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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

#91

Post by istultus »

01100011 wrote: post #83
deangiberson wrote: post #32

I was diagnosed with ulcers at the age of 10, well before Warren's work. For 11 years I dealt with constant pain and people telling me I just needed to learn how to relax. At the age of 21, at my next twice-yearly doctor appointment, my doctor asked me if I had heard about this news. I had, and I was willing to try it out as an experimental treatment. Eight weeks later I was cured. No pain. No after effects. Robin Wa…

Counterpoint: I was diagnosed with a duodenal ulcer at 12. It was from stress. My dad has a large amount of scar tissue in his stomach from repeated ulcers. They magically went away when the doc lit a cigarette and told him they were gonna remove part of his stomach if it happened again. Never had an ulcer after that. Instead he would break out in hives when his stress level rose.

How is that a counterpoint? You're just presenting a rare case, like Zollinger-Ellison, or some genetic or physiologic Vagal over-stimulation. 80%+ of ulcers are caused by H. Pylori infection. Next largest group is misuse of NSAIDS (also the most common causes for pediatric ulcers). Why would a doctor not first test and treat the common things, rather than do an invasive procedure?

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

#92

Post by pfannkuchen »

01100011 wrote: post #83
deangiberson wrote: post #32

I was diagnosed with ulcers at the age of 10, well before Warren's work. For 11 years I dealt with constant pain and people telling me I just needed to learn how to relax. At the age of 21, at my next twice-yearly doctor appointment, my doctor asked me if I had heard about this news. I had, and I was willing to try it out as an experimental treatment. Eight weeks later I was cured. No pain. No after effects. Robin Wa…

Counterpoint: I was diagnosed with a duodenal ulcer at 12. It was from stress. My dad has a large amount of scar tissue in his stomach from repeated ulcers. They magically went away when the doc lit a cigarette and told him they were gonna remove part of his stomach if it happened again. Never had an ulcer after that. Instead he would break out in hives when his stress level rose.

Like you tested negative for h pylori? How do you know it was from stress?

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

#93

Post by cocok »

istultus wrote: post #91
01100011 wrote: post #83

Earlier quoted context omitted.

Counterpoint: I was diagnosed with a duodenal ulcer at 12. It was from stress. My dad has a large amount of scar tissue in his stomach from repeated ulcers. They magically went away when the doc lit a cigarette and told him they were gonna remove part of his stomach if it happened again. Never had an ulcer after that. Instead he would break out in hives when his stress level rose.

How is that a counterpoint? You're just presenting a rare case, like Zollinger-Ellison, or some genetic or physiologic Vagal over-stimulation. 80%+ of ulcers are caused by H. Pylori infection. Next largest group is misuse of NSAIDS (also the most common causes for pediatric ulcers). Why would a doctor not first test and treat the common things, rather than do an invasive procedure?

> Why would a doctor not first test and treat the common things, rather than do an invasive procedure?

For the money he/she would get for doing the invasive procedure. This happens even in developed countries.

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

#94

Post by potkin »

redhed wrote: post #22
tombert wrote: 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.

How long medical advancements take to spread, and also how long the ineffective or outright harmful practices persist.

I guess on HN we're all relatively pro-science. But the world would be a better place if we recognised that our scientific knowledge in some areas is poorer than we like to pretend.

I started feeling that way when I worked alongside some "Evidence-Based Medicine" advocates. Years later I've landed in data science and the standards of statistical analysis and understanding I see especially in the biological sciences has only made me more sceptical.

Way back in 2007 the BMJ as part of its Clinical Evidence project published its systematic research into standards of evidence in support of common medical treatments. Some 2500 treatments were evaluated to determine whether they are supported by sufficient reliable evidence.

• 13% were found to be beneficial. • 23% were likely to be beneficial. • 8% were as likely to be harmful as beneficial. • 6% were unlikely to be beneficial. • 4% were likely to be harmful or ineffective. • 46% were unknown whether they were efficacious or harmful.

It's quite hard to find the original Clinical Evidence project resources (might be a job for the wayback machine) but you can find it referenced all over, e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2071976/ .

In the 1970s the US Office of Technology Assessment conducted a similar evaluation of medical treatments' efficacy and found that only 10% to 20% of medical treatments had evidence of efficacy. I would love to see more recent research in this vein.

There are clearly many complications and caveats around all this. Not all "common treatments" are easily studied -- the gold standard of the RCT is not always feasible or ethical. And of course absence of evidence is not evidence of absence, etc... but it sometimes feels we should be a bit more humble about even our best science.

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

#95

Post by retrac »

leogao wrote: post #71
manmal wrote: post #69

Earlier quoted context omitted.

You likely have chronic heliobacter pylori infection and should really look into that. It’s a silent killer and that way beyond just ulcers since it’s a potent acetaldehyde producing microbe. Tests are often false negative because they can hide in places, eg Candida vacuoles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101746/

Is there a better test than the one that is normally prescribed, to distinguish the false positive cases you describe?

Antibiotics are diagnostic in a sense. Take antibiotics active against H pylori. If your ulcer goes away, it was H pylori.

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

#97

Post by phkahler »

cpncrunch wrote: post #35
phkahler wrote: post #25

Earlier quoted context omitted.

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".

50% of people are infected with H.Pylori, so clearly the bacteria isn't a cause on its own. The myth is more that "stress doesn't cause ulcers", which many people now believe.

But stress doesn't cause ulcers.

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

#98

Post by cpncrunch »

phkahler wrote: post #97
cpncrunch wrote: post #35

Earlier quoted context omitted.

50% of people are infected with H.Pylori, so clearly the bacteria isn't a cause on its own. The myth is more that "stress doesn't cause ulcers", which many people now believe.

But stress doesn't cause ulcers.

It does. See the review above, and in my other comment.

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

#99

Post by OkayPhysicist »

MobiusHorizons wrote: post #82
trhway wrote: post #67

Earlier quoted context omitted.

well, may be civilization would be much better off if we went straight to electrified industrial society using wind and hydro energy bypassing burning of dinosauruses - windmills and watermills were known for millennia, one only had to add copper winding and some magnetic iron, the things available for the last 2000+ years. > We either become an interplanetary species or this planet eventually becomes our tomb. Yes,…

How do you get the prerequisites for solar without access to large amounts of energy? Solar cells are made from silicon wafers which must be refined and doped to work. Maybe we could build windmills if we salvage copper and magnets, but refining even copper would be challenging without access to high heat fossil fuels. I guess you would have to bootstrap using charcoal, which would be very labor intensive.

Photovoltaics are not the only form of solar electricity production. Concentrated thermal solar power can easily get into the hundreds of megawatts range.

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

#100

Post by glhaynes »

Scoundreller wrote: post #28
redhed wrote: post #22

Earlier quoted context omitted.

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”.

I've thought for a long time that medicine in the AI era would end up with nurses being even more important than they are today but with doctors being drastically less so. (I know next to nothing about healthcare; this is just a guess!)
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