Dilip Mahalanabis. Image: Dhyeya IAS/YouTube, fair use
- Much of what was written or shared about Dilip Mahalanabis, after his recent passing, contained toxic nationalism and incorrect or even blatantly false information.
- Numerous tributes have erased the long history of development and advocacy of ORT, including the involvement of many Indian and international scholars and institutions.
- Mahalanabis et al. undertook bold work in difficult circumstances. “In order to treat…people with saline IV, you had to kneel in their feces and vomit,” he later recalled.
- Spreading misinformation and fake stories as part of nationalism and even decolonization is the worst way to learn about stalwarts like Mahalanabis.
Dr Dilip Mahalanabis, one of the world’s leading experts in oral rehydration therapy (ORT), died last month.
The news took me back to 2009, when I was an aspiring public health student with dreams of joining the WHO. I had come across a Mahalanabis interview with another stalwart, Dhiman Barua, in the WHO Newsletter. There he recounted his pioneering work in Bangaon, Bengal in 1971 when he and his associates treated hundreds of cholera and diarrhea patients with the then new and experimental oral glucose-electrolyte solution.
As a young doctor with a strong interest in public health, the work and experiences of Mahalanabis and Barua have made a deep impression on me – and Mahalanbis’ death last month has transported me to fond memories of college.
But I was brought back to the present when I read some of the tributes to Mahalanabis. Along with several thoughtful comments, much of what was written or shared about him contained toxic nationalism and incorrect or even blatantly false information.
I was also struck by how nearly every major media outlet simply rehashed the same details of his life and work in their obituaries and offered little, if any, insight into Mahalanabis as a person. Many comments also proved useless in assessing whether the authors were celebrating Mahalanabis the person or ORS the solution.
These articles are a good opportunity to reflect on how we approach science and history, how we commemorate the dead, and how society and politics intersect with science.
Not the first
Many tributes have unnecessarily and sadly obliterated the long history of development and advocacy of ORT, including the involvement of many Indian and international scholars and institutions. First post gushed that Mahalanabis “never patented its SRO solution” while a popular Twitter account tweeted the blatant lying that he “invented the ORS packet”.
Even an otherwise excellent obituary in the India time stated in the title that he was “the father of ORS”. Most mainstream platforms used the more ambiguous term “pioneer” instead of “invented” – but then failed to accurately describe and contextualize his work, readers perhaps feeling that Mahalanabis was the only, or at least the most deserving, “scientist who developed” ORT.
Mahalanabis was brilliant. And like any brilliant person, he stood on the shoulders and rubbed shoulders with his brilliant peers. As my own recollection of meeting Barua and Mahalanabis together indicated, ORT was a major innovation that was founded on the gigantic efforts of many others.
Barua himself died in 2020 and the few obituaries from the time also describe him as a “pioneer” of ORS. The original 1973 article in which Mahalanabis details the spectacular work of ORT in Bangaon was co-authored with four others. In the opening paragraphs of this article, the authors cited several examples of earlier research on which their work was based and which predated the measurements taken at Bangaon.
In particular, Mahalanabis et al wrote that the “effectiveness of oral glucose-electrolyte solutions” had already been demonstrated in hospitalized patients, and that the ingredients and proportions of the solution they used were derived from earlier findings. Obviously, the ORS, or for that matter the “bag of ORS”, was not “invented” by Mahalanabis – neither the ORS “his”, nor that of a single researcher, to be patented .
Far from being the product of the stereotypical “lone genius” working away from the mess of the real world, ORT was the product of several sensitive and toiling researchers and organizations deep in the diarrheal trenches of the world.
Over the past few decades, historians and other scholars have worked to dispel the myth of the “lonely genius.” Some of these efforts are also part of larger initiatives to “decolonize” modern science and its narratives, with researchers showing that it is incorrect to assume that only white European and American researchers were responsible for major scientific advances in science. era, and that we must remember the invisibility of Indigenous communities and the ‘Global South’ in the conventional histories of modern science.
Given these developments in science thinking, the extreme nationalist content of some popular tributes to Mahalabanis last month was nothing short of shocking. The ignorance and erasure of the collective efforts of people around the world in the development of ORT was striking.
While many elite and privileged caste Indians have always emulated the attitudes of their former colonizers and made absurd claims that ancient Hindus made singular and single-handed contributions to world knowledge, Mahalanabis’ comments showed how the bulldozer of Indian/Hindu exceptionalism might not even spare recent the story.
The work of Mahalanabis
One of the consequences of the misleading and confusing information about Mahalanabis in these tributes and obituaries was that people had little idea of what makes his work so important. A history of the ORT, written three decades ago by Joshua Ruxin, provides useful context here.
By 1970, scientists had already demonstrated that ORT worked well in stable hospital environments under expert supervision – but these studies could not convince the medical and public health communities of the feasibility and effectiveness of ORT. a large-scale ORT treatment.
Mahalanabis et al. undertook bold and innovative work in the disastrous emergency circumstances of 1971 Bangaon. “In order to treat these people with IV saline, you literally had to kneel in their feces and vomit,” Mahalanabis recalled in the 2009 interview. That’s what helped ORT “really hit the map.” because “it probably took this kind of demonstration in times of crisis to really document what could be done”.
Soon after, “ORT began to demonstrate success after success as doctors experimented with it in different cases of diarrhea and in patients of all ages.” In their own words, what Mahalanabis et al. provided ‘confirmation of the effectiveness’ of ORS in a ‘field trial’ where ‘extremely unfavorable logistical and administrative conditions prevailed’.
Another historical aspect that needs to be reconsidered is the oft-repeated claim – which also appeared in the 2009 WHO report Newsletter – that a 1978 editorial in The Lancet wrote that ORS was among the “most important medical advances” of the 20th century. The Lancet said no such thing. What he said was this:
“The discovery that sodium transport and glucose transport are coupled in the small intestine, such that glucose accelerates the absorption of solute and water, was potentially the most important medical advance of this century. .”
In other words, as Ruxin wrote, The Lancet was less enamored with the practical public health aspects of ORT than with the theoretical laboratory aspects of intestinal absorption, which are the physiological basis of ORT. Of course, this does not mean that ORT is insignificant: it is absolutely among the most revolutionary therapeutic innovations of all time. But clearly The Lancet did more than praise ORT.
Finally, despite the abundance of articles and tweets about Mahalanabis, not much has been learned about Mahalanabis as a person, even as a doctor and scholar beyond his 1970s work on ORT. A few journalists were thoughtful and contacted people who knew Mahalanabis personally, as soon as the India time and FinancialTimes. Mahalanabis was said to be a great mentor and “excited to develop the next generation in his field.”
I spoke briefly to Richard Cash, among the three ORT researchers who shared the 2006 Prince Mahidol Prize with Mahalanabis. Cash said Mahalanabis’ deep and enduring commitment to children’s health in India was very admirable. It should be noted that Mahalanabis and his wife also made a large donation to the Child Health Institute, Kolkata in 2017.
If we are truly interested in knowing and celebrating stalwarts like Mahalanabis, spreading disinformation and false stories under the agenda of nationalism and even decolonization is certainly the worst way to go about it.
Instead, how about abandoning the hype and sensationalism – and starting to be sensitive and sensible both in our celebrations of Indians past and present, and in the stories about us that we tell ourselves and in the world ?
Kiran Kumbhar is a medical doctor and historian who currently teaches and does research with the Council for South Asian Studies at Yale University. He works mainly on the history of science and medicine in India, the history of South Asia and global health.