The Great Ulcer War

An engaging slice of recent medical history and controversy.
In this debut book on the history of medicine, Hughes does a remarkable job of balancing the researcher’s precision with the storyteller’s understanding of his audience. Hughes traces the shifts in the medical community’s understanding of ulcers and their causes, focusing on the last two decades of the 20th century and the gradual acceptance of bacteria as the cause of the disease, a process that took more than a decade. That acceptance was the result of research done by physicians outside the mainstream medical establishment, and Hughes is unstinting in his indictment of the pharmaceutical companies who, he says, used their financial power to discredit the bacterial theory, which threatened the profitable market for Zantac and Tagamet. Readers whose knowledge of anatomy is taxed by the game of Operation will have little trouble following Hughes’ explanations of Helicobacter’s role in making holes in the stomach lining thanks to you-are-there descriptions of endoscopies, stomach tubes and researchers’ adventures in conducting experiments on themselves. The writing—while suffering from minor but frequent misplacement of commas—is energetic and often witty, as when Hughes compares drug sales representatives at conferences to “a gastric cell and a swarm of Helicobacter” or writes that “Dr. Tytgat, like a Protestant reformer, nailed the thesis of treatment successes to the conference record.” Hughes describes his own minor role in advancing the bacterial theory—he counseled Sen. Ted Kennedy’s staff to promote Helicobacter research—and there is no coyness about his position as a passionately interested participant. That passion shows as the book traces the long tension between treatment and profit, demonstrating the substantial power held by major pharmaceutical companies looking to protect their investments. Despite the strength of the opponents, this book is the story of the triumph of knowledge and evidence, and Hughes concludes with both the establishment’s acceptance of bacterial theory and a sense of hope for the future of medicine.
A well-written story of medicine, money and politics written by a knowledgeable physician.