Few medical mysteries find resolution with a script as exciting as the one created by Australian doctor, Barry Marshall. Forget the story of an unassuming doctor toiling away for years in a dank laboratory while trying to support a hypothesis with pencils and Petri dishes. Marshall had found a cure and he needed a way to spread the news now. Infecting himself by drinking a Petri dish of bacteria, Marshall would become a guinea pig for his own cause and risk his personal health in an attempt to cure a condition that many patients were dying from.
The issue at hand was curing stomach ulcers. Before the 1980s, doctors often treated peptic ulcers by completely removing the stomach. Many people died from ulcers, bleeding out so profusely that they could not be helped. A whopping 10% of the population was affected by this condition. At the time, ulcers were attributed to high levels of stress, spicy foods and alcohol.
In 1981, Marshall was working as an intern under pathologist Robin Warren, who shared his recent findings with Marshall regarding a gut bacteria known as Helicobacter pylori. This bacterium has a distinct “corkscrew” look and it seemed to survive, and even thrive, in the acidic surroundings of the stomach. Helicobacter pylori is still prevalent today, with an estimated two-thirds of the world’s population carrying it, though many people will never show any symptoms.
As Marshall routinely performed biopsies on ulcer patients, he noticed the prevalence of Helicobacter pylori and he soon became convinced that the pathogen was entirely responsible for stomach ulcers as well as most forms of stomach cancer. The cure, he insisted, was simply to treat the infection with already available antibiotics.
While it seems likely that such news would create a buzz in the medical community, Marshall was most often met with skepticism and disbelief. He presented his ideas at the annual meeting of the Royal Australasian College of Physicians (RACP) in Perth, Australia. The collective group of gastroenterologists found his explanation implausible.
Marshall and Warren decided to send their findings to the peer-reviewed general medical journal known as The Lancet. They included a detailed paper on how Helicobacter pylori had developed over the last century. The paper was so controversial that extra effort and time were required before it was finally published. Unfortunately, it received little attention.
Marshall realized that his findings were being rejected by most medical professionals – regarded as anecdotal. He decided that more proof was necessary and petitioned the drug companies for research funding. He met more resistance. Antacid pills were creating billions of dollars in profit for the medical industry and the reality was that most people weren’t dying from ulcers. They could be made to feel better by swallowing a small pill and reducing their stomach acid. Nearly 4 percent of all Americans were carrying Tagamet in their pockets and paying a monthly prescription for refills.
One drug company proved to be an exception. The makers of Denel replied to Marshall with some interesting findings. Their product seemed to do something that Tagamet could not – it cured the ulcers in roughly 30% of the people using Denel. There was no longer a need for ongoing treatment and the company was quite candid in stating they had no explanation for why this was happening. Marshall was quick to treat Helicobacter pylori with Denel and it destroyed the bacteria. Denel contained bismuth and this small amount of antibiotic ingredient was enough to garner results for many patients. The company teamed up with Marshall and they presented their findings to a microbiology conference in Brussels.
The microbiologists were delighted with what they saw, encouraging a now confident Marshall to keep moving forward. Marshall created a new paper and again presented his findings to another team of gastroenterologists. All was rejected. Marshall was becoming fully aware that Big Pharma had no interest in his cure. The billion dollar antacid industry was bigger than he had anticipated – and they had no intention of discontinuing a product that was creating a profit of more than $3 billion a year.
Extreme Times Call For Extreme Measures
For a short period, Marshall tried to infect animals with ulcers but results proved futile. He needed “human proof” to move forward. The irony of the situation is that Marshall would occasionally see patients bleeding out from severe ulcers – but they weren’t his patients to treat. He could only stand by idly as patients were prescribed antacids and often times, these patients would go on to have their entire stomachs removed.
“It was tough to watch – knowing that all they really needed was a course of antibiotics, but there was absolutely nothing I could do to help. Every patient that I saw suffer created an even greater motivation for me to succeed with my campaign.”
And then it happened.
Marshall was seeing a patient with gastritis – an inflammation of the stomach lining most often caused by H. pylori. He obtained a bacterial sample and treated the patient with an antibiotic mix of bismuth and metronidazole after testing in the lab. An endoscopy confirmed that the patient’s infection was completely eliminated.
Back in the lab, Marshall created a cocktail like none before. The following morning, he consumed a drink that contained a large sample of the bacteria responsible for the gastritis infection. Severe vomiting ensued within a week and after ten days, an endoscopy revealed that the bacteria had spread throughout his gut. He had an offical diagnosis of gastritis.
Marshall now informed his wife of his self-inflicted infection and after she expressed her displeasure, the two agreed that he would continue his experiment until the end of the weekend. The doctor then took the same antibiotic mixture prescribed to his patient. As expected, the antibiotics completely cured the gastritis and Marshall’s health was fully restored.
Rewarding Dedication and Commitment
Following the experiment, Marshall moved to the United States and the news of his n=1 experiment quickly spread. Though skepticism still remained, the FDA and NIH finally published the knowledge in several medical journals and by 1996, antibiotics became the conventional treatment for gastritis, peptic ulcers and stomach cancers.
Marshall has since developed a breath test for Helicobacter pylori and it’s sold all over the world.
Dr. Barry Marshall accepted the Nobel Prize in Physiology or Medicine along with his colleague, Robin Warre. Marshall continues research related to H. pylori and runs the H. pylori Research Laboratory at The University of Western Australia.