“The greatest obstacle to knowledge is not ignorance;
it is the illusion of knowledge”. Barry MarshallL https://www.
Bipolar
Disorder: Lithium-The Aspirin of Psychiatry?
Fremantle:
Medical Heresy & Nobel
Tasmania
& SIDS: The wasted years!
I was visiting my good friend in Fremantle in Perth Perth
Sharks too.
He need not have apologised. I was happy to be near where one of the greatest medical breakthrough since Koch’s
TB over a hundred years ago: Helicobacter pylori.
The temperature was in the mid 40s and the plants were unusual!
© Am Ang Zhang 2013
© Am Ang Zhang 2013
© Am Ang Zhang 2013
© Am Ang Zhang 2013
This is the home of Barry J. Marshall, J. Robin Warren
The Nobel Prize in Physiology or Medicine 2005: "for their discovery of the
bacterium Helicobacter pylori and its role in gastritis and peptic
ulcer disease"
Peptic ulcer – an infectious disease!
This year's
Nobel Prize in Physiology or Medicine goes to Barry Marshall and Robin Warren,
who with tenacity and a prepared mind challenged prevailing dogmas. By using
technologies generally available (fibre endoscopy, silver staining of
histological sections and culture techniques for microaerophilic bacteria),
they made an irrefutable case that the bacterium Helicobacter pylori is causing disease. By culturing the
bacteria they made them amenable to scientific study.
In 1982, when
this bacterium was discovered by Marshall and Warren, stress and lifestyle were
considered the major causes of peptic ulcer disease. It is now firmly
established that Helicobacter pylori causes
more than 90% of duodenal ulcers and up to 80% of gastric ulcers. The link
between Helicobacter pylori infection
and subsequent gastritis and peptic ulcer disease has been established through
studies of human volunteers, antibiotic treatment studies and epidemiological
studies.
Helicobacter pylori causes
life-long infection
Helicobacter pylori is a spiral-shaped Gram-negative bacterium that colonizes the stomach in
about 50% of all humans. In countries with high socio-economic standards
infection is considerably less common than in developing countries where
virtually everyone may be infected.
Infection is
typically contracted in early childhood, frequently by transmission from mother
to child, and the bacteria may remain in the stomach for the rest of the
person's life. This chronic infection is initiated in the lower part of the
stomach (antrum). As first reported by Robin Warren, the presence of Helicobacter pylori is always
associated with an inflammation of the underlying gastric mucosa as evidenced
by an infiltration of inflammatory cells.
The infection is usually asymptomatic but can cause peptic ulcer
The severity of
this inflammation and its location in the stomach is of crucial importance for
the diseases that can result from Helicobacter
pylori infection. In most individuals Helicobacter pylori infection is asymptomatic. However,
about 10-15% of infected individuals will some time experience peptic ulcer
disease. Such ulcers are more common in the duodenum than in the stomach
itself. Severe complications include bleeding and perforation.
The current
view is that the chronic inflammation in the distal part of the stomach caused
byHelicobacter pylori infection
results in an increased acid production from the non-infected upper corpus
region of the stomach. This will predispose for ulcer development in the more
vulnerable duodenum.
How to prove it: He drank the bacteria!
You could say that. I drank the bacteria and at first I was okay. But
instead of being perfectly well and having a silent infection, after about five
days I started having vomiting attacks. Typically at dawn I would wake up, run
to the toilet and vomit. And it was a clear liquid, as if you had drunk a pint
of water and regurgitated it straight back. Not only that, there was no acid in
it. I remembered from my medical student days that if you have a meal where you
drink so much beer that it’s coming back up straight away, it doesn’t have any
acid in it. I knew there was something unusual about vomiting and not having
acid.
Difficult 10 years:
The medical establishment
was difficult to persuade - everyone accepted that ulcers were caused by acid,
stress, spicy foods, and should be treated by drugs blocking acid production. The
big Pharmas were not happy to see any change as patients will have to take
medication for life.
He went to the US to try and persuade the US
A big battle was still going on. I went to America
to fight the battle there, because unfortunately the American medical
profession was extremely conservative: ‘If it hasn’t happened in America United States
Getting Personal:
The personal stuff was usually said behind my back, and my wife used to
catch a bit of it. For example, I was at a conference, presenting our work. By
then I had a few converts, who would be saying, ‘Oh, Barry, this is exciting.
What are you going to do next?’ So they would talk to me, but 90 per cent of
the audience wouldn’t know enough about it. And my wife would be on the bus
tour with all the other wives, sitting in behind some of them. One wife would
be saying to another one, ‘My husband said he couldn’t believe it. They had
that guy from Australia
Finally:
It wasn’t settled until people did a truly
double-blind study, using an acid blocker and also amoxicillin and a third
antibiotic called tinidazol. All of those antibiotics could be given in a
placebo, so one group of patients could take the ‘real’ antibiotics and the
others would take antibiotics that were absolutely identical but were ‘fake’,
and even the doctors didn’t know which patient was getting which treatment.
That trial was done in Austria
and was then published in America ,
in the New
England Journal
[of Medicine], which would have the most stringent criteria for medical
research.
One year later, at a big think-tank in Washington United States US
“Ideas without precedent are generally looked upon
with disfavour
and men are shocked if
their conceptions of an orderly world are
challenged.”
Also, thinking out of the box can be a good idea. Sometimes it’s better
not to know all the dogma, all the things about a very difficult disease. If
it’s very difficult, that means people have been working on it for years and
they haven’t figured out the cure, which means they haven’t figured out the
cause. So having all that knowledge that’s been accumulated in the last 10 or
20 years is really not an advantage, and it’s quite good to go and tackle a
problem with a fresh mind when no-one else has had any luck.
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