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A review by yyc_heather
Whole: Rethinking the Science of Nutrition by T. Colin Campbell
5.0
I found this book really interesting as a medical librarian. The author, a nutritional biochemist (retired) from Cornell University, has spent his life studying nutrients. He's sat on panels for the National Institutes of Health and the American Cancer Society, and is the author of The China Study, the largest ever study to look at a more traditional, largely plant-based, whole-food diet, and how it protects against many chronic diseases. His previous book on the China Study lays out the case for this diet (I haven't read it), but this book really interested me for its critique of how health research in general, and nutritional research in particular, is currently practised.
Campbell argues that Western models of medical research privilege "reductionist" research that studies single cause-effect relationships. This is fine for addressing simple questions, such as whether a new drug is effective against a disease; but woefully inadequate for nutrition and public health, where people lead complicated lives and health conditions are caused by the interaction of many more factors than could ever be traced in a simple randomized control trial. He offers many examples of nutrients that are found to be very beneficial to health when consumed in whole foods, but actually proved detrimental when isolated in supplements (i.e. beta-carotene and vitamin E). He argues that a more effective use of research dollars would be in the funding and health promotion of plant-based whole foods as the route to optimal health, and the funding of more observational studies to find out which diets correlate with better health. He argues that while these studies can't furnish "gold-standard" evidence in the traditional sense, they do a better job of identifying effective avenues for good health policy - he refers to such systems-oriented research as "wholistic" rather than the "reductionist" studies that are important as a starting point, but often not relevant to real patients in the real world.
Campbell looks at how universities, granting agencies, the NIH, and societies such as the American Cancer Society generally ignore or belittle such research, for two big reasons: first, because the existing scientific paradigm favours the reductionist investigation of single-factor relationships (as seen by the fact that RCTs and systematic reviews occupy the top of the evidence pyramid, with observational studies being viewed as lower-quality evidence); and secondly, because all these agencies are beholden to corporate sponsors in the very food industries whose products cause so many of our chronic diseases, or to sponsors in the pharmaceutical industries who want to promote drug therapies over nutritional interventions. He offers many compelling examples from his own personal experience of attempts by these interests to suppress or deny funding to research on the effects of poor nutrition on developing cancer and heart disease; and the effects of good nutrition on preventing/reversing these diseases, and makes a compelling case that nutrition is the single biggest factor behind our ills in the Western world.
As a health librarian who had largely bought into existing paradigms about which research methods provide the "best" evidence, I found this book really eye-opening, and it articulated a lot of the rather vague dissatisfactions I've often felt with the heavy focus on RCTs and systematic reviews to answer questions that aren't necessarily best addressed through these methods, and the use of the PICO (Population, Intervention, Comparison, Outcome) framework to frame research questions that are probably far too complicated to be framed in such a simple way. After reading this book, I will certainly be looking at a lot of the "evidence" around cancer and chronic diseases with a much more skeptical eye, and trying to cut back meat and dairy consumption and add more whole plant foods to my own and my family's diets.
Campbell argues that Western models of medical research privilege "reductionist" research that studies single cause-effect relationships. This is fine for addressing simple questions, such as whether a new drug is effective against a disease; but woefully inadequate for nutrition and public health, where people lead complicated lives and health conditions are caused by the interaction of many more factors than could ever be traced in a simple randomized control trial. He offers many examples of nutrients that are found to be very beneficial to health when consumed in whole foods, but actually proved detrimental when isolated in supplements (i.e. beta-carotene and vitamin E). He argues that a more effective use of research dollars would be in the funding and health promotion of plant-based whole foods as the route to optimal health, and the funding of more observational studies to find out which diets correlate with better health. He argues that while these studies can't furnish "gold-standard" evidence in the traditional sense, they do a better job of identifying effective avenues for good health policy - he refers to such systems-oriented research as "wholistic" rather than the "reductionist" studies that are important as a starting point, but often not relevant to real patients in the real world.
Campbell looks at how universities, granting agencies, the NIH, and societies such as the American Cancer Society generally ignore or belittle such research, for two big reasons: first, because the existing scientific paradigm favours the reductionist investigation of single-factor relationships (as seen by the fact that RCTs and systematic reviews occupy the top of the evidence pyramid, with observational studies being viewed as lower-quality evidence); and secondly, because all these agencies are beholden to corporate sponsors in the very food industries whose products cause so many of our chronic diseases, or to sponsors in the pharmaceutical industries who want to promote drug therapies over nutritional interventions. He offers many compelling examples from his own personal experience of attempts by these interests to suppress or deny funding to research on the effects of poor nutrition on developing cancer and heart disease; and the effects of good nutrition on preventing/reversing these diseases, and makes a compelling case that nutrition is the single biggest factor behind our ills in the Western world.
As a health librarian who had largely bought into existing paradigms about which research methods provide the "best" evidence, I found this book really eye-opening, and it articulated a lot of the rather vague dissatisfactions I've often felt with the heavy focus on RCTs and systematic reviews to answer questions that aren't necessarily best addressed through these methods, and the use of the PICO (Population, Intervention, Comparison, Outcome) framework to frame research questions that are probably far too complicated to be framed in such a simple way. After reading this book, I will certainly be looking at a lot of the "evidence" around cancer and chronic diseases with a much more skeptical eye, and trying to cut back meat and dairy consumption and add more whole plant foods to my own and my family's diets.