A Story of Medicine, Power, and Neglect
Exploring the critical perspective from "Questioning the Solution" by David Werner and David Sanders
Read MoreImagine a medical breakthrough so potent it can snatch a child from the jaws of a deadly disease. A treatment so simple it requires no IV drips, no sterile hospital ward—just a pinch of salt and sugar mixed with clean water. This is Oral Rehydration Therapy (ORT), a "simple saline solution" hailed by The Lancet as "the most important medical advance of the 20th century." It has saved tens of millions of lives from cholera and severe diarrhea.
But what if the story of this miracle cure is only half the story? What if, in our celebration of the technological fix, we've ignored the deeper, more complex sickness—the sickness of poverty and inequality? This is the provocative argument at the heart of Questioning the Solution, a classic text in critical public health that forces us to look beyond the packet of powder to the political and economic structures that determine who lives and who dies.
At its core, ORT is a stunningly elegant solution to a deadly physiological problem. Severe diarrhea doesn't kill through infection alone; it kills through catastrophic dehydration. As fluids flush from the body, they take essential salts like sodium and potassium with them, disrupting the delicate chemical balance needed for organs to function.
The genius of ORT lies in a biological quirk of our gut. Even during the worst diarrhea, the body retains a mechanism for absorbing water and salts. This mechanism, a co-transporter system in the intestinal wall, is like a locked door. The key? It needs both sodium and glucose (sugar) to turn.
A simple ORS (Oral Rehydration Salts) packet contains precisely measured amounts of sodium chloride, potassium chloride, trisodium citrate (or sodium bicarbonate), and glucose. When mixed with water and consumed, the glucose actively transports sodium across the intestinal wall.
Where salt goes, water follows. This process of osmosis pulls water from the gut back into the body's cells and bloodstream, rehydrating the patient. It's a biological workaround—a way to rehydrate a person from the inside out, even while the diarrhea continues. No wonder it was considered a miracle.
While the science was understood by the 1960s, it took a real-world crisis to prove its staggering potential. In 1968, a team of scientists from the Pakistan-SEATO Cholera Research Laboratory faced a devastating cholera outbreak in a refugee camp in Bangladesh (then East Pakistan). With limited resources and overflowing hospitals, they were forced to innovate.
The experiment was conducted in a camp teeming with refugees, where cholera was spreading rapidly and intravenous (IV) fluids were in critically short supply.
Hundreds of patients, from infants to the elderly, suffering from severe, dehydrating cholera were admitted to a makeshift treatment center.
Instead of relying solely on IV drips, the team administered a glucose-electrolyte solution orally. Caretakers, often family members, were instructed to give the patient sips of the solution as often as possible.
The results were nothing short of revolutionary. ORT was not just effective; it was transformative. It slashed the death rate, freed up scarce medical resources, and empowered communities to begin treatment at home.
This experiment provided the irrefutable proof that would lead the WHO to endorse ORT as a cornerstone of global public health.
While the ORS packet is the star, the full "scientist's toolkit" for defeating diarrheal disease is much broader, reflecting the book's central argument.
This is where Werner and Sanders deliver their powerful critique. If ORT is so cheap and effective, why did diarrhea remain a leading killer of children for decades after its discovery, and why does it still claim hundreds of thousands of young lives each year?
The answer, they argue, is that the global health establishment fell in love with the technical fix while willfully ignoring the political context.
The World Health Organization and UNICEF initially promoted a comprehensive approach that included ORT alongside water, sanitation, and nutrition programs.
Under pressure, global health shifted to a "selective" strategy, focusing narrowly on cheap, technological interventions like immunization and ORT packets.
By treating ORT as a magic bullet, health authorities effectively "mopped the floor without turning off the overflowing sink." They treated the symptom (dehydration) while neglecting the cause (dirty water, poor sanitation, and the poverty that creates them).
Questioning the Solution is not an attack on ORT—it's a celebration of its power and a lament for its limitations. The book forces us to confront an uncomfortable truth: the greatest obstacles to health are often not a lack of scientific knowledge, but a lack of political will and a refusal to challenge the status quo.
The real miracle cure was never just the salts and sugar in a packet. It was the potential for a world where every community has the clean water, dignity, and resources to ensure that packet is nothing more than a backup plan. The most important medical advance, it turns out, might just be a more just world.