Nobel Prize Conversations

”I wasn’t interested in learning stuff. I was just interested in understanding, because I could see what a fabulous shortcut it always was”

Meet 2005 medicine laureate Barry Marshall in a dynamic talk with the Nobel Prize’s Adam Smith. Marshall tells us about his blog (something very few laureates had in 2005!), his time as a yo-yo expert and his research that paved the way to a Nobel Prize.  

Self-experimentation is another topic that is up for discussion. Marshall takes us back to the moment he drank a bacterial culture of Helicobacter pylori to prove that gastric ulcers were caused by bacterial infections – it’s a story you don’t want to miss! 

Listen as we take you back to this conversation with Marshall, recorded in February 2014 as part of the series ‘Nobel Prize talks’. The host of this podcast is nobelprize.org’s Adam Smith, joined by Clare Brilliant.

Below you find a transcript of the podcast interview. The transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors.

Clare Brilliant: Welcome to Nobel Prize Conversations and this encore presentation of our February 2014 talk with physiology or medicine laureate Barry Marshall. I’m Clare Brilliant and I’m here with our host Adam Smith. Hi Adam.  

Adam Smith: Hi Claire, here we are again. What a lot of funny things we end up doing together over the years. And it has been many years hasn’t it? It seems to be forever, it’s in a good way. 

Brilliant: It’s hard to believe because looking back on these conversations which were around 10 years ago, we’ve worked together for more than double that time, Adam. Although we weren’t at Nobel then, we were working together back in 2005 when Barry Marshall was awarded his Nobel Prize.  

Smith: Indeed and that prize for the discovery of the link between helicobacter pylori and gastric ulcers was one I remember well because it really captured the public imagination.  

Brilliant: Yeah and that doesn’t sound so dangerous but his methods were quite unusual is that right?  

Smith: Yes, he gained a daredevil reputation for experimenting on himself. He became frustrated because people just didn’t believe that there was a link between the bacterium which wasn’t supposed to be able to live in the stomach and stomach ulcers. So he just drank a concoction of the bacterium from a conical flask himself, gave himself gastric disease and then had to cure himself with antibiotics so it proved the point in a rather dramatic way.  

Brilliant: Yeah and I think we get some insight as to perhaps why Barry Marshall was so fearless. He talks about this in relation to his childhood but I think that comes through in his attitude to experimentation in science later in life.  

Smith: Yes, he’s not much interested in received wisdom, he’s just interested in finding things out for himself and that sense of inquiry seems to know few boundaries.  

Brilliant: It was really interesting to hear him talk about the internet at the time was such a new thing in terms of what it gave him.  

Smith: It’s funny that isn’t it? It does seem like a slightly different world where he talks about the fact that he’s one of the first laureates to use a blog and the power of the internet to make the world smaller. Things that we kind of take for granted now you assume it’s always like it’s been today but actually it changes things radically and it’s really interesting to get this snapshot of how we thought about the internet and blogging 10 years ago.  

Brilliant: Exactly. I think it’s a good point now to listen to Barry in his own words.  

Smith: Yes, now it’s time let’s listen to this second episode in our encore presentation of Nobel Prize conversations with Barry Marshall.  

Barry Marshall: Hello, Barry Marshall here. 

Adam Smith: I’m really pleased to have the possibility of talking. 

Marshall: We’re coming up to we’ll talk about it later, but we’re coming up to the anniversary of it, which is Easter, of course. 

Smith: Yes, exactly. What was the actual date of the experiment? 

Marshall: Well, probably 7 April. I’d have to look on my blog. The 7th of April. 

Smith: It’s interesting you do blog because not many laureates do. What started you off on that? 

Marshall: There were things that rumour built and things that people find out about me get blown out of proportion, then reported in the press, and then they turn up on different websites which is, and so often to set the record straight is worthwhile having a blog to get in there and actually say exactly what happened. The other place you can do that is Wikipedia, which you have to get in and edit every now and again, so one of the famous rumours about me was that I was the Australian yo-yo champion several years in a row. The actual truth was I won the heats in my age group in Perth but was knocked out in the finals. I did win about 24 bottles of Coca-Cola, which was delivered to my house in the street. All the local kits had a bottle of Coke that afternoon, on a hot day. I was pretty famous locally, within a hundred yard radius to my house. I can still play yo-yo.  

Smith: You can.  

Marshall: A bit anyway. 

Smith: Can you do tricks with them? 

Marshall: I could do a couple of tricks, yes.  

Smith: Oh, that was that.  

Marshall: I wouldn’t put any money on me in a competition. 

Smith: Is there a YouTube video out there somewhere of Barry Marshall doing yo-yo tricks?  

Marshall: There’s probably one in Japan somewhere because they did get one off me for the science museum in Tokyo. I did some yo-yo tricks there for one of the reporters for their website.  

Smith: At least in the child population of London I’d say it’s a declining art, but maybe it’s growing in Japan.  

Marshall: It’s quite interesting. I’ve got half people actually present me with yo-yo sometimes when I turn up and ask me to do a trick. But I have probably half a dozen different ones. They are fabulous yo-yos you can get these days. They often have automatic LEDs in them and automatic clutch, so they’ll spin nicely. The technology’s really moved on quite a lot and probably it’s something that’s going to come back. 

Smith: All these things have their cycle. Do you still play for relaxation or just when you’re asked to give a demonstration?  

Marshall: I have to say that every month or so I might get one out and have a go at it. I’m looking around on the left and I can see three of them on my shelf with my collection of different junkie, different items and things. Any kind of interesting junk that I’ve collected during my life, I tend to stick up on the shelves next to my work area because I work at home about a third of the time often I’m just communicating with somebody. Today I was working on Skype, booked for several hours with somebody finishing a paper. As you get more into research, a lot of the time these days is actually spent on the web and communicating with colleagues.  

Smith: The fact that you are an Australian laureate and living in Australia makes you part of quite a small community although Australia’s produced a good number. What’s it like doing science in Australia these days? 

Marshall: It’s a lot easier than it was. I always felt that Australia was about three years behind the rest of the world. That was in the eighties. Now I think we’re just like any other western country, and we’re within a few months, say three to six months of anything happening in the UK or US or Europe. It’s pretty well known about in Australia. Obviously that’s partly due to publications, the internet and various news feeds that you might keep up to date with collaborating, talking to your colleagues. I do think that the Australians need to go to an international meeting each year, because quite often the abstracts and posters and the new ideas and speaking to investigators on new technologies is done at the poster sessions rather than the formal sessions in the conferences. 

Smith: You mentioned earlier that a lot of a scientist’s life is spent on the internet, so you can keep up with pretty much everything that’s going on, but it was that physical isolation that was interesting. Is there though an advantage in place where Australia is? In Europe there are lots of meetings going on and it’s easy to get around, but at the same time, we are very far away from Asian science, for instance, physically. Whereas you are placed quite close to that. 

Marshall: You make a strong point there. The growing area in a lot of sciences and technologies is Asia, particularly led by China. Even though China is having a bit of a quiet year, they’re still growing at 7%. They’re still funding far more scientists and far more new technologies than most other countries. It’s actually pretty active here in Asia. If I have several choices I can quite often choose to go to a meeting in Japan, Korea, China, Malaysia, Singapore, or Indonesia, and sort of get the same opportunities that I might get if I go to Europe often less sophisticated. There is a lot of research going on, particularly in helicobacter stomach diseases with new observations being made.  

Smith: How important do you think it is that there is a good international mix of people working on any one area, any one problem? Does it matter what the nationalities are? 

Marshall: Not so much the nationalities, but of course people have a different slant on it in different countries. I think that we’ll be able to tease out some of the  helicobacter theory built by having people study helicobacter in different countries. I think that probably we’ll find their dietary components overlaying any kind of gastric diseases. Obviously if you have a totally different diet, something that would just sits on the surface of your stomach is going to be quite different in one country versus another. I’m interested in that and I think that sort of thing will be teased out in Asian studies. The other thing is that Chinese studies are very useful for testing hypothesis in humans. You might say, I think that this kind of helicobacter and this gene on the tox, this toxin gene is the key thing for stomach cancer. That’s a great idea. You take it out of the genomics lab in London or somewhere, and you go and study 5,000 people in Beijing. It takes you about a year with a good Chinese group. You come back and say it’s totally irrelevant or it’s looking interesting. That’s the sort of thing. In fact there’s a lot of good theories that have actually gone down the drain after being tested in China and not being seen to be particularly important. 

MUSIC  

Smith: I wanted to talk about you and what made you into the person you are. What kind of childhood did you have? 

Marshall: I was an interesting, fairly smart kid and I did have all kinds of stimulations because my father was a mechanic, an engineer. He worked on a whaling station as a fitter or diesel mechanic. He worked on whaling boats. He worked on cray fishing boats, but he was also doing weekend work on different things. He then became a refrigeration engineer. All these different technologies were actually continually laid out for me as he was credentialed over the first probably 10 or 12 years of my life before we settled down into his main career. 

Smith: What was his main career in the end? 

Marshall: Ultimately he ran a chicken processing factory, and he built that factory in the late sixties. In the sixties, somewhere Kentucky Fried became globalised. All of a sudden in Perth, Western Australia, maybe 1964 or 1965, Kentucky Fried Chicken came to Perth. The consumption of chicken in Australia went from special food that you had on special days, like once a month for Sunday dinner, to something that you could have two or three times a week if you wanted it. It was frozen chicken everywhere. His being in the refrigeration business and the meat processing business, his company really started producing massive amounts of chicken until they were supplying 40,000 chickens a day. There was a very big operation. It ended up being quite sophisticated. I think my father had a bit of an inferiority complex that he didn’t have a tertiary education, but not many people did in 1950. But he did have a good tradesman’s ticket. He was probably one of the smarter tradesmen. He actually built on that with various other training courses. For instance, he had certification ultimately on Caterpillar, Marine diesels, and then he had refrigeration. There was always a lot of technology and quite interesting books around that I could read on thermodynamics. So maybe what it did for me was just make me fearless about technology. I could look at medicine or electronics or engineering and or even look at a trade. Carpentry seems like a lot of fun, but I could look at all those things and say, well, I could do any one of those. I don’t see that there’s any difficulty with them. 

Smith: That is very important, isn’t it? Because the lack of fear, the feeling that you could build it yourself and you don’t have to rely on somebody else’s knowledge and therefore, for instance, that piece of equipment, you don’t just have to trust it’s giving you the answer it should. You can find out why it’s giving you that answer. 

Marshall: True. Whenever I came across something that was very difficult to understand or seemed very difficult or technical, it seemed to me, I just had to find the right person who knew about it, and then they would transfer the knowledge or the understanding. I wasn’t interested in learning stuff. I was just interested in understanding, because I could see what a fabulous shortcut it always was. I think my father was quite a good teacher in anything that he knew he could teach me in five minutes. Some of my teachers at school were like that. But I had a great chemistry teacher. I had a great physics teacher. I recently met one of the Christian brothers, one of the brothers actually gave us, at the boys school, the sex education lectures. That was excellent as well. Quite surprising, really. 

Smith: Somehow he had understanding.  

Marshall: Yes, he was a bit of a character. So it might’ve had an interesting background.  

Smith: Was it by chance that you fell into doing medicine or was it a passion that was growing within you as a teenager? 

Marshall: My mother was a nurse, so as well as my dad’s technical books, there wouldn’t have been much reading material in my house. There were some people, dad’s trades books and engine books. Maybe 10 of those. There would’ve been my mother’s nursing books, because she did nursing. There was anatomy and physiology based in about the 1952 vintage post World War II vintage. I don’t know how good the physiology, anatomy, biochemistry and that in there was probably fairly superficial. But there was a pretty good understanding of disease processes and the anatomy, which I was very interested in and looking through. I probably read those books cover to cover at different times when I was home with the chicken pox or the measles. We only had a radio until I was about 12 years old, then we got TV. So there was really nothing to do if you were at home by yourself, except find books to read. 

Smith: It’s interesting, the differentiation between learning and understanding. It’s obvious, but at the same time, I don’t know whether our school systems these days realise the difference. What do you think? 

Marshall: You do have to have a basic level of knowledge to actually be able to pick out the important new thing. Even in medicine I felt that medicine, I think it takes a while for you to make a discovery, because you have to understand the current paradigm, the problems that exist, what’s rare and what’s common. Then you can see the opportunity or the new observation, or develop a new idea for treating. I do think it takes you maybe at least five years in clinical practice seeing a lot of patients before you know that what you’re seeing is an unusual thing or you’ve got a new idea or a relevant observation. It just so happened that when I met Robin Warren, he showed me these bacteria. I wasn’t interested in ulcers in those days, looking down the microscope and saying, ‘yes, I agree with you, Robin. There’s absolutely no doubt these things are growing in the stomach. And the stomach should be sterile. So that’s great. Let’s figure out how they live there.’ If I hadn’t have a bit of general knowledge of gastroenterology and internal medicine microbiology, I wouldn’t have been able to see the importance of Robin’s observation. Then I might’ve gone off doing something else. There were lots of other interesting projects I could’ve done, but I chose that one. Luckily. 

Smith: Yes. But then, this is a very good point at which it’s the difference between learning and understanding. Again, because you need to learn enough to recognise the importance of the phenomenon, but not learn so much that you are totally committed to the paradigm, the existing paradigm. Therefore say ‘things can’t grow in the stomach. This is just impossible.’ 

Marshall: That’s true. If you have to just be extremely sceptical of anything. The people have taught this now in school. I think this is something that’s happened in the last 10 years in most educational programs. Let’s teach the kids how to be sceptical, how to evaluate new data and reject the stuff that’s not proven and accept things that are proven or look for the evidence and then move on with a solid base rather than having all these very fuzzy bits of foundation knowledge, which have never actually been checked out. It is very sad that your grandchildren are questioning everything you want to tell them. You have to accept that they’re probably smarter than you are. Kids these days are totally fearless about technology which is nice. You can put them in front of any kind of a computer, and the next minute they’ll be on the web, they’ll find their favourite game they’ll be doing. There’s a game they’re all playing, which is where you construct these walls all over the place.  

Smith: Minecraft.  

Marshall: Yes, Minecraft.  

Smith: Yes. I’m suffering with that too. 

Marshall: I don’t know what my grandson’s plan is, but he probably wants to be like the world best Minecraft player at age nine or something like that. He’s good. There’s a chance he could do it, I think. 

Smith: Oh, goodness. Right. I better not introduce him to my eight year old because it sounds like my eight year old would be a bit phased by your grandson’s abilities. 

Marshall: It’s a careful balance though, because when I was a kid, because we had brothers and sisters and everybody was pretty busy just staying alive. If you look at what your mother used to do in those days of the washing, the cooking, getting the groceries and taking the kids here and there and walking up to the vaccine clinic, taking everything, taking half a day to do. You can see why kids in the fifties and sixties weren’t very well supervised compared with today. Nowadays every mother knows where her kid is within 10 meters at any second. They’ve got tracking devices probably. We used to get up to some mischief and do a lot of dangerous experiments. Luckily my brothers and I and my sister all got through in one piece. I think there were a lot of risky activities that went on when I was a kid that you probably wouldn’t let your kids do these days. 

MUSIC  

Smith: So that takes us straight into you and your personal risk. When you decide to drink a bacterial culture, you are the poster child for self-experimentation and kind of ignoring the risks. 

Marshall: Yes. Not many of us, maybe the others all died. 

Smith: How worried by the risk were you when you drank that culture? 

Marshall: I was worried. What had happened was that I had some animal studies planned where we were trying to infect animals, pigs, rats, etc, in the animal research area at Royal Hospital with the helicobacter. We had these plans. I had submitted an application for these experiments. In the application I said, ‘well, at the end, if it didn’t work in animals, we really have to move on and do a human experiment to see if the bacteria could infect humans because they seem to be human pathogens.’ That was like a throwaway line at the end of the research application that I hand in. That was done a year before I’d actually did the self-experiment. Obviously I’d had that in the back of my mind for at least a year and had discussed it with people, even my wife. But not actually recently when I did the experiment so it was done, finally, I decided I have to find out the result of this experiment. I have to get this information. Can this bug, which everyone said was probably a commensal and irrelevant, could it infect a healthy person and lead to all this gastric inflammation, which seemed to be, which could potentially be the underlying problem in people with ulcers? It was an important question. By the time that 18 months had gone by, we’d exhausted all other avenues of research. We didn’t really have cell cultures that we could experiment with very much. I said, ‘Okay, well, I have to do it on somebody, I should do it on myself, because nobody really could assess the risk apart from me. No one knows enough about it.’ All our work was still unpublished. I discussed it with Robin at some point. Then my boss in microbiology, I kind of threw away a few hypothetical lines to him at one day at morning tea, I think. Then I went ahead with planning the experiment, which was initially to get some endoscopy biopsies from myself to show there was no gastritis. I did not have helicobacter at the baseline. Then I chose a bacterium, which was susceptible to antibiotics. So I said, ‘well, it’s a good chance I could get rid of it.’ The third thing was that myself and a couple of groups in England had done some serum epidemiology, like serum surveys of blood donors. It could show that 30-40% of blood donors, apparently healthy people had helicobacter. They couldn’t even remember when they caught it. As far as I was concerned, there was a very good chance that it was going to be asymptomatic. Then we’ll see what happened. Would I get an ulcer eventually? So that when you think of all those, put all those facts in, as I think about it carefully the obvious thing would be to do human experiment. Then the next question was, if it’s such an important question, should I ask an ethics committee to make a decision on whether or not I can do it? 

Smith: Mhm.  

Marshall: Well, if they said no, I still would’ve done it. 

Smith: Yes. I mean, can they regulate? What could I do? Can they regulate self-experimentation? Are there regulations on it?   

Marshall: I have to say that they usually bail out. I haven’t, I’m not going to tell you what my current plans are, by the way.  

Smith: <Laugh>   

Marshall: But they usually bail out and let you do it right. Nowadays, I think they say we don’t know as much about it, but it’s just a risk you would take.  

Smith: Did you ask permission when you drank your culture, or did you just do it? 

Marshall: I just did it. My lab tech knew about it. I said, ‘Next Tuesday we’re going to, I’m going to drink helicobacter. Can you grow me up some plates of helicobacter?’ I turned up that I’d already had the endoscopy, of course. My boss had said to me, so at the beginning of my endoscopy list, which was starting at eight o’clock in the morning, so it’s 7:15. At 7:45 I asked my boss to pass the scope on me and take a few biopsies. He said to me, ‘Barry, I don’t know why I’m doing this, and I don’t want you to tell me.’ He went ahead and did it. But then straight away I had the endoscopy without any anesthesia and straight away did my endoscopy list. A few weeks later, I was then ready to drink the bacteria, which I cultured from a patient. I think it was a Tuesday morning, and I think it was about the 10th of July. I think it was 10th of July 1984 and I drank it. 

Smith: Yes. 

Marshall: And felt fine. 

Smith: But do you remember, was there a sudden moment of contemplation of backing out as the vial came to your lips? 

Marshall: I can tell you exactly what it was like. Can you imagine being in the army and they give you a bit of training on how to jump off a little wooden thing with your parachute strapped to your back. You get a feel for it a few times, and then the next minute you’re up in a plane and the doors open and they say, right hook on and jump. It was like that. It had been well planned, and statistically you were going to survive, should be fine, but it was completely jumping out into the unknown. I had no idea where it was going to go at that point. Obviously, if I became infected and developed gastritis, which is what happened, then I was going to follow that research lineup. If nothing happened, then that meant the whole question was a lot harder than I thought. I could be wrong. That would’ve meant if I continued in research, I would’ve had to put my head down for a few years and work harder on animal models, try to figure out what was going on. It wasn’t just going to be straightforward but because we had the result of gastritis bacteria were cultured and everything then it really did put a fire under the boiler, if you like, of my research. This does seem to be the way to go. Let’s follow it up, but let’s try out different antibiotics, et cetera. It was pretty exciting. But what came out of that study was the information about the acute h pylori infection. I know an awful lot about this now, but then nobody had described it. No one knew anything about acute h pylori infection. It didn’t really exist. When I was writing up that paper, I wrote a first draft. It was really just a prescription of the biopsy, the appearance with histology. I was rather short and I was putting it together. I showed it to my colleague John Armstrong, who was the electron microscopist. He said, ‘Barry, you’ve left a lot, a lot out of this’. I said, ‘well, what, what do you mean?’ He said, ‘Well, that week you took the bacteria, you looked terrible, and you had halatosis. You had such a bad breath.’ I said, ‘Well, hang on. My mother said I had a bad breath. My wife said I did as well.’ So I went back to the lab and asked the work colleagues, and they said, yes, but we were too polite, we didn’t like to tell you. I had a very lonely week when I did that experiment because I was doing other work, but everyone had moved out my lab into the next lab and was just leaving me there by myself. I was working late, and I would be sitting there in the lab all by myself, preparing samples at eight o’clock at night thinking, oh God, I can’t keep this up. It’s not much of a lie. The h pori was in there brewing, and then I started having vomiting attacks and everything, and I’m wondering, ‘well, this is a bit weird. I don’t usually do this. I wonder if it’s the bacteria’. So then I had the biopsies. I was a bit nervous about putting anything clinical into that paper because it’s very subjective. You’re just talking about yourself and saying, well obviously you would say that. There was a bit of that in it. That’s why the paper was written in the third person, that person did that. It wasn’t until about four years later that I owned up to the fact that it was me. 

Smith: That’s interesting. Four years, gosh. Was there any lasting damage to your stomach from the experiment? 

Marshall: I don’t think there was, but I did have vomiting attacks for a few days.  

Smith: Those long years of being disbelieved by the community at large. But on the other hand, being believed by quite a lot of patients who came to you for treatment. It must have been confusing in a way to be popular and unpopular. 

Marshall: Yes. It was a little bit frustrating because usually what would happen if you discovered a new treatment, if you discovered the cause of something that there was absolutely no treatment for, everyone would say, it’s a miracle. We’ll take this, we need something. But to discover the cause of ulcers and have a new treatment, treatment was rather complicated. On a background of, everybody thought they already had the answer anyway, was the acid blocking drugs and every year there was a new one. We had Zantac coming out, getting rolled out all through the eighties. At the end of the eighties, we had omeprazole coming out which was even stronger. That was going to be even better. It’s not like people were waiting around for helicobacter to be discovered. It was a bit frustrating for me that I’d really discovered the cause of ulcers for 10 years too late. If we’d done it in the seventies, well then it would’ve really been a miracle to be able to take amoxicillin or something. It’s a bit harder to get it accepted when there was no longer a super need for it. There was actually a need from the patients because they knew they were not better. But as far as the medical community was concerned, the wonder drugs had made such a difference that they stopped being concerned about ulcers. 

Smith: They’d ameliorated symptoms but couldn’t remove the underlying cause. 

Marshall: That’s right. The fact that patients had to keep taking these $3 a day medicines didn’t really affect the medical profession very much. In Australia, of course, the government paid for them. In America most people probably had them on their insurance or had to pay for them. I ended up in America at that stage, and there were people in America who didn’t have insurance, who were paying a thousand dollars a year for their drugs. I noticed a difference in the United States. People would come from miles to possibly find something that would cure them and get them off these expensive medications. There were a number of things like that that happened in the States because it was not socialised medicine. Whereas in Australia, and probably in the UK, it was all a bit muted because everybody could actually get something for free if they had an ulcer. In the United States, we used to have all kinds of people coming from different places. One of the interesting ones that turned up one day was a fellow who was a US Air pilot. Because he was a pilot, he’s not allowed to take any psychotropic drugs. One of these drugs was potentially metronidazole because in the fine prevented said, some people get neuropathy or hallucinations or something. He could not actually take a h pylori antibiotic treatment without stopping flying. He used to come down and have his ulcer checkup and his medication prescribed when he was on his Christmas holidays. I think he worked from out of Chicago or somewhere, but he used to secretly fly down to Charlottesville, Virginia, see me, get on the treatment, and then take it for two weeks. Then when Abeer was gone, he would then start working again at the end of his holiday. Interesting people like that just to turn up.  

Smith: Would you say that the impact of HP treatment on people was held back by that time? By if you like, vested interest in the other treatments? 

Marshall: I think it was, and there’s two ways it could happen. Obviously they could oppose it and say, we don’t believe it, but if as soon as they do that, they give it some oxygen, if you like, the credibility in that they are opposing it. The better strategy was what most companies adopted, they just would not comment on it. There were a few experts who would stick their neck out and say they didn’t believe it. Then they would get on the lecture circuit with opposed to me, and we would have debates at UCLA and different places about it. There was a lot of mileage in that. The best thing to do was just to continue on as if helicobacter never existed because there was so much money going into H two blocker research that the H two blocker and acid suppression information would swamp anything we could muster from helicobacter treatment studies. We would actually get a lot of publicity from small studies and from research meetings, far out of proportion to the millions of dollars that were being spent on the H two blockers and omeprazole in the eighties. But they probably did delay the rollout of Helicobacter treatment by five years, just by doing what they were already doing and ignoring it. 

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Smith: One slightly unusual aspect of this sort of global group of patients who came to you is that you were able to start this Helicobacter Pylori Foundation from donations you received from them. 

Marshall: I’d never thought of anything like that, but in the early nineties, as I was seeing some high flyers at the University of Virginia. One of the patients who said to me, ‘Oh, Dr. Marshall, can I make a donation to your research?’ And I said, ‘Sure, thank you very much’. I was thinking $50 or something, and he wrote out a check straight away for $3,000, which was fairly significant donation as far as I was concerned. I said, ‘thanks very much’. Then I had to spend weeks trying to figure out how to launder this money into my university research account without the dean taking 20% off the top. I then spoke to some colleagues. One of them was Dr. Steve, he’s now Chief Medicine University of Maryland. Steve said, ‘Barry should start a foundation, and then the money can go in there and you can spend it on whenever you want’. So I did that, and at the same time, the internet was invented. I was interested in that because of my electronics interests and computing. I contracted somebody, actually out of my own pocket, to start up a website. Then I had the Helicobacter Pylori Foundation registered as a tax exempt entity in the United States. Before people were really conscious of the value of the internet. I had an internet site in Virginia, which was the Helicobacter Pylori Foundation, putting out information about helicobacter. It was quite interesting that it really did have quite a take up. Pretty soon there was millions of people on America online who could access it. The reason I did it, because a lot of people were getting interested in helicobacter, and they would say, ‘Oh, Dr. Marshall, can you send us a couple of pictures of helicobacter? We want to do a story’. It became very repetitive then. I would say, ‘Just go to this website and this directory, and you get some pictures. There’s a picture of me, there’s a picture of Dr. Warren, the helicobacter etc’. Having it already meant that we actually were able to roll out lots of publicity about he back to Pylori on five minutes notice. Then we had some news stories, ABC news, CNN. Then someone did a foldout. There was a magazine in the Sunday newspaper called Parade that was distributed to 40 million homes. We did a helicobacter article there and put a link to a website on the bottom of it, had contact Dr. Marshall for small, for more information, send $10 and in a stamped addressed envelope, and we’ll send you some information about it and take your doctor. Then we had 40,000 letters. We only had a tiny little mailbox so if we didn’t pick up the mail for three days, the whole post office would be filled up with the cardboard boxes, mail for us. I suddenly realised the power of the internet. We probably got about 60 or $70,000 just from that one article, and funded a research fellow from Korea for a couple of years in my lab in Virginia. Since then, I’ve always kept that foundation going. That’s helico.com, and we have a quite an active forum there. Anybody can get on and post their symptoms, questions about antibiotics, et cetera. If they have a question that’s a bit technical, someone in my lab will try to answer it. If it’s a really a new thing or very tricky we’ll have a bit of a little meeting about the difficult questions on the site, and I’ve got about a hundred posts on that website, I think. It’s fairly up to date. 

Smith: A lot of people would be quite scared about opening themselves up to that kind of worldwide questioning, going to be deluged by stuff, never deal with it, but obviously you just take it in your stride. 

Marshall: It’s something that is a big responsibility. If someone asks a question about the side effects for an antibiotic, and if you look on the website, you can find things like this and whether they should take it with this or that drug, then you might see about a hundred words of a reply from me, whether bit of a reference at the end of it. You say, ‘Well, Dr. Marshall just knows that stuff’. But in fact, I probably spent four hours doing research on Sunday morning reading the articles. Might’ve called somebody. Last time I did it, I called somebody in Michigan at eight o’clock at night asking him about this paper he’d written. That it’s not something I’d do lightly. We try to give the right answers. The advantage to us is that we are receiving input from all around the world as to what’s going on in the particular country regarding Helicobacter. Obviously by looking at where we get hits from, on our website reports, we can see where people are searching for Helicobacter from. You can see that people in Florida have a lot more Helicobacter than people in Minnesota. If there’s anything new someone might be telling us about it, we learned that there’s a lot of hocus pocus and holistic naturopathy and stuff like that that goes on around the world. We are forever telling people that ‘No, garlic does not cure Helicobacter’. Questions like that. 

Smith: Thank you very much indeed. It’s been absolutely marvelous this conversation. I can’t leave though, without just referring to one famous incident, which is the fact that when you received your phone call telling you that you’d been awarded the Nobel Prize, you and Robin Warren were sitting together having a beer by the river. Maybe there’s somebody out there who can correct us, but I think it’s probably unique that the laureates had been sitting together. You did go for a beer together traditionally, or a dinner together traditionally on the day of the medicine announcement each year. 

Marshall: That’s true. People had been saying to us for about 10 years that we should win the Nobel Prize. It’s very important. I would say, don’t ever say that in public. It’s bad luck. I was concerned one way of never winning the Nobel Prize would be to talk about it. But we did know that it was an important discovery and it would be a candidate. Around year 2002, Helicobacter seemed to be getting lots of publicity. There was lots of interest in it from dairy, various international groups. Robin and I had won several big international prizes by then. Some Swedish person, I suppose said, ‘you know, Barry, I heard a rumour that your discoveries on the short list’. I said, ‘oh, that’s very nice. Let’s not talk about it. Change the subject’. At about 2002, I think we had a little conference on Helicobacter and Robin and I said, ‘Well, when they on announcement night, let’s go down the pub just together’, because we weren’t working together anymore. He was retired. I used to pick him up about four o’clock in the afternoon and take him down to the brewery pub on the Swan River, and we would have fish and chips and have a cup of big beers and then look on our phone or somewhere and listen to the radio, try and see if we could find out who won the Nobel Prize. That information would come out about five 30. It was just the right time, middle of the fish and chips. We’d stay there for about another hour, then I’d take him home and go home. We’d done that for about three years in a row. It seemed to me that the Helicobacter thing had totally peaked by then. It was about the fourth year that we had done it. That was 2005. We were sitting there just getting our fish and chips, and he had a pint of Guinness. I had my pint of Swan lager, I think, and actually the one I used to use drink is Emu export. Then his phone rang. Hans Jörnvall said to Dr. Warren, ‘I’m calling just to tell you that you’ve won the Nobel Prize, but there’s a big problem we can’t find Dr. Marshall. We’ve been calling his home. We’ve called his office. He’s nowhere to be found. What are we going to do? We have to announce it soon.’ Robin Warren said, ‘Oh, he’s here with me at the pub, we’re having a beer together’. He handed the phone over, and then they were able to tell me that I share the Nobel Prize with Robin. But Hans Jörnvall years later said that the committee was actually quite concerned about the fact that we were already celebrating before they’d told us. 

Smith: Yes, they must have thought there was a leak. 

Marshall: Yes. They thought we must’ve had the conference room bugged or something. They’re a little bit concerned about that, but I said ‘No. We always have a beer like that on Nobel Day’.  

Marshall: We still try to do it. We haven’t exceeded a couple of times because we’ve had a pretty heavy travel commitment and sometimes one of us is at a different meeting or different country. But it’s a fun tradition. We always enjoy each other’s company and we don’t take anybody else with us, usually just go by ourselves. 

Smith: Nice story. It’s been extremely kind of you to talk to me. I’m sorry it’s late evening there now. It’s been a joy. Thank you. 

Marshall: Okay. So if people have car accidents from going to sleep during the podcast, I’d disclaim any responsibility. It hopefully won’t happen.   

Smith: I sincerely doubt it. Anyway we talked about risk earlier. There’s always a risk, but I don’t think so. I don’t think so in this case. 

Marshall: Okay. Alright. Thanks very much, Adam. 

Brilliant: This podcast was presented by Nobel Prize Conversations. If you’d like to know more about Barry Marshall, you can go to nobelprize.org. Where you’ll find a wealth of information about the prizes and the people behind the discoveries. 

Nobel Prize Conversations is a podcast series with Adam Smith, a co-production of FILT and Nobel Prize Outreach. The producer for Nobel Prize Talks was Magnus Gylje. The editorial team for this encore production includes Andrew Hart, Olivia Lundqvist and me, Clare Brilliant. Music by Epidemic Sound. You can find previous seasons and conversations on Acast or wherever you listen to podcasts. Thanks for listening. 

Nobel Prize Conversations is produced in cooperation with Fundación Ramón Areces.

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