The First Stage of Discovery

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It’s been a grim fall, with floods, earthquakes, war, and scandal. But there was one satisfying moment: the 2005 Nobel Prize in medicine. The story behind it is a scintillating reminder of the need for humility about knowledge.

Not too long ago, ulcers were considered a psychosomatic disease. Brought on by stress, they attacked hard-driving middle-aged business executives (mostly men, it seemed) who resembled today’s “Type A” personality. Unlike the Type A personality, however, which wins some respect for its dedication to power and control, this kind of executive was considered a bit of a failure. The disease revealed he had a tense life and probably an unhappy marriage.

Doctors thought that stress led to an overproduction of gastric acid, which destroyed the lining of the stomach or intestine, creating a hole or ulcer. Initially, treatment consisted of bland, non-acidic diets, perhaps some psychological therapy. When drugs such as Tagamet, which reduced the stomach’s acid production, came on the market, they racked up billions of dollars in sales. They healed the ulcer – but the ulcer often returned.

An Australian pathologist, J. Robin Warren, began to notice that the ulcer biopsies he examined often had some unfamiliar bacteria. In 1982, he brought in a medical intern, Barry Marshall, to identify and culture these bacteria, and they discovered a new bacterium (Helicobacter pylori). They postulated that this was the cause of the ulcers.

They were right, but it took years to convince the medical establishment, as the media reports about their Nobel Prize emphasize. The New York Times is particularly harsh toward the drug companies (which financed much of the research on ulcers), but physicians, surgeons, and researchers were all skeptical. Most pathologists thought that the acidity of the stomach prevented bacteria from growing. When they saw them through a microscope, they interpreted them as “opportunistic” bacteria, not the cause of the ulcer.

Frustrated at the rejection, Barry Marshall took the dramatic step of drinking a solution made up of H. pylori. He then suffered gastritis (a precursor to ulcers) and cured it with antibiotics. But it was not until 1991 that the connection between H. pylori and gastritis was made official by the Centers for Disease Control and Prevention.

Today, a two-week course of antibiotics usually wipes out the disease – permanently. (The reason that middle-aged executives get ulcers has more to do with the nature of the bacterium than with their lifestyle. The bacterium infects them as children but doesn’t show up until years later.)

Scientific discoveries often take longer than nine years to be accepted, so in the annals of history this chronicle is a short one. Even so, millions of people suffered for years because of the intransigence of the medical establishment. It’s a lesson we shouldn’t forget.

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