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The Discoverer

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In 2005, Drs. Barry J. Marshall and Robin Warren, both Australians, won the Nobel Prize in medicine for proving, partly by accident, that bacteria and not stress was the main cause of painful ulcers of the stomach and intestine. Yes, a general practioner proved that ulcers are not caused by stress, spicy foods, or even cigarettes and alcohol, but rather by a bacterium. It was one of the most richly deserved Nobel Prizes in Medicine ever awarded.

Prior to the discovery, the number one surgical operation (in terms of revenue produced for the surgeons and hospitals) was the vagotomy and antrectomy. Prior to the discovery, the number one drugs were H2 receptor blockers like Tagamet and the then up and coming proton pump inhibitors like omeprazole. Single handedly, he got rid of both the number one surgical operation and the largest part of the market for the number one drugs, dealing a huge blow to both big surgery and big pharma, and making the lives of tens of millions much more pain free and enjoyable.

How many loved-ones had died of a bleeding ulcer? Today, they would have been cured permanently by a two week course of antibiotics. Oh! How having that big mug of thick black coffee without having to chase it with a half bottle of Maalox!

And the Aussie did it without any research grants and over the dead body opposition of the entire world of medicine, gastroenterology, surgery, the NIH, and the pharmaceutical industry. And, for gosh sakes, he used himself as the definitive guinea pig!

In 1982, Dana Farber's Emil Frey won the Karnofsky Award. In his acceptance speech at ASCO, he decried the demise of the "discoverer" (risk taker, not so well organized, high failure rate, but big payoff when successful) because of the ascendancy of the "investigator" culture (no risk taking, well organized, exhaustive analysis of trivial hypotheses, huge payoff when successful).

The mindset of rewarding academic achievement and publication over all else. We would all like to think that organizations, government agencies, scientists, researchers, and even practitioners work together, sharing information "for the benefit of patients." However, each group has its own priorities and its own agenda. Moreover, the image of cooperation between these very different groups only gives the illusion that reform isn't needed. The present system exists to serve academic achievement and publication, but not to serve the best interests of people.

This is a perfect example of thirty-five years of the trail-and-error mind-set (empiricism) that has occupied cancer research. The cancer "investigator" culture that prizes itself on the exhaustive examination of trivial hypotheses, while eschewing support of cancer "discoverer" type research, attempting to create entirely new paradigms of cancer treatment. A dysfunctional culture that pushes tens of thousands of physicians and scientists toward the goal of finding the tiniest improvements in treatment rather than genuine breakthroughs, that rewards academic achievment and publication even though their proven "activity" has little to do with curing cancer.

If you ever get a chance to watch a 1940 movie, starring Edward G Robinson, called "Dr. Ehrlich's Magic Bullet," watch it. Ehrlich is one of the very first pioneers of chemotherapy. Ehrlich was the discoverer of the first effective treatment for syphillis. The movie is a very accurate foreshadowing of chemotherapy of cancer, one century later. Ehrlich's treatment was very toxic, but it worked, sometimes miraculously. This work inspired Alexander Fleming, who later discovered penicillin, which was a true magic bullet (Ehrlich's bullet was a wondrous bullet, but it wasn't magic).

The belief that research grants and the NIH will be our salvation can be so off base. Here and there around the world, there are decisions still being made by folks who aren't in the pockets of American Big Business. Individual intelligence, integrity and curiosity. Maybe there is a glimmer of hope?

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  • 2 months later...

Dr. Julie Parsonnet, Professor of Medicine and of Health Research and Policy at Stanford University School of Medicine, wrote a Perspective of Marshall and Warren's achievement in the December 8, 2005 issue of the New England Journal of Medicine:

The insights that have already been gleaned are certain to be important for similar diseases in other organ systems. Indeed, the discovery of H. pylori has inspired researchers to examine previous convictions with new skepticism and to pursue more aggressively the possibility of infectious causes of myriad chronic diseases, including cancers, rheumatologic diseases, and atherosclerosis.

The clinical and scientific importance of H. pylori has exceeded everyone's wildest expectations. Yet the most important legacy of Marshall and Warren's award may have less to do with science than with the inspiration it should provide to medical practitioners worldwide. This year's (2005) Nobel Prize was a prize for clinicians. At the time of their discovery, Warren and Marshall were physicians doing their daily jobs.

They were not in the laboratory chasing after the Nobel Prize. They had no intention of being in the limelight. They had no research grants for studying ulcer disease. Rather, they happened upon something interesting, and driven by curiosity, they investigated and reported it. They proved again that we, as physicians, can make groundbreaking discoveries in the course of our clinical practices if we attend to our work with open eyes, a sense of curiosity, a desire to understand, and a willingness to pursue ideas to their completion.

In other words, these two doctors from Western Australia won the Nobel Prize by being exemplars of the great clinician described millennia ago by Hippocrates: "Many and elegant discoveries have been made . . . and others will yet be found out, if a person possessed of the proper ability, and knowing those discoveries which have been made, should proceed from them to prosecute his investigations." May Marshall and Warren inspire others to do likewise.

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