H.J. Roberts published a book in 1990, called

The unscientific nature of the allegations made in this book prompted Dr Arturo Rolla of Harvard Medical School to write to the New England Journal of Medicine drawing attention to the irresponsibility of Hyram Roberts' publications.

The author, an internist from West Palm Beach, Florida, became suspicious that many of his patients' symptoms were caused by aspartame. He prepared a questionnaire for his patients that was later given to persons across the country who thought they were having reactions to this sugar substitute.

Headache, dizziness, fatigue, memory loss, mood swings, changes in vision, nausea, diarrhoea, unexplained pains, sleep and personality disorders, and the like are non-specific and very common complaints among persons consulting a physician. When frequent symptoms are matched with the use of a widely consumed product, it is very likely that a chance association will appear. For comparison, the same questionnaire should have been given to a control group not taking aspartame and to another group taking aspartame but without apparent complaints. Only unbiased comparisons of these groups would shed some light on the question of safety.

The author then asked patients who were already convinced that aspartame was the cause of their symptoms to stop using it. The results are predictably biased, because of the counterplacebo effect, but he presents them as scientific evidence. He writes that he is aware of "suggestibility" and "self-serving sensationalism". Nevertheless, he published this book for the general public, full of personal anecdotes of "severe" and "dramatic" reactions, along with the frequent diagnosis of "reactive hypoglycaemia," causing "full blown convulsions," "precipitating migraine headaches," and "narcolepsy".

Dr Roberts did not apply a rigid scientific method to test his hypothesis, but presents it as a fact to the general public without previous scrutiny by his peers. He quotes the Wall Street Journal and other newspapers as often as the scientific press. By the time he raises the question of a connection between aspartame and Alzheimer's disease, his credibility will be questioned even by lay readers. Roberts presents and then criticizes the way the Food and Drug Administration approved aspartame as a food additive, not as a drug. Some of his points are valid. The system, like democracy, is not perfect, but it is the best we have. The author positions himself as a lone crusader fighting industry, government, and the medical establishment ("organisations and individuals having vested interests").

This type of book raises many questions for the medical community. Is it right for a physician with a hypothesis to write a book this nature without first seeking scientific proof and presenting the data to a medical journal or society? I appreciate the concern and effort of the author, but my reaction to his book is as negative as it is strong. There is no place for a publication such as this one. It only adds to public misinformation, confusion and mistrust. There are many other medical and scientific avenues available. I hope the author will continue his effort using more rigid scientific methods, in order to be able to present it to his peers. He has a right to write, but he also has a responsibility as a physician. Freedom of the press relies as much on the honesty and responsibility of the writer as on the government that supports it.

ARTURO R ROLLA, M.D.
Harvard Medical School
Boston, MA 02115

Source:
New England Journal of Medicine 323:1495-1496

22 November 1990