Sockerförsöket. Kariesexperimenten 1943–1960 på Vipeholms sjukhus för sinnesslöa
The Suger Experiments
Summary, in English
In 1942, 99.99 percent of the Swedish population had dental caries. Public Dental Health Care system, which had only been established in 1938, was struggling to cope with the task of providing care to all. The solution proposed by the Swedish Government was research. This thesis examines a medical experiment on the interface between medical science, public health policy, mental health services and the confectionary industry; The Vipeholm Dental Caries Studies from 1943 to 1960. The main sources are archival material from the Swedish Board of Medicine, as well as contemporary publications and government white papers.
The government ordered a public investigation into the causes of dental caries. In response, the Board of Medicine initiated an experiment at “the Vipeholm Hospital for uneducable, mentally retarded patients” – patients with severe learning difficulties – in 1945. For two years, 660 of the patients and 140 of the staff tried different preventive diets containing extra vitamins and minerals. It became obvious however, that the vitamin experiments offered no conclusive results therefore the researchers in full agreement with the board decided that a different approach would be needed. In 1947 an experiment was begun using toffees, chocolate and sweetened drinks to actually invoke dental caries. After a year of carrying out these experiments, the groups eating 24 toffees a day developed a high rate of dental decay and, therefore, after a further six months these groups were excluded from the experiment. During the Sugar Experiment, the confectionary industry had financed a large part of the research and in return expected to be provided with results. The researchers, however, were not ready to supply the kind of results the industry expected; findings concerning safe levels of sweet consumption and recipes for healthy toffees and chocolate. They did, however, change the design of these experiments in 1949 to use more realistic quantities of sweet consumption than the previously exaggerated amounts used. They also postponed publishing the results from 1949 to 1953, a result of pressure from the industry. When at last the findings that confectionary – in particular chewy sweets like toffee – provoked dental caries, was made public in 1953, a public row ensued.
The sweet industry vented its frustration at the one-way exchange with the researchers, claiming their results to be invalid. Peers and politicians alike accused the researchers of “selling out” to the sweet industry rather than remaining scientifically objective. In parliament, both the Board of Medicine and the government were accused of legitimising and supporting unethical experiments in which patients with learning disabilities had been humiliated. The board and the researchers however in unison managed to defend the research results as well as the experimental design so well that all accusations were eventually quashed and thus the Vipeholms Experiments became what they are today: the scientifically solid proof that chewy confectionary provokes dental caries.
This public debate made funding difficult. The government became reluctant to continue its annual support, the industry had pulled out in disgust and no alternative funding was available. A very limited number of the accusations had mentioned the ethics of the experiment. Still, the critics from the Association for the Rights of Children with Learning Difficulties would be the ones to seal the fate of the experiments, which due to the lack of funding and the threat of being publicly exposed as putting children in danger, were finally closed in 1955.
By then however, the results were already being used in a trial to change the patterns of sugar consumption in Sweden. In 1953, the introduction of laws and taxes to make the production, sale and purchase of confectionary and sugar less attractive were suggested to the parliament. In 1957 a massive campaign was launched informing Swedes the length and breadth of the country about the dangers of sweets to their dental health. At the same time a public enquiry suggested a change to the Public Dental Healthcare system from a repairing ethos to one of prevention. All of this was the work of the Board of Medicine, which would turn out to be an independent mediator in the interface between science, care, policy and industry.
By analysing the production of odontological knowledge as a social process, this study tries to broaden the understanding of the micro processes behind public health. Public health is understood to be a co-evolution of science and policy, and the scientists’ production of applicable results are analysed as work. To make the experiment work, the researchers needed a material, a method for registering and the know-how to use them together. To make the results credible, the researchers needed to show their objectivity by drawing a line around the science used which clearly showed areas of non-science; non-science being politics, industry, care, social relations and simply bad science. By making parts of the work process invisible, they could produce an account of the research that best showed the conclusions as a straight line of objective translations from the reactions of patient’s teeth, via the measuring instruments and the researchers protocols to the aggregated facts about dental caries.
The researchers’ routines to assure credible results however, had unforeseen results. The treatment of the patients was not that of autonomous participants in a medical experiment but rather that of patients within institutional care, where the marginalised and un-productive were seen as a threat to the Swedish Welfare State. Nevertheless, the Vipeholm Experiments managed to produce the kind of credible results that could be used to legitimise public health policy, and through successful co-evolution a role-model for public research was established in Sweden, where medical science, public health policy, mental health services and the confectionary industry met between 1943 and 1960. The meeting was good for Swedish public health, but the price was paid not by the public but by the 660 patients at the Vipeholm hospital.
Language editing by Fiona Milton.
- Electrical Engineering, Electronic Engineering, Information Engineering
- Vipeholmsförsöken och tandvårdspolitiken
- Teknik, praktik och identitet
- Dick Harrison
- Boel Berner
- ISSN: 1404-000X
31 mars 2006
Key Huset, Campus Valla, Linköpings universitet
- Christer Nordlund (docent)