Putting your stomach where your mouth is
October 3, 2005 6:05 PM   Subscribe

A young, average intern looking for a research project and an older, oft-ridiculed pathologist from an Australian hospital were scoffed at for a decade for daring to challenge the conventional wisdom that stomach ulcers were caused by stress and diet. It took the intern's self-promotion skills, and a extraordinarily bold move of ingesting a large quantity of the Helicobacter bacteria they believed were the dominant cause of ulcers, giving himself severe gastritis and subsequently curing it with only fairly standard antibiotics, before the medical world started taking notice. Despite the ongoing resistance of an 8 billion dollar industry in over the counter heartburn medication, the two have been finally rewarded with a Nobel Prize for uncovering the easily diagnosed bacterial cause and fairly simple cure of over 90% of peptic ulcers.
posted by DirtyCreature (33 comments total) 1 user marked this as a favorite
 
And they damn well deserve it.
posted by bz at 6:09 PM on October 3, 2005


awesome. Go balls!
posted by pmbuko at 6:13 PM on October 3, 2005


From what I understand, the medical community was operating under very old definitions of 'proof' that a pathogen cased a disease. Namely a body had to be inserted into a new host, which subsequently contracted the disease to prove that the body caused th disease.

That's what I'd heard, anyway, although it seems rather strange, as you would never be able prove anything about a disease that only harmed humans without doing unethical experiments, so I'm thinking now that was probably a mistake made by the reporter covering the story of these two.

Even years later, many doctors didn't know about these bacteria. I hope that their getting the Nobel prize will further knowledge about this with doctors. I know a girl who got ulcers from being bulimic, and I tried to tell her about this, but she didn’t seem to know about it. She had to eat nothing but bland food... although she was very thin.
posted by delmoi at 6:13 PM on October 3, 2005


Wonderful! Having been part of the medical community at that time I would definitely have been one of those who pooh-poohed the idea that a common bacterium could be responsible for peptic ulcers.

This is the glory of science, and is a perfect example of how it will survive assaults from all those who 'know better' and attack the scientific method as not having all the answers and, by their (faulty) logic, consider it inferior to their own schemes of reference which have the supposed advantage of internal consistency. Bravo!
posted by Turtles all the way down at 6:15 PM on October 3, 2005


so stress doesn't cause everything afterall. sounds like they met the criteria for koch's postulate brilliantly.
posted by brandz at 6:23 PM on October 3, 2005


This is the glory of science? If you ask me, the hurdles they had to overcome seem more like a shame than a glory.
posted by nightchrome at 6:39 PM on October 3, 2005


I was hearing about this back when I had an ulcer in 1980. Not that my treatment reflected it!
posted by konolia at 6:49 PM on October 3, 2005


This is the glory of science? If you ask me, the hurdles they had to overcome seem more like a shame than a glory.

Exactly. If it's true that they had to fulfill 'Koch's postulate' then that's idiotic. Koch was just a person, not god.

How does the AIDS virus fulfill Koch's postulate, I wonder?
posted by delmoi at 7:08 PM on October 3, 2005


Also, (long term) stress does weaken the immune system.
posted by delmoi at 7:08 PM on October 3, 2005


I suspect that there will be a whole lot more such unexpected discoveries in the future as we learn more about viruses, viroids, plasmids and prions.
posted by ZenMasterThis at 7:09 PM on October 3, 2005


Great work, gentlemen (and nice post). I remember being taught that bacteria couldn't grow in the stomach - that the stomach was basically sterile. It's mint that these two guys had the guts (so to speak) to challenge an idea so firmly held to be true that it was being taught as irrefutable fact everywhere - from high schools to universities.
posted by bunglin jones at 7:10 PM on October 3, 2005


This is the glory of science? If you ask me, the hurdles they had to overcome seem more like a shame than a glor

Science is performed by fallible humans, who have their own egos, prejudices, and even ignorance involved. The glory of science is that the method is sound and has been proven: even given these limitations it comes up with the right answer eventually. Or, to be more precise, a closer and closer approximation of the right answer. People suffer when their ideas are not accepted. Those with the right ideas eventually triumph.
posted by Turtles all the way down at 7:17 PM on October 3, 2005


"Good triumphs over evil" is an incredibly naive thing to hear from someone touting the glory of science.
posted by nightchrome at 7:24 PM on October 3, 2005


How does the AIDS virus fulfill Koch's postulate, I wonder?

great question, delmoi. dare we try?
posted by brandz at 7:30 PM on October 3, 2005


It will still be news to a lot of scientists that the glory of science is that it has now internalized the cultural critique which it ridiculed or ignored for many years. Its clear that science operates as a social system as well as a methodology, it's great that scientists are starting to accept that, the next step is to start teaching science that way too. This would go a long way to demystifying science in the public eye.

And this must be one of the sweetest Nobel's in recent memory form the POV of the recipients. great stuff.
posted by Rumple at 7:33 PM on October 3, 2005


Rumple, I don't want to belabor this point, but there's nothing new about this. See Thomas Kuhn "The Structure of Scientific Revolutions". This is the way it is done--the scientific community arrives at a hypothesis that explains *almost everything*. At this point it's very difficult to challenge the status quo, because it explains, well, almost everything. Eventually the anomalies mount, and certain bold individuals challenge the established orthodoxy.They have a difficult row to hoe. But eventually they or their followers are listened to, because what they propose explains more than the previously accepted hypothesis. It's been done like that since Galileo, dude.
posted by Turtles all the way down at 7:54 PM on October 3, 2005


I'd bet less than one in twenty patients that I see with acid-dyspeptic issues have a true ulcer/H.Pylori issue. The PPI industry isn't in danger as long as people are obese and eat like shite.
posted by docpops at 7:56 PM on October 3, 2005


Turtles -- I don't want to belabour it either, and I am pretty familiar with Kuhn. The point that is new, and this research is a perfect example of, is that Kuhn doesn't talk much about the bitchiness of science - it isn't just that people think the status quo explains almost everything, its that it is a personal issue with them, careerism, status, funding, etc. meanwhile, the rhetoric of science refuses to acknowledge this.

For example, most scientists I know work on the basis of a very holistic knowledge of their subject and they fumble towards their results -- working hunches, suspicions as much as they make pure deductions, testing, fishing and so forth. They then write up the results in a narrative that has a strict rhetorical format of "I deduced a hypothesis from the theory and tested it and found it not to be falsified". This cements the method but at the price of mis-representing how the work actually happens -- and that matters because if you really believe the rhetoric then you are less likely to follow new paths into new territories. As Kuhn says, the old paradigm hangs on long after its sell-by date, much longer than a rational analysis would allow. This seems to me to be a funny kind of glory for science to have -- far better for it to have a glory of consistency and open mindedness coupled to its powerful method. But scientists are human, and so the bitchiness, the healthy skepticism, the reluctance to challenge the status quo actually hold back the pursuit of knowledge. Kuhn's critique of science -- and the equally apt sociological critiques of the 1990s (well some of those were pretty stupid) -- reveals a flaw in science, not its glory.

And since science matters so much, we all need to be concerned with the sociology of science, and not be cowed by its rhetorical coverups of what is a very messy process.
posted by Rumple at 8:24 PM on October 3, 2005


+1 for the scientific process. Its true that they encountered a lot of resistence for this theory. It didn't make sense from the established viewpoint and the established viewpoint of the time was not non-sensical. So there should have been a lot of people questioning this new explanation. And there were. But damn if evidence didn't show that these blokes were correct. Sometimes you've got to suck it up and admit you were wrong.

Sometimes it takes a long time to come to terms with it. Einstein never really came to terms with Quantum Mechanics in spite of being instrumental in its genesis. I have a really hard time getting my head around the idea of Dark Matter even if I have to agree that the bulk of current evidence points in that theories favor.

I place my bets on science over religion precisely because its fallible, that it puts the chips on the table and says "here's how things are kids" and then someone else is right there to provide the smackdown. Its egos and ideas battling, which makes it emminently human.

There is plenty of cravenness and profit motivation and all the other nasty crap that infects humans involved in science, but I still am willing to give it the benefit of the doubt over most human endeavors owing to stories like this.

On Preview: Rumple, I agree with most of your post, but I think that the distallation of the sometimes chaotic process of discovery into the somewhat sterile language of a journal paper is actually a useful thing. As you point out, it doesn't capture the entirety of the genesis, of the stumbling and searching, but what it does is establish a protocol, a guide map for others that need to replicate the results. Its like an explorer who may wander hither and yon, but eventually produces a map that details a useful trade route. Is that exactly the route they took? No, likely not, but they've decided it is most likely route to the destination. Others are free to disagree and probably will.
posted by afflatus at 8:35 PM on October 3, 2005


For example, most scientists I know work on the basis of a very holistic knowledge of their subject and they fumble towards their results -- working hunches, suspicions as much as they make pure deductions, testing, fishing and so forth. They then write up the results in a narrative that has a strict rhetorical format of "I deduced a hypothesis from the theory and tested it and found it not to be falsified". This cements the method but at the price of mis-representing how the work actually happens

Rumple: Exactly--I've written these papers! But this method works--it would be very difficult to follow a paper that accurately documented one's own thought processes--the false leads, the just not seeing what was there, the doing the experiment before you do the control etc. I don't think that science should be documented in this way; the current method works well. False as it is, it establishes a logical basis for the investigation, based on cited work which itself is assigned greater or lesser value by the author, leading to results and discussion that are evaluated against the objectives of the investigation and the previous evidence. IT DOESN'T MATTER IF THE WAY IT IS WRITTEN ISN'T THE WAY IT HAPPENED! It formalizes one's findings, makes it easier to read and evaluate, and allows the work to contribute to a coherent, cohesive body of literature.
posted by Turtles all the way down at 8:52 PM on October 3, 2005


IT DOESN'T MATTER IF THE WAY IT IS WRITTEN ISN'T THE WAY IT HAPPENED!

So much for investigation of the truth, eh...
posted by nightchrome at 9:01 PM on October 3, 2005


So much for investigation of the truth, eh...

So true. Night all.
posted by Turtles all the way down at 9:07 PM on October 3, 2005


nightchrome: sorry, that was flip and reflective of a bit of frustration, I guess.

Science is all about investigation of the truth. The truth is what everything you do is measured against. So much so that you can't lie: if you do so you will be caught, because the results you present, in the context of the experimental method you describe, will fail to be replicated by others.

What I was referring to in the all caps statement you quoted was the rationale, the story you weave around the presentation of your results. Everyone knows this is bullshit; science is not rhetoric. So, this is a framework that puts your results in some kind of context. The data you present is what is measured against Truth, or truth as far as we feeble humans can divine it right now.

Please make no mistake: you can supply the most convincing rationale why your scientific opinion is right, but in the end the data, and how it was collected, is what ultimately speaks for you.
posted by Turtles all the way down at 9:18 PM on October 3, 2005


Now I really am going to bed. Odd what gets one's dander up isn't it? ;-)
posted by Turtles all the way down at 9:24 PM on October 3, 2005


Oh yeah, there was a story about these guys some years ago on the ABC Radio National "Science Show". Turns out there was an italian doctor IIRC who figured this out in the '70s or so, patients with bad ulcers were coming from far afield to see him, and he treated them with antibiotics. He was only interested in treating his patients so didn't manage to sell it to the medical establishment at large.

The rediscovery of the cause and attribution to helicobacter belong to the Nobel recipients.
posted by arjuna at 9:35 PM on October 3, 2005


I have a feeling that a lot of the things we currently blame on "diet" in general will eventually turn out to have very specific causes. Some of these causes may in fact turn out to be food-related, but the oversimplified diet advice we currently get sometimes sounds like a medieval polemic attributing illness to moral laxity. This Times article about how it's been very difficult to prove certain diet-cancer links was pretty eye-opening, especially the part where doctors debate whether the public should be informed that the science is inconclusive.
posted by transona5 at 10:07 PM on October 3, 2005


There's something very aussie-macho about the way he proved his point. I admire the australians for this kind of gutsy behavior... Don't believe me? Well I'll just eat the damn bacteria myself, then you'll see! Gutsy. No pun intended.
posted by muppetboy at 10:15 PM on October 3, 2005


The formulaic narrative of a scientific paper does indeed make the method easy to follow, and I see the good in that. And it looks like we agree that science is a very human pursuit full of hunch and intuition and the formidable coupling of imagination to method.
What I object to is that the average person on the street *doesn't* tend to see science as a fallible human pursuit but rather as acts of impenetrable deduction of a purely disinterested, detached, quasi-priesthood. Many scientists seem to be content to let this perception reign when for society as a whole it is a dangerous perception.
I consider myself a scientist also, I've written the formulaic narrative, I understand the imperatives that bring it forth, but I believe while useful it is not benign -- I wish the public could understand the messiness of science so that they can engage with it better -- a protestant reformation of science, a banning of the latin mass, if you like.
posted by Rumple at 10:17 PM on October 3, 2005


I certainly agree that the general public would be better served by having a greater insight into the scientific process. I would be suprised to find anyone in the science community who would argue otherwise. Science is fallible and human and I think that it is stronger for it.

The bit I worry about (and I think that many on the academic front worry about) is that the messiness of science is pushed over the true knowledge accumulation. Yes, it is quite true that scientists (even well know popular ones) push theories that end up being incorrect, in part or in whole. But with the limited science education of the general public, this all to easily slides into the right wing's "oh, its only a theory" rhetoric.

Oh, global warming, some people disagree on specifics. Oh, evolution, some people disagree on first origins or methods of speciation. Messiness is confuesed with lack of knowledge and large numbers of people want iron clad answers, with no room for nuance and science can't give that to them.

I'd rather see the high disciples of science out there preaching to the masses (even when they know they are likely wrong in parts) than those of religion, because how many protestant reformations have you seen in christianity and how many have you seen in science?

I can tell you that the scions of science are more easily overthrown than those of religion.
posted by afflatus at 10:45 PM on October 3, 2005


Messiness is confuesed with lack of knowledge and large numbers of people want iron clad answers, with no room for nuance and science can't give that to them.

I agree -- except that Science *does* give that to them (this whole thread started with how debate about heliobacter was stifled in the scientific community), and you also note you would prefer to see the high disciples of science out there.... it warms my heart too to see Dawkins out there sticking the stiletto into the infidels. We need more thoughtful scientists out there fighting the good fight -- that alone demystifies scientists for the general public. Knowing that Einstein was an extremely muscular adulterer is an important leap in this regard!

So I am genuinely torn on this issue. I think Science needs close examination and external critique, yet I also have enormous respect for it. Ultimately, if people were educated from an early age on the human nature of science they would be less likely to be distracted or misled by the messiness of it. It is in this respect that the dogmatic rhetoric of science-as-neutral-endeavour is counterproductive, by lowering expectations and increasing transparency, science can actually come to have more influence in society..
posted by Rumple at 11:18 PM on October 3, 2005


Two other things worry me about this
1. If someone develops a fairly cheap and effective cure for something like bowel cancer or AIDS, how long would it be before the big drug companies stopped exerting resistance on the medical practice network they provide funds to and the cure was widely available?
2. How many "quacks" out there who aren't lucky enough to come in contact with a young, ambitious self-promoter who has nothing to lose, have already discovered something revolutionary and controversial (and not very profitable) but don't have the skills or confidence to get the word out?
posted by DirtyCreature at 11:19 PM on October 3, 2005


I see that the good doctors are now looking for ties between bacteria and Crohn's. It's wonderful to read the news of their theory's vindication on my birthday. I'd like to dedicate my comment to a particular Kaiser Permanente doctor who, 10 years ago, pumped my wonderful erstwhile fiancée full of prednisone for more than a year, wrecking her health, personality, and probably our relationship. I recall said doctor laughing at Marshall's and Warren's theory when I mentioned it back then. Here's a very heartfelt fuck you, quack.
posted by syzygy at 2:04 AM on October 4, 2005


Prednisone? WTF, that stuff hell on the stomach -- I have to take it now and again and my doc always wants me to take some other type of med to prevent an ulcer.
posted by moonbiter at 6:21 AM on October 4, 2005


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