J. Robin Warren

the gut

I prefer correcting my errors up front so everyone knows I recognise them. Alex Haley rather than Arthur Haley wrote Roots. I had a funny feeling when I wrote Arthur yesterday but did not take time to confirm: shame on me. Apologies for this unintended mistake. On the more positive side, we dined downtown last night so we saw the crowd surrounding the Alex Haley statues along Ego Alley as we came from and went to the water taxi launch.

My focus today is brief but a reminder of one of the most traditional of American characteristics; it is probably all countries but I perhaps know this one best (not sure some days): we look for an answer, assume a single correct one exists, then move on to the next problem. This pertains to conflict (see the late Russell Weigley’s work on The American Way of War) or deciding which is the fastest diet to lose fifty pounds (en vogue, apparently, is still keto but diets and I parted ways years ago so I mercifully don’t care). We are a nation with history pointing towards progress so solving something to free us for the next challenge is absolutely comfortable and expected in our ethos.

And occasionally, if not often, wrong. I would argue it’s part of the problem we face often regarding facts when we hear that multiple descriptions of a single incident are appearing. Well, duh. Yes, it turns out each individual filters what she or he sees differently, resulting in somewhat varying accounts. I am not exactly sure why that would surprise us except it violates our preference for simplicity, a condition rarely human in my experience. (To me the variety in accounts matter when they are fabricated for effect but that is really a completely different column). Turns out we are not the only ones who stubbornly hold on an incorrect answer to explain a condition or challenge but evidence, EVIDENCE, needs be the bottom line rather than pixie dust, wishing full thinking, conspiracy theories, or willful lying for personal gain..

This is all relevant today because of J. Robin Warren’s obituary. A pathologist from Down Under, Warren and his collaborator Barry Marshall, fought the conventional wisdom about ulcers. I grew up, as did many of you, hearing that ulcers resulted from stress, anxiety, and the associated angst so common in life. Television reinforced it for many of us with shows highlighting an accountant nearly dying from a stressful audit or someone else grabbing her stomach because of stress.

Stress matters, we know, but Warren and Marshall hypothesized that H. pylori, a spiral-shaped bacterium, was instead the cause of illness, based on a sample Warren examined in 1979. This incident led him to question the conventional explanation.

The gastroenterologists, gut docs, poo poohed the paper these men published in the British medial journal, The Lancet. Medicine deemed for the better part of a century that stress caused of this common but extremely painful condition. These same specialists rejected the prospect of the gut even having bacteria since the assumption was, clearly not rigorously tested, that the stomach was a sterile environment.

Warren, an “eccentric” according to the obituary, tested his hypothesis by “gulping down a broth of the bacterium”, then addressing the with antibiotics as would be used in any other infection (don’t do this at home). The scientific community required fully a decade to come around, grudgingly acquiescing to the accumulating evidence, on how to treat ulcers rather than following the prior assumption wildly wrong. The two men won the Nobel Prize for their discovery decades later.

This is an example of how often we, even the most educated among us, trust what are ultimately false assumptions rather than considering evidence that disrupts our comfort level. As a now retired Lieutenant General said when advised he was putting out an erroneous tale about history on a visit to East Asia twenty years ago, “I know you are right but I like my version better”. That’s fine but in medicine and most of fields, he can hold his view for himself but it might affect others so it’s worth getting it right. Turns out that evidence-based science matters.

This is additionally a reminder of science using a method that we see discarded too frequently these days. A scientist must develop a hypothesis, rigorously test that hypothesis, show the evidence she is using to substantiate her analysis, then others must be able to replicate the entire process independently. It’s not enough to trust one’s gut but evidence and replication of the process is vital—and the gold standard. Our intuitions may trigger us to examine a topic but intuition is insufficient to provide evidence. When COVID disputes over bleach and other possible treatments arose, it was the rigorous, replication process that critics sought as assurance these were neither psuedo-science or outright frauds. If one is certain another method or medicine works on an illness, we have a method for determining its authenticity, and later its safety as well. Engineering and other fields use the same tried and true testing.

Finally, Warren’s death reminds all of us that it is appropriate to challenge conventional wisdom. Not to do so would deprive all of us of so many advances. Think about how often you hear discussions regarding the microbiome in that same gut today, an impossibility if we still held the incorrect but common thinking on the stomach.

It was a beautiful sunrise over an hour plus this morning. It never gets old but changes every day.

Thank you for reading Actions create consequences today or any day- it is a privilege to share your time. Please feel free to circulate if you find it valuable. Thank you to the subscribers who pay for this newsletter because your support helps me a great deal.

Be well and be safe. FIN

Cristopher Crenner, “Ulcers, Stress, and the Discovery of Heliocobacter pylori”, The Lancet, 15 June 2024, retrieved at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01206-6/abstract

Alex Haley, Roots: The Saga of An American Family. New York: Doubleday, 1976.

Michael S. Rosenwald, “J. Robin Warren, Who Proved Bacteria Causes Ulcers, dies at 87”, NewYorkTimes.com, 9 August 2024, retrieved at https://www.nytimes.com/2024/08/09/health/j-robin-warren-dead.html

Russell F. Weigley, The American Way of War. New York: MacMillan, 1973.