Talk:Robert K. Crane/Archive 1

Archive 1

cotransport discovery directly led to development of ORT?

I added a {{fact}} tag to this line because the claim is not referenced. References 7 & 8 do not support this point. Crane's research definitely provided a physiological basis for understanding the mechanism underlying ORT, but I was not aware of that these findings were actively used when developing ORT. Chaldor (talk) 08:07, 15 April 2009 (UTC)

• The claim is now referenced. Armando Navarro (talk) 12:04, 15 April 2009 (UTC)

I'm sorry to continue picking at this, but I still have some doubts. I can't really believe that an article where Crane praises himself about the impact of his discovery can be truly considered a reliable source (see the issues surrounding self-published sources on WP:V). The NEJM article doesn't mention Crane at all, and it isn't clear that the article is even referring to the same discovery (mid 1960s is not when Crane published the work). Further, I would like to point out that the NEJM article isn't necessarily reliable either as it's not a text on ORT development. It makes the claim and the reference that it provides for the statement, Claeson, et.al., only discusses the impact of ORT, not the development. Normally, I wouldn't put references through such technical scrutiny, but I feel this claim falls under the WP:V guideline that exceptional claims require high-quality sources.

Further, I would like to present some evidence potentially to the contrary of the claim. Based on the story of Phillips and his use of ORT in Taiwan in 1962, it seems doubtful that he had any knowledge of Crane's work at the time. Phillips is one of, if not the, discoverers of ORT, yet I don't see Crane credited when discussing the rationale of Phillips's discovery. The same clearly also goes for Chatterjee (as his clinical findings predate Crane's publication date). See the references in the ORT article for the links.

I'll admit that this is a nuanced delineation to make, but I think it's an important one. By claiming that Crane's work directly lead to ORT, it's asserting that people took the discovery of the cotransporter, and knew precisely what to do with it and how best to apply it to treat the long-standing problem of cholera dehydration. I think instead, it was more that clinicians (like Phillips and Chatterjee) discovered some beneficial effect when administering salt+sugar in their fluids, and then later, the medical community was able to use Crane's discovery to explain the phenomenon. I think claiming that Crane's discovery directly let to ORT is misleading. I think it should read more that Crane's discovery helped to provide a physiological basis for the effectiveness of ORT. Or one could also say that Crane's discovery helped to validate the effectiveness of ORT, etc. Chaldor (talk) 09:11, 16 April 2009 (UTC)

• I decided to be bold here and make the change that reflects, in my opinion, more solid evidence and a more reasonable timeline per my points listed above. Chaldor (talk) 20:32, 19 April 2009 (UTC)
• Question has been posed to WP:RSN. Chaldor (talk) 20:46, 19 April 2009 (UTC)

The Chatterjee reference is from 1957 so it obviously can’t be used to detail the subsequent development of ORT. Therefore you base your arguments on a single reference : Ruxin, who states that “the view of the scientific establishment on the discovery and development of ORT overlooks the practical work in Dacca and Calcutta and reserves its ultimate praise for the most theoretical studies.”. What is most important to note in this statement is that there exists a “view of the scientific establishment on the discovery and development of ORT” and, as the Pasternak and Snyder references I have provided also contribute to show, this consensus among the “scientific establishment” stresses the importance of the “theoretical studies”. Your argument that “exceptional claims require high-quality sources” should therefore not be applied to my claim for Crane but to your own claim to the contrary which is based on Ruxin’s minority opinion in the scientific community. The section titled “Exceptional claims require exceptional sources” in Wikipedia:Verifiability states : “Certain red flags should prompt editors to examine the sources for a given claim : (…) claims that are contradicted by the prevailing view within the relevant community”. By his own admission Ruxin is developing “claims that are contradicted by the prevailing view within the relevant community” or, in other words, Ruxin is developing what Wikipedia usage describes as a fringe theory : “ideas which purport to be scientific theories but have not gained scientific consensus”. “Coverage on Wikipedia should not make a fringe theory appear more notable than it actually is. (…) Other well-known, reliable, and verifiable sources that discuss an idea are required so that Wikipedia does not become the primary source for fringe theories.”

For the same reasons, there is no serious cause to doubt the credibility of the Pasternak or Snyder references when they are in complete accord with the scientific consensus. This consensus is expressed by Snyder using the exact same words as me : the discovery of cotransport “led directly to the development of oral rehydration therapy”.

You criticize my Pasternak and Snyder references, but you do not mention a third, included in the section on ORT in the Wikipedia Crane article (and also in the Ruxin reference), that also establishes the scientific consensus :

Editorial. “Water with sugar and salt”. Lancet 2, August 5, 1978, pp. 300–301 : “The discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water, was potentially the most important medical advance this century.”

All of the above references are prior to the mid-90s. Below are some more recent references from 1999 to 2007 to further establish that the scientific consensus on this topic has remained the same today :

Stanley G. Schultz. “From a pump handle to oral rehydration therapy: a model of translational research”. Advances in Physiology Education, Volume 31, 2007, p. 292 : “By 1975, ORT employing solutions of salt and sugar was established as a safe, inexpensive alternative to intravenous rehydration in all ages and regardless of the etiology of the diarrhea, leading Lancet to opine that ‘The discovery that sodium transport and glucose transport are coupled in the small intestine so that glucose accelerates absorption of solute and water was potentially the most important medical advance this century.’ In this respect, it is of interest that Susruta, the father of Ayurvedic medicine in India (circa 1000–500 BCE), recommended drinking a ‘profuse quantity of tepid water in which rock salt and molasses have been dissolved’ for the treatment of diarrhea. And, there are many reports of occasional salutary use of oral glucose-saline solutions in cholera. But, lacking a sound scientific foundation and well-controlled studies, these sporadic reports did not ‘take hold.’ There are few more telling examples in the history of medicine where the credibility provided by a firm basic science foundation played a greater role in translational research.”

William B. Greenough, III. “The human, societal, and scientific legacy of cholera”. Journal of Clinical Investigation, Volume 113, Issue 3, February 1, 2004, p. 337. “In 1978, a Lancet editorial titled ‘Water with sugar and salt’ stated that ‘The discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water was potentially the most important medical advance this century’. Rarely has science so swiftly transmuted an arcane biophysical observation into a practical, low-cost treatment that continues to save millions of lives each year without the need for hospitals, trained staffs, or advanced technologies.”

Daphne A Christie, E M. Tansey (eds). “Intestinal absorption”. Wellcome Witnesses to Twentieth Century Medicine, Vol. 8, The Wellcome Trust, London, 2000, p. 21 : “There is an editorial in the Lancet in 1978 (which I suspect may have been written by somebody in this room), which states that the discovery that water absorption was linked to sodium and glucose absorption was one of the major medical advances of this century because it opened the door to oral rehydration therapies.”

Stephen M. Kavica, Eric J. Frehmb, and Alan S. Segalc. “Case Studies in Cholera: Lessons in Medical History and Science”. Yale Journal Of Biology And Medicine, 72 (1999), p. 404. “Death from cholera gravis results from untreated hypovolemic shock with metabolic acidosis. The cornerstones of therapy are 1) to give the patient back what is lost - a lot of isotonic fluid - as the villagers believed; and 2) to stop the losses. To replete the lost substances in 1831, physicians attempted intravenous volume resuscitation. However, if they would have known about Na-coupled glucose transport, they could have made an oral rehydrating solution containing NaCl, KCl, and bicarbonate of soda of the same com- position as what the patient was losing, along with glucose. For this reason alone, the identification of sodium-coupled epithelial cotransport processes was a major medical breakthrough. Although Reid had provided experimental evidence supporting the transport of sugars against a concentration difference at the turn of the century, the dependence on luminal sodium was first observed by Riklis and Quastel in the late 1950s. In the early 1960s, Crane and colleagues advanced these ideas and showed that sodium-dependent sugar cotransport occurred in the luminal brush border of small intestinal epithelial cells.”

P.S. : I would like to point out that the Pasternak reference which quotes Crane, which you say should be criticized because of “issues surrounding self-published sources on WP:V”, is not published by Crane but by Bioscience Reports. This therefore raises no “issues surrounding self-published sources” because Bioscience Reports is clearly a “third-party publication”, Crane is an “established expert” and, moreover, Crane is not contradicting the “prevailing view within the relevant community”.

Armando Navarro (talk) 12:15, 9 May 2009 (UTC)

• I think I must be failing to explain my idea properly. The very fact that the Chatterjee reference is from 1957 is my entire point. ORT was developed independently and even arguably prior to any understanding of how or why it worked. The clinicians simply discovered that it worked, and then later the findings from Crane and others helped established the why. Looking back, of course this understanding was very crucial and a very important advance in medical understanding. I am not questioning that. However the understanding did not lead to the development of ORT. It was already being used before the physiological basis was understood. If this distinction doesn't make sense, then I don't know how else to explain it. There's a difference between knowing that something works, and knowing why something works. Crane helped explain why it works, but he didn't develop it (or lead to its development). It was already developed and used. He helped validate it, he helped give it credit, helped provide a physiological basis for it, but his findings did not directly lead to its development. Do you disagree with this? Chaldor (talk) 07:56, 16 May 2009 (UTC)

The question is not whether I agree or disagree with you, the question is whether the relevant community agrees or disagrees with you because according to Wikipedia policy : “the threshold for inclusion in Wikipedia is verifiability, not truth”.

The point of contention is whether or not the discovery of cotransport LED DIRECTLY to the development of ORT. There are two diverging views on this matter :

• one view affirms that cotransport led directly to the development of ORT,
• the other view affirms that cotransport DID NOT lead directly to the development of ORT.

According to Wikipedia policy, the way to give prominence to one view over another is to show that one view is the accepted view or majority view within the relevant community.

I have provided above numerous references that show that the view that affirms that cotransport led directly to the development of ORT is the accepted view within the relevant community.

The view that affirms that cotransport DID NOT lead directly to the development of ORT is supported by Ruxin who, and this is the most important point, completely admits himself that his view is not accepted within the relevant community. The Ruxin reference therefore supports the prominence of the opposing view.

The Chatterjee reference is very close to the event in question : the development of ORT. According to Wikipedia policy : “primary sources are sources very close to an event.” “Wikipedia articles should rely mainly on published reliable secondary sources”.

Furthermore, since the Ruxin reference supports the prominence of the opposing view, the view that affirms that cotransport DID NOT lead directly to the development of ORT is only supported by a SINGLE source : Chaterjee. This view is therefore a fringe theory. Wikipedia policy : "If proper attribution cannot be found among reliable sources of an idea's standing, it should be assumed that the idea has not received consideration or acceptance; ideas should not be portrayed as accepted unless such claims can be documented in reliable sources."

Armando Navarro (talk) 12:51, 16 May 2009 (UTC)

I don't quite understand why you are pegging my statements as a fringe theory. What I am saying isn't a fringe theory at all, it is the known, published timeline of events according to the medical literature. If this is simply a matter of having more articles to reference to prove to you that this isn't coming from a single source, then I can do that. Here's two articles that discuss this that I came upon in a five-minute pubmed search:

Bhattacharya SK (1994). "History of development of oral rehydration therapy". Indian J Public Health. 38 (2): 39–43. PMID 7530695.

Stephen J. Savarino (2002). "A Legacy in 20th‐Century Medicine: Robert Allan Phillips and the Taming of Cholera". Clinical Infectious Diseases. 35 (6). doi:10.1086/342195. PMID 12203169. {{cite journal}}: Text "year 2002" ignored (help)

The second article goes into great deatil about Phillips's attempts. Though Phillips's theories regarding why ORT worked were wrong, you cannot deny that he did use ORT to treat patients in 1958 in Bangkok, and then again in 1961 in the Phillipines, and again later, etc. This is why he is attributed with the discovery of ORT (as opposed to Chatterjee whose literature wasn't well regarded in the West). He didn't understand why the oral formula worked, he had some ideas that weren't right, but he was just shooting in the dark with good success. This is the point I'm trying to make. Between doctors like Chatterjee and Phillips and the references I have provided, I think it's pretty clear that ORT was developed prior to and independent from the understanding of its physiological basis. Was its mechanism illustrated and defended later by the theoretical studies? Absolutely. However, again, the studies did not lead to its discovery.

To be frank, even after all the evidence had been amassed and shown, the medical community was resistant to the idea, despite the physiological evidence. This only further highlights that the development/broad use/application/spread of ORT was not due to the theoretical studies, but by clear illustrations of its efficacy. Unlike today where translational research is pushed as the norm, it was not the case in the 60s and 70s. The real turning point was the Bangladesh War of Liberation and the results shown by Mahalanabis. Even a theoretically heavy history review article, Stanley G. Schultz (2007). "From a pump handle to oral rehydration therapy: a model of translational research". Advan. Physiol. Edu. 31: 288–293. doi:10.1152/advan.00068.2007. PMID 18057392., admits that point as well. I'm pretty sure this is very clear, journal-backed, non-fringe evidence that illustrates my point. Chaldor (talk)

Contrary to what you state above, the Bhattacharya reference does not support your view that the discovery of cotransport DID NOT lead directly to the development of ORT but the opposite view. Bhattacharya states that the observations of sodium-glucose cotransport “formed the scientific basis for the discovery of ORT”.

From the abstract of the Bhattacharya reference: “Before oral rehydration therapy (ORT) was developed, intravenous fluid therapy was the mainstay of fluid therapy for diarrheal dehydration. The following early observations, however, formed the scientific basis for the discovery of ORT: a group of physiologists observed that glucose enhances the absorption of sodium and water across the intestinal brush-border membrane of experimental animals and that no morphological changes occur in the gut epithelium of cholera patients. Captain Phillips of the US Army in 1964 first successfully tried oral glucose saline on two cholera patients.”

The Savarino reference does not mention a use of ORT in 1958 or in 1961. Savarino dates the development of ORT to the late 1960s : page 713 : “His conception of a simpler cholera treatment was realized in the late 1960s with the development of glucose‐based oral rehydration therapy, a monumental breakthrough to which many other investigators made vital contributions.”

Most importantly, the Savarino reference does not clearly support your view, since it first asserts as a fact the opposite view on page 717: it states that the findings of Philipps’ 1962 oral fluid replacement studies were “built upon” sodium-glucose cotransport studies and then it only reports that Phillips later claimed the opposite: “…although Phillips later claimed that he had no foreknowledge of these seminal studies when he initiated this line of clinical research.” But Savarino never confirms that Phillips’ claim is a fact or repudiates the opposite view which is previously asserted as a fact in the article.

From page 717 of the Savarino reference : “In October 1961 and for several years thereafter, annual outbreaks of El Tor cholera occurred in The Philippines (…) The intravenous treatment methods used by the Navy proved highly efficacious in this setting (…) Phillips came to realize, however, that intravenous rehydration was impracticable for mass application (...) he undertook oral fluid replacement studies in June 1962. Applying the same meticulous balance techniques, they assessed water and ion clearances after oral administration of fluids of varying electrolyte composition and tonicity, and, for the first time, showed in adult patients with cholera that oral glucose stimulated the absorption of sodium. These findings built upon prior animal tissue studies showed that glucose enhances the intestinal transport of sodium and water, although Phillips later claimed that he had no foreknowledge of these seminal studies when he initiated this line of clinical research.”

Armando Navarro (talk) 02:12, 17 May 2009 (UTC)

Third opinion

I'm here due to a request posted on Wikipedia:Third opinion. Correct me if I'm wrong, but it seems to me that the discussion above boils down to two statements:

1. ORT was developed independently prior to Crane's cotransport discovery; Crane's discovery explained why ORT works.
2. Medical consensus credits Crane's discovery as leading up to the development of ORT, although there is some dissent.

Both statements are verifiable, with reliable sources. I don't understand why there would be a problem describing both points in the article. This is an encyclopedia. We are supposed to write articles that are encyclopedic. If reliable sources support multiple viewpoints, then those viewpoints should be presented and given appropriate weight.

Am I missing something here? ~Amatulić (talk) 19:53, 10 June 2009 (UTC)

I agree, that pretty much sums it up. I was never disagreeing about what the medical community is currently saying in hindsight, it's just different from the documented history (of course there's a bias to make themselves more intelligent/rational than they actually are/were). I would be quite happy if the article was updated to reflect both these points. Thanks for the comment. Chaldor (talk) 17:27, 12 June 2009 (UTC)

As I have shown above the discussion really boils down to two views:

1. a tiny-minority view
2. the scientific consensus

Therefore there is a problem in describing both views in the article because Wikipedia policy states : “Views that are held by a tiny minority should not be represented except in articles devoted to those views. (…) to include a tiny-minority view, might be misleading as to the shape of the dispute.” (…) “If a viewpoint is held by an extremely small (or vastly limited) minority, it does not belong in Wikipedia regardless of whether it is true or not and regardless of whether you can prove it or not, except perhaps in some ancillary article.”

Armando Navarro (talk) 07:43, 13 June 2009 (UTC)

And this is the point of disagreement. My history and referenced back statements are not a tiny minority view. The tiny minority views refer to things like discussing whether the earth is a flat disk or a round sphere in an article of the earth. This is a small biography and if there is a discrepancy in the literature/inconsistency in the presentation of history, it should be noted. It's not a tiny, minority view, it's a clear, documented, and well-referenced fact. Just because you don't agree with it doesn't mean you can label it a tiny minority view and toss it out of the article. I believe the third opinion saw it the same way, and did not find it to be a tiny minority viewpoint. Chaldor (talk) 18:22, 19 June 2009 (UTC)

Yes, my third opinion saw it that way. If verifiable and reliable sources of recorded history contradict medical consensus, that is something significant that should be described in this article. Also, "scientific consensus" is meaningful only in the context of science. Consensus among scientists doesn't strike me as a good gauge for evaluating the truthfulness of their beliefs about histories, biographies, religion, beer, or other non-science subjects. ~Amatulić (talk) 19:24, 19 June 2009 (UTC)

The scientific consensus is supported by numerous sources. The opposing view is only supported by one source : Ruxin. A view supported by only one source is obviously a tiny minority view when it is overwhelmingly contradicted by the scientific consensus. Armando Navarro (talk) 11:15, 23 June 2009 (UTC)

Chaldor provided more than one source above. An historical timeline that contradicts the beliefs of a particular group is significant and should be mentioned. ~Amatulić (talk) 17:18, 23 June 2009 (UTC)

As already explained above : Chatterjee is just a primary source therefore, apart from only one source : Ruxin, all other sources support the scientific consensus. Armando Navarro (talk) 07:40, 24 June 2009 (UTC)

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