A7

The science of life
Steve Griffiths

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First, a Science of Life Anatomy and Medicine pop quiz!

a) Name a celebrity who gets out of a limo flashing a part of the anatomy not usually shown publicly.

b) What is the major cause of ulcers and persistent tummy troubles?

Most of us get the first one on the fly. Heck, I think there are four possible answers. But the second one? Who said "stress" or "spicy food"? I'm one.

Neerrrrk (that will be the "wrong" buzzer then).

The number one cause of ulcers and a host of other gastric maladies is a corkscrew-shaped microbe called Helicobacter.

A driven young intern named Barry Marshall and his unassuming yet heroic boss, Robin Warren, identified this cause and effect relationship in Australia 25 years ago. Today, we need to be informed about the exposure of celebrity nether-regions or antipodean anatomy, if you will, yet most of us would not be able to name two Aussies named Barry and Robin other than two of the Bee Gees.

As far as science "news" reporting goes, we are generally informed that someone has had an adverse reaction to something that otherwise benefited millions; then we're all expected to panic and drive up advertising.

Science should enrich, illuminate and enhance our appreciation of life, not give us the willies. Quite aside from allowing us to make better decisions, provide perspective and context in quotidian life, it prevents us from getting 'ripped off,' intellectually and financially.

Unfortunately, as the late, beatific Carl Sagan frequently pointed out, we are served by a popular media interested in selling titillation, fear, angst and conspiracy. Sagan is still spot-on: When science is allowed out to play, it is presented as quirky, creepy or malevolent.

Ineluctably, this lack of exposure also explains why we still sponsor weird psychopathic divine beings that drive international and domestic policy, or permit us to dwell on space-aliens that peep through bedroom windows.

Well OK, you might say, let's get back to the original story.

Barry and his mates discovered that microscopic drill bits are currently wiggling around in 80 per cent of us, with a spectrum of irritation between zero and morbidity.

This is why our Aussies might be considered brave and heroic.

Unlike myths that are simply recognized because, well, they 'just are,' scientists poke, prod and ridicule each other to the point of career assassination. Often, even the most eminent of our respected elders are blinkered like Shire horses by what they were taught in medical school and besides, like any rat race, there are a lot of failed and professionally jealous mammals slithering about out there.

So when upstarts like Barry and Robin present data which, despite being glaringly self-evident or intuitively elegant, it is typically declared to be heresy. This can drive one half-mad, yet in science, 'the truth will always out.'

Here's Barry reminiscing about sharing his early observations of Helicobacter and the treatment of his patients with gastric distress (parentheses mine):

"One day, after I presented my histology (microscopic) data showing the healing of Gastritis with bismuth (Pepto-Bismol), the senior hospital pathologist stated 'Dr. Marshall, these changes seem very subtle.'

"Actually, the changes were quite dramatic, and this was the first time anyone in the world had been able to heal gastritis!

"I bit my tongue to stop myself from saying 'are you crazy?' Others suggested again that these commensal (harmless) bacteria merely infected people who already had ulcers. But quite clearly I had presented data from patients with gastritis who did not have ulcers.

"By combining bismuth with metronidazole (an antibiotic), I was able to eradicate Helicobacter in most patients, in just two weeks.

"When that failed I could use bismuth with amoxicillin (another antibiotic) to cure half the remainder. For people facing stomach surgery for ulcers, all these antibiotics seemed rather trivial."

Barry saw many patients with symptoms, but with no ulcers. Many doctors believed that such patients had it all in their heads. However, Barry treated many "crazy people" whose symptoms improved during antibiotic treatment.

He continues:

"I realized then that the medical understanding of ulcer disease was akin to a religion. No amount of logical reasoning could budge what people knew in their hearts to be true. Ulcers were caused by stress, bad diet, smoking, alcohol and susceptible genes. A bacterial cause was preposterous."

Lesser mortals might be cowed by rejection and subtle if not outright derision, but not Barry.

What did he do? Well of course, like any good scientist, he drank some.

He got very ill: cramps, fevers, vomiting, halitosis; the whole Kahuna. Finally, they were able to prove that a human subject could be infected by, suffer from and be treated for our squiggly demon. He further reasoned that it might be possible that ulcer patients would not recall an initial infection at an early age, perhaps between 2--3 years.

The spectacular projectile-vomiting that many of us witness as parents may settle into a lifelong symptomless phase that leads to ulcers and a host of other tummy troubles: because the bacteria are not affected by any of the usual therapies, the disease may become a lifelong see-saw.

In truth, Helicobacter is spread by the fecal-oral route or exposure to vomit from sick brothers and sisters.

Finally, in contrast to his patients, Barry's self-inflicted infection ran its course: he did not remain infected. His altruism yielded the first indication that such things might happen regularly and that some of us are able to deal with an acute infection without worry -- for now.

After Barry Marshall's heroism, the pennies started to drop from the eyes of the greater scientific community.

Some reluctance to funding remained because, in terms of economics, a cure is not a moneymaker for the government or the pharmaceutical industry.

As indicated above, 80 per cent of us are, or have been infected with Helicobacter and it may never cause any problems. These fellows have been with us for a very long time and in fact they may be used as 'molecular clocks.' By comparing Helicobacter DNA sequences, we can determine where their hosts -- our ancestors -- took a left or right turn from their cousins during the trek out of Africa.

Now, aside from being an inspiring story about how 'sometimes the good guys win' -- Barry and Robin won the Nobel Prize for Medicine in 2005 -- it also turns out that the connection between Helicobacter and stomach cancer is as strong as that for cigarettes and lung cancer.

Yes. The attention given to Helicobacter further accentuated an established observation that cancers, particularly of the mucosal surfaces such as the gut-lining, frequently correlate with inflammation: that reddening which indicates that the riot police, our immune cells, have moved into the area. These guys stomp on the bad microbes and get 'bystander cells' to multiply and repair the damage and it's a real 'scorched earth' policy.

With all that front-line activity and multiplication going on, there is a greater possibility that the genetic chips will stack up and create a misbehaving cell. It is for good reason that cancers have been said to emerge from 'wounds that never heal.'

Medical policy makers are now vigorously researching and discussing the pros and cons of prevention. Should we consider blanket vaccination? It's a toughie even to the point that the recruitment of control, or placebo, groups are ethically challenging because Helicobacter is a registered carcinogen.

Also, perhaps as might be expected after a decade of acceptance, we're now seeing antibiotic resistant Helicobacter that require increasingly shrewd combinations of anti-bacterials.

Here is another problem arising from patients that do not complete antibiotic treatment -- substantial 'wiggle room' for the emergence of bacteria decked out in molecular kevlar. There is a parallel here of course to the scourge of antibiotic resistant bacteria that are affecting our hospitals -- it's evolution going on right under our noses -- and similarly given a boost by poor education and hence hygiene.

Thus, if there was a greater appreciation for the Science of Life, we might improve the quality of our existence, save billions of dollars in health care and inspire new generations to help us and our offspring stay healthy, wealthy and wise.

Well, at least healthy and wise.

n Dr. Steve Griffiths is a researcher at the Atlantic Cancer Research Institute in Moncton. His column, the Science of Life, appears in this section on the third Tuesday of each month.