BACTERIA: ENOUGH TO GIVE YOU AN ULCER by
Allan J. Tobin and Jennie Dusheck |
| Read this article to find out how possible
it is for "scientific experts" to miss the truth, even when confronted with it. And read to see how the persistent searcher for
truth can suffer ridicule and loneliness. |
In 1984, an obscure Australian physician named Barry
Marshall secretly performed a dangerous experiment that would ultimately deprive
some of the world’s largest corporations of billions of dollars. Marshall’s radical idea was born in 1979 when
his colleague and friend J. Robin Warren noticed that tissues
taken from ulcer patients were often infected with bacteria.
To find one bacterial infection in the stomach would have been strange; to find dozens was bizarre. The human stomach secretes acid so concentrated that few organisms survive it for more than a few minutes, let alone live and reproduce in it. Yet Warren found bacteria flourishing there.
Warren’s
discovery suggested an alternative to doctors’ long-standing belief that ulcers
are caused by excess stomach acid. Ulcers,
every medical textbook reported, were caused by the oversecretion of stomach acid
in people with overanxious, frustrated personalities.
Such personality problems were thought to be aggravated by the stressful
pace of modern life. But if a bacterium
could infect the stomach, Marshall and Warren realized, maybe it could cause ulcers. Intrigued by this idea, Marshall began ordering
biopsies for all his patients who had stomach problems. He found that nearly every patient with ulcers
was infected with the same bacterium.
The
most common kind of ulcer is a peptic ulcer, an open wound located where the stomach
joins the small intestine, at the bottom of the stomach. The word peptic comes from the Greek word
peptein, to digest. Nearly one in ten adults has a peptic ulcer. Some people with ulcers feel no discomfort,
but most experience at least mild pain, and many suffer excruciating pain for
weeks at a time throughout their adult lives.
In rare cases, blood may pour from the wound so freely that the victim
bleeds to death. The standard treatment
for ulcers had always been a high-fat, bland diet, tranquilizers,
psychotherapy and, in severe cases, surgery. Mainly, however, doctors prescribed
antacids—lots of antacids.
Antacids are the
biggest-selling prescription drugs in the world. In 1992,Americans bought $4.4 billion worth
of the drugs. Prescription antacids are remarkably effective at controlling the
secretion of stomach acid, but remarkably ineffective at controlling ulcers.
Ninety-five percent of ulcer patients have a new ulcer within 2 years of
treatment. That means people who have ulcers take the
$100-a-month antacids almost continuously. In
a lifetime, an ulcer-sufferer can spend tens of thousands of dollars on antacids.
Yet, if ulcers
were caused by a bacterium, a 2-week course of antibiotics might cure millions
of people permanently of what would otherwise be a lifetime of suffering.
If Marshall’s hunch was right, he had very good news, although not for
the companies selling antacids.
Marshall, however,
had insignificant credentials as a doctor and none
as a researcher. In 1980, he seemed to
have no more chance of selling his idea to the biomedical community than his bacteria
had of flourishing in the corrosive environment of the stomach.
Nevertheless, in 1983, Marshall presented his hypothesis at a scientific conference
in Brussels. His presentation was a disaster.
He was unknown; he was young, inexperienced, and overexcited; and he had
a seemingly screwball idea. “He didn’t
have the demeanor of a scientist,” recalled Martin Blaser, professor of medicine
at Vanderbilt University. “He was strutting
around the stage. I thought, this guy
is nuts." When Marshall's presentation was over, his audience of
eminent medical researchers shifted uneasily in their seats, embarrassed. A few laughed. They couldn’t believe he was serious. Most bacteria can barely survive a brief passage through the stomach.
How could they flourish there for months or years?
Besides, Marshall
had no scientific evidence to back up his claim. Maybe, his audience told him, the bacteria
had contaminated the stomach samples after the stomach tissues had been
removed. Or maybe the bacteria were harmless
and unrelated to the ulcers. Or maybe
the bacteria were able to colonize the stomach as a result
of the
ulcer.
Marshall
realized that the only way to settle these questions was to study the bacterium
in an experimental animal. He needed to
find an animal whose stomach could be infected with the bacterium. After returning to Australia, he began feeding
the bacteria to rats. The bacteria died
in the rats’ stomachs without having any effect. He fed the bacteria to pigs, with the same
result. Now he began to wonder could the
bacteria really infect a stomach? Maybe
the researchers in Brussels had been right to laugh at him.
Desperate
to prove that he was no nut, Marshall did something highly unusual (and controversial).
First, he had a stomach exam and biopsy to make sure his stomach was healthy. Then he made an “ulcer bug” cocktail containing
at least a billion bacteria, and, in a few swift gulps,
drank it down, The cocktail was enough, he hoped, to infect
his stomach. He told no one ahead of
time—not the medical ethics board at the hospital, not
his wife. They wouldn’t have approved,
he knew.
At first, nothing happened. Then, nine days later, nausea woke him early
and he
vomited. For
another week he was tired, irritable, and hoarse. He had headaches and foul breath. A second stomach exam and biopsy showed that his stomach was inflamed
and swarming with bacteria.
By
the third week, Marshall was lucky enough to have recovered
completely. He had not proved that the
bacteria could cause ulcers, or even that it could in
infect
the stomach for years at a time. But he had done something that strongly suggested
that the bacterium, still unnamed at the time, could at least infect
a
healthy human stomach—one that didn’t already have an ulcer.
In time, other more-established researchers began to take an interest. Mainly, they were interested in proving Marshall wrong. But by the end of 1980’s, evidence that the bacterium could infect the stomach was unassailable. In 1989, the bacterium was named Helicobacter pylori because of the bacterium’s helical shape and because it was known to colonize the pylorus, near the stomach’s exit. By 1993, definitive studies by other researchers had shown that some 80 percent of ulcers were caused by H. pylori, and were treatable with antibiotics.
Drug companies, initially somewhat negative about Marshall’s idea, began to see a silver lining in the cloud the Australian had created. It was true that people treated with only $20 worth of antibiotics had a relapse rate of only about 10 percent—which meant an ulcer sufferer would spend thousands of dollars less on drugs. On the other hand, infection by H. pylori turned out to be one of the most common bacterial infections in humans in the world—infecting up to half of all people worldwide. And mounting evidence suggested that chronic infection by H. pylon not only caused ulcers but also increased the risk of developing stomach cancer. Here was a market for antibiotics consisting of billions of people. Marshall’s cloud definitely had a silver lining.
By 1993 drug companies were hastily developing new diagnostic tests for H. pylori and new antibiotics to treat the infection. Biotechnology companies were trying to develop a vaccine, to be given in childhood that would protect against H. pylori ulcers, and maybe even stomach cancer, a leading cause of death in Asia. In early 1994, experts at the National Institutes of Health declared antibiotics the official treatment for most ulcers. For the first time, doctors began treating their patients with antibiotics that would offer a permanent cure. Change came slowly. By 1996, only one-third of doctors were prescribing antibiotics for ulcer patients.
The rest continued
to prescribe antacids only.Marshall ultimately won acceptance as a scientist,
earning a position on the faculty at the University of Virginia Medical School.
He succeeded in part because he possessed many of the attributes of a good
scientist. He had curiosity, intelligence
vision, and the dogged determination to pursue an idea—even when his stubbornness
made him appear foolish. Perhaps most
important, Marshall displayed an unusual independence
of thought that allowed him to pursue an idea unimaginable to more dogmatic thinkers.
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