Today, the ethics and fundamentals of the McCarrison Society are needed more than ever before and not just for the leading affluent countries. Peoples worldwide are facing a serious challenge from the rise in non-communicable diseases. These diseases now cause a greater mortality and burden of ill health than tuberculosis, malaria, AIDS, and all other infectious diseases combined. The recent rise in mental ill health to the top three of the global burden of ill health turns the scenario into a grave and sinister outlook if the challenge is ignored (1).
The McCarrison Society was formed by people in medicine - both human and veterinary, dentistry, farming and those with an interest in nutrition and good health. It was formed to honour Sir Robert McCarrison, a pioneer in nutrition research. Sir Robert carried out the very first experiments to demonstrate the effect of nutrition on the epidemiology of disease.
Many scientists were driven in the early part of last century to discover new vitamins and unravel their chemistry. Vitamins were found to be the cause of single disease entities: vitamin C and scurvy, vitamin D and rickets, vitamin A and blindness, B vitamins and beri-beri. Vitamin B12 was the last to have its structure defined in the 1940s. Once done, the conclusion drawn was that we now know everything about nutrition, and medical research turned to the genome. That phase has only just ended. The much féted call for post-genome research to find the gene for obesity and the other ills of modern life is now in full gear.
Sir Robert, however, had worked on a different dimension. As a medical major in the army, responsible for the soldiers and local staff, he recognised that many diseases afflicted the city dwellers of India whilst the children and people of the villages were robust and healthy. His experiment with a thousand rats or more, fed the diets of the city and the village, showed you could produce the diseases of the city by feeding the city diet. Not just one disease but the lot. He also showed the effects of bad nutrition during pregnancy with abortions, perinatal mortality and severe maternal depression leading to abandonment of the offspring and even cannibalism of the newborn. The relevance of the latter to social problems of today is now evident.
What McCarrison had shown was that a bad diet produced, not just one disease, but a whole recognisable pattern of diseases. The idea that a bad diet could have this overwhelming effect was lost in the hype over the latest new single vitamin and its specific effect, followed quickly by the interest in genomics. Yet it is precisely this image-pattern that we see today. Diseases that were a rarity at the beginning of the last century rose generation after generation throughout the century to be no 1 killers of today. This was not caused by a changing genome but a changing diet. The evidence can be seen from the data on the Japanese who migrated at the beginning of last century to the West of the USA. Their children and grandchildren have grown up to have the same disease pattern as their US hosts, whilst their relatives who stayed in Japan have, until very recently, been free from it.
When I worked in East Africa from 1960 - 1965, there was not a single case of breast, colon or prostate cancer, no cardiovascular heart disease and any diabetes seemed relatively mild. Nor was this absence of such diseases due to poor diagnostic facilities. The National Institutes of Health of the USA was specifically interested in this contrast and set up a cancer registry under the late Professor Jack Davis at the Makerere Medical School, Kampala, where I was working. Under Jack's direction, Dennis Burkitt discovered the first virally induced cancer, namely Burkitt's Lymphoma, proving that these people knew what they were doing.
The East Africans had different diseases and we published much at that time illustrating their relationship with nutrition, as for example, was the case for the commonest surgical emergency of intestinal obstructions (volvulus and intussusception in adults) and the unusually high incidence of bladder cancer not traceable to bilharziasis.
However, we are now seeing a changing panorama of disease worldwide. May I quote from the Lancet: "Globalisation has forced the North to confront directly the problems of the South. The diversity of today's multicultural society has encouraged governments to think about the needs and history of their mixed populations. And the advent of a new era in international terrorism has invited reflection about the social conditions that breed violence". (2)
In these last weeks we have heard of the G8 meeting in Canada, to address these problems of the world. Dominated by economists, this type of organisation has consistently expressed the view that increasing wealth will solve ill health of the third world. This view is falsified by the fact that it is precisely amongst those in the third world who are becoming the new rich, that are now exhibiting the consequences in the rapid increase in mortality from Western Diseases, i.e. heart disease, diabetes, certain cancers, obesity and mental ill health.
A NATO Workshop in 1988 predicted this increase in ill health in countries, in which these diseases were previously not a problem. This workshop called for action to stop the export of ill health (3). Tragically despite regular G8 summits nothing has been done. Their economist driven philosophy was seen as a panacea. In the Philippines it had become apparent that CHD was already the first cause of mortality in Manila by 1994. In the Malaysian New Straits Times, of the 27/06/1994 Penang Diabetes Society president Amir Hamzah, complained that the incidence of diabetes had doubled in the last 12 years. Dr K.A. Kadir in support, stated that diabetes had become the most common non-communicable disease in Malaysia. Dr Ismail Merican wrote a month later (25/07/1994) that between 10 and 25 per cent of primary schoolchildren in the country were estimated to be obese. By the 27/12/1994 the newspaper conceded that heart disease was the first cause of mortality in Malaysia. In 2001, Lee Lam Thye wrote on mental health of citizens: "The recent surge of violent crimes is sending shock waves through the country".
Until McCarrison's message of the importance of real food for health, is learnt, the globalization of Western disease will continue unabated with developing countries facing the dilemma of 'out of the frying pan into the fire'. It is not adverse social conditions on their own that breed violence and mental disorder. It is not just poverty on its own that breeds disease. We now understand that human nutrition is special and it contains essential elements responsible for the development of the brain and mental health, the heart and blood vessels as well as the immune system. The experimental evidence on this matter is now very robust. It is not our genes that are altering. It is the way nutrition is affecting their behaviour that matters. The priority now has to be to address the issue of good nutrition and health world wide, as the most urgent challenge of this new century.
- 1. www.globalforumhealth.org
- 2. Editorial, Lancet Vol 359 February 2, 2002.
- 3. NATO Advanced Workshop on Dietary w3 and w6 Fatty Acids. Biological Effects and Nutritional Essentiality. ed C. Galli, AP Simopoulos, Belgirate, (1988) Plenum Press New York.