Pellagra, rarely encountered today, is defined by its classic triad of symptoms: dermatitis, diarrhea, and dementia. Previously unreported in North America, pellagra was prevalent in the southern United States during the early 20th century. The effort of Joseph Goldberger, MD, to eradicate pellagra, is an unappreciated historical case study in ethics. It crystallizes the ethical conflict in human subjects research in public health between protecting individuals and improving the public welfare and highlights why an erroneous belief regarding the etiology of an expanding epidemic was maintained despite substantial scientific evidence.
In 1914, the US Public Health Service commissioned Dr. Goldberger to investigate pellagra. Following community observation, Goldberger challenged previous theories that pellagra was infectious, noting that it was more consistent with a dietary deficiency. To validate his hypothesis, Goldberger intervened in the diets of orphanages, asylums, and prisons both to cure and induce pellagra. He also demonstrated that healthy volunteers could not be inoculated with the disease.
Like the first cases of AIDS, pellagra was limited to populations towards whom there was public apathy, if not hostility. As the epidemic grew, concluding that pellagra was from malnutrition and poverty, rather than infection, would have forced acknowledging the existence of an underclass and taking steps to ameliorate their condition. Consequently, the investigation of the disease and introduction of preventive measures were impeded for years.
The story of Joseph Goldberger illustrates how even when presented with incontrovertible scientific evidence, political values can influence the public health agenda to preserve a social hierarchy.
Learning Objectives:
Keywords: History, Politics
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.