The China Study

One of our readers asked that we evaluate a book I had not previously heard of: The China Study: Startling Implications for Diet, Weight Loss and Long-Term Health, by nutrition researcher T. Colin Campbell, PhD, with his non-scientist son Thomas M. Campbell II. The China Study was an epidemiologic survey of diet and health conducted in villages throughout China and is touted as “the most comprehensive study of nutrition ever conducted.” The book’s major thesis is that we could prevent or cure most disease (heart disease, cancer, diabetes, autoimmune diseases, bone, kidney, eye and other diseases) by eating a whole foods plant-based diet, drastically reducing our protein intake, and avoiding meat and dairy products entirely.

Opinions of the book

There’s a lot of praise for this book on the Internet. It was named VegNews Book of the Year. PETA loves it (not surprisingly). Heather Mills McCartney calls it inspirational. It was featured on and endorsed by two of her favorite doctors: Mehmet Oz and Dean Ornish. Its author was even interviewed on Coast to Coast AM.

But I also found this critical review which makes some excellent points and accuses the authors of misrepresenting the findings of the study. And this commenter on an forum also charges Campbell with misrepresenting the data from the study and points out numerous flaws in his reasoning.

Problematic references

I didn’t look at the praise or criticism of others until after I read the book, and the following represents my independent impressions. I approached the book as I do any book with scientific references: I read until I come across a statement of fact that strikes me as questionable and then I check the references given for the statement. This immediately got me off on the wrong foot with this book. In the first chapter I found the statement:

Heart disease can be prevented and even reversed by a healthy diet.

The end notes listed 2 references in support of this assertion. The first reference was not about diet alone, but about a combination of several lifestyle interventions (Dean Ornish’s intensive program). 28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care control group. The experimental group had less artery narrowing.

The second was a study of 22 patients with severe heart disease in a single physician’s practice. Their disease was arrested or reversed over a 5-year period not by diet alone but with a combination of a very low fat diet and cholesterol-lowering drugs. These studies were published in 1990 and 1995 respectively and as far as I know have not been replicated. And they were small preliminary studies of the kind that should be used only to guide further research, not the kind of definitive studies that can be used to guide clinical decisions.

Neither reference supports the claim that diet (by itself) can reverse heart disease and neither of them has anything to do with preventing heart disease – all the subjects in both studies already had the disease.

Reading further, I found that this was not an isolated oversight, but part of a pattern. For instance, Campbell asserts that diet is an effective treatment for melanoma and supports that claim by citing a Tijuana study of the discredited Gerson protocol, which includes coffee enemas and other non-dietary interventions. Patients allegedly cured of cancer by this method were tracked down by a naturopath who found that 5 years later all but one had died of their cancer and the only one still alive was not cancer free.

Actually there are a couple of more credible references listed on PubMed suggesting that a low-fat diet might be beneficial for melanoma. Why did the author not cite those studies but pick a disreputable one?

Sloppy citations like these do not disprove the author’s thesis, but they throw doubt on his scientific rigor and reasoning abilities.

The China Study

The China Study involved 100 adults in each of 65 counties in China. Only those between the ages of 35 and 64 were studied; for mortality rates they eliminated death certificates of those over the age of 64 as “unreliable.” They pooled blood samples from everyone in a village so they would have large enough samples to measure over 109 nutritional, viral, hormonal and other indicators in blood. They also measured 24 urinary factors, mortality rates for more than 48 diseases, 36 food constituents, 36 nutrient and food intakes, 60 diet and lifestyle factors, and 17 geographic and climatic factors. All in all, they studied 367 variables and made 8000 correlations. I’ll leave it to others to comment on the study design and the statistical analysis.

The Chinese eat far less animal protein than Americans and far less total protein than even American vegetarians. They eat more calories per kilo of body weight than Americans, apparently without weight gain even among the subset of Chinese who were least physically active (Campbell attributes this to thermogenesis from carbohydrate metabolism as compared to protein metabolism, and he claims that vegetarians feel more energetic and naturally exercise more, using up extra calories). They found that Chinese cholesterol levels are far lower than Western levels and decline as the amount of protein in the diet declines. They found a strong dose-effect relationship between the amount of animal protein in the diet and the rates of many diseases like heart disease and cancer.

Conflicting data

I found a number of studies in PubMed that reached very different conclusions. I’ll quote from one typical example and provide links to a couple of others.

Vegetarians form a non-homogenous group consisting of semivegetarians (plant food, dairy products, eggs and fish), lacto-ovo vegetarians (plant food, dairy products, eggs) and vegans (plant food only). According to pure vegetarian ideologists, people consuming vegetarian diet have better health and live longer than nonvegetarians, because persons consuming milk, dairy products, meat, eggs and fish are at health risk.In fact the most healthy people in Europe are inhabitants of Iceland, Switzerland and Scandinavia, consuming great amounts of food of animal origin. Meta-analysis of several prospective studies showed no significant differences in the mortality caused by colorectal, stomach, lung, prostate or breast cancers and stroke between vegetarians and “health-conscious” nonvegetarians. In vegetarians, a decrease of ischemic heart disease mortality was observed probably due to lower total serum cholesterol levels, lower prevalence of obesity and higher consumption of antioxidants. Very probably, an ample consumption of fruits and vegetables and not the exclusion of meat make vegetarians healthful.

And there’s this one And this one.

Campbell criticizes all Western studies of low-fat and low-protein diets because the Western versions of those diets still have far more fat and protein than the average diet in China. The Nurse’s Health Study found no connection between breast cancer and the amount of fat in the diet, but Campbell points out that it really only compared carnivorous nurses to slightly less carnivorous nurses. The “low-fat” group was still eating a very high-fat diet by Chinese standards. This is a very valid criticism, and it also applies to the relatively ineffective Western efforts to lower cholesterol and reduce the risk of heart disease with diet.

Observations from other countries tend to contradict the correlations found in China. The African Maasai eat a diet high in animal protein (meat, milk and blood from their cows) – yet they have low blood cholesterol levels and low rates of heart disease. Among the Eskimos (who ate an animal-based, very high protein, high fat diet) heart disease was practically unknown.

Campbell doesn’t attempt to explain a glaring exception to his data: stomach cancer rates are higher in China than elsewhere in the world – he doesn’t even mention that fact.

He cites all kinds of research to support his hypothesis that animal protein is bad. Toxins like aflatoxin and nitrosamine cause rats and mice to develop cancers, but carcinogenesis is prevented by feeding them a low protein diet. Casein (one specific animal protein in milk) has been linked to some human diseases. Links between fat, animal protein, vitamin D and other nutrients confuse the issue. The incidence of many diseases varies with latitude – is it the difference in sun exposure, the blood levels of vitamin D, the fact that people at higher latitudes eat more fat, that they eat more meat?

Diet recommendations

He marshals a lot of evidence, but is it sufficient to support his recommendation that everyone give up animal protein entirely, including dairy products? I don’t think so. There are legitimate concerns that such a diet may not be without risks. Even Campbell recognizes that strict vegetarians are likely to need vitamin B12 supplementation. If cow’s milk is prohibited for growing children and osteoporotic adults, they will likely need a supplemental source of calcium and vitamin D. Without careful nutrition guidance, children deprived of milk might end up malnourished. Breast milk is animal protein – should we avoid breast-feeding too?

He criticizes conventional recommendations for a diet with 45-65% of calories from carbohydrates, 20-35% from fat and 10-35% from protein, showing how the following menu satisfies those requirements:

1 cup Froot Loops
1 cup skim milk
1 package M&M milk chocolate candies
Fiber and vitamin supplements

Grilled cheddar cheeseburger

3 slices pepperoni pizza
16 oz soda
1 serving Archway sugar cookies.

But that’s a bit of a straw man argument. In reality, most current nutritional advice makes very much the same recommendations Campbell does except for his strict prohibition of animal protein. For instance, for cancer prevention the American Cancer Society recommends a diet high in fruits, vegetables, whole grains, and legumes and low in red meat and alcohol, along with regular exercise and weight control.

Except for proponents of the low-carb diet fad for weight loss, almost everything I have read recently in the way of diet advice is consistent with the ACS recommendations. More veggies, less red meat, fewer calories.


It would be wonderful if we could prevent cancer and all those other diseases by avoiding animal protein. It would have the extra added benefit to the environment of increasing the productivity of agricultural land and reducing the greenhouse effects of gassy cows. I look forward to future well-designed studies investigating the effects of very low protein and animal-protein-free diets. Meanwhile, The China Study makes a good case, but the case isn’t quite good enough.

Posted in: Book & movie reviews, Cancer, Nutrition

Leave a Comment (71) ↓

71 thoughts on “The China Study

  1. Jerebear559 says:


    I’d be extremely cautious linking to any Weston A Price Foundation article on grounds that they give a credible critical review of any piece of scientific (or pseudo-scientific, for that matter) literature.

    Weston A Price is deemed a questionable dentist and the Weston A Price Foundation is deemed a questionable resource of health information by Quackwatch.

    Their agenda is to propagate, among other things, the claim that a high-fat diet with plenty of full-fat, pastured-fed muscle and organ meats and lots and lots of raw, full-fat dairy will produce optimal health and cure many chronic diseases.

    Keeping their agenda in mind, it’s no wonder that they have an article vociferously arguing against the China Study, which purports the same outcome as their advocated diet, but in a somewhat diametrical manner.

    Actually, since you seem to dive into utter nonsense–I say that in a good way…we need someone to trudge through the extraordinary diet claims–, you should critique the insanity over at the Weston A Price Foundation (WAPF). It’s a thorough philosophy, which can keep you busy for a long time, and it also tries to look somewhat scientific in its articles, citing rather obscure and out-of-date sources (I know, a hallmark of quackery). Most WAPF claims are diet- or health-related, making this water I think you’d be most appropriate treading.

  2. zoe says:

    It’s a credit to your scruples that you would impartially evaluate the claims of this book.

    Since the author is of the unswayable moral conviction that eating meat and dairy is evil, he will take no more care with his science than suits his agenda. It would be like reviewing a book written by teetotallers on the health effects of alcohol.

    Or, for that matter, a book on creation science.

    The author does not care about the truth of the matter, it is only a means to win souls to his cause.

  3. SrrAB says:

    I haven’t read the book myself, but I can comment briefly on some of the problems with this study design.

    1) Was any baseline health info on the participants ascertained and controlled for? Was family history of illness controlled for?

    2) Was this a simple random sample? What was the loss to follow up? Was it uniform among all groups? Did the author control for age, sex, physical activity, etc?

    3) I’m not sure I understand this, but they pooled the blood of 100 participants and then tested the blood? This is ecological data and cannot apply to any individuals, it may just say something about the population of the village, IF the sample is representative.

    4) Is there any good reason for the age restrictions? They’re already sampling 6500 people, they’d have plenty of power to look for effects in younger and older people!

    5) Excluding death certificates of persons over the age of 64 CLEARLY introduces bias! Were the death certificates of all persons over 64 equally unreliable from village to village? Those people easily could have died from an outcome of interest but were excluded just because the author thought the certificate was unreliable. This had to have been done intentionally to get nicer data.

    I may be raising issues that have been dealt with in the book, but I’m very suspect that the authors picked a conclusion, then designed a study with built-in bias they knew would support their conclusion. Maybe there is a reason this was published as a book and not as a peer-reviewed paper before moving to the book press.

  4. Harriet Hall says:


    I recognize that the Weston Price website is biased and pseudoscientific. I also recognize that the review I cited had some excellent, cogent criticisms of the China Study that were not available elsewhere.

    It would have been unfair of me to reject the review just because of where I found it. If you have specific criticisms of the review, please explain.

  5. Fifi says:

    Harriet – What is does is associate you and your opinions with the site and its general slant/bias (unless you clearly distance yourself from the other beliefs on the site and even then it seems like cherry picking from a site that cherry picks! …if you see what I mean…). It’s very much like using a procircumcision site for info on circumcision or a White power site for genetic information – it brings your own credibility into question since you’re relying upon a source that has no credibility or a clear bias to back up your argument. It’s also not unlike people using that whale site or healthfreedomusa for information to back up their sCAM beliefs.

  6. David Gorski says:

    Harriet, given how much I admire your work over the years, it pains me to say this. It really does. But on this one point I’m going to have to agree with Fifi. The source does matter, even if the specific content linked to is sound, although I think Fifi definitely went too far in likening you to sCAMmers. That was a low blow, and uncalled for.

    I had been completely unaware of Weston Price; so I perused the site. It took me only moments to find highly dubious material there. From my perspective, if Weston Price is biased and pseudoscientific, that taints even the good stuff there, no matter how cogent that good stuff is. In other words, I would not cite the review because of its source, any more than I would cite something I agree with that appeared in JPANDS because of the taint by association. (I know, it’s very rare that anything with sound science appears in JPANDS, but you never know.) Alternatively, I would point out that the publication or site from which I derived the link and explicitly point out that much of the site is highly dubious but that I found this one article to be sound. I think that can be acceptable under some circumstances, but it’s difficult to pull off.

    Let me put it this way. In my review of Paul Offit’s book Autism’s False Prophets, I took Dr. Offit to task for having cited approvingly Steve Milloy and Michael Fumento, either ignoring or unaware of their numerous crank views, because on the issue of antivaccine lunacy they are correct. Here’s what I said at the time:

    Of course, no review would be complete if I didn’t briefly mention two things that bugged me about this book. No book is perfect, and Dr. Offit’s is no exception. Don’t get me wrong, though. Overall Autism’s False Prophets is an excellent book that I recommend highly. Nonetheless, I do have two minor nits to pick. The first is that Dr. Offit approvingly quotes Steven Milloy twice and Michael Fumento once, both of whom are well known corporate shills, apologists for conservative politics, antienvironmentalists, and anthropogenic climate change “skeptics.” (Indeed, Steve Milloy is known for his famous and dubious “Ultimate Global Warming Challenge.”) Moreover, both have been accused of ties to the very tobacco companies to which Dr. Offit compared antivaccinationists to, and both have conflicts of interest in the form of ties to and/or funding from the industries whose interests they virtually always champion, be it big oil, big pharma, or big tobacco. That they happen to be correct in condemning the antivaccination movement is not a good enough reason to cite them, and Dr. Offit could have made his points just as well without including quotes from such tainted sources. Even though the quotes themselves argue Dr. Offit’s case about science and society and the law, anyone who has skeptically examined the rhetoric of Milloy or Fumento will know that neither of them is a credible spokesman for science-based medicine.

    That is why I never, ever cite Fumento or Milloy (or any other cranks or crank websites), even when they are right about something, as Fumento and Milloy are about vaccines. They are just too wrong about too many other things. I also try very hard not to cite dubious sources for support, even if the specifics of what I link to are sound. I admit that I don’t always succeed, but I try.

    Take this final remark as a compliment, because that’s what it is: You didn’t need to link to the Weston Price site. Your review was excellent without it, and it really didn’t add anything to your well-written and well-argued review.

  7. Harriet Hall says:

    One could argue that it added to my article because even a pseudoscientific site could find valid criticisms of the book.

    I won’t apologize for citing the review on the Weston Price website, because I think it is a good review; although in retrospect I might have mentioned that it was a rare gleam of reason on a generally unreliable website.

    I was trying to be fair and show that there were both pro and con opinions of the book. I also mentioned that Oprah had featured it; and I certainly don’t consider her a reliable source.

    I don’t go looking for pearls in the mud of a pigsty, but if I happened to see one there, I wouldn’t refuse to pick it up just because of where I found it.

  8. Fifi says:

    Dr Gorski – I wasn’t saying Dr Hall was equivalent to the sCammers, what I was saying that she’s making herself look the same and it disempowers her argument (here and in other situations). It not only disempowers the integrity of her own posts but also reflects poorly on the sciencebasedmedicine blog overall since it starts to create a double standard regarding biased evidence/opinions and also links the blog to industry shills and pseudoscientific sites (thereby empowering any “you’re in the pockets of industry” critics). How exactly is being honest about how a behavior looks a “low blow”? Isn’t the aim of this blog to protect scientific integrity? Or is it to promote an ideology (by any means necessary)? Isn’t keeping one’s own house clean important if fingers are pointing to the dirt in other people’s houses?

    I also agree that Dr Hall didn’t need to link to the Weston Price site or any other reviews in general – overall doing that as the prelude actually weakens the piece from an editorial standpoint (though I understand it was probably meant to contextualize). I actually enjoy Dr Hall’s blogs even when I don’t agree with her about something simply because she tends to come at things from a real world/GP perspective rather than academic’s or specialist’s one.

  9. Dacks says:

    I second the suggestion for one of you docs to delve into the Weston Price scene. Where I live I happen to be surrounded by WAP acolytes who regularly write “health” columns in the local paper promoting the benefits of raw milk. I have been invited repeatedly to join their group, and have based my demurrals on the fact that I don’t follow gurus. But I’d love to have some more specific info.

  10. Fifi says:

    To make a general suggestion, this blog would be very, very well served by getting a science-based nutritional expert and a science-based sports physician on board. Nutrition and exercise are one of the biggest areas of woo out there and one’s that touch the lives of more people than woo “cures” for disease. Both are areas where even GPs and other physicians tend to be biased towards their own chosen lifestyle (exercise and diet habits) and beliefs, and where there’s still a lot of speculative research going on and many remaining mysteries to solve. (This isn’t intended as an insult, it’s just noting that MDs are human!) Just as much nutrition woo comes out of the food industry as out of sCAM, ditto for exercise woo coming from the fitness industry. This is one area where both the mainstream and alternative industries need to be taken to task by science literate people! I think you’d find a lot of interested readers and may actually – if it’s communicated well and without hostility – move many away from the sCAM pseudoscience they believe is science into understanding the state of the current science.

  11. Zetetic says:

    Seems I recall that stomach cancer is related to a certain type of talc treated rice that is popular in asian countries.

  12. Fifi says:

    Dr Hall wrote – “I was trying to be fair and show that there were both pro and con opinions of the book. I also mentioned that Oprah had featured it; and I certainly don’t consider her a reliable source.”

    Actually it seems clear in your blog that you don’t consider Oprah a reliable source since you compare her coverage to a “critical view which makes some excellent points and accuses the authors of misrepresenting the findings of the study” which you agree with. This may not be what you intended to convey but it’s the way it comes across. It’s particularly unfortunate since the review is on a site that tends to misrepresent the findings of studies! I’d suggest the analogy is more like finding a real pearl on string of fake pearls than finding a pearl in the muck – can you see how this becomes problematic when it’s about helping people discern the science from the pseudoscience? And how you’re essentially linking your own perspective (and this blog) to that of a site that uses pseudoscience to promote industry interests?

  13. cheglabratjoe says:

    I understand where these comments are coming from, but isn’t this one big ad hominem argument? You’re all saying that citing a certain source is bad because of what that source is. As Harriet said, the site had good points about the book being reviewed. Thus, I think it was fair to mention it. If the citation was extraneous (as David claimed), then perhaps including it wasn’t the best idea, given the site’s woo baggage. But, I don’t think it deserves this backlash.

    Fifi, I think you’re being especially over-the-top. One citation in one article is disempowering, ruins integrity, sets a double standard, and indicates industry-shill-hood? Come on, now. More important is your comparison to citing That site doesn’t contain bad information simply *because* it is that whale site; the information is wrong because it is wrong. You’re taking Scopie’s Law way too seriously.

  14. Fifi says:

    cheg – You are entitled to your opinion, of course. Really it’s about what perspective one is coming from – unbiased scientific discourse or effective communication. My critique comes from the perspective of being an effective communicator and advocate of science-based medicine. This isn’t the first time Dr Hall has referred to sites with a clear bias to back up her perspective. (For the record, I have no idea whether it’s laziness or bias or something else but it gives the appearance of promoting a biased perspective – don’t discount the power of image, it’s what’s made sCAM so successful!) Authors here regularly dismiss certain sources and studies/opinions from certain publications on the grounds that those publications aren’t reliable and are lacking in integrity. In general, most people who aren’t MDs aren’t actually going to be expert enough in medical science to be able to understand studies, they need them interpreted. The reality is not even all doctors are experts in all areas of medicine and they themselves rely upon experts in certain areas.

    The Weston-Price site is a propaganda site, just like Whale. I fail to see the difference that you seem to see – particularly since Weston-Price is known to be a front for corporate interests. I particularly fail to see the difference in terms of image creation and communication.

    I guess the question is whether authors here are interested in communicating and getting their message and accurate information about science and good sources of scientific information across to a wider audience or are just interested in preaching to the choir.

  15. cheglabratjoe says:


    I don’t understand the point of your last paragraph. I can’t speak for the authors, of course, but I would guess that they want to get science-based medicine across to a wide audience. I don’t see what this issue has to do with that. Harriet didn’t say “here’s a great site, treat everything you read there as gospel!”

    Part of science is being skeptical. You should be skeptical of everything linked here or anywhere. If it’s a link to Science or Nature article you can probably safely lower your defenses; if it’s a link to you probably shouldn’t even click the link. The site she linked to is in between, apparently closer to the latter than the former. So, you ought to be skeptical of anything on it, but Harriet feels this one section is valid and pertinent to her entry.

    What would you have done, if you were in Harriet’s shoes? You just read a valid and interesting criticism of something on a woo-woo site. Should you look for the same criticism on a site you consider legitimate? Should you present the criticism as your own original idea? Should you leave that criticism out of your writings? I don’t think any of those options are good ideas, though some are obviously much better than others. Even someone’s pretty-good suggestion above (to cite with a disclaimer) would still evoke most of your concerns about associating with a woo site. What would you have done?

  16. Fifi says:

    cheg – Sure part of science is being skeptical (and thanks for the undoubtedly well meaning talking down! ;-) Skepticism is also part of discerning propaganda – particularly when it’s a question of science vs pseudoscience rather than science vs magic/religion (pseudoscience may be woo but it’s pretending to be science and works hard to be indiscernable to the average person). In communication terms, who we link to and are associated with contribute to our aura (meant in terms of commmunication and image building not radiant supernatural energy).

    What would I have done? I would have left off the whole “intro” bit since it’s not very effective from an editorial perspective to begin with. There are also plenty of ways to point to the actual information that was correct on the Weston Price site while also acknowledging what their bias is. If Dr Hall shares that bias then it’s a matter of honesty for her to be clear about it. I mean, if one has an ideological issue with vegetarians or prejudice against vegetarians then basic honesty requires one be up front about that.

    I’m an advocate of eating whole foods and not a fan of the food industry myself but I still wouldn’t refer people to the Weston Price site for info on these matters or indicate they’re a source that I rely upon for information.

  17. Fifi says:

    The whole “being fair” thing also seems odd to me since one of the recurring complaints of blog authors here is that professional journalists do science a disfavor by giving “fair and balanced coverage” which gives equal time to pseudoscientists as scientists in the name of “fairness”.

  18. Dacks says:

    “particularly since Weston-Price is known to be a front for corporate interests. ”

    ?? More info, please.

  19. David Gorski says:

    Dr Gorski – I wasn’t saying Dr Hall was equivalent to the sCammers, what I was saying that she’s making herself look the same and it disempowers her argument (here and in other situations).

    Your words:

    It’s very much like using a procircumcision site for info on circumcision or a White power site for genetic information – it brings your own credibility into question since you’re relying upon a source that has no credibility or a clear bias to back up your argument. It’s also not unlike people using that whale site or healthfreedomusa for information to back up their sCAM beliefs.

    Please explain to me: How is this not comparing what Harriet did to sCAMmers or–even worse, which I should have mentioned before–white supremacists and thereby likening her to them? How else am I to interpret your words?

    No, Fifi, although you made what I consider to be a valid point that I actually still agree with, namely that citing articles from highly dubious sources risks contaminating one’s argument with association with pseudoscience even if the specific article being cited was science-based, you were way over the top and out of line, period. In fact, rereading your original comment again, I can’t believe I didn’t call you out for that the first time–definitely an oversight on my part.

  20. My two cents:

    On the one hand, while I was reading the post but before I read the comments, I was ready to invoke a variation of Scopie’s Law to criticize Campbell and son for having cited “a Tijuana study of the discredited Gerson protocol” as evidence that “diet is an effective treatment for melanoma.” Game, set, and match. End of story. It’s ovah. If it’d been me instead of Harriet, I wouldn’a read another word.

    Than I had a little break in the action today and just for the helluvit went to PubMed and rang up TC Campbell and found a buncha articles that you can get for free in their entirety. I perused a few. Suffice it to say that he doesn’t seem nearly as stupid in these (no delicate way to put it) as his Gerson citation suggests. There are still problems: so far it looks as though EVERY article supports current trendy, tree-hugging notions about diet and disease. Low animal fat/protein prevents heart disease, cancer, and every other scourge of modern life. It even prevents carcinogenesis associated with aflatoxins, among the most carcinogenic substances known. There’s something just a little too pat about all this. It’s also notable that although Campbell’s papers emanate from Cornell (Ithaca, not the medical center in NY), he’s almost always working with one or more co-authors from China, back to the ’80s at least. Makes ya wonder:

    There’s more in the way of particulars, such as an off-handed statement that “At the start of this study [1981, I think], it was known that [cancers, heart diseases, and diabetes] are much less common in China [than in the west]…” and that in China,

    “for about a dozen different cancer sites, age-standardized mortality rates were highly localized geographically. Mortality rates ranged [varied, I think he meant] from as much as a few dozen to a few hundred fold, being far greater than the mere 1.5-2.0 fold geographic extremes observed for the U.S.”

    He seems to have accepted the China data without question. I don’t know that “it is known, [etc.],” and I wouldn’t trust any pronouncements of that sort from China that likely originated during the Cultural Revolution, which ended in 1976. Regarding the highly variable geographic mortality rates, I haven’t yet found the first time he discussed them, but my initial reaction is to doubt that those data can be trusted either. My second reaction, even if I became convinced that they could be trusted, would be to look for plausible confounders having nothing to do with diet, such as differences in the availability of competent, modern medical care. Perhaps he did that, but he doesn’t say it here:

    Regarding the above teapot tempest: yeah, dissing an article because it’s on WAPF is ad hominem, but sometimes ad hominem is a useful shortcut (see Scopie). Nevertheless, if the reviewer is reasonable, as is Harriet, one owes her the benefit of the doubt. Here’s my ad hominem: I’ll take my respect for Harriet over my contempt for WAPF any day, or at least until proven otherwise.

    Let’s not quibble over ‘ookilled ‘oo.

  21. Fifi says:

    Dacks – Actually I may be wrong about that…though their rabidly pro-raw milk and anti-soy bias does make one go “hmmmm”. It appears that it’s like a lot of non-profits of it’s kind where the non-profit arm is more about promoting ideolgoy that is likely to support sales of products outside of the non-profit (in this case diet books written by the Foundation’s founders).

    I don’t disagree with all their premises but like many dietary woo sites they seem to start with common sense then veer off into ideology (some of which I’m sympathetic too but it doesn’t change it from what it is :-).

    “The main sources of support for the Weston A. Price Foundation are the dues and contributions of its members. The Foundation does not receive funding from the government or the food processing and agribusiness industries. It does accept sponsorships, exhibitors and advertising from small companies by invitation, whose products are in line with WAPF principles. [9] [10] Current sponsors can be seen at the main page of Weston A. Price. The sponsors include meat and fish producers, as well as health product companies.
    The WAPF states it is dedicated to “restoring nutrient-dense foods to the human diet… [and] supporting particular movements that contribute to this objective including accurate nutrition instruction, organic and biodynamic farming, pasture-feeding of livestock, community-supported farms, honest and informative labelling, prepared parenting and nurturing therapies. Specific goals include establishment of universal access to clean, certified raw milk and a ban on the use of soy in infant formulas. The organization actively lobbies in Washington DC on issues such as government food triangle definition and composition of school lunch programs.”[11]
    [edit]Sally Fallon
    Sally Fallon is the co-founder and president of The Weston A. Price Foundation. According to the WAPF, she received a B.A. in English from Stanford University and a M.A. in English from UCLA.[4] She co-authored two cookbooks with WAPF co-founder Mary G. Enig — Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats[12] and Eat fat, Lose fat: lose weight and feel great with three delicious, science-based coconut diets, the latter of which are diets based on coconut.[13]”

  22. Dacks says:

    Waaay off topic, but

    “ and biodynamic farming…” Arrgh! As a (mostly) organic gardener/farmer this conflation always sets my teeth on edge. Biodynamics is based on the principles of Rudolph Steiner, also the force behind Waldorf schools, and includes things like stirring a concoction for a certain number of strokes in a clockwise (or is it counterclockwise?) direction, and burying a cow’s horn filled with compost for a period of time to infuse it with magical powers.

  23. Fifi says:

    What I was intending to convey that behaving a certain way makes you (or me or that guy over there) no different than other people behaving a certain way – so I guess I was saying that Dr Hall was behaving in a way that is just like sCAMmers and makes her look like she’s taking a page out of the same book. That doesn’t mean I actually think she’s trying to run a scam (but then a lot of people who practice CAM aren’t trying to scam people either). I myself am not perfect nor have I magically managed to avoid being prone to doing human things like make mistakes. I don’t expect Dr Hall (or you or anyone else) to be perfect either. However, being unable to recognize a personal bias, a biased source of information or brushing it off as unimportant (or just being “fair”) when it’s pointed out seems a bit odd to me considering that “fair and balanced” journalism is frequently criticized here when it’s written by others.

  24. cheglabratjoe says:


    Didn’t mean to talk down to you, but, to repeat myself and echo David, you’re still hitting this point way too hard. Harriet said: “here’s the book being credulously promoted, but here are two critical opinions on it.” One of those critical opinions is on a woo site, but it is still a valid criticism and is itself not BS. I suppose it would have been prudent for Harriet to add a clear disclaimer about the site’s biases (if nothing else to, prevent this blog-comment brouhaha), but I don’t think it was vital. And, I definitely don’t think it tarnishes SBM’s “aura.”

    It seems like you (and others) would dismiss this review out-of-hand due to its source. While this may be a good rule of thumb (as Kimball pointed out), it is not strictly valid and in this case would have been counter-productive. Harriet apparently feels (and I don’t think anyone has disagreed with her) that the author did good work in writing it, so it ought to be considered. This consideration should certainly be taken with a grain of salt, but then again so should *everything.*

    Besides, we probably should encourage infighting between pseudoscientists. Divide and conquer. ;)

  25. Fifi says:

    cheg – I’m just frustrated because I see authors here making some very elementary mistakes regarding communication to a general audience. And some very specific mistakes if they’re hoping to reach people who actually use CAM (not to mention that linking to a site with praise for their science tends to give the impression that all the science on that site is reliable). At times I do sincerely wonder if the objective is science education, the promotion of science based medicine or simply another version of the American culture war where it’s about ideological battles. Of course, the authors here are as human as all of us so perhaps I just shouldn’t expect them to be paragons of bias free virtue.

    Just so you know where I’m coming from (in case context helps), I grew up godless around medicine (two doctors for parents, one a researcher as well) so skepticism is there by both nature and nurture. I also worked in a pain clinic for a period helping people understand the body/mind connection (so I have some experience explaining things in ways that the average person can understand, in two languages). I neither deify nor demonize the medical profession or science (though I am very aware of the historical biases, some which can linger). My main profession is as a writer and I work in communications and write about cultural theory, hence my concern with communication and image construction.

    I’m sure that the link doesn’t tarnish SBM’s aura for you cheg, you’re already a fan and you’re a scientist (aka “the choir”). However, for someone who isn’t science literate and who may be on the fence or into CAM or a vegetarian, linking to that site could make a difference since it’s got a reputation that precedes it. I like how Dr Hall comes across generally (and I have a bias towards liking women doctors for obvious reasons), however I now have doubts about her ability to be unbiased about certain issues.

  26. weing says:

    I don’t get what the hullabaloo is all about. A broken clock is correct twice a day. If you let your guard down and suspend skepticism just because an article appears in Nature, Science, Lancet, or NEJM, then you are a fool. If these, ostensibly reliable journals can publish crap and fraudulent articles, isn’t it possible for something reliable appear in a crappy journal or website?

    If someone is into CAM, militant vegetarianism, or whatever, the only thing that this website can do is to present the knowledge and the science behind the phenomena as lucidly as possible. That way a reader can have an ‘A HA!’ moment.

    We are all human, I presume. Since childhood, I have gone every year evaluating my knowledge and blushing at “How could I have been so stupid as to believe that last year!”

  27. David Gorski says:

    I don’t get what the hullabaloo is all about. A broken clock is correct twice a day. If you let your guard down and suspend skepticism just because an article appears in Nature, Science, Lancet, or NEJM, then you are a fool.

    Indeed, Bienveniste’s “memory of water” paper about homepathy was originally published in Nature, if I recall correctly.

  28. David Gorski says:

    I’m just frustrated because I see authors here making some very elementary mistakes regarding communication to a general audience.

    And you’re making some howlers of mistakes trying to persuade anyone of anything. For instance, even though I tend to agree more than disagree with your point, you’ve totally managed to annoy the hell out of me with your clumsy and overwrought manner of making it.

  29. daedalus2u says:

    I must disagree with most of the other commenters here and support Dr. Hall. I really do like her metaphor of finding a pearl in a pigsty. I try to keep my eye out for gems wherever I am ;)

    One goal of educating oneself is so that one can critically evaluate information independent of the source and use what is of value where ever it is found. If someone is only capable of recognizing a pearl when it is in a setting in a jewelry store, one will not be successful trading in pearls.

    I think the reduced cancer rates Dr Atwood mentions are correct, but are due to effects mediated through hygiene hypothesis-type effects not diet. There is a significant increase in lifetime breast cancer incidence following migration from rural or undeveloped areas to developed areas. This holds for Hispanic women:

    and also for Asian women:

  30. cheglabratjoe says:


    Sheesh, I said it *probably* would be safe to lower your guard … no need to name-call. I agree with your point, though. Reputable sources might be full of crap, and crummy sources might have a worthwhile nugget or two. Everything needs to stand on its own merit.


    I understand your frustration, but you’re setting yourself up to be frustrated. You claim the authors of this blog are setting up an ideological “war,” but on the contrary that’s exactly what *you* are doing. The authors are promoting science. Science isn’t a position or a side or an ideology. It’s a method, it’s a tool. It can certainly reach conclusions, but they will always be (at least a little) tentative pending future evidence.

    If someone comes to this blog, decides that the authors are completely correct, and trusts everything they say or link to, then something has gone wrong. That person has not received the scientific/skeptical message of this blog. Luckily, I don’t think anyone would do that. Hell, this *entire entry* is about NOT trusting a source (this book) or that source’s legit-looking citations.

    You’re claiming that I don’t have a problem with this entry because I’m in the choir. Well, I think you might only have a serious problem because you’re in the peanut gallery …

  31. weing says:


    No offense meant.

  32. cheglabratjoe says:

    No worries, I should have added a tongue-out smiley or something to indicate that I wasn’t really offended. Clearly my use of a silly word like sheesh didn’t cut it. Commenting on the internet makes me realize how much I use sarcasm to get points across, but I feel stupid adding smilies all the time to denote it.

  33. Fifi says:

    Dr Gorski – I’m being honest and I don’t actually think offending or annoying people by being honest is that big a deal, whether it’s myself or others being offended. (Though it is a bit of a counter-productive strategy for EBM blog to take that tack, unless the aim is to give pleasure to the skeptics rather than engage those on the fence or simply looking for information and not a new ideology.) I’m not trying to sell you anything – it’s an opinion/perspective/analysis freely offered because I care deeply about people and medicine, and because I point people in the direction of this blog. (Plus it’s easier to use things one is passionate about as a form of procrastination!) You can take or leave what I write according to the worth and value of the information to you.

    At this point I’m actually trying to figure out if I consider SBM to be a blog to continue pointing people on the fence to for a number of reasons, the main one being that a lot of people I have pointed in this direction are quite turned off by it and it confirms some of their (often not entirely unfounded) prejudices against the medical establishment. (Granted, many of the people I point towards the blog aren’t American so the emphasis on American politics and the medicine/power/money axis is also a turn off for some.) However, once again, these are the kinds of people that I suspect you’re trying to reach.

    Ultimately, I’m much more interested in people and practical reality on the ground than ideologies and intercine power struggles in ivory towers. (Or the rather tedious logic vs emotion prejudices of hard science, not surprisingly often promoted by people who are uncomfortable and less skillfull with emotions than they are logic. We need both to make rational, compassionate choices.) I’m aware that politically, culturally and socially I’m coming from a position and understanding of the world that is diametrically opposed (or simply not understandable) to some of the blog authors here – both in terms of how technology has changed and transformed our world vis a vis communication and perceptions of reality (much as MRIs have radically changed neuroscience) and the sociopolitical effects of globalization.

    All in all, now that Obama is in power I’m much less worried about the future of science and medicine – and the influence of Obama on Canada (though the lingering Bush effect here is worrying). Not only is Obama young enough to be on the engaged side of the digital divide (and is clearly a master of communication) but he doesn’t seem married to nostalgia-based/reactionary orthodoxies either – it bodes well. I suspect we’ve come to where our paths divide and our interests diverge so I’ll refrain from critiquing and annoying you and the other authors and, if reading without speaking up becomes too annoying for me, I’ll move on to more enjoyable and useful pastures. Or, since spring is around the corner, just go tend to my garden and local transformation rather than pointing out the flowers and weeds in yours. Good luck with your garden :-)

  34. Fifi says:

    cheg – “It’s a method, it’s a tool. It can certainly reach conclusions, but they will always be (at least a little) tentative pending future evidence.”

    Thanks again for the talking down to and assumption I have no clue what science is about simply because we don’t agree. I find it interesting that YOU don’t seem to realize that the practice of medicine isn’t merely about science, it’s about people too. I’m well aware that science is a method, however the authors here are people not methods and they DO at times reveal ideological biases.

    As I noted, I grew up godless with science as the way to understand how the world works. I have no belief in science as an absolute, it’s not my religion (nor replacing a religion I’ve given up). I simply don’t have a religion nor a political dogma. I have personal beliefs about the world (that are essentially secular humanist) but I do understand they’re personal and they change as I learn more about what it is to be human (as an individual and collectively). Growing up around neuroscience research made me very aware that scientists are people and that ego, ideology and bias enter into science as promoted by people. To pretend otherwise is to return to the dark days of science and ignore the massive influence religion had on science for a very long time. Scientific methodology was created specifically to address these aspects of being human and has slowly been undoing the religious/cultural biases that have plagued science (and been perpetuated quite cruelly by scientists and doctors at times). The scientific method isn’t perfect but it’s the best we’ve got. Just don’t mistake being a scientist with being personally objective, it’s the kind of hubris that gives science and scientists a bad name. And don’t mistake being a doctor with being a scientist, they require different skills even if they overlap and inform each other (in the best possible scenarios).

  35. cheglabratjoe says:


    You’re all over the place. You open by saying that you don’t have a problem with insulting people with the truth, but then you say it’s counter-productive for SBM to do just that. Why would you hesitate to point people at this blog? If they’re going to be offended by the truth, how do you propose to get through to them?

    This sounds very much like the “framing” issue that flares up over at scienceblogs periodically. You’re worried about this blog scaring away hardcore CAM advocates because of the way they “frame” it, but I don’t think that’s a problem. A dyed-in-the-wool homeopath isn’t going to be swayed by a blog post, no matter how it’s written. That person believes in magic. For him/her to be correct, chemistry would have to be wrong. That person needs to educate themselves and change their mind on some major issues to see that their sacred cow is nonsense. On the other hand, I think that someone truly on the fence could be swayed by this blog. Why do you think otherwise?

    I suppose I might be talking down to you at this point, but that’s because you’re still not getting it. You’re making this out to be an ideological battle, and it’s not. The authors want medicine to be science-based. They want procedures to be backed by evidence. They want research to be funded with prior-probability in mind. They want ideologically-based decisions out of medicine. This is not an ideology!

    I also note that you’re now talking down to me. Of course individual scientists have biases, and of course science is built to remove these biases as best as possible. That’s why the authors are promoting SCIENCE and not scienTISTS. They don’t write articles saying “trust everything out of this university, they’re good scientists!”

    Furthermore, I’m well aware that medicine isn’t just about science; it’s about people. This is one of the (only?) things CAM does well, and SBM would be wise to co-opt it. This issue has been addressed … *on this very blog*! But, you probably don’t credit the authors for that, as you assume that they are not “skillful with emotions” and “preaching to the choir” from their “ivory towers.”

  36. durvit says:

    To make a general suggestion, this blog would be very, very well served by getting a science-based nutritional expert and a science-based sports physician on board.

    Excellent idea – it’s also a striking omission over on Science Blogs but it would be tremendously useful here.

    People frequently claim that only 1 in 10,000 women develop breast cancer in China and attribute that to The China Study – was there any decent supportive evidence in the book for that?

  37. Fifi says:

    cheg – No, for me it has nothing to do with scaring away hardcore CAM advocates (and plenty of them post here, they love sites like this!). I wouldn’t even bother sending them to this site and I rarely even bother arguing with them unless it’s for fun (it’s religion, faith is impervious to reason and only fools think they can change faith via imposed skepticism since it only makes faith stronger to oppose it). It has to do with regular people who just aren’t science literate and innately hyper analytical and skeptical who get confused by pseudoscience. Pseudoscience – be it new age woo or technofetishist woo promoted by doctors – is the big problem. I’m more concerned with the kind of people who find CAM “works” for them – not the faithful but those who aren’t familiar enough with science to be able to discern highly sophisticated performances of a sciency nature (that often have a kernel of real science). That’s why linking to a site that promotes pseudoscience and praising the science there (without a disclaimer about the rest of the site) seems problematic to me.

    You keep assuming I’m “not getting it” because I don’t agree with you and am skeptical about some of this blog’s approachs and some of the author’s ability to see and acknowledge their own biases. I’m not a newbie to this blog (though you do seem to be in terms of posting at least). I don’t see the blog authors as a mass and they don’t always agree with each other (and you may have noted that my concerns about the issue – which was initially raised by someone else – was seconded by a blog author here even though he objects to my perspective and way I express myself). I fully understand that the objective of this blog is to promote science-based medicine, can you at least see that linking to and praising sites that promote pseudoscience (with no disclaimer) is doing exactly the opposite and undermines the stated intent of these blogs?

  38. Fifi says:

    For the record, I have no idea how skillful or not the blog authors here are regarding emotions. It’s just a rather basic observation that some people are neurobiologically primed to be more analytical and others to be more emotional – both extremes tend to think how they are is superior. Obviously science attracts a lot of highly analytical people, medicine tends to attract a wider variety of people since motivations vary from money to power over others to compassion for others (and many combinations of both).

  39. Fifi says:

    cheg – You’re clearly working with some huge assumptions about my intentions and knowledge and seem to be reflexively defending this blog against any criticism. Do you think this blog and authors are above being held to the same standards they expect of others and should be immune to the criticisms they level against others?

  40. Fifi says:

    As for the abrasive honesty issue, I see discussion between individuals to be a very different form of communication than a blog post or an article. Just as discussing something casually with someone is very different than academic debate or a discussion within the context of a therapeutic relationship. Do you see all forms of communication as being exactly the same? Is this why it’s confusing to you?

  41. weing says:

    “It’s just a rather basic observation that some people are neurobiologically primed to be more analytical and others to be more emotional – both extremes tend to think how they are is superior.”

    How about all those in-betweens? Do they somehow tend to feel that how they are is inferior?

  42. Fifi says:

    No weing, from my observations they usually assume how they are – aka “normal” – is superior most of the time too and that people on the extreme ends of the spectrum are inferior (or “crazy” or “evil” or whatever the Othering de jour is). Science was pretty hung up on the “normal” thing for quite a while but has since started to recognize natural difference and not cast it as “unnatural” simply because it’s not “normal”. Yay for science and the technologies that allow science to move beyond the social and religious prejudices that blinded scientists to reality for so long (even with the scientific method at their disposal).

  43. weing says:

    Would you then say that it is human nature to feel superior to others?

  44. Fifi says:

    I’d say that comparing and categorizing is a basic cognitive function so comparing and categorizing is part of human nature. Hierarchal attributions of worth regarding other humans based on difference and sameness seem to be a combination of nature and nurture….and how big and inclusive our “us” group is.

  45. cheglabratjoe says:


    Not that it matters, but I’ve been lurking at this blog since its inception and have only recently started commenting. I’ve usually agreed with your opinions when I’ve read them, but I still think that you’re blowing this way out of proportion and have been out of line a number of times (and counting).

    I don’t think you’re “not getting it” simply because we disagree, I think you’re not getting it because you yourself have made some big assumptions that are clouding your opinions. You asked if I thought the authors here are above criticism … are you even reading my comments? I’ve said explicitly a number of times that *everything* needs to stand on its own merit. In fact, that’s precisely why I didn’t have a big problem with Harriet’s link. Of course the authors here are not above criticism; I hope you were being sarcastic or were asking this question rhetorically, but it doesn’t seem so.

    In fact, it sure feels like you’ve assumed that I’m just an emotionally-challenged choirboy defending my ivory tower against all criticism. Again, I have to wonder if you’re even discussing the matter with me, or with the caricature of me you have pictured in your head. Concerning this very issue, I’ve ceded the point that it would’ve been good for Harriet to put a disclaimer about the other contents of the site containing the review. Does that not count as a criticism for you? Are *you* dismissing *my* opinion because I don’t think that this issue warrants as much backlash as you feel it does?

    As for your other comments, you’re simply echoing the main issue with promoting scientific skepticism. If the person in question isn’t scientifically-minded, then you’re going to have trouble getting science across to them. Duh. If they’re relying on anecdotes and trusting pseudoscientists, all we can really hope for is to plant a little seed of skepticism that hopefully will grow with time. We can’t just show them Randi’s beard and expect a cold-turkey revelation-type conversion.

    I think this entry (and, generally, this blog) would have a good shot at inserting that kernel, and I don’t see how that one link to a questionable website changes those odds. After all, if they’re not a “innately hyper analytical and skeptical” person, are they really going to check Harriet’s sources anyways?

  46. Fifi says:

    cheg – Apparently we both feel we’re not being heard or understood and are being treated as caricatures. And we’ve both stepped over each other’s line. We seem pretty even at this point, we can either call it quits or attempt to understand the other person.

    The point is that pseudoscience, by it’s very nature, can be difficult to discern from science and often masquerades as science (and often has doctors involved). Most people aren’t raised as scientists or trained to be analytical – and people who know a bit of science tend to be the most suceptible to pseudoscience (engineers and computer programmers, for instance). If a doctor can be seduced by pseudoscience, why would you expect non-doctors to be immune? You are aware that CAM use is most prevalent amongst educated and quite well off people?

    By “scientifically minded” do you mean people who believe they’re purely rational beings? People who are more analytical by nature?Or simply people with a training in medicine?

  47. Fifi says:

    Why would you assume that people who aren’t analytical won’t click a link? Clicking on links isn’t a sign of being analytical. You seem to be being a bit of a shruggie here.

  48. cheglabratjoe says:


    I was using “scientifically minded” as a catch-all phrase for the people you keep wondering aloud about (whether or not this blog is targeting them). Some of your own terms: “most people [who] aren’t raised as scientists or trained to be analytical,” “regular people who just aren’t science literate and innately hyper analytical and skeptical,” “[the] kind of people who find CAM “works” for them,” “those who aren’t familiar enough with science to be able to discern highly sophisticated performances of a sciency nature.” I appreciate your attempt to ground the discussion, but do we need to pick nits over definitions? We’re talking about the same people.

    Yes, pseudoscience masquerades as science and can be difficult to detect. (Which one of us was patronizing and talking down to the other, again?) At what point did I indicate that this wasn’t important? On the contrary, that’s exactly why you can’t trust things that appear valid (as I’ve said). How many times are you going to argue towards me with points I’ve used myself? The whole point (as I’ve said) of Harriet’s review was that you can’t trust something (the book) that looks like it’s well-researched and trustworthy.

    And I like that you called me a shruggie; I’m very impressed by your familiarity with terms coined on SBM. My point was that a single link to a valid article on a crummy site wasn’t going to change ANYTHING for ANY reader. A “scientifically minded” reader would know not to trust the entire site wholesale. A woo-woo person would still potentially receive the kernel of skepticism from the article that we’re hoping to implant. There’s a chance that people on the spectrum in between would be turned off by or sucked in by the connection to the bad site, but I find this extremely unlikely.

    Again, as I’ve granted you, a short disclaimer about the nature of the site would’ve been ideal. But, it doesn’t warrant your catastrophizing. Fifty comments and concern about sending your friends here for information? Really? Over a single link to a good article on a bad site?

  49. cheglabratjoe says:

    Ha, contradicted myself. Change: “My point was that a single link to a valid article on a crummy site wasn’t going to change ANYTHING for ANY reader.”

    To: “My point was that a single link to a valid article on a crummy site wasn’t ***likely*** to change ANYTHING for ANY reader.”

    There’s technically a chance that Harriet poisoned someone’s mind by linking to WAPF. But, really, someone’s assessment of this as a tempest in a teacup couldn’t be more apt.

  50. Fifi says:

    It appears we’re both speaking down to each other and you’re continuing to do so. Thanks for the attempt to belittle via the “catastophizing” remark (nice example of what I was discussing briefly with weing though), I’m sure it seems that way since you’re all shruggie about the issue and clearly not listening to why I objected. I do get that it’s not a big deal to you and you don’t understand why it is to me. I’ll try to explain again.

    1-It’s not just one link, it’s starting to be a pattern.

    2-It’s actually because of negative feedback about this blog from people I directed this way that I’ve stopped directing many people here (particularly one’s who aren’t part of either the SBM or CAM choirs), this link isn’t the cause but it does contribute to why sending people here who aren’t already in the choir is problematic.

    3-This isn’t the first time Dr Hall has done this, if it was the first time she did it, no big deal. There’s a difference between innocence and willful ignorance – once you know better but you don’t do better, which is it? I now see Dr Hall as being unaware of her own biases or incapable of acknowledging them, that seems problematic to me on a site that promotes science-based medicine.

    To be clear, that doesn’t mean that I don’t think Dr Hall’s opinions are interesting or that she has nothing of value to share (or is a lesser human being in any way). In fact, I quite enjoy her “common sense” attitude for the most part, I just don’t trust her analysis of the science or her sources (her expertize) or to recognize her own potential biases.

    I don’t presume to be an expert in everything (or even the end all or be all in fields I am highly conversant in) so I have trusted references and a network of trusted experts in various fields who I consult when something is over my head (there’s no shame in not knowing something and referring to people who know more about a certain subject). Do you believe you can adequately analyse the evidence in every single field of scientific endeavor or do you trust certain experts when you’re not an expert yourself? Or have you gone back and done every single experiment ever to garner your expansive knowledge of everything? I’ve always understood science is about collective knowledge not being an individual master of the universe but maybe I missed something. Are there experts in any field you trust or are you one of those people who believes themselves to be an expert at everything?

    4-There’s been lots of heated criticisms from authors on this blog about how “fair and balanced” in journalism does a disservice to science (usually liberally dotted with misunderstandings about how journalism and media work) and here we have Dr Hall defending her link to a pseudoscientific site under the “fair and balanced” excuse. Which is it? “Fair and balanced” is okay or it’s a means for pseudoscience to creep in the side door?

    Why are you so obsessed you’re counting posts and even involved in this discussion if this means nothing to you?

  51. daedalus2u says:

    Fifi, as used on this blog, “fair and balanced” means taking what people say at face value, looking at their data and premises, and do their conclusions follow from them using valid logic. It means looking at the actual data those premises and conclusions are based on, and do those conclusions follow from them.

    This is in contrast to what the term “fair and balanced” means in main stream media where “fair and balanced” means giving equal credence and equal time to conclusions independent of the data, premises or reasoning that has gone into them.

    I am reminded of the quote from A Man for All Seasons

    Alice: Arrest him!
    More: Why, what has he done?
    Margaret: He’s bad!
    More: There is no law against that.
    Roper: There is! God’s law!
    More: Then God can arrest him.
    Roper: Sophistication upon sophistication.
    More: No, sheer simplicity. The law, Roper, the law. I know what’s legal, not what’s right. And I’ll stick to what’s legal.
    Roper: Then you set man’s law above God’s!
    More: No, far below; but let me draw your attention to a fact — I’m not God. The currents and eddies of right and wrong, which you find such plain sailing, I can’t navigate. I’m no voyager. But in the thickets of the law, oh, there I’m a forester. I doubt if there’s a man alive who could follow me there, thank God.
    Alice: While you talk, he’s gone!
    More: And go he should, if he was the Devil himself, until he broke the law!
    Roper: So now you’d give the Devil benefit of law!
    More: Yes. What would you do? Cut a great road through the law to get after the Devil?
    Roper: I’d cut down every law in England to do that!
    More: Oh? And when the last law was down, and the Devil turned round on you, where would you hide, Roper, the laws all being flat? This country’s planted thick with laws from coast to coast — man’s laws, not God’s — and if you cut them down — and you’re just the man to do it — do you really think you could stand upright in the winds that would blow then? Yes, I’d give the Devil benefit of law, for my own safety’s sake.

    Retrieved from “”

    Thomas More would give the Devil the benefit of law to protect himself from erring due to abandoning the law. He would apply the law irrespective of how he feels toward the person the law is being applied to.

    Skeptics adopt skepticism to protect themselves from error and faulty reasoning leading to wrong conclusions. It is not something that can be abandoned because one feels it is appropriate to do so. That is exactly where it is most important to apply the heuristic of skepticism most vigorously. It is precisely when that heuristic is not applied that errors creep into our thinking.

  52. cheglabratjoe says:


    I care because I think it would be a shame if people dismissed this review (or this site in general) over a single link to a biased source. If you have other criticisms or see this as part of a pattern, so be it; I can’t speak to any of that. I’m trying to point out that this individual issue isn’t a game-stopper.

    It’s a valid piece of work from a bad source. I still don’t see what effect it would have on people you send to this site. All Harriet said was: “here’s a positive review, here’s a negative review.” In fact, she pointed to two negative reviews, one of which was from some random guy on Why aren’t you blasting her for promoting reviewers as valid sources? That’s a site that (supposedly) removes unfriendly reviews under slight lawsuit pressure from authors.

    Speaking of which, your “fair and balanced” comment was a low-blow; Harriet didn’t say that. She said she was being fair by mentioning that positive and negative reviews existed. That’s different than what you claimed: “Dr Hall defend[ed] her link to a pseudoscientific site under the “fair and balanced” excuse.” In no way was she presenting science and pseudoscience as equals under a “fair and balanced” argument. That certainly wasn’t as bad as when you brought up white supremacists, but it’s still seriously misconstruing her words.

    It sounds to me like you came to the conclusion that Harriet is hopelessly biased awhile ago, and you’re just using this minor issue as a springboard to complain about her. That’s to say nothing of the fact that you’re now resorting to twisting her words around to make your point stronger. I don’t know that I’ll have any more responses for you, Fifi.

  53. Fifi says:

    Daedalus – The “fair” was in reference to links to Oprah, Weston Price and an Amazon review, that’s hardly comparing the data.

  54. Fifi says:

    Great googly spaghetti monster, back to the White power reference (I guess the history channel is to blame for the eternal obsession with the Nazis)…the point wasn’t that I think Dr Hall is equivalent to a Nazi, the point was that referring to the science on a rabidly anti-vegetarian and pro-dairy site regarding a book review of a pro-vegetarian book and expecting the science to appear unbiased or cherry picked is like referring to a review of genetic science on a White power site as a reliable source and then getting all “what but the science is good….”.

    At the very least it’s just sloppy. Overall it gives the impression that Dr Hall was reaching to present a negative review that corroborated her own. And, yes, the Amazon link is weak sauce too. As is the Oprah one. The whole intro is actually, as I said before. But clearly this is more about you getting to waggle your finger and tsk tsk about how I crossed the line than anything else for you. Your rather dramatic umbrage on the behalf of Dr Hall is noted, as is your avoidance of my question about why you’re counting posts and engaged here. You seemed to have brought a mighty big spoon to the table to stir up this tempest in a teapot you object to so much.

  55. cheglabratjoe says:


    Fine, you win … we’ll call the link “sloppy” and the intro “weak sauce.”

    I’m not continuing to respond to your comments just to tut-tut you, nor have I avoided your question about why I’m continuing to respond. The first sentence of my previous comment: “I care because I think it would be a shame if people dismissed this review (or this site in general) over a single link to a biased source.” I answered your question before I said anything else!

    I’ll ask again: are you even really reading what I’m writing? You’ve established that your histrionics (back at’cha for the “dramatic umbrage” ;) ) aren’t about this issue and are instead about your dislike of Harriet’s “trends.” It doesn’t seem that you’re arguing about anything Harriet or I have actually written here.

    To recap: (i) you aren’t actually arguing about this entry (since you’re misrepresenting it and bringing up unspecified old stuff), and (ii) you aren’t actually arguing against my comments (since you don’t appear to be reading them). I’ll throw your question back at you: what are YOU engaging in here?

  56. Harriet Hall says:


    I am deeply offended by your accusations; your comments about me border on libel. You accuse me of willful ignorance and of inability to analyze scientific evidence. You accuse me of bias but you have not shown that I am biased or that my citations unreasonably influenced my conclusions in any way. Your venom has no credibility. All you have done is convince me and others that you are the one who is biased. .

  57. nwtk2007 says:

    Harriett! Libel?

    You invited comments. You got comments. It ain’t libel or anything close.

    And you’re both biased.

    Deeply offended? Get over yourself.

    Also, what ‘s wrong with a little venom if it gets you to thinking?

    Maybe FiFi has an “agenda”.

  58. David Gorski says:


    While I can’t agree that Fifi’s comments border on libel, I do agree she’s gone over the line. She really needs to take a chill pill and try to get some perspective here. This nonsense has continued far past the point that it might have been useful, and to the extent that I might have contributed to it, I’m sorry.

    Even though I actually agree that it was probably not a good idea for you to have used that tainted citation, Fifi has escalated what should have been a mere disagreement about what sources are and are not appropriate into a rather nasty and completely unnecessary fight. It should be possible to discuss civilly whether using an actual decent article culled from a highly dubious source is ever appropriate or whether the taint of the source from which it was culled is too great; it’s a legitimate argument. Invective such as what we’ve seen from Fifi is neither necessary nor called for.

  59. Harriet Hall says:

    Surely no one who has been reading what I write could possibly believe I am biased in favor of the Weston Price website. Does anyone really think that I am biased in some way that interfered with my objectivity in reviewing The China Study? The comments so far have been strikingly devoid of any criticism of my arguments and conclusions.

  60. CarolynS says:

    I hope people who are referred to this blog will find Fifi’s comments enlightening and interesting.

  61. pmoran says:

    “But I also found this critical review which makes some excellent points and accuses the authors of misrepresenting the findings of the study. And this commenter on an forum also charges Campbell with misrepresenting the data from the study and points out numerous flaws in his reasoning.”

    Harriet, one criticism. These reviews are clearly written by the same author, and the Weston Price one at that. Compare the text.

    You are no more biased than anyone else. You freely admitted that you got off on the “wrong foot” with this book after encountering some major claims being made on feeble evidence. That is as it should be. This is “good bias”. Good bias ensures that novel ideas are subjected to sufficiently intense critical scrutiny well before they become regarded as “medical knowledge”.

    We are also all aware of the pitfalls in interpreting epidemiological research. The matter was never going to hang upon a opinion piece (as clearly stated by you) in a blog such as this.

  62. ImperfectlyInformed says:

    I can understand why Fifi is so upset. My offhand guess is that most of the readers here are not highly qualified scientists, particularly ones specialized in nutrition and medicine. Pointing them to a Weston A. Price site where Chris Masterjohn does excellent analysis of the book might make them think that Chris Masterjohn has other worthwhile opinions.

    Next thing you know, these innocent yet inquisitive skeptical lambs could be reading Masterjohn’s review of the Cholesterol Wars: The Skeptics vs. the Preponderance of the Evidence by Daniel Steinberg (, where he argues that statins reduce cholesterol, but what’s really happening to reduce heart disease is the reduction in Rho activation, which is correlated to cholesterol. A quick search on Google scholar yields a 2005 review article ( whose abstract states “regulation of eNOS by Rho GTPases, therefore, may be an important mechanism underlying the cardiovascular protective effect of statins”.

    It’s not conducive to the anti-quackery fight to admit even the possibility that some fringe scientists could make reasonable points. The introduction of even a small doubt into what skeptics call the “lipid hypothesis” could shake one’s faith in the whole Quackwatch ideology, possibly leading one closer to the dark side. Don’t get me wrong — I think Quackwatch is correct on most of the topics he covers, but certainly not all.

    I would love to see a critical analysis of Chris Masterjohn’s contentions. I have no idea if what he’s saying makes any sense, but his critical review of Steinberg’s article points out quite a few studies which Steinberg apparently failed to cover.

    pmoran: It seems that the commenter, JayY, copy/pasted Masterjohn’s review into Amazon. The introductory comments are original.

  63. tcc1 says:

    I have been invited to comment on Harriet Hall’s critique of our book, “The China Study”.

    To begin, I find it unusually difficult to respond because Dr. Hall has misrepresented too many facts. Most importantly, she (and many others in the discussion thread) misunderstand my research. Reference to “The China Study” seems to some, especially those who disagree with my views, to be focused almost entirely on the human study in China when, in fact, this is only one study, albeit an important one, in a long series of studies. The book makes this clear to the vast majority of readers so I become quite puzzled when someone makes conclusions as if I am depending on one study and one alone. I ran a relatively large experimental research laboratory for many years before the China Study and published our work in more than 300 peer-reviewed publications, mostly in top medical and scientific journals. Further, this research was generously funded almost entirely by NIH, which means that it was rigorously reviewed at several levels.

    What my son, Tom, and I wrote was a chronological synopsis of my 40+ years of experimental research, coupled with my 20 years of continuous work on expert panels charged with writing national and international food and health policy. I chose this format for the book not to advocate a ‘diet’ but, instead, to simply tell the story as I learned it, leaving the reader to decide what to believe. Obviously, I eventually arrived at a belief that a whole foods plant-based diet creates the best health but I did not do this work to ‘prove’ this conclusion. On the contrary, I began with a view that was exactly the opposite, arising in part from being raised on a dairy farm, milking cows, then doing my doctoral research (1958-61) to improve on our ability to produce more of that really good nutrient, animal-based protein.

    Clearly after a wide diversity of experiences and studies (including our main NIH grant that lasted for 27 consecutive years), I had to conclude the opposite. One of my early observations was quite provocative, namely, that the main protein of cow’s milk, casein, is the most relevant human carcinogen ever discovered. Because this effect was so striking and repeatable, yet so provocative (especially for me), I then expanded our investigations to be more comprehensive and to elucidate basic biological principles. The more research that we did, the more provocative became the information being produced.

    I am not a fan of scientific research ‘proving’ anything, thus I really don’t understand the rather rambling discourse on this thread about what constitutes ‘proof’. If that is the standard to be followed in science, we mostly will end up with a huge collection of narrowly focused observations that create more confusion than clarification. Rather, my standard is to do research from a wide vantage point, so as to gain perspective. Indeed, this is essential if one is ever to truly understand biology, especially nutrition. Biological phenomena are exceedingly complex and marvelous. Yet, by considering the control mechanisms by which the symphony of reactions are integrated into a symphony, together with examining the trends exhibited by related reactions, it is possible to reduce complexity to simplicity.

    Dr. Hall relies on two main ‘criticisms’, one by a 24 year old with no experimental research training (Masterjohn), no peer-reviewed publications and no understanding of what nutrition is about. The other (the anonymous JayY, whose offensive diatribes got him removed from Amazon) mostly relied on the ‘critique’ of Masterjohn. I am sorry to say, also, that Dr. Hall herself very likely has had no formal training in nutrition (MDs don’t get training in med school) and no experimental research experience (I find no publications on PubMed) and because of her MD experience has been long bathed in a biological paradigm that is the antithesis of nutritional biology. Why didn’t she also note those who have praised the book like a Nobel laureate and Vice Provost at Cornell and a very distinguished, 17-year President of Cornell.

    Her personal bias also shows when she points out that my co-author son, Tom, is a “non-scientist” and, further, that the animal rights group, PETA, likes the message. She should know that Tom, a theater and communications major at Cornell and an aspiring actor in Chicago, initially was helping me to put my writing into a readable form. He did exceedingly well (the book gets high marks by virtually everyone for its literary quality), learned a lot of medicine and biology, then decided to go to med school. Even though he had been an arts major with no science courses, he was in the 98th percentile on his MedCat exam, and now is finishing his third year with flying colors while being on scholarship in medical school. Moreover, I have had no relationship with PETA.

    Most of Dr. Hall’s other ‘criticisms’ are quite trivial. Stating that she started off “on the wrong foot” when I made a statement, with 2 published citations, that heart disease can be reversed by diet says more about her than about me. These two studies, both published, were truly remarkable. Esselstyn, a long-time distinguished surgeon at the Cleveland Clinic, started with 18 seriously ill heart patients who were told that there was no other treatment. They had had 49 coronary events during the previous 8 years prior to the study, presumably destined for the pearly gates in a few short years. Dr. Esselstyn (who did not know me at the time) turned them around by the same dietary lifestyle that my research supported. They suffered only 1 ‘event’ during the next 23 years! He has since published his own book of these experiences. Esselstyn did use Lovostatin in that early study (he couldn’t have done otherwise, given the medical guidelines of the day) but later was able to produce for a fellow 44-year old colleague a remarkable reversal of a diseased coronary artery with diet alone. The pictures of this man’s artery are in our book and Dr. Esselstyn continues to this day to practice his remarkable medical care on other patients. Most importantly, other cardiologists are now doing this. Just recently, I gave a keynote at a well-known cardiology conference where the organizing cardiologist is now doing the same thing, as is the long time Editor-in-Chief of the journal, Cardiology.

    I could go on and on but suffice to say that I cannot take seriously critical comments like these. I did not ask the reader to believe anything. Instead, I simply said, “Try it for yourself”. We did not prove anything but the ‘weight of the evidence’ together with its biological plausibility suggested that people could gain health. The best ‘proof’ that a scientific finding can offer, in my view, is its ability to predict future events, thus my suggestion to the reader to simply ‘try it’.

    Since publishing the book over 4 years ago, it continues to sell at a rate even higher than it did in the beginning, now almost 4 times a national best seller. I have given almost 300 lectures, mostly to medical and professional venues and conferences and the feedback that I get is rather overwhelming. People are telling me how they respond in so many ways, involving all kinds of disease outcomes and health enhancements. For any doubters, read the 500+ unsolicited reviews on Amazon. In the meanwhile, I appreciate having this opportunity to respond and, in the meanwhile, consider what this information could mean for our family, friends and fellow citizens.

  64. Harriet Hall says:


    I’m willing to make a deal. I will retract all my comments about the opinions of others, PETA, etc. if you will retract all your comments about your son’s MCAT scores, your success in getting grants, the success of your book, and ad hominems about my knowledge of nutrition. None of that has any bearing on the scientific value of the evidence you present.

    I focussed on the China Study because that was the title of the book. I also addressed the author’s other research in the paragraph beginning “He cites all kinds of research to support his hypothesis that animal protein is bad.” I read it, but I didn’t find it convincing and I found other evidence not in the book that seemed to put its conclusions in doubt.

    You admit that the two studies you cited for heart disease being reversed by diet were not of diet alone. Then you cite one (!?)measly case report of a patient who improved on diet alone. You do not comment on your melanoma citation, which simply can not be justified.

    You said, “The best ‘proof’ that a scientific finding can offer, in my view, is its ability to predict future events, thus my suggestion to the reader to simply ‘try it’.””Try it for yourself” is not a scientific approach. The whole scientific method is based on the need to correct the errors that arise when we rely on personal experience. We need to “try it” with good prospective randomized controlled studies.

    You say that “casein, is the most relevant human carcinogen ever discovered.” I wonder how many toxicologists and oncologists would agree with that statement. Would you tell patients that smoking is safer than drinking milk?

    You said you “eventually arrived at a belief that a whole foods plant-based diet creates the best health.” That’s what it is, a belief. It is not backed by sufficient high-quality patient-oriented evidence to convince the scientific community that advising such a diet for the general population is in order.

    I ended by saying that you make a good case, but it isn’t yet good enough. Your comments haven’t changed my mind. I await further studies with great interest, but I’m not ready to try an extremely low protein, no animal protein diet.

  65. anoopbal says:

    I know this is an old comment, but can’t help comment on comment made by the author of the book ” The China Study”.

    Campbell says “I simply ask the readers to try it for yourself”. I am just amazed that a researcher who has received NIH funding for this long can make such a statement. This is the same comment made by all those peddlers who desperately wants someone to by their stuff.

    And I agree that it is hard to be so unbiased when you write a book and have to come out with something meaningful. In that case, write a chapter saying “Limitations of the book” or something similar and talk a bit about the other side too.

  66. leann says:

    I recently picked up Campbell’s China Study book and read through it, and found this article looking for more perspective on his claims. I have nothing at all to say about the scientific accuracy of his claims, since I have zero scientific background, but, I wanted to address some of the comments made towards the end of the article because they misrepresent the book.

    “There are legitimate concerns that such a diet may not be without risks. Even Campbell recognizes that strict vegetarians are likely to need vitamin B12 supplementation. If cow’s milk is prohibited for growing children and osteoporotic adults, they will likely need a supplemental source of calcium and vitamin D. Without careful nutrition guidance, children deprived of milk might end up malnourished. Breast milk is animal protein – should we avoid breast-feeding too?”

    Campbell argues, (I can’t say whether he’s right or wrong) that consuming animal protein actually depletes calcium from your body, and that countries that consume high amounts of dairy also have the highest rates for osteoporosis. (His comments about calcium loss in people doing the Atkin’s diet particularly struck me.) He has lots of graphs and mentions studies that show these things, so he does attempt to address these things. He also discusses sunlight exposure in order to get enough vitamin D.

    He also mentions breastfeeding as the appropriate food for children under 2, and argues that milk consumption in babies is linked to diabetes. I have young children, so that might stick in my mind more than in someone else’s.

    Dr. Hall also creates a mock diet meeting Campbell’s dietary suggestions using highly processed foods. Clever, but Campbell repeatedly argues in favor of Whole food, plant based foods, over and over again, and to avoid processed foods.

    I appreciate Dr. Hall’s thoughts on the research done in the book, and will keep it in mind, but the last part of the article made me feel that perhaps she didn’t read the book all that carefully, and was only looking for faults.

  67. Harriet Hall says:


    Please read more carefully. The mock diet of processed foods was a direct quotation of an example given by Campbell in his book, not something I invented.

  68. Margee says:

    I have recently finished The China Study and found the information very thought-provoking. The area of nutrition has been something I was not taught much about in medical school and I am trying to find out as much as I can on my own. We live in a society of fast-food convenience, diminishing activity and a capitalist enterprise system. Along with that we have increasing rates of chronic diseases that are debilitating and costly on a personal and national level. There is enough evidence to suggest the most nutrients come from food closest to it’s original form. We can get protein in plant-based food . There are more saturated fats and cholesterol in animal-based foods. It makes more sense that eating more plants and whole grains is healthier. Unfortunately politics and capitalism contribute to making that sound “controversial” . Our nation’s diet is not sustainable as it stands now and if Dr. Campbell’s book does not make the case well, then lets get a study going that will.

  69. Gripe says:

    “Dr. Hall relies on two main ‘criticisms’, one by a 24 year old with no experimental research training (Masterjohn), no peer-reviewed publications and no understanding of what nutrition is about. The other (the anonymous JayY, whose offensive diatribes got him removed from Amazon) mostly relied on the ‘critique’ of Masterjohn.”

    What does this have to do with the validity of the criticisms in their reviews? The term ‘fallacious prat’ springs to mind.

    “Since publishing the book over 4 years ago, it continues to sell at a rate even higher than it did in the beginning, now almost 4 times a national best seller. I have given almost 300 lectures, mostly to medical and professional venues and conferences and the feedback that I get is rather overwhelming. People are telling me how they respond in so many ways, involving all kinds of disease outcomes and health enhancements. For any doubters, read the 500+ unsolicited reviews on Amazon. In the meanwhile, I appreciate having this opportunity to respond and, in the meanwhile, consider what this information could mean for our family, friends and fellow citizens.”

    Again, what on Earth has this got to do with the specific criticisms of reviewers? Unbelievable. The good doctor appears to be giving us a lesson in how NOT to reason.

    And just for the record, the review of JayY was simply copied and pasted from Anthony Colpo’s review, which was written independent of Masterjohn’s – perhaps a lesson in why one should address the argument, not the source. It may shock Campbell to note that the reviews raise similar points not as a result of plagiarism, but simply because both authors found the same problems with his methodology, interpretations and conclusions. The subsequent (and, if it’s possible, even more fallacious) rebuttal from Campbell has been addressed by both reviewers on their respective personal websites, should anyone care to read.

    As for those of you criticising Masterjohn’s review because he is a member of Weston Price, shame on you! How true it is that those who sit on their pulpits of objectivity and rationalism are often the most subjective and irrational of all. If you commenters are, as you so proudly proclaim to be, science-based, then kindly conduct more science and less speculation – Perhaps you might like to begin with the Lipid Hypothesis, since many of you appear to more acquainted with 1970’s pop science than the latest unbiased nutrition research.

  70. jvance says:

    Here’s one potential mechanism whereby diet could have some effect on melanoma:

    Dietary fat appears to play a role in metastasis, by causing the cancer cell membranes to take on a more rounded shape, spacing them further apart and making it easier for them to break off from the tumor and spread through the bloodstream.

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