June 2004
Comments
I think, it is a purely criminal story. So I’ve sent letters to British police, US Attorney-General and to European fraud-fighting agency OLAF. Surprisingly, I failed to get a single response.
Nevertheless, I have got several informative comments from a number of scentists and major participants of H.Pylori story.
At first, I even received a pretty kind note from Barry Marshall ("Maybe you are a little harsh but no doubt it will get people thinking."). Apparently, it was an ill-considered premature letter - reanimating this scandal does not look today profitable to H.Pylori industry. So, very soon Dr.Marshall expressed a more reasonable loss of interest to my work ("I have so much work on-line from emails that I have set your letter aside...").
Significantly more interesting comment came from David Graham - major opponent of H.Pylori discovery who made at late stages of HP story a very serious positive contribution promoting HP discovery to final official recognition (he was the author of the first editorial in NEJM on H.Pylori in 1993 and it was him who told to senator Kennedy that there is at last sufficient data to say that ulcers is caused by H.Pylori [1] ). Naturally, his comments on my findings were clearly negative ("I think you have made a spurious correlation... Your correlation is retrospective and misses the actual flavor of the issue... I think that your hypothesis deserves to be neglected...") Yet he also appended to his letter a file with his own interpretation of HP history which contained a so obvious falsification that on the aggregate his letter definitely strengthened confidence in appropriateness of my allegations against Glaxo.
I also greatly appreciate other comments. Further, I group them by major points of my investigation that seem to be worth discussing.
1. Whether Nature/Science did publish nothing on H.Pylori discovery?
As a silly cowardly (and not too diligent) scientist I was slightly afraid to commit a trivial mistake declaring that there were no publications in Nature/Science on H.Pylori theme for so many years. Obviously, this risky claim might be easily disproven by pointing to a pair significant articles. Now I can sigh with relief - I have not received a single objection or even doubt concerning this statement. So, this question is closed now.
2. Why Nature/Science published nothing on H.Pylori?
Searching for all possible answers to this question was not primary objective
of my article. My explanation of Nature/Science silence by corruption links
with drug industry is plainly obvious. It is based on the common knowledge
that if some "independent" institution (or govt. official, or local policeman,
or anything else ) for many year shows some activity (or inactivity)
significantly favouring some commercial organization it is usually explained
by corruption and NEVER by mere coincidence. I have just wild guesses
what specific sort of corruption link might exist between Glaxo and Nature/Science
editors. It is clearly indicated in the main text.
Nature/Science editorial boards might try to present an alternative
decent explanation for their dead silence on HP discovery. I have asked
Nature/Science editors for any comments on my investigation; naturally,
they vouchsafed me no answer.
Of course, it is easy to make a nice nelly explanation that Nature/Science did not publish anything on HP theme because somehow it was not exactly their theme. Yet it seems pretty hopeless. From one viewpoint HP discovery is identical to discovery of AIDS virus (to which Nature/Science printed paranoid amounts of publications) and from another viewpoint it is identical to discovery of H2 blockers on which the original article by Sir James Black was also published in Nature (236:385-90, 1972). Perhaps, here I also ought to quote some grounding documents with mission statements of Nature/Science proving that disseminating objective information on HP discovery was their basic duty, yet it seems plainly obvious and, again, I am not a too diligent scientist. Help would be greatly appreciated.
I don't know significant anecdotal stories on rejections HP articles from Nature/Science. Though Dr.Marshall informed me that his HP article was rejected from NEJM in 1987 - it also proves the point.
3. How great was the contribution of Nature/Science silence to HP discovery misfortunes?
The "antiterrorist initiative" of sci.journals consortium lead by Nature,
Science and PNAS is an undisputable proof that the service of covert
stifling of "unpalatable" scientific research is presented in their pricelist.
The fact that this service was activated against HP discovery also
does not deserve any discussion.
The question remains whether boycott of HP discovery by Nature/Science
was the primary cause of HP discovery troubles. Perhaps, there were other
more important factors.
I have not found such factors. There is only one available alternative
explanation that delay in recognition of HP discovery was just a natural way
of diffusion alien ideas in a traditionally conservative environment of medical
profession. Apparently, this interpretation of HP story originates from David
Graham and, in the absence of any definitive ideas on what actually happened
with their works from Warren/Marshall it should be considered an official
version of HP story.
As I wrote in the main text, I can well believe that this "natural obscurantism"
inerpretation of HP troubles may be valid only for first several years of HP story.
Extending this
explanation for the whole 10-year-long period of HP misfortunes requires rather awkward
falsifications.
The most important one may be seen in the following listing [by D.Graham, ref.2] of requirements
for establishing the cause of stomach ulcers:
Table1.Dr.Graham was quite consistent in saying that reliable treatment is a requirement for establishing infectious nature of ulcers; here is what he advised to senator E.Kennedy, (obviously, publication was on "reliable treatment"):
Some requirements before the hypothesis that Helicobacter pylori could be accepted as the cause of peptic ulcer disease
Ability of reliably culture the organism
Reliable diagnostic tests to confirm its presence
Reliable treatments
Randomized clinical trials showing benefits of treating the infection
Integration of the new knowledge into the established data base
"The world changed with a January 1993 paper in JAMA" says Graham. "It had no new information but enough data to say that if you cure HP, you cure ulcers" [ref.1]This is a classical "sentence first - verdict afterwards" trick. Establishing the infectious etiology of ulcer disease and finding a reliable treatment for it are absolutely different problems! It is the most fundamental paradigm of medicine: at first the cause of the disease should be identified and then the knowledge of this cause draws more researchers and money, facilitates and accelerates further search and evalauting effective treatments. Identification of infectious etiology of stomach ulcers failed to get adequate publicity and therefore official recognition and THAT was the primary trouble in HP story.
Of course, there were also lot of troubles with official approving the effective antibacterial treatment. Actually these are the troubles whose existence Dr.Graham tries to deny.
In this paragraph, I should also express great thanks to Peter
Hinkle and to Michael Wynne for pointing to an error in the original version
of my work. I wrote that practising doctors were also underinformed on
HP theme thanks to Nature/Science silence. Of course, I was wrong. Practising
doctors rarely read Nature or Science, much more often they get professional
information from other sources. So, the silence of these two journals on
HP theme did not influence significantly the supply of information on H.Pylori
to this group of people. I was misled by statements that in early 90-es
only about 5% of ulcers patients get antibacterial treatment. At first glance,
this number means that only slightly above 5% of doctors knew about this
treatment. Surely, if 5% of doctors practically use the new therapy which
is tainted by some vague discussions and which is not approved officially,
of course it means that closer to 100% of them should have been informed
about it.
It is not an important error. Conclusive confirmation of antibacterial
treatment required conducting long-term statistical study. And though hypothetically
every practising gastroenterologist might decide for himself whether
he should use antibacterial treatment (read the HP publication - and the
drugs were on the market) it could be just a sort of gambling. In reality,
practitioners could not influence the fate of HP discovery regardless
of whether they were informed about it or not. They had to wait for an "officially"
approved approaches.
4. HP Vaccine
This is an off-topic for the present investigation, yet, quest for
HP vaccine seems to be today the most important practical problem in HP
research. Than, I also have some special interest to vaccines because
of my old iconoclastic works on basic theory of
vaccines. So, I've sent 20 e-mails to authors of sci.publications on HP
vaccine asking for comments yet, alas, I have got nothing in response
to speak of. Unfortunately, it supports again my old sneaking suspicions
that vaccinology is governed by idiots.
Perhaps, I may express my disappointment in a form of trivial opinion
that HP vaccine research has collapsed into the same meaningless parasitic
form as it happened with AIDS vaccine. Here is a short qoute from a big
6-year-old review on HP vaccine. I guess, nothing changed since that time.
(Note a striking similarity to AIDS rhetoric):
A convincing body of data now exists supporting the potential for successful immunization against H pylori. However, we are still at a preliminary stage in clinical development. The best immunogens, the best mode of presentation, the number of doses needed, optimal age at immunization, expected benefit, cost-effectiveness, and other factors involved in vaccine development require further study.
The complex pathogenesis of this infection, including the presence of antigens on H pylori shared with the host (a mechanism for immune evasion), demands novel approaches to the development of a final vaccine formulation. [ref.3]
References
1. Brian O'Reilly - Why doctors aren't curing ulcers -- Fortune (June
9, 1997)
2. Graham DY. Overview of Helicobacter pylori infection: History, epidemiology,
diseases and future. In: Helicobacter pylori infection in gastroduodenal
lesions. The second decade. JM Pajares Garcia, P Correa, GI Perez Perez
(Eds), Prous Science, Barcelona, 2000; pp 1-11.
3. Thomas P. Monath et.al.- Infect Med 15(8):534-546, 1998 (http://www.medscape.com/viewarticle/417377)
