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If you like Barry Marshall's story, you might also like:
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Gertrude B. Elion,
David Ho,
Judah Folkman,
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Barry Marshall
Barry Marshall
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Barry Marshall Interview (page: 7 / 8)

Nobel Prize in Medicine

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  Barry Marshall

It sounds like you've had a real passion for your work. Is that still what keeps you going?

Barry Marshall: I think the passion's died down a little, but I still love it. In those days, every single day we would get a new idea. With these new bacteria, ten of them would fall by the wayside, but one out of ten maybe would be successful and we'd have a new treatment, a new diagnostic test. We'd see something different happening in the patients. We'd find antibodies in the blood. It was just a wonderful discovery. It was exactly like one of these archaeologists telling us the story of how he discovered this new Egyptian tomb. He was crawling through this little dusky corridor and then, bingo! The door was opened and there was this incredible chamber with all these Egyptian relics in it. It was actually like that with helicobacter.

Once I'd done that experiment and realized that there were all these other things happening with the infection, and studied the literature, it was then revealed to me, if you like, that lo and behold, lots of doctors over the years had described this exact syndrome. But it was many years between the initial infection, where you vomited, and the ulcer. You might have got this initial one when you were five years old, and your mother said, "Well, a stomach virus." A few days later, you're better. But the bug sits there in your stomach, working away, causing damage. And then 20 or 30 years later, when you're doing all those things -- drinking coffee, going to college and having a really hectic life -- your acid level builds up a little bit. Bingo, you've got an ulcer. So I connected up these two widely dispersed episodes and I published a hypothesis, which everyone said, "Wow. This is a great hypothesis, because we can test it." And they checked it out and they couldn't prove it wrong.

Was the course of treatment basically what you had suggested?

Barry Marshall: The years after that were still somewhat difficult, in that we didn't have a very good treatment. The treatment we had had side effects, and the patients could tell which treatment they were on by the color of the tablets and everything. So it was hard to do a double-blind study. After 1990, new combinations of antibiotics were tried by hundreds of different people, until we had a cure for about 80 percent. It was just antibiotics and simple drugs that you could put into a placebo, or an active drug trial. The study that really clinched it for the skeptics was published in The New England Journal in 1993 by Henschel from Austria, where he just uses antibiotics versus placebo in people with ulcers and showed that he got exactly the same results as Dr. Marshall had got five years before. So, that is what proves something in medicine. Someone who isn't you gets the same result and says, "Hey, he must be right." Convincing the skeptics is tough and it does take time.

You're Australian, and you were working against a pretty strong North American medical group. Did that play into it?

Barry Marshall Interview Photo
Barry Marshall: Yes, and no. If I'd discovered the initial findings in the United States, I might have just discounted them. There's a very structured and very conventional gastroenterology program in the United States. If your head's just full of that conventional learning (50 percent of which is incorrect), it's very difficult to get a new concept in. So it's wonderful in some ways if you don't know everything. If the field is not well understood, maybe it's better to find your way into it and take the leads as they come, rather than saying, "Here's the body of knowledge. I'm going to study this bit, and advance that bit of knowledge." Maybe you just need to be lateral. The second thing about Western Australia is that it's a little incubation chamber. I was able to work there for a couple of years and be rather eccentric and brash and do weird experiments, all the things that I wanted to do, without too much exposure, with a few mentors that were trying to dampen down this enthusiasm. My wife obviously had a major impact on that. She's got more tact than me and probably saved me from some tough situations. "You can't write that letter," to the medical superintendent, whoever I was writing a letter to at that particular time. It turned out to be a very nice combination. And I did connect up with the right people. By the time I connected up with people in the United States I knew I was right. I thought it would only take two years before everyone believed it. But I knew that an idea which is so useful and so beneficial would definitely find favor anywhere, if it was allowed to just float. I wasn't supported by the big drug companies. There was plenty of money going into ulcer research, but not into these bacteria. Although I wasn't supported by them, I knew that eventually they would either go down or they'd change camp. And a bit of both happened.

Can you tell us a bit about the other areas you're starting to explore?

Barry Marshall Interview Photo
Barry Marshall: Well, we found that we had a tiger by the tail with this bacteria. Not only did ulcer patients have it. That's pretty simple -- they wanted treatment with antibiotics -- but more than half the people in the world are infected with helicobacter. Now, in the U.S. it's 30 percent. It's more likely to be older people who might have picked it up in the Second World War, in the trenches, or in some poor conditions that they were living in, some hollow in West Virginia where they didn't have running water and the toilet wasn't properly connected or whatever. So people who are older and were alive before the Second World War can have it. Younger people born in the U.S. probably wouldn't have it, but people who were born outside the U.S. that immigrated in, more than half of them would probably have the bacteria. So this sort of interesting combination is going on, and these people would still get ulcers and they're susceptible to stomach cancer. That's the U.S. scene.

In India or Africa, China, Russia, where conditions have been very poor over the last 50 years, more than half the population has the bacteria. It's not terribly expensive, but they can't afford to spend $50 on an antibiotic treatment for their stomach complaint. Many of them, in fact, have no symptoms. It may be that if you catch it when you're very, very young, two years of age, your acid level is dampened and you never get enough acid to get symptoms or ulcers, and it festers away there. You may get a very marginal form of malnutrition. In England, children with helicobacter were found to be slightly shorter, about a centimeter shorter than the control group. Maybe it sets you up to be more susceptible to other infections that could kill you, such as cholera, and there's some literature on that.

Barry Marshall Interview Photo
So in some ways, helicobacter is kind of like dandruff on the stomach. It's abnormal, it causes an irritation, but many people would go out and fulfill their normal lives and not even know about it. However, it does set you up for ulcer, or possibly a one percent chance of stomach cancer. So I'm in favor of treating everybody and wiping the whole thing out. But of course, we don't have the tools to do that now. We don't have simple diagnostic tests. We don't have a free antibiotic therapy. The concept of treating half the world with antibiotics is pretty horrific to most doctors, because of these resistant bacteria that would develop. The only possible solution is a vaccine. So many companies now are looking at vaccine ideas, and putting millions of dollars into a vaccine. But it's not going to be very profitable, because the patients will only take it once. And the people who need it can only afford to spend a couple of dollars on it, so World Health won't buy it. So, in some ways it's going to be a long haul I think to finish the helicobacter story.

Of course, the other side of it is the ecological or evolutionary aspect of it. How long has mankind had helicobacter? Supposedly, they found some helicobacter genes in pre-Columbian mummies in Latin America. I've spoken to an Egyptologist, and he's going to try and get me some Egyptian mummy stomachs, we can cut up to see if we can find the bugs.

So you're not finished?

Barry Marshall: No. There's a lifetime of work in it. There are literally thousands of scientists now in the helicobacter business.

I've got a lucky combination of a team of scientists working with me on interesting questions that I'm curious about. I also have some connections with industry, so if we have a good idea for new treatment or a new test, we can try it out on the patients, who are always very, very willing to take part in my research. They say, "Well, he did it on himself, so we can trust him, I suppose."

[ Key to Success ] Integrity

We bring products into the mainstream medical treatment very quickly, in a year or so, we hope.

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