Gut Feeling Brings a Great Discovery

Barry Marshall Professor of Microbiology, University of Western Australia A researcher who took the adage ‘physician heal thyself’ to heart or, rather, his own stomach made a breakthrough medical discovery. The Health category winner took the old adage of ‘physician heal thyself’ to heart, or rather his own stomach, to make a breakthrough medical discovery.

Barry Marshall Professor of Microbiology, University of Western Australia, a researcher who took the adage ‘physician heal thyself’ to heart or, rather, his own stomach made a breakthrough medical discovery. The Health category winner took the old adage of ‘physician heal thyself’ to heart, or rather his own stomach, to make a breakthrough medical discovery. Few researchers make a discovery which transforms the care of millions, while overturning accepted medical wisdom about a common health problem. Even fewer have the chance to witness the impact of such a discovery in their own lifetime, and to enjoy watching it create a new medical and scientific industry. And fewer still can thank an accident for helping with the discovery in the first place. Barry Marshall is internationally famous, in health and medical circles at least, for just such a discovery. He helped prove that an unusual bacterium, now known as Helicobacter pylori, causes stomach ulcers. The finding was a huge challenge to medical thinking and a pharmaceutical industry based on the treatment of ulcers with acid-suppressing drugs. Further, it was scientific heresy: everyone knew that bacteria couldn’t survive in the stomach’s acidic environment. Marshall was not the only researcher involved in the discovery. Robin Warren, a pathologist at Royal Perth Hospital, first observed the spiral-shaped bacteria in stomach biopsies in the early 1980s, and was convinced they had some role in causing stomach inflammation. Marshall, who was then training to become a physician, spent several months working with Warren trying to culture the bugs, succeeding only accidentally when the culture was left longer than usual because of a lack of laboratory staff over an Easter break. They then began to gather evidence that the bug was contributing to ulcers, but faced great resistance from their peers. This led to Marshall’s dramatic decision to swallow a solution containing the bug to prove it caused disease. It did. But it took many more years for Marshall to persuade colleagues that ulcer patients with H. pylori should be treated with antibiotics. Selection panellist Martin Van Der Weyden says the other remarkable aspect of the discovery is that it was made “not in one of our much lauded research institutes but in a simple clinical setting”. Marshall recently edited a book, Firsthand Accounts From the Scientists Who Discovered Helicobacters, 1892-1982, which makes it clear that many scientists in many countries over many years believed that a bug was causing ulcers. But it was Marshall’s relentless enthusiasm that eventually changed medical thinking, and revolutionised management of stomach ulcers. He estimates that 200,000 Australians and tens of millions of people internationally are treated for H. pylori each year. Apart from relieving suffering and preventing ulcer-related deaths, the treatment is probably also preventing some stomach cancers. The discovery has also changed the epidemiology of stomach ulcers. Once about 15% were caused by non-steroidal anti-inflammatory drugs such as aspirin; these days about 50% are due to such medications, reflecting the success of H. pylori treatment, says Marshall. But not even a scientific breakthrough can provide simple solutions. Resistance to antibiotic therapy is growing, and Marshall estimates that treatment fails to eradicate the bug in about 15% of patients. Debate about who should be tested and treated continues to be lively; most people infected with the bug will not develop a stomach ulcer or cancer, and so universal treatment is not recommended. Twenty years after the discovery, Marshall continues an exhausting lecture schedule. Otherwise, most of his time is spent in research and teaching, as well as seeing patients with difficult-to-treat infections. He has an H. pylori research laboratory at the Sir Charles Gairdner Hospital, and a biotechnology business which distributes diagnostic tests. As for his next breakthrough, Marshall hopes it will be a vaccine for H. pylori, but acknowledges that other companies have invested millions in this without success. Marshall and Warren have gathered many prestigious awards, but perhaps even greater recognition awaits. “Scientists strive for immortality through their science but the badge of immortality the Nobel Prize is given to only a few,” says Van Der Weyden. “If any Australian is in the pipeline for ‘The Prize’, it is Barry Marshall.” Marshall laughs when this is mentioned. “Robin Warren and I are waiting for some people on the Nobel committee to develop an ulcer,” he jokes. (Source: ninemsn online)