Tuesday, October 04, 2005

Heliobacter Pylori

"Discovery consists of seeing what everybody has seen and thinking what nobody has thought." - Albert Szent Györgyi, 1937 Nobel Laureate in Physiology and Medicine

Two Australians have won the Nobel Prize in Medicine for proposing the radical idea in 1982 that the organism Heliobacter Pylori was responsible for gastritis or stomach ulcers; not "stress"; Type A personalities; or excess stomach acid.

Most people today don't appreciate what a revolutionary idea this was at the time. I remember other physicians talking about how the authors of the paper on this subject were laughed at during their presentation at a scientific meeting. Here is an excerpt from a medical textbook from 1967:

...certain patterns of relationships were more common in 'ulcer' families. Thus the mothers of ulcer patients tended to have psychogenic symptoms, and to be striving, obsessional, and dominant in the home; fathers tended to be steady, unassertive, and passive.

The description of these families...emphasizes the conflict in duodenal ulcer patients between dependence engendered by a powerful mother and demands of adult roles."

The variations in peptic ulcer in different geographical, historical, and social contexts are unequivocal evidence of the influence of ways of life in this disease. The specific elements that contribute to the variations probably include diet, alcohol, cigarette smoking, emotional strain, personality, and genotype... . This does not exclude the possibility that a major single causal effect awaits discovery.

Can you imagine the courage necessary to go against the medical establishment when many people have made up their minds about what is true? The nature of science--and all discovery for that matter--is to look at what everyone else is looking at, but to think differently about it.

When this exciting discovery first came out, it made me wonder how many other "settled matters" in medicine are really so settled?

I had occasion to remember that thought some years later when my own daughter was diagnosed with Sydenham's Chorea after having had an undiagnosed Strep Throat (she is perfectly OK now, several years later and just needs to be on prophylactic antibiotics until adulthood). This made me become an instant expert on what are called PANDAS (Pediatric Autoimmune Neurological Disorders Associated with Streptococcus). I found out, for example, that approximately 20% of obsessive compulsive disorder in childhood is associated with Strep infections.

I also discovered that there are a lot of people who suspect that Strep and other infections may play key roles in other medical disorders--such as heart disease.

These ideas are not yet well-known or appreciated in the general medical community. Can you imagine the revolution that would occur if it was proven that infection is the major etiology of heart disease?

My only point here is to emphasize that sometimes the things we think are absolute truth and proven beyond a doubt are neither. Scientists especially should be open to new ideas and hypotheses and refrain from the kind of orthodoxy and rigidity of thinking that stifles free inquiry and research.

The proof that H. Pylori caused peptic ulcers and gastritis revolutionized the treatment of this dsorder and decreased human suffering and death. Barry Marshall and J. Robin Warren are the kind of innovative thinkers and researchers that were able to "think outside the box" and then to take on the medical establishment. By doing so they made an important contribution to the world and to Medicine. Bravo!

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