The expert and medical progress : Experts' influence on the views of peptic ulcer and dyspepsia and its treatment in Scandinavia during five decades

Abstract: In this study the experts' influence on the recommendations for treatment of peptic ulcer in Scandinavia during the period 1940-1975, on the development of the first H2-receptor antagonist, cimetidine, on the adoption and use of H-receptor antagonists during the introductory phase in Scandinavia 1978-1986, and on the controversy about dyspepsia, is analysed.Experts during 1940-1960 promoted their "cures" containing severe diet restrictions and bed rest, convinced of their benefit. These recommendations were rapidly abandoned when a few controlled trials were published.Members of the team, synthesising cimetidine were convinced in their research despite the lack of results for years, showing great personal courage in decisions, sometimes against management.During the introduction of H-receptor antagonists, the interpretation of the results in the numerous publications differed between experts. The debates about a too swift acceptance, initial treatment or further investigations, surgical or medical treatment, and whether peptic ulcer disease had a psychosomatic background did not influence the prescription rate, only the removal of restrictions on reimbursement and prescription rights did.The debate about the definition and treatment of dyspepsia led to a controversy with external factors involved. Experts showed that dyspepsia was associated with psychosocial factors and that acid-reducing treatment was of no benefit. Others promoted the theory that dyspepsia was partly caused by gastric acid. The pharmaceutical industry tried to widen the market for anti-ulcer drugs and authorities intervened, trying to reduce the costs. The controversy was abandoned by experts and solved in clinical practice, resulting in continuing rise of the sales of acid reducing drugs, and eventually differentiation by the approval of reflux-like symptoms as an indication.In conclusion this study shows that human factors, such as courage, conviction and personal interpretation of facts, are decisive for experts' opinions. Doctors' wish to help and the patients' demands steer drug consumption if available drugs are shown to be safe and effective.