The History of Intravenous and Oral Rehydration and Maintenance Therapy of Cholera and Non-Cholera Dehydrating Diarrheas: A Deconstruction of Translational Medicine: From Bench to Bedside?

Abstract

The “bench to bedside” (BTB) paradigm of translational medicine (TM) assumes that medical progress emanates from basic science discoveries transforming clinical therapeutic models. However, a recent report found that most published medical research is false due, among other factors, to small samples, inherent bias and inappropriate statistical applications. Translation-blocking factors include the validity (or lack thereof) of the underlying pathophysiological constructs and related therapeutic paradigms and adherence to faulty traditional beliefs. Empirical discoveries have also led to major therapeutic advances, but scientific dogma has retrospectively retranslated these into the BTB paradigm. A review of the history of intravenous (I.V.) and oral therapy for cholera and NDDs illustrates some fallacies of the BTB model and highlights pitfalls blocking translational and transformative progress, and retro-translational factors, including programmatic modifications of therapeutic advances contradicting therapeutic paradigms and medical economic factors promoting more expensive and profitable medical applications inaccessible to resource-limited environments.

Pharmacological Management of Cholera: A Century of Expert Opinions in Cecil Textbook of Medicine

“…10,12 However, the major change came when Rogers introduced intravenous hydration. 13 Cholera, a potentially fatal condition in the absence of rapid intervention, is manifested by diarrhea, most commonly unaccompanied by fever and severe dehydration, as a result of hydroelectrolyte losses through diarrhea that can reach 13.5 L/day for adults and 368 mL/kg body weight in children. 7 The patient in serious condition also has changes in hematocrit, hyponatremia, and other changes related to dehydration (increased concentration of nitrogen, creatinine, calcium, and magnesium in the blood), but the most severe complication remains hypovolemic shock leading to death.…”

Enteral Resuscitation: A Field-Expedient Treatment Strategy for Burn Shock during Wartime and in Other Austere Settings

“…This resuscitation strategy was further refined at the SEATO-Pakistan Cholera Research Laboratory in Dhaka and the Johns Hopkins Center for Medical Research and Training in Calcutta. This culminated in the work by Mahalanabis treating refugees of the Bangladeshi War of Independence, which demonstrated the effective use of ORS to treat cholera patients in a severely resource-limited field setting, leading to the widespread adoption of ORS around the world [24,25]. Since this report in 1968, the mortality from diarrhea in children under the age of five has dropped from 4.6 million per year to 500,000 [26].…”

The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap

“…In this study, we estimate the 2 effect of the hospital desegregation campaign on mortality among Black one-through 11-month-old infants (i.e., Black postneonatal mortality) and its effect on the decision of Black mothers to give birth at home or in the hospital. We estimate the effect of the campaign on Black postneonatal mortality because, by the 1960s, therapies administered almost exclusively in hospitals (such as intravenous infusion of antibiotics and fluids for volume replacement) were successfully being used to treat gastroenteritis and pneumonia (Collins and Thomasson 2004;Almond et al 2006;Nalin 2022). Gastroenteritis and pneumonia were among the leading causes of Black postneonatal mortality in the early 1960s, before Southern hospitals were integrated (U.S. Department of Health, Education, and Welfare 1963).…”