As the media,
politicians and the Australian medical research sector rush to
congratulate our newest Nobel laureates – and to bask in their
reflected glory – it is worth reflecting on the truth of the long and,
at times, lonely journey Barry Marshall and Robin Warren have taken to
reach this point.

Rather than welcoming and supporting the work
of “local heroes,” many Australian gastroenterologists were highly
critical and disbelieving of Marshall and Warren’s (ultimately) Nobel
Prize-winning work, and continued for many years to stubbornly deny
that Helicobacter pylori had much, or indeed any, role in the
pathogenesis of ulcer disease.

Barry Marshall was made to feel
quite uncomfortable when he attended specialist conferences – he was
regarded by many as a maverick and even a loony, especially when the
story of his drinking “swampwater” in order to infect himself got
around. Worse still, this lack of acceptance was often blamed on
Marshall’s personality (he has been described as “brash”) or justified
as a response to him apparently seeking publicity and glory. It
certainly didn’t help that he was not a gastroenterologist by training.

Given
Marshall and Warren’s pioneering work, Australia should have been the
first place in the western world to accept the full H. pylori story.
But, shamefully, it was not. Although a Working Party reported to the
1990 World Congress of Gastroenterology (which incidentally was held in
Sydney) that H. pylori was definitely an important cause of ulcer
disease, many prominent leaders of the gastroenterology specialty in
Australia continued to deny its importance, or to claim that it was a
cause of only a small minority of cases of ulcer disease, well into the
mid-1990s. As examples:

  • In 1991, Parke Davis got scant support from local “opinion leaders”
    when it brought an international speaker (and member of the Working
    Party) to Australia to discuss H. pylori eradication as an approach to
    treating ulcer disease.
  • In a drug company-sponsored 4-page educational publication for GPs
    published in Australia in 1992, only the last two paragraphs mention H.
    pylori, and only in the context of how this company’s anti-acid drug
    might one day have a role – in combination with antibiotics – in
    eradicating the bacterium. It was only 4-5 years later, when such
    combinations were shown to be effective in eradication, that education
    and promotion to GPs about the role of H. pylori in ulcer disease
    really started to pick up momentum.

Marshall’s work was
much more readily accepted internationally than locally, and so he
spent what may perhaps have been his most productive years as a researcher
overseas. Medical journalist Melissa Sweet gave some of the back-story
in this article in the SMH in 1997, as reproduced on Barry Marshall’s personal website.

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Peter Fray
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