Nobel

by John Q on October 3, 2005

Congratulations to Barry Marshall and Robin Warren, winners of the 2005 Nobel Prize for Medicine for the discovery that stomach ulcers are caused, not by stress as was formerly believed, but by a bacterium, Helicobacter pylori. This is a classic Nobel-type discovery beginning with Warren’s acute observation, and continuing with Marshall’s work in culturing and identifying the bacterium.

It’s a striking observation that, thirty years ago, nearly everybody “knew” two things about stress: it was the primary cause of ulcers and it was particularly common among people men in executive jobs. Although widely held, these beliefs had never been properly tested by research and both turned out to be false. Surprising as it may seem, it’s more stressful to be ordered about than to order other people about. More precisely, the prevalence of stress-related diseases increases as you go down hierarchies of authority, status and so on.

The Nobel Prize for Economics[1] must be coming up soon. I have some ideas as to who should win, but as I’m very peripherally involved in the selection process, I’ll keep them to myself.

fn1. Strictly speaking, the Bank of Sweden Prize in Economic Sciences in Memory of Alfred Nobel

{ 23 comments }

1

tmg 10.03.05 at 5:54 pm

“the prevalence of stress-related diseases increases as you go down hierarchies of authority, status and so on.”

I can see this, at least in the academic setting that I am in now. It seems that the people who are the most stressed are the people who are recieving the orders. If you are getting assigned to do things, there is little flexibility in your scedule compared to, say, a person in an executive position. These people have the ability to change what is required of them and to delegate tasks as neccesary.

2

Kenny Easwaran 10.03.05 at 7:39 pm

What’s really striking is how many people seem to “know” those same two facts today. Hopefully this Nobel Prize will make more people realize that ulcers can be fairly easily cured.

3

Barry 10.03.05 at 8:01 pm

Henry: “..but as I’m very peripherally involved in the selection process, I’ll keep them to myself.”

Henry – 50-50 split. What about it? Just put in a good word, that’s all I’m asking.

4

David Palmeter 10.03.05 at 8:25 pm

Jagdish Bhagwati is long over-due for the economics Nobel.

5

Chris 10.03.05 at 9:03 pm

I’ll chime in with David P.: My money (as it were) is on Bhagwati. I can’t imagine they’d pass over him again this year.

6

Brendan 10.04.05 at 2:52 am

I know the Marmot book gets all the publicity (and deservedly so, it’s a very good book) but his thesis was anticipated to a certain extent by Leonard Sagan’s The Health of Nations (good title!). Which is also a very good book.

http://www.findarticles.com/p/articles/mi_m1175/is_n4_v22/ai_6507681

7

James Wimberley 10.04.05 at 5:19 am

What’s a fair economic value for Marshall and Warren’s discovery? Since it’s unpatentable pure research (the finding) plus an existing medical procedure (a course of antibiotics), the value placed in it by the market is €0. The previous innovation in ulcer treatment was Glaxo’s drug Zantac, which earned the company very roughly €10bn over its patent life. There’s no suggestion that patients felt ripped off, so €10bn was a pretty fair value. Since the Marshall and Warren discovery is at least as great a step forward, I suggest €10bn is a reasonable first guess at its economic value. I’m very glad the Nobel prize comes with a decent pile of cash for the two as well as glory.
Someone on this blog should be able to refine the estimate. But already it stands as a reminder of the enormous real value of non-market information, from Pythagoras’ theorem to Shakespeare’s plays and the TCP/IP protocol.

8

Daniel 10.04.05 at 7:19 am

Why is Bhagwati “overdue” for the economics Nobel? Why does everyone keep saying this? What’s his big contribution the equal of cointegration, options pricing or assymetric information? Is the idea that the Nobel prize ought to be awarded for an agglomeration of workmanlike articles on trade theory (Krugman) or that someone ought to be given it for appearing in the popular press a lot writing about how the conventional wisdom is entirely correct?

9

Daniel 10.04.05 at 7:20 am

by the way, the reason JQ is being so coy about his predictions is presumably that he has won it but has been told not to spoil the announcement.

10

Walt Pohl 10.04.05 at 7:32 am

The fact that Daniel beat me to the joke I was just about to make is the sign of a sinister conspiracy.

11

John Emerson 10.04.05 at 8:01 am

“The prevalence of stress-related diseases increases as you go down hierarchies of authority, status and so on.”

In the same way that physically dangerous or debilitating work is passed down the chain of command to the peons, so is stress.

I don’t know if statistics are kept, but heads of state seem to live longer than anyone else. Being catered to and flattered, having people doing what you tell them to do, and having people available to take on all the unpleasant tasks — these are all good for your health.

The exceptions prove the rule. For example, Nicolae Ceaucescu only lived to the age of 71, but I’m sure he would have lived to 90 if he’d succeeded in maintaining his status.

12

Peter Clay 10.04.05 at 8:10 am

What’s a fair economic value for Marshall and Warren’s discovery?

If you take the arguments commonly made for expanding patentability and apply them, it is possible to argue that it had negative economic value: that is, it reduced the income of pharmaceutical companies by $10bn while only maintaining the level of benefit to patients. In the pro-patent world, mere techniques like this should be patentable so that all of the economic value recieved by patients can be expropriated by the inventor of the technique.

13

bob 10.04.05 at 10:30 am

For what it is worth, ISI has “predicted” the 2005 Nobels based on citation analysis. (So far they’ve been zero for two, despite guessing three different possible awards in each category. The same thing happened in 2004). See http://scientific.thomson.com/news/newsletter/2005-08/8289814/

14

SeanD 10.04.05 at 10:44 am

Is anyone else completely at a loss as to ‘stress’ is supposed to be? It is, I think, supposed to have something to do with being busy, and, as the post mentions, not having control over why one is busy or what one is busy doing. But I think it would be widely agreed that not being busy can be stressful– chronic unemployment is, after all, hardly restful, even if one manages to get by economically.

Medically, stress seems to be a catch-all: go see your doctor with practically any non-specific system, and the diagnosis will be stress or some stress-induced condition. And though stress-related stomach problems are no longer chalked up to ulcers, that catch-all has been replaced by IBS and GERD as manifestations of stress. In my experience these diagnoses are in practice interchangeable- one doctor’s IBS is another man’s GERD, with drugs to match.

Is anyone aware of a definition in the medical/psychological literature of ‘stress’? My feeling would be that it’s a sort of cluster concept, like ‘game’- though it lacks defining characteristics, everyone knows its there.

15

Slocum 10.04.05 at 11:33 am

It is interesting the things that the medical establishment ‘knows’ with certainty until somebody bothers to check. When my daughter was born (not so long ago in 1989) I was soundly chewed out by a nurse in the hall while wheeling my newborn daugher back to the nursery because I’d laid her on her back (she was awake and looking up at me at the time), “We NEVER lay babies on the backs here!”. And then just a few years later, somebody actually did a bit of empirical research and found the risk of crib-death was highest when babies were on their stomachs. Ooops.

16

Daniel 10.04.05 at 2:36 pm

Is anyone aware of a definition in the medical/psychological literature of ‘stress’?

It is a sort of cluster concept, but the physical symptom at the centre of the cluster is elevated levels of the hormone cortisol AFAICT.

17

antirealist 10.04.05 at 3:02 pm

…the physical symptom at the centre of the cluster is elevated levels of the hormone cortisol…

The word “symptom” does not means what you think it does.

18

Daniel 10.04.05 at 3:07 pm

I daresay I will survive

19

antirealist 10.04.05 at 4:31 pm

Whatever else we think or know about stress, it seems clear that it is something experienced. So it’s hard to see quite how the concentration of a chemical can be at the centre of the stress concept cluster. To me, this seems like a kind of category mistake.

20

antirealist 10.04.05 at 10:06 pm

And another thing.

At least half of the western population is infected with H pylori – probably a lot more – but the prevalence of peptic ulcer disease is only around 10%. Nothing in the brilliant and paradigm-shifting work of Warren and Marshall alters or explains the facts that peptic ulcers are commoner in smokers, boozers, people with blood group O, and people in stressful situations.

Popular accounts which treat peptic ulcer disease as just an infectious disease caused by H pylori are simplistic misrepresentations of what is known about this disorder.

21

ogmb 10.05.05 at 1:31 am

negative economic value: that is, it reduced the income of pharmaceutical companies by $10bn while only maintaining the level of benefit to patients.

Well, it maintained the level of (health) benefit at roughly $10bn less cost.

22

John Quiggin 10.05.05 at 2:16 am

Thanks for the Sagan reference, brendan, it looks interesting.

23

James Wimberley 10.05.05 at 5:56 am

A rejoinder in the little subthread I started on the economic value of M&W’s discovery. In 22 ogmb writes: “Well, it maintained the level of (health) benefit at roughly $10bn less cost.”
That can’t be quite right. M&W isn’t a panacea and I believe drugs are still used alongside it, so there is a mix of complementarity and substitution. Clearly the range of effective treatments has increased. The other problem is that the Zantac patent has expired and Glaxo’s rent has gone, so the cost would have collapsed anyway.
Perhaps it’s best to reason in terms of consumer’s surplus: €10bn is a lower bound (not a central estimate) for Zantac, ergo for M&W.

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