Johannes Andreas Grib Fibiger (April 23, 1867 – January 30, 1928) was a Danish doctor and professor of anatomical pathology at the University of Copenhagen. He received the 1926 Nobel Prize in Physiology or Medicine for his discovery of the Spiroptera carcinoma. He claimed that a type of roundworm, which he called Spiroptera carcinoma (but is correctly named Gongylonema neoplasticum), could cause stomach cancer (squamous cell carcinoma) in rats and mice. Later research showed that his conclusion was incorrect.

While working at the Institute of Pathological Anatomy at the University of Copenhagen, Fibiger found new roundworms in wild rats in 1907. He believed the roundworms caused stomach cancer in those rats. In 1913, he reported that he could cause cancer in healthy rats by using the roundworms. At the time, his discovery was called "the greatest contribution to experimental medicine." In 1926, Fibiger and Katsusaburo Yamagiwa were both nominated for the Nobel Prize in Physiology or Medicine. Yamagiwa had previously caused cancer in rabbits by applying crude coal tar to their ears. However, the 1926 prize was not given to them. The following year, Fibiger was chosen alone to receive the 1926 Nobel Prize.

After Fibiger's death, other scientists found that Gongylonema neoplasticum does not cause cancer. The tumors and cancer Fibiger observed were actually caused by a lack of vitamin A in the rats' diets. A review of Fibiger's research later showed that he had mistaken non-cancerous growths for cancerous ones. In 2010, Erling Norrby, who was a leader at the Royal Swedish Academy of Sciences and a professor at the Karolinska Institute, said that Fibiger's Nobel Prize was "one of the biggest mistakes made by the Karolinska Institute."

Fibiger's research on diphtheria helped create a method in medicine called the controlled clinical trial, which is still used today to test treatments.

Biography

Fibiger was born in Silkeborg, Midtjylland, Denmark. He was the second son of Christian Ludvig Wilhelm Fibiger and Elfride Fibiger (née Müller). His father was a local physician, and his mother was an author. He was named after his uncle, who was a clergyman and a poet. His father died of internal bleeding when Fibiger was three years old. After this, the family moved to Copenhagen, where his mother earned money by writing. She also founded the first cooking school in Copenhagen, called the Copenhagen Cooking School.

Fibiger’s namesake uncle helped support his education. In 1883, at age 16, he passed his matriculation exams and began studying zoology and botany at the University of Copenhagen. He supported himself by teaching and working in laboratories. He graduated in 1883. He later studied medicine and earned his medical degree in 1890. For a few months, he worked as a physician at different hospitals. He also studied under Robert Koch and Emil Adolf von Behring in Berlin. Between 1891 and 1894, he worked as an assistant to C. J. Salomonsen at the Department of Bacteriology at Copenhagen University. From 1894 to 1897, he served in the Royal Danish Army Medical Corps. During his time in the army, he completed his doctoral thesis titled Research into the Bacteriology of Diphtheria. The University of Copenhagen awarded him a doctorate degree in 1895. He continued his research on diphtheria at Blegdamshospitalet in Copenhagen as a junior physician. In 1897, he became a prosector at the Institute of Pathological Anatomy at the University of Copenhagen. He was later promoted to full professor and became the institute’s director in 1900. He also worked as principal of the Laboratory of Clinical Bacteriology of the Army from 1890 to 1905 and served as director of the Central Laboratory of the Army and as a consultant physician to the Army Medical Service in 1905.

Fibiger died of cardiac arrest in Copenhagen on January 30, 1928.

Contributions

Fibiger's graduate research focused on diphtheria. He created a better way to grow bacteria in a laboratory. He found that there are two types of the diphtheria bacillus (Corynebacterium diphtheriae) that cause different symptoms, now called nasopharyngeal and cutaneous diphtheria. He also made a blood serum to treat the disease. He was known for his organized approach to research. One of his experiments in 1898, in which he tested the blood serum for diphtheria, is considered by some to be the first controlled clinical trial. While working as a Junior Physician at Blegdamshospitalet, he tested his diphtheria serum on 484 patients. Like modern clinical trials, he divided patients into groups: those who received the serum and those who did not. He found that more patients who did not receive the serum died than those who did. According to an article in The British Medical Journal in 1998:

While studying tuberculosis in lab rats, Fibiger discovered tumors in some wild rats collected from Dorpat (officially Tartu, now in Estonia) in 1907. Rats with stomach tumors (papilloma) also had nematodes and their eggs. He found that some tumors were metastatic (cancerous). He hypothesized that the nematodes caused the stomach cancer. After years of research, he proved in 1913 that the nematode could cause stomach cancer. He published his findings in three papers and presented them at the Académie Royale des Sciences et des Lettres de Danemark (Royal Danish Academy of Sciences and Letters) and the Troisième Conférence Internationale pour l’Étude du Cancer (Third International Conference for Researches in Cancer) in Brussels that same year. He knew the nematode was a new species and temporarily named it Spiroptera carcinom in 1914. With Hjalmar Ditlevsen of the Zoological Museum at the University of Copenhagen, he described it as Spiroptera (Gongylonema) neoplastica in 1914. Ditlevsen revised the description in 1918 and gave it the final name Gongylonema neoplasticum. Fibiger never used the formal scientific name and consistently used Spiroptera carcinoma.

Fibiger's experiment was the first to show that worm parasites can cause cancer and that cancer can be caused in experiments. His discovery was supported by the work of two Japanese scientists, Katsusaburo Yamagiwa and Koichi Ichikawa, in 1918. Yamagiwa and Ichikawa showed that cancer (carcinoma) could be caused in rabbits by painting coal-tar on the inner surface of their ears. Other experiments later confirmed that coal-tar could cause cancer in mice. With this evidence, Fibiger's work was considered an important step in cancer research.

Personal life

Fibiger married Mathilde Fibiger (1863–1954), who was his cousin. Mathilde helped her mother with her business while Fibiger studied medicine. They married on August 4, 1894. Fibiger had colon cancer, and one month after receiving his Nobel Prize, he died of a heart attack on January 30, 1928, due to his worsening cancer. He was survived by his wife and two children.

Nobel Prize controversy

Fibiger was nominated for the Nobel Prize in Physiology or Medicine 18 times between 1920 and 1926. In 1926, he and Katsusaburo Yamagiwa both received nominations. Folke Henschen and Hilding Bergstrand were chosen by the Nobel Committee to review the nominations. They had different opinions. Henschen believed Fibiger and Yamagiwa should win the prize, stating that their work on experimental cancer was important enough to share the award. Bergstrand disagreed, arguing that their research did not prove new medical facts and was not significant enough for the Nobel Prize. Because of this disagreement, the Nobel Committee could not decide and did not give the prize in 1926. In 1927, Fibiger received seven nominations, but Yamagiwa was no longer nominated. Instead, Otto Heinrich Warburg and Julius Wagner-Jauregg were considered. Einar Hammersten, another reviewer, supported Fibiger and Warburg. The Nobel Committee decided to award the 1926 prize to Fibiger and Warburg together, and the 1927 prize to Wagner-Jauregg. However, the Karolinska Institute later disagreed with the decision to award Warburg, and Fibiger became the sole winner of the 1926 prize. Warburg eventually won the Nobel Prize in 1931.

Fibiger’s discovery was not challenged during his lifetime. The only serious criticism came from F. D. Bullock and G. L. Rohdenburg in 1918. They claimed that the tumors Fibiger created in his experiments were similar to non-cancerous tumors that naturally occur in certain cells. Fibiger defended his work, stating that the tumors were true cancers and that their occurrence in younger animals did not change their classification.

After Fibiger’s death, scientists discovered that vitamin A deficiency, not the parasites Fibiger studied, caused the tumors. The parasites only caused tissue irritation, which led to cancer. This idea was challenged by Richard Douglas Passey and his colleagues in 1935, who found that the parasites Fibiger used did not cause cancer in rats. They suggested Fibiger may have mistaken a non-cancerous tumor for true cancer. In 1937, W. Cramer showed that Fibiger’s tumors were not cancerous. Finally, in 1952, Claude R. Hitchcock and E. T. Bell repeated Fibiger’s experiments using advanced tools and confirmed that the tumors were not cancerous and were instead caused by a lack of vitamin A.

Some people believe that Yamagiwa’s exclusion from the Nobel Prize was also a mistake. Yamagiwa’s research on how tumors develop is now a key part of cancer studies. Because of this, some argue that Fibiger’s Nobel Prize was not fair, as Yamagiwa was not recognized. Encyclopædia Britannica’s guide to Nobel Prizes in cancer research highlights Yamagiwa’s work as a major achievement but does not mention Fibiger.

Although the parasite Fibiger studied, G. neoplasticum, does not cause cancer, other parasites like Schistosoma haematobium, Opisthorchis viverrini, and Clonorchis sinensis are now known to cause cancer in humans.