2005 Nobel Prize Winners in Medicine

What would you do in the name of research? This seems to be the question that can fire up a young scientist to win the Nobel Prize later on.

I'm delighted with this year's choice for the Nobel Prize winners in the field of Medicine.

This year's winners, Dr J. Robin Warren, 68, a retired Australian pathologist from Royal Perth Hospital, and Dr Barry Marshall, 54, a gastroenterologist and professor of microbiology at the University of Western Australia, underwent a whole lot of drama and ridicule before achieving the highly-coveted award which, along with fame, comes with a hefty prize money of $750,000 each.

These 2 West Australians were having beer at a quaint Perth Cafe when they got a call from the Nobel HQ in the Karolinska Institute in Stockholm, Sweden, informing them of their victory. They are recognized for discovering that bacteria, not stress or lifestyle, causes 90 per cent of stomach ulcers, and gastritis. They were also able to show that both are curable with proper antibiotic medication.

I remember this period. Even during the 1990s when I was in medschool, not many doctors were convinced that a bacteria like Helicobacter pylori can cause ulcers. [Here's a good close-up image, an electron micrograph of the organism.] The culprit then was mainly stress, and intake of aspirin, and other painkillers. Ulcers were a lifestyle illness. Change your lifestyle to prevent the disease. No one entertained the idea that it was actually an infection.

Even in medical circles, the two researchers were ridiculed and treated with skepticism. There was no one who believed that a bacteria can survive the acidic environment of the stomach. What did Barry Marshall do? Here, he relates how persistent he was with his research:

"I had an endoscopy on the Tuesday morning. Robin looked at the biopsies and they were 100 percent normal," Marshall says. "The following week I grew the bacteria up in a little Petri dish. I took 20 millilitres of this murky liquid and drank it at 10am. I didn't eat anything all day so as not to disturb the bacteria. Three days later I started feeling a bit bloated --- and I developed bad breath, but nobody told me. On the fourth day, I jumped up out of bed and ran to the toilet and vomited. This happened three days in a row."

As crook as Marshall was feeling, the scientist in him was fascinated: "My vomit didn't have any acid in it. I was vomiting what seemed like regurgitated water."

On examining decades of scientific literature, Marshall and Warren identified a syndrome of acid-free vomiting that had apparently been prevalent a century earlier. It became clear that people carried the bug from childhood, until it made some of them ill in middle age. Improved sanitation and antibiotics have slashed the transmission --- only about a third of Australians older than 40 have H. pylori.

[Sydney Morning Herald, Oct 05 2005]

His wife, Adrienne, almost went ballistic when she learned that Marshall had swallowed a solution containing the bacteria Helicobacter pylori to prove a theory. The couple had 4 young children, and Dr Marshall was then working 14-hour days, seeing patients all day, and doing research at night, and when he took the Helicobacter solution he instantly became "dreadfully ill".

Now, she's happy that her husband won the prestigious Nobel prize and is looking forward to tour Sweden with him this coming December, the usual time for the awarding ceremonies.

I think equal recognition should also be given to Tom Borody, then a young Sydney gastroenterologist who subscribed to the Marshall-Warren theory, and was the one responsible for coming up with the best ulcer treatment combination, that of two antibiotics and an acid suppressor. He was also one of the first doctors who advocated biopsy of the gut, and prescribed antibiotics when Helicobacter pylori was found....only to a "please explain" letter from his professional association.

Even publishing reports of healing using antibiotics did not help put a dent to the skepticism of the medical world. The Marshall-Warren theory received "cool reception at gastroenterological meetings." It took more than 20 years to bring home the point and change everyone's point of view about ulcers.

Today, one of their chief critics, Dr John Graham, who is now Chairman of Medicine at Sydney Hospital, remains critical of the Marshall-Warren findings. He offers congratulations for the efforts of the two scientists to prove their theory, but remains doubtful of their findings.

In conclusion, how does one manage to win a Nobel Prize?

One must be persistent and obsessed, I think. So obsessed to the point of making oneself a guinea pig to prove a point. One must also be prepared to fail and to be ridiculed by colleagues. Nothing comes easy in this world, especially if one is up against long-standing conventional wisdoms. After all, how many years did it take to prove that the world is round instead of flat?