Past incompetence predicts future progress

Monday, February 25th, 2019

Gregory Cochran is (darkly) optimistic about how much low-hanging fruit is out there in the world of medical research:

If we look at cases where an innovation or discovery was possible — even easy — for a long time before it was actually developed, we might be able to find patterns that would help us detect the low-hanging fruit dangling right in front of us today.

For now, one example.  We know that gastric and duodenal ulcer, and most cases of stomach cancer, are caused by an infectious organism, Helicobacter pylori.  It apparently causes amnesia as well. This organism was first seen in 1875 — nobody paid any attention.

Letulle showed that it induced gastritis in guinea pigs, 1888. Walery Jaworski rediscovered it in 1889, and suspected that it might cause gastric disease. Nobody paid any attention.  Krienitz associated it with gastric cancer in 1906.  Who cares?

Around 1940, some American researchers rediscovered it, found it more common in ulcerated stomachs,  and published their results.  Some of them thought that this might be the cause of ulcers — but Palmer, a famous pathologist,  couldn’t find it when he looked in the early 50s, so it officially disappeared again. He had used the wrong stain.  John Lykoudis, a Greek country doctor noticed that a heavy dose of antibiotics coincided with his ulcer’s disappearance, and started treating patients with antibiotics — successfully.   He tried to interest pharmaceutical companies — wrote to Geigy, Hoechst, Bayer, etc.  No joy.   JAMA rejected his article. The local medical society referred him for disciplinary action and fined him

The Chinese noticed that antibiotics could cure ulcers in the early 70s, but they were Commies, so it didn’t count.

Think about it: peptic and duodenal ulcer were fairly common, and so were effective antibiotics, starting in the mid-40s. Every internist in the world — every surgeon — every GP was accidentally curing ulcers  — not just one or twice,  but again and again.  For decades. Almost none of them noticed it, even though it was happening over and over, right in front of their eyes.  Those who did notice were ignored until the mid-80s, when Robin Warren and Barry Marshall finally made the discovery stick. Even then,  it took something like 10 years for antibiotic treatment of ulcers to become common, even though it was cheap and effective. Or perhaps because it was cheap and effective.

This illustrates an important point: doctors are lousy scientists, lousy researchers.  They’re memorizers, not puzzle solvers.  Considering that Western medicine was an ineffective pseudoscience — actually, closer to a malignant pseudoscience  — for its first two thousand years, we shouldn’t be surprised.    Since we’re looking for low-hanging fruit,  this is good news.  It means that the great discoveries in medicine are probably not mined out. From our point of view, past incompetence predicts future progress.  The worse, the better!


  1. Ezra says:

    Used to hear all the time about surgery for ulcers. It was stress that caused the ulcers so we were told. You don’t hear of that anymore and for some time.

  2. L. C. Rees says:

    Excessive aspirin or NSAID use can lead to stomach ulcers as well. That’s what caused mine.

    They’re probably the number two cause of stomach ulcers in the developed world behind our little friend H. pylori.

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