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Robin Warren, pathologist who rewrote the science on ulcers, has died

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Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#21
post #13

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected t…

https://www.amazon.com/Why-Zebras-Dont-Ulcers-Third/dp/08050...

Why zebras don't get ulcers

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#22
post #13

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected t…

Same thing happened to me about 6 years ago. Told me to relax and not eat spicy foods. Makes me wonder how long medical advancements like this take to really spread to most doctors.

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#24
post #9

This guy was a true unsung hero of the medical world and he really embodied the hacker spirit. Thank you for your contributions.

I think getting a Nobel Prize is as sung as it gets

Barry Marshall has taken most of the credit away from Robin since the prize was awarded.

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#25
post #7

Earlier quoted context omitted.

Can help to fix the: "this is caused by stress", when actually you needed antibiotics that already exists and were known at the time :|

Thats a bit of a myth though. Stress is still known to be a factor in causing ulcers. https://www.ingentaconnect.com/content/ben/cpd/2020/00000026...

What is a bit of a myth? Sounds like stress is a factor but the bacteria is a direct cause in 90 percent of cases. The myth was that stress is "the cause".

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#26
post #13

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected t…

I have IBS. During my last visit, my GI doctor apropos of nothing blurted out, "you've got to get your anxiety under control!"

"What are you talking about?" I asked.

"You said the stress of getting ready to leave for the office triggers your attacks," he said.

"I work from home!!" I said. "_YOU_ posed a hypothetical and I answered with a hypothetical: that it would certainly be stressful if that happened. I also said I still have the IBS attacks when I don't have a stressful day."

In my opinion general practitioners (who are not therapists) putting their patient's issues down to "anxiety" or stress is like doctors diagnosing "hysteria" in 19th century women: it contains the in-built subtext that you're not a reliable narrator of your own symptoms, and there is no evidence you can present to disprove the accusation of "hysteria" or "anxiety".

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#27
My father is a GI researcher, and gave a talk on Warren and other innovators and innovations in the field (which includes endoscopy, the direct result of an innovation in computer networking, Narinder Singh Kapany's paper on fiber optic cable).

Anyway, the term that was used to describe the resistance to Warren and Marshall's resesarch was "the Acid Mafia."

Barry Marshall realized that some of the patients that Robin Warren was telling him about were his own patients. He had learned fiberoptic endoscopy, and he was performing biopsies on these same patients and knew their medical histories. So this clinical connection lit a spark, and the two of them teamed up and made a remarkable discovery. What they did was to simply correlate this finding with the presence of active chronic gastritis. They published their first paper, a brief letter to the editor in Lancet in 1983t, which described a series of their patients with active gastritis and the present of this curved bacillus in their stomachs.

They went on then to make further correlations between the curved bacilli and peptic ulcers and eventually gastric cancer. This discovery was innovative and totally new. and was met with huge resistance by the medical establishment. The notion that peptic ulcer was an infectious disease met with near universal rejection. I actually remember the journal club in a Boston teaching hospital near here where this was first presented. The discovery was universally rejected by most of us in attendance. The problem was that in certain parts of the world, 80% of the population were infected. How could something that common be a cause of a disease like peptic ulcer that only occurs in, say, 1% of the population?

Barry Marshall wrote in his note cards and some of his later publication “Everyone was against me, but I knew I was right.”

So who was against him? The acid mafia, a powerful group of senior investigators who championed the idea that hydrochloric acid was the key to formation of stomach ulcers. When we were residents and fellows we had to know a lot about gastric hydrochloric acid secretion. So those who believed in the primacy of stomach acid were definitely strongly opposed to these Australian upstarts, Marshall and Warren. (https://archive.blogs.harvard.edu/lamont/2020/01/30/advances...)

Another pattern that came up in these discoveries was the doctors and researchers experimenting on themselves. For example:

In this instance the experimental subject was Barry Marshall himself. He swallowed a pure culture of Helicobacter pylori that he had isolated from one of his patients that he had previously biopsied and cured. So he knew that the strain was treatable and curable. He drank the culture of H pylori and over the next several weeks developed severe acute Helicobacter infection with nausea, vomiting, and severe dyspepsia. He stated that his halitosis was so bad, that his wife told him that he had to sleep on the couch. After the infection was established he treated himself with the anti-Helicobacter therapy and completely recovered. His experiment was soon published in the Medical Journal of Australia in 1985.

Basil Hirschowitz, the godfather of endoscopy, also followed the self-experimentation path:

Hirschowitz heard about [the fiber optic] paper from a cardiology resident who had heard about it at journal club in London. Hirschowitz flew to London, met Kapany and Hopkins in a pub, and discussed their invention. They were very encouraging to Hirschowitz and gave him a few glass fibers to take back to Ann Arbor. Hirschowitz returned to his fellowship at Michigan and built the first fiberoptic gastroscope with help from Larry Curtis and Wilbur Peters who were physicists. After a few years of trial and error, they produced the first gastroscope ... Like a lot of fellows and young researchers in science, first tested the device on himself in February 1957. He managed to control his own gag reflex, passed through his esophagus and looked around in his own stomach.

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#28
post #22
post #13

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected t…

Same thing happened to me about 6 years ago. Told me to relax and not eat spicy foods. Makes me wonder how long medical advancements like this take to really spread to most doctors.

That’s “translational medicine” or “translational science” —> getting lab proven stuff to the bedside.

And yeah, it can take a while.

My dream is to a have a dumb doctor/mechanic/plumber/blah that just researches even the most basic questions unless it’s something really odd-ball and only then defaulting to their “expert opinion”.

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#29
post #13

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected t…

I have IBS. During my last visit, my GI doctor apropos of nothing blurted out, "you've got to get your anxiety under control!" "What are you talking about?" I asked. "You said the stress of getting ready to leave for the office triggers your attacks," he said. "I work from home!!" I said. "_YOU_ posed a hypothetical and I answered with a hypothetical: that it would certainly be stressful if that happened. I also said…

Yeah, that's my issue; stress is a somewhat nebulous thing that's hard to directly quantify and therefore it can be a kind of "catch all" for nearly anything.

I'm not saying that stress doesn't have effects, but I think a diagnosis based on "stress" can often be reductive; who doesn't feel some stress throughout the day?

Re: Robin Warren, pathologist who rewrote the science on ulcers, has died

#30
post #13

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected t…

Last time I asked my doc about something he wasn't sure of, he googled it in front of me and frankly I respect the hell out of that.
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