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Subject: Doctoring the numbers - medicine's greatest fraudby S. H. Shakman
To the Editor. -- This letter exposes a fraudulent scheme, introduced in a letter to this journal by W. L. Holman with details published elsewhere(1); which was apparently specifically intended to discredit prominent research results published in this journal by Edward C. Rosenow and in former A.M.A. President Frank Billings' associated work(2), and broad and continuing implications. Rosenow, head of experimental bacteriology for the Mayo Foundation from 1915-1944, published nearly 300 articles (including 45 in this journal) over the period 1902-1958. His animal experiments repeatedly demonstrated the phenomenon of elective localization, whereby organisms isolated from dental and other foci of persons with a wide range of diseases were found to have a specific affinity for corresponding tissues when injected into laboratory animals. Billings suggested that cells in these tissues adsorb the bacteria out of the circulation " as if by a magnet ".(2) For example, Rosenow found that 60% of 103 animals injected with bacteria from stomach ulcer patients developed stomach or duodenal hemorrhages, compared with 17% of 405 animals injected with other strains. Holman calculated from Rosenow's data that such lesions had developed in 62 of the former ("specific") vs. 68 of the latter ("non- specific") instances, performed the same sort of calculations with Rosenow's other data (Table 1), and carefully stated that it is " a 50 percent chance " that any particular localization is due to a specific or non-specific strain. Based on this faulty and essentially meaningless construction, he referred to Rosenow's elective location hypothesis as "a theory with little if any experimental basis" and dismissed Rosenow's experimental results as "unconvincing".(1) The continuing broad significance of Holman's deception is exemplified in Paul Beeson's 1976 authoritative assessment of American medicine(4). Beeson asserted that the focal infection work of Rosenow and Billings had been disproved in 1940 by Reiman and Havens.(5) Reiman and Havens, in turn, exclusively credited Holman's 1928 article with having negated Rosenow's animal experiments. Holman's handiwork also is widely cited in the foundational dental literature underlying the common modern dental practice of retaining devitalized teeth (which Rosenow vehemently opposed), as for example perpetuated through the lasting legacy of Louis I. Grossman(6), which in turn continues to contribute to modern opposition to the focal infection concept in general. At the 1940 Dental Centenary Celebration, Rosenow presented results of experiments involving more than 11,000 animals by 32 investigators including himself (Table 2), and cited confirming studies of precipitation and cutaneous reactions, electrophoretic mobilities, and agglutination and other tests.(3) In all, the works of Rosenow and associates seem to have gone far beyond merely fulfilling the venerable Koch-Henle criteria of disease causation for a wide range of diverse diseases. The fact that Rosenow's work has been wrongfully discredited mandates reassessment, including reconsideration of his emphases on the role of oral focal infections and his unique methodology for the preparation and use of autogenous vaccines. Former A.M.A. President Walter Bierring has firmly asserted that Rosenow's work had been definitely confirmed, and predicted "perchance it is safe to assume that the 'Rosenow heresy' may yet become the medical guide of the future."(7) Perhaps Dr. Bierring's future has arrived. Stuart Hale Shakman 1248 Fifth Street P.O. Box 382 Santa Monica, CA 90406-0382
References: 1. Holman, WL. The localization in animals of bacteria isolated from foci of infection. JAMA. 1927;88:424-425 (preliminary letter, without details); Archives Path. & Lab. Med. 1928;5: 68-136; table on p. 133. 2. Rosenow, EC. Elective Localization of Streptococci. JAMA. 1915; 65:1687-1691, data on p. 1688; data also in Billings, F., FOCAL INFECTION, The Lane Medical Lectures (Delivered on Sept. 20-24, 1915), D. Appleton and Co., N.Y. & London, 1916, p. 36. 3. Rosenow, EC. Focal infection and elective localization in relation to systemic disease: a review and results of further studies. Dental Centenary Proceedings, Maryland State Dental Association and the American Dental Association, March 1940, pp. 261-282. 4. Beeson, PB. Focal infection and systemic disease; in Bowers J, Purcell E, eds., Advances in American Medicine: Essays at the Bicentennial, 1. N.Y.:J. Macy Foundation; 1976, pp. 151-2. 5. Reiman HA, Havens WP. Focal infection and systemic disease: A critical appraisal. JAMA. 1940;114:1-6. 6. Grossman LI. Root Canal Therapy, 1940-1955 (eds. 1-4); continued as Endodontic Practice, 1960-1988 (eds. 5-11). Philadelphia; Lea & Febiger. 7. Bierring WL. Focal infection: Quarter century survey, Frank Billings Lecture. JAMA. 1938;111:1623-1627.
Rosenow's Data Holman:
LESIONS IN SOURCE \/ \/ ANIMALS % WITH (NUMBER)
ANIMALS' \/ \/ PATIENTS WITH: INJECTED LESIONS (W/LESIONS)
Stomach/Duodenum Stomach ulcer 103 60% (= 62) 48%
(w/hemorrhages)
Other diseases 405*** 17%*** (= 68) 52%
130
Stomach/Duodenum Stomach ulcer 103 60% (= 62) 67%
(with ulcer)
Other diseases 405 7% (= 30) 33%
92
Joints Rheumatic fever 71 66% (= 47) 36%
Other diseases 437 19% (= 84) 64%
131
Endocardium Endocarditis 44 84% (= 37) 30%
Rheumatic fever 71 46% (= 33) 27%
Other diseases 393 13% (= 52) 42%
122
Myocardium Rheumatic fever 71 44% (= 32) 38%
Myositis 40 35% (= 14) 17%
Other diseases 397 9% (= 36) 44%
82
Muscles Rheumatic fever 71 27% (= 19) 24%
Myositis 40 75% (= 30) 38%
Other diseases 397 7% (= 29) 37%
78
Gallbladder Cholecystitis 41 80% (= 33) 43%
Other diseases 467 9% (= 43) 57%
76
Appendix Appendicitis 68 68% (= 46) 71%
Other diseases 440 4% (= 19) 29%
65
Kidneys Rheumatic fever 71 39% (= 28) 52%
Other diseases 437 6% (= 26) 48%
54
Skin Erythema nodosum 20 90% Not listed
Herpes zoster 61 70% by Holman
Other diseases 427 4%
Parotid Mumps 19 73% Not listed
Other diseases 489 0% by Holman
Pancreas Mumps 19 42% Not listed
Other diseases 489 4% by Holman
Table 2. ELECTIVE LOCALIZATION OF STREPTOCOCCI-11,479 ANIMALS [4]
LESIONS IN SOURCE: DENTAL/OTHER ROSENOW ELEVEN TWENTY TOTALS
ANIMALS' FOCI IN PERSONS WITH CO-WORK. OTHERS
# % # % # % # %
Stomach Stomach/duodenum ulcer 1539 65 1231 52 280 60 3050 57
Other diseases 3341 8 1798 6 996 3 6135 06
No systemic disease 1329 14 665 7 300 7 2294 11
Joints Arthritis 1447 53 1225 58 415 59 3087 56
Other diseases 3433 13 1804 7 861 39 6098 15
No systemic disease 1329 18 665 11 300 31 2294 18
Eyes Iritis, other eye dis. 272 42 328 43 186 53 786 45
Other diseases 4608 1 2701 1 1090 1 8399 01
No systemic disease 1329 8 665 0 300 2 2294 05
Myocardium Myocarditis 36 61 39 38 94 59 169 54
Other diseases 4844 3 2990 7 1182 11 9016 06
No systemic disease 1329 6 665 3 300 17 2294 07
Muscles Myositis 891 72 50 58 86 56 1027 70
Other diseases 3989 6 2979 9 1190 12 8158 08
No systemic disease 1329 3 665 7 300 13 2294 05
Kidneys Pyelonephritis 168 73 96 83 96 58 360 72
Other diseases 4712 6 2933 3 1180 16 8825 07
No systemic disease 1329 9 665 7 300 19 2294 10
Colon Ulcerative colitis 527 58 60 60 119 42 706 56
Other diseases 4353 2 2969 0 1157 1 8479 01
No systemic disease 1329 5 665 0 300 0 2294 03
TOTALS 6209 3694 1576 11479
Response from JAMA, 12 Dec. 1997:
American Medical Association
Physicians dedicated to the health of America
Journal of the American Medical Association
515 North State Street
Chicago, Illinois 60610
312 464-5000
312 464-5824 Fax
http://www.ama-assn.org
December 12, 1997
Stuart Hale Shakman, PhD
1248 Fifth Street, PO Box 382
Santa Monica, CA 90406-0382
RE Letter#JLD71261
Dear Dr. Shakman:
Thank you for your recent letter to the editor. Unfortunately,
because of the many submissions we receive and our space
limitations in the Letters section, we are unable to publish your
letter in THE JOURNAL.
After considering the opinions of our editorial staff, we
determined your letter did not receive a high enough priority
rating for publication in JAMA. We are able to publish
only a small fraction of the several thousand letters submitted
to us each year, which means that published letters must have an
extremely high rating.
We appreciate your interest, and thank you for the opportunity to
review your letter.
Sincerely,
/s/
Phil B. Fontanarosa, MD
Senior Editor, JAMA
Director, Department of Editorial Affairs
PBF:LYH
