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Professor Barry Marshall A turning point in medicine

"Against prevailing dogmas, you discovered that one of the most common and important diseases of mankind, peptic ulcer disease, is caused by a bacterial infection of the stomach. Your discovery has meant that this chronic and disabling condition now can be permanently cured by antibiotics to the benefit of millions of patients. Your pioneering work has also stimulated research all around the world, to better understand the link between chronic infection and diseases such as cancer."

Nobel Prize Award Ceremony at the Concert Hall in Stockholm, Sweden, on 10 December 2005

Barry Marshall (right) and Robin Warren, 2007. This photograph, taken by Robin Sellick in 2007, shows Marshall and Warren in Perth with their Nobel Prizes. This photo is from the National Portrait Gallery. https://www.portrait.gov.au/people/barry-marshall

Stomach ulcers were previously considered to be a chronic disease, often fatal, with no known cures or causes. That was, until, Barry Marshall made a discovery which was a major turning point in medical history.

Peptic ulcers are ulcers that develop in the inside lining of the stomach, small intestine or lower oesophagus. Up until 1982, when Dr Barry Marshall made a life-changing discovery in the world of medicine, it was commonly believed stomach ulcers (or, more scientifically ‘peptic ulcers’) were caused by spicy food or over-exposure to stress. But when Dr Marshall met Professor Robin Warren, a leading pathologist, he realised that the cause was different – much against the liking of large drug companies.

Barry Marshall grew up in Kalgoorlie, but spent much time moving all around Australia. His passion for medicine was always developing and helped him – when he was only 12 – save his sister’s life when, at just eighteen months, she drank a bottle of kerosene. Barry immediately put all his medical knowledge into place, by doing CPR and mouth-to-mouth resuscitation, which in the process of breathing into her mouth, he smelt the kerosene and knew what had caused the sudden emergency, and when the ambulance arrived, they barely had to do anything since Barry had already saved her life.

After finishing high school, Barry was unsure what he wanted to do. He enjoyed maths and science, but felt his skills in those areas were not strong enough to become an electrical engineer, so he instead went to medical school because biological sciences sounded interesting, and they had never learnt it at school.

In 1972, he and his wife Adrienne married, and went on to have four children. But Barry did not settle down, ready to rest for an easy life. Instead he set his mind to work, determined to succeed even more than he had previously – and it paid off when in 1979 he was appointed Registrar in Medicine at Royal Perth Hospital. But he did not stop – he was just further motivated to change the world.

That opportunity came when he met Professor Robin Warren, a pathologist with a particular interest in gastritis, during a course at Royal Perth Hospital in 1981. Together they started researching peptic ulcers. Robin found clusters of bacteria surrounding the ulcers. Pleased with the discovery, they announced to the public that stomach ulcers were caused by a bacterial infection – not spicy foods or stress – and could be cured with a simple antibiotic. The pharmacies disputed this – the remedies they sold were expensive and made them a lot of money. The annual profit from selling Tagamet and Zantac (the antacids that were being sold to treat ulcers at the time) was more than $1 billion! They also argued that no bacteria could thrive in the harshness of the stomach’s acids – which was clearly untrue since Barry and Robin had just proved the bacterium to be present.

Although they had proved the bacteria was present, as the pharmaceutical companies pointed out, they had not proved that the bacteria caused the ulcers so the duo first resorted to infecting mice and piglets with helicobacter pylori (h. pylori, the never-seen-before bacteria found infecting patient's guts), but only to receive failed results, because h. pylori only infects primates. The chemists said the reason why the test had failed was because it was not caused by h. pylori (a cork-screw shaped bacteria), but Barry knew they were just trying to cover up the truth. It was prohibited to test on humans – so he tested it on the only human he could ethically recruit. He knew what he had to do.

In 1982, he did not tell his wife he was going to drink a broth of h. pylori and give himself a stomach ulcer, since he knew she would object. Instead, he extracted some h. pylori from a patient suffering from stomach ulcers, stirred it into a broth, and drank it. Barry was in much more pain that he had predicted – but still he persevered. Once a peptic ulcer had formed – he knew when the tell-tale symptoms started: vomiting, foul-smelling breath, feeling sick, exhausted and energy-deprived only five days later – he went back into the lab and biopsied his own stomach a further five days later, then gave himself a dose of antibiotics. Steadily, he made a path back up to recovery, very different to other patients with peptic ulcers who had been treated with supposed “panaceas” – there was no need to remove his stomach, no bleeding to death – and he was cured. Barry had suspected the ulcer would develop over the course of a few years. The news went viral: courageous Barry Marshall put his life on the line to save millions of patients. Not only did they discover that antibiotics cured peptic ulcers, amid the process they realised stomach cancer was also caused by an infection of h. pylori!

Barry and Robin were awarded a shared Nobel Prize in 2005 for Physiology or Medicine for their perseverance and Barry’s selfless act for the greater good. “For their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease,” was the prize motivation.

Professor Barry Marshall's official Nobel Prize certificate
Barry Marshall receiving his Nobel Prize from the King of Sweden, 10 December 2005

Without Barry’s initiative to question the obvious: if stomach ulcers are caused by stress and spicy food, then how come some patients are stress-free and have extremely bland diets? the discovery would not have been made.

Millions of people were dying at the hand of peptic ulcers – and just one man curious enough to question medical belief, changed their lives, marking a turning point in medical history.

Barry Marshall delivering his Nobel Lecture, 8 December 2005

Bibliography

Primary Sources

Marshall, B. (2005). The Nobel Prize. Retrieved from Barry J. Marshall - Biographical: https://www.nobelprize.org/prizes/medicine/2005/marshall/auto-biography/

Secondary Sources

Sellick, R. (2007). Barry Marshall and Robin Warren, 2007. National Portrait Gallery, Canberra. Retrieved from the National Portrait Gallery: https://www.portrait.gov.au/portraits/2007.56/barry-marshall-and-robin-warren/

Pincock, S. (2005, October 22). The Lancet. Retrieved from Nobel Prize Winners Robin Warren and Barry Marshall. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67587-3/fulltext

Barry J. Marshall Photo Gallery. (2005). Retrieved from The Nobel Prize: https://www.nobelprize.org/prizes/medicine/2005/marshall/photo-gallery/

Unknown Author. (2005). Barry J. Marshall - Facts. Retrieved from The Nobel Prize: https://www.nobelprize.org/prizes/medicine/2005/marshall/facts/

Steven D. Levitt and Stephen J. Dubner. (2014). Think Like A Freak. London: Allen Lane.

The Marshall Centre. Retrieved from The University of Western Australia: http://www.marshallcentre.uwa.edu.au/

Barry Marshall's turning point in the world of medicine saves lives every day .....

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