J. Robin Warren, Who Proved That Bacteria Cause Ulcers, Dies at 87
He endured skepticism but won a Nobel Prize for his work upending the conventional wisdom that stress, diet or alcohol caused the painful condition.
Dr. J. Robin Warren, an Australian pathologist who shared a Nobel Prize for discovering that most stomach ulcers were caused by the bacterium Helicobacter pylori — and not, as had been widely believed, stress, alcohol or spicy foods — died on July 23 in Inglewood, Australia. He was 87.
His death, at a care home, was announced by the University of Western Australia in Perth, where he was an emeritus professor for many years. His daughter-in-law Gigi Warren said the cause was complications after a recent fall.
In 1984, Dr. Warren and his collaborator, the gastroenterologist Barry Marshall, published a paper in the British medical journal The Lancet describing their finding that the spiral-shaped bacterium now commonly called H. pylori festered in the stomachs of patients with ulcers and gastritis. Dr. Warren had first noticed the bacterium on a gastric biopsy sample in 1979.
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The paper’s conclusion upended centuries of conventional wisdom about the cause of ulcers. (Psychoanalysts had even written of the “peptic ulcer personality.”) Doctors typically prescribed stress reduction, a bland diet and, starting in 1977, drugs like Tagamet and Zantac to tame the burning acids. Severe cases were sometimes treated with surgery.
When the study was published, gastroenterologists were skeptical. They expressed concern about whether to trust potentially paradigm-shifting findings made by two unknown researchers in Australia. And the idea that bacteria could even grow in the stomach was considered blasphemy.
“For about 100 years, or 1,000 years, the standard teaching in medicine was that the stomach was sterile and nothing grew there because of corrosive gastric juices,” Dr. Warren told The New York Times in 2005 after he and Dr. Marshall won the Nobel Prize in Physiology or Medicine. “So everybody believed there were no bacteria in the stomach. When I said they were there, no one believed it.”
The study was also at odds with the marketing done by pharmaceutical companies, which had spent millions of dollars developing acid reduction drugs. Those medicines cleared up ulcers, but the condition often returned again and again. Dr. Warren and Dr. Marshall’s work suggested that antibiotics would be a more effective treatment.
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“The prospect that antibiotics might cure ulcers was a serious threat to the world record profitability of the recently developed wonder drugs that stopped the secretion of gastric acid and healed ulcers rapidly,” Dr. William S. Hughes wrote in “The Great Ulcer War” (2014), a history of the Australian duo’s fight over proving that H. pylori caused ulcers.
Fed up with the skepticism and pushback after their paper was published, Dr. Marshall had a rather unconventional idea: infecting themselves with H. pylori.
“I didn’t like that idea at all,” Dr. Warren later said, “so I think I just said no.”
But Dr. Marshall went through with it, gulping down a broth of the bacterium. A few days later, he became severely ill with gastritis — the precursor to an ulcer.
That still wasn’t enough proof. It would take almost a decade for physicians to finally accept the findings and change how they treated ulcers: with antibiotics, just as they would treat any other bacterial infection.
“Now there is the possibility of curing the condition, which was unthought of before,” Hugo Gallo-Torres, a Food and Drug Administration official, said in 1994, adding, “We had treated ulcers with anti-secretory compounds for so many years, it was hard to accept that a germ, a bacterium, would produce a disease like that.”
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John Robin Warren was born on June 11, 1937, in North Adelaide, Australia. His father, Roger, studied viticulture and was a winemaker. His mother, Helen (Verco) Warren, was a nurse who had dreams of becoming a doctor but couldn’t afford medical school.
He studied medicine at the University of Adelaide, graduating in 1961. He wanted to specialize in psychiatry, but he wasn’t accepted into the residency program. He chose clinical pathology instead, committing himself to a solitary life staring into a microscope.
“In practice, ‘Clinical Pathology’ meant mainly laboratory hematology, which I thoroughly enjoyed,” Dr. Warren wrote in his Nobel autobiography. “Although the usual work entailed reporting on blood smears and bone marrow, we had a wide range of other tasks, including examining feces for parasites, examining urine and testing skin and nails for fungus.”
In 1968, he became a pathologist at Royal Perth Hospital, which is affiliated with the University of Western Australia.
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“He was a bit eccentric,” Dr. Marshall said in an interview. “You’re a pathologist living down in the basement there, cutting up dead bodies and that. So you didn’t have to be a people person really to succeed at that job.”
What Dr. Warren did have was a kind of scholarly stubbornness.
“He’s uninfluenced by other people’s opinions,” Dr. Marshall said, adding that even when colleagues laughed at their attempts to prove H. pylori caused ulcers, “as far as he’s concerned, that was the facts. And if you didn’t believe it, it’s because you were just incompetent or something.”
Dr. Warren married Winifred Williams, a psychiatrist, in 1962. She died in 1997. They had five children. (Complete information on survivors was not immediately available.)
At the outset of Dr. Warren’s obsession with H. pylori, his wife was among the few people in his life not to deem him crazy — though she was certainly qualified to do so.
“Before I met Barry, Win was the only person to accept my work and encourage me,” he wrote in his Nobel autobiography. “As a psychiatrist, she could have suggested I was mad. But she stood beside me and helped me when no one else would.”
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