Who Owns a Scientific Invention?: The Truth About ORS

The following first appeared in the form of a thread on X and has been produced in article form with the author’s permission. The author has earlier written on the topic for The Wire. 

A few days ago a popular X account repeated an oft-cited piece of misinformation: Dilip Mahalanabis “never patented his” ORS formula. This is a piece on how science and scientists’ work are distorted in the social media jungle these days.

In 2022 when Mahalanabis died, the news took me back to years ago when I was an aspiring public health student. I had come across a 2009 interview of him and another stalwart, Dhiman Barua, in the WHO’s Bulletin. In it he recounted his pioneering 1971 work in Bangaon, Bengal.

However, I was uncomfortably lurched back to the present upon reading some of the supposed tributes ppl were paying to Mahalanabis. Alongside thoughtful commentaries, a lot of what was written or shared contained toxic nationalism and incorrect, often blatantly wrong, information.

Besides, all the major media outlets rehashed the same few details of his life and work, offering few glimpses of Mahalanabis as an individual. In many commentaries, it was difficult to gauge whether it was Mahalanabis the person or ORS the solution that was being commemorated.

The tributes, obituaries, and commentaries on Mahalanabis got me wondering about how we approach science and history, how we commemorate the dead, and how society and politics intersect with science.

First and foremost, I was surprised by the unfortunate erasure of the long history of the development of oral rehydration therapy (ORT), including the involvement of many researchers and institutions both Indian and international.

Firstpost gushed about how Mahalanabis “never patented his ORS solution”, and a popular account on X spread the blatantly false information that he “invented the ORS sachet”.

Mahalanabis was a genius. And like every genius he stood on the shoulders of and rubbed shoulders with other geniuses. As my own memory of coming across Barua and Mahalanabis together indicated to me, ORT was a massive innovation behind which were the mammoth efforts of many.

The original 1973 paper in which Mahalanabis laid out the details of the spectacular ORT work in Bangaon, was written jointly with four other experts. At the start of the article, they cited much earlier research & fieldwork on which their work was based.

For example, they wrote that the “effectiveness of oral glucose-electrolyte solutions” had already been demonstrated in hospitalized patients, and that the ingredients and proportions in the solution they used were derived from previous research.

Clearly, ORS – or for that matter the “ORS sachet” – was not “invented” by Mahalanabis, and neither was ORS “his” (or of any single researcher’s) to patent.

In fact, far from being the product of the stereotypical lone genius scientist working alone away from the messiness of the world, ORT/ORS was the product of multiple researchers and organizations toiling deeply in the world’s diarrhoea trenches.

In recent decades, historians and other scholars have worked to dispel the myth of the typical “lone genius” portrayal of great scientists: The journal Nature for instance, published an article titled “Einstein Was No Lone Genius” in 2015.

Some of these efforts are part of larger initiatives towards “decolonizing” modern science and its narratives, with scholars showing how it is incorrect to assume that only white European/American male researchers were responsible for the major modern-era scientific advancements.

Considering these recent progressive directions in thinking about science, it was jarring to witness the extreme Indian/Hindu nationalistic content of some popular tributes paid to Mahalabanis. The erasure of the collective efforts of researchers across the globe was striking.

One consequence of the misinformation in these obituaries, was that people were left with really little idea of what it is that makes Mahalanabis so important. The 1994 history of ORT by Joshua Ruxin provides useful contextualization of his work.

By 1970, it had been demonstrated that ORT worked well in stable, hospital settings under expert supervision, but these studies were inadequate to convince the mainstream medical and public health communities of the feasibility and effectiveness of large-scale ORT treatment.

In their own words, what Mahalanabis et al accomplished was to provide “confirmation of the effectiveness” of ORS in a “field trial… [where] extremely adverse logistic and administrative conditions prevailed”.

Once again, let it be remembered that Mahalanabis even himself (with his co-authors) laid no claim to having “invented” ORT/ORS — their claim to fame was for having demonstrated the effectiveness of employing locally-produced ORS treatment in a large-scale field setting.

Another historical aspect that needs revisiting is the oft-repeated claim that ORS was termed by a 1978 Lancet editorial as the (or among the) “most important medical advance” of the twentieth century. However, the Lancet said nothing of the sort.

What a 1978 editorial (‘Water with Sugar and Salt‘) did say: “The discovery that sodium transport & glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water, was potentially the most important medical advance this century.”

It is true that as a general rule, trend-setters in fields like public health receive far less media acclaim than those in other areas in science and medicine: one saw, for example, surgeons rather than public health experts being overwhelmingly invited to TV studios during COVID.

This common bias against supposedly “unglamorous” fields could be one of the main reasons why many of us stumbled upon Mahalanabis and his work only after his death.

Nevertheless, if we are genuinely interested in learning about and celebrating such stalwarts and their achievements, then propagating misinformation and false histories under the agenda of nationalism and even decolonisation, is certainly a sad way to do that.

Kiran Kumbhar is a historian, teacher and former physician, currently affiliated with the Johns Hopkins University School of Medicine.