The Medicine Nobel Prize: observation and determination

An observant pathologist and an enterprising physician from Australia have won the Nobel Prize for Medicine for the discovery of Helicobacter pylori and its role in peptic ulcer disease and gastritis in 1982. Robin Warren, a clinical pathologist in Royal Perth Hospital noticed abundant curved bacteria in stomach biopsy specimens with severe inflammation. If the number of bacteria were less the inflammation was proportionately reduced. With the help of Barry Marshall who was a trainee doctor in the same hospital an attempt was made to culture these bacteria. After many unsuccessful attempts, a set of culture plates were mistakenly incubated for thrice the normal time. A new bacterium was discovered H.pylori. But controversy continued to rage. What was the original sin - the inflammation or the bacteria? Many felt that it was the inflamed mucosa that provided a supportive haven for the H.pylori. Finally the controversy was settled in a dramatic manner. Barry Marshall swallowed some of the bacteria, developed gastritis, underwent endoscopic biopsy from which H.pylori was then cultured. So this years prize goes in fact to clinical medicine and intense self belief (BMJ 8 October 2005;331:795).

Environment

Root causes: A gargantuan study which will enlist 100,000 children across the US and study the effect of environmental influences on children health and adult diseases has got the final green signal. The study quoted as 'a giant step towards improving childrens health' has been carefully planned for the last 5 years. In some cases data will be collected even before conception and children will be followed upto 21 years. Environmental influences such as diet, ambient air, and the home and school environment including second hand tobacco smoke, lead, radon and asbestos will be analyzed. The study has exited research workers across the globe and study investigators hope data from other countries could also be pooled (BMJ 8 October 2005;331:798).

Epidemic

Avian influenza: The spectre of another bird flu pandemic is again haunting the world. It started with 50 million chickens dying of it early this year in Vietnam, Cambodia and Korea. The disease spread to Indonesia where because the government did not undertake mass culling of birds like in other countries, it has now become endemic. In August 2005 it was reported in other species most importantly civets which had played a key role in spreading SARS. In mid 2005, countries including the US started stockpiling anti-virals such as tamiflu and zanamivir (Relenza). Since September 2005, 5 human cases of deaths due to bird flu in Indonesia by the H5N1 strain have been confirmed. What was more worrisome was a study published in the Lancet in September 2005 which said that 83% of strains isolated since 2003 show evidence of drug resistance. The latest threat is from Turkey where more than 1000 migratory birds recently died of suspected bird flu. The international community is gearing up in a big way to handle the pandemic and hopes it will not a be a repeat of 1918 when millions of people lost their lives ([email protected] Published online: 12 September 2005; | doi:10.1038/news050912).

Gouri Rao Passi,
Consultant,
Department of Pediatrics,
Choithram Hospital & Research Center,
Indore -452001, Madhya Pradesh,
 India.
E-mail: [email protected]