Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Pellagra

Episode Date: October 14, 2016

Immigrants get the job done, and that extends to curing a mysterious disease once blamed on everything from bad corn to summertime. This week, Dr. Sydnee and Justin introduce you to the doc who cracked the case. Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history and nothing the hosts say should be taken as medical advice or opinion It's for fun Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it just sit back relax and enjoy a moment of distraction from that weird growth You're worth it All right from that weird growth. You're worth it. TAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAPTAP Hello, everybody. Welcome to Saul Bones, a male tour of Miss Guy's Medicine. I am your co-host, Justin McAroy. And I'm Sydney McAroy.

Well, Sidster, Squid, Cricket. Yes. It's happened again. The Great Injustice has once upon been visited on the McAroy household. What is this injustice? Well, it's so polite of you to act like you don't know, but the truth is It happened again said I got passed over once again for what what were you expecting to be recognized? For what were you expecting to be recognized? Well, Sydney the great the Nobel prizes came out and I didn't get a one of them so for the Nobel Prize

once again which one? Which one did you think you had nailed down this year? prices came out and I didn't get a one of them. So for the Nobel Prize. Once again. Which one? Which one did you think you had nailed down this year? Podcast. Oh, that's the only problem. There's just not a podcast prize. A Nobel, Nobel podcast prize. Well, and Roman Mars would win it probably, or iron glass or somebody.

Hey, hey, what? Don't cut yourself short. Well, you might get it. There's always next year. Who could have thought, how could Alfred Pino Bell have ever envisioned that someday there would be a podcast prize? Yeah.

And that Justin Macro would win it. Yeah, I think they would probably invent it just so I could be recognized for my contribution. Listen, if they'll give a literature one to Bob Dylan, them, who knows, it's all Higgledy Pickledy, cast and dogs out there. I have no opinion on that, I don't know. Well, that's fine.

I don't know, I mean, is everyone who writes in the running? I don't know. Yeah, anyways, they're putting the paper. Bob Dylan's pretty cool, man, that's all I'll say. He seems like a cool cast. He seems like a cool dude, music makes me happy. He's not a good, I was Costello, but hey, that's them's the breaks. I mean, he's no Jimmy Buffett.

Sorry, Bob. He's no JB. Why are we talking about the Nova Prize again? I've forgotten already. Because I thought it was notable that among the winners of the Nova Prize this year were six Americans who are immigrants. Wow, that is notable.

I think it is. in the fields of chemistry and physics and economics. Among them, there were six American immigrants. Just adding to the fact that immigrants make this country great. Yes, immigrants do help make this country great. Absolutely. I thought we should celebrate that.

All right, and like, let's do it. Are we talking about one of them? Yes, one of them. Well, no, not one of those. No, no prize winners. No, no, no, no. No, no, no. No, we're gonna talk about Pallagra, which is a disease.

But I'm gonna get to, you're gonna see how this fits. Oh, okay, I love that. Inmediate res, and then we back up, and it's like, all becomes clear. Yeah. And at the end, we you say, and that's the rest. And how you know, you're a rest of the story. Is that how it goes? Yeah, that's Paul Harvey. Right. You had to explain that reference to me because I didn't understand it. That's okay. I'll get you a few, he's got some books and stuff. Okay. So let's talk about Pallagra. Thank you to Ethan and Rebecca and Hannah for recommending this topic. Now Justin, do you know what Pallagra is?

I have no idea. It's, I had to have you say it like four times when we started because I had never heard of it. Now, to be fair of, of diseases that you could be unaware of that, I think that I'll cut you a break on this one because it's not very common these days, especially not here where we live. It comes, the word comes from the Italian for sharp skin. And basically it boils down to,

for the most part, a vitamin deficiency. Niasin, specifically vitamin B3. Now, it's a little bit more complex than it usually has to do with some deficiencies and protein and other B vitamins and such. But the main thrust of it is that when we say Pallagro, we're really talking about a niacin deficiency. Okay. So it's also called, by the way, there are lots of names for it. One of my favorite is St. Ignatius itch, which I just, I had to share because I really enjoyed it. I don't know why it's called St. Ignatius

itch. I didn't read about it. I just thought it was a funny name. There are lots of other names. It's, niacin is not hard to get in your diet now. Okay, so you probably get plenty of niacin in your diet as is. It is in lots of different foods. I feel like it's been advertised as part of Raisin Brand. Does that track for you? It's in Raisin Brand, you think, or total.

No total is the one that we're doing. It probably does. My son and I both flavin' are tied in my head. Yes, they often run together and actually deficiencies of them often run together as well, which is why sometimes if you read descriptions of pelagra, you might find features of other vitamin deficiencies in there because they tend to go together. If you don't get one, you probably don't get the other. Okay.

Now, niacin is in lots of foods. It's in turkey, chicken, peanuts, peas, tuna, liver, mushrooms, beef, avocado, sunflower seeds. Lots of things naturally, plus we fortify lots of foods with niacin. It is not hard to get niacin. Yeah. Okay. Now. In today's world.

In today's world. For the most part, for the most part. It's characterized, the disease is actually characterized. We used to say it's the disease of the 3Ds, somewhat misleading because there are other symptoms and some of these, you know, it's like any disease. We kind of have like the classic picture of it, but everybody's a little different, so there can be variations on a theme. But mainly you would have dermatitis, that's where the name Pallagra comes from, because you get a really bad dermatitis inflammation like red, looks like a sunburn and then peole kind of skin, often around like the neckline and then anywhere exposed to sun, sun will make it worse.

You can get really bad GI problems, so lots of diarrhea, that's the second D and the third D is for dementia because it can cause a lot of neurological problems that can eventually progress to a dementia. Sometimes I see it the four Ds because people add death in there, but I think that's kind of a dramatic. Wow for a deficiency. Oh, you can die of it. I mean, you don't necessarily, but you can. No, it is a big problem when it happens. It's pretty rare today, like I said, especially in where we live in the US, because it is fortified in many of our foods. And plus, we eat a lot, you know. But there are places where it still exists, we'll get to that.

Pallagra dates back to 1763 when Don Gasper-Cosal first described it among Spanish peasants. They used to call it mal de la Rosa and they thought it was, it was confused a lot for leprosy because of the skin condition. They didn't really understand it. They kind of described it. They saw it. They knew that it had something to do with poverty, something to do with not having enough of something. Something. But there was no understanding of what that would mean, you know, what that would have something to do with food.

You actually can trace the spread of it along with the spread of maize from the new world. Okay, why? Because it is common in people who ate corn-based diets, because they were often deficient in niacin. And so as you see the Mays agriculture, the growing Mays spread from the U.S. or well, the New World, you know, before it was the U.S.

to Europe. You can see that Pallagra follows. So it was a spread to Europe and then to other Mays-based areas in certain countries in Asia and Africa, you find Pallagra follows. So is it spread to Europe and then to other maize-based areas in certain countries in Asia and Africa, you find Pallagra. Now you might be asking the question, why am I not mentioning South America or Latin America at all? Yeah, I know that there are corn-based dishes in that part of the neck of the woods. Absolutely. They treat their maize, though, with lime and wood ashes. That's just a traditional practice. It's been done for

as long as they've been eating corn. And that actually makes the nice and that is already in there easier for our bodies to absorb. We say it increases the bioavailability. So that process probably saved them from pelagra, even though that, I mean, I'm certain that isn't why they were doing it. It also sounds delicious, by the way. I'm like super, super hungry for a Latin American corn right now. We'll go eat some corn after this. I would just crush some corn. Back in the main thing I want to talk about Pallagra is in the US, because in the late 1800s and early 1900s, Pallagra and the United States, especially the Southern United States,

was a huge problem. It may have been in the US all the way back to the 1820s, but we really see good descriptions of it and the problem that it was causing how prevalent it was in 1907. And from 1907 to 1943, million Americans were diagnosed with polyagra and a hundred thousand of those died. Wow, so this is a huge problem.

This is a huge problem. And as I mentioned mainly in the south There were a lot of people there who were living in poverty and they ate diets that consisted of various corn-based products and Really not much else. So as you can imagine there were a lot of other nutritional deficiencies that they were suffering from but but Palagro was the the big bad one that the US was seeking a solution for. So, like I mentioned, the symptoms everybody was having these horrible rashes. It was making them weak. They were unable to work. You know, it made you very tired all the time.

Lots of GI issues. And then these progressive neurological problems that were, again, even if it, if you didn't die from it, could cause a lot of damage and a lot of morbidity. So the US government started to try to figure out what is going on and how can we fix it? We need to appoint a commission, we need to have scientists, let's get the surgeon general involved, let's go down there and let's try to figure out what's going on. Now in the past theories on Pallagro were like a lot of other diseases. Maybe they knew it was associated with places where you eat a lot of corn, so they thought maybe there was a toxin in the corn.

That makes sense. They thought maybe it was just something that some people got because it tended to recur in the same people, and it tended to be seasonal because the sunlight made the rash worse. So you would see the same people tending to get sicker every year in the spring and summer. So you thought, well, maybe it's just like, this is something for people, get... Are like, are deficiencies like this? Something that like, it seems weird to me that everybody wouldn't get that. You know what I mean? Like, if, if, if, that everybody wouldn't get this disease, if a culture wouldn't get this disease,

if a culture didn't ingest up nice and a lot. I mean, it really, I mean, we were talking about social classes. So everybody who only had, only could afford this food to eat did get it. Okay, that makes sense. More or less, I mean, everybody would. Yeah.

Now everybody has different thresholds and who knows how much storage they had ahead of time. So like timeline, who gets it first and how bad does it get that has a lot more to do. And what other nutritional deficiencies ran with it? You know, what did you just have be three deficiency or other things too? Yeah, I mean, since.

So at the time, if you remember, at this point in history, we had just figured out the germ theory of disease. So I bet they were crazy dependent on germs. Absolutely. That was a hot new trend. It was very trendy. It was very popular to say, well, obviously, this is caused by a germ. I don't know if you're familiar.

Cracked it. There's this new theory that everybody's talking about. That would be amazing to just hear like, oh, I see your arms in a cast. Was it a germ? I hear that those cause a lot of issues these days. Was that germ related? That was exactly what it was very trendy. Germ theory of disease was like the pumpkin spice latte of its time.

Is that trendy? I think that might be out now. Oh no. I feel like salted caramel is like the new pumpkin spice. Is it skinny jeans? Are there still in? I, now listen, I had. Jeggings.

I had, uh, Funny Mustaches. They have a chocolate coffee with hot flavors. And now it's Starbucks, the Chile Mocha. Oh. I think that may be that may be the new thing, hot, like spicy chocolate, maybe like the new salt caramel. What about coconut milk?

That's really big right now, right? You can get it with coconut milk, it's so hot. Coconut milk is so hot right now. Okay, we have to get back on track. Okay, the surgeon general appointed Dr. Joseph Goldberger to figure this out. Okay. Now let me give you a little backstory. Goldberger, something case. Dr. Joseph Goldberger to figure this out. Now, let me give you a little backstory. Goldberger's on the case.

Dr. Goldberger. So he was born in 1874 in... Oh, it's a themesong. That's a themesong I just made up for him. He deserves a themesong. He was born in 1874 in Hungary and his parents were initially sheep herders and their flock died, was decimated anyway. They didn't have sheep to herd and so they packed

up the whole family, six kids and moved to the US. And they opened a small grocery store on the lower east side of Manhattan, ran it together and the kids all helped as well. And so that was that was Joe, can I call him Joe? I can call him Joe. That was his first name. That was his first job. He went to the city college of New York and he initially pursued engineering. That was his plan. But there was a visiting lecturer who came in and gave a lecture on physiology and the human body and he became so fascinated with the inner workings of the human body that he changed his mind and transferred to Bellevue and got a medical degree instead. Wow. It became a doctor. So I'll call him Dr. Goldberger now. He has just earned it at this point.

Congratulations, Doc. He's no longer Joe. He started a private practice in Pennsylvania at first, but he got really bored. He was a really clever guy. He was very curious and private practice was just not his thing. So he got bored.

And he joined the US Marine Hospital Service, which later would transform into what we know is the US Public Health Service. Okay. Right. Because at the time, there was this idea that we could send these smart doctors kind of out to various places in the country, or maybe even outside the country, to track down like epidemiological mysteries, like a disease is spreading, we don't know what's

going on, we don't know how to stop it. Let's send all these smart doctors out and try to figure it out. And that sounded very exciting. And he was very intellectually curious and this suited him well. And everybody was crazy for germs. Everybody was crazy for germs. We had just learned about germs. We were really excited.

So they're so hot right now. He initially started working on actually inspecting other immigrants who came through the port for like communicable diseases. Because that was... What a traitor. No, I guess not. No, he's a doctor, he's responsible for public health. That's true.

I guess inspecting other immigrants for germs is only bad and creepy if you're not a doctor. You just appoint yourself that. That's like not a good look. No, no, exactly. Somebody should, I mean, he was doing it because the government wanted to do it. Hold up, hold up. Not so fast. It's going to look over for germs. They're very hot right now. And you would be quarantined. I mean, that was the plan was to quarantine you until you got better. And then, and then let you continue that

the plan was not to send anybody back. Let me make that clear. I'm not saying bad things probably didn't happen. I don't know that whole history, but that was his job. After that, because he was so good at being an epidemiologist and figuring out disease patterns and where did things come from and that stuff, he started getting assignments all over the place. He went to Mexico, Puerto Rico, and parts of the South to study yellow fever.

He actually got yellow fever in the process. But don't worry, he beat it. He worked in the hygienic lab in Washington for a while, which we've talked about before, later became the National Institute of Health. Hygenic lab has got to be the uncoolest place during germ fever. Like, uh, gross, you work where with no germs? Oh, poor you. He got to work with typhoid there, though. Uh, I guess that's pretty good. He just was very hygienic about it. Yeah, right. Uh, he went, he went to Texas to study to study dangae fever and got dangae. Uh, He went to Mexico to study Typhus and got Typhus.

Oh, man, Goldberger. But the important thing is he survived it and I bet he was pretty tough. He actually, the way that letters indicate he viewed it was they were like battle scars. Like he thought, it was kind of cool. Like, I got so into it that I got it. Man, I had the craziest diarrhea. It was like diarrhea all the time. But here's the thing.

I used to, I understand that. I used to think like if I could just get a little malaria and then get better, I don't think that anymore. I don't think that anymore. You're like a disease tourist. I'm older and smarter and I understand that that's a terrible thing to want. When I was younger, I could see myself thinking that that's a terrible thing to want. Okay.

When I was younger, I could see myself thinking that if I was so immersed in something. Anyway, he also got married at this time period and to add to what a tough kind of... A lucky lady. No, it was actually a great match because they were both fascinated with science. They both very strongly believed in the scientific method and in science to improve the lives of people, especially medical science. But he was Jewish and she was an Episcopalian and that was very daring at the time. Both families were quite displeased.

Scameless. Yes. All of this work led to better understanding of all these diseases that he was studying and how they were transmitted and he was very celebrated. So it was not surprising in 1914 when the surgeon general appointed him to, you know, study Pilagra. This all led up to this moment. He had heard of some early experiments that had been done where they had tried to figure

out, like, trace the disease and who has it and study and, like, population studies. And it was all supposedly related to either a germ, a lot of people thought a germ, or maybe just the corn that had gone bad, people were just eating corn that had gone bad. You're right. And that really didn't seem to make sense to him, because what he noted is that they studied Pallagra in a lot of like institutional settings, orphanages

or psychiatric hospitals, those kinds of things. And all of the people who live there, you know, the orphans or the inmates or whatever in a prison or the patients in a psychiatric hospital, they all had it, but the staff didn't. So you would think if it was like, if they were eating from the same source and it was a disease, if that was the vector, then they would, the staff would have it as well. Right. If it was a germ. Right. Yes, exactly. If you know, germs don't know social class. They infect the rich and the poor equally. So that didn't make sense to him.

So he thought something with the diet may be what the problem is. So he set up a series of experiments, experiments in orphanages and psychospitals where he basically gave everybody a better diet, fresh meat, fresh milk, vegetables, and then saw if they got better. And then he continued to give them a better diet through the next year to see if they got Palagra again the next year. And they didn't. And they didn't.

So he had all, now I should know a couple of things about this. One, he didn't have a control group, but that was basically because they just couldn't give some orphans good food and other ones bad food. Yeah, it's like, because that's really, excuse me, sir. Why do you only eat cheetos? Don't get me wrong. I love the cheesy flavor. But sir, can't I have a spot of meat? No, eat your cheeto. You're in the control group. You're in the control group. Eat up. Now, to be fair, that's good. You're in the control group. You're in the control group, eat up. Now to be fair, there's a lot you could, uh,

ethicists would battle about at this point. Um, I'm sure no one signed consent for this. I'm sure no one knew they were participating in any dietary experiments. I think it's nice that they at least didn't include a control group, not so robust scientifically, but much more humane. Either way, the point is they figured out from this that improving the diet, giving people more, they really thought fresh meat was tied

to this would improve the pelagra. He also set up an experiment among inmates in a Mississippi prison where they were offered freedom in return for participating in this study, again, not great, ethically, 11 men signed up for this and they were basically given a really deficient corn-based diet for five months. And six of them got Pallagra. So they thought, well, there you go. It's a diet thing. You just improve the diet, they get better, they don't get Pallagra, that's the end of it.

And then 11, whatever they did, we're set free. I don't know if they were murderers or... Quick, Justin checks the internet sidebar. Cheetos totally have nice in them. So... Forget that. Forget that. You wouldn't, that wouldn't be a good job.

Don't slander Cheetos anymore. So we figured it out. So that was it, right? Medical, the medical community said, thank God, pelagra's behind us. Yeah, so, so, so we figured it out. So that was it, right? Medical, the medical community said, thank God, put plagiarism behind us. Yeah, you'd think. But before I tell you what happened next, why don't you come with me to the billing department? Let's go. Are you easily confused by terms like cultural appropriation, cisgender, and woke? Or maybe you find yourself constantly explaining terms like these and you need a place to

vent. Do you have a love for all things pop culture, social commentary, and politics? Sounds like you need minority corner where you can learn, laugh, and play. Sounds like blues clues. Only it's more black, laugh, and play. Sounds like blues clues. Only it's more black, gay, and ladylike. James and Annette will happily administer your weekly dose each and every Friday. You can listen on Maximum Fun or wherever you get your podcast.

Minority Corner with the K because the C was taken. Okay, so you were about to tell me some whack stuff about how the medical community did not immediately line up behind this amazing new discovery. That's right, the scientific community. Which is okay, that science, right? It is, you guys love to be skeptical before you accept new truths, right?

It's, yes, absolutely. I think it's fair to say that in science, not necessarily, if something is brand new, just not assuming that it's correct, but studying it and being vigorously curious, I not assuming that it's correct, but studying it and being vigorously curious, I would say, is always important. That being said, I also think that people are predisposed to believe that if they figured something out and it makes sense to them that they're right, and sometimes accepting new

information, assimilating that into your understanding of the world can be difficult. And this was very hard for the scientific community. They didn't think it made sense. They didn't like the idea that it wasn't a germ, because they were all about germs. I think it was probably also fair to say that, as I mentioned, Dr. Goldberger was an immigrant, and he was a Jewish immigrant.

And there was probably a lot of prejudice and discrimination that played into a lot of people's combating this and saying that that can't be right. There was also a lot of association with the South and with poor people and with somehow that this was like a negative, it cast a negative view of them and that played into it as well. So a lot of Southerners were angry about it.

So how do they convince them? So to prove his idea, in 1916, Goldberger injected his assistant, George Wheeler, with five CeSis of blood from someone who had Pallagra. I mean, very impressive, but only slightly less so because he's like, uh, George? George, can you come in my office for a second? George. Now I should be noted, George volunteered for this and in return, George injected Dr. Goldberger with six CCs of blood.

Wow. Okay. From someone with Pallagra. And nobody got sick, right. But they weren't done. That's not enough. The sign that. Let's take it further. Okay. So they took a cotton swab. Don't make it further than injecting someone's blood, but.

Yeah, they took a cotton swab and they swabbed the inside of a patient who had Pallagra's nose with a cotton swab and they took that cotton swab and stuck it up their own noses. Swab the inside of their noses. Like a... Yekaroni, then I'm assuming nobody got sick. Nobody got sick, but that's not enough. They're not done.

Okay. Then they took a swab, swab the inside of a polyagrapat, patient's throat. Okay. And... Then we got sick. Well, then they swab their own throats with that same throaty swab, that same mucusy throaty swab. Stop!

Nobody got sick, but that's still not enough. I'm sure it's enough. There's more. I'm certain that's enough. Wait, there's more. I just ran ahead. Oh, God. They took scabs from the rash of a polygropation

And I'm assuming like kind of ground them up made them a little powder made them small made them dusty powder Powdery scabby dusty put them inside capsules and swallowed them And nobody got sick. Yeah, somebody did his name's Justin ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, he called them filth parties why don't have he called them earth that i should say it was probably something from the media they were a bit of filth parties and he had other volunteers including his wife like i said she was a big fan of the scientific method as well she believed in this and it made sense scientifically not just because she probably also loved her husband i'd say that's part of it but uh... together they swallowed scab pills and injected each other with blood and swabby other's noses and other people joined in and they know one got pelagra and that should have been enough but but yet it was not and while all

this is happening let me say because this all sounds like fun and games like we're having these filth parties and doctors are writing in JAMA that in the Journal of the American Medical Association, that this is wrong. But people in the South are still getting pelagic and some of them are dying. This was being made worse by the land tenure system, the sharecropping system at the time was very unjust. A lot of people were living in poverty already, and then the price of cotton was dropping at this point in history around 1920.

And so many, many farmers were, and their families were starving as a result. And the government wasn't doing anything about it at that point. Goldberger kept mourning, listen, if we don't change this land tenure system and use more diversification of crops and allow these people,

allow these people access to more foods. Like, this is going to keep getting worse. More people are going to get sick and more people are going to die. But nothing was changing. President Harding and the public health service tried to direct funds to stop the crisis. They actually tried to send more money and more doctors and send relief to the South. But a lot of the Southern lawmakers and congressmen did not want this. They didn't want help, they didn't want this narrative,

they wanted it to kind of be silenced because they were worried about people not wanting to do business with the South because all their workers are sick. You know, you don't want to do business with a Southern company because everybody's too weak and sick to work. And they didn't want to hurt tourism. So they wanted this kind of squashed, and they didn't want Washington sending them money and assistance. So without putting any of this into practice, the South continued to suffer in all of his predictions

about more people being second, more people to be dying, or dying were coming true. Do you know what changed things? What? Not Dr. Goldberger, unfortunately, the Bow Weevil. How did the Bow Weevil change things? The Bow Weevil in the 1920s came to the South and decimated cotton crops.

So they had to start growing other things. Mm-hmm. And what they grew, they also were eating and nice and became part of their diet again. And we start to see Pallagger cases dropping. So because the Bow We the bully ate the cotton, they had to grow their stuff and the other stuff. Had Nyson and they ate that and there you go. It's amazing.

Throughout the 20s, Goldberger continued to try to understand because he knew that it was a diet based thing, but let me make it clear. He did not know it was Nyson at this point. Right. It probably would have been a much easier sell because you could point to a culprit rather than something amorphous, like bad diet. And then you can fix it too.

And the problem was the ways that he had fixed it so far were not cheap. Giving people meat and vegetables and milk and all the different, like the good diet that he was giving people while they needed that anyway was not feasible. You couldn't just hand that to was giving people while they needed that anyway, was not feasible. You couldn't just hand that to everyone in the American South at that point. So if he could isolate what it was and it was something cheaper, that would have been

better. So he kept trying to find like the polyagraph actor. What was it that people were missing? He found that whatever it was, it was in Brewer's yeast, which was really easy to add to food, but still people resisted. He also figured out that black tongue disease, which was a disease that dogs got, it was the same thing. It was just pelagran dogs.

So still trying to isolate, what are we not eating, what are dogs not eating? In 1927, the Mississippi River flooded famously. There's a huge flood of the Mississippi River. And he traveled up and down the river because he knew people then would be displaced and not getting the proper diet, not getting proper food. And he traveled up and down the river trying to help people get this bruised, you should in your food. Listen, you're going to need this or you're going to get Palagra.

Nobody really believed him. Nobody appreciated it. He was not able to finish his work on his own. In 1929, he got renal cell carcinoma and passed away. But his work did continue. He had inspired scientists who believed that there was something there to keep working. And it was within the next decade

that they figured out that niacin was the missing factor. They figured it out first. A scientist of a hem gave it to dogs and fixed black tongue disease. They figured out that trip to fan is an amino acid that's a precursor to niacin. scientists of a ham gave it to dogs and fixed black tongue disease. They figured out that tryptophan is an amino acid that's a precursor to niacin, so you can just give people tryptophan and that often fixes the problem. That's the turkey one, right?

Yes, absolutely. And Wilk. Yeah, there you go. And it is very easy to add to foods. So they started fortifying lots of breads with the first thing, but lots of foods with tryptophan and then Pallagra was gone. He was nominated five times for a Nobel Prize. He did not win.

He did not win. I would say a lot of this discrimination was probably a lot of the things I've mentioned already because people were resistant to believing him. His wife though did receive $125 a month in pension in perpetuity and recognition of his service. So I mean, that was the government's way of recognizing his contributions. His work does continue today, even though Pallagra is not something that as a physician practicing in the US in the modern world that I see, it is still a problem in developing nations where

there are still issues with dietary deficiencies. It's mainly a problem in in povrished areas. And then in refugee populations, this is always some, this is always a huge concern. And like I've mentioned, there are lots of foods that are rich in ice and there are lots of ways to supplement a diet with niacin. It's just we've got to get it to people. Okay, get to people. So I start every day with a big slice of nice and do you ever try that?

A little apple butter on there? No, I'll take that. Delicious. Now I figure this will be our first in a series I'd like to call like immigrants. They get the job done. I love it. Thank you, Lynn. And thank you immigrants for all the medicine and the highlighting the importance of niacin

Yes, I'm going to today lift myself and post ban on niacin. I Don't know why I've been clinging to it for so long. I know what I was afraid of you don't have pull aggressor You have not been banning niacin all right doc you eat a bolicereal every night. That's true. Oh, yeah That's a little nice and I'm fine. It's everything's fortified now. Yeah fine. You're fine. It's fine. It's why you don't even won't do items you heard it for me first That's gonna do for us here this week. Thank you so much for joining us. Thank you to our sponsors Thank you to the maximum fund dot org family podcasts you are

Finally, a podcast, you are all excellent. I want to recommend one. The Dead Pilot Society is one I want to recommend. That is a show where they resurrect pilot scripts that never got turned into TV shows and do like a stage reading of them. This week is John Hodgman's script called Only Child starring John Hodgman as a 14-year-old John Hodgman, and it is Hust Air Col. So go check that down on all of the other MaximumFun.org podcasts. And thanks, taxpayers.

For all that in this user's own medicines, this is the Intro and Outro of our program. Anything else else sister? I think that's it. Well, that's going to do it for us then. Until next week, my name is Justin McAroy. I'm Sydney McAroy. And as always, don't drill a hole in your head. Alright! Maximumfund.org

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