I agree with Margen, and I summar-

Editorial ize below the results obtained by these

investigators.
Nutrition Education: How Effective? Dr. G. Ritzel, a physic!an with the
When the Journal of NUTRITION EDUCATION was first published, it Medical Services of the School District
was described as a publication for a wide spectrum of nutrition educators. of Basel, Switzerland, published in 1961
As the JNE continues its growth, it becomes more and more evident that his report on a study made with 279
nutrition education is carried out by people with a wide variation of profes- skiers in a ski resort during two periods
sional training. This diversity is an important asset to the effectiveness of nu- of 5 to 7 days. Every subject was ex-
trition education. amined every day as to symptoms of
The nutrit,ion educator must remember that the nutrient needs of the in- colds and other infections, with the rec-
dividual continue from birth to death. The needs will change throughout the ords largely on the basis of subjective
lifetime. The motivations change. The accumulation of knowledge changes. symptoms, reported by the subjects, ,and
A nutrition education program devised for a Head Start program would be partially supported by objective observa-
entirely different from a high school science class. The course in nutrition tions by the physicians. The conditions
for the nurse would be different from that for a food technologist. were such that the incidence of colds was
Some very well thought-out objectives are being developed in some of large enough (approximately 20%) to
the approaches to nutrition education. The articles by Ardith Von Housen permit results with statistical significance
and Carol Suter in this issue describe objectives for very different programs. to be obtained. The subjects were rough-
Studies to define the problems have been developed for some time. Food con- ly of the same age and had similar nu-
sumption surveys, dietary histories, and studies of attitudes about food and trition during the period of the study.
nutrition, nutrition knowledge, and food habits help to identify the problem The ascorbic-acid subjects received 1,000
areas for emphasis in nutrition education. mg of ascorbic acid per day. The tablets
Programs are being carried out at all levels of need but how much is known of ascOl'bic acid or placebo were distrib-
about the effectiveness of the programs? How do you evaluate your nutrit,ion uted every morning and were taken by
education program? The agriculturalist can show how effectively he has taught the subjects under observat;on such that
the farmer by showing dollar increases in the farmer's income. The effective- the possibility of interchange of tablets
ness of ,the doctor's treatment, shows in the patient's recovery. was eliminated. The investigation was
The nutrition educator may be gathering data, formal or informal, while double-blind. After the completion of the
conductitng a program. How effective are the data in evaluating changes in investigation the records were turned
eating habits of the individuals receiving the nutrition education? over to a completely independent group
There are no easy answers. Perhaps it is time to draw up parameters by of professional people, also provided
which nutrition education can be effectively evaluated. For example, when with identification numbers for the tab-
there is some tangible evidence through data that students 'are maintaining lets, and this group carried out the sta-
better eating habits as a result of a coordinated nutrition education program tistical evaluation of the observations.
in the schools, nutrition education will remain in the school curriculum. Data The number of colds for the 140 persons
should be collected and evaluated on nutrition education carried out at all in the placebo group was 31, and that
stages in life and by different educational approaches. for the 139 persons in the ascorbic-acid
Helen D. Ullrich ::roup was 17. There was accordingly
observed a decrease by 45 % in the in-

Points of View cidence of colds in the ascorbic acid

Vitamin C and Colds
The review of my book Vitamin C
and the Common Cold by Dr. Sheldon
Margen (1. Nutr. Educ., Spring, 1971,
p. 131) is largely negative and full of
pejorative expressions ("serious lack of
sophistication," "quite deceptive," "er-
roneous interpretation," "quite meaning-
less"). The review contains some factual
errors" and in my opinion fails to do
justice to the arguments
, in the book.
I shall merition only one factual error.
In the review the author states that I had
failed to mention that in the work of
Glazebrook and Thomson the incidence
of colds was unaffected by vitamin C.
In fact, on page 42 I referred to the
reported incidence of colds and tonsilli-
tis in the control group of 1,500 students
studied by Glazebrook and Thomson,
and in the ascorbic-acid group of 335
students, and pointed out that there were
48 I JOURNAL ' OF NUTRITION EDUCATION
13 percent fewer colds (colds and tonsilli-
tis). I did not mention the figures for
colds individually. In Table 1 of the
paper the numbers of colds are recorded.
There were 17% fewer colds in the as-
corbic-acid subjects than the control sub-
jects (no difference in the incidence of
tons iii tis, which was smaller). It is not
true, as reported by Glazebrook and
Thomson, that the incidence of colds
was unaffected by vitamin C.
The study by Glazebrook and Thom-
son is, however, not one of the best
studies of ascorbic acid and the common
cold. Margen in his review says that
"One of the most convincing studies
quoted, and in my opinion the only con-
vincing study, is that of Ritzel." He also
writes that "Probably one of the most
significant papers in .this entire area is
that of Walker, Bynoe, and Tyrrell of the
Common Cold Research Unit of Great
Britain."
group, as compared with the placebo
group. The integrated morbidity, as
measured by the average number of days
of illness per subject in the group, was
61 % less for the ascorbic acid group
than for the placebo group, and 64%
less as measured by the average number
of individual symptoms (recorded every
day) per person in the group. All of
these differences have statistical signifi-
cance, at a confidence level greater than
95%.
Walker, Bynoe, and Tyrrell studied 91
subjects, 47 of whom received three
rrams of ascorbic acid per day for three
days before inoculation with viruses
(rhinoviruses, influenza B, or B814 vi-
rus), and for six days after inoculation ,
and 44 subjects received a placebo. The
incidence of colds was only 6% less for
the ascorbic acid group than for the
placebo group. This difference is not sta-
tistically significant. Moreover, the num-
ber of subjects and the incidence of
FALL, 1971
 colds is such that ,a protective effect
greater than about 40% would have been
required to give statistically significant
results.
These two studies seem to me, as to
Margen, to be important and reliable
ones. The study by Ritzel gave the result
that, administration of one gram per day
of ascorbic acid had the effect of decreas-
ing the incidence of colds, in comparison
with the placebo group, by 45 %, and de-
creasing the integrated morbidity by over
60 %, for subjects exposed to cold viruses
in the usual way, by casual contact with
other people. The study by Walker,
Bynoe,and Tyrrell gave the result that
the protective effect of three grams per
day of ascorbic acid is not greater than
40% (reported 6%, not statistically sig-
nificant), for subjects who are inocu-
lated with suspensions of cold viruses.
Further careful studies of the sort re-
ported ,by Ritzel and ,by Walker, Bynoe,
and Tyrrell are needed. At the present
time the evidence of the careful work
of these investigators indicates that as-
corbic acid has a rather large and statis-
tically significant protective effect against
the common cold for subjects who are
exposed to cold viruses in the ordinary
way, and a considerably smaller protec-
tive effect for subjects who are inocu-
lated with suspensions of cold viruses.
Linus Pauling, Professor of Chemis-
try, Stanford University, Stanford,
Calif. 94305.
Margen's Reply
In Dr. Linus P'auling's comments on
my review of his book, Vitamin C and
The Common Cold, he states the review
contains some factual errors. He points
to only one "factualerror"-that I stated
that the work of Glazebrook and Thom-
son demonstrated that the incidence of
colds was unaffected by vitamin C. Paul-
ing maintains that there were 17% fewer
colds in the ascorbic acid subjects than
in the controls. The study is not, balanced
as far as controls and exposed are con-
cerned,and Pauling is in error: the num-
ber of control students was not 1,500 as
,
he mentions, but 1,100. The incidence
of colds in the subjects on vitamin C was
21.2%; that of the control 26%. The con-
clusion of Glazebrook and Thomson is :
"It is obvious, therefore, that vitamin C
had no effect on the incidence either of
common cold or tonsillitis." The experi-
ment became complicated by the intro-
duction of recruits into the study, and
the following final conclusions were
reached by the authors:
"Large doses of ascorbic acid were
FALL. 1971
given to a group of adolescent,s in the eralities? Food guides are developed for
institution over a period of several the general public, not for the profession-
months. A record was kept of the inci- al nutritionist.
dences of infectious diseases in this You also suggest that, "A grouping of
treated group and in the remainder (con- foods by nutrient content seems to make
trois). The following conclusions were more sense in today's wor1d.~' This has
reached: always been the basis for USDA,as well
"(a) The incidences of common cold as many other, guides. Allocation of
and tonsillitis were the same in the two mixed dishes such as pizza or casserole
groups. dishes to one or more food groups in a
"(b) The average duration of illness guide will depend on their basic ingredi-
due to ,t he common cold was the same in ents. Serving size needs to be considered
the two groups." too.
Pauling then comments on my evalua- Before we "throw the baby out with
tion of the study of RitzeL This study is the bath water," I suggest that we con-
an interesting one, although certainly as sider the meaning and purpose of a guide
an epidemiological study leaves much to as contrasted with a guarantee of nutri-
be desired. There are insufficient parti- tional adequacy. Rigid rules of "eat this
culars within the study to enable one to and that" would be needed in order to
analyze the data properly. However, it guarantee an adequate intake. These
is sufficiently "convincing" to indicate allow no choices.
that further work in the area should be Essentials of An Adequate Diet
undertaken. (Home Economics Research Report No.
As for Pauling's comments on the 3, USDA-now out of print) sets forth
work of Walker, Bynoe and Tyrrell, the principles and limitations of the four
these studies demonstrate no effect of food groups. In this we find repeatedly
large doses of vitamin C. Pauling appears the statement that the minimum serv-
to make a philosophical error in his in- ings listed form the foundation for a
terpretation of the statistics applied to good diet. They provide a substant,ial
this problem. He is correct that it, would share of the , RDAs. Also stated, is that
require a 25 to 40% decrease in the num- minimum : servings (based on average
ber of colds in order for a reduction to choices from nationwide food consump-
be statistically significant. The fact that tion studies) need to be supplemented by
there was not ,a reduction of colds with nutrients from ,additional servings of the
vitamin C is the important finding of same types of foods as well as foods not
this experiment. In view of Pauling's ex- listed in the four groups.
pected relationship between the dosage I am looking forward to the open
of vitamin C and cold incidence, the lack forum you invite on the subject of food
of effect in the studies of Walker, Bynoe guides. It will be most profitable, how-
and Tyrrell are particularly damaging ever, if our objective is clearly stated. Is
to his thesis on the protective effect of it to guide or to guarantee? If it is to
vitamin C on the common cold. guarantee, will we need to regiment peo-
As I stated in my review of the book, ple's food "choices"?
I do believe that the question is still not Ruth M. Leverton, Science Adviser,
answered satisfactorily, but that the evi- Agricultural Research Service, USDA ,
dence for the effectiveness of vitamin C Washington , D.C. 22050.
is still very poor.
Sheldon Margen, M.D., Professor of
Changing Food Habits
Human Nutrition and Chairman,
Economists have a right, indeed an
Dept. of Nutritional Sciences, Univer-
obligation, to interpret and analyze data
sity of California, Berkeley, Calif.
94720. relat,e d to nutritional achievement and
changes in nutritional behavior. The eco-
nomics of development has dealt with
Teaching Tools the relationship between labor producti-
I am accepting the invitation offered vity and nutrition. Furthermore, it is
in your editorial in the Winter, 1971, now established that there is a close re-
issue to ,c omment on teaching tools and lationship between nutrition and mental
food guides. retardation. The effect of mental retarda-
You suggest that it is time to find a tion on the marginal productivity of
new tool when we as nutritionists "teach labor is self evident.
with a tool we can't even apply consis- An article, "Implications of Chang-
tently to ourselves." Could it be that we ing Food Habits For Nutrition Educa-
as nutritionists have so much det,ailed tors," which appeared in your Spring,
information that we cannot tolerate gen- 1971, issue, examines some of the "so-
JOURNAL OF NUTRITION EDUCATION I 51