The importance of the renegade

I had a duodenal ulcer in the 1980s. It apparently started when I was under a fair bit of stress in a new job and it was stress which was the standard explanation for ulcers at the time. The initial symptom was a feeling of being hungry almost all the time. Then, one night, it became extremely painful and I was taken to hospital. The standard treatment in those days was a drug called Cimetidine, which inhibited stomach acid production¹. This, for me, was coupled with a slight modification to diet. The result was very effective. After a while, I was essentially back to normal, and have never been bothered by ulcers since.

Also in the 1980s, during a gastroenterology rotation at Royal Perth Hospital, a doctor Barry Marshall was shown a letter from pathologist Robin Warren in which he pleaded for someone to work with him on “20 patients with bacteria in their stomach”, where the bacteria shouldn’t be, because of the acid in the stomach. Marshall was interested because the bacteria Warren had seen were like a genus called Campylobacter. Marshall was familiar withCampylobacter, which causes a common infection you can get off chickens, because his father used to work in a chicken factory. Warren thought these bacteria were somehow linked to gastritis, an inflammation of the stomach. In the scientific literature at the time, a large proportion of papers seemed to assume that gastritis was simply related to getting older, eating spicy food, drinking too much alcohol, or sundry other causes. In most of these papers there was no mention of bacteria².

After attempting to culture these bacteria for some time, they were eventually successful and identified the new bacterium as Campylobacter pyloriin 1985^2,3. This was later assigned to a new genus as Helicobacter pylori⁴, with H. pyloribeing the type species⁵. Marshall and Warren initially found no link between gastritis when testing patients randomly, but when they tested 13 people with duodenal ulcers, they found all of them had H. pylori. With such a small sample size it might have been just coincidence, and besides, correlation is not necessarily causation. So they sampled more patients².

The drug industry took the line that it was the weakness caused by the ulcer that made people susceptible to infection by the bacterium. This was because the ulcer drug business was worth between three and five billion dollars annually. As far as the drug companies were concerned, an ulcer drug was something that you needed to take daily for a decade or more to keep your ulcer under control. If ulcers could be cured by a simple course of antibiotics in a week or two, the value of their ulcer drug would decrease along with their share price².

Marshall and Warren attempted some animal experiments, but could not get H. pylorito infect animals. So Marshall decided to test it on himself. By this time, Marshall was at Fremantle Hospital, running his own mini-laboratory and doing the research in his spare time, with some money from drug companies (those making antibiotics) and a ‘rebel’ in an ulcer drug company. When that rebel presented some of the results in the US, he was told to go away. The company did not want to know².

Marshall made sure that he did not have H. pyloriin his gut by getting his then boss in gastroenterology, Ian Hislop, to do an endoscopy and several biopsies. Hislop said “Barry, I’m not going to ask why I’m doing this”. Sometimes it is better not to know. So, Marshall drank the bacterial cocktail. After a few days he developed vomiting attacks and other assorted symptoms, and after 10 days he had another biopsy and the bacteria were everywhere; and he had severe gastritis. It took another 10 years for the causal association between H. pylori, and gastritis and ulcers, such as my duodenal ulcer, to be demonstrated in the first truly double-blind experiment. Final vindication came when the National Institutes of Health in the United States accepted that the key to treatment of duodenal and gastric ulcers was eradication of H. pyloriinfection by the use of antibiotics. Then, in 2005, Marshall and Warren received the Nobel Prize in Physiology or Medicine for their discovery⁷.

Science constantly advances and corrects itself, and publicly funded science is the best way to do this, because science searches for truth, whereas corporations are mostly concerned with their share price and shareholder satisfaction. If ulcer sufferers had to depend on science done by corporations, we’d probably still be taking Cimetidine for ulcers, because it was a big money-spinner. At the time of my duodenal ulcer, I read up about them and found out there was actually a death rate of a percent or two. Corporations wouldn’t let the deaths of a few punters get in the way of their profits.

Sources

1. https://en.wikipedia.org/wiki/Cimetidine
2. https://www.science.org.au/learning/general-audience/history/interviews-australian-scientists/professor-barry-marshall
3. https://en.wikipedia.org/wiki/Helicobacter_pylori
4. https://en.wikipedia.org/wiki/Helicobacter
5. http://www.bacterio.net/helicobacter.html
6. https://www.npr.org/sections/health-shots/2018/09/09/645629133/infectious-theory-of-alzheimers-disease-draws-fresh-interest?utm_source=twitter.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20180909
7. https://www.nobelprize.org/prizes/medicine/2005/press-release/