Circulation of Knowledge: Explorations into the History of Knowledge - Hardcover

Hardcover

ISBN 10: 9188661288 ISBN 13: 9789188661289

Publisher: Nordic Academic Press, 2018

Synopsis

Historians have long been interested in knowledge - its nature and origin, and the circumstances under which it was created but it has only been in recent years that the history of knowledge has emerged as an academic field in its own right. In Circulation of Knowledge, a group of Nordic scholars explore a range of theoretical and methodological approaches to this new and exciting area of historical research. The question of knowledge in motion is central to their investigations, and especially how knowledge is transformed when it circulates between different societal arenas, literary genres, or forms of media. Reflecting on twelve empirical studies, from sixteenth-century cartography to sexology in the 1970s, the authors make a significant contribution to the growing international research on the history of knowledge.

About this title

About the Author

Anna Nilsson Hammar is a lecturer in history at Lund University.

David Larsson Heidenblad is a lecturer in history at Lund University.

Kari Nordberg is a historian and lecturer at the University College of Southeast Norway.

Johan Östling is associate professor and senior lecturer in history at Lund University.

Erling Sandmo is professor of history at the University of Oslo.

Excerpt. © Reprinted by permission. All rights reserved.

Circulation of Knowledge

Explorations in the History of Knowledge

By Johan Östling, Erling Sandmo, David Larsson Heidenblad, Anna Nilsson Hammar, Kari H. Nordberg

Nordic Academic Press

Copyright © 2018 Nordic Academic Press and the authors
All rights reserved.

ISBN: 978-91-88661-28-9

Contents

Acknowledgements, 
The history of knowledge and the circulation of knowledge, 
I PUBLIC CIRCULATION OF KNOWLEDGE, 
1. Cholesterol knowledge in circulation in Finnish society, 1970–2010 Laura Hollsten, 
2. The celebrity sexologists Inge and Sten Hegeler Kari H. Nordberg, 
3. Influential books and the history of knowledge David Larsson Heidenblad, 
4. The case of subsidies in eighteenth-century Sweden Erik Bodensten, 
II CONDITIONS OF CIRCULATION, 
5. Theoretical considerations on the circulation of knowledge in everyday life Anna Nilsson Hammar, 
6. Resistance to pedagogical knowledge in a university setting, c.1965–2005 Anders Ahlbäck, 
7. The public debates on education in Sweden, c.1800–1830 Isak Hammar, 
8. A sixteenth-century example Kajsa Brilkman, 
III OBJECTS AND SITES OF KNOWLEDGE, 
9. The sea-pig and the walrus as objects of knowledge in the sixteenth century Erling Sandmo, 
10. A gigantic skeleton and a Danish eighteenth-century naturalist Camilla Ruud, 
11. A circulating cure for syphilis Susann Holmberg, 
12. Dialogues, systems, and the question of genre Helge Jordheim, 
About the authors, 

CHAPTER 1

Public, private, and experience-based knowledge

Cholesterol knowledge in circulation in Finnish society, 1970–2010

Laura Hollsten

Public health concerns are an important driving force in producing new knowledge about the human body. The scientific paradigms of the day and socioeconomic conditions have always influenced the ways in which this knowledge has been created, distributed, and received. It is because of its bearing on public health that knowledge about cholesterol has been of great societal and economic significance in the late twentieth century. Knowledge of this substance, produced by the human body, has also been of deeply personal interest for individuals concerned about their health.

Knowledge of cholesterol has circulated in the media since the Seven Countries Study, which investigated coronary heart disease and stroke in seven countries in 1956–1970. The cornerstone of this knowledge has been the lipid hypothesis, which links high cholesterol levels with cardiovascular diseases, and is widely accepted within the medical community. The lipid hypothesis has become the governing paradigm in explaining cardiovascular disease, to the extent that researchers refer to it as the lipid consensus.

This essay investigates the circulation of knowledge about cholesterol in Finnish society by analysing a variety of sources such as scientific articles, newspaper articles, public debates, and blog posts. The objective is not to give an account of the cholesterol debate, but rather to chart the patterns of the circulation of knowledge. Thus the primary sources have been selected to cast light on the various strands of knowledge in circulation. The so-called fat debate in the largest newspaper in Finland, Helsingin Sanomat, has recently been studied by Jallinoja et al.; however, in this article more attention has been paid to the largest Swedish-language newspaper in Finland, Hufvudstadsbladet, with a readership of about 100,000. This concentration on the Swedish-language press reflects the fact that one of the most vocal opponents of the lipid hypothesis, the Danish physician Uffe Ravnskov, is based in Sweden and participated in the Hufvudstadsbladet debate. The source material also includes health blogs posted before 2010, the year when a programme on Finnish national television questioned the lipid consensus, sparking a long and lively debate that continues today.

Previous social science research on the cholesterol debate has concentrated on discourses, scientific controversies, and the social construction of competence, while the question of cholesterol has been investigated to an extent by medical historians. However, neither the cholesterol debate nor the knowledge transfer about cholesterol has been studied in terms of knowledge circulation. From a historical perspective, it is interesting to study this circulation in the run-up to the Finnish debate. It is shown here how public, private, and experience-based knowledge became intertwined, with knowledge generated and transformed while circulating between different actors and media. Finland is a useful case study because of the almost total dominance there of the lipid hypothesis as the ruling paradigm for explaining heart disease, and because of the high rates of coronary heart disease, as identified by the Seven Countries Study. Indeed, according to the World Health Organization (WHO), men in eastern Finland held the world record for heart disease in 1975.

This essay argues that the concept of circulation enhances our understanding of how knowledge of cholesterol was produced, distributed, and received. In addition, it shows how such knowledge was shaped by the various types of media that carried it, and especially people's knowledge of the new products developed to lower cholesterol. The study is informed by Anders Daum's view that popular science is a 'changing set of processes, practices, and actors that generate and transform public knowledge across time, space, and cultures'. This perspective allows for a view of knowledge which is not limited to the realm of science, but embraces the multiple forms of public knowledge in circulation. What is more, it takes into account that public knowledge is formed not only by scientific research and official recommendations based on science, but also by individuals who through their articulated experiences contribute to the growing body of public knowledge. Other key concepts are experience-based knowledge and private knowledge. Private knowledge is 'what one knows, one thinks and what one believes to be true'. It is knowledge based on experience, but also includes elements that are shared in a culture, in addition to containing other more individualistic elements. When it comes to health, private knowledge — consisting of theories, beliefs, personal experience, observations, interpretations, and a hierarchy of acceptance from various sources — is a useful concept. While public knowledge about health tends to be universalist and based on comprehensive population-based trials, private knowledge is more particularistic and individualistic. The two are brought together and intertwined in the course of knowledge transfers or circulations between the public and the private. The concept of circulation hence enables us to investigate how knowledge of cholesterol was created in research projects, and how it was recreated as it moved, often across national boundaries, communicated by experts and scientific journals to primary healthcare, consumers, and the popular debate, via national recommendations, popular science, and the social media.

Cholesterol knowledge in the making

In 1758, the French physician François Poulletier de la Salle was the first to isolate cholesterol, and found it to consist of a waxy, fat-like substance located in all cells of the body. The early knowledge of cholesterol was characterized by circulation within the scientific sphere — while transcending national borders, it was limited as far as we know to the scientific community. The first scientist to establish a link between cholesterol and cardiovascular disease was the Russian pathologist Alexander I. Ignatowski (1875–1955), who in 1907 conducted an experiment where he fed rabbits full-fat milk, eggs, and meat. Ignatowski's results caught the eye of Nikolaevich Anichkov, who proceeded to conduct an experiment where he fed rabbits purified cholesterol. In 1912 he defended his doctoral thesis on 'Inflammatory changes in myocardium: apropos of myocarditis'. However, Anichkov's results did not lead to further interest in the role of cholesterol in cardiovascular disease in humans, since rabbits are herbivores. At the time, atherosclerosis was understood to be the result of senescence rather than high cholesterol levels. Forty years later, Anichkov's results were revisited by a scientist at the University of California at Berkeley, John Gofman, who eventually found a correlation between heart attacks and elevated levels of blood cholesterol in the early 1950s. Finally, in 1953, a hypothesis about the epidemiological connection between blood cholesterol and coronary atherosclerosis was presented by Ancel Keys. A physiologist at the University of Minnesota, Keys launched the Seven Countries Study, designed to establish whether the occurrence of heart attacks in 15,000 middle-aged men over a ten-year period was linearly proportional to their blood levels of cholesterol.

The seven countries that participated in the study were the US, Japan, Italy, Greece, the Netherlands, Finland, and Yugoslavia. It received much publicity and led to a number of well-known publications such as Keys' How to eat and stay well (1959) with Margaret Keys, Coronary heart disease in seven countries (1970) and How to eat well and stay well: The Mediterranean way (1975). There appeared to be strong indications that saturated fats increased the risk of cardiovascular disease. At this point, cholesterol entered the public sphere in the industrialized countries. In 1969, a spokesperson for the American Heart Association stated that heart disease, previously understood to be the inevitable accompaniment to old age, could be prevented by reducing cholesterol. Although many cardiologists still criticized the cholesterol theory, it gradually began to gain attention. In a historical perspective however, starting with Anichkov's findings in 1913, the acceptance of the lipid hypothesis was a long uphill battle.

Finland and the lipid hypothesis

Finland was one of the countries included in the Seven Countries Study; the Finnish part of the study was initiated in North Karelia in eastern Finland in 1956. North Karelia is a rural area where the men had the highest international occurrence of mortality from cardiovascular disease. Another early trial was the Finnish Mental Hospital Study in 1968, conducted by a research group led by Osmo Turpeinen, and inspired by Keys' ideas and the Seven Countries Study.

Because of the alarming situation in Finland, and particularly in North Karelia, the issue of coronary health attracted increasing attention at the national level. As a result, a comprehensive community-based preventive programme was launched in North Karelia in 1972 in order to reduce the risk factors for cardiovascular health (which included smoking, high blood pressure, and high cholesterol levels). The project was to run until 1997. One of its key figures was professor and principal investigator Pekka Puska, later director of the National Institute of Public Health. By popularizing its research results, Puska played an important role in converting scientific knowledge into a more practically oriented form of public knowledge. Known as Mr Public Health, he became the public face of the North Karelia project and the prevention of cardiovascular disease with the help of a cholesterol-reducing diet, regularly appearing in the media to share his knowledge about the role of cholesterol in cardiovascular health. In addition, knowledge about cholesterol was spread by means of education and media campaigns, competitions, and lay advocates.

The community-based North Karelia project mobilized a variety of local actors such as healthcare personnel and local organizations, including the Women's Association for Home Economics, the Church, and the army. There was community action — such as rewarding villages or towns that were successful in reducing residents' cholesterol — combined with changes in the national legislation. Farmers, who previously had been paid for their dairy produce based on its fat content, were now encouraged to produce low-fat milk and grow a new variety of rapeseed for oil. Tobacco advertising was banned. The participation rate in health examinations and surveys run by the project was high.

As a result of the publicity about the North Karelia project, public, authority-based knowledge of cholesterol circulated widely in Finnish society, both in the media and among individuals. For example, Mikko Jauho finds that local residents in North Karelia corresponded with the project office concerning their health surveys, while project officials answered questions from the public in two local newspapers. Jauho's findings show that some of the residents' understandings of the causes of heart problems differed from those projected by the project. The locals' private knowledge was not necessarily experience-based, but originated in their perception of a healthy lifestyle and diet as well as the region's history of deprivation and food shortages.

The North Karelia project produced a wide variety of knowledge, generating over 400 international medical journal articles. Its collaboration with the WHO has brought it considerable authority in the public arena. Scientific knowledge about cholesterol thus gained formal status and was adopted by medical experts, politicians, physicians, and other public figures. In addition, this scientific knowledge was popularized as it circulated into community interventions and educational programmes. Here, cholesterol knowledge quickly evolved into a more practically oriented knowledge of nutritional choices and lifestyle. Although the questions of smoking and exercise were prominent, the main concern centered around the issue of diet. The advice was further repeated by the media, often boiling down to the question of animal versus vegetable fats. Representatives of the project visited schools across Finland to ensure that even young children learnt to avoid saturated fats in favour of vegetable fats. Although many participants embraced the new recommendations, substituting low-fat milk for whole milk, others were less enthusiastic. As Jauho's study of the response of local participants to the North Karelia project shows, low-fat options in schools and shops occasionally met with passive resistance, but the resistance could also be more active, as in the case of one of the letters to the project, in which a middle-aged woman from a rural area accused it of representing meat and dairy farmers as 'enemies of humankind'. The resistance should be understood in the context of the structural changes taking place in North Karelia, where agriculture and dairy farming had traditionally been strong. The new knowledge was not always welcome, and a lack of trust sometimes created blockages in its circulation.

In spite of the divided opinions, the link between high cholesterol and cardiovascular disease was further strengthened in the 1990s, in part as a result of studies on statins, the cholesterol-lowering medicines introduced in the 1980s. After several large-scale clinical trials of statins in the mid-1990s showed decreases in LDL cholesterol, they eventually became a cornerstone in the treatment of heart disease, adding a new component to cholesterol knowledge. According to the former Professor of Internal Medicine at Helsinki University Hospital, Matti Tikkanen, the use of statins was initially low, and some experts were of the opinion that they should be used only in exceptional cases such as familial hypercholesterolemia. However, their use rose throughout the 2000s to the point when 660,000 people were taking them in 2010. Given the consumption of statins, Professor Antero Kesäniemi's complaint (in 2005) that Finns, according to a global study of attitudes towards cholesterol management, were careless about high cholesterol, is somewhat surprising. After all, there was plenty of information about the health hazards posed by high cholesterol. Kesäniemi's comment can be interpreted as evidence of the medical establishment's continuing determination to lower the Finnish population's cholesterol with the help of knowledge, diet, and medication.

Thanks to the North Karelia project, lay people all over Finland gradually accepted the now state-sanctioned medical knowledge about cholesterol, together with its practical applications. This knowledge had been translated into specific and concrete advice about diet and lifestyle which, although not always popular, was most often perceived as the best way to avoid cardiovascular disease.

Benecol, the embodiment of knowledge

In addition to being of importance to the medical community, knowledge about cholesterol has been instrumental in the creation of products aimed at lowering cholesterol levels. Such products have been marketed in Europe and elsewhere in the world since the 1990s. The first of these products to appear on the market was Benecol, launched by the Finnish food company Raisio in 1995. The process that led to Benecol's development shows how medical knowledge about cholesterol was combined with knowledge from the paper pulp industry. Initially, knowledge produced in medical research and knowledge produced in the study of industrial processes circulated separately, but once they had been put together the interaction between them continued.

The active ingredient in Benecol is sitostanol, shown in the late 1970s to be the most effective of the plant sterols in reducing serum cholesterol. Plant sterols occur naturally in many grains, vegetables, fruits, nuts, and seeds. The average human diet contains roughly equal amounts of plant sterols and cholesterol. Plant sterols and cholesterol possess many common features on a molecular level, and they have a similar chemical structure. When eaten, sterols appear to partially block the uptake of cholesterol, which leads to a reduction of cholesterol levels in the blood.

In the early 1970s a Finnish paper mill, Kaukas, was looking for ways to use the sitostanol that was produced from the tall oil, a by-product of pulp production. In order to investigate how the produce could be put to use, three Finnish paper pulp companies, Kaukas, Enso-Gutzeit, and Kymmene, provided financing for a research group led by Professor Eero Avela to work on tall oil research at Åbo Akademi University in Turku. The Åbo Akademi research team, Kaukas, and a small engineering company named Linotekno collaborated on the technical development, and the production of sitosterol could begin in 1981. Researchers at Kaukas then studied the medical properties of sitosterol. Originally, the plan had been to sell it to a Finnish medical company with a view to producing steroid hormones, but that company backed out. Kaukas subsequently contacted the leading cholesterol researcher in the country, Professor Tatu Miettinen at the University of Helsinki. By coincidence, Miettinen had just been dismissed as chairman of the scientific advisory board of Finland's leading dairy company, Valio. Meanwhile, new research in Germany and Japan indicated that sitostanol, saturated from sitosterol, was more efficient in lowering cholesterol than sitosterol. Miettinen contacted Raisio Margarine Ltd., a division of the agricultural and chemical company Raisio, and suggested using sitosterol and sitostanol in its products.

(Continues...)

Excerpted from Circulation of Knowledge by Johan Östling, Erling Sandmo, David Larsson Heidenblad, Anna Nilsson Hammar, Kari H. Nordberg. Copyright © 2018 Nordic Academic Press and the authors. Excerpted by permission of Nordic Academic Press.
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Edition details

• Publisher: Nordic Academic Press
• Publication date: 2018
• Language: English
• ISBN 10: 9188661288
• ISBN 13: 9789188661289
• Binding: Hardcover
• Number of pages: 256
• Editor: Ostling Johan