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Paradigm Shifts in Malaria Study and Control Verhave MWJ 2012, 3:7 Paradigm shifts in malaria study and control Jan Peter Verhave1∗ 1The author is a malariologist, retired from the Radboud University Medical School, Nijmegen, the Netherlands and has a qualification in Medical History, Free University Amsterdam. *[email protected] Abstract The history of the study of malaria, its parasites and vectors, and aspects of public health and control has shown some irregularities. Mostly the research was a steady accumulation of knowledge, but there were also deadlocks, fundamental disagreements and sometimes a drastic reorientation. In this article we follow the major events, some of the investigators involved, and how they promoted their ways of the fight againstthisdisease.Everyepisodeormomentiscalibratedwith the theory of science, developed by Thomas Kuhn. His idea of paradigms in science and sudden shifts is helpful for the understanding of what steered the various levels of malaria research. It also may keep investigators on the alert of dead ends and breakthroughs in future. 1Introduction have decided doubts about the feasibility of getting rid of malaria. So many scientists, so many opinions. The ma- jority of workers just do their everyday tinkering in the lab- Studying the history of science in general, or one particular oratory or in the field; only a few anticipate on the unpre- scientific subject, raises the question whether the progress- dictable future of malaria research and control. Mostly it is ing insight is a continuum or a process that goes in fits and like sailing a calm tropical river, but unexpectedly, a cascade restarts. Is the increase in understanding of, for example the looms up, or even a dangerous fall. The course of research disease malaria more or less predictable or erratic? What and its application is generally smooth, but there are periods are the factors that play a role in the accumulation of knowl- of jerking along. edge and technical abilities? For answers to such questions we have to rely on (medical) historians and ”practitioner How do leading malariologists deal with consensus or historians” -in this case (retired) malariologists- who have divergence of opinions on how to tackle the problem and written about the history of the disease and its control. Also protect the suffering of people? Is it a matter of money, the schemes of thought of science philosophers may offer education, uplifting of socio-economic standards, biotech- helpful insights. Once we enter into such a discourse, we nology, or logistics? And what about our ethical, moral or have to be aware that historiography is coloured by nation- religious points of view, do they matter in this endeavour? ality and scientific background of the writers and the time Not to speak of dealing with local and western politicians in which they live(d). and the peoples they represent. We are now more than a century living with the mod- Thomas Kuhn, an American science historian (1922- ern idea of malaria, as a feverish disease, caused by some 1996) has given insight in the way science progresses, in parasitic protozoa of the genus Plasmodium and transmitted his book ”The Structure of Scientific Revolutions” and his by anopheline mosquitoes, a highly complex intercourse of following publications. His ideas found a ready reception three organisms belonging to different phyla in the animal in the scientific world. But the history of malaria has never kingdom. Thanks to modern science and changing habits been described in the Kuhnian way. The aim of this essay is in populations, the countries in the moderate climate zones to test how the successive episodes in the understanding of are mostly free of malaria since about half a century; Sub- malaria and its control fit with his ideas. Kuhn’s key word Sahara Africa, Southern Asia, the Southwest Pacific and paradigm shift is now used for any new idea in science and tropical South America remain more or less highly endemic. by the public at large, whether it is relevant to Kuhn’s own Scientists at present active in research have a long way to go theory, or not. In the context of malaria, many examples can on the road towards mastering the disease, the parasite and be found through the internet. We’ll see if this casual use of its vectors. Some conjure up visions of great effects, with the term is all correct. vaccines, drugs or sophisticated vector debilitation; others After summarizing the theory of Kuhn we follow the MalariaWorld Journal,www.malariaworld.org 1 Sept2012,Vol.3,No.7 Verhave MWJ 2012, 3:7 course of history of malaria with seven-league strides (de- verse enough, it will lead to a crisis,thusendingtheperiod pending on historiographers of past and present (see bibli- of normal science.Inanycommunityofscientists,thereare ography: history is an interpretative discipline!) and test some who are bolder than most, who seek alternatives to ex- how Kuhn’s theory applies to scientific progress in the past. isting paradigms or because they perceive a path forward or The main point of this exercise is to make future malari- have a breakthrough in research. Others will resist the al- ologists of various disciplines aware of differences in the ternative, which will be subject to scorn and scrutiny. The approach to malaria, because research will lead to new in- crisis will precipitate revolutionary science,usuallyduring sights and tools, and also to make them prepared for diver- ashortperiod,andtemporarily,thereisnoparadigm. gence of opinions. Some believe it will be possible to elim- Successive transition from one paradigm to another via inate or even eradicate the disease; others remain skeptical a scientific revolution is the usual developmental pattern of and fear the retaliation of nature. Awareness of deeply felt mature science.Suchashiftisachangeinafundamental differences to come (e.g. future vaccination effects) may model of events or methods and leads to innovation. In time, help to avoid clashes and find common grounds. as the challenging paradigm is supported by additional evi- dence, it will replace the old paradigm, and a paradigm shift 2Kuhn’stheory will have occurred. The new way of thinking has become incommensurable with the old. There is no way of mutual understanding (unless with the help of historians who have Knowledge about our environment begins with no fixed learned to master both languages). Questions, terminology idea, no paradigm, but two or many ideas about how it and methodology are essentially different. Kuhn makes his works. There is interest in a phenomenon,but no consensus point by using clear examples. In reality there are grey ar- about facts or methods. There may be different schools of eas of transition and he admits that. As we shall see, when thought that compete. It is considered as immature science. fitting his ideas to the history of malaria, it sometimes wrig- Once a theory gets accepted by the scientific community gles. aconsensusemergesandimmature science matures. One paradigm governs from then on the research in normal sci- 3Kuhniantheoryappliedtomalaria ence that gets the character of puzzle-solution.Itisaprag- matic activity that fits with time and ideas about the world in which the researchers live. The paradigm itself needs no 3.1 From miasma to protozoa proof; the cumulating facts match with the theory and with reality. Students and young researchers submit to the lead- Fevers have always been considered as a phenomenon ing scientists, who tell them what to investigate and what caused by external sources. For many patients and their not; this creates an atmosphere of conserving the paradigm. families it was simply the Almighty who sent the scourge. Young people are discouraged to use their intuition and to But for doctors and students of nature, the main factor express originality. Dogma’s and a conservative attitude are causing fever has been bad air that emanated from foul essential for the progress of normal science,whichbuilds marsh water, hence the Italian term mal’aria, literally ’bad on previous achievements and may reach major progress, air’. This was coherent with the prevailing miasma theory. sometimes over a long period of time. As the American sci- Also the term paludismo, used in the Romanesque language ence writer Paul de Kruif put it in the nineteen fifties: ”in group, indicated the marshes as the place of origin of the our land you train investigators as you train seals before they fevers. But there was growing discontent with the mias- get a penny of the all-important research grant money.” The matic nature of malaria. Scientists began to investigate mi- facts in normal science have significance within the prevail- crobes as causes of the fevers. In 1879 Tommasi-Crudeli ing paradigm.Thissocial-epistemologicalrelationshipbe- and Klebs indicated that water originating from marshes tween the workers at various levels, who face nature in its contained microbes that would convey malarial disease. approachable aspects, is typical in Kuhn’s theory. The point was never proven, but as malaria at that time was a At certain points in time, the sturdy house of research container term for many types of fever (intermittent, remit- may shake because the paradigm is questioned. Scien- tent, bilious, including typhoid and other feverish diseases) tific discoveries unveil anomalies (or vice versa the aware- it would have been difficult to confirm the theory anyway. ness of anomaly leads to discovery). The insecurity about Historians are faced with changes in the meaning of terms: the prevailing paradigm and about the puzzle solving of malaria in 1850 was the agent of ”malarious disease” (i.e. a normal science may come about through technical fail- disease caused by bad air), whilst it is now used for the dis- ures or through a (sometimes serendipitous) discovery, or ease itself (”plasmodiosis”). That shift gradually dawned. auniquecombinationwithnewtechnologydevelopedin Several doctors had already seen ”pigment” in blood and or- other realms of science.
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