This month’s blog post sees our CEO, Katrina Burchell reflect on how far, or not, patient’s treatment for Pernicous Anaemia has come since 1926.
In a recent feature on notable medical anniversaries of 2026, the BMJ highlights many milestones spanning centuries—from the birth of Averroes in 1126, master of philosophy, theology, medicine, and law, to landmark discoveries in bacteriology and major epidemics. Among these items sits a significant and sobering reference for our community: the introduction of liver therapy for Pernicious Anaemia in 1926.
While the list includes a wide sweep of scientific achievements—discoveries by Koch, Scheele, and Lombroso, the establishment of Edinburgh Medical School in 1726, and the 1976 Yambuku Ebola outbreak—few entries resonate quite like this one for those living with or supporting someone with this autoimmune condition.
1926: When Raw Liver Changed Everything—But at a Cost
In 1926, George Minot and William Murphy demonstrated that feeding patients large quantities of raw liver could reverse the deadly course of Pernicious Anaemia.
Historical accounts describe patients consuming up to a pound of raw liver daily—a treatment that was not only unpleasant but physically difficult for those already suffering severe symptoms. More detailed accounts of this era highlight the “astonishing recoveries” this therapy produced, but also how grim and arduous the approach truly was.
This represented medicine in its infancy for Pernicious Anaemia. At the time, cobalamin remained undiscovered and the mechanisms behind stomach cell damage and intrinsic factor deficiency were unknown. While the treatment was lifesaving, it was inherently horrendous by modern standards.
2026: A Century Later—How Are We Still Getting It Wrong?
And yet, as the BMJ paper marks 100 years since this breakthrough, an uncomfortable comparison emerges.
Despite advances in diagnostics, B12 therapy, and clinical understanding, today’s Pernicious Anaemia patients still endure experiences that many would argue are equally horrendous—just in a different guise.
Modern PA patients frequently report:
- Late or missed diagnosis — often after years of worsening symptoms
- Undertreatment, especially long intervals between B12 injections or inadequate dosing even though research and published guidelines advocate otherwise.
- Dismissal of symptoms, attributed to stress, ageing, or unrelated causes
- Fragmented care, with inconsistent primary care practice, lack of education and practitioner awareness
- Significant impact on work, cognition, mobility, and mental health leading to permanent neurological damage for the individual and a significant ‘hidden’ economic loss, characterised by thousands of lost working days and the high systemic costs associated with treating advanced, preventable complications.
While no one today is forced to eat raw liver to survive, many patients are left fighting for appropriate treatment, battling symptoms that could be alleviated, and struggling to have their concerns taken seriously.
The irony feels cruel to the patient and patient advocate:
In 1926, the treatment was brutal but effective. In 2026, treatment exists—but accessing it can be brutal.
A Tale of Two Horrors
When we compare the BMJ’s list of medical anniversaries, we see events that shaped medical science—major epidemics, Nobel Prize‑winning discoveries, groundbreaking publications. The liver treatment for pernicious anaemia stands among them as a turning point that transformed a fatal illness into a manageable one.
Yet, here we are a century later, in a world with far superior medical tools, and patients still face:
- Diagnostic delays longer than any acceptable standard
- Symptoms dismissed despite classic presentations
- Therapies limited not by science, but by protocol
And that is a tragedy no anniversary should have to commemorate.
What This Anniversary Should Inspire
The message is clear:
The raw liver era taught us that treatment matters—and that when clinicians take patient symptoms seriously, lives are transformed.
A century on, we have the knowledge, the tools, and the evidence to treat Pernicious Anaemia effectively. What we need now is the will—across healthcare systems, policymakers, and clinical practice—to ensure no patient is left suffering needlessly.
Because no one should look back at 1926 and feel that, in some ways, patients had it better.
Thank you this made for very interesting reading.
You do a fantastic job to help support people and particular thanks to Karyl for taking the time to support me recently.
Lynne Gibson
Early in 1927, Minot was called to treat Mrs J K Lilly, wife of the President of Eli Lilly, who had pernicious anaemia. The liver extract became commercially available as “Lilly 343”, but sadly the Harvard committee would not allow them to patent the process, Lilly were persuaded to give the patent to the public.
The public do not have the same monetary drive and expertise and hence here we are a whole 100 years later and methylcobalamin is still not in the BNF. Here we are still battling with authorities to get enough liver extract to be well, still battling with a total lack of understanding of the historical position that led to today’s problems.
One hundred years for the truth to be realised and accepted.
I was diagnosed with pernicious anemia before the age of 30 years old.
I was treated with injections of B13 done my a nurse, then my husband, then me.
As I am tested for B12 every 3 months, I discovered that large oral doses of oral B12 are also effective. I have been using this approach for 20+ years and it continues to work
Hope this helps others with B12 deficiencies.
My comment is that it is certainly NOT the case that large oral doses of B12 are effective treatment for all cases of Patients with proven P.A.So I could not let that comment go unchallenged . For many P.A. patients , injections are the only solution .