Peptic ulcer and the discovery of Helicobacter pylori - from skepticism to the Nobel Prize

Every once in a while peptic ulcers are mentioned here as a parallel to ME/CFS.

Peptic ulcers were seen as something caused by stress and/or bad dietary habits until the discovery of the bacterium Helicobacter pylori in the stomach by two Australian doctors, Barry Marshall and Robin Warren. They faced a lot of skepticism and opposition in the beginning but eventually their discovery earned them a Nobel Prize in 2005.

However, things really didn't go smoothly first. I have recently come across these two articles from 2005, the year they won the Nobel Prize and I think they are worth sharing.

One, titled 23 years of the discovery of Helicobacter pylori: Is the debate over? is from a journal:

The clinical community, however, met their findings, with skepticism and a lot of criticism and that's why it took quite a remarkable length of time for their discovery to become widely accepted. They had to just push it harder and harder with all experimental and clinical evidences.

In 1985, for example, Marshall underwent gastric biopsy to put evidence that he didn't carry the bacterium, then deliberately infected himself to show that it in fact caused acute gastric illness. This 'self-help' experiment was published in the Medical Journal of Australia [4] to describe development of a mild illness over a course of 2 weeks, which included histologically proven gastritis.

This extraordinary act of Marshall demonstrated extreme dedication and commitment to his research that generated one of the most radical and important impacts on the last 50 year's perception of gastroduodenal pathology. ​

The other one is from the New York Times, titled Nobel Came After Years of Battling the System:

When two Australian scientists set out in the early 1980's to prove that a bacterium, Helicobacter pylori, caused stomach inflammation and ulcers, they met opposition from a medical-industrial complex entrenched in the belief that psychological stress was the cause.

Opposition to their radical thesis came from doctors with vested interests in treating ulcers and other stomach disorders as well as from drug companies that had come up with Tagamet, which blocked production of gastric acid and was becoming the first drug with $1 billion annual sales.

Ulcer surgery was lucrative for surgeons who removed large portions of the stomach from patients with life-threatening bleeding and chronic symptoms. Psychiatrists and psychologists treated ulcer patients for stress.

The concept of curing ulcers with antibiotics seemed preposterous to doctors who had long been taught that the stomach was sterile and that no microbes could grow in the corrosive gastric juices.​

 

Barry Marshall has been a medical hero of mine since the 90s. I wrote a blog on this on Phoenix Rising some years back. Medical conferences subsidized by big pharma were banned from discussing this for about ten years. The breakthrough came because patients kept insisting to the media that something had to be done. It was patient power mostly, not medical advocacy from within the profession. I regard this as important for ME advocacy, there are lessons to be learned.

https://forums.phoenixrising.me/blog-articles/here-we-go-round-the-merry-go-round-part-one.1228/
https://forums.phoenixrising.me/blog-articles/here-we-go-round-the-merry-go-round-part-two.1229/

 

That doctors considered the above diagram on the origin of peptic ulcers to be more persuasive than the hypothesis that a bacterial infection could be responsible says a lot about medicine.

 

The asymmetry of bullshit in action. Once something wrong has gotten its legs on, it takes disproportionate efforts to slow it down before it can be replaced. It's sad that not only does it also apply in medicine, it seems to be especially strong because of the rigid hierarchical nature of medicine. Although modern militaries manage better so strict hierarchy isn't enough, a culture of self-interest clearly plays into it.

This is what makes the whole MUS paradigm and psychosomatic beliefs in general so dangerous. All it can accomplish is delay scientific progress and harm people, but it can do that for decades by the mere inertia of making any effort at stopping it impossible. No matter how much harm it causes, once the harm has been approved, reputations become tied to its failure.

This is something that will need to be a core concept in a future competent healthcare system. All the race to the bottom has accomplished is a dive straight down. Race to the bottom seems to be the only active mode right now, it's as if the profession had given up entirely, or maybe it never really had it and it mostly was a combination of sheer brute force and desperate people forcing acceptance of reality.

Saddest of all is that episodes like this are completely erased, as if they never happened. Nothing ever learned, the race to the bottom will not be compromised.

 

This prompted me to look it up, its known as Brandolini' s law.

In short - https://artsandculture.google.com/entity/brandolini-s-law/g11ddz0b12h?hl=en

A slightly longer discussion, with a counter-example - https://statmodeling.stat.columbia.edu/2019/01/28/bullshit-asymmetry-principle/

 

Yep, going by 2 cases I knew in friends of friends around 3yrs ago (pre-covid) GPs in my area must have a pathway that still treats ulcers as psychosomatic - stress chat and come back in 2 weeks first. The 'pathway' was slow enough for both (who ironically didn't know each other and wouldn't come across each other, yet got it at the same time) to end up in A&E 6weeks in.

At that point (one arrived by ambulance) every test begins with the most life-threatening.

So ulcer - the most barn door (even at the start when they went to GP) - was the very last test done pretty much.

I say pathway as the 2 were at different GP surgeries one male (non-stressful job), one female, different ages neither particularly bad in any habit and did some exercise etc and the advice and timing of each suggestion they were given was identical. Apart from the male specifically got told to try eating an apple a day after his first come back after 2 weeks, with claims a chemical cured something.

What's the point of all the science if it is undermined actively at the gatekeep for no sensible reason? Is antibiotic for it even expensive or a massive problem? I'm sure I've heard of a 3rd similar story in the last year too.