What causes a disease? What prevents it? -- the case of pellagra


"Goldberger's discovery could not prevent pellagra in the 1910s and 20s in the United States, but could in the 1930s" -- support or dispute this proposition.

On this brainstorming page, add Knowledge claims, Action proposals, and Questions for inquiry without spelling out the K-A-Q connections. Reviewing this page may help you identify a starting point for one or more KAQ pages of special interest to you.

Knowledge claims
(see additional KAQs by ss and mjp)
K1. Hereditarianism is only one of a complex of factors that prevented understanding the cause of pellagra and delayed its cure (jrc)

K2. The eugenics movement played a key role in the obfuscation of pellagra's cause.

K3. Cheap southern labor was desirable enough by the power-holders that it was more convenient to blame heredity (something not so easily changed by social wellness initiatives).

K4. Medical training at the time was sub-par and doctors lacked the critcal thinking and fact-checking to refute Davenport's thesis.

Actions that follow from some Knowledge claim: What could people do on the basis of this knowledge claim?

Questions for further Inquiry: What more do you want to know—

Q1. What were the multiple factors that may obscure understanding of a disease? – factors that may be social, cultural, economic, limit to the actual state of knowledge in the field, influence of medical paradigms (e.g. “infection” as causative factor in pellagra, “bad constitution inherited from parents” as a causative factor). (jrc)

Q2. What were the prevailing medical paradigms that influenced epidemiology in the early part of the century? How did these affect the hypotheses that developed to explain the disease of pellagra? (jrc)

Q3. Is there any parallel paradigm operating today (the gene as the basic unit of explanation for disease and wellness)? (jrc)

Q4. What was the direct link to heredity that Goldberg contested? Why was Davenport’s “evidence” so compelling? (jrc)

Q5. What had changed by the Thirties to made Goldberger’s discovery acceptable? (jrc)


K1: “The size (444 pages), scientific complexity, and ‘authoritative’ tone of the Davenport report combined with the low standard of medical education that produced physicians who did not have the capacity to question the report’s veracity, meant that most accepted the conclusion that it was “bad genes” and not “bad diet” that was responsible for pellagra.”
A: The actions taken are outlined in the scenario. There were policy diversions created by this report preventing the government from taking adequate measure to stall pellagra


Q1: How are scientific and more specifically medical reports evaluated?

Q2: What methods can be used to create proper scientific dialectic for a problem?

Q3: What are the methods that scientists have used to propel incorrect research (South Korean stem cell issue)?

Q4: What policy measures can be taken(if any) to prevent this, what academic measures are taken?

Q5: How much research is needed before a report is considered conclusive to act upon?


K2: “To reach this conclusion, he also had to explain that although pellagra was not an inheritable disease in the sense that brown eye color was inheritable, the course of the disease did indeed depend on certain “constitutional, inheritable” traits of the affected individual”
A: This conclusion is seen as conclusive even though I don’t think it is.

Q1: What is the scientific background on this type of conclusion?

Q2: How can this inheritability be altered using scientific/social means?

K3: “Although the disease had been known about for far longer than other diseases, pellagra was possibly never considered within the ranks of the great plagues such as malaria, yellow fever, or typhoid because it struck only the poorest.”
A: The consequences of the lack of attention for this case are the, “millions of completely avoidable premature deaths, chronic degenerative diseases and other disorders.”

Q1: That is the medical difference between a disease and a plague?

Q2: What is the economic difference between a disease and a plague?

Q3: What ethical argument can be made for research for one over the other?

Q4: How to pharmaceuticals today treat a disease if it only values the poor, since they cannot pay for the cure?

K4: “The Great Pellagra Cover-Up fro 1916-1933 was the result of ‘scientific racism.’”
A: This is a major ethical claim, and I’m not sure that it has been validated.

Q1: What was the intent, principle, and intended consequence behind the Cover-Up?

Q2: What forms of ‘scientific racism’ still exist?

Q3: Does medicine always have bias, should it?

K5: “His argument was dismissed by MacNeal who proposed that the analysis of mass data by statistical correlations – a method adopted by Davenport – was preferable to just “theorizing” about the data.”
A: The statistical correlations, if incorrect, are a means of deciphering good and bad science.


Q1: How were the statistical correlations incorrect?

Q2: When is theorizing about data acceptable?

Q3: What actions can be taken to prevent bad statistics?

K6: “the continuing social and economic problems caused by pellagra (disease-caused absenteeism in the textile mills; the loss of European markets for American corn due to the mistaken belief that corn was responsible for the disease)”
A: The government willfully avoided the cure.

Q1: What are cost-benefit economic analyses of the situation? Do they support or harm the procedure in which the disease was avoided?

Q2: What other factors are taken into account when conducting policy of a disease? (ex: votes)

Q3: How does the information from the economic analysis aid third world development?

(ss)

A variety of factors surrounding the economics of the day and social standing of Goldberger and Davenport played a key role in allowing the medical community and policy makers to continue to discount Goldberger's findings and avoid taking care of the root problems of poverty and malnutrition.

K1. Goldberger was a Jew from a poor background. Davenport's "pedigree" gave him an edge in credibility due to the unspoken elitist/racist tendencies of policy makers and the medical community.

A1.

Q1. Evidence? (pjt)



K2. Cheap Southern labor was an important factor in many industries. Admitting that diseases like pellagra could be attributed to solveable problems like malnutrition could have impacted the cost of labor, as social pressures mounted for employers to provide adequate wages and thus adequate nutrition.

A2.

Q2. Evidence? (pjt)

See Marks, Harry M. 1947- "Epidemiologists Explain Pellagra: Gender, Race, and Political Economy in the Work of Edgar Sydenstricker"
Journal of the History of Medicine and Allied Sciences - Volume 58, Number 1, January 2003, pp. 34-55