A discovery from Down Under breeds controversy
By Edward Doyle
Ulcers should no longer be viewed as a sore in the lining of the stomach, but instead as an infectious disease. So concluded the two Australian physicians who discovered the link between the Helicobacter pylori bacteria and peptic ulcer disease, beginning one of modern medicine's meaner debates.
From the start, the medical community was skeptical of the new theory about ulcers--and not shy about attacking its source. The two Australians, Robin Warren, MD, and Barry Marshall, MD, were not researchers but practicing physicians, a fact that led many in the academic community to view their research as suspect. "Barry Marshall was saying from the start that this was an infectious disease and that the treatment for it was antibiotics, but there was not enough data to support that," recalled David Y. Graham, FACP, chief of gastroenterology at Baylor College of Medicine in Houston, Texas.
The theatrics that followed--Drs. Marshall and Warren actually drank some of the bacteria to prove that they would get gastritis and cure themselves with antibiotics--further alienated many in academic medicine. "The worst thing someone could say is that you sound like Barry Marshall," Dr. Graham said.
Very quickly, the debate veered away from facts and figures and took on an almost religious tone. "Instead of looking at the issue scientifically, there was an 'I believe' mentality," explained Martin J. Blaser, FACP, director of the division of infectious diseases at Vanderbilt University School of Medicine in Nashville, Tenn. And while a handful of believers were ready to accept H. pylori eradication therapies--and in some cases were already putting them to use--the skeptical majority wanted no part of this new theory.
Dr. Marshall, now clinical associate professor of medicine at the University of Virginia and president of the Helicobacter Foundation, an educational institution in Charlottesville, Va., remembers the furor that the reported relationship between H. pylori and gastric ulcers caused. Speaking to groups of gastroenterologists, he said, was like running a gauntlet. "Nine out of 10 would be standing up waiting to have a go at you," he recalled. "Then occasionally someone would get up and in a very timid voice say that he had treated his mother-in-law with antibiotics and that she was feeling much better. The audience would boo and tell him to sit down."
Looking back, experts say, physicians' somewhat harsh reaction to H. pylori should come as no surprise. After all, new theories on how to treat all kinds of diseases are reported in the media everyday, giving physicians reason to be conservative." A lot of things that sound like they may be true to start with don't turn out to be true, so skepticism is well warranted," explained R. Brian Haynes, FACP, professor of medicine and clinical epidemiology and chief of the health information research unit at McMaster University in Hamilton, Canada. "There are not too many breakthroughs like that, and I guess it's possible for doctors to not expect anything to be a breakthrough, to lump all new things in the same category of wait and see."
Even Dr. Marshall is not surprised that physicians have only begun to embrace H. pylori eradication therapies. "In medicine some theories take a lot longer to be adopted because there is already an incorrect dogma that is well established," he said. "Besides, everybody thought they were an expert on ulcers. They said why is this Dr. Marshall telling us about ulcers, there is so much literature that we don't need anything new, we already have 28 things that cause ulcers. But as it turns out, 27 of those 28 things were actually H. pylori.
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