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...