Nobel-Prize Cluelessness (stomach ulcers)
Wherein the Nobel Prize is given for discoveries that are misleading. From a New Scientist article about medical self-experimentation:
Junior doctor Barry Marshall was sure the medical establishment was wrong about the cause of stomach ulcers. The received wisdom was that they were caused primarily by lifestyle factors, but Marshall and pathologist Robin Warren were sure that the bacterium Helicobacter pylori was to blame.
It turned out that Helicobacter pylori was present in half the stomachs in the world — only a tiny fraction of which developed ulcers. So much for causation. Marshall and Warren did not consider that lifestyle factors might cause immune efficiency to go down, leading to increased growth of the bacterium. In a famous example of self-experimentation, Marshall ingested a giant amount of the supposedly dangerous bacterium — but, uh-oh, didn’t get an ulcer.
Thanks to JR Minkel.
April 4th, 2009 at 7:07 am
The article said that he was infected and got “gastritis, which can eventually lead to ulcers.” Also, stomach ulcers are treated with antibiotics. It’s like saying that S. aureus doesn’t cause infections because it resides on lots of people’s skin and nasal tracts. Doesn’t follow. Few bacteria cause outright illness with no other factors involved.
April 4th, 2009 at 8:36 am
Dennis, I’m afraid I don’t understand your point. If ulcers are in fact a sign of an immune system working poorly, they would be better treated with treatments that boost the immune system.
April 4th, 2009 at 9:20 am
Seth, originally I had trouble understanding your own point. I understand you to be saying that the real cause of ulcers is a poorly functioning immune system. What I’m trying to say is that it is perfectly reasonable to state that H. pylori causes ulcers, just as it is reasonable to state that rhinoviruses cause colds, even though perhaps only people with run-down immune systems get either one.
April 4th, 2009 at 9:28 am
I believe Robert Sapolsky discusses this in his book Why Zebras Don’t get Ulcers. I believe the conclusion is that Heliobacter is a necessary but not sufficient condition to get ulcers. And that Marshall deserved some credit for changing some minds.
On a related point, Stephan at Wholehealthsource and Peter at Hyperlipid have each recently discussed the fact that Heliobacter and other bacteria in the body may feast and grow on hydrogen - a bacterial byproduct of poor digestion in the gut. For example, see http://wholehealthsource.blogspot.com/2009/02/sugar-hydrogen-bacteria-and.html
April 4th, 2009 at 9:50 am
Dennis, thanks for explaining that. You are right, that is how causation talk often goes. But it is misleading. If 100% of people were infected with Heliocopter pylori, would it still make sense to say the bacterium causes ulcers? Well, no.
April 4th, 2009 at 9:55 am
Seth, I actually didn’t realize how complicated the Marshall story was. Then I started reading this: http://www.csicop.org/si/2004-11/bacteria.html
Seems like a textbook example of the oversimplification of scientific history.
April 4th, 2009 at 1:01 pm
Seth, I hate to belabor this point, but probably the great majority of infectious illnesses have at least something to do with a compromised immune system. For example, zinc supplementation has been shown to dramatically decrease incidence of the flu, because zinc strengthens immunity. But one would not want to say therefore that the influenza virus does not cause the flu. An immune system at 100% functioning might be able to stop almost any infection, but that doesn’t mean that microbes aren’t the cause of illnesses. Likewise, only 20% of lifelong smokers develop lung cancer, probably because their immune systems don’t eliminate cancerous cells. Therefore cigarettes don’t cause lung cancer?
Likewise, many people are carriers of Staphylococcus aureus, which causes boils among other things, just as many carry H. pylori. No matter how many people don’t get boils, S. aureus still causes them, just as H. pylori causes ulcers.
Does anyone besides yourself believe that the Nobel Prize was given to these men by mistake?
April 4th, 2009 at 2:35 pm
It sounds like this debate turns on what we mean by “infection.” I think when we use that term it generally means the out of control growth of some microorganism. Same with cancer. We may have pre-cancerous cells sprinkled here and there in our bodies but until they start growing into potentially life-threatening tumors we wouldn’t diagnose it as cancer.
April 4th, 2009 at 2:57 pm
Dennis, I have never heard anyone else make this point, no. If I simply posted what everyone already knew — or at least agreed with — it wouldn’t be a very interesting blog.
April 6th, 2009 at 3:26 pm
It seems worth noting here that the Spanish Flu that killed millions early in the last century (and which incidentally, started in the midwest U.S., and spread by U.S. military deployment), hit hardest those with the strongest immune systems.
April 8th, 2009 at 9:45 pm
[…] Seth’s blog » Blog Archive » Nobel-Prize Cluelessness (stomach ulcers) […]
April 10th, 2009 at 12:10 pm
[…] Seth Roberts goes so far as to say the bacterium is not even the cause of stomach ulcers: Marshall and Warren did not consider that lifestyle factors might cause immune efficiency to go down, leading to increased growth of the bacterium. […]
September 10th, 2009 at 4:34 pm
[…] In a previous post I said that the Nobel Prize to Barry Marshall and Robin Warren — for supposedly showing that H. pylori causes stomach ulcers — was a mistake. Because half the world has the bug in their stomach, and only a tiny fraction of them get ulcers, the true cause of those ulcers lies elsewhere, probably with an impaired immune system. Marshall famously drank a flask full of H. pylori and didn’t get an ulcer, yet took this to support his theory. A classic example of self-deception. Recently Lam Shiu-kum, a former dean of medicine at the University of Hong Kong, was convicted of a giant fraud. He siphoning millions of dollars of medical fees into his own pocket: Dr Lam, 66, brought a 39 year association with the university, his alma mater, to an abrupt end in March 2007 when the investigation into billing irregularities began. He is a distinguished gastroenterologist who conducted pioneering research into chemoprevention of stomach cancer through the eradication of Helicobacter pylori. His team also conducted the first double blind, controlled study into curing peptic ulcers by H pylori eradication. […]