Prevention and Control Strategies for Non-Communicable Disease: Goldberger, Pellagra and Rose Revisited

Round 1

Reviewer 1 Report

To the author

I think that the significance of the paper lies in reminding us all, not to merely look at the causes to the individual, but always also seek the causes of the population incidence.

I would have preferred a title referring directly to what the paper is about, something like “Prevention and control strategies for non-communicable disease: Rose, pellagra and Goldberger revisited”

From line 197 onwards the author described his experience with pellagra cases in Tanzania. I am interested in the historical incidence of pellagra in sub-Saharan Africa, but the only relevant literature under the name “Frank” I could find was about two Malawian pellagrins diagnosed at a Malawian district hospital published by Frank GP et al.. The author also referred to pellagra being wide-spread in Africa – I really would have loved to see a reference to that. Although we have information on pellagra related to civil unrest and war, there is a dire need for information from the general population in Africa (excluding Egypt).  Pellagra may have been, and probably still is, much more common than reflected by reports and publications. I therefore urge the author to publish on his personal experience with pellagra in Tanzania.

Personally, and for several reasons, I would remove the larger part of the paragraph before conclusions (from 209).

References

Reference 1 – you cited 11 authors

Reference 5- you cited 3 plus et al, and yet the paper has fewer references than reference 1
Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387-93. doi: 10.1016/0140-6736(91)93068-k. PMID: 1674771.

Author Response

The author thanks the reviewer for his positive and constructive comments, in response to which the following edits have been made to the original manuscript:

1. The title has been changed to the one suggested by the reviewer: "

Prevention and Control Strategies for Non-Communicable Disease: Goldberger, Pellagra and Rose Revisited

2. The reviewer quite reasonably suggests further referencing of my statement that pellagra has been widespread in Africa for a long time, but was apparently not able to find any -- perhaps because he/she searched for publications by any author named "Frank." I was able to find many suitable references, but have only inserted three representative ones (new reference #s 15-17) spanning the last 74 years, as these reviews contain many more citations if the reader wants them.

3. The reviewer suggests deleting the five lines of text after line "#209" (which is now line 215 in the revised manuscript). However, I feel this short section is essential for readers with less familiarity with the modern pandemic of obesity and non-communicable diseases, since otherwise the precise nature of the analogy with the pellagra epidemic, via Rose's conceptual framework, will not be clear. Indeed, the main message of the whole paper -- as precisely stated by this reviewer in his first sentence is "Seek the causes of (population) incidence, not of (individual) cases." This central message is only stated on lines 215-219 of my paper, and so is essential as its "punchline."

4. The references with incorrect numbers of cited authors  -- #1 and #5 -- have been corrected in line with MDPI guidelines, which state that up to ten authors should be listed.

Reviewer 2 Report

Dear Professor Frank

Thank you for the opportunity to read and review your manuscript. Your paper rehearses Rose's work on population v individual interventions to address public health challenges, using the example of Pellagra in parts of the USA in the early 20th Century and drawing lessons for the challenge of NCDs in the 21st Century in LMICs. 

Overall the manuscript is written well and offers a succinct and useful introduction to this topic area for readers. 

I have a small number of suggestions to improve the draft: 

1. Are NCDs correctly described as a pandemic? Many authors and definitions restrict 'pandemic' and 'epidemic' terms to infectious diseases. You might want to offer a definition if you want to retain this term for NCDs.
2. Figure 1 is unreadable on the draft I received. 
3. In line 30 you describe health inequalities as both persistent and protean - are these terms not contradictory? 
4. I'm not sure if the use of the term 'Old South' is commonly understood - perhaps simply saying which Southern US states are implicated might be clearer. 

 

Author Response

The author thanks the reviewer for his/her very positive comments, and has revised the new manuscript to address his/her concerns, as follows:

1. While the reviewer may not be familiar with the use of the term "pandemic" to describe waves of increased cases of non-infectious disease that sweep the planet, that use of "pandemic" is widespread, particularly with regard to the international obesity pandemic, as evidenced by the titles of these prominent papers in that field:

a) Moodie, R., Stuckler, D., Monteiro, C., Sheron, N., Neal, B., Thamarangsi, T., ... & Lancet NCD Action Group. (2013). Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet, 381(9867), 670-679.

b) Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., & Gortmaker, S. L. (2011). The global obesity pandemic: shaped by global drivers and local environments. The Lancet, 378(9793), 804-814.

c) Frank J. (2016). Origins of the obesity pandemic can be analysed.(World View commentary) Nature, 532 (April 14),149.

 2. I am not sure why Figure 1 was unreadable for this reviewer, but not the other two -- perhaps the wrong software was being used? In the new manuscript, it is submitted precisely as cut and pasted from its cited source, which is the website found in Reference #3. [I note that this Figure appears entirely legible in the journal's initial typeset version of the manuscript.]

 3. The original manuscript's reference to health inequalities as being "both persistent and protean" is not a contradiction, since protean refers to the fact that typical socio-economic inequalities in health are manifested across multiple, biologically-diverse disease entities, whereas persistent refers to their well-known tendency to persist over long periods, even though the precise major causes of ill health and premature mortality change. This is well explained in an early and foundational book chapter, co-authored by the author: Hertzman C, Frank JW, Evans RG. Heterogeneities in Health Status and the Determinants of Population Health.  IN: Evans RG, Barer M and Marmor T (Eds.) Why Are Some People Healthy and Others Not? Hawthorne, New York: Aldine-De Gruyter, 1994, 67-92.

4. I have changed all instances in the manuscript of "the Old South" to "the southeastern USA" for the benefit of readers not familiar with the former term.

 

Reviewer 3 Report

This is an interesting paper and I always enjoy reading how learn from the past and develop new conceptual frameworks for NCDs. As a nutritionist I especially appreciate how niacin deficiency is used as an example to support the conceptual framework. Pellagra was the only nutritional defeiciency to reach epidemic proportions in the Americas. My only suggestion would be to revise the abstract so that it clearly explains the purpose of the paper. 

 

Author Response

The author thanks the reviewer for his/her very positive comments on the manuscript. In response to his/her only concern, the abstract has been substantially edited/amplified to better explain the purpose of the paper.