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The Coelacanth is one bug ugly fish. It is also nothinglike what science once thought it was. Public domain.Not meaning to seem like some unwashed lunatic, but science is sometimes a bit overrated. “Follow the science” became the rallying cry throughout the darkest days of COVID. However, it turned out to be just a form of virtue signaling — a means to point out how much more culturally responsible some people felt they were compared to others.
Reality is that nobody knew what the best solution was to the thorny problem of a novel global pandemic. We still don’t. We were all just doing the best we could.
Some of that stuff was pretty darn crazy. There was ample unfettered lunacy on both sides. It was kind of nuts to push the entire species to take a vaccine that could not have been adequately tested due to immutable time constraints.
It was also a bit unhinged to overdose on equine worm medicine that you scored at the local Tractor Supply because some dude with an internet connection said it was a good idea. Nobody was thinking straight.
Anyway, I digress. I do that a lot, as you have no doubt noticed. I’m sure my long-suffering wife covets your prayers. The point is that we should take “science” with a grain of salt. Failure to do so can lead to sketchy vaccines and horse medicine overdoses.
By studying the damage done to combat aircraft that made it home during World War 2, statisticians hoped to make the machines more survivable.
However, the data had to be interpreted correctly. Wikipedia photo by Martin Grandjean.
Past Performance, Future Results
Science is fluid. It evolves in response to new discoveries. The competent scientist should be open-minded and willing to relinquish dogmatically held concepts if newer, more insightful ideas arrive to take their place. Some of that looks a bit daft with the crystalline clarity of hindsight.
It wasn’t so long ago that we were treating medical maladies with leeches and tobacco smoke enemas. In the 19th century, tobacco smoke enemas were used to manage everything from bowel obstructions to constipation, head colds, hernias, respiratory failure, and belly cramps.
Practitioners of the day even used this curious therapy to try to resuscitate drowning victims. That all seems pretty stupid in retrospect.
Everybody in the world seems to be on blood pressure medication these days. It was only within my lifetime that we figured out that the kidneys control blood pressure and that elevated blood pressure was such a compelling risk for heart disease and stroke. And then there was the coelacanth.
The coelacanth was the archetypal transitional form in the fossil record. This big, bug-ugly fish really looked the part. He had short, muscular fins that looked a bit leg-ish, like he could scurry up on shore, gulp a little air, and then slide back into the water, thereby setting the evolutionary stage for fish to become amphibians.
Coelacanth fossils even fell into the right slot in the fossil record — they purportedly died out in the late Cretaceous Period, some 66 million years ago. All that worked great right up until 1938, when one of these ghastly monsters showed up smelly and gross in a fish market in South Africa.
The Coelacanth is what scientists call a Lazarus Taxon, a creature that seems to have petered out zillions of years ago, only to show up again unexpectedly in the present for no good reason. It is also a really deep-water fish. If you bring it close to the surface or near the shore, it just dies. It never actually aspired to become an amphibian after all.
The point simply being, question everything. Science is dynamic — it’s always a work in progress. Cling to its tenets, but do not do so intransigently. Nobody wants to be that guy who thinks tobacco smoke enemas are established science, only to find out later they were actually ridiculous.
During World War 2, scientists and engineers were desperate to produce the most survivable combat aircraft possible. Public domain.
Survivorship Bias
During World War II, the Allies were faced with appalling, unsurvivable losses among the bomber forces launched against the Germans in Europe. The Statistical Research Group at Columbia University was tasked with assessing the empirical data and making suggestions to airplane designers concerning where our warplanes should be improved.
These scientists evaluated crippled aircraft returning from combat missions and found the damage to be clustered around the wingtips and tail assemblies.
Some among them, therefore, posited that these were the places on the aircraft that should be more heavily armored. A Columbia statistician named Abraham Wald, however, disagreed.
Wald observed that they only had access to the planes that survived. The aircraft that were lost were the ones that were NOT hit in the wingtips and tail. If anything was to be armored further, it needed to be the engine nacelles and fuselage, the very spots that were not damaged in the surviving planes.
This statistical concept is called survivorship bias. Really smart people looked at the same data set and drew entirely different conclusions.
Ruminations
So, be sensible in the way you look at life, but try not to cling unduly to the things of science. Draw enlightened conclusions based upon the best data but then don’t get your feelings hurt if new information proves you wrong. That’s the only reliable way to avoid a tobacco smoke enema.
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House Guns with Will Dabbs, MD
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One of my favorite rounds – The 44 Magnum
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Uberti 1873 Turkey Hunting
How committed are you to your profession? If you are a Walmart greeter or work at Chick-fil-A, that might just mean being nice to people all the time so as to stay in character.
If you are a trial attorney, you might kick innocent babies or torture beagle puppies in your free time just to keep that edge. However, if you were a research physician at the Royal Perth Hospital specializing in gastroenterology in 1979, a truly serious level of commitment might take you to a whole new place.
This is Australian Dr. Barry Marshall. He and a colleague changed the way the world viewed stomach ulcers. He also obviously enjoys a refined sense of humor. The Nobel Prize organization is headquartered in Sweden.
Facebook photo.
The Guy
Barry Marshall was born in Kalgoorlie, Western Australia, in 1951. He was the eldest of four kids. His dad did a variety of things to make a living, and his mom was a nurse. When he came of age, Marshall attended the University of Western Australia School of Medicine.
While Registrar in Medicine at Royal Perth Hospital, Marshall and a fellow research physician, Dr. Robin Warren, began studying the gut microbiome.
Curiously, there are more bacteria in and on your body than there are cells. That means when you look at someone, there is actually more stuff that’s not them than is them. That applies to dirty farmers, adorable little infants, and even pretty girls. That’s kind of creepy if you let yourself think about it.
Drs. Marshall and Warren observed that a lot of people with gastritis, stomach ulcers and gastric cancer tended to have spiral bacteria in their stomachs.
Eventually, they cultured Helicobacter pylori and suspected that particular microscopic beastie to be the culprit. When they announced their suppositions, they were laughed out of the scientific circles.
Their paper on the subject, presented to the Gastroenterological Society of Australia, was rated in the bottom 10% of submissions in 1983. After all, everybody knew that gastric ulcers were caused by spicy foods and high-stress jobs. Marshall later said, “Everyone was against me, but I knew I was right.”
There was reason to be skeptical. The first 30 of 100 gastric samples that the men harvested did not culture out H. pylori. However, Marshall later discovered that the lab techs were discarding the cultures at the two-day mark, which is customary. H. pylori takes longer than that to grow. Warren and Marshall believed they were on to something.
Put Up or Shut Up…
Marshall tried to replicate his results using piglets, but that didn’t work. In frustration, he had a baseline endoscopy done of himself, wherein a gastroenterologist ran a flexible scope into his stomach to see if anything was amiss. They found Dr. Marshall’s stomach to be as fit and healthy as such organs can be.
Dr. Marshall then cooked up a broth of H. pylori bacteria and drank it himself. He expected it to take about a year to see any discernible effects. Marshall got sick on day 3 after drinking that vile stuff.
His wife first pointed out that her husband had developed some simply ghastly breath. This was due to the H. Pylori bacteria inhibiting stomach acid production, a condition known as achlorhydria. At the end of the first week, he began viciously vomiting.
Now thoroughly sick but intrigued, Dr. Marshall submitted to a second endoscopy that demonstrated massive inflammation and minimal acid production. His H. pylori cultures were positive for the bug. On day 14, he had a third endoscopy and began antibiotics. A short while later, his GI symptoms steadily abated. Repeat endoscopy demonstrated that his stomach was healthy again.
Genius Rewarded
In 2005, Doctors Warren and Marshall traveled to the Karolinska Institute in Stockholm, Sweden, to accept the Nobel Prize in Physiology and Medicine. The official attribution was, “For their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.” Together, these two guys fundamentally shaped our understanding of stomach ulcers.
The method by which one acquires an H. pylori infection is kind of gross. However, since that time, physicians have begun checking for the presence of H. Pylori bacteria in patients with GI issues. That can involve a biopsy during an endoscopy, a blood test, or something called a Urea breath test.
The typical H. pylori patient has been taking proper stomach medication like omeprazole or pantoprazole for months, yet still has worsening reflux. Sometimes this robs a person of sleep. It reliably takes spicy foods off the menu.
Dr. Marshall is a popular figure among fellow physicians and medical students simply because of his amazing dedication to his art. Facebook photo.
Hope, Inc.
Thanks to Dr. Barry Marshall’s willingness to lay it on the line to chase a hunch, we now have some powerful tools to help get rid of persistent gastric reflux. I diagnose and treat symptomatic H. Pylori infections in my clinic not infrequently.
All that stems back to that day when Dr. Marshall drank that concoction of bacterial sludge just to see if his hunch was correct.
Dr. Marshall’s unconventional approach to his research legitimately changed the world. In doing so, Marshall violated more than a few codified rules of medical research.
It could just as easily have killed him. However, he did end up winning the Nobel Prize, so there’s that. At the end of the day, luck favors the bold, even if that means drinking some vile bacteria cocktail to make your point.