, then you've got to try to explain that. My father was a humble man, you know. He would not be quick to take a lot of credit for things.
Ivan France had a set of beliefs, opinions. He thought you lived longer if you lowered your cholesterol. He thought that a healthy diet was one rich in vegetable oils and low in saturated fats. He believed in margarine and not butter. Those were the beliefs that drove his research agenda. But what Robert France is talking about when he says, "My father was a humble man," is something far more crucial than belief.
He's talking about his father's principles, the foundation of his father's thinking. Ivan France's foundational principle was humility. He was fully prepared to accept at any given moment that his beliefs might not be right and that he might not know the answer. In helping to prove his father wrong, the son was upholding his father's memory. "When I interviewed Robert France, I had just lost my father, three days before. That's why I was at home in Canada.
I was going to cancel the interview, but in the end that seemed as much trouble as doing it. So I sat in my rental car on my cell phone, and as Robert France talked about his father, it seemed to me that he was describing my father as well. Graham Morris Leslie Gladwell. An academic, a mathematician, slender, a full head of hair. He would sit at his desk at home and write his mathematics papers in elegant longhand, pencil, eraser, all just so.
Maybe if my father hadn't just died, I wouldn't have made that connection. But then and there, it seemed inescapable. And the more I listened, the more I realized that France was talking about things that I had been thinking about as well. What is a child's obligation to his parent? I took my father's presence for granted for as long as he was alive. And when he died, the first shocking realization was that I had to find a way to keep him alive in my heart, to honor his memory. How do we do that?
not by honoring our parents' beliefs. We are different people than they are, born in different eras, shaped by different forces. What we are obliged to honor in our parents is their principles, the rules by which they live their lives. That's what I found so beautiful in Robert France's act. The busy professional, a doctor at one of the most prestigious medical centers in the world,
drove 90 miles each way, four times, to spend hours alone in a cluttered basement looking for a box of tapes that would end up proving that his father was wrong. And why did he do it? Because he understood that in pushing the science forward in defiance of ego and preconception, he was upholding the principles by which his father had lived. There is something impossibly beautiful about that act. In my grief, it has given me solace.
Revisionist History is produced by Mia Lobel and Jacob Smith with Camille Baptista, Stephanie Daniel, and Xiomara Martinez-White. Our editor is Julia Barton. Flan Williams is our engineer. Original music by Luis Guerra. Special thanks to Andy Bowers and Jacob Weisberg at Panoply. I'm Malcolm Gladwell.
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