COMMENTARY

How Far Would You Go for Science?

Association for Research in Vision and Ophthalmology (ARVO) 2014 Annual Meeting

Roger F. Steinert, MD

Disclosures

June 27, 2014

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Hi. I am Dr. Roger Steinert, Chair of Ophthalmology at the Gavin Herbert Eye Institute of the University of California, Irvine. I would like to discuss a very fascinating keynote lecture given at the recent Association for Research in Vision and Ophthalmology (ARVO) annual meeting by Dr. Barry Marshall.[1]

Dr. Marshall won the Nobel Prize for his discovery and proof that Helicobacter pylori was the cause of peptic ulcer disease. You may recall that for many decades, it was medical dogma that peptic ulcers were caused by stress, spicy foods, and things of that nature. The treatment was aimed at reducing stomach acid by drinking milk and taking buffered solutions.

While doing a fellowship in internal medicine, Dr. Marshall connected with a pathologist named Dr. Robin Warren, who had an interest in the same area. They discovered that they were culturing H pylori bacteria from patients who had stomach ulcers and postulated that the bacteria were, in fact, the cause of the ulcers.

The story goes that this was scoffed at by the medical establishment at the time because it ran counter to the theories about stomach ulcers; and, moreover, there was a belief that bacteria couldn't survive in the stomach because of the acidic environment.

Ultimately, after some failed experiments, including trying to infect pigs with H pylori, Marshall himself swallowed a petri dish with H pylori in it. He thought that perhaps a year or 2 later, he would develop an ulcer and prove that the H pylori was to blame. Things moved a lot faster than that. He apparently started to feel quite ill, and only 3 days after ingesting the H pylori, he developed bad breath, followed by increasing nausea, loss of appetite, and, ultimately, vomiting.

He underwent an endoscopy and cultures before swallowing the H pylori and repeated those tests right after he became ill. Live H pylori was cultured right out of his stomach; but, in addition, his stomach lining was severely inflamed. He took an antibiotic that was effective against H pylori and very rapidly improved, and his symptoms disappeared. A repeat endoscopy showed resolution of the gastritis.

This satisfied Koch's postulate about proof that a disease is caused by a certain microbe. If the microbe isn't there, and a person doesn't have the disease, you challenge the person with the offending agent, and the disease occurs. When you cure the offending agent, the disease disappears.

At that point, they had proved that H pylori caused acute gastritis. However, that also set in motion the need to prove that H pylori was the cause of peptic ulcer disease and may well be linked to stomach cancer.

There is much more to the story, but the point -- and the reason Dr. Marshall has been telling this story -- was the theme of his keynote lecture at ARVO: discoveries pop out of strange and unexpected places, and you cannot make great breakthroughs and advances by following a well laid-out pathway in advance. You must have curiosity and a willingness to think outside the box and explore things that may seem pretty far-fetched at the time. If you do that, you can then get a pleasant surprise and take things in a new direction. Dr. Marshall was promoting that idea of curiosity, open-mindedness, willingness to explore, and willingness to fail.

I'm Dr. Roger Steinert on behalf of Medscape. Thank you very much for listening, and I would be interested in any thoughts or reactions you might have.

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