Thread by @fawfulfan

If you're still wondering, "How did we ever let politics derail the COVID response?" Well, we've let politics interfere with public health crises several times throughout history.

I'd like to tell the story of Dr. Joseph Goldberger — kind of the Anthony Fauci of his day.

Goldberger was a Hungarian Jewish immigrant who became a renowned epidemiologist with the Public Health Service in 1899, screening new arrivals at Ellis Island, and doing research to fight infectious diseases all around the country.

In 1914, Goldberger was tasked with tracking down the cause of pellagra, a previously rare illness flaring up in the South.

Victims developed painful blistering rashes, diarrhea, and paranoid delusions. Tens of thousands were sickened and up to 40% of sufferers eventually died.

At the time, the understanding of bacterial infection had just become mainstream among doctors and public health officials — Goldberger having done much work on it himself — and so most people were expecting pellagra to be an infection, with some sanitary way to contain it.

But Goldberger realized pellagra wasn't spreading like an infectious disease. The people getting it were mostly Southern sharecroppers, children in orphanages, prisoners, and patients in insane asylums — basically, it only hit poor people, and only at certain times of year.

He realized the one thing these groups had in common was their diet — mainly molasses, canned corn and pig fat — and the doctors and prison guards overseeing them, who had lean meat and fresh vegetables, never got sick.

So it was probably a dietary deficiency, not an infection.

Goldberger soon proved this with a series of experiments.

He gave meat, vegetables, milk, and eggs to children at orphanages with an outbreak, and their symptoms vanished. He then fed a group of prisoners cornmeal, molasses, and pig fat for months while also scrupulously...

...cleaning, disinfecting, and isolating them, and they developed pellagra despite there being no vector for pathogens to spread. Finally, he and several volunteers injected themselves with blood from pellagra sufferers, swabbed their noses with their fluids, and swallowed...

...capsules packed with their urine, feces, and sloughed off rash scabs, none of which proved capable of transmitting the disease.

Scientists, even those who began as skeptics of the dietary theory, were pretty much convinced Goldberger was right at this point.

Politicians, however, were not.

See, the problem was that Goldberger basically proved the Southern agricultural economy was making people sick. The reason pellagra had become so common where previously it had been rare was that huge tracts of productive...

...agricultural land in the South were being cleared away for cotton, leaving very little land to grow food crops or raise livestock, and making the South dependent on corn imports from the Midwest to feed the lower classes.

It was just a lot easier to believe pellagra *must* be a bacterial infection — if it was a dietary deficiency, it would mean the South had to shift away from its best-selling cash crops and spend more money on the welfare of laborers, prisoners, orphans. They just didn't want to.

So essentially, Southern politicians took a hard line of denialism against Goldberger, smeared him, accused him of making it all up. When the federal government proposed food aid to the South to improve the diets of workers, Southern congressmen actively fought to kill it.

Eventually, World War II diversified the Southern economic base and boosted living standards, improving people's diets. And in the 1940s, pellagra was effectively eliminated when the vitamin at the root of the deficiency, niacin, was discovered, and added to all processed goods.

But Goldberger, who died of kidney cancer in 1929, never lived to see the health crisis he worked on for over a decade solved. In large part because of the obstinacy of political leaders who just found it easier to deny the science. Hundreds of thousands died who didn't need to.

This may have been a different kind of illness than COVID, but there are obvious parallels. A deadly disease, that didn't need to be as bad as it was, but for politics getting in the way of solutions that medicine had — and vilifying those trying to help.