Challenging Science’s Status-Quo: The tale of Barry Marshall

He even downed a liquid shot of bacteria to give himself an ulcer… Just to prove the link.

This is a story of perseverance and the“never give up” attitude of a Western Australian by the name of Barry Marshall, who won a Nobel Prize in 2005 for his work linking stomach ulcers with the bacterium Helicobacter Pylori. He had to drink a shot of the bacteria, and rely on a tabloid to champion his research, to get there.

Around 20 years earlier, he was humiliated. His discovery and research linking this spiral-shaped bug with ulcers of the stomach and duodenum received very little attention from the scientific community. He didn’t even make the best 56 of 67 abstracts to be presented at a meeting run by Australia’s Gastroenterological Society:

Barry Marshall receives notification from the Gastroenterological Society in 1983 that his abstract is amongst the bottom 20% for presentation
“To gastroenterologists, the concept of a germ causing ulcers was like saying that the Earth is flat. After that I realized my paper was going to have difficulty being accepted. You think, “It’s science; it’s got to be accepted.” But it’s not an absolute given. The idea was too weird.”

A harsh verdict for Barry Marshall, who ranked in the bottom 20% of submitted abstracts for what he judged to be pioneering work. It wasn’t just his work, of course. The Western Australian was training as a gastroenterology doctor and encountered Dr Robin Warren, a pathologist who was trying to find out the cause of painful stomach ulcers, and had in particularly found a bacteria was present in biopsies of almost every patient who had these: Helicobacter Pylori. Not only stomach ulcers, this same bacteria were also seen on biopsies of stomach cancer patients. 

Marshall was very interested in Warren’s findings, and opened the history books to investigate this spiral bug which was first described in 1893, and even suggested to have a link with ulcers back in 1940. Why had the theory linking it with ulcers disappeared in the forties? The answer is that the doctor who suspected this, again based on patients who had the organism, was encouraged to stop his research because it “wasn’t easy to prove” to the scientific community. The consensus was that bacteria couldn’t survive and thrive in the stomach acid, so would there’s no way that it could contribute to ulcer formation. Imagine if this link had been discovered four decades before.

Ulcers were caused by stress — this was the status quo. Other challengers over the decades came and went. One of these, John Lykoudos, was fined by Greek health authorities when he refused to stop giving people with ulcers antibiotics. 

But Marshall and Warren did not mind being scientific pariahs. They believed that this perception was wrong. Marshall would not give up on the hypothesis that these bacteria cause gastric ulcers, and increase the risk for stomach cancer. 

“If I was right, then treatment for ulcer disease would be revolutionized. It would be simple, cheap and it would be a cure. It seemed to me that for the sake of patients this research had to be fast tracked. The sense of urgency and frustration with the medical community was partly due to my disposition and age. However, the primary reason was a practical one. I was driven to get this theory proven quickly to provide curative treatment for the millions of people suffering with ulcers around the world.”

However, Marshall’s work was met with scepticism wherever he went.

“There was interest and support from a few but most of my work was rejected for publication and even accepted papers were significantly delayed. I was met with constant criticism that my conclusions were premature and not well supported. When the work was presented, my results were disputed and disbelieved, not on the basis of science but because they simply could not be true. It was often said that no one was able to replicate my results. This was untrue but became part of the folklore of the period. I was told that the bacteria were either contaminants or harmless commensals”.

There was, of course, another motivation to the lack of interest with Marshall’s work. 

“I tapped all the drug companies to request research funding for a computer. They all wrote back saying how difficult times were and they didn’t have any research money. But they were making a billion dollars a year for the antacid drug Zantac and another billion for Tagamet. You could make a patient feel better by removing the acid. Treated, most patients didn’t die from their ulcer and didn’t need surgery, so it was worth $100 a month per patient, a hell of a lot of money in those days. In America in the 1980s, 2–4% of the population had Tagamet tablets in their pocket. There was no incentive to find a cure… I had this discovery that could undermine a $3 billion industry, not just the drugs but the entire field of endoscopy. Every gastroenterologist was doing 20 or 30 patients a week who might have ulcers, and 25 percent of them would. Because it was a recurring disease that you could never cure, the patients kept coming back”

These portentous pecuniary walls did not faze Marshall. With immense commitment to his cause, he decided to take things a step further. He stuck to his guns and took a shot of H.Pylori himself, stirring the bug which he took from the gut of a sick patient into a broth. 

“I swizzled the organisms around in a cloudy broth and drank it the next morning”

He did not know what to expect, and was fine for a few days. But then he started vomiting and his breath became awful, and he started feeling exhausted. His wife found out, which didn’t rule out the stress hypothesis, but these were the first time he had experienced stomach inflammation symptoms in his life. He arranged an endoscopic biopsy on himself to confirm the diagnosis, treated himself with antibiotics and was cured with no lasting effects. He was convinced.

But unfortunately, others weren’t. Marshall’s research was on the verge of obscurity. In 1984, Aussie Tabloid The Star caught wind of this. Previously the domain of alien abduction and celebrity gossip, they printed the headline:

“Guinea-pig doctor discovers new cure for ulcers … and the cause”

Amazingly, this headline from a tabloid newspaper piqued the interest of scientists and funding providers, and gradually incepted the idea that this might be something worth looking into. Patients starting hearing about it, and came to Marshall asking to be given antibiotics. It took a few more years for enough other doctors to try out the “charlatan” treatment suggested in the rag and asked for by their patients, and be shocked and swayed by the results. It’s hard to find another example of tabloid health journalism having such a positive long-term impact.

Over ten years after his paper was first rejected, the National Institutes of Health (NIH) held a summit and released a statement to say:

The key to treatment of duodenal and gastric ulcer was detection and eradication of Helicobacter pylori.

Eleven years after that, Marshall and Warren were given a Nobel Prize “for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease”. Ulcers were transformed from a chronic and disabling condition to a much more curable one. The standard of care for an ulcer is now treatment with an antibiotic, and stomach cancer is all but eradicated from the Western world. 

Marshall’s figurative middle finger to the scientific community underlined the point that people shouldn’t just reject a theory because it contradicts what was previously believed. If medical journals are gatekeepers for the status quo, maybe something needed to change.

Barry Marshall in 2017. Ever the experimenter, he suffered an injury due to a power saw after a home DIY project. Credit: Picture: Ian Munro/The West Australian

Question everything: Science should be a constant process of curiosity and re-evaluation. Marshall had to drink a shot of spiral-shaped bugs and get picked up by a tabloid paper to show that.

Full rejection letter from the Gastroenterological Society of Australia, 1983
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Seeing Things

An Art Exhibition inspired by the hallucinations of Charles Bonnet Syndrome

Visual Hallucinations

It was a pleasure to attend the first day of the Seeing Things interactive art exhibition, which is taking place at the lovely Forum in Norwich over the next two weeks.

Charles Bonnet Syndrome is a type of visual hallucination which people can experience after sight loss. In comparison with other types of hallucination, those who experience these know that they are just a creation of the brain as a reaction to visual loss.

 Fascinating paintings depicting some of these hallucinations. Source: Own photo

 

The Art of Charles Bonnet

This art exhibition, set up by the NNAB, features art from people who suffer from the syndrome, as well as other visual artists who have been inspired from speaking to those who experience these vivid hallucinations, which have their own unique attributes in comparison with other types of hallucinations.

To the left – a bear statue in front of some upside-down cupcakes. Strange faces can also be a feature of the condition. Source: Own photo

Experiences

Dominic Ffytche, a world expert in the condition, gave a fantastic lecture about the Syndrome, and it was indeed fascinating to listen to the experienced of sufferers from the condition. The audience comprised of people who suffered from the condition, people who had not previously heard of the syndrome and clinicians, such as myself, who are aware about the condition but want to understand more and gain perspective.

I was particularly intrigued by the number of people who experience hallucinations of old period clothing from different eras, which seems to be a consistent feature of the syndrome. Interestingly, even when the syndrome was first described 250 years ago — the literature describes sufferers talking about people wearing period dress of the time. Perhaps 18th century formal-wear has a hallucinatory quality to it?

 Dr Dominic Ffytche, an expert in the condition, shows images of certain visual hallucinations that people experience. Source: own photo

Gaps

Even though Charles Bonnet Syndrome was first described 250 years ago, by a Swiss philosopher who was writing about his grandfather’s experiences having lost his sight to cataracts, we still do not know why exactly it happens. Certainly, we suspect that the brain fills in the gaps generated from visual loss by producing new fantastic pictures or old images which it might have stored. For many people, these hallucinations are not a problem but for some they can, understandably, be distressing. Certainly, it helps to understand these hallucinations and it is useful for both sufferers, the public and clinicians (such as yours truly) to be aware and understand this fascinating condition.

 An interesting hallucination — bear and inverse cupcakes. Source: own photo

To this end, it is fantastic to have an art exhibition which both raises awareness and bewitches us, humbling us as clinicians into realising there is still so much about the eyes and the brain that we don’t yet understand. Do you have any experience of this condition? Please feel free to comment below.

Links:
Royal National Institute of Blind People
Norfolk and Norwich Association for the Blind
NHS Charles Bonnet Syndrome Information

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Professor Stephen Hawking “Our attitude towards wealth played a crucial role in Brexit. We need a rethink”

Source: https://www.theguardian.com/commentisfree/2016/jul/29/stephen-hawking-brexit-wealth-resources

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Money was a key factor in the outcome of the EU referendum. We will now have to learn to collaborate and to share

Does money matter? Does wealth make us rich any more? These might seem like odd questions for a physicist to try to answer, but Britain’s referendum decision is a reminder that everything is connected and that if we wish to understand the fundamental nature of the universe, we’d be very foolish to ignore the role that wealth does and doesn’t play in our society.

I argued during the referendum campaign that it would be a mistake for Britain to leave the European Union. I’m sad about the result, but if I’ve learned one lesson in my life it is to make the best of the hand you are dealt. Now we must learn to live outside the EU, but in order to manage that successfully we need to understand why British people made the choice that they did. I believe that wealth, the way we understand it and the way we share it, played a crucial role in their decision. As the prime minister, Theresa May, said in her first week in office: “We need to reform the economy to allow more people to share in the country’s prosperity.”

We all know that money is important. One of the reasons I believed it would be wrong to leave the EU was related to grants. British science needs all the money it can get, and one important source of such funding has for many years been the European commission. Without these grants, much important work would not and could not have happened. There is already some evidence of British scientists beingfrozen out of European projects, and we need the government to tackle this issue as soon possible.

Money is also important because it is liberating for individuals. I have spoken in the past about my concern that government spending cuts in the UK will diminish support for disabled students, support that helped me during my career. In my case, of course, money has helped not only make my career possible but has also literally kept me alive.

On one occasion while in Switzerland early on in my career, I developed pneumonia, and my college at Cambridge, Gonville and Caius, arranged to have me flown back to the UK for treatment. Without their money I might not have survived to do all the thinking that I’ve managed since then. Cash can set individuals free, just as poverty can certainly trap them and limit their potential, to their own detriment and that of the human race.

Paying for my care as a severely disabled man, and my work, is crucial; the acquisition of possessions is not.

So I would be the last person to decry the significance of money. However, although wealth has played an important practical role in my life, I have of course had a different relationship with it to most people. Paying for my care as a severely disabled man, and my work, is crucial; the acquisition of possessions is not. I don’t know what I would do with a racehorse, or indeed a Ferrari, even if I could afford one. So I have come to see money as a facilitator, as a means to an end – whether it is for ideas, or health, or security – but never as an end in itself.

Interestingly this attitude, for a long time seen as the predictable eccentricity of a Cambridge academic, is now more widely shared. People are starting to question the value of pure wealth. Is knowledge or experience more important than money? Can possessions stand in the way of fulfilment? Can we truly own anything, or are we just transient custodians?

These questions are leading to a shift in behaviour which, in turn, is inspiring some groundbreaking new enterprises and ideas. These are termed “cathedral projects”, the modern equivalent of the grand church buildings, constructed as part of humanity’s attempt to bridge heaven and Earth. These ideas are started by one generation with the hope a future generation will take up these challenges.

I hope and believe that people will embrace more of this cathedral thinking for the future, as they have done in the past, because we are in perilous times. Our planet and the human race face multiple challenges. These challenges are global and serious – climate change, food production, overpopulation, the decimation of other species, epidemic disease, acidification of the oceans. Such pressing issues will require us to collaborate, all of us, with a shared vision and cooperative endeavour to ensure that humanity can survive. We will need to adapt, rethink, refocus and change some of our fundamental assumptions about what we mean by wealth, by possessions, by mine and yours. Just like children, we will have to learn to share.

If we fail then the forces that contributed to Brexit, the envy and isolationism not just in the UK but around the world that spring from not sharing, of cultures driven by a narrow definition of wealth and a failure to divide it more fairly, both within nations and across national borders, will strengthen. If that were to happen, I would not be optimistic about the long-term outlook for our species.

But we can and will succeed. Humans are endlessly resourceful, optimistic and adaptable. We must broaden our definition of wealth to include knowledge, natural resources, and human capacity, and at the same time learn to share each of those more fairly. If we do this, then there is no limit to what humans can achieve together.

• Stephen Hawking recently launched www.unlimited.world

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OrCam MyEye Headset Review – Demonstration & analysis of the My Eye wearable OCR vision aid glasses

OrCam’s MyEye is an Optical Character Recognition wearable device which takes the picture of text and converts it into sound. It also recognizes faces and products and currently retails for 3500 dollars in America and Canada, and 2200 pounds in the UK.

It has two main parts: the combined camera-speaker unit and the computer unit which contains a rechargeable battery. In this video, the awesome Tony explains the advantages that he has already experienced.

This kind of device can have a massive impact on the life of the around 300 million people in the world who are vision impaired. I hope it becomes more mainstream and affordable.

This video will never be monetised.

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