In This Episode: “Doctor knows best,” the saying went. While delivered as reassurance, its real meaning was much more sinister, as I’ll explain. This is the story of the final nail in that idiom’s coffin because really, it was a lie all along. The crazy thing is, that didn’t happen all that long ago.


089: The Deserved Death of “Doctor Knows Best”

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Transcript

“Doctor knows best,” the saying went. While delivered as reassurance, its real meaning was much more sinister, as I’ll explain. This is the story of the final nail in that idiom’s coffin because really, it was a lie all along. The crazy thing is, that didn’t happen all that long ago.

Welcome to Uncommon Sense, I’m Randy Cassingham.

When I was a kid, it was common knowledge what caused stomach ulcers: spicy food; stress, especially from overwork; excess stomach acid.

The first doctor to describe gastritis, the stomach condition that leads to ulcers, was the “Father of Medicine” himself: Hippocrates, in around 400 B.C. Yet it wasn’t until 1868 that German physician Adolph Kussmaul found a treatment that worked pretty well: compounds containing the element bismuth, which is still used today — it’s the active ingredient in Pepto Bismol, a trademark for bismuth subsalicylate.

But even in the 19th and 20th centuries, doctors were still at a loss as to the cause of ulcers, which are found not just in the stomach, but also the duodenum, the upper part of the intestines that the stomach empties into. They suggested non-specific “chemical factors.” Russian doctors suggested infections.

In 1881, microbiologist Theodor Klebs suggested bacteria was the cause, as might be expected from a microbiologist. But that was doubted by many doctors, and was finally fully shut down in 1954 by a large-scale study by a gastroenterologist, Dr. Ed Palmer, which he said proved there were no bacteria in the human stomach whether the person had gastritis or not. The idea: bacteria just couldn’t live in the acidic environment of the stomach.

“These findings, supported by the efficacy of antacids,” said biologist Carl Bergstrom of the University of Washington, “supported the alternative ‘chemical theory of ulcer development,’ which was subsequently canonized.” So there you go: medical canon was “chemicals” caused ulcers, but of course we still knew spicy food and stress at least made them worse, right?

In 1971 a new drug was introduced to combat ulcers: Tagamet. It’s actually an antihistamine (an “H2 receptor agonist”), which inhibits the production of stomach acid. Because as westerners moved into the industrial era, with increasing on-the-job stress, the incidence of ulcers skyrocketed. Pretty much proves the stress theory, right? Well, Tagamet to the rescue! It was approved in the U.K. in 1976, and in the U.S.

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