Medicine would Never have been the same without them!
-Karun Bhattarai
MBBS BPKIHS (Batch 2018)
The Doctor Who Drank Infectious Broth, Gave Himself an Ulcer, and Solved a Medical Mystery!
In 1910 an article was published in the
Lancet stating "acid gastritis" or “hyperchlorhydria” as the sole
cause for Duodenal Ulcer (1) . Therefore, in order
to treat duodenal ulcer, truncal vagotomy or antrectomy (cut off the bottom of
the stomach and reconnect to the intestine) was considered as the only
treatment available for about seven decades. Marshall while he was in the third
year of his internal medicine training, in 1981; worked on a project with Dr.
Robin Warren, the hospital pathologist, who was seeing some bacteria on
biopsies of all ulcer and stomach cancer patients for two years, which were all
identical. Microbiologists had no dogma to overcome about the causes of
gastritis and peptic ulcers but the wider medical community remained hard to
convince. Dr Marshall had a patient with gastritis. He got the bacteria and
cultured them, then worked out which antibiotics could kill patient’s infection
in the lab (in that case, bismuth plus metronidazole). He treated the patient
and did an endoscopy to make sure his infection was gone. The same year, in an
act born to some extent of frustration, Marshall deliberately infected himself
by drinking a solution swimming with the bacterium, as part of a successful and
widely reported experiment to prove Koch's postulates. But many clinicians
still remained unmoved. It wasn't until the early 1990s that the evidence of
Marshall and Warren became impossible to ignore, at which point pharmaceutical
development and clinical practice underwent a shift towards eradication of H.
pylori to treat ulcers. For their discovery of the bacterium Helicobacter
pylori and its role in gastritis and peptic ulcer disease, the Nobel Prize in
Physiology or Medicine 2005 was awarded jointly to Barry J. Marshall and J.
Robin Warren (2) .
Medical Imaging Technology (CT Scan,MRI) and Non-Interventional Visualization of Body!
One of the England engineer Godfrey
Hounsfield came up with an idea that instead of taking x-ray from just one
angle, if taken from all angles around one could determine something covered
inside the box. He then set to work constructing a computer that could take
input from X-rays at various angles to create an image of the object in
"slices". In 1979 Cormack A.M
and Hounsfield G.N were jointly awarded the Nobel Prize in Physiology or
Medicine for the development of computer assisted tomography (CAT), popularly
known as CT Scan these days. But it came with great bane of radiation
hazard!
Continuous efforts were being done in
advancement of imaging technology where the principle of Nuclear Magnetic
Resonance (Felix Bloch and Edward Purcell, 1946 NP1952) originated but was not
kept in clinical practice yet. Up until 1970s MRI was being used just for
chemical and physical analysis of molecules. Early detection of internal
neoplasm was greatly hampered during those days because of increased
permeability of many tumors to x-rays. A study found different biological
responses among Tumor cells and Normal cells when resonated magnetically within
magnetic field (3) . Consequently, the mankind was able to scan
human anatomy without a drop of radiation using a different principle than that
of CT scan. Instead of x-rays field used in CT Scan, MRI used Magnetic field to
resonate the protons present in fats and water in human body and using complex
algorithms transcribed into the series of images of scanned section. In
recognition of this contribution to mankind, the Nobel Prize in Physiology or
Medicine of 2003 was awarded jointly to Paul C. Lauterbur and Sir Peter
Mansfield "for their discoveries concerning magnetic resonance imaging (MRI)."
Project 523; Artemisinin yielding ancient Herbs and Nobel Prize
According to a recent WHO report, 97
countries have ongoing malaria transmission, and an estimated 3.4 billion
people are at risk of malaria, of whom ~1.2 billion are at high risk (4) .
What if the secret of modern medicine is encrypted
within the ancient herbs? It was early 1970s in China (period when scientific
research was strictly prohibited). In response to a request from the Vietnam
government for help on malaria treatment, the Chinese government launched a
secret operation called 523 Project during their Cultural Revolution. Professor
Youyou Tu (an 84-year-old, female scientist) joined the project; she searched
more than 2,000 recipes and compiled 640 recipes used for the treatment of
fever written ~1700 years ago. Professor Tu suddenly realized that high
temperature could be the cause of instability in antimalarial activity they
experienced. She decided to use ether, replacing ethanol, to extract the active
ingredients from the plant leaves. Professor Tu was the person who discovered
an efficient method for extracting the active ingredient from the A. annua plant (5) (the plant which the
world was witnessing for years and yet was left unnoticed!)
For her discoveries concerning a novel
therapy against Malaria, Prof Youyou Tu shared Nobel Prize for Medicine and
Physiology in 2015.
References
1. Some points in the diagnosis and treatment of
chronic duodenal ulcer. Moynihan, B.G.A. 4610, 1912, The Lancet,
Vol. 179, pp. 9-12.
2. Nobel Prize
winners Robin Warren and Barry Marshall. The Lancet . 9495,
s.l. : Elsevier Ltd., 10 22, 2005, The Lancet , Vol. 366, p. 1429.
3. Tumor Detection
by Nuclear Magnetic Resonance. Damadian, Raymond. Mar 19, 1971,
Science, pp. 1151-1153.
4. World Health
Organization. World Malaria Report 2014. s.l. : WHO , 2014.
p. 3. 978 92 4 156483 0 .
5. The discovery
of artemisinin and the Nobel Prize in Physiology or Medicine. SU
Xin-Zhuan, MILLER Louis H. 11, s.l. : Springer , 10 16, 2015,
SCIENCE CHINA Life Sciences, Vol. 58, pp. 1175–1179.
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