Oral Rehydration Therapy For Diarrhea

Oral rehydration therapy (ORT) is given to people (usually children) suffering from diarrhea, which before ORT was often fatal. It is very simple: The sufferer drinks water with sugar and salt ad libitum (as much as they want). You probably haven’t heard of ORT — at least, I hadn’t. Everyone has heard of antibiotics. Yet “in 10 years [ORT] saved more lives than penicillin had in 40.” Infant diarrhea was once (and may still be) the main cause of death in poor countries.

A history of its discovery supports several things I’ve said on this blog. One is Thorstein Veblen’s point about the disdain among professional scientists for useful research:

ORT might also have been developed long before 1968 but for the attitudes of the dominant medical establishment toward practical experimentation, which the Cholera Research Laboratory and the National Institutes for Health shared. Nalin believes that “the people at the lab … got kudos for the extent to which [their] work was not practical. As soon as it became practical it was discarded like a soiled towel–it was too common, too hands-on… so the prestige went to people who measured trans-intestinal fluxes or electrical currents”.

No one who has attended an elite law school, medical school, or graduate program in education will be surprised by this.

Another is the great resistance among the medical establishment to cheap and effective solutions:

The formidable and persistent ignorance of the Western medical establishment, which continues over twenty-five years after the discovery of ORT, is phenomenal. While its refusal to advocate ORT may be due in part to the notion that ORT is only necessary for people in the developing world, its actions appear to be driven also by financial considerations. Most hospitals do not train physicians in the use of ORT since they have no financial reason to do so. [I think "since" overstates what is known -- Seth] The use of intravenous therapy, which often involves keeping a dehydrated child overnight, assures [greater] insurance reimbursement. Sending children home with ORT would [reduce] profits. Furthermore, recent studies show that diarrhoeal illness among the elderly may incur even greater health care costs that could also be reduced by the use of ORT. At a time of heated discussion about cost-containment in health care, it seems all the more ironic and egregious that a superior, cheap, and proven therapy [fails to replace] a far more expensive one. Estimates based on the cost of hospitalizations and physician visits suggest that ORT could save billions of dollars annually.

As an example of the resistance of American doctors to a better therapy, an ORT researcher, who had used it on Apache reservations in America, told this story:

I had an anthropologist friend who adopted an Apache child from the [Arizona] reservation where we were working. He used to be the anthropologist on the reservation. And then he [left the reservation and] went to Arkansas to teach and the Apache child came down with severe diarrhea and he called me up and he said desperately, “Look, my son’s in the hospital and they’re giving him all sorts of intravenous fluids. The diarrhea’s not stopping, he’s losing weight, they’re not feeding him. I know that you did this work in Arizona [on the reservation] and it didn’t look like that. . . . Would you call this professor of pediatrics and just collegiately talk to him?” So I called up the professor and told him that in our experience with Apache children this is what we found and here’s the publication and so on. And he said to me, “Doctor, doctor, our [Arkansas] children are not the same as your [reservation] children”. He was treating an Apache child from the same reservation.

Shades of Downton Abbey (where Lady Sybil died because a London doctor was listened to instead of a rural doctor).

9 Responses to “Oral Rehydration Therapy For Diarrhea”

  1. Morex Says:

    ORT in Mexico is very popular and fully endorsed by the government. It’s even in our law. Heres the Official Mexican Norm for Children’s Health (In Spanish). http://www.salud.gob.mx/unidades/cdi/nom/031ssa29.html

    If you go to a public clinic you can get packets with a powder to prepare serum at home, for free. It’s called Suero Vida Oral (Oral Life Serum) and it saves countless lives a year.

    Over the years, since I have memory, there have been very aggressive health marketing campaigns. Now everyone knows where to get the serum and how to use it.

    Here’s a PDF of a flyer you’d find in public elementary schools and clinics. http://www.promocion.salud.gob.mx/dgps/descargas1/programas/1_postal_vida_suero_oral_dgps.pdf

    It’s a surprise to me that this hasn’t been implemented in other countries.

    Here’s

  2. Morex Says:

    Addendum.

    Here are a couple of TV commercials.

    This one is a 30 seconds cartoon with a cherished Mexican character, Cantinflas. This aired in the 80′s He explains how to use the serum and how it can save a kid’s life. http://www.youtube.com/watch?v=jY9hVRknI3M

    Here is a 2:30 minutes commercial with a little more info. This one is from the 90′s. http://youtu.be/LF8g8oVOQm4?t=7s

  3. Dena Shunra Says:

    FWIW, I came across oral rehydration therapy in a BBC World Service broadcast. Noticed it immediately, because the long words were in such stark contrast to the simple meaning: “drink water. With salts/sugar melted in.”

    I’m pretty sure this was more than a decade ago.

  4. Paul Says:

    Dena, it is not quite that simple. The ratio of salts is important. Water on its own won’t work. If there is too much sugar it will make the diarrhea worse. Too much salt is really bad. For instance, sports drinks have too much sugar and won’t work.

    When I had diarrhea recently I just drank Pedialyte. It is interesting to note that they don’t seem to make anything targeted at adults although as far as I can see there is nothing child-specific in Pedialyte.

  5. Nancy Lebovitz Says:

    I’ve heard of it now and then for twenty years or more, and I’ve spent my life comfortably in the middle Atlantic of the US. I’m not sure whether either of us has unusually weird information resources.

  6. Nancy Lebovitz Says:

    A poll about whether people have heard of ORT. 10 yes, 1 no. I’m pretty sure my readers are mostly American and European.

    My tentative theory is that science fiction readers (me and probably a large majority of my commenters) are likely to pick up odd facts, even before the internet.

    One commenter mentioned that Gatorade and Pedialyte are well-known remedies.

  7. Lauren Rosenthal Says:

    Seth, would it be possible for you to have a facebook link after each post so that reposting your blog posts would be easy?

    Lauren

  8. Adam Says:

    I dispense ORT regularly as a pharmacist, but I often see what you mention too – doctors prescribing IV fluids, IV antiemetics, etc. Although we haven’t had a case at my place of work, a local Chinese pharmacist told me she has seen Dystonias (uncontrollable muscle tightening, similar to a seizure) in a child treated with these anti-nausea medications. Sometimes simple is better.

  9. Jim Says:

    Seth,
    Your comment about medical and law schools reminded me of a conversation I had with one of my law school professors. He had gone to an Ivy League law school, and then into private practice (big NY law firm) for three years. He said that if he had stayed at the law firm any longer, his resume would have been “tainted,” and it would have been difficult for him to get a job as a law professor.