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The power of "how do you know"?

What causes stomach ulcers? How do you cure it?

We know the answer. It's stress. Irregular meals. Spicy food. These are causes. And if we reduce or avoid these, we will be fine. And here's a graphic that we would all probably have seen (in this context, peptic ulcers are stomach ulcers)

Stomach ulcers.jpg
warren and marshall.png

As a young resident in the 80s, Marshall was treating gastritis with a pathologist, Robin Warren. They noticed a pattern. Stomach ulcers seemed to occur in the presence of spiral bacteria. They took a sample of this bacteria, and cultured and studied it. This bacteria will be later be named the H Pylori, which we introduced earlier. Warren and Marshall then decided to administer antibiotics that tackled the bacteria infection as a treatment for gastric ulcers. The patients recovered. Warren and Marshall believed that this was proof that H Pylori was what caused gastric ulcers.

However, Warren and Marshall found it very difficult to convince their colleagues and bosses. When they pointed out the presence of the bacteria, the community refuted that H Pylori was not the cause, but a result of the gastric ulcers.  Warren and Marshall pushed back - 


"How do you (the senior doctors) know that it is the effect and not the cause?"


The explanation they got was unanimous. The belief was that no bacteria could live in the stomach for long due to powerful stomach acids. Since bacteria will be eliminated quickly by stomach acids, there was no possibility that bacteria can cause ulcers. However, this belief was premised on research done many years ago, where technology was much poorer. 

In 1983, Warren and Marshall submitted their findings to the Gastroenterological Society of Australia. The reviewers rated the paper in the worst 10% of those they had received. Fellow colleagues mocked and ridiculed them. 


But Marshall was adamant. In 1984, Marshall had a baseline endoscopy done.


And in the ultimate demonstration of his beliefs, he then drank cultured H. pylori bacteria. He expected that the bacteria would take effect some months later. But within days, he suffered from nausea and severe vomiting. After one week, he did a second endoscopy. The endoscopy showed a grotesque sight of severe inflammation. His stomach lining was studded with stomach ulcers, filled with the H pylori bacteria. Marshall then took antibiotics and fully recovered from the stomach ulcers. He and Warren were proven right. 

But as we have undoubtedly experienced in our own lives,


It's one thing to be right,
but it's quite another to persuade others they are wrong


Even when the evidence was so overwhelming, it took another 10 years before the National Institutes of Health finally stated that ulcers were almost exclusively caused by H. pylori and could be treated with antibiotics. And it was more than 20 years after Marshall had risked his own well-being, that he and Warren were awarded a Nobel Prize for their research.


Even today, there are still physicians and medical institutions recommending changes to diet and stress. as treatment for stomach ulcers, as the esteemed neuroscientist VS Ramachandran comments:


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