One Page in the History of Starvation and Refeeding.

There is a long history of starvation, including reports dated back to antiquity. Despite exceptional scientific developments, starvation still exists today. The medical aspects of starvation were well established in the twentieth century, particularly following studies related to the 1943-1944 Bengal famine in India and starved prisoners of war and survivors of World War 2. The refeeding of the starved victims provided disappointing results. Nevertheless, those studies eventually led to the development of a new branch of research in medicine and to the definition of what is now known as refeeding syndrome. This paper briefly reviews the history and groundwork that led to today's understanding of starvation and refeeding, with a particular emphasis on the observations from studies on starved Holocaust survivors and prisoners of war after World War 2. The relevance of these studies for modern times is briefly discussed.

Investigating the citing communities around three leading health-system frameworks.

Of numerous proposed frameworks for analyzing and impacting health systems, three stand out for the large number of publications that cite them and for their links to influential international institutions: Murray and Frenk (Bull World Health Organ 78:717-31, 2000) connected initially to the World Health Organization (WHO) and then to the Global Burden of Disease Project; Roberts et al. (Getting health reform right: a guide to improving performance and equity, Oxford University Press, Oxford, 2004) sponsored by the World Bank/Harvard Flagship Program; and de Savigny and Adam (Systems thinking for health systems strengthening, WHO, 2009) linked to the WHO and the Alliance for Health Policy and Systems Research. In this paper, we examine the citation communities that form around these works to better understand the underlying logic of these citation grouping as well as the dynamics of Global Health research on health systems. We conclude that these groupings are largely independent of one another, reflecting a range of factors including the goals of each framework and the problems that it was meant to explore, the prestige and authority of institutions and individuals associated with these frameworks, and the intellectual and geographic proximity of the citing researchers to each other and to the framework authors.

Remembering Dr Mark/Meir Dvorjetski: Physician, Survivor, Teacher, Historian, and Pioneer of Shoah Medicine Research.

Meir Dvorjetski was a Holocaust survivor, teacher, and historian. He is best remembered for his descriptions of the medicine practiced by the Nazis during World War II, as well as the diseases, disorders, syndromes, and deaths resulting from such practice-particularly, though not solely, on the Jewish race. Dvorjetski's contributions to Holocaust research at Bar-Ilan University in Israel, his underground partisan work, his contributions to society, and his testimony at the Eichmann trial have all been well documented. However, his earlier years-including his survival of the Holocaust, and his less-known medical achievements and contributions to historical records regarding the Holocaust-have not been covered as thoroughly. These latter items are the focus of this paper, with a closing commentary on the relevance of his work for the 21st century.

Starvation Genocide: Diabetes and Cancer in the Lodz Ghetto.

BACKGROUND: Extermination via starvation was described in detail as an alternative or precursor to the final solution during the Holocaust in World War II. The main causes of death in the ghettos were exhaustion, environmental conditions (inadequate protection in extreme climates), infectious diseases, or starvation. In previous studies on the Lodz Ghetto, the causes of death via typhus exantematicus, tuberculosis, and heart failure were investigated [1,2]. In this article, we introduce the topic of diabetes in the presence of starvation and assess the incidence of malignancies in the years 1941-1944. The findings from the Lodz Ghetto would retroactively support the Warburg theory.

Starvation Genocide: Myocardial Infarction in the Lodz Ghetto.

BACKGROUND: Medical records discovered after the liberation of ghettos in Nazi-occupied Europe are unique documents that report on the suffering of inmates, on ravaging infectious diseases, and on starvation-related organ degeneration and the resulting mortality. We offer a pathogenetic explanation for the scarcity of acute myocardial infarction in the Lodz Ghetto, Poland, 1941-1944.

Starvation Genocide and the Triumph of Raphael Lemkin.

Today, in the 21st century, most people are aware of the term genocide. However, few people are aware that this term only entered the English language in the 1940s, as a result of the dedicated work of a brilliant and successful man who deprived himself of a private family life so that he could be free to fight for his ideas. Although Raphael Lemkin was instrumental in the recognition of genocide by the United Nations, he died too early and was buried with no honor. This paper reviews the life and work of Raphael Lemkin, and his triumph in seeing genocide recognized as a crime.

Starvation Genocide in Occupied Eastern Europe 1939-1945: Food Confiscation by and for the Nazis.

The genocide effected by the Nazi regime during World War II, intended for the local population in Eastern Europe, took the form of allocation of daily food rations: 100% for the Germans; 70% for the Poles; 30% for Greeks; 20% for Jews. Hermann Göring, the Reichsmarschall of the Nazi Empire created a blueprint for full alimentation of the occupying German forces through theft of land and food of the Soviet Union thus forcing its "racially inferior" population to starve, adopted on 29 April 1941. In the weeks leading to the German invasion of the Soviet Union in June 1941, the Reich Minister for Food, Richard Darré, and his State Secretary, Herbert Backe, developed the "Hunger Plan", which led to death by starvation of at least seven million Soviet civilians, Jews and gentiles. This article reviews responsibility for the formulation and implementation of this form of genocide.

The World Health Organization and the global standardization of medical training, a history.

BACKGROUND: This article presents a history of efforts by the World Health Organization and its most important ally, the World Federation for Medical Education, to strengthen and standardize international medical education. This aspect of WHO activity has been largely ignored in recent historical and sociological work on that organization and on global health generally. METHODS: Historical textual analysis is applied to the digitalized archives and publications of the World Health Organization and the World Federation for Medical Education, as well as to publications in the periodic literature commenting on the standardization of international medical training and the problems associated with it. RESULTS: Efforts to reform medical training occurred during three distinct chronological periods: the 1950s and 1960s characterized by efforts to disseminate western scientific norms; the 1970s and 1980s dominated by efforts to align medical training with the WHO's Primary Healthcare Policy; and from the late 1980s to the present, the campaign to impose global standards and institutional accreditation on medical schools worldwide. A growing number of publications in the periodic literature comment on the standardization of international medical training and the problems associated with it, notably the difficulty of reconciling global standards with local needs and of demonstrating the effects of curricular change.

Research on Tuberculosis in Nazi Germany and the Cruelest Medical Experiments on Jewish Children: An Observational Review.

BACKGROUND: Germany was a scientifically advanced country in the 19th and early 20th centuries, particularly in medicine, with a major interest in research and the treatment of tuberculosis. From 1933 until 1945, Nazi Germany perverted scientific research through criminal experimentations on captured prisoners of war and on "subhumans" by scientifically untrained, but politically driven, staff. This article exposes a series of failed experiments on tuberculosis in adults, experiments without scientific validity. Nonetheless, Dr. Kurt Heißmeyer repeated the experiment on Jewish children, who were murdered for the sake of personal academic ambition. It is now 75 years since liberation and the murdered children must be remembered. This observational review raises questions of medical and ethical values.

What Happened to the Global Forum for Health Research?

The Global Forum for Health Research (GFHR) was founded in 1998. It was the culmination of an advocacy movement started in 1987 to campaign for the expansion and coordination of health research benefitting low- and middle-income countries. It was largely funded by the World Bank and embraced that institution's emphasis on cost effectiveness. But its small budget prevented it from assuming the central role in global health research that its supporters had envisaged. It took on more modest tasks, focusing on advocacy, organising an annual conference and monitoring research funding. In 2010, it was absorbed amid general indifference by another small organization, the Council on Health Research for Development (COHRED) and eventually disappeared from sight. We argue in this paper that its fate had two major causes. First, it resulted from operational and budgetary problem and its inability to attract the new money that was pouring into Global Health (GH). Second, it reflected the aggressive efforts by the WHO to reclaim leadership in this domain. Underlying this failure, however, was the inherent difficulty of coordinating the ideologically fragmented and individualistically oriented GH research domain.

Hand Deformities in the Paintings of Giacomo Ceruti (1698-1767), Nicknamed 'il Pitocchetto' for his Depictions of the Poor.

BACKGROUND: Giacomo Ceruti was a renowned painter in northern Italy during the middle third of the 18th century, although he is not well-known today. He produced pictures in several different genres but his reputation after his death was based primarily on his portrayal of beggars and poor working people; hence, his posthumous nickname, il Pitocchetto, the little beggar. Of medico-artistic interest is the realism with which he depicted the hands of his impoverished subjects, a quality that enables them to be examined for signs of pathology or trauma. The present article displays some representative examples of hand deformities in Ceruti's paintings, thus extending into the 18th century the authors' previous research on medical aspects of art works from the 15th to the 17th century.

International Health Research and the Emergence of Global Health in the Late Twentieth Century.

An influential policy network emerged from two overlapping developments of the 1970s and 1980s: new research programs focusing on tropical diseases and debates about how to implement the concept of primary health care at the World Health Organization. Participating actors came together in an informal network that, by the late 1980s, expanded advocacy to include the promotion and reorganization of all forms of research that might improve health in the Global South. This goal became associated with a search for new research methods for determining priorities, a quest that reached a peak in the early 1990s when the World Bank entered the picture. The bank brought money, economic analyses, and neoliberal ideology to the research advocacy movement and helped stimulate an upsurge of cost-effective forms of economic thinking in global health (GH) circles. This expanded research network provided some of the conceptual foundations and leadership for several of the most emblematic institutions of the new GH. These included new organizations to bring together and coordinate public and private actors in pursuit of common aims and new forms of economic rationality. The network's advocacy work contributed as well to a massive expansion of GH research at the turn of the century.

Observations on Osteoporosis in Three Generations of Descendants of Holocaust Survivors.

BACKGROUND: Throughout history, studies on episodes of famine have led to the discovery of metabolic abnormalities and hormonal aberrations as well as an increased incidence of cancer and mental health conditions. Starvation during early life is thought to nfluence the programming of childhood and adult bone metabolism, which may result in poor bone health in later life. This observational case series includes a small group (with no control group) of famine-exposed Holocaust survivors and their descendants. We proposed an investigational mechanism to determine any association between starvation and osteoporosis, both in the individual survivors and in their descendants.