501M1 State of Health Transcript

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TCC501: State of Health


 
 
 
 
  Certificate in Plant-Based Nutrition Course One: Nutrition Fundamentals State of Health

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

1

TCC501: State of Health Chapter
 1:
 Introduction
 
  Welcome
  to
  our
  Certificate
  Program
  in
  Plant-­‐Based
  Nutrition,
  an
  online
  course
  offered
  in
  collaboration
  with
  our
  partner,
  eCornell
  Incorporated.
  This
  is
  the
  first
  lecture
  in
  the
  very
  first
  of
  three
 courses—501—and
 it
 will
 be
 focused
 on
 an
 overview
 of
 health
 statistics
 to
 sort
 of
 ground
  us
 in
 the
 connections
 between
 nutrition,
 health,
 and
 the
 practice
 of
 medicine.
 
  In
  the
  course,
  we’ve
  had
  both
  non-­‐professionals
  and
  professionals
  participating
  together,
  and
  we’re
  rather
  pleased
  with
  this
  approach.
  There
  might
  be
  the
  thought
  that
  it
  might
  be
  useful
  to
  separate
  these
  two
  groups.
  But,
  in
  reality,
  what
  we
  have
  found
  is
  that
  the
  interchange
  and
  the
  interactions
  between
  professionals
  and
  non-­‐professionals—doctors
  and
  their
  patients,
  if
  you
  will—has
 been
 both
 really
 quite
 informative
 and
 productive.
 And
 so,
 we’re
 kind
 of
 proud
 of
 this
  approach.
 
  This
 course
 is
 being
 offered
 for
 continuing
 education
 credit
 for
 professionals—we’re
 really
 quite
  excited
 about
 what
 we
 have
 here,
 and
 I
 think
 we
 offer
 a
 unique
 program.
 The
 professional
 credits
  awarded,
 among
 others,
 include
 continuing
 medical
 education
 credits
 for
 physicians,
 nurses,
 and
  pharmacists.
 
 
  Chapter
 2:
 Ten
 Leading
 Causes
 of
 Death
 
  I
 want
 to
 start
 out
 in
 this
 first
 lecture,
 in
 the
 overview
 of
 the
 health
 conditions
 that
 exist
 in
 our
  country,
 by
 simply
 listing
 the
 10
 leading
 causes
 of
 death.1
 [See
 slide
 number
 4.]
 This
 particular
  list
  has
  actually
  stood
  pretty
  fast
  for
  quite
  a
  number
  of
  years,
  maybe
  shifting
  here
  and
  there
  a
  little
 bit,
 but
 basically
 heart
 disease
 is
 the
 most
 prominent
 of
 these
 diseases,
 cancers
 aren’t
 too
  far
 behind,
 and
 of
 course,
 as
 you
 can
 see,
 the
 rest
 of
 them
 are
 listed.
 
  And
 I’ve
 starred
 the
 diseases
 that
 have
 a
 strong
 nutrition
 linkage,
 and
 what
 you
 will
 see
 here
 is
  that
 we
 have
 seven
 for
 which
 there
 is
 really
 good
 evidence
 to
 suggest
 that
 they
 have
 a
 strong
 link
  to
 diet
 and
 nutrition.
 These
 diseases
 we
 oftentimes
 call
 chronic
 degenerative
 diseases,
 indicating
  of
  course
  the
  fact
  that
  they
  tend
  to
  progress
  over
  a
  fairly
  long
  period
  of
  time,
  thus
  being
  chronic,
  and
 they
 also
 tend
 to
 be
 degenerative
 in
 the
 sense
 that
 normal
 tissue
 is
 gradually
 degenerating
 as
  one
 would
 tend
 to
 see
 with
 age.
 And
 in
 fact,
 most
 of
 these
 diseases
 tend
 to
 occur
 and
 increase
  with
 age.
 
  Chapter
 3:
 Other
 Chronic
 Diseases
 
  But
  besides
  these,
  there
  are
  also
  the
  other
  chronic
  conditions
  and
  chronic
  diseases
  that
  we
  should
 take
 into
 consideration.
 Diseases
 that
 don’t
 necessarily
 cause
 death,
 but
 nonetheless
 are
  problematic.
 No
 discussion
 of
 health
 today
 would
 be
 complete
 without
 first
 starting
 to
 talk
 about
  obesity,
 the
 obesity
 epidemic
 that
 exists
 in
 our
 country
 these
 days.
 And
 even
 though
 obesity
 per
  se
 doesn’t
 necessarily
 cause
 death,
 it
 nonetheless
 is
 indicative
 of
 diseases
 to
 come.
 And
 so,
 about
 

1
 Anderson
 RN.
 “Deaths:
 leading
 causes
 for
 2000.”
 National
 Vital
 Statistics
 Reports
 50(16)
 (2002)
 

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

2

TCC501: State of Health two-­‐thirds
 of
 adults
 now
 are
 overweight—that’s
 a
 lot
 of
 people.2
 One-­‐third
 of
 adults
 are
 obese,
  this
 meaning
 that
 their
 body
 mass
 index
 exceeds
 30.
  3
 Being
 overweight,
 their
 body
 mass
 index
  would
 exceed
 25.
 The
 young
 people
 are
 especially
 vulnerable
 to
 this,
 and
 what
 we’ve
 seen
 during
  the
 last
 30
 years
 is
 an
 increase
 in
 the
 obesity
 of
 teenagers
 in
 particular,
 and
 even
 younger
 people.
  In
  fact,
  obesity
  incidence
  in
  young
  people
  has
  increased
  about
  three-­‐fold
  during
  the
  last
  three
  decades,
  which
  is
  a
  remarkable
  increase,
  and
  of
  course
  it
  suggests
  that
  there
  are
  going
  to
  be
  problems
 to
 come
 if
 we
 don’t
 bring
 this
 under
 some
 control.
 4
 
  About
 80%
 of
 young
 people
 who
 are
 obese
 may
 turn
 out
 to
 be
 obese
 when
 they’re
 adults.5
 That’s
  at
  least
  what
  the
  current
  records
  would
  tend
  to
  suggest.
  Then
  those
  people
  are
  going
  to
  experience
 the
 kind
 of
 chronic
 degenerative
 disease
 that
 was
 listed
 in
 the
 previous
 slide.
 
  Osteoporosis
  is
  another
  condition
  that
  we
  talk
  a
  lot
  about
  in
  the
  present
  day.
  It’s
  usually
  not
  necessarily
 a
 cause
 of
 death,
 but
 it
 turns
 out
 that
 amongst
 older
 women,
 upwards
 of
 half
 of
 these
  women
  have
  evidence
  of
  osteopenia,
  which
  is
  a
  precursor
  to
  osteoporosis.6
  So,
  this
  tends
  to
  occur
 of
 course
 with
 the
 onset
 of
 the
 menopause
 years
 and
 that’s
 a
 very
 costly
 condition.
 
  Chronic
  pain
  is
  another
  condition
  that
  is
  experienced
  by
  a
  lot
  of
  people.
  It
  is
  not
  listed
  as
  a
  specific
  disease,
  but
  chronic
  pain
  includes
  a
  variety
  of
  conditions
  such
  as
  lower
  back
  pain
  and
  arthritic
  pains
  of
  various
  and
  sundry
  kinds.
  Bursitis
  is
  yet
  another
  one
  in
  this
  sort
  of
  class.
  Headaches—the
 more
 serious
 being
 the
 migraine
 headaches
 that
 people
 experience.
 And
 chronic
  pain
 really
 interestingly
 does
 respond
 to
 changes
 in
 diet
 in
 a
 favorable
 direction,
 and
 it’s
 quite
  fascinating.
 
  Hypertension
 is
 another
 common
 ailment
 like
 some
 of
 these
 others,
 although
 hypertension
 is
 not
  necessarily
 a
 cause
 of
 death,
 but
 it
 certainly
 is
 indicative
 of
 problems
 to
 come,
 especially
 in
 the
  cardiovascular
 disease
 category.
 
  Chapter
 4:
 The
 Cost
 of
 Care
 
  Here
  are
  a
  couple
  of
  ideas
  that
  I
  think
  most
  of
  us
  know
  but
  may
  need
  emphasis—it
  can’t
  be
  overemphasized
 too
 much:
 namely,
 that
 the
 health
 problems
 that
 we
 now
 experience
 turn
 into
  medical
 care
 costs.
 [See
 slide
 number
 6.]
 And
 as
 far
 as
 per
 capita
 medical
 care
 costs
 in
 the
 United
 

2
 Cynthia
 L.
 Ogden,
 P.
 D.,
 and
 Margaret
 D.
 Carroll,
 M.S.P.H.
 Prevalence
 of
 Overweight,
 Obesity,
 and
 Extreme
 Obesity
 Among
 Adults:
 

United
 States,
 Trends
 1960–1962
 Through
 2007–2008.
 (National
 Center
 for
 Health
 Statistics
 -­‐
 Division
 of
 Health
 and
 Nutrition
  Examination
 Surveys,
 2010).
  3
 Cynthia
 L.
 Ogden,
 P.
 D.,
 and
 Margaret
 D.
 Carroll,
 M.S.P.H.
 Prevalence
 of
 Overweight,
 Obesity,
 and
 Extreme
 Obesity
 Among
 Adults:
  United
 States,
 Trends
 1960–1962
 Through
 2007–2008.
 (National
 Center
 for
 Health
 Statistics
 -­‐
 Division
 of
 Health
 and
 Nutrition
  Examination
 Surveys,
 2010).
  4
 Cynthia
 Ogden,
 P.
 D.,
 and
 Margaret
 Carroll,
 M.S.P.H.
 Prevalence
 of
 Obesity
 Among
 Children
 and
 Adolescents:
 United
 States,
  Trends
 1963–1965
 Through
 2007–2008.
 (National
 Center
 for
 Health
 Statistics
 -­‐
 Division
 of
 Health
 and
 Nutrition
 Examination
  Surveys,
 2010).
  5
 Whitaker
 RC,
 Wright
 JA,
 Pepe
 MS,
 Seidel
 KD,
 Dietz
 WH.
 Predicting
 obesity
 in
 young
 adulthood
 from
 childhood
 and
 parental
  obesity.
 N
 Engl
 J
 Med.
 1997
 Sep
 25;337(13):869-­‐73.
  6
 Looker,
 A.
 C.,
 Melton,
 L.
 J.,
 3rd,
 Harris,
 T.
 B.,
 Borrud,
 L.
 G.
 &
 Shepherd,
 J.
 A.
 Prevalence
 and
 trends
 in
 low
 femur
 bone
 density
  among
 older
 US
 adults:
 NHANES
 2005-­‐2006
 compared
 with
 NHANES
 III.
 J
 Bone
 Miner
 Res
 25,
 64-­‐71,
 doi:10.1359/jbmr.090706
  (2010).
 

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

3

TCC501: State of Health States
 are
 concerned,
 we
 are
 #1
 in
 the
 world,
 about
 twice
 as
 high
 as
 the
 second
 country,7
  8
 but
  yet
  when
  attempts
  have
  been
  made
  to
  rank
  us
  in
  respect
  to
  quality
  of
  healthcare
  compared
  to
  other
  Western
  industrialized
  countries,
  we
  rank
  somewhere
  between
  35th
  and
  40th,
  depending
  on
 the
 criteria
 being
 used
 to
 rank
 us.910
 
  So,
 the
 question
 that
 obviously
 arises
 is
 how
 can
 we
 be
 spending
 so
 much
 money
 and
 getting
 so
  little
 in
 return?
 
 
  The
  cost
  of
  healthcare
  is
  looming
  large,
  and
  we’ve
  all
  heard
  a
  great
  deal
  about
  this
  in
  recent
  years—to
  be
  specific,
  the
  cost
  [for]
  companies
  that
  tend
  to
  have
  self-­‐insured
  employee
  populations.
  As
  the
  cost
  goes
  up,
  it
  becomes
  ever
  more
  difficult
  for
  the
  companies
  to
  continue
  operating
 and
 supporting
 their
 workers.
 And
 so
 as
 a
 result,
 it
 has
 led
 in
 some
 cases
 to
 companies’
  going
  overseas
  and
  using
  cheaper
  labor,
  because
  there
  they
  usually
  don’t
  have
  to
  pay
  for
  healthcare
  costs.
  So
  that’s
  one
  of
  the
  consequences.
  And
  the
  cost
  of
  healthcare
  among
  public
  agencies
 is
 in
 a
 similar
 category.
 You
 either
 lay
 people
 off
 or
 cut
 back
 on
 programs,
 as
 is
 the
 case
  with
 schools.
 
  Schools
  have
  a
  particular
  burden
  in
  the
  sense
  that
  the
  retirees,
  as
  they
  get
  older,
  their
  health
  costs
 are
 covered
 by
 the
 program.
 As
 that
 tends
 to
 go
 up—and
 healthcare
 costs
 are
 rising
 rapidly
  in
 the
 last
 two
 or
 three
 decades
 in
 this
 country—as
 healthcare
 costs
 go
 up,
 costs
 go
 up
 amongst
  the
 school
 teacher
 retiree
 pool
 that
 have
 to
 be
 covered
 because
 it
 is
 an
 entitlement
 program.
 And
  when
  a
  larger
  percentage
  of
  the
  total
  budget
  available
  to
  schools
  is
  going
  to
  support
  that
  kind
  of
  activity,
  what
  it
  tends
  to
  mean
  is
  to
  cut
  back
  on
  the
  education
  programs
  in
  the
  school
  itself.
  Really
 quite
 a
 serious
 problem.
 
  Chapter
 5:
 State
 of
 Heath
 Statistics
 
  In
 the
 next
 slide,
 I
 would
 like
 to
 touch
 on
 a
 problem
 that
 people
 tend
 to
 be
 generally
 aware
 of,
 but
  perhaps
  without
  knowledge
  of
  some
  of
  the
  specific
  numbers.
  [See
  slide
  number
  7.]
  There
  now
  are
  something
  like
  24,000
  prescription
  over-­‐the-­‐counter
  medicines
  that
  are
  registered
  in
  the
  United
 States.
  11
 24,000—that
 is
 a
 huge
 number.
 We
 seem
 to
 have
 drugs
 for
 virtually
 every
 kind
  of
 condition.
 
  Another
  figure
  that
  just
  sort
  of
  illustrates
  the
  problem:
  about
  74%
  of
  the
  American
  population
  uses
 at
 least
 one
 prescription
 per
 year.12
 That’s
 3
 out
 of
 4
 of
 us.
 And
 amongst
 seniors,
 generally
  meaning
  people
  65
  years
  of
  age
  and
  older,
  somewhere
  between
  85%
  and
  93%
  of
  seniors
  are
 
7
 World
 Health
 Organization.
 Technical
 Report
 Series
 No.
 425.
 “International
 Drug
 Monitoring:
 the
 Role
 of
 the
 Hospital.”
 Geneva,
 

Switzerland:
 World
 Health
 Organization,
 1966.
 

8
 Health
 Insurance
 Association
 of
 America.
 Source
 Book
 of
 Health
 Insurance
 Data:
 1999–2000.
 Washington,
 DC,
 1999.
 
 

9

World Health Organization. The world health report. “The World Health Report 2000—Health systems: improving performance’ Geneva, Switzerland: World Health Organization, 2000.

10
 Some
 of
 the
 criteria
 used
 to
 rank
 healthcare
 systems
 include:
 life
 expectancy
 adjusted
 for
 disability,
 a
 high
 level
 of
 

responsiveness,
 or
 a
 fair
 distribution
 of
 the
 financing
 burden.
 Responsiveness
 was
 measured
 by
 asking
 participants
 to
 rate
 their
  experiences
 of:
 dignity,
 autonomy
 and
 confidentiality
 (jointly
 termed
 respect
 of
 persons);
 and
 prompt
 attention,
 quality
 of
 basic
  amenities,
 access
 to
 social
 support
 networks
 during
 care
 and
 choice
 of
 care
 provider.
  11
 Website
 http://www.drugs.com/drug_information.html.
 
 Accessed
 January
 2012.
 
  12
 http://assets.aarp.org/rgcenter/health/rx_midlife_plus.pdf
 

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

4

TCC501: State of Health regularly
 using
 drugs
 or
 pharmaceuticals.13
 The
 cost
 for
 these
 folks
 is
 now
 approaching
 $3,000
 a
  year.14
 You
 can
 imagine
 the
 number
 of
 seniors
 who
 simply
 can’t
 afford
 that
 kind
 of
 cost.
 This
 is
  out-­‐of-­‐pocket
 cost,
 by
 the
 way,
 and
 this
 is
 up
 from
 $550
 per
 capita
 in
 1992.
 In
 this
 short
 period
 of
  time,
 it’s
 gone
 from
 $550
 up
 to
 almost
 $3,000
 a
 year.15
 
  Also,
 on
 average,
 it
 is
 now
 said
 that
 these
 seniors
 are
 getting
 close
 to
 40
 prescriptions
 filled
 per
  year.16
 That’s
 huge.
 And
 amongst
 the
 seniors
 who
 are
 using
 pharmaceuticals,
 and
 that’s
 most
 of
  them,
  the
  average
  number
  of
  drugs
  they
  take
  per
  day
  is
  8
  drugs
  per
  day.17
  Again,
  it’s
  really
  an
  alarming
 figure,
 and
 of
 course
 we
 all
 know
 some
 of
 the
 older
 people
 who
 have
 the
 little
 pillboxes
  and
 follow
 very
 carefully
 scripted
 prescription
 procedures
 during
 the
 course
 of
 the
 day.
 While
 all
  this
  huge
  use
  of
  drugs
  is
  occurring
  on
  the
  one
  hand,
  on
  the
  other
  hand
  we
  know
  from
  some
  studies
 that
 were
 done
 now
 approximately
 15
 years
 ago,
 showing
 that
 we
 also
 are
 getting
 over
  100,000
  prescription
  drug
  deaths
  per
  year.18
  So
  here
  we
  are
  using
  an
  enormous
  volume
  of
  these
  drugs
 as
 people
 get
 older
 and
 yet,
 at
 the
 same
 time,
 over
 100,000
 people
 are
 incurring
 the
 costs
  of
 using
 these
 drugs
 in
 the
 form
 of
 losing
 their
 lives.
 
  Chapter
 6:
 Where
 Does
 Nutrition
 Fit
 In?
 
  So,
  in
  the
  next
  slide,
  [slide
  number
  9]
  since
  I
  am
  talking
  here
  in
  this
  particular
  course
  about
  nutrition
 and
 how
 does
 this
 fit
 in,
 I’ve
 just
 posed
 the
 question.
 So
 where
 does
 nutrition
 fit
 into
  the
  scheme
  of
  things—with
  the
  kind
  of
  conditions
  we
  have,
  the
  huge
  number
  of
  diseases
  that
  tend
 to
 kill
 us
 before
 time,
 and
 a
 huge
 number
 of
 them
 that
 are
 influenced
 by
 diet,
 and
 instead
  we’re
 turning
 to
 drugs?
 So,
 I
 think
 it’s
 fair
 to
 ask
 the
 question:
 where
 does
 nutrition
 fit
 in?
 Well,
 it
  really
  doesn’t.
  It
  really
  doesn’t
  in
  a
  number
  of
  different
  ways;
  first
  off,
  it
  tends
  not
  to
  fit
  in
  because
 the
 public
 is
 really
 confused
 about
 what
 nutrition
 really
 means,
 and
 so
 I
 think
 we
 would
  all
 agree
 that
 this
 subject
 is
 very,
 very
 poorly
 understood
 and
 most
 people
 hardly
 know
 what
 to
  do
 in
 order
 to
 really
 to
 take
 advantage
 of
 what
 nutrition
 can
 do.
 
  Nutrition
 also
 as
 a
 scientific
 topic
 receives
 really
 only
 miniscule
 amounts
 of
 funding
 compared
 to
  the
 funding
 to
 do
 research
 in
 other
 areas
 of
 medicine
 at
 the
 National
 Institutes
 of
 Health,
 which
 is
  the
 premier
 biomedical
 research
 agency—not
 just
 in
 the
 United
 States,
 but
 in
 the
 world.
 At
 the
  present
 time,
 there
 are
 somewhere
 in
 the
 neighborhood
 of
 about
 27
 institutes
 and
 centers
 and
  programs
  that
  are
  included
  in
  the
  National
  Institutes
  of
  Health.
  27
  institutes
  and
  centers
  and
  programs—there
  is
  not
  one
  that’s
  called
  the
  Institute
  of
  Nutrition,
  just
  to
  give
  you
  some
  indication
  of
  how
  little
  respect
  nutrition
  gets
  within
  the
  biomedical
  research
  organizations.
  There
 is
 some
 nutrition
 programming
 and
 a
 small
 amount
 of
 funds,
 maybe
 2%
 or
 3%
 or
 4%
 or
  so,
 in
 a
 couple
 of
 the
 big
 institutes
 like
 Heart
 and
 Cancer.
 But
 that
 funding,
 with
 which
 I
 am
 quite
 
13
 http://www.cdc.gov/nchs/data/databriefs/db42.htm
  14
 Cost
 Overdose:
 Growth
 In
 Prescription
 Spending
 for
 the
 Elderly:
 Accessed
 online
 2/12
 at
 

http://familiesusa2.org/assets/pdfs/drugod852b.pdf
 
 
15
 Cost
 Overdose:
 Growth
 In
 Prescription
 Spending
 for
 the
 Elderly:
 Accessed
 online
 2/12
 at
 

http://familiesusa2.org/assets/pdfs/drugod852b.pdf
 
16
 Cost
 Overdose:
 Growth
 In
 Prescription
 Spending
 for
 the
 Elderly:
 Accessed
 online
 2/12
 at
 

http://familiesusa2.org/assets/pdfs/drugod852b.pdf
 
17
 Cost
 Overdose:
 Growth
 In
 Prescription
 Spending
 for
 the
 Elderly:
 Accessed
 online
 2/12
 at
 

http://familiesusa2.org/assets/pdfs/drugod852b.pdf
 
18
 Starfield,
 B.
 Is
 US
 health
 really
 the
 best
 in
 the
 world?
 JAMA
 284,
 483-­‐485
 (2000)
 

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

5

TCC501: State of Health familiar,
  has
  been
  used
  primarily
  for
  testing
  nutrients
  as
  nutrient
  supplements,
  which
  I
  quite
  frankly
 call
 pharmaceutical
 research,
 not
 nutrition
 research.
 So,
 the
 funding
 for
 nutrition
 within
  the
 medical
 research
 establishment
 is
 almost
 non-­‐existent.
 
  Secondly,
  the
  doctors
  the
  public
  turns
  to
  for
  getting
  professional
  information
  on
  health,
  for
  obvious
 reasons,
 unfortunately
 are
 not
 trained
 in
 nutrition.
 There’re
 a
 couple
 of
 programs
 that
  have
 nutrition
 for
 sure,
 but
 for
 the
 most
 part
 doctors
 are
 really
 not
 learning
 about
 nutrition.
 
 
  In
  addition,
  nutrition
  doesn’t
  fit
  into
  our
  narrative
  and
  our
  thinking
  because
  at
  the
  policy
  level—
  and
  I
  spent
  about
  20
  years
  in
  national
  policy
  development—policy,
  insofar
  as
  nutrition
  is
  concerned,
 doesn’t
 really
 apply
 in
 an
 effective
 way.
 In
 large
 measure
 because
 the
 standards
 that
  are
  set,
  whether
  I
  am
  talking
  about
  recommended
  dietary
  allowances,
  for
  example,
  or
  food
  labeling
 and
 other
 national
 education
 policies,
 these
 standards
 that
 are
 established
 unfortunately
  have
  reflected
  a
  very
  strong
  influence
  from
  the
  food
  and
  drug
  industry,
  which
  is
  most
  unfortunate
 because
 they
 are
 interested
 in
 selling
 products,
 not
 necessarily
 interested
 in
 selling
  health.
 
  Chapter
 7:
 US
 Medicine:
 Annual
 Deaths
 
 
  This
 is
 a
 publication
 that
 I
 referred
 to
 before,
 that
 was
 published
 in
 the
  Journal
 of
 the
 American
  Medical
  Association
  in
  the
  year
  2000.19
  [See
  slide
  number
  10.]
  And
  it
  lists
  here
  the
  number
  of
  deaths
  per
  year
  in
  the
  United
  States
  as
  a
  result
  of
  errors
  and
  other
  medical
  misfortunes
  concerning
 the
 present
 medical
 system.
 And
 you
 can
 see
 that
 between
 the
 medication
 errors
 and
  unnecessary
  surgery
  that
  occurs,
  and
  hospital
  errors
  and
  hospital-­‐borne
  infections
  and,
  of
  course,
  the
  figures
  that
  I’ve
  referred
  to
  before—drug
  adverse
  effects
  being
  more
  than
  100,000— the
 total
 deaths
 we
 are
 seeing
 in
 the
 year
 2000,
 and
 there
 is
 some
 indication
 it
 is
 more
 now,
 that
  it
 hasn’t
 really
 necessarily
 slowed
 down.
 225,000
 deaths
 per
 year
 from
 basically
 going
 through
  the
 medical
 system
 to
 get
 care
 actually
 turns
 out
 to
 be
 the
 number
 three
 cause
 of
 death.
 
  And
 you
 recall
 in
 that
 first
 list
 I
 talked
 about
 the
 first
 10
 causes
 of
 death.
 I
 haven’t
 seen
 a
 list
 that
  anyone
  has
  yet
  put
  out
  to
  show
  that
  the
  number
  three
  cause
  of
  death
  is
  actually
  going
  to
  the
  hospital
 or
 the
 medical
 system
 to
 get
 care.
 
  In
  the
  next
  slide,
  [slide
  number
  11]
  I’ve
  taken
  advantage
  of
  some
  of
  these
  numbers,
  and
  these
  numbers
  by
  the
  way
  are
  rough
  approximations,
  and
  they’re
  also
  very
  conservative.
  What
  I’ve
  done
  is
  to
  make
  an
  estimate,
  for
  example,
  of
  the
  proportions
  of
  the
  three
  major
  diseases—the
  proportions
  of
  these
  diseases
  that
  do
  not
  need
  to
  occur
  were
  we
  to
  use
  nutrition
  properly.
  And
  I
  am
 suggesting,
 for
 example,
 that
 if
 we
 assume
 that
 a
 third
 of
 all
 cancers
 could
 be
 prevented
 by
 an
  appropriate
 use
 of
 diet—and
 as
 I
 have
 mentioned
 before,
 this
 number
 really
 comes
 from
 a
 report
  in
  1981
  by
  Sir
  Richard
  Doll
  and
  Sir
  Richard
  Peto
  at
  the
  University
  of
  Oxford20
  when
  they
  estimated
  that
  35%...and
  their
  estimate
  was
  conservative,
  by
  the
  way,
  because
  they
  suggested
  upwards
  of
  70%
  of
  cancers
  could
  be
  prevented
  by
  appropriate
  use
  of
  diet.
  So,
  I
  am
  using
  this
 
19
 Anderson
 RN.
 “Deaths:
 leading
 causes
 for
 2000.”
 National
 Vital
 Statistics
 Reports
 50(16)
 (2002)
  20
 Doll
 R,
 Peto
 R.,
 The
 causes
 of
 cancer:
 quantitative
 estimates
 of
 avoidable
 risks
 of
 cancer
 in
 the
 United
 States
 today.
 J
 Natl
 Cancer
 

Inst.
 1981
 Jun;66(6):1191-­‐308.
 

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

6

TCC501: State of Health figure
 of
 one
 third—as
 I
 say,
 it’s
 a
 conservative
 figure—that
 of
 the
 550,000
 deaths
 that
 existed,
 a
  third
  of
  those
  cancers
  could
  be
  prevented.
  That
  gives
  182,000.
  If
  we
  also
  assume
  that
  about
  a
  third
 of
 all
 heart
 diseases
 (that
 would
 be
 a
 more
 common,
 of
 course,
 cause
 of
 death)
 that
 gives
 us
  237,000.
 And
 let’s
 say
 we
 assume
 that
 a
 third
 of
 all
 strokes
 and
 other
 cardiovascular
 diseases
 like
  coronary
 heart
 disease
 above—but
 in
 any
 case
 we’ll
 take
 about
 a
 third
 of
 all
 strokes
 and
 a
 third
  of
  all
  diabetics,
  and
  I
  think
  most
  people
  would
  agree
  these
  are
  very
  conservative
  estimates
  in
  terms
 of
 the
 percentage
 of
 these
 diseases
 that
 could
 be
 spared—or,
 I
 would
 suggest,
 perhaps
 you
  can
 cure,
 certainly
 in
 the
 case
 of
 heart
 disease
 and
 stroke.
 
  And
 then,
 we
 add
 to
 that,
 let’s
 say
 we
 were
 able
 to
 cut
 down
 the
 prescription
 drug
 use
 by
 half.
  Put
 all
 those
 numbers
 together,
 add
 them
 up,
 and
 the
 revised
 cause
 of
 death
 in
 my
 terms
 is
 that
  the
  number
  one
  cause
  of
  death
  is
  nutritionally
  controllable
  diseases.
  It’s
  very
  clear.
  I
  would
  emphasize
  again
  this
  is
  a
  very
  conservative
  estimate.
  This
  essentially
  highlights
  the
  huge
  problem
 in
 the
 practice
 of
 medicine
 caused
 by
 a
 lack
 of
 knowledge
 of
 nutrition.
 
 
  Now
 I
 am
 going
 to
 now
 use
 numbers
 that
 are
 more
 realistic
 in
 my
 estimation,
 and
 I’ve
 got
 some
  new
  numbers
  here.
  [See
  slide
  number
  12.]
  Let’s
  say
  that
  two-­‐thirds
  of
  all
  cancers
  could
  be
  prevented.
 I
 think
 that’s
 reasonable
 to
 assume.
 In
 fact,
 as
 I
 said
 before,
 the
 original
 publication
  that
 gave
 rise
 to
 this
 sort
 of
 latitude
 in
 sort
 of
 shifting
 numbers
 around
 a
 little
 bit
 is
 the
 report
 by
  Sir
 Richard
 Doll
 and
 Sir
 Richard
 Peto
 at
 the
 University
 of
 Oxford,
 when
 they
 were
 submitting
 a
  report
  to
  the
  General
  Accounting
  Office
  in
  Washington.
  Doll
  and
  Peto
  are
  perhaps
  the
  best-­‐ known
 biostatistical
 epidemiologists
 in
 the
 world
 today,
 and
 were
 very
 important
 in
 this
 activity.
 
 
  So,
 let’s
 say,
 two-­‐thirds
 of
 all
 cancers
 could
 be
 prevented,
 we
 got
 a
 number
 there.
 90%
 of
 heart
  diseases.
 Again,
 I
 am
 going
 to
 say
 that’s
 a
 conservative
 estimate,
 but
 it’s
 certainly
 a
 more
 realistic
  one
  because
  we
  now
  know
  from
  the
  work
  of
  Dr.
  Esselstyn
  and
  Dr.
  Ornish
  and
  others
  that
  virtually
 100%
 of
 the
 people
 who
 have
 heart
 disease
 in
 advanced
 stages,
 they
 can
 reverse
 their
  conditions
 back
 to
 a
 state
 where
 the
 risk
 of
 suffering
 another
 attack
 is
 close
 to
 zero.
 So,
 let’s
 say
  90%
 of
 all
 heart
 diseases
 could
 be
 prevented,
 80%
 of
 all
 strokes
 and
 diabetes—again
 these
 are
  reasonable
  numbers,
  really,
  and
  let’s
  say
  we
  could
  cut
  down
  the
  use
  of
  these
  unnecessary
  prescription
 drugs
 by
 80%,
 so
 we’ve
 got
 some
 numbers
 there.
 
  You
  can
  see
  the
  new
  number,
  that
  the
  number
  one
  cause
  of
  death
  for
  the
  nutritionally
  controllable
 diseases
 is
 over
 a
 million,
 and
 put
 that
 number
 beside
 cardiovascular
 diseases
 and
  cancer.
 So,
 I
 think
 this
 kind
 of
 perspective,
 using
 the
 numbers
 in
 this
 way,
 is
 basically
 saying
 to
 us
  that
  we
  have
  this
  huge
  opportunity
  to
  really
  do
  something
  about
  our
  healthcare
  system
  if
  we
  simply
  understood
  what
  nutrition
  can
  do
  and
  then
  find
  appropriate
  ways
  to
  implement
  this
  information
 into
 the
 marketplace.
 
 
  Chapter
 8:
 Toward
 a
 New
 Nutrition
 Paradigm
 
  I
 want
 to
 now
 shift
 your
 attention
 a
 little
 bit
 in
 this
 overview
 to
 what
 I
 am
 really
 driving
 towards,
  not
 only
 with
 respect
 to
 this
 lecture,
 but
 for
 the
 remainder
 of
 the
 course,
 and
 that
 is
 I
 am
 going
 to
  suggest
 that
 we
 at
 the
 present
 time
 do
 have
 a
 nutrition
 definition
 that
 we
 tend
 to
 work
 with,
 but
 I
 
For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

7

TCC501: State of Health am
 going
 to
 also
 suggest
 a
  new
 nutrition
 definition
 for
 the
 future.
 So,
 let’s
 consider
 first
 the
 way
  we
 think
 about
 nutrition
 at
 the
 present
 time.
 
  When
  we
  conduct
  research
  or
  set
  standards
  such
  as
  the
  Dietary
  Guidelines,
  we
  are
  really
  referencing
  the
  independent
  effects
  of
  individual
  nutrients
  on
  health.
  This
  can
  be
  misleading,
  because
  the
  effect
  of
  many
  nutrients
  acting
  in
  concert
  may
  not
  be
  the
  same
  as
  what
  we
  might
  predict
 if
 we
 were
 to
 take
 all
 the
 individual
 effects
 of
 those
 same
 nutrients
 and
 essentially
 add
  them
 together.
 
 
  And
  so,
  the
  measurements
  that
  we
  use
  to
  create
  food
  labels
  in
  the
  marketplace
  appear
  to
  be
  rather
 specific
 if
 you
 look
 at
 the
 label.
 Food
 manufacturers
 do
 attempt
 to
 control
 and
 standardize
  the
  quantities
  of
  nutrients
  present
  in
  foods
  as
  much
  as
  possible
  in
  the
  food
  processing,
  but
  as
  I’ll
  discuss
 a
 little
 later,
 the
 amount
 of
 nutrients
 that
 are
 actually
 present
 in
 food
 varies
 enormously.
  But
  nonetheless,
  we
  think
  about
  nutrition
  in
  terms
  of
  the
  absolute
  amounts
  of
  nutrients
  presumably
 present
 in
 the
 package
 of
 foods.
 
 
  The
 Recommended
 Dietary
 Allowances
 or
 RDA,
 again,
 is
  focused
 on
 individual
 nutrients—that’s
  the
  way
  we
  think
  about
  it,
  and
  this
  whole
  concept
  of
  talking
  about
  nutrition
  in
  the
  context
  of
  individual
 nutrients
 comes
 out
 in
 the
 marketplace
 in
 our
 use
 of
 nutrient
 supplements,
 now
 a
 $30
  billion
  a
  year
  industry,
  and
  we’re
  now
  learning
  that
  these
  nutrient
  supplements
  are
  really
  not
  working.
 
  Similarly,
  when
  we
  actually
  study
  nutrition
  in
  research
  protocols,
  we
  tend
  to
  work
  with
  individual
 nutrients
  as
  we
  study
  them,
 controlling
 everything
 else
 out
 of
 the
 picture,
 so
 to
 speak,
  and
 as
 I’ll
 discuss
 in
 another
 lecture
 on
 experimental
 testing,
 you
 can
 see
 that
 even
 the
 kinds
 of
  studies
  that
  we
  tend
  to
  favor
  are
  those
  that
  really
  focus
  in
  on
  what
  the
  effects
  of
  individual
  nutrients
  are.
  So,
  that’s
  our
  present
  nutritional
  paradigm.
  It’s
  this
  definition
  of
  looking
  at
  nutrients
 as
 singular
 agents
 minus
 their
 context.
 
  In
 contrast,
 I
 think
 it’s
 time
 to
 think
 differently
 about
 nutrition—a
 definition
 that
 I
 would
 say
 is
  far
  more
  realistic,
  it’s
  much
  more
  natural,
  and
  I
  call
  it
  the
  “wholistic”
  effects
  of
  nutrients
  on
  health,
 which
 represent
 a
 synergistic
 effect.
 That
 is,
 nutrients
 tend
 to
 work
 together,
 obviously.
  We’ve
  known
  this
  for
  a
  long
  time,
  and
  now
  there
  are
  just
  an
  almost
  unlimited
  number
  of
  nutrient-­‐nutrient
 interactions
 that
 have
 been
 published
 as
 we
 study
 them.
 We
 know
 they
 exist;
  they
 are
 very
 important.
 
  And
  so,
  as
  we
  talk
  about
  the
  wholistic
  effects
  of
  nutrients
  on
  health,
  I’m
  going
  to
  suggest
  that
  what
  we
  really
  need
  to
  focus
  on
  are
  the
  whole
  food
  effects
  as
  they
  relate
  to
  health,
  where
  nutrients
  can
  naturally
  work
  together
  to
  create
  a
  response.
  So
  now
  that
  was
  a
  nutritional
  paradigm.
 
  Now,
  let’s
  shift
  our
  thinking
  a
  little
  bit
  here
  and
  talk
  about
  the
  medical
  paradigm
  on
  the
  next
  slide.
 
 [See
 slide
 number
 14.]
 
  Chapter
 9:
 Toward
 a
 New
 Medical
 Paradigm
 
  For individual student use only: please do not copy or distribute. 8
© 2012, T. Colin Campbell Foundation and TILS

TCC501: State of Health The
  present
  medical
  paradigm
  is
  what
  I
  refer
  to
  as
  a
  classic
  case
  of
  reductionist
  thinking,
  or
  reductionism.
 Once
 again,
 as
 I
 said
 with
 respect
 to
 nutrients,
 we
 tend
 to
 focus
 on
 one
 thing
 at
 a
  time.
 
  In
 the
 case
 of
 medicine,
 we
 really
 depend
 on
 the
 use
 of
 drugs,
 and
 just
 drug
 use
 alone
 by
 older
  people
 is
 just
 over
 the
 top.
 And
 a
 lot
 of
 people
 actually
 do
 believe
 in
 fact
 that
 if
 we
 are
 going
 to
  improve
  our
  health
  care
  system,
  we
  need
  to
  have
  better
  access
  to
  drugs
  and
  more
  drug
  development.
  I
  would
  argue
  strenuously
  against
  that
  particular
  approach,
  but
  that’s
  a
  very
  reductionist
  approach—considering
  the
  effect
  of
  one
  chemical,
  namely
  a
  drug,
  on
  one
  effect
  in
  the
 body,
 that
 leads
 to
 one
 kind
 of
 disease.
 In
 fact,
 the
 development
 of
 drugs
 is
 in
 many
 cases
 now
  being
  targeted
  to
  very
  specific
  sites
  and
  so
  we
  refer
  to
  this
  as
  targeted
  therapy.
  Again,
  it’s
  this
  very
  singular
  reductionist
  approach—one
  chemical
  affecting
  one
  particular
  topic,
  for
  the
  most
  part,
 ignoring
 the
 larger
 context.
 
  Nutrient
 supplements,
 to
 the
 extent
 they’re
 used
 in
 the
 present
 medical
 paradigm,
 it’s
 the
 same
  philosophy.
 Trying
 to
 see
 what
 level
 of
 nutrients
 we
 need
 to
 consume
 is
 based
 on
 research
 that
  has
 been
 focused
 on
 the
 individual
 nutrients.
 
  Also,
 the
 present
 medical
 paradigm
 that
 we
 all
 know
 is
 true
 is:
 we
 tend
 to
 let
 diseases
 happen.
  When
  the
  doctors
  discover
  the
  diseases—or
  we
  discover
  them
  ourselves,
  and
  then
  get
  some
  evidence
 from
 the
 doctors.
 So
 what
 we
 end
 up
 doing
 in
 the
 present
 medical
 paradigm
 is
 to
 treat
  symptoms—to
  treat
  symptoms.
  We
  give
  a
  little
  bit
  of
  attention
  to
  trying
  to
  prevent
  disease
  in
  future,
  but
  in
  the
  total
  context
  of
  things,
  there
  is
  very
  little
  attention.
  Not
  many
  people
  pay
  attention
  anyhow.
  So,
  the
  present
  medical
  paradigm
  is
  focused
  on
  the
  treatment
  of
  symptoms,
  which
 incidentally,
 once
 we
 get
 to
 know
 what
 these
 chemicals
 are,
 what
 these
 drugs
 are,
 it’s
 only
  natural
  to
  assume
  there
  are
  going
  to
  be
  toxic
  side
  effects
  to
  every
  single
  one
  of
  these
  drugs.
  This
  is
 just
 a
 matter
 of
 time
 before
 we
 actually
 discover
 the
 side
 effects
 that
 occur.
 So,
 we
 are
 using
  these
  single
  things
  again,
  out
  of
  context,
  and
  having
  to
  experience
  toxic
  side
  effects
  along
  the
  way.
 
  Again,
  I
  want
  to
  turn
  our
  attention
  to
  the
  possibility
  of
  a
  different
  medical
  paradigm
  for
  the
  future—one
 that
 is
 based
 on
 wholism,
 not
 reductionism;
 where
 we
 depend
 on
 food,
 not
 nutrients
  or
 chemicals.
  Depending
 on
 food,
 not
 nutrients
 or
 chemicals.
 I
 am
 going
 to
 suggest
 that
 based
 on
  the
 evidence
 we
 now
 have,
 nutrition
 and
 food
 can
 be
 used
 to
 actually
 treat
 diseases,
 essentially
  with
  no
  toxic
  side
  effects.
  So,
  I
  would
  ask
  you
  just
  to
  compare
  the
  present
  medical
  paradigm
  and
  future
 medical
 paradigm,
 and
 see
 my
 point
 is
 that
 the
 future
 medical
 paradigm
 really
 is
 a
 much
  more
 effective
 strategy
 for
 creating
 and
 maintaining
 health
 than
 is
 the
 first
 system.
 And,
 if
 we
 do
  have
 problems,
 we
 now
 know
 we
 can
 actually
 treat
 those
 problems
 with
 the
 same
 approach
 as
  we
 would
 when
 we
 are
 preventing
 these
 diseases.
 
  I
  put
  the
  word
  transition
  here
  [slide
  number
  15]
  just
  to
  call
  your
  attention
  to
  the
  fact
  that
  we
  have
  a
  big
  challenge
  in
  front
  of
  us.
  We
  are
  trying
  to
  shift
  one
  huge,
  huge
  multifaceted
  industry
  to
  this
  latter
  medical
  paradigm,
  and
  of
  course
  I
  am
  sure
  all
  of
  you
  can
  appreciate
  the
  kind
  of
  challenge
  that
  lies
  ahead
  of
  us.
  But
  I
  think
  the
  key
  to
  all
  of
  this
  is
  simply
  to
  understand
  what
  nutrition
 can
 do,
 get
 it
 on
 record,
 and
 then
 try
 it
 for
 ourselves,
 and
 you
 can
 see
 what
 really
 can
  happen.
  For individual student use only: please do not copy or distribute. 9
© 2012, T. Colin Campbell Foundation and TILS

TCC501: State of Health
  Chapter
 10:
 Research
 Assumptions
 
 
  I
 am
 going
 to
 try
 to
 finish
 up
 here
 with
 giving
 some
 consideration
 to
 the
 research
 assumptions
  that
 we
 also
 tend
 to
 have
 when
 we
 are
 looking
 at
 the
 questions
 like
 this,
 and
 I
 think
 everybody
  needs
 to
 know
 that
 research
 for
 the
 most
 part—at
 least,
 respectable
 researchers
 start
 out
 with
 a
  hypothesis
  about
  something:
  that
  A
  causes
  B,
  or
  whatever
  the
  case
  may
  be.
  And
  so,
  we
  will
  consider
  that
  hypothesis,
  do
  some
  work
  on
  it,
  and
  then
  get
  some
  results
  that
  quite
  frankly
  do
  reflect
 a
 personal
 bias
 as
 we
 went
 into
 this
 study.
 
 
  The
 first
 question
 that
 I
 would
 ask
 is:
 Who
 is
 choosing
 the
 hypothesis
 and
 why
 did
 they
 choose
  that
  hypothesis?
  Science
  is
  not
  perfect.
  I
  would
  like
  to
  suggest
  that
  researchers
  or
  medical
  professionals,
  especially
  when
  they
  are
  starting
  their
  careers,
  may
  begin
  with
  some
  questions.
  They
  may
  want
  to
  investigate
  some
  important
  questions,
  so
  they
  form
  a
  hypothesis.
  But
  if
  I’m
  evaluating
 the
 strength
 of
 their
 research
 later
 I
 would
 like
 to
 know
 who
 chose
 the
 hypothesis
 and
  why
  did
  they
  choose
  that
  particular
  hypothesis?
  Often,
  the
  hypothesis
  does
  reflect
  what
  turns
  out
  to
  be
  a
  considerable
  amount
  of
  personal
  bias,
  whether
  they
  know
  it
  or
  not.
  And
  the
  research
  hypothesis
  that
  is
  actually
  examined
  over
  years,
  quite
  frankly
  can
  still
  be
  focused
  very
  specifically
 on
 individual
 entities
 in
 the
 food.
 
  Once
 we
 start
 doing
 that,
 looking
 at
 one
 thing
 at
 a
 time,
 that’s
 the
 old
 drug
 model,
 single
 nutrient
  supplement
 model,
 we’re
 back
 into
 the
 game
 of
 reductionism
 again,
 and
 we
 end
 up
 with
 a
 huge
  amount
 of
 confusion
 with
 the
 American
 public.
 And
 so
 biases
 occur
 at
 all
 levels
 of
 research,
 and
  what
 really
 turns
 out
 to
 be
 an
 interesting
 kind
 of
 phenomenon
 is
 that
 the
 biases
 that
 we
 tend
 to
  have
  doing
  this
  kind
  of
  research
  are
  biases
  that
  we’re
  dragging
  up
  from
  personal
  past,
  maybe
  bias
  associated
  with
  a
  funding
  agency,
  biases
  supported
  by
  a
  lot
  of
  colleagues
  as
  well.
  And
  so,
  bias
 comes
 from
 here,
 there,
 and
 everywhere,
 and
 pretty
 soon
 the
 biases
 sort
 of
 aggregate
 into
  almost
 a
 crescendo
 of
 bias;
 we
 finally
 get
 to
 a
 point
 in
 having
 a
 bias
 that
 we
 don’t
 even
 see
 it.
 We
  are
  living
  within
  the
  inner
  realm
  of
  this
  bias
  and
  don’t
  tend
  to
  question
  it—it
  becomes
  so
  pronounced
 in
 a
 sense,
 without
 [our]
 necessarily
 knowing
 it,
 that
 it
 becomes
 a
 theory,
 becomes
 a
  way
 of
 living,
 a
 way
 of
 thinking.
 
  I
 just
 want
 to
 point
 out
 that
 science
 is
 not
 so
 perfect
 as
 people
 tend
 to
 believe
 it
 is.
 It’s
 a
 great
  concept.
 If
 we
 can
 do
 it
 right,
 we
 can
 learn
 a
 lot,
 but
 it’s
 also
 subject
 to
 bias.
 
  I
  want
  to
  point
  out
  that
  as
  we
  focus
  our
  attention
  on
  one
  thing
  at
  a
  time,
  as
  we
  do
  in
  the
  present
  system,
 this
 gives
 rise
 to
 confusion
 because
 we’re
 just
 choosing
 the
 little
 trees
 in
 this
 big
 forest
  and
 trying
 to
 draw
 conclusions
 about
 the
 whole
 forest
 by
 looking
 at
 one
 thing
 at
 a
 time.
 One
 of
  the
 best
 examples
 of
 this
 is—I’ll
 mention
 later
 and
 I
 should
 introduce
 it
 now—is
 this
 idea
 that
  randomized
  controlled
  trials
  are
  supposedly
  the
  gold
  standard.
  I
  don’t
  consider
  this
  the
  gold
  standard
 at
 all;
 it’s
 a
 gold
 standard
 for
 testing
 drugs,
 but
 it’s
 not
 the
 gold.
 It’s
 probably
 one
 of
 the
  most
 misleading
 kinds
 of
 experimental
 trials
 that
 I
 can
 possibly
 think
 of
 in
 research,
 because
 a
  randomized
 controlled
 trial
 is
 one
 [in
 which]
 we’re
 looking
 at
 one
 thing
 at
 a
 time.
 
  In
  theory,
  you
  can
  do
  randomized
  controlled
  trials
  supposedly
  double-­‐blinded,
  looking
  at
  a
  certain
  kind
  of
  diet
  and
  comparing
  another
  kind
  of
  diet,
  but
  people
  then
  don’t
  give
  much
  For individual student use only: please do not copy or distribute. 10
© 2012, T. Colin Campbell Foundation and TILS

TCC501: State of Health attention
  to
  that
  kind
  of
  thing,
  and
  they
  don’t
  do
  that
  kind
  of
  thing
  because
  they
  are
  always
  looking
 for
 the
 specific
 agent
 in
 that
 food
 or
 that
 dietary
 pattern.
 
  In
  any
  case,
  there
  is
  another
  assumption
  that
  is
  prominent
  in
  our
  system.
  In
  the
  next
  slide,
  I
 just
  want
  to
  point
  out
  a
  couple
  of
  other
  ideas
  too.
  [See
  slide
  number
  21.]
  Namely,
  that
  as
  we
  do
  research,
 and
 as
 science
 publishes
 this
 research,
 and
 especially
 as
 the
 media
 then
 tell
 this
 to
 the
  American
  public
  and
  so
  forth,
  and
  all
  these
  biases
  tend
  to
  creep
  in,
  we
  have
  a
  tendency
  in
  research
  to
  publish
  the
  results
  that
  favor
  our
  hypothesis
  or
  whatever
  it
  may
  have
  been
  in
  the
  first
 place;
 that’s
 why
 I
 raised
 the
 question
 [of]
 who
 is
 choosing
 these
 hypotheses
 and
 why
 did
  they
 choose
 them.
 And
 once
 they
 get
 sort
 of
 invested
 in
 doing
 that
 kind
 of
 research
 and
 getting
 a
  certain
 kind
 of
 result,
 then
 everything
 from
 thereon,
 if
 it
 favors
 the
 hypothesis,
 they
 will
 tend
 to
  publish
 it.
 If
 it
 doesn’t,
 it
 doesn’t
 get
 published,
 and
 that’s
 a
 serious
 problem.
 There
 is
 evidence
 of
  that.
 There
 have
 been
 surveys
 done
 of
 that,
 showing
 that
 there
 is
 a
 tendency
 to
 publish
 favorable
  results
 when
 we
 should
 be
 looking
 at
 the
 reverse.21
 22
 
  So,
 on
 the
 last
 comment,
 I
 talk
 about
 trying
 to
 gain
 an
 understanding
 of
 “proof”
 and
 “truth.”
 I’d
  like
 to
 use
 these
 words
 with
 much
 less
 certainty.
 In
 my
 realm
 of
 thinking,
 as
 far
 as
 research
 is
  concerned,
 I’d
 like
 to
 talk
 about
 science
 being
 an
 art
 of
 observation,
 basically
 pursuing
 a
 truth.
  Not
 necessarily
 ever
 finding
 a
 truth,
 but
 pursuing
 the
 truth,
 and
 in
 the
 process
 actually
 gathering
  evidence
 to
 a
 point
 where
 we
 have
 so
 much
 evidence,
 let’s
 say,
 for
 a
 certain
 point
 of
 view
 that
  then
 enables
 us
 to
 make
 decisions
 about
 ourselves,
 or
 about
 the
 society.
 So,
 for
 me,
 it’s
 a
 weight
  of
 evidence
 concept—not
 looking
 at
 one
 thing
 at
 a
 time,
 especially
 doing
 it
 with
 precision.
 The
  more
 precise
 we
 get
 in
 these
 kinds
 of
 studies,
 I
 would
 suggest,
 the
 more
 likelihood
 it’s
 going
 to
 be
  an
 irrelevant
 result
 in
 our
 everyday
 life.23
 
  So,
 I
 like
 the
 idea
 in
 science
 of
 looking
 at
 the
 network
 of
 evidence,
 the
 breadth
 of
 the
 evidence,
  and
  the
  consistency
  of
  the
  evidence
  from
  all
  different
  kinds
  of
  perspectives
  to
  try
  to
  get
  a
  feeling
  for
 that,
 as
 opposed
 to
 trying
 to
 search
 for
 the
 magic
 bullets.
 
  Chapter
 11:
 Nutrition
 and
 the
 Medical
 Practice
 
  Nutrition
  doesn’t
  fit
  into
  medicine,
  as
  I
  said
  before;
  it
  just
  doesn’t,
  and
  this
  cartoon
  explains,
  I
  think,
  really
  quite
  well.
  [See
  slide
  number
  22.]
  And
  so,
  what
  we
  need
  in
  this
  business
  is
  to
  get
  away
 from
 the
 usual
 model
 of
 thinking
 about
 doing
 things
 really
 precisely
 and
 saying
 that’s
 the
  best
  of
  science;
  that’s
  really
  not
  true.
  We
  need
  to
  stand
  back
  and
  look
  at
  the
  broader
  perspective
  of
 the
 results
 we
 get,
 and
 using
 critical
 thinking,
 just
 really
 think
 about
 what
 we’re
 getting
 and
  see
 if
 it
 makes
 sense
 from
 all
 these
 different
 perspectives.
 
 

21
 Chan
 AW,
 Altman
 DG.
 Identifying
 outcome
 reporting
 bias
 in
 randomised
 trials
 on
 PubMed:
 review
 of
 publications
 and
 survey
 of
 

authors.
 BMJ.
 2005
 Apr
 2;330(7494):753.
 Epub
 2005
 Jan
 28.
 
22
 Lesser
 LI,
 Ebbeling
 CB,
 Goozner
 M,
 Wypij
 D,
 Ludwig
 DS.
 Relationship
 between
 funding
 source
 and
 conclusion
 among
 nutrition-­‐

related
 scientific
 articles.
 PLoS
 Med.
 2007
 Jan;4(1):e5.
 
23
 By
 “precise”
 Dr.
 Campbell
 is
 referring
 to
 research
 conducted
 on
 single
 nutrients
 and
 single
 effects,
 as
 opposed
 to
 examining
 the
 

broader
 context
 with
 a
 wholistic
 perspective.
 

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

11

TCC501: State of Health And
 so,
 the
 only
 way
 that
 we’re
 going
 to
 get
 nutrition
 into
 the
 practice
 of
 medicine,
 into
 our
 lives
  and
  then
  we
  understand
  it,
  is
  to
  first
  recognize
  that
  it
  is
  a
  very
  complex
  subject
  and
  we’ve
  got
  to
  treat
 it
 with
 respect—at
 least
 the
 science
 with
 respect,
 and
 then
 gather
 the
 evidence.
 
  Chapter
 12:
 Consequences
 of
 Deciding
 What’s
 for
 Dinner
 
 
  In
  the
  next
  slide,
  [slide
  number
  24]
  I’m
  just
  simply
  showing
  this
  idea
  that
  nutrition
  operates
  within
  the
  body
  in
  a
  very
  complex
  way,
  and
  we’ve
  got
  to
  look
  for
  the
  balance
  of
  evidence,
  and
  look
  at
  it
  carefully
  and
  try
  to
  control
  our
  biases,
  at
  least
  be
  aware
  of
  the
  biases
  we
  have.
  That
  extends
 all
 the
 way
 to
 what
 we
 decide
 to
 do
 with
 everything
 in
 our
 lives.
 In
 other
 words,
 deciding
  what’s
 for
 dinner
 has
 consequences,
 and
 I’m
 going
 to
 suggest
 based
 on
 the
 first
 slides
 I
 showed
  that
 the
 diseases
 occur
 because
 we
 don’t
 understand
 nutrition.
 I
 mean,
 a
 huge
 proportion
 of
 the
  diseases
 are
 really
 related
 to
 what
 we’re
 choosing
 to
 eat
 and
 the
 nutritional
 effect
 they
 have,
 and
  it’s
  not
  just
  on
  our
  bodies.
  It’s
  related
  to
  strongly
  to
  environmental
  degradation;
  whether
  it’s
  the
  global
 warming
 issues,
 contamination
 of
 water,
 soil
 loss.
 
  We
 already
 know,
 as
 I
 mentioned
 before,
 that
 it’s
 associated
 to
 the
 way
 we
 do
 things
 now—it
 has
  excessive
 medical
 costs.
 Inappropriate
 research
 design
 and
 interpretation,
 I’ll
 briefly
 just
 touch
  upon
 that;
 we’ll
 learn
 more
 about
 that
 in
 the
 course,
 political
 policy
 corruption
 too
 comes
 into
  play,
 and
 all
 of
 these
 sorts
 of
 outcomes
 or
 consequences
 are
 really
 important
 and
 they
 all
 start
  with
 what
 we
 decide
 to
 eat.
 
  And
 the
 last
 slide
 is
 just,
 I’ll
 leave
 you
 with
 a
 thought;
 namely,
 it
 kind
 of
 helped
 me
 to
 think
 about
  it
  this
  way,
  I
  think.
  [See
  slide
  number
  25.]
  We
  need
  to
  investigate
  the
  details.
  I’m
  not
  against
  reductionist
  research—I’m
  very
  much
  for
  that
  kind
  of
  very
  detailed
  kind
  of
  research.
  But
  we
  should
 investigate
 what
 those
 details
 mean
 in
 a
 larger
 context,
 and
 use
 the
 details
 to
 support
 the
  construction
 of
 the
 bigger
 picture
 we
 are
 coming
 to
 understand.
 So,
 we
 investigate
 the
 details
 but
  apply
 the
 generalities.
 This
 is
 just
 a
 sort
 of
 thought
 that
 I
 would
 leave
 with
 you
 as
 you
 go
 through
  the
 series
 of
 courses.

For individual student use only: please do not copy or distribute.
© 2012, T. Colin Campbell Foundation and TILS

12

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