University of Minnesota

“If It Isn’t Fun.” – The “Real Story” Behind the Seven Countries Study

Intense personal experience probably determines the direction of much human enterprise and of many careers. A young man meets President John F. Kennedy and vows to become President one day. Another is dishonorably discharged from the military service and vows to kill the President one day. Such experiences may be positive and uplifting, or painful and humiliating. Either may have powerfully motivating, earthshaking consequences.

I have a theory about the real origins of the Seven Countries Study, or at least about a critical moment that may have incited it. This story will not be confirmed or denied by Ancel Keys, who quietly changes the subject when asked about it. But the event was recounted to me by one of the principals, George Pickering.

In 1954, the fledgling World Health Organization called its first Expert Committee on the Pathogenesis of Atherosclerosis to consider the burgeoning epidemic of heart attacks. Several medical leaders of the time were assembled in Geneva: Paul Dudley White of Boston, Gunnar Björk of Stockholm, Noboru Kimura of Japan, George Pickering of Oxford, Ancel Keys of Minnesota, and others.  As reported by Pickering, the discussion was lively, tending to tangents and tirades.

Ancel Keys was in good form — outspoken, quick, typically blunt. When, at this critical conference, he posed with such assurance his dietary hypothesis of coronary heart disease, he was ill-prepared for the indignant reaction of some.

George Pickering, recently named Knight of the Realm by Queen Elizabeth, interrupted Keys’s peroration. He put it something along these lines: “Tell us, Professor Keys, if you would be so kind, what is the single best piece of evidence you can cite in support of your thesis about diet and coronary heart disease?” 

Keys, ordinarily quick on the draw, was taken aback. Rarely, of course, is there ever a “single best piece of evidence” supporting any theory. Theory is developed from a body of evidence and varied sources. This is particularly true in regard to the many facets of lifestyle that relate to disease. It is the totality and congruity of evidence that leads to a theory — and to inference of causation.

Keys fell headlong into the trap. He proceeded to cite a  piece of evidence.  Sir George and the assembled peers were easily able to diminish this single piece of evidence, and did so. By then it was too late to recover, or for Keys to summon the total evidence in a constructive, convincing argument. 

My theory is that Keys was so stung by this event that he left the Geneva meeting intent on gathering the definitive evidence to establish or refute the Diet-Heart Theory. Out of this singular, moving, personal experience — so my theory goes — came the challenge, the motivation, and eventually, implementation of the Seven Countries Study.

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