Bacteria, ulcers, and ostracism? H. pylori and the making of a myth: medicine's purported ostracism of the discovery of H. pylori has achieved a mythological quality. But it isn't true. After appropriate initial scientific skepticism, the hypothesis was accepted right on schedule

Skeptical Inquirer, Nov-Dec, 2004 by Kimball C. Atwood, IV

In the September/October 2003 SKEPTICAL INQUIRER, I wrote an article critical of the research agenda of the National Center for Complementary and Alternative Medicine (NCCAM) (Atwood 2003). Subsequently, reader Myra Jones argued in a letter to the editor that "we as skeptics should not throw the baby out with the bath water. Just because the NCCAM has funded bad science doesn't mean that ... some alternative medicine might not have valid claims. Many practices now accepted were once thought crazy by the medical mainstream" (Jones 2004). Part of my reply to her was this: "For example, which practices? Initial skepticism of any new claim is an appropriate part of the scientific approach.... Other than that, I challenge Ms. Jones to name a single example, since the era of scientific medicine began in the second half of the nineteenth century, of a correct claim that faced dogmatic, closed-minded rejection by the 'medical mainstream' for any significant amount of time" (Atwood 2004).

Be careful what you ask for. A few weeks later, the editors received this letter from Dr. Tess Gerritsen:

   As a physician, a long-time skeptic, and a member of CSICOP,
   I'm happy to agree with most of Dr. Atwood's points about
   alternative medicine. However, when he challenged letter writer
   Myra Jones to come up with a "a single example, since the era
   of scientific medicine began in the second half of the nineteenth
   century, of a correct claim that faced dogmatic, closed-minded
   rejection by the 'medical mainstream' for any significant amount
   of time," I must respond ill Ms. Jones's defense.

      When I was first starting out in medical practice, back in
   the early 1980s, the accepted treatment for peptic ulcer disease
   was a bland diet plus antacids and more antacids. Later, histamine
   H2-receptor antagonists were added to the treatment.
   But that was it, case dosed.

      Then, in 1984, physicians Warren and Marshall from
   Australia claimed that peptic ulcer disease was not caused
   merely by overproduction of gastric acid, but rather by a specific
   bacterium: Helicobacter pylori, to be specific. They recommended
   antibiotic therapy. Believe me, they were ridiculed
   by  the medical establishment. I recall my colleagues, and even
   my own physician-husband, scoffing at the idea of peptic
   ulcers being an infectious disease. For the next thirteen years,
   most of the "medical mainstream" refused to let go of their
   calcified notion that the only treatment for ulcers was to combat
   gastric acid secretion. After all, that was what we all learned in
   medical school. Therefore, it had to be the truth!

      It wasn't until 1997 that the CDC finally put out the word
   to the nation's doctors: Drs. Warren and Marshall had been
   correct all along. Helicobacter pylori was, indeed, the cause of
   most cases of peptic ulcer disease. The treatment, at long last
   accepted by mainstream medicine, is now antibiotics.

      This is only one example; Fm sure lily physician colleagues
   can think of others. This is a case where skepticism (my own
   and that of others) delayed the use of effective ulcer treatment
   for over a decade. I think Ms. Jones's warning that we "not
   throw out the baby with the bath water" is indeed a good one.
   Skepticism is good and healthy, but at its extreme, it can turn
   into rigid dosed-mindedness.

This is art oft-heard argument. Ms. Jones, in response to my challenge, offered the same example in a private e-mail to SI editor Kendrick Frazier. "CAM" supporters brought it up a couple of years ago at a meeting of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, of which I was a member. At least one recent article in a mainstream medical journal has made the same claim, without attribution (Kaptchuk 2003). Medicine's purported ostracism of the discovery of H. pylori--to some extent, as we shall see, fostered by one of its discoverers--has achieved a mythical quality.

But it isn't true. I have no reason to doubt that many physicians scoffed when first faced with the notion of a bacterial basis for peptic ulcer disease (PUD). It is not the case, however, that the medical mainstream dogmatically rejected the proposal for an undue period of time. A brief history shows that the hypothesis was accepted right on schedule, but only after "appropriate initial skepticism"--the premise of my challenge--was satisfactorily answered. Some of the other particulars of the mythical version of the story are also incorrect.

Before proceeding, I would like to reiterate another point made in the context of the challenge: all biomedical proposals, "CAM" or otherwise, can only be judged according to what is known about nature. The warning that by refusing to commit scarce resources to the investigation of implausible claims, we risk "throwing the baby out with the bath water," implies that we have little basis for deciding which claims merit further investigation. But that isn't true, either.

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Bacteria, ulcers, and ostracism? H. pylori and the making of a myth: medicine's purported ostracism of the discovery of H. pylori has achieved a mythological quality. But it isn't true. After appropriate initial scientific skepticism, the hypothesis was accepted right on schedule

Skeptical Inquirer, Nov-Dec, 2004 by Kimball C. Atwood, IV

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