Image Credit: Chantal Garnier / Unsplash. This image has been modified.

Consider the Evidence When You Make Life-or-Death Decisions

In the 1940s and ’50s, the American Medical Association was not only saying that “smoking in moderation” wasn’t a problem, but that, on balance, it may even be beneficial. After all, most physicians themselves smoked, so how bad could it be? With such a position taken by one of the country’s leading medical groups, where could you turn if you just wanted the facts?

According to one tobacco company ad, “science advances new data that may completely change your idea of cigarettes!” And what might those new data tell us? “She was too tired for fun…and then she smoked a Camel.” (You can see the unbelievable ads in my video Evidence-Based Eating, starting at 0:29). In another ad, baseball legend Babe Ruth told us, “Now! Medical science offers proof positive!” that the brand he was hawking is the safest to smoke of all the leading cigarettes—well, he told us, that is, when he still could talk, before he died of throat cancer.

Now, some of the science-based evidence did leak out, causing a dip from an average of 11 or so cigarettes a day per person down to 10, as you can see at 0:50 in my video, but those who got scared of possible health risks from smoking could always choose “[t]he cigarette that takes the FEAR out of smoking!” Even better, why not choose the cigarette that “gives you the greatest health protection?”

Had a website existed during the time of these outrageous ads making such outrageous claims—a site that delivered the science directly to the people, bypassing commercially corruptible institutional filters—it would have featured a study of Seventh-day Adventists in California in 1958 that showed that nonsmokers may have at least 90 percent less lung cancer than smokers. With so much money and personal habit at stake, there will always be “dissenters.” Given the seriousness of these diseases and the sum total of evidence, though, we shouldn’t wait to put preventive measures in place.

If you’re a smoker in the 1950s in the know and privy to the science-based realities of smoking, you realize the best available balance of evidence suggests your smoking habit is probably not good for you. So, what do you do? Do you change your smoking habits, or do you wait? If you wait until your physician tells you—between puffs—to quit, you could have cancer by then. If you wait until the powers that be officially recognize it, like the Surgeon General did in the subsequent decade, you could be dead by then.

It took more than 7,000 studies and the deaths of countless smokers before the first Surgeon General report against smoking was finally released in the 1960s. Wouldn’t you think that after the first 6,000 studies or so, they could have given people a heads up? One wonders how many people are suffering needlessly right now from dietary diseases.

Let’s fast-forward 55 years to a new Adventist study out of California warning Americans about the risks of something else they may be putting in their mouths: “Vegetarian diets are associated with lower all-cause mortality.” It’s not just one study either. According to a recent review, a total sum of evidence suggests that mortality from all causes put together, including many of our dreaded diseases were significantly lower in those eating more plant-based diets. As well, “[c]ompared with omnivores, the incidence of cancer and type 2 diabetes was also significantly lower in vegetarians.”

So, instead of someone going along with America’s smoking habits in the 1950s, imagine you or someone you know is going along with America’s eating habits today. With access to the science, you realize the best available balance of evidence suggests your eating habits are probably not good for you. So, what do you do? Do you change your eating habits, or do you wait? If you wait until your doctor tells you—between bites—to change your diet, it could be too late.

Just like most doctors smoked back then and didn’t tell their patients to change, despite the overwhelming evidence published for decades, most doctors today continue to eat foods that are contributing to our epidemics of dietary disease.

For more on this topic, check out my series of videos on parallels to smoking and the tobacco industry’s tactics, including:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

77 responses to “Consider the Evidence When You Make Life-or-Death Decisions

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  1. Life or death decisions? Does anybody deliberately “choose” death? :-0

    Yes, I guess you could say they do, if they decide to put a loaded pistol in their mouth and pull the trigger. *ewwww*

    1. YR,

      In the Bible it says

      I have set before you life and death, blessing and cursing: therefore choose life, that both thou and thy seed may live (King James because it is the version that isn’t copyrighted.)

      But the concept that each and every decision in front of us is either one toward life or toward death and that choosing life affects our children is one of my favorite verses because of how simplifying it is.

      It is this easy to use, free, internal measuring stick that we can carry around with us every day, like being able to use your own feet to measure a room.

      I think when I was young, I would have thought of it as ridiculous to think of every single thing as a “life” or “death” decision, but instead of making things more dramatic, it genuinely simplifies everything and calms everything down.

      My brother used to listen to a song, “Wine is fine. Whiskey’s quicker. Suicide is slow with liquor” and when you don’t have a sense of what brings life and what brings death because of how long it takes the death to happen, there is a vague inner notion as if you kept running red lights and knew it might catch up with you eventually.

    2. Millions of people “choose” death every day by eating the foods that cause sickness, degeneration, inflammation and disease. That is the choice they are making.

      1. You could look like it like that. However:

        Logic 101?

        People who follow a SAD diet often die from poor nourishment;
        They don’t always realize this while they’re scarfing down said diet.
        Nevertheless, they “choose” to die from following the SAD diet. (?)

        1. YR,

          I agree with you.

          And even when they DO know that what they are eating isn’t healthy, their reaction is often: Just give me the drugs so I can keep eating what I eat now. That is, if they accept that what they are eating isn’t really healthy for them, and is in fact downright unhealthy.

          1. Hmmm….sorta like Catholics back when I was young.

            They might “do the dirty” with someone outside of matrimony, knowing that the Church, etc. considerate it wrong — assuring themselves they’ll go to confession the following Saturday and confess their mortal sin to a priest. (Otherwise, they’ll go to hell.)

        1. Your understanding of English is faulty. Dr Greger is using the term correctly. A life or death decision simply refers to a decision
          1. having death as a possible result: a life-or-death struggle
          2. so extremely important as to be crucial: a life-or-death decision

          Choosing to drink and drive, or to chance crossing a busy road without a pedestrian crossing, are life and death decisions. In other words, they are vitally important whether we fully understand that or not since they could result in our or somebody else’s death.

  2. I love the photo.

    Actually, I really like all the photos that show beautiful veggies and fruit, and delicious food. Kudos to whoever is/are responsible for selecting them. They are a fantastic positive message. Thank you!

    1. Dr J, Some of these veggie photos look like a work of art. I wonder who does the arranging? It’s definitely not the typical vegetable stand of years ago.

      1. I think it had to be specifically chosen for its art because of all of the potatoes. Meaning, they wouldn’t be serving cold potatoes and it would be challenging to sell vegetables arranged that way.

        But it was intentionally arranged more in the way flowers would be arranged.

      1. Nor does a 10 week study of 16 people consuming green tea extract in meat patties tell us much bout the long term effects of diet on mortallity.

    1. That’s hardly relevant is it? A 4 week study on biomarkers doesn’t tell us anything about mortality and diet. It also explicitly states that we need more studies to understand why fruit and vegetable consumption prevents CVD.

  3. The photographer is chantel garnier
    There are more of hers on that page, but maybe not all are hers. I tried to paste her profile page but I lose the text box.

    Re: choices. There is a lot to be said for not making the lives of others (sentient beings) miserable for sure … goes without saying. But as for life, not everyone is enjoying this trip and their choices will reflect that.

  4. Very good blog today that should wake up a lot of people about the realities—-. Some folks search for what they really want to be in agreement with and want to do or continue. Smoking (and MJ) are examples. Many will search the web for what agrees with their belief that smoking is fine. Time will show those who smoke but over a longer time period. Research showed, overtime also. For every person I have a discussion with about this topic, they come back with an article that approves their point of view which is opposite to mine. I’m not giving up but can’t stand to lose another friend.

      1. What’s the problem? I don’t understand your point.

        The article concludes ‘Further studies are needed in order to unravel the mechanism of effect of vegetable consumption in cardiovascular prevention.’ That sounds entirely consistent with Dr Greger’s argument.

  5. Many people survive the military only to die from one of the habits they acquire there ~ cigarette smoking. It is nearly ubiquitous.

    Another habit picked up in the military is poor diet of course. (I was in the US Navy ’69 – ’73. Please don’t thank me for my service because the Navy gave me much more than I was called on to give back.)

    1. It’s changed. Eating at Air Force dining halls has changed, now sometimes the healthiest option I can find when I travel. Everything from veggie burgers to buddha bowls with tofu. Plus large salad bar. My best WFPB option is some towns.

    2. Navy Corpsman,

      My husband was in the navy, too: ‘64-‘70. Submarine service. And he smoked — even aboard the submarine. But he said the food on a submarine was better than on surface ships.

      And he did quit smoking afterward, in about ‘71 or ‘72. Cold turkey. His late first wife told him one day that she had decided that they were both going to quit — and they did.

      And his second wife told him, soon after they met 12 years ago, that she couldn’t cook meat for him, but that he could order it when they ate out. He decided to eat vegetarian full time. And when I stopped eating dairy and eggs, and to avoid processed food, so did he.

      Wise wives. Smart husband.

  6. Dr. Greger, I want to thank you for the work you are doing! I find your articles very interesting and informative!
    I’d like to see lots more being done to teach children how bad smoking is! I signed a pledge when I was in my early teens, after a really good presentation at my school, showing what smoking does to ones lungs! I pledged to never smoke, drink alcohol, or even coffee and tea! And I’ve never had any of those bad habits!!! I had promised, and I’ve kept my promise!
    My second daughter told me she had decided when she was eight yrs old that she would smoke someday!!!!! This shows what I mean!! Start teaching when children are younger than eight!!!!!

    1. I was relentlessly against my teenage daughter smoking. I pulled out all the stops to get her to not smoke although she had started. She’s 35 now and doesn’t smoke.

      SHE’S the one who showed me an article from Harvard saying that milk was unhealthy when she was a teen. Now if I could only get her on a WFPB diet. I don’t quit trying, although it’s difficult since I only see her on holidays when she can get home.

      1. Lisa,

        I have been thinking about how frustrating it is to watch loved ones and know they are making decisions that will harm their health.

        My sister-in-law serving my brother high fat keto after his kidney was removed breaks my heart in a million pieces especially when he didn’t mind eating vegan and I think it is Gundry that Messed her mind up so much. She is afraid of vegetables.

        And I am afraid of her choices.

        1. How about your brother? Could you work on him? Maybe get him to ask for certain foods–instead of pushing for a “way” to eat? (Just a thought.)

        2. Don’t give up! I lost my brother probably to a combination of diabetes and a blocked carotid artery when he was 61 and it was very painful. He was the baby of our family and always very funny and loyal to his friends, family, and animals.

  7. Donna, when I sat on my Dads lap over eighty years ago, he asked me to promise him never to smoke. His sincerity stuck with me and I’ve never tried it. I miss his wisdom (and Mom too) everyday. We had huge organic garden and always had fruit on the porch. Encouraged us to grab some every time we went in and out to play. The entire stalk of bananas wa 5 cents and hung from a huge hook. Have such good healthy memories of long ago. My dad was a professional boxer and wrestler. My oh my! Forgive this oldie lady.

    1. Our dad was a heavy unfiltered Camel smoker and stuck up the house. All the furniture, the air, the curtains….his breath! His teeth looked like hell. (It eventually killed him at 58 years old.)

      Nobody else in my family ever smoked. I took one puff when I was 15, choked a bit, and never touched another ciggie.

  8. Off topic: I just got my second “Hi Grandma” call. If I don’t recognize a phone number in my Caller I-D, I will (depending on my mood, usually let the answering machine take the call) say nothing at all. If nobody speaks at the other end after less than a minute, I hang up. (Loudly!)

    Today after several seconds’ pause, the voice at the other end said “Hello?” I asked who was calling. All the guy said was “Hi Grandma, this is Michael.” I said, “Oh no, that scam call again! I don’t have a grandson named Michael.” He tried again: “Jim?”

    I said, “Oh fer god’s sake, get yourself a real job!” He told me to suck a part of his anatomy (yuck!), and then we both hung up. (I shouldn’t chatter with these pathetic souls.)

    Dr. Poop (Oz) had an interesting segment on today’s show about robocalls and scammers. This sickness is pervasive….don’t get caught! We just can’t answer our phones anymore. :-(

  9. Seventh-day Adventists have more to share then just our health message. There’s a reason they’ve been so enlightened on Health because it’s scripturally based. Our Creator knows what is best for us to eat, drink, think and do to be healthy. He, God as our creator, also knows the end from the beginning. I hope you will delve into God’s word to learn about spiritual life and death. As that is much more important than our physical life and death. They go hand in hand. “What profit a man if he shall gain the whole world and lose his own soul“. Matthew 16:26 ❤️

      1. Not saying you’re wrong, Fumbles, but YOU’RE perceiving this is “just delusional nonsense” is just delusional nonsense. And so it goes! Maybe it’s the “certainty” in a person’s statement — it’s my way or the highway — that another person objects to, not the fact that the person might believe it.

        Who are we to say that what another believes is true, isn’t! You might wake up someday and decide that everything you believed in life was a truthism was in actuality just a crock of doggie doo.

        1. YR, Regarding the article at the link you posted, I tend to agree with Rene Descartes’ view rather than Spinoza. After all, Descartes made a big leap forward in mathematics when he introduced the Rectangular Cartesian Coordinate system which essentially unified Geometry and Algebra, which before, were separate fields of study. Smart man, he was.

          1. The author’s take on it:

            “…but it’s better to believe too much and be caught out once in a while than be too cynical and fail to capitalise on the useful and beneficial information that is actually true.”

        2. The statement of someone’s belief as an absolute fact is certainly irritating. How many gimcrack religions are there? How many have there been throughout human history?

          They can’t all be/have been right. In fact given the complete lack of any credible evidence that any of them is right, I’d venture that logic and common sense compel us to conclude that none of them are. The odds that Rose’s personal belief is correct are about the same as the Moon being made of green cheese. Probably less if one thinks about it.

          But, yes, it’s possible that I could wake up tomorrow with a second head and super powers but it’s unlikely.

            1. Good point, YR! I’ll have to agree with you on that viewpoint: … those not hearing the music would definitely think that those who do, are crazy. We all have a different “World view” depending on our inherited genetics and “education”, especially in our formative years as youths.

              If I may add a little humor here, whenever I hear dancing and insane in the same sentence, I think of the Elaine Benis dance routine in one of the Seinfeld episodes.


  10. As far as changing the diet, a year and a half ago, I told some of my friends that watching videos about healthy food every day probably helps more than anything.

    When I came here, I didn’t expect to go Whole Food Plant-Based at all.

    I just focused on learning.

    I feel like so many of the problems are about having been brain-washed in the first place, so washing the brain back in a different direction for a few months without the pressure to actually do anything at all may work for a lot of people.

    I have younger friends who grew up almost entirely on McDonalds and they never saw cooking modeled and never ate a piece of fruit or a vegetable.

    Sometimes, just watching and seeing how pretty they are and trying a banana or an orange or apple or some watermelon. The ones kids eat seem like a good place to start.

      1. Chris,

        I did look at one of the studies and I am not sure why you think it came against Dr. Greger’s article.

        I went back up and re-read his and went back to the conclusion of yours and I see that your study is saying that they are still trying to figure out WHY vegetable intake improves all-cause mortality and his article is pointing out that it happens.

        “Vegetarian diets are associated with lower all-cause mortality.” It’s not just one study either. According to a recent review, a total sum of evidence suggests that mortality from all causes put together, including many of our dreaded diseases were significantly lower in those eating more plant-based diets. As well, “[c]ompared with omnivores, the incidence of cancer and type 2 diabetes was also significantly lower in vegetarians.”

        Your article isn’t denying that it happens.

        It is saying,

        “Further studies, including also the evaluation of potential changes in the human gut microbiota [45], are need in order to unravel the mechanism of effect of vegetable consumption in cardiovascular prevention.”

        1. Hi Deb

          OK there are two studies:

          No significant changes were detected in clinical, immunological, and antioxidant markers in biological samples, except for an increase in white blood cell count for the low vegetable consumption group (p < 0.05 ). The study provides additional evidence about the uncertainty of providing a clear evidence for vegetables in modulating markers of immune function and antioxidant status. Further studies are needed in order to unravel the mechanism of effect of vegetable consumption in cardiovascular prevention

          So the conclusion from this study was that there was uncertainty in saying that vegetables were good for you even though one group consumed a high amount.

          The second study:

          Since no long-term effects of GTE were observed, the study essentially served as a fruit and vegetables depletion study. The overall effect of the 10-week period without dietary fruits and vegetables was a decrease in oxidative damage to DNA, blood proteins, and plasma lipids, concomitantly with marked changes in antioxidative defence.

          This study shows that NOT having vegetables, reducing vegetables is good for you!

          So a) no proof veggies are good for you and b) evidence showing they are bad for you

          Pretty contradictory I'd have thought, to this blog.

          1. That seems a bizarre argument. I’m sure that smoking for 4 weeks or 10 weeks wouldn’t kill you, cause lung cancer or heart disease either. It would hardly prove that smoking is harmless though would it?

  11. I am trying to understand if you think that means that it is better to not eat vegetables?

    Or are you saying that Dr. Greger is wrong about the mechanism?

    I didn’t see a mechanism given above.

    1. Hi Deb

      My thinking as I put in the opening post is simply this:

      UNLESS a blog deals with criticisms/contradictions head on then it’s really only going to be ‘preaching to the choir’. For example, if this was a ‘carnivore blog’ then I’d post that unless it dealt with ‘study X’ showing vegan diet to be superior etc then that blog would be ‘preaching…’

      That’s my only point.

      I don’t have a view as to the ‘best’ way to eat – I try and understand evidence.

      For example, you may not like this but it seems interesting:

      1. Chris:

        I think one shouldn’t base one’s eating habits on one lonely study. Taking a look at the bulk of them suggests that this study is not one about which to worry.

  12. I had dinner at an Indian restaurant called Guru in Copenhagen tonight. There was a large sign above the door that read,”When diet is wrong, medicine is of no use. When diet is correct medicine if of no need.” – Ancient Ayurvedic Proverb Great meal!

  13. Chris,

    I honestly am not sure what you are trying to communicate with the links.

    Are you saying that vegetables are over-rated?

    Or that Dr. Greger has focused too much on antioxidants and not enough on the microbiome?

    1. My ONLY point is that UNLESS a blog confronts contradictions then people who are not already convinced may remain unconvinced and that helps no-one.
      For example: if a blog was written that showed how bad smoking was BUT AT THE SAME TIME did not comment on a study that ‘showed’ smoking cures lung cancer then someone somewhere, who smoked, would read the blog, think about how smoking ‘cures cancer’ and continue smoking.

  14. Chris,

    This research lab said that the antioxidant activity of fruits and vegetables wasn’t being measured properly.

    “The problem is that the antioxidant activity of the solid fraction (the fibre) isn’t measured, as it’s assumed that it isn’t beneficial. However, this insoluble fraction arrives at the large intestine and the intestinal microbiota can also ferment it and extract even more antioxidant substances, which we can assess with our new methodology,” José Ángel Rufián Henares, professor at the University of Granada, explains.

    His team has developed a technique called ‘global antioxidant response’ (GAR), which includes an in vitro simulation of the gastrointestinal digestion that occurs in our body, whilst taking into account the ‘forgotten’ antioxidant capacity of the solid fraction.

    “The antioxidant activity is, on average, ten times higher than that which everyone thought up until now, and not just in juices, but also in any other kind of food analysed with this methodology,” highlights Rufián Henares, who notes its possible application: “This technique and the results derived from it could allow dieticians and health authorities to better establish the values of the antioxidant capacity of foods.”

  15. My sole point is simply that a blog that promotes healthy eating etc etc should ALSO consider studies (just 1-2) that have totally contradictory views/results and comment on them . Not so much by posting more and more studies supporting a view but by saying:

    This study (name of study) purported to demonstrate that REDUCING VEGETABLES was a good thing. However there were several errors such as….etc

    It’s like studies supporting statins are often ripped apart from anti-statins people; studies on, say, saturated fat are also analysed etc etc

    1. Chris,

      Dr. Greger does do that, on several papers about different topics, which he describes in various videos.

      Did you evaluate the research? Where and by whom was it done? Who funded it? How large were the study groups? Was there a control group? What was being studied? Was it appropriate? How was the data collected, and analyzed? Do the conclusions make sense, in view of the methods and results? How applicable were these results to endpoints of interest — being, good health, decreased morbidity and mortality?

      Maybe you could provide an analysis for us here?

    2. Chris,

      Thank you for answering.

      It helps me to understand what you are trying to communicate.

      I think, if you look at the bigger scope of the site, eventually, the topics like the dangers of eating too much spinach or who shouldn’t eat turmeric etc do show up.

      Just for his short videos, he wrote a book that started off over 800 pages. He had to edit out hundreds of pages, but I think someone said that he narrowed it to 82 studies on intermittent fasting alone.

      It is really hard to do the process you are talking about because he could literally write a book on each of these topics and that would be useful to a subset of the audience but most of the audience would not stand for it.

      1. Chris,

        He has more of researchers reading every single study and they are doing the process you are talking about, but there are 100,000 studies every year.

    3. chris,

      I tried to look for studies that would demonstrate that reducing vegetables was a good thing, but those studies don’t exist.

      I found a systematic review and it said

      The health benefits of a high consumption of fruits and vegetables are well known [1]. Associations with all-cause mortality [2, 3] and mortality from cardiovascular disease [2, 3], including coronary heart disease [4] and stroke [5, 6], are well evidenced. Associations also suggest a reduced risk of hypertension [7], osteoporosis [8], body weight and adiposity [9, 10], dementia and cognitive decline [11, 12], and some cancers [13–15], although the evidence for cancers is less consistent [1, 3]. Intervention studies increasing the consumption of fruits and vegetables also demonstrate improved microvascular function [16], improved microvascular function and inflammatory status [17], improved profiles in inflammatory and oxidative stress [18], improved immune response [19], and improved weight maintenance [20].

      They did say that the specific bioactive compounds in fruits and in vegetables can vary greatly.

      Many of the studies that are out there are trying to figure out which fruits and which vegetables have which benefits and that process can take the rest of our lives to figure out.

  16. Dr. Ron Weiss was really interesting in Chef AJ’s summit.

    His talking about the pesticides allowed within organic was fascinating and yet so discouraging.

    The fact that things can say organic and have pesticides from plants is so frustrating.

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