Barry Marshall Interview (page: 7 / 8) Nobel Prize in Medicine	Print Interview

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.
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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: 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.

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