In a previous post I said that the Nobel Prize to Barry Marshall and Robin Warren — for supposedly showing that H. pylori causes stomach ulcers — was a mistake. Because half the world has the bug in their stomach, and only a tiny fraction of them get ulcers, the true cause of those ulcers lies elsewhere, probably with an impaired immune system. Marshall famously drank a flask full of H. pylori and didn’t get an ulcer, yet took this to support his theory. A classic example of self-deception.
Recently Lam Shiu-kum, a former dean of medicine at the University of Hong Kong, was convicted of a giant fraud. He siphoning millions of dollars of medical fees into his own pocket:
Dr Lam, 66, brought a 39 year association with the university, his alma mater, to an abrupt end in March 2007 when the investigation into billing irregularities began. He is a distinguished gastroenterologist who conducted pioneering research into chemoprevention of stomach cancer through the eradication of Helicobacter pylori. His team also conducted the first double blind, controlled study into curing peptic ulcers by H pylori eradication.
I suppose this supports my case. As far as I know, almost all doctors and med school professors believe H. pylori causes stomach ulcers; I have never heard dissent about this.
More. What goes unsaid, and maybe unnoticed, in the debate about health care, is that it is hard to have decent health care (that is, decent health) when those in charge don’t know what they’re doing. The stomach-ulcer-etiology problem is a small example of a big thing. In case I’m not being blunt enough, let me be even more blunt: This example illustrates that the average doctor, the average med school professor, and at least two Nobel-Prize-winning med school professors (not to mention those who award Nobel Prizes) have a lot of room for improvement in their interpretation of simple facts. My previous example of the infectious-disease expert (a med school professor) who overlooked the immune system is another example of vast room for improvement. It’s hard to get good health care from people whose understanding of health is terribly incomplete yet don’t realize this.
If wiping out H. pylori cures ulcers, why can’t we say it causes them? Otherwise you might as well say women walking alone (without, perhaps, learning karate first?) causes rape.
Your intestines are heavily innervated. The trillions of individuals of hundreds or thousands of bacterial species in your gut are fully equipped to apply operant conditioning to you. They are also equipped, in principle, to produce any conceivable drug or mind altering substance. They have been demonstrated to respond to common hormones, and can probably tell a great deal about your condition from chemistry and nerve activity. Why should we not conclude that they have learned of your influence and are forcing you to speak on their behalf?
Nathan said: “Why should we not conclude that they have learned of your influence and are forcing you to speak on their behalf?”
Finally, the truth comes out about “Seth” (aka Bacteria Collective) and “his” (their) blog. We must stop this before they take control of other leading academics and scientists!! Now … I … Must. Have. My. Daily. Yogurt. Farewell. For now. Fellow. Humans …
“If wiping out H pylori cures ulcers, why can’t we say it causes them?” Huh? I don’t follow the logic. Lots of solutions don’t involve the true cause. For example, patching a tire fixes a leak. It doesn’t follow that lack of a patch caused the leak.
Anthony: It’s worse than that; they can make him want to speak on their behalf, and be motivated to come up with imaginative presentations that promote their goals. Note, too, that many of the bacteria in Seth’s gut are (mostly) genetically identical to those in your gut and mine. In a real evolutionary sense, they are part of the same extended individual as the ones in mine, and yours. What benefits mine, and yours, benefits the same genes as are expressed in his. (Apparently they all feel a need for more omega-3 fats.)
Seth: It doesn’t follow, but carrying a patch kit is easier than avoiding every pointy thing when you’re out riding. The cause of the leak was a hole. The cause of the hole was a nail. The cause of the nail was somebody’s carelessness… Or maybe the hole is because the tire was too thin. It sounds like you’re arguing something akin to Aristotle’s material, efficient, formal, and final causes, which always devolves into mush. If you think ulcers are better to prevent than to treat, that’s a claim that seems objectively supportable.
… the big question, though, is how did Seth’s bacteria, uniquely, learn to use operant conditioning? They have observed him performing it, and lecturing about it, but lots of psych professors do that. Maybe he’s just the first, of those, who started out kindly disposed toward them.
@Nathan,
Suddenly, it’s all becoming clear. Humans are just a way for certain Lactobacillaceae (who know who they are) to reproduce themselves! We’ve just been an unwitting extended phenotype! Now, where’s my flax-seed oil? For some reason I have a craving for it …
Seriously,
Wading into the causality debate. Typically when people talk about ‘the’ cause, the implication is that there is just one cause, but there are almost always multiple things you can change to bring about an effect (or to not bring about an effect).
I think that what we want are causes that make more sense to focus on, are easier to change, have less deleterious side-affects, and so on.
@Nathan,
Perhaps it’s a unique mutation in Seth’s bacterial population?
I feel obliged to add this:
https://www.partiallyclips.com/pclipslite.php?id=1623
And speaking of inappropriate Nobel prizes, let’s not forget that Portuguese neurologist António Caetano de Abreu Freire Egas Moniz won the Nobel Prize for physiology or medicine in 1949. What was his contribution to society? Well, he invented and popularized the pre-frontal leucotomy, a variation of lobotomy. For more information, see this excellent book called “Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness”, by Elliot Valenstein:
https://www.amazon.com/Great-Desperate-Cures-Psychosurgery-Treatments/dp/0465027113/
There is also a movement (unsuccessful, so far) to strip Egas Moniz of his prize:
https://www.psychosurgery.org/news-opinion/why-nobel-should-rescind-the-prize/
“Marshall famously drank a flask full of H. pylori and didn’t get an ulcer, yet took this to support his theory.”
This simply shows that the presence of H. pylori is necessary, but not sufficient, to cause the ulcer. That seems to be true of most germs. We’re all of us exposed to all kinds of disease-related germs every day, but don’t necessarily contract every disease to which we’re exposed.
Review Koch’s postulates of the germ theory of disease:
https://en.wikipedia.org/wiki/Koch%27s_Postulates
Koch’s postulates are:
1. The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy animals.
2. The microorganism must be isolated from a diseased organism and grown in pure culture.
3. The cultured microorganism should cause disease when introduced into a healthy organism.
4. The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.
However, Koch abandoned the universalist requirement of the first postulate altogether when he discovered asymptomatic carriers of cholera[1] and, later, of typhoid fever. Asymptomatic or subclinical infection carriers are now known to be a common feature of many infectious diseases, especially viruses such as polio, herpes simplex, HIV and hepatitis C. As a specific example, all doctors and virologists agree that poliovirus causes paralysis in just a few infected subjects, and the success of the polio vaccine in preventing disease supports the conviction that the poliovirus is the causative agent.
The third postulate specifies “should”, not “must”, because as Koch himself proved in regard to both tuberculosis and cholera,[2] not all organisms exposed to an infectious agent will acquire the infection. Noninfection may be due to: chance or to the host’s immune system successfully repulsing the invading pathogen; acquired immunity, as from previous exposure or vaccination; or genetic immunity, as with the resistance to malaria conferred by possessing at least one sickle cell allele.
The second postulate may also be suspended for certain microorganisms which we cannot (at the present time) grow in pure culture, such as some viruses. In summary, a body of evidence that satisfies Koch’s postulates is sufficient but not necessary to establish causation.
For H. pylori to cause ulcers, recent research suggests that is must first set up residence in the vacuoles of phagocyctes: https://www.eurekalert.org/pub_releases/2009-01/sfeb-hpc012709.php. The presence of H. pylori in the stomach is then a necessary but not a sufficient cause of ulcers. Clearing H. pylori from the vacuoles of phagocytes could then cure the disease even without clearing it from the stomach.
These comments about “necessary but not sufficient” and Koch’s postulates suggest to me that Warren and Marshall’s confusing use of “causes” (in “H. pylori causes ulcers”) has been a distraction — the question most helpful to answer is why a few people infected with H. pylori get ulcers yet almost all of them don’t. As far as I can tell, Koch’s postulates and studies of phagocyctes don’t help us figure that out.
Seth,
This sentence borders on the misleading, hopefully not intentionally so.
“Marshall famously drank a flask full of H. pylori and didn’t get an ulcer, yet took this to support his theory.”
Marshall had gastritis after drinking the H. pylori. And gastritis can lead to ulcers. It hardly seems necessary for him to proceed all the way to developing an ulcer for the sake of that experiment. You can disagree with the current paradigm about H. pylori and ulcers and still acknowledge Marshall’s experiment accurately.
Jeff
p.s. I’m not a doctor but the gastritis -> ulcer relationship seems to be mentioned at reputable websites.
“It hardly seems necessary for him to proceed all the way to developing an ulcer for the sake of the experiment.” That’s where I disagree. His theory was about ulcers, not gastritis. If you can show me evidence that gastritis always leads to ulcers, I’ll revise my opinion.
smoking doe not always result in lung cancer, therefore it can’t “cause” it?
So what if smoking one cigarette per month doesn’t cause lung cancer? I fail to see the relevance.
I think the word interaction may apply here.