Adapt or Die: Three Case Studies in Which the Failure to Adopt Advances from Other Fields has Compromised Paleopathology

Abstract

Over the past several decades, the field of paleopathology has rapidly advanced, but a continuing delay in incorporating scientific advances and a lack of methodological rigor hinder its progress. Inconsistencies in the presentation of data, the persistent use of non-standardized criteria and non-specific skeletal lesions to diagnose diseases, and the misuse of or delay in adopting critical, relevant concepts and methods from other disciplines obfuscate the current state of evidence and unnecessarily prolong debates. Here, we present three major research questions that have been affected by these issues: the origin and antiquity of syphilis in the Old World; the pathogen responsible for the Black Death; and whether the incidence of cancer has risen in recent human history. Drawing on these examples, we conclude with recommendations that could facilitate a more rigorous, scientific approach to important questions in paleopathology.

A possible case of acquired syphilis at the former Royal Hospital of All-Saints (RHAS) in Lisbon, Portugal (18th century): a comparative methodological approach to differential diagnosis

“…Numerous studies have also been published with regard to the geographic and chronological origin of syphilis, with emphasis to its possible association (or not) with the arrival of Columbus to the New World (e.g. Baker et al, 1988;Rothschild et al, 2000;Saunders et al, 2000;Powell and Cook, 2005;Rothschild, 2005;Harper et al, 2008;de Melo, 2010;Harper et al, 2011;Armelagos et al, 2012;Mays et al, 2012;Rissech et al, 2013;Schaffer and Carr, 2013;Zuckerman et al, 2014).…”

An isotopic case study of individuals with syphilis from the pathological-anatomical reference collection of the national museum in Prague (Czech Republic, 19th century A.D.)

“…Controversy surrounds the origin and antiquity of this disease. A plethora of papers proposing numerous hypotheses on these topics has been generated but failed to end the debate (Aufderheide and Rodríguez-Martín, 1998;Baker and Armelagos, 1988;Blondiaux, 2008;Crane-Kramer, 2002;Crosby, 2003;Dutour et al, 1994;Gaul et al, 2015;Guerra, 1978;Harper et al, 2011;Harrison, 1959;Quétel, 1990;Rothschild, 2005;Wood, 1978;Zuckerman et al, 2016). For a brief history of the disease in the Czech lands, the reader is encouraged to consult the works of Mikalová (2013) and Vargová et al (2017).…”

Advancing the understanding of treponemal disease in the past and present

“…Because many of the lesions characteristic of treponemal disease are also found in other conditions, they have low specificity (i.e., the lesion occurs in multiple diseases). Lesions also differ in sensitivity, or the proportion of affected individuals who exhibit the lesion (Frangos, Lavranos, & Frangos, ; Hackett, :102–103; Zuckerman et al, ). Periosteal reaction, for example, has low specificity but high sensitivity and, by itself, is not diagnostic of any specific condition (see Roberts, :107; Weston, , , ).…”

“…Site contextualization often is inadequate as well. Such publications detract from more secure studies (e.g., Mays, Crane‐Kramer, & Bayliss, ), leading proponents of the New World origin (the Columbian hypothesis) to dismiss all pre‐1493 evidence from the Old World (e.g., Zuckerman, Harper, & Armelagos, ). A review by Harper et al () is controversial due to the authors' assumptions and methods, including subjective application of “corrections” for marine contributions to diet to adjust radiocarbon dates for purportedly pre‐Columbian sites in the Old World, and rejection of secure dating using standard archaeological methods (see Section 4.1 for details).…”