I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work.
I got a different doctor after that.
Robin Warren is someone who I respected the hell out of. It takes a lot of tenacity and determination to go against something when everyone is constantly telling you you're wrong. He will be missed.
ETA:
I should point out that I am aware that stress can aggravate and (potentially) cause some forms of ulcers, though I really wasn't terribly stressed at that point in my life, which I tried explaining to the doctor and he wouldn't hear it. My job was going fine, I didn't really have any debt, I had a decent relationship with my girlfriend (now wife), I really didn't feel stressed out at all.
Same thing happened to me about 6 years ago. Told me to relax and not eat spicy foods. Makes me wonder how long medical advancements like this take to really spread to most doctors.
For example, several years ago significant cataract improvement was achieved by applying to eyes lanasterol (chemical in your body clearing cataract naturally) with DMSO (well known widely used solvent which is used in particular to deliver various medicine through the skin, etc., and some adventurous people are also using it to for example deliver dye into eyes to change the eye color). Several other scientific teams at different places tried to reproduce the result by applying lanasterol without DMSO, and no improvement happened. They concluded that the original study effect is non-reproducible and that the application of lanasterol is non-effective. I'm not kidding - you can google these articles yourselves.
Of course, as lanosterol is how your body does it when things work ok on their own. The issue is delivery, and for unknown reason they are doing it without DMSO or anything similar. Lanosterol with its large molecular weight have no chances of making it inside on its own. The other way of course is injecting it directly into the eye, and it probably would have to be done many times, and, once injections stop, the crystalline accumulation may happen to start again (as cataracts indicate that the body probably have some issue producing and delivering lanosterol naturally), ie. cataract returning, and in this case the cataract surgery starts to look like not that bad of an approach solving the issue once and for all.
>Medicine advances so slowly.
This is one on my deepest existential fears - not just in medicine - the Ancient Greeks could have had steam turbine based ships, yet it took more than 2000 years, and i'm wondering with a tint of fear what wonderful things we're missing on and what Dark Ages we have to pass through before getting to those things (and i'm not going to see them being long gone before it). The high-tech with AI, etc. is the only area where i feel that the progress has at least some minimally reasonable speed (or at least it is hardly reasonable to ask Nature for something faster than the Moore law), and if it were in high-tech there would be already 10 start-ups funded by at least $100M each perfecting and productizing the combinations of DMSO+lanosterol and exploring the similar approaches :) Unfortunately it seems there is no money here, and the Robin Warren's discovery didn't make him a billionaire.
the bigger problem is that if society collapses again there are few easily-accessible resources anymore, particularly fuel/energy. Consider the coincidence of factors that led to the industrial age in Britain… some of those can’t be reproduced again.
Mining garbage dumps for resources could of course be a thing, but probably not abundant energy.
This time there is no plan B. We either become an interplanetary species or this planet eventually becomes our tomb. Probably a couple millennia.
well, may be civilization would be much better off if we went straight to electrified industrial society using wind and hydro energy bypassing burning of dinosauruses - windmills and watermills were known for millennia, one only had to add copper winding and some magnetic iron, the things available for the last 2000+ years.
> We either become an interplanetary species or this planet eventually becomes our tomb.
Yes, only my version of the "tomb" is that it would be our planetary scale ant city/colony as we become totally connected and our societies naturally become highly totalitarian (not necessarily due to some ideology, you'd just naturally have less and less space/resources/opportunities for your private endeavors). Some ant colonies exist uninterrupted for several thousand years, no progress, just happy busy ants doing their happy stuff. Only few of us who'd get off that planet will have a chance to continue the civilizational progress. Kind of bifurcation of our species. Interesting that Musk advances our civilization in both directions - neural implants as well as SpaceX.
How do you get the prerequisites for solar without access to large amounts of energy? Solar cells are made from silicon wafers which must be refined and doped to work. Maybe we could build windmills if we salvage copper and magnets, but refining even copper would be challenging without access to high heat fossil fuels. I guess you would have to bootstrap using charcoal, which would be very labor intensive.
Photovoltaics are not the only form of solar electricity production. Concentrated thermal solar power can easily get into the hundreds of megawatts range.
Well, you’re not going to find centuries of easily-accessible fuel by raiding gas stations. Good luck drilling natural gas two miles under the gulf with your renaissance era mineshafts.
More specifically Max Planck wrote: "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it ..."
How long medical advancements take to spread, and also how long the ineffective or outright harmful practices persist.
I guess on HN we're all relatively pro-science. But the world would be a better place if we recognised that our scientific knowledge in some areas is poorer than we like to pretend.
I started feeling that way when I worked alongside some "Evidence-Based Medicine" advocates. Years later I've landed in data science and the standards of statistical analysis and understanding I see especially in the biological sciences has only made me more sceptical.
Way back in 2007 the BMJ as part of its Clinical Evidence project published its systematic research into standards of evidence in support of common medical treatments. Some 2500 treatments were evaluated to determine whether they are supported by sufficient reliable evidence.
• 13% were found to be beneficial.
• 23% were likely to be beneficial.
• 8% were as likely to be harmful as beneficial.
• 6% were unlikely to be beneficial.
• 4% were likely to be harmful or ineffective.
• 46% were unknown whether they were efficacious or harmful.
It's quite hard to find the original Clinical Evidence project resources (might be a job for the wayback machine) but you can find it referenced all over, e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2071976/ .
In the 1970s the US Office of Technology Assessment conducted a similar evaluation of medical treatments' efficacy and found that only 10% to 20% of medical treatments had evidence of efficacy. I would love to see more recent research in this vein.
There are clearly many complications and caveats around all this. Not all "common treatments" are easily studied -- the gold standard of the RCT is not always feasible or ethical. And of course absence of evidence is not evidence of absence, etc... but it sometimes feels we should be a bit more humble about even our best science.
Continuing education in medicine is a big problem. Once someone graduates med school, their knowledge mostly freezes. The good ones keep up on latest developments but some don't.
That’s “translational medicine” or “translational science” —> getting lab proven stuff to the bedside.
And yeah, it can take a while.
My dream is to a have a dumb doctor/mechanic/plumber/blah that just researches even the most basic questions unless it’s something really odd-ball and only then defaulting to their “expert opinion”.
I've thought for a long time that medicine in the AI era would end up with nurses being even more important than they are today but with doctors being drastically less so. (I know next to nothing about healthcare; this is just a guess!)
This is a problem with alot of thirdwirld surgery. If some old doctor gets to operate your appendix, he might gut you like fish,like they did back in the 80s, scar from heart to hip.not even due to missing equipment but a lack of schooling and experience on newer techniques.
I went to an ear doctor recently, who was so old that I think he graduated when I was a toddler. But when I describe my symptom he says "Well, let's also see what ChatGPT says."
So some part of new medical information might spread faster than I had thought.
* My ear problem turned out to be that my ear canal was full of wax. I guess we didn't really need ChatGPT that day.. ¯\_(ツ)_/¯
Unless things have changed fundamentally since I was in medical school (UCLA Class of 1974), a doctor's visit should start with taking a history and move on to a physical examination. I would think ChatGPT wouldn't even have been mentioned once your PE revealed a wax-filled external ear canal.
I have IBS. During my last visit, my GI doctor apropos of nothing blurted out, "you've got to get your anxiety under control!"
"What are you talking about?" I asked.
"You said the stress of getting ready to leave for the office triggers your attacks," he said.
"I work from home!!" I said. "_YOU_ posed a hypothetical and I answered with a hypothetical: that it would certainly be stressful if that happened. I also said I still have the IBS attacks when I don't have a stressful day."
In my opinion general practitioners (who are not therapists) putting their patient's issues down to "anxiety" or stress is like doctors diagnosing "hysteria" in 19th century women: it contains the in-built subtext that you're not a reliable narrator of your own symptoms, and there is no evidence you can present to disprove the accusation of "hysteria" or "anxiety".
Yeah, that's my issue; stress is a somewhat nebulous thing that's hard to directly quantify and therefore it can be a kind of "catch all" for nearly anything.
I'm not saying that stress doesn't have effects, but I think a diagnosis based on "stress" can often be reductive; who doesn't feel some stress throughout the day?
Actually, "stress" is extremely easy to measure: You have stress, you have specific hormones in your bloodstream.
Those hormones change things in your body, like redirect the blood in your body contracting or extending blood vessels.
>who doesn't feel some stress throughout the day?
It is a quantity thing, you can feel stressed during seconds, or during hours or during entire days.
For example, in a war when your family members could die at any moment, you feel stress for days. In you live in peace you just don't have an idea what that means.
I have not lived war myself but I had close contact with people in Ukraine and in the past conflicts like Congo or Central Africa Republic and other African wars.
Stress effects were obvious for people living in farms. Animals like hens can stop laying eggs or cows stop giving milk just by stress alone.
This is the poster example I use for how dramatically information can change within our lifetime. I still encounter people that are unaware that most of the "stress causes ulcers" was just wrong.
It certainly matters more in medicine, where you have very serious risk of causing people pain, but as I've gotten a bit older I've become a lot more sympathetic to people having trouble keeping up with the world sometimes.
Like, it's not a good excuse, don't get me wrong, but as much as I try, I simply cannot keep up with the entire state of the art of computer science. I wish I could, and a younger me without a family and responsibilities actually would mostly keep up with everything, but now it just feels like there's never quite enough time to learn everything I really should.
I do try and keep up, I have a million textbooks and the like, and I try and at least go through the example problems for them, but it's pretty easy to fall behind in that stuff.
While a GP should keep up to date with ulcer research, and "I'm busy!" isn't a great excuse when serious pain and/or lives are on the line, but it's something I at least understand better now.
> Like, it's not a good excuse, don't get me wrong, but as much as I try, I simply cannot keep up with the entire state of the art of computer science. I wish I could, and a younger me without a family and responsibilities actually would mostly keep up with everything, but now it just feels like there's never quite enough time to learn everything I really should.
This is the part of this conversation that I don't get. Yes, it is impossible for one person to contain the entire body of knowledge, which means you're not going to know some of the time, and that might be embarrassing or otherwise troublesome.
However... it should be rare that you operate in complete isolation. You should be regularly interacting with other practitioners, including people whose entry into the field is newer, and therefore should be aware of the current state of the art. There should be interactions where that information is shared, both allowing projects you work on to take advantage of advances in the state of the art even if you don't know about it, and for you to become aware of advances in the state of the art.
Oh, I absolutely do not use this to demean people that are wrong. The point is that well established and largely effective knowledge on how things work can be completely changed with most of us not realizing it. All the more reason not to get upset with someone for not being aware of some advances. This should include self.
The handful of times I've had ulcers in the past it was certainly correlated with stress. Perhaps indirectly through some other effects, but stress feels like part of the equation IME, at least for some people.
You likely have chronic heliobacter pylori infection and should really look into that. It’s a silent killer and that way beyond just ulcers since it’s a potent acetaldehyde producing microbe. Tests are often false negative because they can hide in places, eg Candida vacuoles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101746/
Stress can aggravate ulcers, as it can aggravate any number of underlying conditions. Similarly eating spicy food can make the symptoms of acid reflux much worse thanks to capsaicin in the refluxing acid. But in both cases the root cause is something else.
There’s an interesting level to this as there is a link between stress and ulcers. Stress reduces the mucous barrier and how quickly you heal, so reducing stress actually was helping people with ulcers. Antibiotics however where more effective in most but not all cases.
I really wasn't stressed at that time; outside of the typical annoyances of being alive, my life was going pretty ok at that point, which I tried telling the doctor and he didn't believe me. After that I went to a different doc and she gave me antibiotics and I healed after a few weeks.
I am extremely thankful that I have not had an ulcer again since then, because it was the worst thing ever.
I've always been a little annoyed about the "relax" part – of course stress exacerbates everything. We know how inflammation works globally throughout the body. Of course we would have already thought of that.
I got a different doctor after that.
Robin Warren is someone who I respected the hell out of. It takes a lot of tenacity and determination to go against something when everyone is constantly telling you you're wrong. He will be missed.
ETA:
I should point out that I am aware that stress can aggravate and (potentially) cause some forms of ulcers, though I really wasn't terribly stressed at that point in my life, which I tried explaining to the doctor and he wouldn't hear it. My job was going fine, I didn't really have any debt, I had a decent relationship with my girlfriend (now wife), I really didn't feel stressed out at all.