Using evidence to beat death

By Howard White, CEO, The Campbell Collaboration

We play a New Year’s Game at Campbell:* each staff member sends round an email with their top book, music and movie from the year. I have learned it best to keep a mental note of my frontrunners as I too easily forget what happened last week, let alone within the last year.  I have just read my likely top book for the year. It is a book I expect to recommend to many people. My own copy is now passing round the family. And I bought one for my brother before I was half way through.

My pick for the top book of the year:

How Not to Die by Michael Greger. This is an evidence-based approach to what to eat to not only reduce the likelihood of dying of the major causes of death - heart disease, diabetes, cancer etc. - but maybe even reverse these ailments for those already suffering from them. The evidence is from RCTs and systematic reviews where available. Observational data are sometimes used, but usually with apologies regarding the possible selection bias. But this is not a technical tome. It is written in the style of a racy best seller.

However, if it were to be a novel a reviewer might well complain that the solution offered in each chapter is the same. Because there is a single diet which will reduce the likelihood of dying from the top 15 killers in the United States: a plant-based diet. From the remarkable preventive health powers of broccoli to the immune-boosting turmeric, eating up your fruit and vegetables (well, beans and nuts as well) is the answer to a long, healthy life.

The book runs to 500 pages so how to work out what this means for eating right? Readers of my recent writings on the knowledge brokering pyramid (e.g. this blog) will know I was very pleased to see that it can all be summarized in a simple infographic which can serve as a checklist - in the book it is a checklist.

I am already a fan of James Wong’s evidence-based cook book How to Eat Better - a cook book with a picture of the evidence pyramid with systematic reviews at the top – which has useful tips like leaving mushrooms in the sun before cooking to zap their vitamin D content one hundred fold, combing turmeric with black pepper for its benefits to the immune system to take effect, and serving cooked broccoli with mustard. All good stuff, but How Not to Die gives the scientific basis for how you will benefit – by not dying – from following such advice.

Reading this book has professional as well as personal implications for me.

At a systematic review workshop in Kampala (Uganda) last year, a question came up about the medical benefits or otherwise of traditional herbal remedies. When drugs are so expensive if such herbs are effective then they may be a sensible alternative. Neither I nor the medical researchers in the audience knew of any research. I have done a quick search. There are some systematic reviews. One of the most recent simply reports the high use of traditional herbal medicines for hypertension concluding that research on effectiveness is needed. Clearly an under-researched area.

So, what I propose is a comprehensive assessment of the health benefits of all African plants and herbs, all to be put together in an easy to use evidence portal.  This is a large-scale, multi-year, multi-million research project in need of funding. Any takers?

Two points to note. First, this is to promote herbs in place of drugs. For some reason, herbal remedies are lumped with homeopathy. Herbs are an active ingredient which can affect the body – positively or negatively (think arsenic or hemlock).  Homeopathic ‘remedies’ are hocus pocus. They have no active ingredient, and so no possible effect other than a placebo effect, as has indeed been shown in several Cochrane systematic reviews (e.g. on asthma).

Second, it is not only about cure but prevention but promoting a healthy plant-based diet. But the rising tide of bad diet is not restricted to developed countries. In Kampala, 44 per cent of women are overweight or obese. But we know that just providing information on healthy alternatives doesn’t bring about behavior change. We continue to struggle to find effective strategies for improving lifestyle choices – an area in which the Campbell nutrition group would welcome further reviews.

There is much work to be done.

In the interests of work-life balance, here are my current front-runners for this year’s New Year’s Game: music Ruins by First Aid Kit and movie Three Billboards Outside Ebbing Missouri. 

*The game was brought to Campbell from 3ie, who in turn took it from the Centre for Global Development via Bill Savedoff.

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