Terrors of the Table: The Curious History of Nutrition
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《新英格兰医药杂志》
We know accurately only when we know little; with knowledge doubt increases.
— Goethe
Had the author of this book taken Goethe's observation to heart, he might have featured the successes in the study and the advancement in the understanding of nutrition through the centuries, however slow at first, rather than providing anecdotal reporting on spurious beliefs and false starts. This book is, perhaps, an extension of the delight in debunking science that marked Gratzer's two earlier books (The Undergrowth of Science: Delusion, Self-Deception, and Human Frailty. New York: Oxford University Press, 2000; and Eurekas and Euphorias: the Oxford Book of Scientific Anecdotes. New York: Oxford University Press, 2002) rather than an attempt to present an objective history and assessment. The title is misleading.
As a history of nutrition, the book's structure makes it difficult to follow the evolution of thinking on the subject. In contrast, the chapters on the discovery of the micronutrients — trace elements and vitamins — provide interesting reading. Not only does the author focus here on unraveling information about one nutrient at a time, but also the evidence and arguments presented are of a type likely to be familiar to the reader. A major conceptual barrier in the late 19th and early 20th centuries was the challenge to conventional wisdom of the argument that the absence of an essential factor, rather than the presence of a noxious agent, could cause disease.
Throughout the narrative, Gratzer presents examples of the addition of toxic substances to medicaments and foods — additions made in the sincere belief, based on the thinking of earlier periods, that there would be a benefit. This narrative provides a background for the emergence later of the regulation of foods and drugs, though this aspect of the history of nutrition is not featured in the book. Rather, the author presents his own view of the harm, both ancient and modern, wrought by food processing and profit-motivated industry. There is little attempt to present the positive side of food processing, in terms of the preservation of food and the year-round availability of what had once been a seasonal food supply.
However, as a portrayal of alleged Terrors of the Table, this book is certainly not another Silent Spring (Rachel Carson, 1962). The supposed terror of our current food supply is presented primarily in the final two chapters. These seem to be almost add-ons, rather than a continuation of the story, and tend toward poorly documented, selection-biased sensationalism, rather than objective history. Conversely, there is an interesting account of a series of popular weight-reduction diets and their supposed rationales that is reminiscent of the early thinking about diet and health described previously in the book. Gratzer includes a 12-page appendix, titled "The Hard Science," but it adds little useful information (the structures of selected nutrients, for example). The brief discussion of intermediary metabolism is so oversimplified and incomplete as to be misleading. Indeed, the discussion might encourage a naive reader to believe some of the rationales of weight-control diets that the author criticizes.
For the astute reader, the book offers an important lesson. The apparent strength of evidence and the validity of rationalizations are in the eye of the beholder. What was regarded as logical and valid in one era is now seen as spurious, as revealed in the author's successful effort to place his history in perspective. It is a sobering thought in our era, when medical scientists, clinicians, and policymakers proclaim the need for evidence-based medical practice, and they busy themselves developing concept papers on standards of evidence. How will they be viewed a century from now? Future medical historians, one hopes, will say that they did their best with what they knew.
The book jacket presents a question: "Should we always trust the pronouncements of experts on nutrition?" It would appear that Gratzer would probably respond in the negative. In fact, there is only one approach possible, and that is to gather groups of experts and develop a collective judgment that is based on the best available evidence, as judged by current standards. This is the process recently used by the Institute of Medicine to formulate Dietary Reference Intakes. Gratzer's history ends without discussion of the fascinating story of how estimates and interpretations of the quantitative needs for nutrients of humans are developed. Are the pronouncements of the experts always correct? No, but group judgments can be expected to be more reliable than lone opinions, though admittedly, such judgments often reflect the views of one or two strongly opinionated persons.
We must heed the truism offered by Bertolt Brecht: "That which is sure is not sure. As things are, they shall not remain." The curious history of nutrition is far from complete.
George H. Beaton, Ph.D.
University of Toronto
Toronto, ON M5S 1A1, Canada(By Walter Gratzer. 288 pp)
— Goethe
Had the author of this book taken Goethe's observation to heart, he might have featured the successes in the study and the advancement in the understanding of nutrition through the centuries, however slow at first, rather than providing anecdotal reporting on spurious beliefs and false starts. This book is, perhaps, an extension of the delight in debunking science that marked Gratzer's two earlier books (The Undergrowth of Science: Delusion, Self-Deception, and Human Frailty. New York: Oxford University Press, 2000; and Eurekas and Euphorias: the Oxford Book of Scientific Anecdotes. New York: Oxford University Press, 2002) rather than an attempt to present an objective history and assessment. The title is misleading.
As a history of nutrition, the book's structure makes it difficult to follow the evolution of thinking on the subject. In contrast, the chapters on the discovery of the micronutrients — trace elements and vitamins — provide interesting reading. Not only does the author focus here on unraveling information about one nutrient at a time, but also the evidence and arguments presented are of a type likely to be familiar to the reader. A major conceptual barrier in the late 19th and early 20th centuries was the challenge to conventional wisdom of the argument that the absence of an essential factor, rather than the presence of a noxious agent, could cause disease.
Throughout the narrative, Gratzer presents examples of the addition of toxic substances to medicaments and foods — additions made in the sincere belief, based on the thinking of earlier periods, that there would be a benefit. This narrative provides a background for the emergence later of the regulation of foods and drugs, though this aspect of the history of nutrition is not featured in the book. Rather, the author presents his own view of the harm, both ancient and modern, wrought by food processing and profit-motivated industry. There is little attempt to present the positive side of food processing, in terms of the preservation of food and the year-round availability of what had once been a seasonal food supply.
However, as a portrayal of alleged Terrors of the Table, this book is certainly not another Silent Spring (Rachel Carson, 1962). The supposed terror of our current food supply is presented primarily in the final two chapters. These seem to be almost add-ons, rather than a continuation of the story, and tend toward poorly documented, selection-biased sensationalism, rather than objective history. Conversely, there is an interesting account of a series of popular weight-reduction diets and their supposed rationales that is reminiscent of the early thinking about diet and health described previously in the book. Gratzer includes a 12-page appendix, titled "The Hard Science," but it adds little useful information (the structures of selected nutrients, for example). The brief discussion of intermediary metabolism is so oversimplified and incomplete as to be misleading. Indeed, the discussion might encourage a naive reader to believe some of the rationales of weight-control diets that the author criticizes.
For the astute reader, the book offers an important lesson. The apparent strength of evidence and the validity of rationalizations are in the eye of the beholder. What was regarded as logical and valid in one era is now seen as spurious, as revealed in the author's successful effort to place his history in perspective. It is a sobering thought in our era, when medical scientists, clinicians, and policymakers proclaim the need for evidence-based medical practice, and they busy themselves developing concept papers on standards of evidence. How will they be viewed a century from now? Future medical historians, one hopes, will say that they did their best with what they knew.
The book jacket presents a question: "Should we always trust the pronouncements of experts on nutrition?" It would appear that Gratzer would probably respond in the negative. In fact, there is only one approach possible, and that is to gather groups of experts and develop a collective judgment that is based on the best available evidence, as judged by current standards. This is the process recently used by the Institute of Medicine to formulate Dietary Reference Intakes. Gratzer's history ends without discussion of the fascinating story of how estimates and interpretations of the quantitative needs for nutrients of humans are developed. Are the pronouncements of the experts always correct? No, but group judgments can be expected to be more reliable than lone opinions, though admittedly, such judgments often reflect the views of one or two strongly opinionated persons.
We must heed the truism offered by Bertolt Brecht: "That which is sure is not sure. As things are, they shall not remain." The curious history of nutrition is far from complete.
George H. Beaton, Ph.D.
University of Toronto
Toronto, ON M5S 1A1, Canada(By Walter Gratzer. 288 pp)