Understanding the molecular mechanisms that underpin homeostasis and disease is of crucial importance. Rational and precise preventive and therapeutic strategies depend on it. And indeed, facilitated by the staggering pace at which new technologies are evolving, it is becoming easier to interrogate molecular processes almost by the day. From time to time, however, it might be worth remembering that plain, careful and purely descriptive research can be — and indeed has been — the foundation of transforming molecular insight and huge clinical progress. The 1984 Lancet publication by Barry Marshall and Robin Warren, who were awarded the Nobel Prize in Physiology or Medicine for their work, is a prime example of this.

In this seminal paper, they describe the presence of small, Gram-negative, spiral or curved bacteria in the antral mucosa of roughly half of their 100 prospectively sampled patients presenting for gastroscopy. Very accurately, they report these bacteria as “appearing to be a new species related to the genus Campylobacter” and that signs of inflammation are seen at sites where the bacteria reside. Their detailed description led them to propose that these bacteria might be a key factor contributing to active chronic gastritis, and gastric and duodenal ulcers, which challenged the prevailing dogma that this group of disorders is caused by gastric acid. By extension, this observation also pointed to a link between infection, inflammation and the development of cancer — thus pioneering yet another hugely important conceptual framework.

bacteria might be a key factor contributing to active chronic gastritis, and gastric and duodenal ulcers

Their unpretentious paper relied solely on light microscopy and minced tissue cultured on blood and chocolate agar — and on NOT working during the Easter holiday (“At first plates were discarded after 2 days but when the first positive plate was noted after it had been left in the incubator for 6 days during the Easter holiday, cultures were done for 4 days.”). Thus, a descriptive study, made by two prepared, well-rested and outstanding minds, has changed how we think about infection, inflammation and cancer, fuelling numerous mechanistic reports and benefiting countless patients. A great teaching case on more than one level, I believe.