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..man, proud man, Dress’d in a little brief authority, Most ignorant of what he’s most assur’d… From Measure for Measure by Wm Shakespeare The web has been alive with commentary the past few weeks since Denise Minger lobbed her first cannonball of a critique across the bow of The China Study, the vessel T. Colin Campbell, Ph.D. rode to fame and bestsellerdom. Seems like everyone is now jumping into the fray and gunning for poor Dr. Campbell, who early on in the fracas made a few halfhearted attempts to fight back but has now fled the scene. I’ve been laying low watching it all play out, and so now figured it’s about time I add my two cents worth to the debate. But first a little history. I met Dr. Campbell about ten years ago (five or so years before the publication of the popular book The China Study) when we both spoke at the same conference. He was a nice enough man who spoke about the work he and his team had done in China gathering the data published in the massive 894 page monograph Diet, Life-style and Mortality in China (pictured above left). As Dr. Campbell presented his data ‘demonstrating’ the superiority of a plant-based diet and demonizing protein of animal origin, I didn’t think much about it because the data was all in the form of observational studies, which, as all readers of this blog should know by now, despite often showing correlation don’t prove causation. My lecture, which followed Dr. Campbell’s, was, as you might imagine, a lecture of a different sort. Then we both sat on a panel after our talks and fielded questions. And were both cordial to one another. A few years ago, I became vaguely aware that Dr. Campbell had written a popular book on his work in China titled, appropriately enough, The China Study. I assumed it pretty much mirrored his presentation I had watched, so didn’t rush out and grab a copy. Over the past few years a number of people have asked about The China Study through the comments section of this blog, and I’ve typically answered that the data are all observational and so not really meaningful in terms of causation. (Note: Throughout this post whenever I refer to the popular book Dr. Campbell wrote, I’ll call it by it’s title The China Study, and when I refer to the large study Dr. Campbell was involved with in China and was the basis for the monograph Diet, Life-style and Mortality in China, I’ll call it the China study.) About a year ago, I wrote a guest post for Tim Ferriss’s The Four Hour Workweek blog. It actually wasn’t a guest post as much as it was an excerpt of a chapter from our book The Six-Week Cure for the Middle-aged Middle extolling the virtues of saturated fat. It was a popular post that has garnered to date 520 plus comments, many of them fairly spirited. I agreed to answer a number of the comments and did so. I noticed as I sifted through them that a handful were absolutely fawning of Dr. Campbell and The China Study. Here is a sampling: The number one study of diet and disease is the China Study. All other data points are slivers compared to the volume of data and statistical correlations that came from the China Study.
that most of the data was available online for free. This study was a massive undertaking. it was in a large format. I pulled up his book on Amazon and read through a few comments. As I was awaiting its arrival I told Gary Taubes what I had done. After reading a number of these. I’ll take a look at the ‘real’ China study (as opposed to the popular book of that name) and do one too. the first 82 are a study overview.Have you read The China Study? Dr. No one can possibly accuse the team members of not giving it their all. is a translation of the English half). I tracked down a copy of the 894 page book in a bookstore in the UK and forked over $240 to purchase it and have it shipped. It wasn’t at all what I thought it would be. Page after page after page of correlations. what the hell. Half knowledge is a scary thing in the hands of influential people. Campbell points out repeatedly that none of the weight loss studies such as Atkins or South Beach diet follow any type of peer reviewed scientific method. most of which were even more nauseatingly gushing than the above. requiring thousands upon thousands of man hours and God only knows how much money. and he replied that he had done the same thing himself a few years earlier. Campbell had going on that had attracted such devotees. I ordered a copy of The China Study. even worse. Tim…and to think I was such a big fan of yours. And I’ll critique the popular book. I was amazed at the size of it. I knew that both Anthony Colpo and Chris Masterjohn had done their own critiques of the original data. Not only was it the 894 pages as advertised. It was pretty apparent that the disease of non-critical thinking was at epidemic proportions. Check out researchers that actually meant to study nutrition–like Dr. I don’t doubt him. Much larger than a volume of the Enclyclopaedia Britannica. I didn’t bother counting them. And that I could have borrowed his. When the book arrived. Campbell says there are 367 variables. . And. description of methodology and author commentary. The remainder of the 894 pages are raw data and correlations. Maybe it’s another genius marketing ploy (like the myth riddled protein Atkin’s diet)–people love to feel good about their personal yet poor decision making–and diet is very personal. so I figured. but Dr. each of which is compared with every other variable. presumably. Here are a couple of photographs shamelessly using our own book to show the size of this behemoth Of the 894 pages. I decided I had better take a look to see what Dr. This is by far the weakest (and least cited) argument I have ever read on diet–especially increasing saturated fats. It is written in the form of a scientific paper with half the page in English and half in Chinese (which. which I figured was a rehash of the China project. T. while I’m at it. Colin Campbell’s The China Study comes to mind.
I stuck my copy of the $240 book of correlations in my library and forgot about it. correlations are not causation. Lock them down as Ancel Keys did if they had to. Upon reading her blog post. Campbell – there are over 8000 statistically significant correlations. Campbell’s own colleagues abandoned him to this study and told him it would be worthless. full of sound and fury. But in the end it is still only an observational study. More about this later. correlation is not causation. It doesn’t really matter whether he interprets them correctly or not. Any scientist worth his/her salt will tell you that all you can do with data from observational studies is use them to form hypotheses that can be rigorously tested in randomized. they are only correlations. Then and only then (assuming the study results show it) can you even begin to talk about causation. Even some of Dr. Why not randomize subjects into two groups and provide one a plant-based diet and the other a meat-based diet or something similar. And even though – again. correlation is not causation… I wondered why Dr. Repeat after me one last time: Correlation is not causation. Once I saw that the original China study was nothing but a huge number of correlations. Surely the money spent on the China study could’ve covered that.Here is one page of correlations. Campbell and his group didn’t spend a fraction of the time and money they spent on this behemoth of a spreadsheet full of correlations on a real study that could provide hard evidence. according to Dr. Campbell interpreted them correctly when he tries to make his case that a plant-based diet is optimal. was described perfectly by Shakespeare in the words of MacBeth: …it is a tale Told by an idiot. So enough for me. my first reaction was This is great. Get some real data. The whole enterprise. costly and time consuming though it was. I quickly lost interest. Until Denise Minger’s critique hit the net. controlled trials. someone took the time to do what I was . Signifying nothing. I discovered later that I wasn’t the only one who wondered that. This one between stearic acid and all the other variables studied. What is the point in going through the brain damage of ferreting around in these to see if Dr.
giving the impression that I had at least minimally checked it out and had approved it. And this from the man’s own pen.going to do. No. Which was that I had fallen victim to the confirmation bias. Campbell had his interpretations right was tantamount to the medieval theological argument over how many angels could stand on the head of a pin. my confirmation bias ensured that I accepted it at face value. Campbell wrote: But she suffers one major flaw that seeps into her entire analysis by focusing on the selection of univariate correlations to make her arguments (univariate correlations in a study like this means. And my participation certainly wasn’t required. Campbell’s notions of the superiority of the plant-based diet. I figured Dr. and I had seen Colpo and Masterjohn catch him on it. Campbell is dead wrong in his ideas about the superiority of a plantbased diet.) After this went on for a while. (It didn’t really make me feel better to know I wasn’t alone in falling into the confirmation bias quicksand. I had tweeted and retweeted Ms. I doubt that all these people checked Ms. In other words. . Colin Campbell himself. I became suffused with angst. I continued to read with mounting glee Ms Minger’s successive critiques and a few other bloggers who had critiques of their own. because I felt I needed to go through all the calculations myself to make sure Ms.) My angst wasn’t because I had possibly fed the flames of a misinformation wildfire – I wasn’t particularly worried about that because mountains of other data (including first hand data from my own clinical practice) have persuaded me that Dr. my angst arose for two other reasons: first. Minger’s analysis a number of times. comparing 2 variables–like dietary fat and breast cancer–within a very large database where there will undoubtedly be many factors that could incorrectly negate or enhance a possible correlation). In it. so I was more than happy to uncritically accept evidence confirming his error without lifting a finger to double check said evidence myself. I didn’t realize that salvation was at hand. as such. Dr. his first response to Denise Minger’s critique of his work appeared on the Tynan. T. All this falderal over whether or not Dr.net website and rescued me from my pit of self-loathing. I would’ve been all over it looking for analytical errors. Minger went even further and really caught Dr. for example. Campbell had cherry picked his correlations to make the case he wanted to make. Take a look at this post from Richard Nikoley’s Free the Animal blog. it doesn’t really matter how one slices and dices the data because meaningless correlations by any other names are still just as meaningless. And that my savior was none other than Dr. there is no dearth of material here for people to attack without any two attacking the same data twice. Once the fact that I had succumbed to my confirmation bias settled in around me. I’m sure. Ms. Campbell with his pants down. had forwarded it on. I had my second reaction to the whole affair. (Believe me. and. Yep. correlation-misinterpretation speaking. Minger and others whose work I had circulated were truly correct in their analyses. the China study is an observational study comparing one variable to another (univariate correlations) and. She acknowledges this problem in several places but still turns around and displays data sets of univariate correlations. But since Ms. As I was wallowing in self pity over all this. Campbell was wrong. because I was distressed that I so easily fell prey to the confirmation bias. My bias was that Dr. Minger’s work accorded with my own beliefs. second. Since these observational studies are meaningless in terms of causality. I’m sure I played a fairly large role in the rapid dissemination of the anti Campbell/China study info. many of whom. Minger’s calculations before posting. I had emailed it to a number of people. meaningless. I knew that if a blogger somewhere had come out with a long post describing an analysis of the China study demonstrating the validity of all of Dr.
Minger’s critique. but somehow had lost my focus on it. leaving me to conclude that the rest must be about something else. It is obfuscatory in so many ways it could truly qualify as a work of obfuscatory genius. he said: One further flaw…is her assumption that it was the China project itself. Now he says that only one chapter is about the China study. But we knew enough about these stages of cancer to be able to structure our research more intelligently. Only one chapter? As I mentioned above. it’s an obfuscation.I’d known this all before. and others like her. Campbell’s tale of the China study and the conclusions he had drawn from it. which I hadn’t yet taken from the pack it came in from Amazon. It . almost standing alone. In Chapter 3 titled Turning Off Cancer. He mysteriously refers to the Archives of Pathology as an obscure journal when it is anything but. Here is his setup paragraph starting on page 50: At the start of our research. Writing of her. one that is in no way atypical. of course. Campbell made in his response to Ms. opened it and started reading. we went about our experimental studies meticulously and in depth in order to obtain results that would withstand the harshest of scrutiny. He has described the three stages of cancer – initiation.** I feel much the same way about The China Study. I was ready to wash my hands of the whole affair when I came across another statement Dr. Dr. that determined my conclusions for the book (it was only one chapter!). why does protein affect the cancer process? What are the mechanisms. ambiguity. Except it’s not really a lie. I found the book. and show you what I mean. Campbell wrote about 14 pages earlier in the book. Campbell is starting to hit his stride in his anti animal protein jihad. Wow! In 1976 author Mary McCarthy famously said live on the Dick Cavett show of her rival Lillian Hellman: Every word she writes is a lie. The “findings from India that a low-protein diet represses tumor formation” were the results of a rodent study published in the Archives of Pathology in 1968 that Dr. ignore much of the rest of the book. It would be difficult for a mere mortal to pen so much confusion. including ‘and’ and ‘the’. distortion and misunderstanding in what is basically a book-length argument for a personal opinion masquerading as hard science. that is. We had no shortage of questions. Let me take just one tiny section of the book. the stages of cancer formation were known only in vague outline. in my studied opinion. In fact. She. I always figured The China Study was simply Dr. Could we confirm the findings from India that a low-protein diet represses tumor formation? More importantly. promotion and progression – and is setting the stage for his description of his laboratory work implicating animal protein in all three stages. The China Study is a masterpiece of obfuscation. how does protein work? With plenty of questions to be answered.
the answer was clear (Chart 3. After a series of experiments. But the notion of the paper initiating his quest being discovered by Dr. As Dr. other grains and even hay. Campbell in an “obscure medical journal” fosters the impression of him as a leave-no-stone-unturned kind of guy. It is an extraordinary transformation substance. Let’s deconstruct. but did so very quickly. These four little paragraphs and accompanying chart take up less than a page in space. especially II. Paradoxically this enzyme both detoxifies and activates aflatoxin. he does ultimately tell the reader he is talking about rat studies and not human studies. Reread them to see if they indicate anywhere that the author is talking about rat studies. The study from India showed that rats given aflatoxin along with a high-protein diet got liver cancer while rats given the same amount of aflatoxin while consuming a low-protein diet didn’t. It is converted in the liver to a much more toxic compound and is often used in laboratory experiments with animals to induce cancer and other problems.was published then by the American Medical Association and still is today under the new name Archives of Pathology & Laboratory Medicine. [III] We initially determined whether the amount of protein that we eat could change this enzyme activity. and are tiny glittering gems of obfuscation. [IV] Decreasing protein intake like that done in the original research in India (20% to 5%) not only greatly decreased enzyme activity. Campbell progresses through this chapter. Moving on.2). we hypothesized that the protein we consume alters tumor growth by changing how aflatoxin is detoxified by enzymes present in the liver. That’s almost the implication. Enzyme activity could be easily modified simply be changing the level of protein intake. [II] At the time we started our research. What does this mean? Decreasing enzyme activity via low-protein diets implied that less aflatoxin was being transformed into the dangerous aflatoxin metabolite that had the potential to bind and to mutate DNA. Note how he writes “the protein we consume”? I’m sure many people took these paragraphs to mean that the studies were done on humans. Even the little throw away but incorrect phrase “obscure medical journal” is part of the greater picture of obfuscation that maintains throughout the book. take a look at how subtly these four paragraphs are written. but he doesn’t mention the word rat for another two pages after the above . Aflatoxin is a substance released from a fungus often found in peanuts. corn. First. Campbell has to say about protein and cancer initiation: [I] How does protein intake affect cancer initiation? Our first test was to see whether protein intake affected the enzyme principally responsible for aflatoxin metabolism. the mixed function oxidase (MFO). here is what Dr. friend or foe to the body. This enzyme is very complex because it also metabolizes pharmaceuticals and other chemicals.
the less conversion of the aflatoxin into the really nasty stuff. They are a distinct species separate and apart from humans. making a huge issue of the fact that rats didn’t get cancer after dosing with aflatoxin irrespective of how much plant protein they ate is pretty disingenuous. Most disingenuous of all in the above four paragraphs and chart is the lack of full disclosure in these paragraphs of the very study Chart 3. If you’re worried about cancer – and who isn’t – you’re now starting to look at animal protein a little differently. So. Implication: plant protein protects against cancer. and since they eat it as well. I would bet that most have adapted over the generations to the combination of plant protein and aflatoxin. (1992) Diet and Cancer in Humans and Rodents. The implication: animal protein causes cancer. I found a little disclaimer Dr. in my opinion. He describes experiments showing that rats getting diets high in casein (a milk/animal protein) develop more cancer at the same dose of aflatoxin than do rats getting a lower-casein diet. Grain and hay are common places for growth of the fungus that produces aflatoxin. there wouldn’t be the rodent problem on farms that there is. meaning that the lower the protein intake.2 is made from. The rodents usually used in lab experiments are Sprague-Dawley rats. You can read the last paragraph of the study (highlighted in yellow) below: . Campbell wants. Chart 3. But he hasn’t told you the complete story. By this time it’s probably implanted in the minds of many readers that he’s talking about human studies. Let me explain. Science 255(5041). And think about this. J Nutr. He demonstrates in rat studies that giving the rats a lower protein diet decreases the activity of this enzyme. If this did them in regularly. which they eat. If you were to visit a farm and search for rodents.) and read it. where do you think you would be most likely to find them? In the grain or in the milking area? Like Dr. Since rodents spend most of their days in this stuff (grains). Dr. I ran quick checks on a bunch of the studies referenced in The China Study. Campbell. Rats and mice are in the hay and in the grain. Campbell didn’t bother to mention in The China Study. Campbell claims can initiate the formation of cancer. and inbred strain that has a tendency to develop cancer easily. PH. too. these rats can develop cancer just from a change in diet. Certain enzymes in the liver convert aflatoxin into a more toxic substance that Dr. Same thing happened with soy. You have a helluva time keeping them out of the animal feed. I grew up in a rural area and spent a lot of time on a farm. Jan 10: 141) In fact. When I pulled the study from which this chart was adapted (Mgbodile MUK and Campbell TC. 102: 53-60. (1972) Effect of protein deprivation of male weanling rats on the kinetics of hepatic microsomal enzyme activity. As I’ve written often in these pages. and all checked used Sprague-Dawley rats. Which is what Dr. rodents aren’t just furry little humans.paragraphs. (See Abelson. Campbell then gave his rats diets of varying amounts of plant protein (wheat gluten) and found that they did not get cancer after exposure to aflatoxin irrespective of protein dose.2 above and on page 52 of his book shows this graphically.
eh? He hits the nail on the head. Namely.e. and animal-based foods are not. Protein utilization may be influenced by what is eaten along with the protein. Writes he referring to the China study: We had a study that was unmatched in terms of it’s comprehensiveness. In other experiments corn starch was used instead of sugar and the effect of the protein on the enzyme was diminished. [Italics in the original] So.” Yet the China study “does not prove that diet causes disease. See what I mean about a masterpiece of obfuscation? I could go on and on. the strength and consistency of the majority of the evidence is enough to draw valid conclusions. take a look at a scan of my copy: On page 73 Dr. That caveat certainly didn’t make in into The China Study. but I’ll quit after I give you just a couple more examples. meaning that the protein along with starch did not have nearly the same effect as protein with the sugar.” A quick search of that phrase in the online version of the NY Times reveals that it came from an opinion . We had what the New York Times termed “the Grand Prix of epidemiology.” Say what? Don’t believe me. i. Standing alone. On page 107 of The China Study Dr. whole plant-based foods are beneficial.Nice. “whole plant-based foods are beneficial. Campbell dons the mantle of prestige conferred by one of America’s most august newspapers. Campbell writes: At the end of the day.. and animal-based foods are not. quality and uniqueness. Then one inch below (literally) he writes the following: The China Study was an important milestone in my thinking. Sucrose (table sugar) was eaten along with the protein used in this experiment. Who knows whether or not it’s even the protein that has the effect and not the sugar? It can’t be shown from this study. the China study produces valid conclusions as to causality. it does not prove that diet causes disease.
selenium on breast cancer. Campbell shows in Chart 3.2 appear on. I could go on and on and on. Let’s go back to the bottom of page 52. Before I finish. a kindred spirit to Dr. work together to cause disease. I am not aware that I used either of these words in the book. Campbell responded to Ms. [i.] It’s okay to measure the specific effect of. we found one! That. or mechanism. but it’s not okay to measure multiple nutritional conditions in the same study. One of my colleagues at Cornell. This tiny bit of the book that I’ve chosen to lay bare is truly the tip of the iceberg. I had put forth the idea of investigating how lots of dietary factors. Brody. If that was what we intended to do. a big. Dr. they say. by which protein works to produce its effects [on cancer formation and progression]. Just for grins.e.. who had been involved in the early planning of the China Study. he said he wanted nothing to do with such a “shotgun” approach. when Dr. got quite heated in one of our meetings.2 how protein is involved in stimulating the liver to convert aflatoxin to the toxic product that he implies is involved in cancer initiation. some known but many unknown. vegetarian) in a way that disingenuously suggests that this was my main motive.piece by none other than Jane Brody. Campbell describes it on page 105-106: When we first started this project we encountered significant resistance from some people. then I’ve got to draw this to a close. Thus we had to measure lots of factors. I prefer the broader picture.] An array of largely unspecified factors doesn’t show anything. And speaking of the so-called plant-based diet. Minger’s critique. One final note: she repeatedly uses the ‘V’ words (vegan. say. but I’m sure you get the picture. is almost the dictionary definition of the confirmation bias summed up in one sentence. meaningless observational study] This colleague was expressing a view that was more in line with mainstream scientific thought than with my idea [i. I found a long grocery list of references. I wanted to focus on the science. See plant-based diet When I flipped over to ‘plant-based diet’ on page 414. Here’s what I found on page 417: vegetarianism or veganism.. just one more. not once. Campbell apparently can’t resist obfuscating. we were to learn something quite remarkable.e. I turned to the index of The China Study to see if ‘vegan’ or ‘vegetarian’ were indexed. has written a number of low-fat cookbooks and is a believer in the plant-based diet. He then reports how he wanted to see if animal-based protein was involved in the other phases of the cancer progression cascade. controlled trial that might demonstrate causality would be a better use of the funds. So he and his grad students started to look. Campbell’s own colleagues bailed out from the China study because he recognized it for what it was: a giant observational study that was meaningless. he took her to task for mentioning the words ‘vegan’ and ‘vegetarian’ as it applied to his work. Dr. Campbell. Here is how Dr. So she hardly qualifies as an unbiased commenter. a randomized. for we are investigating the incredible complexities and subtleties of nature . in the hope of identifying important dietary patterns. my friends. [He and like-minded colleagues are correct. not on these ideologies. [They are right. regardless of whether or not they were justified by prior research. Almost every time we searched for a way. the page the paragraphs above and Chart 3. He writes: As time passed. Okay. I want to get back to something I mentioned earlier about how one of Dr. Even in his online response to his opponents.] He and like-minded colleagues think that science is best done when investigating single – mostly known – factors in isolation. a lipophobe of the deepest hue.
” Third. controlled trials.] Absolutely. plant-based diet followers): As you will see in this book. Dr. What happened to the ability to read critically? Has it vanished from the populace? Based on the comments on The China Study on Amazon it would seem so. On page 107 Dr. In my opinion. live patients throughout his career – he wasn’t. Campbell writes the following: . Atkins starting on page 95 that runs for almost three pages. who wrote a vastly more scientific book. to keep your heart healthy and to normalize your blood pressure. Once again. Believing that the entire book is based on the greatest and most important nutritional study ever completed. Does this mean that I think the shotgun approach is the only way to do research? Of course not. there is a mountain of scientific evidence to show that the healthiest diet you can possibly consume is a high-carbohydrate diet. have conducted research and have reported on their findings in professional forums. I would vastly prefer to put my own care in his hands than I would those of Dr. Campbell uses an impassioned written speech to persuade the scientifically untrained that the China study carries vastly more scientific value than it actually does. I could go on and on. You may ask if I took anything of value from my reading of this book? I did. as I mentioned earlier. it’s a large observational study. Bob Atkins and I have had our differences. he writes the following about the deceased diet doctor: There are snake oil salesman. who has never treated a patient in his life. who have formal training. First. like Dr. He has an entire section on Dr.itself… So I say we need more. there really isn’t much of substance in the entire 400 plus page book. sorry. who have no professional research. you’ll at least enjoy coming across some real howlers such as this one believed only by the vegetarian/vegan zealots out there (oh. Dr. it is useful only in developing hypotheses to be tested with randomized. Perhaps it is a testament to the poser of modern marketing savvy that an obese man with heart disease and high blood pressure [here he inserts a citation for an article discussing Dr. Does it provide enough information to inform some practical decision-making? [No.” We need more thought about overall dietary patterns and whole foods. but were he still alive. and there are scientists. [italics in the original] I wonder if Gary Taubes. And as such. After quoting from one of Dr. Do I think that the China Study findings constitute absolute scientific proof? Of course not. Campbell. Campbell. the few sections of The China Study I dissected are just a tiny fraction of the whole. If you don’t want to test your critical reading skills. but an observational study nonetheless. Campbell mentions Protein Power by name on page 19 and labels it a modern protein fad diet that “continue[s] to inflict a great variety of dangerous health disorders. not less. What saddens me about all this is that hundreds of thousands (probably millions) of people who can’t (or won’t) read critically have fallen for the premise of The China Study without even thinking about it. a bench scientist doing rat studies in a lab. Second. of the “shotgun approach. The entire 894 page study proves not a shred of causality.Atkins was a trained cardiologist who took care of thousands of real. he is absolutely and unnecessarily brutal in his treatment of Dr. Atkins’ death] became one of the richest snake oil salesmen ever to live. Robert Atkins. selling a diet that promises to help you lose weight. professional training or professional publications in the field of nutrition. let me tell you a few things. Campbell. A way below-the-belt commentary when you consider that Dr. Atkins’ books. would agree? Lest you think I’m being too hard on poor Dr. But I encourage you to buy it and read it to test your own critical reading skills.
have low cholesterol. but I follow almost the opposite diet as he does yet I. I stopped eating meat fifteen years ago. is probably the same. Campbell. I am more physically fit now than when I was twenty-five. One view of the value of epidemiology A day almost never passes without someone sending a comment my way about some recent study. he had a trim physique when I met him 10 years ago. can’t possibly indicate causality. And I’m going to take Dr. so I’ll assume it’s all true. ** Lillian Hellmann was predictably furious over McCarthy’s comment and adopted the typical American response: she sued. except on very rare occasions. I’ll try to incorporate as many of the functional changes as I can within the design framework I have and within the limits of my pocketbook. First I would like the heartily thank everyone who took the time to send me a comment on how to make this blog better both functionally and in content. Granted. To demonstrate my profound gratitude for all the blog topic selections. showing that low-carb diets cause brain fog or decreased longevity or cancer of some type or any number of conditions any of us would rather not have. In one of those turns in which the law of unintended consequences jumps up and bites one. But only because I’ve had it rattling around in my brain for the past week. I’m younger than Dr. and I stopped eating almost all animal-based foods. including dairy. MY cholesterol has dropped. plucked by the media from the hundreds published that same day. and appreciated every one. I have no reason to doubt Dr. too. is there any truth to this? My answer follows: This data comes from an observational study. Campbell’s own medical and dietary history (except maybe for the part about being more physically fit than he was at age 25 – that’s a tough act for someone who is 73). which. Hellmann disengaged by dying during the proceedings. and I am forty-five pounds lighter now than was when I was thirty years old. and. many of her untruths came to light in the courtroom as McCarthy was forced to defend her statement. as such. I read every single suggestion. I am now at an ideal weight for my height. Campbell at his word about what he eats. It’s no wonder we took over the earth.The results of this study…convinced me to turn my dietary lifestyle around. These comments always end with the plaintive request. . even as I’ve aged. As I recall. very low blood pressure and am ideal weight for my height. assuming nothing has changed. within the past six to eight years. What this all tells me is how wonderfully adaptive the human species is where diet is concerned. I’m going to put up a post that absolutely no one asked for.
You’ll read that these data ’suggest’ or that they ‘imply’ or that this ‘may cause’ that. read these to say that vitamin C prevents the common cold. the rug on the floor. I hadn’t thought of the pigs on my grandfather’s farm. I always stayed up late and I always woke up early. As I thought faster and faster. The fact that they do know is evident in the weasel words they use in describing their findings. Their value is in generating hypotheses. We read that a large study population of people is separated into two groups based on blood levels of vitamin C. my bed. I would always fall asleep before I had ever thought of everything there was to think of. sex. their beds. they never have a perfect study with exactly the same number. medications. Then I would try to figure if there was anything I hadn’t thought of. the moon. I can simply link instead of explaining what these terms mean each time I have to use them. is the driving force behind the disparity.Since I get these comments so often and answer them the same equally often. you may ask. But I’m being too harsh. And the researchers who do them know it. Or whatever. the researchers decide to monitor these two groups for a year and find that the group with the highest blood levels of vitamin C has the fewest colds. lifestyle. immediately I would think of something. however. These are the studies in which researchers look for disease disparities between large populations of people with different diets. continuing to compile things that could be thought of. medication. both of which serve the same purpose. Of course. this time. age. I’ve never been one to sleep much even when I was a kid. And since every one seems to believe that vitamin C protects against the common cold. lifestyle. One group of subjects has high blood levels. the closet. and I would think of my brothers sleeping in the room with me. we would all probably be a lot better off if all the researchers doing observational studies had followed my lead and fallen asleep mid study. lifestyles. And so they don’t really ever prove anything. Observational studies – also called prospective or cohort studies and sometimes even epidemiological studies – are the kind most often reported in the media simply because there are so many of them. and on and on and on. My mind would race. starting with the pigs on my grandfather’s farm and going from there. If disease disparities are found to exist between groups. These findings are rushed into publication. the correlation is that higher . The observational study demonstrates a correlation. We’ve all seen these studies by the score. Or my father’s shoes. etc. the other group has lower blood levels. The non-technically trained public. incomes. I would finally hit a quitting point. It all seems so reasonable and so scientific. Then I would start the game again. As a consequence. In our example above. my dad’s car. the tree outside. My brain never seemed to slow down. Problem is they can never possibly think of all the differences between the groups. They try to think of all the differences between two large populations of subjects so that they can statistically negate them so that only the observation in question – the vitamin C level in the example above – is different between the groups. These studies do have some value. why is it such a stretch to say that vitamin C prevents colds? I can explain by way of a game I used to play with myself as a child. why aren’t these studies sound? If the one group with the greater blood levels of vitamin C had significantly fewer colds. but the truth is that these studies don’t mean squat. and soon we read everywhere that vitamin C prevents the common cold. then researchers try to make the case that the difference in diet. In fact. My way of trying to get to sleep was to try to think of everything that could be thought of. I figured it was about time to write a post on what an observational study really is so that I can link to it when I give my standard reply. or at least should know it. But. I can then add this post to the ones on the glycemic index and relative risk. etc. Or I hadn’t thought of the fire hydrant out front. And usually the media helps to sway opinion by slanting the story in the same direction. of course. etc. I was always ruminating on something. Researchers doing observational studies have much the same problem. on both sides with the only difference being the study parameter.
we could hypothesize that vitamin C prevents the common cold. with those men shaving less having a greater risk. Observational studies only show correlation. Thus the first hypothesis was born: Infrequent shaving correlates with heart attack. We may find that those who took the vitamin C got significantly fewer colds. The title of the study is Shaving. Irrespective of how many scientific baubles are strewn through them. Then we give one group of subjects vitamin C and the other a placebo and watch them for a year. If this same study is repeated a number of times with the same outcome. If you want to bear with me. They are like zombies. so now we compare that to vitamin C intake. we can then do a randomize. worthwhile only as generators of hypotheses. charts and tables. or less frequently. The 34 men with beards were not classified. especially as vitamin C levels are concerned. We can recruit subjects. They give the appearance of scientific life. Another group of men of similar age who hadn’t had a heart attack were designated as controls. And long statistical analyses of the data derived. CORRELATION IS NOT CAUSATION More often than not observational studies are chock full of all kinds of technical-looking graphs. Someone noticed that about half of the men in a small group of subjects who had a heart attack shaved once every two or three days. placebo-controlled trial. not causation. of course. not causation. Upon questioning it was discovered that all of the men in the control group shaved every day. so we can say that our study demonstrates that vitamin C prevents the common cold. however. Once we have the hypothesis. We already know how many got colds. So. I’ll show you a bizarre observational study that was actually performed that demonstrates everything you need to know about observational studies. hypothetical. The study was published in 2003 in the prestigious American Journal of Epidemiology. Researchers recruited 2. not observational studies.vitamin C levels correlate (in this particular study) with lower rates of colds. At the end of the year (or whatever the study period is). every other day. randomize them into two groups that are as equal as possible. (Click here for free full text) This study purports to show that the frequency of shaving correlates with risk for developing heart disease. they are nothing but observational studies. A case-control study comparing the frequency of shaving in 21 men under 43 years of age who had suffered a myocardial infarction and 21 controls found that nine of the cases but none of the controls shaved only every 2 or 3 days. Men were asked about their frequency of shaving by a medical interviewer during phase I. then it can be said to be proven that vitamin C prevents colds. but they are really scientifically dead. But at this stage that would be just an hypothesis – not a fact. see who is on vitamin C and who is on placebo. Here’s the finding that initiated this study. .) But these studies are randomized trials. Many even have complicated equations. Responses were classified into categories ranging from twice daily to once daily. The researchers had access to a large population of subjects from another ongoing study called the Caerphilly Study. These categories were dichotomized into once or twice per day and less frequently. They demonstrate only correlation. Coronary Heart Disease. from this data.513 men aged 45-59 from this study and gave them comprehensive medical workups including extensive laboratory testing. and Stroke. we break the codes. a fact that everyone doing research and reading about research should have tattooed on their foreheads. (This study is.
I’m sure they would have found more. The one fifth (n = 521. What then? Of the 521 men who had elevated cholesterol. and were more likely to smoke. It triggers our confirmation bias. they may have designed a randomized clinical trial to show causality. instructed the men in one group to shave daily and the men in the other to shave every third day. It’s all so easy to see. i. But – and this is important – it doesn’t make any more sense than the shaving study. It’s a ridiculous idea. If you’re interested in a longer. Suddenly we have a study that seems to make sense. Of the 521 men who shaved less frequently than daily. were less likely to be married. But let’s just suppose that we take this same study and substitute the term ‘elevated cholesterol’ for ‘infrequent shaving. When the data were further refined it was determined that The age-adjusted hazard ratios demonstrate increased risks of all-cause. as compared with 31. We can all see that. Or is it? The researchers doing this study aren’t so stupid that they really think that the act of shaving itself has anything to do with a man’s risk for developing heart disease. to have angina. It should be obvious that the shaving or lack thereof has nothing to do with heart disease or early death. And these are just the differences the researchers found.1 percent died during the follow-up period. the lack of shaving is merely a marker for all the other conditions that are risk factors for heart disease. 21.’ Now what do we see? Let’s change one of the quotes from above to reflect this change. more in-depth article on observational studies. lower socioeconomic class. unmarried. as compared with 31. so this second study appears reasonable to us. We nod our heads sagely.. We don’t believe for a second that shaving has anything to do with heart disease. had a lower frequency of orgasm. cardiovascular disease. etc. Proof that shaving daily prevents heart disease.1 percent died during the follow-up period. But the reality is that both studies are exactly the same – and neither proves anything.e. Had they looked harder. So there you have it. so we can easily dismiss those findings. Both are observational studies. they went to great lengths to show that shaving was merely a marker for other things going on that may well have something to do with risk for developing heart disease or increased all-cause mortality. randomized them into two groups. 45. They could have recruited men without heart disease. Then after 20 years the researchers could tell whether or not shaving protects against heart disease.3 percent of men who had low or normal cholesterol. In fact. small stature. and to work in manual occupations than other men. smoking. 45. heart attack and/or stroke. But the idea that shaving itself has anything to do with heart disease is so ludicrous that no one would ever do such a study. just like I did when I played my ‘think of everything that can be thought about’ game with myself as a kid. and noncardiovascular-disease mortality and all stroke events among men who shaved less frequently. But we are more than ready to believe that the elevated cholesterol caused those men who had it to have heart attacks. We are programmed to think cholesterol is bad and causes heart disease. But if these researchers had really believed that the data showed that the lack of frequent shaving itself may have been the driving force behind the development of heart disease.4%) of men who shaved less frequently than daily were shorter.3 percent of men who shaved at least daily.The men in the study were followed for the next 20 years with follow-up exams periodically to monitor for history of chest pain. take a look at Gary Taubes .
et al. Epidemiol. 2001 30:1-11 . Int. G. I’ve tried to take a little different slant than he did so that my post and his article would cover all the bases. D. Cartoon above from: Smith.long piece in the New York Times a few years ago. J.