Open Questions

Open Publication of The Modern Rise of Population

Why It Is Open Thomas McKeown's 1976 analysis credited the mortality decline mainly to better nutrition, with hygiene and medicine playing later, smaller roles. Demographers disputed this from the moment it was published, and historians such as Simon Szreter later argued McKeown understated public health infrastructure, including water supply, sewage systems, housing improvement and vaccination. The balance of causes remains debated rather than settled.

What Would Settle It A reanalysis of period-specific, cause-specific mortality data alongside the timing of nutrition gains, sanitation infrastructure and medical intervention, with enough precision to separate their individual contributions, something existing historical records have not settled.

Expertise Needed History of medicine and historical demography

Question posed in Wikipedia: Thomas McKeown, Wikipedia, Legacy section.

Open Caloric Balance

Why It Is Open The mainstream energy balance model treats a caloric surplus as the cause of fat gain. The carbohydrate-insulin model, argued most fully by David Ludwig and colleagues in a 2021 American Journal of Clinical Nutrition paper, proposes the reverse: that a shift in substrate partitioning toward fat storage, driven by the insulin response to dietary carbohydrate, itself creates the positive energy balance rather than following from it. Kevin Hall and other researchers have published data its authors say falsifies the carbohydrate-insulin model, proponents disagree that the tests were decisive, and systematic reviews have not found the long-term weight-loss advantage for low-carbohydrate diets the model would predict.

What Would Settle It Controlled metabolic ward studies isolating substrate partitioning and hunger signaling from calorie intake, replicated across research groups holding competing positions, with pre-registered outcome measures both camps accept in advance.

Expertise Needed Nutrition science, endocrinology

Question posed in Wikipedia: Carbohydrate-Insulin Model, Lead and Scientific debate sections.

Open Community-Led Total Sanitation

Why It Is Open A systematic review of 200 studies concluded the evidence base on CLTS effectiveness is still weak, with little monitoring or evaluation of impacts despite large international funders backing the approach. A 2013 study of 116 African villages declared open defecation free after CLTS found that, using broader criteria, an overall slippage rate of 92 percent had occurred, and a 2018 study found little evidence for sustained sanitation behavior change as a result of CLTS.

What Would Settle It Long-term, controlled follow-up studies tracking latrine use, sustained open-defecation-free status and health outcomes several years after a community's CLTS trigger event, rather than short-term post-triggering counts alone.

Expertise Needed Public health and development economics, through long-term randomized or controlled evaluation.

Question posed in Wikipedia: Community-led Total Sanitation, Effectiveness section / Challenges and Difficulties section.

Open Quality-Adjusted Life Year

Why It Is Open Disability-rights advocates argue the QALY's own arithmetic discriminates: a treatment that moves a person with a permanent disability from a lower baseline toward the best health realistically available to them will almost always generate fewer QALYs than the identical intervention given to someone who can reach a full 1.0 score, so a strict per-QALY funding threshold systematically ranks disabled patients' care lower regardless of how much the treatment actually helps them. Health economists who defend the measure argue any health system faces a finite budget, that QALYs are the least-bad common currency for comparing wildly different interventions on relative value for money, and that the alternative, funding decisions with no explicit metric at all, is not more fair, only less transparent about the trade-offs it is already making. Both positions appear across the literature and in real policy: the United Kingdom's National Institute for Health and Care Excellence has used a pound-p

What Would Settle It A structured comparison of health outcomes for disabled populations under strict QALY-threshold rationing against outcomes under an explicit disability-weighted or equity-adjusted alternative, paired with a settled legal and ethical consensus on whether unadjusted QALY-based allocation itself constitutes disability discrimination or merely a value-neutral budget constraint.

Expertise Needed Health Economics, Disability Studies, Bioethics

Question posed in Wikipedia: Quality-Adjusted Life Year, Debate section.

Open Health Screening Program

Why It Is Open Accounts differ on the founding moment: one traces organized periodic screening to the Life Extension Institute, formed in the United States in 1913; another dates its annual-examination program to 1914; still others point to individual physicians recommending periodic examinations decades earlier. No single year is treated as canonical across sources.

What Would Settle It A history-of-medicine source that traces the specific institutional and professional-society record (AMA recommendations, insurance-industry practice, the Life Extension Institute's own founding documents) closely enough to fix a defensible first year, rather than a secondary account repeating an approximate date.

Expertise Needed History of medicine, public health history

Question posed in United States Centers for Disease Control and Prevention Official Site.

Open Dietary Goals for the United States (McGovern Report)

Why It Is Open The committee's own contemporaries, including the American Medical Association, argued the randomized-trial evidence available at the time was not conclusive; a 2015 systematic review of that era's trials (Harcombe et al., Open Heart) found they did not support the fat-reduction guidance. The guidance nonetheless anticipated later epidemiological findings that some public health bodies still endorse in modified form, so the historical evidence question and the current guideline question are not the same question.

What Would Settle It A historical consensus among nutrition scientists and historians of science on how to weigh the era's limited randomized-trial evidence against later, larger observational and trial evidence; this atlas records the dispute rather than adjudicating it.

Expertise Needed Nutrition science, history of science

Question posed in Harcombe et al. 2015, Open Heart: RCT Evidence Behind the 1977/1983 Dietary Fat Guidelines, Zoe Harcombe, Julien S Baker, Stephen Mark Cooper, Bruce Davies, Nicholas Sculthorpe, James J DiNicolantonio, Fergal Grace.