The effect of rising food prices on food consumption: systematic review with meta-regression

BMJ 2013; 346 doi: (Published 17 June 2013)
Cite this as: BMJ 2013;346:f3703

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Evidence Based Medicine relies heavily on systematic reviews, a type of studies where the aim is to retrieve all existing evidence (i.e. primary studies or trials) on a given health problem in order to obtain the best evidence possible1. One difficulty in tracing down primary studies and their authors is the fact that many Spanish speaking authors have two family names, one given after their father, the second after their mother, instead of the one in countries of Anglo-Saxon stock. Consequently, most Spanish speaking researchers have a group of publications retrieved by searching engines with one (usually the first family name) and a second group, usually published by journals in Spanish, signed under two family names. This is of special importance when trying to pin down double or split publication of the same trial in several journals, and if authors need to be contacted to clarify information within a trial.

Taking as an example a relevant ENT researcher named José Luis Llorente Pendás (where José Luis is his first name, and Llorente Pendás his family name), Pubmed finds 62 articles under Llorente Pendás JL, and 106 (different from the prior 62) under Llorente JL. Notice that people from Spanish origin usually call themselves just with their first surname (in the case above, Dr. Llorente, instead of Dr. Pendás, which would probably be how a native from the UK or the USA would address him).

Spanish has reached second in the world in the number of speakers in 2012, and in 2030, 7,5% of the world population will be Spanish-speaking2, well ahead of Russian (2,2%), French (1,4%) and German (1,2%). Therefore this problem will probably increase in the near future, as the number of articles in Spanish increases. It may hinder the capacity to track the papers authored by Spanish speaking researchers, and constitutes a possible source of bias not described in the literature so far.


1. Guyat G, Rennie D, Meade MO, Cook DJ. JAMA Evidence. User´s Guide to the Medical Literature. 2nd Edition. McGraw Hill Mecical. New York 2008. 524-542.
2. Instituto Cervantes. El español en el Mundo. Anuario 2012. Available online at: [].

Competing interests: None declared


Laura Rubio Rodriguez

Hospital Vital Alvarez Buylla, Murias s/n 33616 Mieres, Asturias. Spain

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Of the cultural powerhouses of England a century ago, that of George Bernard Shaw was furnaced by the tissue of plants. A son of Ireland, the behemoth of polemic and philosophy was a staunch votary of the vegetarian life throughout his days. Viewed by the cognoscenti as the greatest playwright since Shakespeare, GBS used the artifice of drama to project his sentiments on the sociopolitical plight of his times. From amongst his wide-ranging oeuvre, plays such as “Man and Superman” belong to the literary pantheon of Britain and today resonate with the masses if only by familiarity of concept.

A superman himself – opinionated but urbane and erudite – the tall figure from Dublin attended a lecture in his twenties which impressed on him the benefits of a diet predicated on fruits and foliage. From the compendium of Shavian quotations, the “a man of my spiritual intensity does not live on corpses” is one that conveys his pungency of mind whilst ratifying his aversion to animal flesh.

Vegetarianism proved not an errant folly of youth, but remained with GBS till the day he died at the age of ninety-four after falling manfully from a ladder. Into his nineties he had been pruning the trees which flourished in his orchard at Hertfordshire. Producing a corpus of substantial work, and retaining a stoutness of limb far into his dotage, the Dublin-born playwright is one of the bastions of vegetarianism in Britain.

Exotically non-conformist, and seen as neo-lunacy, the vegetarianism of GBS found camaraderie from the nation of India, a subcontinent with a richer ethnic diversity than that of Europe, but with a streak of vegetarianism that permeates the whole of its societal bedrock. Thus Ireland and India met in a cordial handshake when GBS met Mahatma Gandhi and exchanged ideas on life, people, societies, and their two-man partisanship of the vegetarian club. For Gandhi, a slender Indian from the province of Gujarat, a vegetarian diet was merely a facet of his regional heritage. For GBS, a Celt of Irish-Scots ancestry, the decision to become vegetarian was an expression of spiritual introspections, and therefore adopted of his own volition.

Progressing onward from cultural norms and the spiritualism of the individual, the economists of agriculture tell us that a much smaller allotment of land is needed to generate plant-source food when compared with animal-based nutriment. A batch of articles from the popular press inform us that the growing of food requires neither a garden nor a clemency of weather. Commodious tupperware, a sleep of grow-bags, and long trays sponged with compost can be used to produce all manner of kitchen necessaries. Plastic sheets with perforations can be used over the winter months where the householder lacks the expedient of a greenhouse. It is notable that the subculture of the greenhouse has become a rarity in the suburbs, as the nation has moved to screen-based lifestyles and our map has become smothered by corporate supermarkets. But now with the cost of food spiralling to lofty heights, the time is propitious for effecting a return of suburban horticulture.

Unlike many other ecosystems across the planet the British Isles are an exceedingly fertile zone. Indeed the first glimpse from the air is a scene of verdant splendour and the epithet “this green and pleasant land” is found carved into sandstone obelisks which commemorate those who fell in the largest theatres of war. A dish of vegetables from the garden should feature on the table in times that are typified by the spectre of monetary malaise and mass obesity. The stringency of the original Shavian edict may be moderated for the twenty-first century to less puritanically declaim, “add lean meat in accordance with personal taste.”

Omens of more economic difficulty and ripples from the past half-decade both favour the charting of a course which lessens a reliance on the supermarket and its batteries of hoggishly-caloried foods. To do away with the supermarket altogether is impractical, but a greater inclusion of home-grown food would be a logical shift in advocating health and countering the cost of living as it climbs over the imminent years.

This topical research paper in the BMJ advances the issue of how the increasing cost of food will impinge on poor countries and people in the lower echelons of income in Britain. In rich countries, people live cocooned lives and are less attuned to the circumstances of their neighbours. Religion has also long been passé for a major part of the populace, so that a new following – a national commonwealth – should be evolved to better conserve resources and promote educative efforts for children that will equip with them with skills beyond a use of the computer. Simply imbuing Popeye The Sailor Man with a partiality for spinach was once highly successful in making children eat their greens.

Transferring from the abstract to the anecdotal, there used to be a subject called Home Economics taught in the secondary schools of England. Classes were given on the preparation of wholesome meals, as well as on the cultivation of necessaries such as onions, potatoes, tomatoes, and broad beans. The architects of national education in a country which is the home of Newton and Shakespeare should return these elements of a British education back to the curriculum. The rest of us would do well to experiment with trays of compost, commodious tupperware, and tomato grow-bags before finally wielding the hoe to cultivate this green and pleasant land. And, as in the days of the past, where much is grown there is much that can be shared.

Competing interests: None declared

Jagdeep Singh Gandhi, Consultant Ophthalmic Surgeon

Worcester Royal Eye Unit, Worcestershire Royal Hospital, Worcester, UK

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