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| Michael Blanding | https://news.colgate.edu/magazine/2019/02/06/the-strange-case-of-dr-ho-man-kwok/ | August 1, 2023 | 5 | Media/articles/images/MSG-OpenerFinal11-copy.jpg |
The Strange Case of Dr. Ho Man Kwok | Colgate Magazine
#medical #food #history
Illustrations by James Steinberg
A medical hoax leads to a 50-year mistruth about MSG and an unexpected Colgate connection.
Since the initial reporting of this story, information has come to light calling into question Howard Steel’s role in the MSG controversy. For more on this fascinating story, listen to This American Life episode 668.
The letter was just a few paragraphs long. Published in the New England Journal of Medicine (NEJM) under the heading “Chinese-Restaurant Syndrome,” it began: “For several years since I have been in this country, I have experienced a strange syndrome whenever I have eaten out in a Chinese restaurant.” It went on to describe symptoms including “numbness in the back of the neck, gradually radiating to both arms and the back, general weakness, and palpitation.”
For the next couple of paragraphs, the writer speculated on the cause of his ailments, suggesting that perhaps it was due to the food’s high sodium content or some ingredient in soy sauce or cooking wine. “Others have suggested,” he continued, “that it may be caused by the monosodium glutamate used to a great extent for seasoning in Chinese restaurants.” The letter ended with an appeal to other doctors to conduct more research and was signed “Robert Ho Man Kwok, MD, Senior Research Investigator, National Biomedical Research Foundation, Silver Spring, Md.”
Professor Jennifer LeMesurier first heard about the letter in 2013, when she and her husband were watching an episode of the PBS show The Mind of a Chef with David Chang, featuring Japanese ramen noodles. LeMesurier perked up when a guest mentioned the controversy over monosodium glutamate (MSG), a food additive in Asian cuisine that has long had a harmful reputation. Not true, the guest said, MSG was perfectly safe — and, in fact, the whole controversy had started with one letter to the NEJM back in the 1960s that bogusly claimed MSG caused illness.
“It was a throwaway line,” remembers LeMesurier, an assistant professor of writing and rhetoric at Colgate. Yet, it made her curious. Could a decades-long food controversy really have started with one letter? Then a graduate student at the University of Washington, LeMesurier went to the medical library the next day where, sure enough, she found the missive in an old issue of NEJM from April 4, 1968. Wondering if there had ever been any response, she began to pull subsequent issues of the journal and found a cascade of other letters that either detailed their writers’ own unfortunate run-ins with Chinese food, or ridiculed the whole idea. Both types of letters had one thing in common, however — a disturbing undercurrent of racism that seemed to blame the unsavoriness of Chinese food rather than the chemical itself for its supposed effects. “You would expect doctors to be very clinical, but this quickly veered into ethnic name-calling,” LeMesurier said.
She published her findings last February in a paper titled, “Uptaking Race: Genre, MSG, and Chinese Dinner,” in Poroi: An Interdisciplinary Journal of Rhetorical Analysis and Invention. In it, LeMesurier argues that the racist distrust of MSG snowballed through the media to create a hysteria over the additive that has continued to the present day. In detailing the outsized effects that letter has had, though, she never doubted its authenticity — until a few months later.
In January 2018, LeMesurier was shocked when she listened to a voicemail message. The caller identified himself as Dr. Howard Steel ’42, a Colgate alumnus and former trustee. “Boy, have I got a surprise for you,” he said. “I am Dr. Ho Man Kwok.”
A Fateful Wager
It started out as a bet. In 1968, Steel was a young orthopedic surgeon at Shriner’s Hospital and a professor at Temple University in Philadelphia. Another doctor, Bill Hanson, used to rib Steel about his specialty, saying orthopedic surgeons were too stupid to get published in a prestigious journal such as the NEJM. In fact, he bet Steel $10 he couldn’t make it into its pages. “That was a threat, and he was willing to make a buck,” said Steel in an interview earlier this year, before he passed away in September at the age of 97.
At the time, Steel and Hanson used to go to a Chinese restaurant called Jack Louie once a week, drinking too much beer and overeating — invariably feeling sick afterward. Following one of those episodes, Steel had a fit of inspiration. “I decided, well, I’ll write a little article and send it to the New England Journal of Medicine,” Steel said. “I’ll make it so obvious, they will know immediately [that it’s fake].” After penning the notorious letter, he signed it Robert Ho Man Kwok, which he thought would be an obvious play on words.
“It was a breakdown of a not-nice word we used when someone was a jerk,” Steel said. “We called them a human crock of you-know-what.” If anyone needed further proof that the letter was a spoof, he also made up a fake medical institution, the National Biomedical Research Foundation of Silver Spring, Md. “It doesn’t exist.”
A few weeks later, when the letter was actually published under the title “Chinese-Restaurant Syndrome,” Steel was pleased with himself and promptly went to Hanson to pay up. Lest anyone think the phenomenon was real, Steel contacted the letters editor to tell him it was “a big fat lie,” he said. When he didn’t hear back, Steel called the journal’s editor, Franz Ingelfinger. “I told him it was a bunch of junk, it was all fake, it was all made up, and he hung up the phone on me,” Steel claimed. The brush-off was even more surprising, considering he knew Ingelfinger from his boyhood in Atlantic City (see “A Charmed Life”).
As LeMesurier researched the journal, she discovered that NEJM actually had a long tradition of such “comic syndrome letters.”
After the NEJM published his letter, Steel watched with a mix of humor and horror as the MSG controversy unfolded, with dozens more letters to the editor responding to his original. He persisted in calling the publication’s office, leaving messages for Ingelfinger without response. A current spokesperson for the NEJM can’t confirm whether or not the publication considered pulling the letter. “Due to the fact that it was published 50 years ago … we can’t comment or speculate on its publication, or the purported refusal at the time to retract it,” responded Julia Agresto, a media relations and communications specialist, via e-mail. Today, she said, letters are peer reviewed on a “case-by-case basis,” but she does not know if Steel’s letter was peer reviewed. “However, we would imagine that it was not,” she wrote.
Years later, as LeMesurier read all of the MSG letters, she tried to parse their subtle mix of earnestness and dry humor. One of them, published May 16, 1968, by H. Schaumburg of Albert Einstein College, claimed that he, too, “on three occasions experienced a tightening of my masseter and temporalis muscles, lacrimation, periorbital fasciculation, numbness of the neck and hands, palpitation, and syncope” within 20 minutes of eating Chinese food. The overly scientific phraseology (lacrimation means crying) is the first clue that Schaumburg may have been writing with tongue in cheek, and LeMesurier’s suspicions only grew when she read that he and his companions had “consumed twenty-four ounces of beer” before one episode, and that he would be “delighted to submit a grant, perhaps a career development award, to the National Institutes of Health for an intensive study (with foreign travel funds) of this problem.”
As LeMesurier researched the journal, she discovered that NEJM actually had a long tradition of such “comic syndrome letters,” as one observer called them: missives that used pretentious medical language to poke fun at a common problem. One letter, for example, decried the “cryogenic cephalagia” — otherwise known as “brain freeze” — that accompanied drinking slushies. The letters about Chinese-restaurant syndrome, however, seemed different. Rather than focus in on the symptoms of the supposed ailment, they increasingly focused on the fact that it was associated with Chinese food — with some writers apparently “in on the joke” while others weren’t.
The Truth about MSG
MSG is a naturally occurring food substance, with a distinctive savory taste known by Japanese as umami. “It’s a chemical the same way water is a chemical,” said LeMesurier, who is herself of Korean descent, raised by white parents. “If you have ever eaten aged cheese or heirloom tomatoes, you’ve eaten MSG.” Its powdered form was created in 1908 by a chemist in Japan, and it made its way with Chinese immigrants to the United States, where it was commonly added to dishes in Chinese restaurants.
Despite the fact that MSG appears in everything from flavored potato chips to Parmesan cheese, the letter writers universally described experiencing symptoms after eating foods such as “egg foo yung” or “duck sauce.” One writer described what he called his “Chinese headache.” Another detailed aching in the arms after eating egg rolls. A definitive note from the NEJM editor even targeted one specific Boston restaurant, Yee Hong Guey, for its adverse effects and coined the mock-scientific term post-cibal-sinal (roughly “after eating Chinese”) syndrome as an official name for the ailment.
Although LeMesurier doesn’t think the writers were being overtly racist, she believes they were picking up on larger stereotypes in the culture of Asian Americans as exotic and strange. “They had a supposed subject, the Chinese-Restaurant syndrome, but the focus was really on Chinese identity and getting in digs about these stereotypically Chinese foods,” she said. “They used Kwok and MSG as figureheads for everything that was silly and frivolous and dangerous about Chinese identity.”
In that, they joined a long tradition of exoticism and mistrust of Chinese food, LeMesurier found. Since Chinese immigrants first appeared in America en masse in the mid-1800s, media has been ridiculing their food. A 19th-century cartoon depicts Chinese people eating rats, and many writers of the period similarly describe Chinese food as dirty or unclean — including Mark Twain, who refers to a Chinese grocer selling a “mess of birds’-nests” and sausages each containing “the corpse of a mouse.” The NEJM letter writers picked up on these tropes, with one writer choosing the exotic bird’s-nest soup as a stand-in for all Chinese food and another referencing Chinese foods in a doggerel poem as a “vile miasma.”
Although LeMesurier doesn’t think the writers were being overtly racist, she believes they were picking up on larger stereotypes in the culture of Asian Americans as exotic and strange.
Ironically, while LeMesurier was researching her paper, she came across a reference to a real Dr. Robert Ho Man Kwok, who died in 2014, and she logically assumed he was the original letter writer. Many of the NEJM letter writers at the time, however, made the same joke as Steel, playing on the word Kwok with “crock” — though it’s unclear whether they suspected the name was real or a pseudonym. The one letter that got closest to Steel’s ruse commented: “For certainly he is Dr. Human Crock, and his ‘Chinese-restaurant syndrome’ is totally illusory and nonexistent.”
However self-aware the letter writers were, the joke was totally lost on the mainstream media, which picked up the story almost immediately. A New York Times article from May 19, 1968 — six weeks after Steel’s letter — took Chinese-restaurant syndrome at face value, noting that it had been first identified by “a Cantonese doctor named Robert Ho Man Kwok,” who had come to the United States “eight years ago.” How the Times had gotten specific information about this doctor who didn’t exist is anyone’s guess. Like the NEJM letter writers, the paper ignored MSG’s larger prevalence in food to focus squarely on Chinese cooking as the culprit for MSG’s ill effects, even interviewing Chinese restaurant owners around New York to defend their cuisine.
A Cautionary Tale
From a made-up malady to “comic syndrome,” now problems with MSG had become a nationally recognized ailment. “The New York Times and other national newspapers gave legitimacy to a lot of the stereotypes around Chinese cooking,” said Ian Mosby, a historian from York University in Toronto, who wrote a paper in The Social History of Medicine in 2009 examining Chinese-restaurant syndrome.
That journalistic misunderstanding is unfortunate, but hardly surprising, said Jeff Bary, a Colgate astrophysics professor who teaches the course, “Saving the Appearances: Galileo, the Church, and the Scientific Endeavor,” about how prejudice in culture influences the way we talk about science. “It represents a lack of scientific literacy on the part of people in the media, not to be savvy enough to know the difference between a letter submitted like this and a true scientific study,” he said. At the same time, he added, cultural forces can predispose journalists and readers alike to believe in science that wasn’t necessarily true. “On the face of it, it’s pointing to racism in the culture that they are so willing to accept this negative perception of another culture’s food,” Bary said. “It’s a narrative that fits into a particular worldview.”
Ironically, however, once the media established that worldview, doctors then set about to prove it, coming full circle from treating Chinese-restaurant syndrome like a joke to studying it as a real phenomenon. In fact, the same letter writer who kidded about receiving “foreign travel funds” to investigate the syndrome, pharmacologist Herbert Schaumburg, conducted the first actual experiments exposing subjects to MSG. Along with his colleague, neurologist Robert Byck, he gave MSG intravenously to 13 people and orally to another 56, recording symptoms including burning, facial pressure, chest pain, and headache. Publishing their findings in Science in February 1969, they concluded from this scant evidence that “Chinese-restaurant syndrome” was real. Other scientists followed with more studies, including some that injected large amounts of MSG into mice and monkeys, alleging long-term effects.
None of them could explain why a chemical that had always been in such common use was suddenly spawning such extreme reactions. “It would be safe to say that the studies were pretty poorly done,” Mosby said. “There were almost no double-blind studies.” In fact, other studies began appearing as soon as 1970, taking issue with the methods of Byck, Schaumburg, and other researchers. By then, however, Chinese-restaurant syndrome had caught on in the culture, and the general public began warily checking labels in an effort to cut MSG from their diets. Consumer advocate Ralph Nader even lobbied Congress to ban its use in baby food.
More recently, studies have roundly debunked the idea that MSG is harmful. Multiple studies using placebos have shown no difference in effects on people eating food with or without MSG. In 1995, the Food and Drug Administration asked an independent scientific group, the Federation of American Societies for Experimental Biology, to study MSG’s safety. It found that only a small number of people experienced any side effects, and that was only after consuming six times the normal serving of MSG on an empty stomach.
Contacted at Albert Einstein College of Medicine, Schaumburg stands by his research. “We don’t think this stuff is harmful, but it definitely has a pharmacological effect,” he said. “If you take it intravenously, everyone is going to have incredibly distressing symptoms.” Most people, Schaumburg continued, don’t have any consequences from MSG when they eat it because they don’t absorb it. A small number of people who absorb it more readily could have effects if they eat food with MSG on an empty stomach, “like wonton soup as an appetizer,” he said. Schaumburg took issue with the implication in LeMesurier’s paper that there was any kind of racism involved in how MSG is perceived.
“It’s a narrative that fits into a particular worldview.” — Professor Jeff Bary
No matter how many articles appear exposing the fallacy of Chinese-restaurant syndrome, prejudice against MSG persists. According to a survey by the International Food Information Council, an industry-funded nonprofit, 42 percent of the population still actively avoids MSG. That’s slightly less than the percentage who avoid artificial flavors and colors, but more than those who avoid caffeine, GMOs, or gluten. Major snack food brands such as Frito-Lay and Utz have apologetically posted information pages about the substance on their website and prominently display to consumers which of its products do and don’t contain MSG. Meanwhile, reviewers of Chinese restaurants on Yelp still complain about hearts racing and limbs tingling after eating.
For LeMesurier, the story of MSG is a cautionary tale of how a simple prejudice can seep its way into a culture, even from scientists who should know better. “A lot of times people get into medicine because they want to fix things, but sometimes the fixing becomes the goal rather than dealing with what is really going on in a situation,” she said. “Medical students need to understand the ethics of writing, especially when representing a culture or a person and talking about sensitive things.” When Steel contacted her soon after her paper came out, it only solidified her feelings. “In a weird way, it shows the power of these narratives, that this wasn’t based on any facts at all,” she said.
Steel maintained that his letter wasn’t intended to be racist, and — insisted that he never caused any real harm with the controversy he helped launch. “Everyone is eating Chinese food anyway,” he said. In that claim, at least, he is right. According to a recent survey by food research firm Technomic, Chinese is the most popular ethnic cuisine in America, just edging out Mexican and Italian. Even so, Steel was earnestly apologetic about the trouble he caused with his fake letter. “I wish I had never written the damn thing,” he said. Lest anyone think that he somehow profited from the mishap, however, he was quick to add that his erstwhile colleague Dr. Hanson never made good on their wager. “I never got the 10 bucks,” Steel said. “Bill never paid me a dime.”
Howard Steel ’42
A Charmed Life
As improbable as the MSG controversy sounds, it was just one event in a life that reads like a page torn out of David Copperfield or Forrest Gump. Howard Steel’s family started Steel’s Fudge on the Atlantic City Boardwalk, which still doles out fudge and salt water taffy to sunburned beachgoers today. Sadly, both of Steel’s parents died of separate diseases before he turned 5, leaving him an orphan in the care of an aunt, with an allowance from the bank. He excelled in both football and academics, earning acceptance to Harvard, Yale, Columbia, and Princeton — but the bank told him the schools were too expensive.
His high school English teacher, who was a Colgate alumnus, offered to drive him up to see the campus. When Steel spoke with the dean, the dean offered him admission along with a football scholarship on the spot, Steel remembered. He fell in love with the University, where he majored in physics and chemistry, and served as president of Theta Chi as well as president of his class.
Listening to a radio report about the deepening conflict of World War II, on Dec. 6, 1941, Steel enlisted in the Navy and convinced his fraternity brothers to join, too. The next day, Japan bombed Pearl Harbor. But Steel never saw combat. While in boot camp, another soldier accidentally shot in his direction, whizzing past his head and taking off part of Steel’s ear. The Navy gave him a Purple Heart, and then took it away when it realized he hadn’t been shot in combat.
After his service, Steel drifted down to Philadelphia, graduating with a medical degree from Temple University in an accelerated program of only two and a half years. He took up a residency at Temple University Hospital, and eventually was appointed chief of staff at Shriners in 1966, just before his fateful letter to the NEJM.
Steel went on to have a distinguished career as a surgeon, founding the first pediatric spinal injury center at Shriners and pioneering new surgical techniques. Some of his grateful patients pooled together their money to create a foundation in his name with more than a million dollars, which supports lecture series at orthopedic associations around the world.
For those who worked with him, Steel’s joie de vivre left an indelible mark. In a 2012 video made about his legacy, colleagues called him “magnetic,” “charismatic,” and a “legend in the operating room.” During lectures to medical students, he would play The Beatles. And when he walked the halls, the toys and lollipops he had for his pediatric patients would be falling out of his white coat pockets. “Happiness should never be allowed to escape from the practice of medicine,” he said.
Steel, a Colgate trustee emeritus, died Sept. 5, 2018. He is survived by his wife, Elizabeth; five children, including Anna ’91; three stepchildren, Turner Cary Smith ’77, Celia Smith Carroll ’76, and Townsend Cary Smith ’81; son-in-law Brian Carroll ’76; 11 grandchildren; and two great-granddaughters.