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From Silicosis to Chronic Respiratory diseases: an approach via epidemiological history (in France, Europe, Southern Africa, from the 1900s until today)

Final Report Summary - SILICOSIS (From Silicosis to Chronic Respiratory diseases: an approach via epidemiological history (in France, Europe, Southern Africa, from the 1900s until today))

The SILICOSIS project has aimed at capturing the neglected effects of silica (and other inorganic) dust exposure (under various forms from long-term moderate to short-term intense ones), on the triggering or aggravation of a range of systemic, idiopathic diseases. Its method has been driven by a combination of disciplines: a) history (social history, history of science, demographic history) in order to understand why and how the pathogenic effects of dust (especially crystalline silica dust) have been under-estimated even though workers’ exposure has dramatically risen since 19th century Industrial Revolution b) sociology and social survey, in order to help patients (but also control samples) objectify their past and present to dust, a banal risk which is generally neglected and easy to forget c) medicine, through the mobilization of various specialties since SILICOSIS dealt with systemic diseases which may strike various organs. In particular, pneumonology, rheumatology, dermatology, pediatrics, internal medicine, anatomopathology, mineralogy, have been associated to the project, plus of course epidemiology.
The project has managed to a) successfully integrate all these dimensions, both in an interdisciplinary way crossing the border between social and natural sciences; and in an intradisciplinary way, by combining sub-disciplines which rarely work together (in particular a range of medical specialties); b) produce publications recognized in those various fields, from history of public health with a book published at Johns Hopkins University Press, to papers in medicine including The Lancet and The Lancet Global Health, plus a range of specialized journals; c) produce databases at the crossroads between sociology (life course trajectories) and epidemiology, as well as in lexicometry and demography. Results are statistically very significant, with a particular high level of robustness in the case of sclerodermia and rhumatoid polyarthritis; d) demonstrate that most of the diseases under concern include a social and environmental dimension, which crosses the medicolegal border between occupational and “general” diseases, and opens the way to prevention strategies; e) produce a survey tool which is reproducible for innovative research on other diseases. Even though SILICOSIS is completed, its methods are currently starting to be transposed to idiopathic interstitial lung diseases.

The novelty of the SILICOSIS methods lays in the fact that it integrates techniques stemming from various disciplinary fields. History provides a) a measure of the statistical under-estimation of the mortality associated with the diseases under scrutiny; b) the long-term genealogy of nosological and etiological categories and reasoning applied to the diseases under scrutiny, including the use of lexicometric techniques. One of the major originalities of SILICOSIS is to include the study of medical ignorance within the survey techniques. Whereas agnotology is generally only used as a critical tool, SILICOSIS turns it into a research instruments. It considers that the challenge of research is not only to create but also to stabilize new knowledge. This helps explain why the project has tackled several idiopathic systemic diseases at the same time, rather than just one: the transversal effect of dust is one of the reasons why medical knowledge on the inorganic particles has been difficult to stabilize.
One of the originalities of SILICOSIS is to integrate these findings produced by the use of history, into medical and epidemiological research. Sociology, public health and survey research, play a major role by designing a research tool which is reproducible for other diseases. Those disciplines have helped design a questionnaire which helps patients (and members from control samples) to objectify their exposure to dust all over their life course. This questionnaire is also informed by microhistory and of course by medicine. In a relatively short, realistic format (40 minutes), this questionnaire details most forms of dust exposure recorded in the medical literature, and combines them with a thorough interrogation on socioeconomic variables, informed by sociology of health and sociology of professions. The data produced are explored through classical epidemiological and econometric tools. But they are also combined, for some diseases of for some particularly intriguing clinical cases, with information produced through intensive interviews based on sociological techniques.