Health Services Study Research Articles

The Thompson-McFadden Commission and Joseph Goldberger: contrasting 2 historical investigations of pellagra in cotton mill villages in South Carolina.

As pellagra reached epidemic proportions in the United States in the early 20th century, 2 teams of investigators assessed its incidence in cotton mill villages in South Carolina. The first, the Thompson-McFadden Commission, concluded that pellagra was likely infectious. The second, a Public Health Service investigation led by Joseph Goldberger, concluded that pellagra was caused by a dietary deficiency. In this paper, we recount the history of the 2 investigations and consider how the differences between the 2 studies' designs, measurements, analyses, and interpretations led to different conclusions. Because the novel dietary assessment strategy was a key feature of the Public Health Service's study design, we incorporated simulated measurement error in a reanalysis of the Public Health Service's data to assess whether this specific difference affected the divergent conclusions.

Tuskegee University experience challenges conventional wisdom: is integrative bioethics practice the new ethics for the public's health?

The Tuskegee University National Center for Bioethics in Research and Health Care was established in 1999 in partial response to the Presidential Apology for the United States Public Health Service's Study of Untreated Syphilis in the Negro Male conducted in Macon County, Alabama, from 1932 to 1972. The Center's mission of promoting equity and justice in health and health care for African Americans and other underserved populations employs an integrative bioethics approach informed by moral vision. Etymological and historical analyses are used to delineate the meaning and evolution of bioethics and to provide a basis for Tuskegee's integrative bioethics niche. Unlike mainstream bioethics, integrative bioethics practice is holistic in orientation, and more robust for understanding the epistemic realities of minority life, health disparities, and population health. The conclusion is that integrative bioethics is relevant to the survival of all people, not just a privileged few; it could be the new ethics for the public's health.

Limiting Standards of Bacterial Quality for Sources of Purified Water Supplies

The growing difficulties experienced in obtaining purified water supplies of safe and palatable quality from sources highly polluted by sewage and industrial wastes have made apparent the need of applying some rational standard whereby excessive pollution of these sources can be brought under some definite and economical control. In several states, a tentative standard of this kind has been adopted, based on the results of a comprehensive study of the limitations of current water purification processes made a few years ago by the U. S. Public Health Service in connection with its investigations of stream pollution. Although the results of this study have been fully published elsewhere, it has seemed desirable to undertake in this paper an interpretation of them with particular reference to the formulation of a working standard such as above indicated and to illustrate its application in one or two specific cases. In connection with the Public Health Service's study, three major series of observations were made. The first consisted of a detailed collective survey of the performance of 17 representative municipal water purification plants located on the Ohio and several other rivers; the second, of a similar survey of 14 plants located along the Great Lakes; and the third, of a long series of observations, aggregating some five years in time, at a large-scale experimental water filtration plant located on the Ohio River at Cincinnati. Although the combined data of this study embraced almost every conceivable combination of water treatment, ranging from simple chlorination to highly elaborated filtration, with double-stage coagulation, sedimentation and chlorination, the process most frequently observed was ordinary rapid-sand filtration, aided by post-chlorination. As this particular combination of treatment appears to represent the normal type used most widely throughout the United States, its performance represents probably the most reasonable basis of any general requirements which might be adopted for limiting raw water pollution.