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

I got a different doctor after that.

Robin Warren is someone who I respected the hell out of. It takes a lot of tenacity and determination to go against something when everyone is constantly telling you you're wrong. He will be missed.

ETA:

I should point out that I am aware that stress can aggravate and (potentially) cause some forms of ulcers, though I really wasn't terribly stressed at that point in my life, which I tried explaining to the doctor and he wouldn't hear it. My job was going fine, I didn't really have any debt, I had a decent relationship with my girlfriend (now wife), I really didn't feel stressed out at all.

I believe that my ulcer was caused by daily doses of the antibiotic Tetracycline which the family Dermatologist prescribed for acne. Once I stopped taking it, my symptoms were gone.

https://www.britannica.com/biography/Robin-Warren

> It defied the conventional wisdom that bacteria could not survive in the highly acidic environment of the stomach, and many scientists dismissed his reports.

There is some point in the process where those "many scientists" should have been prevented from doing any further peer reviews, at the very least. If you always say No, your opinion has no value.

But in practice it turned out to be more complicated than the narrative; X is still somewhat true and ulcers and gastric disorders are both caused by, and affected by, multiple factors. Certainly, stress can exacerbate an existing latent ulcer or gastric disorder, making many people attribute the cause to stress, but this quickly gets into "proximal causes" and "ultimate causes".

As for working with doctors who didn't get the memo, I've learned that you sort of have to sneak up new information to them without making them feel challenged by a non-expert. It's a form of social engineering.

“Man, we find your problem”

Fortunately, the Canadian medical system knew about Dr Warren’s work and so I was properly treated with antibiotics and completely cleared up in 2 weeks, never had a recurrence.

I owe that guy a lot, I’ve heard many horror stories about ulcer treatments since then, it’s shocking this isn’t known by literally 100% of doctors (of all specialties)

https://www.nature.com/articles/s41591-024-03153-w

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.