Al Sommer on Better Science: Data Versus Beliefs

BALTIMORE - December 2, 2020. Al Sommer is more than a public health legend—he’s a fighter of uphill battles. Perhaps best known for his involvement in saving millions of lives through research on vitamin A supplementation, his greatest feat may have been getting the right people to pay attention to the right research.

For decades before Sommer began his research in the 1970s, scientists and physicians had been trying to address vitamin A deficiency in the developing world, focusing on the problem of blindness. Sommer observed another correlation with vitamin A deficiency: higher mortality from infectious diseases like measles. Addressing the deficiency was complicated, because in resource-poor nations in Asia, most people did not have access to eggs, fish, and other animal products that contain the best sources of vitamin A. The workaround—and accepted wisdom at the time—was that dark, leafy greens could bridge the gap. Greens are rich in beta carotene, a plant pigment that the human body converts into vitamin A.

“The nutritionists all said a cup of leafy greens would cure it,” Sommer says. “And I accepted it.”

Agencies such as UNICEF and the World Health Organization (WHO) had relied on studies showing that the body needs three molecules of beta carotene to create one molecule of vitamin A. But that was in a test tube. Cooked, the conversion rate was more like six to one.

“I bought that standard line,” says Sommer.

He advocated for mixing leafy greens into the rice that children ate—and then he observed how the kids would pick the greens out before eating the rice. That’s when he started to tell people that leafy greens were not a solution.

“We were feeding moms and kids tons of green, leafy vegetables, and nothing changed,” he says.

In 1972 at a WHO meeting, new research was presented indicating that large amounts of green leafy vegetables had little impact on vitamin A status. Sommer thought it the best paper presented. No one else believed the results. According to Sommer, when the findings were presented, “all the nutritionists said rubbish.” Subsequent studies, two decades later, demonstrated that the standard, accepted six to one ratio was more like twenty-four to one. During those two decades, researchers such as Sommer, Saskia De Pee (who had worked with Muhlilal and currently collaborates with the Center for a Livable Future), and Keith West (at the Bloomberg School) presented similar data, while the global community held fast to their beliefs about dark, leafy greens. Finally fed up, Sommer organized an unofficial three-day meeting with a 15-member expert advisory group of people who would emerge from the meeting with evidence-based recommendations.

“I decided that we needed to stop woofing around and face facts,” says Sommer. “We had to stop with all this horticultural stuff. To get enough beta carotene, kids would have to eat a pound of greens every day, and their stomachs simply weren’t big enough.”

After three days, the group emerged with the same old story.

“I went bonkers,” says Sommer. “I said, ‘What the f— are you guys talking about?’ and I told them to go back and re-think their recommendations—after they actually reviewed the data. They completely changed their recommendations.”

In the end, millions of lives were saved because Sommer had finally convinced the agencies to provide vitamin A supplements.

The lessons that Sommer draws from this experience? First, people have their belief systems, and they don’t want to let go of them—and scientists are not in the least immune. Belief systems must be challenged; call people on what doesn’t sound true and isn’t supported by the evidence. Second, when you ask people to draw new conclusions by challenging their belief systems, allow them to own their conclusions. Let them come up with it themselves. Let them write it in their own words. Let them make recommendations, and encourage them to submit them to scientific journals if they can. And third, keep doing good research. “There are so many crappy studies,” says Sommer. “We have to  call these out and keep people honest.”

These days, two of the issues Sommer feels most strongly about are climate change and industrial food animal production, or IFAP. But, he admits, these issues are so much thornier than, say, vitamin A deficiency. It’s not possible to do randomized, clinical trials to determine causes and effects of climate change, or adverse health outcomes from IFAP. Even though we’re living through climate change and have seen the effects in our lifetimes, there’s a belief system—tribal in nature, he says—that puts up powerful resistance to taking action.

The same goes for IFAP. While there’s plenty of evidence about how conventional livestock production methods harm rural communities, farmworker health, ecosystems, and the animals themselves, the resistance to change is powerful.

“The problem is that you have so many [financial] interests,” says Sommer. “You have people who like to eat burgers, people who make money serving them, people who make money raising livestock.”

He tells the story of what he calls “before-CLF days,” when he was working with Center for a Livable Future co-founder Bob Lawrence on the issue of meat production and consumption. He, Lawrence and other colleagues brought together a group of executives from fast-food chains such as McDonald’s and Burger King, and told them, “You guys ought to be selling apples and salads.”  The response they got was that if they could make money selling apples, they would. But they had tried selling apples and salads, and nobody was buying them.

“Vitamin A was easy. There were not a lot of vested interests there,” says Sommer. “There’s no money in green, leafy vegetables. But nothing will beat that guy at McDonalds.”

Businesses will always protect their profits, he says, and he told me the CEO of a major grain company has been buying up land in Saskatchewan, Canada, like it’s going out of style. They know they won’t be able to grow grain in the Midwest in twenty-five years, he says. The company’s climatologists are more beholden to the bottom line than to a belief system.

Considering what we’re up against, I asked him what he thinks is our best bet for reforming the food system and addressing climate change. He says we could try legal maneuvers, creating policies and laws to implement change—“But good luck on that one, getting Republicans and Democrats to agree on anything.”

Legislators are moved by what the public wants, says Sommer. Pressure must come from the public. “The public might make it clear to legislators what they want,” he says, “and the Koch brothers may still invest so much money that they overrule the public’s will.” (David Koch died last year; his brother Charles Koch is the eleventh-richest person in the world.) But we have to keep trying to convince the public with massive education campaigns and simple messages tailored to specific populations. He gives an example: to communities on the Gulf Coast, talk about hurricanes. In other communities, focus on other issues, the ones that most affect them. Keep it local, and keep it relevant.

Communication and context is everything, he says. He points to the Center for a Livable Future as a good model, noting that the Center was partly the brainchild of “a marketing guy,” Sid Lerner. The Center currently collaborates with Saskia De Pee, who has already authored several papers with director Martin Bloem and other CLF colleagues. Their connections to the vitamin A story as it unfolded in Indonesia, and around the world, are a valuable context for their current work on sustainable diets.

Also, according to Sommer, in addition to creating momentum through expanding awareness, we must offer alternatives for people who feel financially threatened by change—if we don’t, the battle may not be one we can win. And we need larger coalitions that take in more points of view, even if we disagree with some of them.

“We need bigger tents,” he says, “more tribes.”

For more perspective on food systems, read the CLF Global Thought Leaders Series.

Illustration by Mike Milli, 2020.