However, steroids were initially used in clinical practice in the 1930s and 1940s for many indications not considered appropriate now.
In the case of Kennedy, if he did in fact have celiac disease, the steroids would have suppressed the inflammation in the intestine and reduced his symptoms, making diagnosis of celiac disease less likely to be established. The occurrence of Addison’s disease in his sister, however, argues for a familial [genetic] cause of his Addison’s disease, rather than an iatrogenic one.
Green says that despite the intense medical scrutiny his doctors failed to diagnose it, yet at the time there was sufficient knowledge about the disease to allow for a diagnosis.
“Could celiac disease have been diagnosed in Kennedy during his lifetime? Possibly. The disease was first recognized in 1887, as was its treatment with an elimination diet. It was recognized to occur at all ages. However, it was not until the 1950s that the shortage of bread during the Second World War and its subsequent reintroduction in Holland led to the recognition of wheat's role as a cause of this malabsorption syndrome. It was in the 1970s that physicians became aware of the more subtle presentations of the disease. The diagnosis of celiac disease initially requires consideration that it may be present in an individual patient; even now many physicians do not consider the diagnosis.
It would, however, be possible to diagnose celiac disease in JFK now, if biopsies taken during his life, or autopsy material of the small intestine had been archived and was now made available. Frozen blood samples could also provide diagnostic material, for there are serologic tests now available that are specific for the condition.
A diagnosis of celiac disease, if it had been made, could have been treated by diet alone. This would have prevented all the manifestations of the disease and its complications.
Due to the strong genetic component of celiac disease, Kennedy’s family may well be interested in obtaining the diagnosis as well.
(This article was previously published on HNN/History News Network)
* Dr. Peter H.R. Green, director of the Celiac Disease Center at Columbia University, is a professor of clinical medicine at the College of Physicians and Surgeons, Columbia University and attending physician at the Columbia University Medical Center. Celiac disease has been his focus for almost 20 years, with equal concentration on patient care and research. He is one of the few physicians in the United States with an intense clinical academic interest and expertise in celiac disease. He is the author of Celiac Disease: A Hidden Epidemic, which has been called “the definitive resource for celiacs and those yet to be diagnosed.”
For more information on celiac disease visit: celiacdiseasecenter.columbia.edu
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