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Missing the forest for the trees in biomedical research: the example of noma.

Month after month passed after the outbreak of the epidemic, without the higher governmental authorities taking the least notice of its occurrence. Autumn had gone, winter was approaching and with it the spectres of hunger and cold—nothing was done. Finally, small sums of money were granted for direct distribution to the needy, but the red tape of the bureaucracy was such, even in this, that they requested detailed receipts on the distribution of the money which was supposed to be given out in the smallest of amounts, so as to be able to submit them to the general auditing chamber. Finally, the press began to broadcast, through Prussia and the whole of Germany, the inconceivable and incredible happenings in Upper Silesia. –Rudolf Virchow, “Report on the Typhus Epidemic in Upper Silesia” 1 Thus Rudolf Virchow describes the German government’s response to the epidemic of “typhus” in Upper Silesia in the 1840s. Virchow, the polymath pathologist (who is most famous for developing the cell theory of disease) was a political activist who fought on the barricades during the European revolutions of 1848. He argued that the essential cause of this epidemic that affected tens of thousands was the Prussian government’s inaction and cultural mandates imposed on a foreign, colonized people. As Howard Waitzkin notes, “Virchow argued that defects of society formed a necessary condition for the emergence of epidemics. According to this analysis, inadequate social conditions increased the population’s susceptibility to climate, infectious agents and other specific causal factors—none of which alone was sufficient to produce an epidemic. For the prevention and eradication of epidemics, social change was as important as medical intervention, if not more so.” 2 Ironically, despite being a founder of the modern cell theory of disease, Virchow criticized