[HN Gopher] Robin Warren, pathologist who rewrote the science on...
___________________________________________________________________
Robin Warren, pathologist who rewrote the science on ulcers, has
died
Author : bookofjoe
Score : 138 points
Date : 2024-08-02 10:47 UTC (12 hours ago)
(HTM) web link (www.washingtonpost.com)
(TXT) w3m dump (www.washingtonpost.com)
| anon115 wrote:
| i had h pylori and got infected twice resulting me in having
| chronic gastritis,daily heartburn, and esophagitis and ppi' made
| it worse had to eat plain foods for about approx 3 years to get
| better.and also drink cabbage juice daily, and eat brocolli
| sprouts (it kills the bacteria) you can also increase the potency
| of broccoli sprouts with mustard seeds. and their was another way
| of having to heat the broccoli sprouts but i forgot the process
| themadturk wrote:
| My mother-in-law suffered from ulcers for years before this
| discovery. She was successfully treated and lived the rest of her
| life ulcer-free.
| bookofjoe wrote:
| https://archive.ph/V6n3e
| neonate wrote:
| https://web.archive.org/web/20240801085715/https://www.washi...
| quantumwoke wrote:
| This guy was a true unsung hero of the medical world and he
| really embodied the hacker spirit. Thank you for your
| contributions.
| rvnx wrote:
| Can help to fix the: "this is caused by stress", when actually
| you needed antibiotics that already exists and were known at
| the time :|
| cpncrunch wrote:
| 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.
| ..
| EdwardCoffin wrote:
| A perhaps easier to understand explanation of this is this
| part of a Robert Sapolsky talk on stress, prepositioned to
| the bit where he talks about the interaction of stress with
| the bacteria [1]. The summary is that the body is good at
| repairing the damage the bacteria do, unless the person is
| under constant stress which inhibits the repair work.
|
| [1] https://youtu.be/D9H9qTdserM?si=bLeu9PmUgcCEAT41&t=1759
| cpncrunch wrote:
| Stress itself damages the stomach and gut, reducing
| mucous barrier, as per the Arunabha review.
| cue_the_strings wrote:
| I had gastritis (duodenitis, in fact) a couple of years
| back, and the first thing they did was test me for H.
| pylori. I didn't have it. Doctor told me a vast majority of
| people with such issues do.
|
| After a gastroscopy, they concluded that it was just stress
| and nothing else, but inflamation wouldn't heal on its own,
| so I got pantoprazole (PPI) and stopped ingesting
| potentially irritating food (caffeine, alcohol, spicy
| food). I also shortly changed jobs, which alleviated the
| stress. Mind you, I never had heartburn, just pain. My
| condition didn't improve for a while after that, until I
| stopped drinking carbonated water (the only carbonated
| beverage I consumed), that fixed it in less than a month.
| After that, I gradually weaned myself off of pantoprazol in
| 6 months.
|
| There literally was no other probable cause except for
| stress (I was stressed, wholly self-induced), and after I
| switched industries and no longer felt that I'm wasting my
| time working for peanuts, the PPIs helped cure the
| symptoms.
| raincom wrote:
| Wow, carbonated water is not good overall.
| cue_the_strings wrote:
| Yeah, and I didn't drink too much of it either; like 1 or
| 2 glasses a day, often 0, probably 1 on average.
| phkahler wrote:
| 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".
| cpncrunch wrote:
| 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.
| hooverd wrote:
| what stress exactly? will a bad breakup cause ulcers? will
| hitting the gym cause ulcers?
| cpncrunch wrote:
| Burns and other life threatening conditions are the main
| cause. Between 60 and 100% of patients entering the ICU
| have stress ulcers. Chronic workplace stress, job
| frustration and family problems are also associated with
| ulcer development.
|
| https://www.ingentaconnect.com/content/ben/cmm/2008/00000
| 008...
| geokon wrote:
| I think getting a Nobel Prize is as sung as it gets
| quantumwoke wrote:
| Barry Marshall has taken most of the credit away from Robin
| since the prize was awarded.
| toomuchtodo wrote:
| Related: https://news.ycombinator.com/item?id=41118638
| dang wrote:
| I've moved those comments hither. Thanks!
| toomuchtodo wrote:
| Please accept this comment as my perpetual permission to edit
| or remove my stub comments in this regards, and replace them
| with your own references.
| erikig wrote:
| I didn't know the wholes story but I thank Robin. As a teen, I
| remember the relief when the years of advice to "learn to relax"
| and "stop stressing out" was replaced by meds that fixed my
| ulcers in weeks.
| adamc wrote:
| Here's a guy who had epilepsy severe enough that his parents
| feared to send him to college who made an enormous difference in
| the lives of many people.
| tombert wrote:
| 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 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.
| Retric wrote:
| There's an interesting level to this as there is a link between
| stress and ulcers. Stress reduces the mucous barrier and how
| quickly you heal, so reducing stress actually was helping
| people with ulcers. Antibiotics however where more effective in
| most but not all cases.
| tombert wrote:
| Yeah I made an edit to kind of clarify on that.
|
| I really wasn't stressed at that time; outside of the typical
| annoyances of being alive, my life was going pretty ok at
| that point, which I tried telling the doctor and he didn't
| believe me. After that I went to a different doc and she gave
| me antibiotics and I healed after a few weeks.
|
| I am extremely thankful that I have not had an ulcer again
| since then, because it was the worst thing ever.
| dralley wrote:
| The handful of times I've had ulcers in the past it was
| certainly correlated with stress. Perhaps indirectly through
| some other effects, but stress feels like part of the equation
| IME, at least for some people.
| xenadu02 wrote:
| Stress can aggravate ulcers, as it can aggravate any number
| of underlying conditions. Similarly eating spicy food can
| make the symptoms of acid reflux much worse thanks to
| capsaicin in the refluxing acid. But in both cases the root
| cause is something else.
| manmal wrote:
| 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/
| apwell23 wrote:
| https://www.amazon.com/Why-Zebras-Dont-Ulcers-Third/dp/08050...
|
| Why zebras don't get ulcers
| redhed wrote:
| 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.
| Scoundreller wrote:
| 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".
| kevinmchugh wrote:
| Science advances one funeral at a time
| BurningFrog wrote:
| Several, if you count the patients.
| MichaelDickens wrote:
| Robert Warren is most likely older than the doctor in
| question, so it would seem the science needs at least two
| generations of funerals in this case.
| trhway wrote:
| sometimes i think even funerals can't help.
|
| For example, several years ago significant cataract
| improvement was achieved by applying to eyes lanasterol
| (chemical in your body clearing cataract naturally) with
| DMSO (well known widely used solvent which is used in
| particular to deliver various medicine through the skin,
| etc., and some adventurous people are also using it to for
| example deliver dye into eyes to change the eye color).
| Several other scientific teams at different places tried to
| reproduce the result by applying lanasterol without DMSO,
| and no improvement happened. They concluded that the
| original study effect is non-reproducible and that the
| application of lanasterol is non-effective. I'm not kidding
| - you can google these articles yourselves.
| melling wrote:
| Sounds like they are still trying to use lanasterol:
|
| https://pubmed.ncbi.nlm.nih.gov/36484206/
|
| I see stories about this being used for cataracts going
| back almost a decade.
|
| Medicine advances so slowly.
| trhway wrote:
| Of course, as lanosterol is how your body does it when
| things work ok on their own. The issue is delivery, and
| for unknown reason they are doing it without DMSO or
| anything similar. Lanosterol with its large molecular
| weight have no chances of making it inside on its own.
| The other way of course is injecting it directly into the
| eye, and it probably would have to be done many times,
| and, once injections stop, the crystalline accumulation
| may happen to start again (as cataracts indicate that the
| body probably have some issue producing and delivering
| lanosterol naturally), ie. cataract returning, and in
| this case the cataract surgery starts to look like not
| that bad of an approach solving the issue once and for
| all.
|
| >Medicine advances so slowly.
|
| This is one on my deepest existential fears - not just in
| medicine - the Ancient Greeks could have had steam
| turbine based ships, yet it took more than 2000 years,
| and i'm wondering with a tint of fear what wonderful
| things we're missing on and what Dark Ages we have to
| pass through before getting to those things (and i'm not
| going to see them being long gone before it). The high-
| tech with AI, etc. is the only area where i feel that the
| progress has at least some minimally reasonable speed (or
| at least it is hardly reasonable to ask Nature for
| something faster than the Moore law), and if it were in
| high-tech there would be already 10 start-ups funded by
| at least $100M each perfecting and productizing the
| combinations of DMSO+lanosterol and exploring the similar
| approaches :) Unfortunately it seems there is no money
| here, and the Robin Warren's discovery didn't make him a
| billionaire.
| paulmd wrote:
| the bigger problem is that if society collapses again
| there are few easily-accessible resources anymore,
| particularly fuel/energy. Consider the coincidence of
| factors that led to the industrial age in Britain... some
| of those can't be reproduced again.
|
| Mining garbage dumps for resources could of course be a
| thing, but probably not abundant energy.
|
| This time there is no plan B. We either become an
| interplanetary species or this planet eventually becomes
| our tomb. Probably a couple millennia.
| maxerickson wrote:
| They'd mine ruins of the fallen civilization, not dumps.
| trhway wrote:
| 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, only my version of the "tomb" is that it becomes our
| ant city/colony as we become totally connected and our
| societies naturally become highly totalitarian (not
| necessarily due to some ideology, you'd just naturally
| have less and less space/resources/opportunities for your
| private endeavors). Some ant colonies exist uninterrupted
| for several thousand years, no progress, just happy busy
| ants doing their happy stuff. Only few of us who'd get
| off that planet will have a chance to continue the
| civilizational progress. Kind of bifurcation of our
| species. Interesting that Musk advances our civilization
| in both directions - neural implants as well as SpaceX.
| jcynix wrote:
| More specifically Max Planck wrote: "A new scientific truth
| does not triumph by convincing its opponents and making
| them see the light, but rather because its opponents
| eventually die and a new generation grows up that is
| familiar with it ..."
|
| https://en.wikipedia.org/wiki/Planck%27s_principle
| throwup238 wrote:
| Most famously quoted in the _Structure of Scientific
| Revolutions_ , which seems apt to link here: https://en.w
| ikipedia.org/wiki/The_Structure_of_Scientific_Re...
| Log_out_ wrote:
| This is a problem with alot of thirdwirld surgery. If some
| old doctor gets to operate your appendix, he might gut you
| like fish,like they did back in the 80s, scar from heart to
| hip.not even due to missing equipment but a lack of schooling
| and experience on newer techniques.
| cbsmith wrote:
| Why limit it to third world surgery? Sounds like it's a
| problem with a lot of first world medicine as well.
| jorblumesea wrote:
| Continuing education in medicine is a big problem. Once
| someone graduates med school, their knowledge mostly freezes.
| The good ones keep up on latest developments but some don't.
| yongjik wrote:
| I went to an ear doctor recently, who was so old that I think
| he graduated when I was a toddler. But when I describe my
| symptom he says "Well, let's also see what ChatGPT says."
|
| So some part of new medical information might spread faster
| than I had thought.
|
| * My ear problem turned out to be that my ear canal was full
| of wax. I guess we didn't really need ChatGPT that day..
| -\\_(tsu)_/-
| bookofjoe wrote:
| Unless things have changed fundamentally since I was in
| medical school (UCLA Class of 1974), a doctor's visit
| should start with taking a history and move on to a
| physical examination. I would think ChatGPT wouldn't even
| have been mentioned once your PE revealed a wax-filled
| external ear canal.
| phaedrus wrote:
| 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".
| tombert wrote:
| 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?
| apwell23 wrote:
| > stress is a somewhat nebulous thing
|
| So is IBS. I am not sure its fair to expect precise
| diagnosis for a nebulous "disease".
| apwell23 wrote:
| did you find out what the cause was?
| tootie wrote:
| 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.
| taeric wrote:
| This is the poster example I use for how dramatically
| information can change within our lifetime. I still encounter
| people that are unaware that most of the "stress causes ulcers"
| was just wrong.
| tombert wrote:
| It certainly matters more in medicine, where you have very
| serious risk of causing people pain, but as I've gotten a bit
| older I've become a lot more sympathetic to people having
| trouble keeping up with the world sometimes.
|
| Like, it's not a good excuse, don't get me wrong, but as much
| as I try, I simply cannot keep up with the entire state of
| the art of computer science. I wish I could, and a younger me
| without a family and responsibilities actually _would_ mostly
| keep up with everything, but now it just feels like there 's
| never quite enough time to learn everything I really should.
|
| I do _try_ and keep up, I have a million textbooks and the
| like, and I try and at least go through the example problems
| for them, but it 's pretty easy to fall behind in that stuff.
|
| While a GP _should_ keep up to date with ulcer research, and
| "I'm busy!" isn't a great excuse when serious pain and/or
| lives are on the line, but it's something I at least
| understand better now.
| taeric wrote:
| Oh, I absolutely do not use this to demean people that are
| wrong. The point is that well established and largely
| effective knowledge on how things work can be completely
| changed with most of us not realizing it. All the more
| reason not to get upset with someone for not being aware of
| some advances. This should include self.
| cbsmith wrote:
| > Like, it's not a good excuse, don't get me wrong, but as
| much as I try, I simply cannot keep up with the entire
| state of the art of computer science. I wish I could, and a
| younger me without a family and responsibilities actually
| would mostly keep up with everything, but now it just feels
| like there's never quite enough time to learn everything I
| really should.
|
| This is the part of this conversation that I don't get.
| Yes, it is impossible for one person to contain the entire
| body of knowledge, which means you're not going to know
| some of the time, and that might be embarrassing or
| otherwise troublesome.
|
| However... it should be rare that you operate in complete
| isolation. You should be regularly interacting with other
| practitioners, including people whose entry into the field
| is newer, and therefore should be aware of the current
| state of the art. There should be interactions where that
| information is shared, both allowing projects you work on
| to take advantage of advances in the state of the art even
| if you don't know about it, and for you to become aware of
| advances in the state of the art.
| yread wrote:
| Another important pathologist who died recently is Dr. Fletcher
| (he was a president of USCAP at some point)
| https://oncodaily.com/stories/115317.html
| yakito wrote:
| The vast majority of people still today directly associate any
| stomach pain with stress as their first thought. I would even
| venture to say that many doctors still inquire about stress
| during a consultation. Even though it is not the cause of ulcers,
| it is true that stress amplifies the symptoms of existing ulcers
| and increases stomach acid production. Personally, I find stress
| fascinating.
| vjk800 wrote:
| I'm still waiting for a similar discovery to treat GERD. Having
| the condition, I've become a bit of a couch expert on GERD
| literature and it seems that everyone and their dog have a
| completely different opinion on what, in the end, causes it.
| apwell23 wrote:
| Same. It has been bane of my existence for last 3 years.
| te wrote:
| https://my.clevelandclinic.org/health/diseases/8098-hiatal-h.
| ..
| ilamont wrote:
| 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._
| deangiberson wrote:
| 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 Warren impacted my life in a
| very real way.
| memcg wrote:
| I had a bleeding ulcer in high school in the 70s, so assuming it
| was stress, the staff at my all male Catholic HS started to treat
| me like a human being. It wasn't stress, but I enjoyed the
| change.
|
| 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.
| dekhn wrote:
| This is one of those situations where the narrative is fairly
| simple: people believed X, it was wrong, a few iconoclasts
| demonstrated in a fairly convincing way that Y was indeed the
| case, and then over time, the story got rewritten in the
| literature.
|
| 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.
| codesnik wrote:
| Huh. Could you tell more on ways of sneaking up information to
| them? I personally am so undiplomatic I have hard time even to
| imagine, how to do it.
| dekhn wrote:
| I typically made a dumb reference to something I saw in the
| literature (JAMA, BMJ, etc) while also saying "but I guess
| that's just a controversial new opinion".
|
| Basically you want to avoid directly confronting them by
| implying they are dumb or wrong. Instead, appeal to
| authority, but in a soft way, and downplay the confidence of
| the new result.
|
| I had many years of being undiplomatic until I saw a video of
| Kevin mitnick. His normal nature was quite undiplomatic and
| fairly autistic, but when he did social engineering, he did
| an amazing job of telling people what they wanted to hear.
| Now, when I think something, instead of stating it in a clear
| and undiplomatic way, I rewrite it in a way that my mental
| model suggests increases the probability the listeners will
| change their minds and agree with me. This took a great deal
| of practice to be able to do in real time.
| ein0p wrote:
| Seems like there wasn't really any "science of ulcers" before he
| wrote it, so saying that he rewrote it is inaccurate
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