You might think that medicine, with such strong doese of science and logic, is on field in which root cases are always well understood.
Alas, you would be wrong. The human body is a complex, dynamic system about which a great deal remans unknown. Writing as recently as 1997, the medical historian Roy Poerter put it this way: "We live in an age of science, but science has not eliminated fantasies about health; the stigmas of sickness, the moral meanings of medicine continue." As a result, gut huncheas are routinely passed off as dogma while conventional wisdom flourishes even when there is no data to back it up.
Consider the ulcer. It is essentially a hole in your stomach or small intestine, producing a searing and surging pain. Bu the early 1980s, the acuses of an ulcer were said to be definitively known: they were inherited or caused by psychological stress anspicy food, either of which could produce an overabundance of stomach acid. To anyone who has ever eaten a pile of jalapenos, this seams plausible. And as any doctor could attest, a patient with a bleeding ulcer was likely to be stressed out. (A doctor might just as seasily not that shooting victims tend to bleed a lot, but that doesn't mean the blood caused the gunshot.)
Since the causes of ulcers were known, so too was the treatment. Patients were advised to relax (to cut down on stress), drink milk (to soothe the stomach), and take a Zantax or Tagamet pill (to block the production of stomach acid).
How well did this work?
To put it charitably: so-so. The treatment did hel manage a patient's pain, but the condition wasn't cured. And an ulcer is more than a painful nuisance. It can easily becom fatal due to peritonitis (caused by a hole going clear through the stomach wall) or complications from bleeding. Some ulcers required major surgery, with all the attendant complications.
Although ulcer patients didn't make out so well under the standard treatment, the medical community did just fine. Millions of patients required the constant service of gastroenterologists and surgeons, while pharmaceutical companites got righ: the antacides Tagamet and Zantak were the first true blockbuster drugs, taking in more than $1 billion a year. By 1994, the global ulcer market was worth more than $8 billion.
In the past, some medical researcher might have suggested that ulcers and other stomach ailments, including cancer, had a different root cause-perhaps even bacterial. But the medical establishment was quick to point out the glaring flaw in this theory: How could bacteria possibly survive in the acidic cauldron of the stomach?
And so the ulcer-treatment juggernaut rolled on. There wasn't much of an incentive to find a cure-not, at least, by the people whose careers depended on the prevailing ulcer treatment.
Fortunately the world is more diverse than that. In 1981, a young Australian medical resident named Barry Marshall was on the hunt for a research project. He had just taken up a rotation in the gastroenterology unit at Royal Perth Hospital, where a senior pathologist had stumbled onto a mystery. As Marshall later described it: "We've got 20 patients with bacteria in their stomach, where you shouldn't have bateria living because there's too much acid." The senior doctor, Robin Warren, was looking for a young researcher to heal "find out what's wrong with these people."
The squiggly bacteria resembled a species called Campylobacter, which can cause infection in people who spend time with chickens. Were these human bacteria indeed Campylobacter? What kind of diseases might they lead to? And wy were they so concentrated among patients with gastric trouble?
Barry Marshall, as it turns out, was already familiar with Campylobacter, for his father had worked as a refrigeration engineer in a chicken-packing plant. Marshall's mother, meanwhile, was a nurse. "We use to have a lot of arguments about what was really true in medicine," he told an interviewe4r, the esteemed medical journalist Norman Swan. "She would 'know' things because they were folklore, and I would say 'That's old-fashioned. There's no basis for it in fact.' 'Yes, but people have been doing it for hundres of years, Barry.'"
Marshal was excited by the mystery he inherited. Using samples from Dr. Warren's patients, he tried to culture the squiggly bacteria in the lab. For months, he failed. But after an accident-the culture was left in the incubator three days longer than intended-it finally grew. It wasn't Campylobacter; it was a previously undiscovered bacteria, henceforth known as Helicobacter pylori.
"We cultured it from lots of people after that," Marshall recalls. "The we could say, 'We know which antibiotic kills these bacteria.' We fitured out how they could live in the stomach, and we could play around with it in the test tube, do all kinds of useful experiments.... We were not looking for the cause of ulcers. We wanted to find out what these bacteria were, and we thought it would be funt to get a nice little publication."
Marshall and Warren continued to look for this bacteria in patients who came to see them with stomach trouble. The doctors soon made a startling discovery: among 13 patients with ulcers, all 13 also had the squiggly bacteria! Was it possible that H. pylori, rather than merely showing up in these patients, was actually causing the ulcers?
Back in the lab, Marshall tried infecting some rats and pigs with H. pylori to see if they developed ulcers. They didn't. "So I said, 'I have to test it out on a human.'"
The human, Marshall decided, would be himself. He also decided not to tell anyone, even his wife or Robin Warren. First he had a biopsy taken of his stomach to make sure he didn't already have H. pylori. All clear. Then he swallowed a batch of the bacteria that he had cultured from a patient. In Marshall's mind, there wer two likely possibilities:
1. He would develop an ulcer. "And then, hallelujah, it'd be proven."
2. He wouldn't develop an ulcer. "If nothing happened, my two years of research to taht point would have been wasted."
Barry Marshall was probably the only person in human history rooting for himself to get an ulcer. If he did, he figured it would take a few years for symptoms to arise.
But just five days after he gulped down the H. pylori, Marshall began having vomiting attacks. Hallelujah! After ten days, he had another biopsy taken of his stomach, "and the bacteria were everywhere." Marshall already had gastritis and was apparently well on his way to getting an ulcer. He took an antibiotic to help wipe it out. His and Warren's investigation had proved that H. pylori was the true cause of ulcers-and, as further investigation woudl show, of stomach cancer as well. It was an astonishing breakthrough.
Granted, there was much testing to come-and an enormous pushback from the medical community. Marshall was variously ridiculed, pilloried, and ignored. Are we to seriously believe that some loopy Australian found the cause of ulcers by swallowing a batch of some bacteria that he says he discovered himself? No $8 billion industry is ever happy when its reason for being is under attach. Talk about gastric upset! An ulcer, rather than requiring a lifetime of doctor's visits and Zantac and perhaps surgery, could not be vanquished with a cheap dose of antibiotics.
It took years for the ulcer proof to fully take hold, for conventional wisdom dies hard. Even today, many people still believe that ulcers are caused by stress or spicy foods. Fortunately, doctors now know better. The medical community finally came to acknowledge that while everyone else was simply treating the symptoms of an ulcer, Barry Marshall and Robin Warren had uncovered its root cause. In 2005, the were awarded the Nobel Prize.
The ulcer discovery, stunning as it was, constitutes just one small step in a revolution that is only beginning to unfold, a revolution aimed toward finding the root cause of illness rather than simpley swatting away the symptoms.
H. pylori, it turns out, isn't some lone-wolf bacterial terrorist that managed to slip past security and invade th stomach. In recent years, enterprising scientists-aided by newly powerful computers that facilitate DNA sequencing-have learned that the human gut is home to thousands of species of microbes. Some are good, some are bad, and others are situationally good or bad, and may have yet to reveal their nature.
Just how many microbes to each of us host? By one estimate, the human body contains ten times as many microbial cells as human cells, which pust the number easily in the trillions and perhaps in the quadrillions. This "microbial cloud," as the biologist Jonathan Eisen calls it, is so vast that some scientists consider it the largest organ in the human body. And within it my lie the root of much human health...or illness.
In labs all over the world, researchers have begun to explore whether the ingredients in this sparwling microbial stew-much of which is hereditary-may be responsible for diseases like cancer and multiple sclerosis and diabetes, even obesity and mental illness. Does it seem absurd to think that a given ailment that has haunted humankind for millennia may be cause by the malfunction of a micro-organism that has been merrily swimming through our intestines the whole time?
Perhaps-just as it seemed absurd to all those ulcer doctors and pharmaceutical executives that Barry Marshall knew what he was talking about.
To be sure, these are early days in microbial exploration. The gut is still a frontier-think of the ocean floor or the surface of Mars. But already the research is paying off. A handful of doctors have successfully treated patients suffering from intestinal malidies by giving them a transfusion of healthy gut bacterial.
Where to these healthy bacteria come from, and how are they sluiced into the sick person's gut? Before going further, let us offer two notes of caution:
1. If you happen to be eating as you read this, you may wish to take a break.
2. If you are reading this book many years after it was written (assuming there are still people, and they still read books), the method described below may seem barbarically primitive. In fact we hope that is the case, for ti would mean the treatment has proven valueable but that the delivery methods have improved.
Okay, so a sick person needs a transfusion of healthy gut bacteria. What is a viable source?
Doctors like Thomas Borody, and Australian gastroenterologist who drew inspiration from Barry Marshall's ulcer research, have identified one answer: human feces. Yes, it appears that the microbe-rich excrement of a healthy person may be just the medicine for a patient whose own cut bateria are infected, damaged, or incomplete. Fecal matter is obtained from a "donor" and blended into a saline mixture that, according to one Dutch gastroenterologist, looks like chocolate milk. The mixture is then transfused, often via an enema, into the gut of the patient. In recent years, doctors have found fecal transplants to be effective in wiping out intestinalinfections that antibiotics could not. In one small study, Borody claims to have used fecal transplants to effectively cure people who were suffering from ulcerative colitis-which, he says, was "previously an incurable disease."
But Borody has been going beyond mere intestinal ailments. He claims to have successfully used fecal transplants to treat patients with multiple sclerosis and Parkinson's disease. Indeed, while Borody is careful to say that much more research is needed, the list of ailments that may have a root cause living in the human gut is nearly endless.
To Borody and a small band of like-minded brethren who believe in the power of poop, we are standing at the threshold of a new era in medicine. Borody sees the benefits of fecal therapy as "equivalent to the discovery of antibiotics." But first, there is much skepticism to overcome.
"Well, the feedback is very much like Barry Marshall's," says Borody. "I was initially ostracized. Even now my colleagues avoid talking about this or meeting me at conferences. Although this is changing. I've just had a nice string of invitations to speak at national and international conferences about fecal transplantation. But the aversion is always there. It'd be much nicer if we coulde come up with a non-fecal-sounding therapy."
Indeed. One can imagine many patients being turned off by the words fecal transplant or, as researchers call it in the academic papers, "fecal microbiota transplantation." The slang used by some doctors ("shit swap") is no better. But Borody, after years of performing this procedure, believes he has finally come up with a less disturbing name.
"Yes," he says, "we call it a 'transpoosion.'"
--Book: Think Like a Freak (2014)
--Authors: Steven D. Levitt & Stephen J. Dubner
Has she had testing done to rule out any unwanted viruses? When I became a donor for my daughter, I was tested for hep.c, h pylori, c diff etc.
