Dogma Days (A Different Slant on H. pylori and Ulcer Disease)
October 14th, 2006 by The Doc
First and foremost, this site represents a forum for the exchange of information. That said, I should probably point out that a lot of the information found here will be controversial. Surprised? Don’t be. After all, much of what we discuss here will deal with scientific data, which is usually contested by the very people who generate it. Additionally, we’re talking about how such “waffling data” pertain to our understanding of biological systems (that’s us, folks). And we humans are an unpredictable bunch, to say the least. The only thing more unpredictable and more prone to change than people is their science. Today’s discredited whimsy was yesterday’s dogma, if you follow my drift.
Just as an example, consider the long-entrenched notion that stomach ulcers were caused by stress, by dietary indiscretion, by smoking, by evil spirits… Honestly, we in medicine never really had a clue about what causes ulcers (or lots of other problems, probably). When two Australian scientists, Barry Marshall and Robin Warren, proposed their own theory back in the early 1980s, the rest of us thought they had snapped their caps. You see, they discovered a bacterium in the lining of human stomachs that caused inflammation in the surrounding tissues, and they speculated that this bug might have something to do with creating ulcers. Preposterous! Everyone knew that bacteria could not survive in the acidic environment of the stomach. How could a couple of unknowns from the outback of Australia, of all places, expect their learned colleagues to accept such a hypothesis?
Well, it took a long time for us to catch on—Marshall even swallowed a batch of his bugs to prove his point—but we now know that the majority of recurring stomach ulcers are, after all, caused by Helicobacter pylori. Indeed, an entire pharmaceutical sub-industry has sprung from this newfound knowledge. In 2005, Marshall was awarded a Nobel Prize for his contribution to science.
What many physicians don’t know (or possibly don’t want to admit) is that H. pylori was actually first discovered in 1875 by German biologists. The organism could not be easily grown outside the stomach, however, so it was soon forgotten. In 1899 a Polish scientist rediscovered the bacterium and postulated that it was involved in gastric pathology (read, ulcers). Unfortunately, Jaworski’s “Handbook of Gastric Disease,” wherein he set forth his ideas, was written in Polish. Sadly, even then the medical community was an arrogant bunch, so the treatise was largely ignored.
Perhaps just as compelling is the fact that for many years, bismuth subsalicylate (good ol’ Pepto-Bismol), was used fairly effectively for treating ulcers. Its mechanism of action was a mystery, however, so it fell out of use (and, not surprisingly, a slew of more expensive and patentable medications were hitting the market). We now understand that Pepto-Bismol has an antibiotic effect that makes life unpleasant for H. pylori.
So what’s my point? Well, Western Medicine is a great place to visit, but turn your watch back a few decades upon arrival, open your wallet, and don’t expect new ideas to catch on too quickly.