In 1984, a thirty-two-year-old Australian doctor named Barry Marshall walked into his hospital laboratory in Perth, stirred a cloudy broth of bacteria into a glass, and drank it. He did not tell the hospital's ethics committee, and he barely told his wife. Within days he was vomiting, exhausted and foul of breath, and a biopsy of his stomach showed that the lining had become raw and inflamed. He had made himself ill on purpose, and he was delighted, because he had just proved a point that the entire medical establishment refused to accept.
The point was this: stomach ulcers are caused by an infection, and can be cured with antibiotics. For most of the twentieth century, doctors were certain that could not be true. Peptic ulcers — painful sores in the lining of the stomach and the upper intestine — were blamed on stress, spicy food and, above all, excess acid. "No acid, no ulcer" was the medical mantra. Everyone knew that nothing could live in the stomach anyway; its acid was strong enough to strip paint, a sterile cauldron in which no bacterium could survive. Ulcer patients were told to relax, drink milk and take acid-suppressing drugs, which soothed the symptoms but rarely cured the disease, so that ulcers came back again and again, sometimes for a lifetime, occasionally bleeding or perforating and killing the sufferer.
The bug in the biopsies
The heresy began with a pathologist named Robin Warren, who kept noticing curved, spiral-shaped bacteria clinging to samples of inflamed stomach tissue — bacteria that, according to everything he had been taught, should not be there. Teaming up with the young Marshall, the two set out to grow the organism and prove it was real. The bug proved maddeningly hard to culture; the breakthrough came almost by accident when, over a long Easter weekend in 1982, a set of dishes was left in the incubator far longer than usual, and colonies of the slow-growing bacterium finally appeared. They had discovered what would be named Helicobacter pylori, the "spiral bacterium of the stomach's exit."
Marshall and Warren gathered evidence that the microbe was present in the great majority of ulcer patients and argued that it, not stress or acid alone, was the true cause. The response from the profession ranged from indifference to ridicule. A whole industry of acid-blocking drugs rested on the old theory, and the idea that a common ailment could be an infection curable in a fortnight seemed too neat, and too threatening, to be believed. Marshall could not ethically infect a patient to prove cause and effect, and animal models had failed. So he chose the one experimental subject he could consent for: himself.
Down the hatch
Having confirmed his own stomach was healthy and free of the bacterium, Marshall swallowed his cultured brew of Helicobacter. When he duly developed acute gastritis — the inflammation that precedes ulcers — and doctors recovered the same bacteria from his gut, he had demonstrated, in the most direct way imaginable, that the microbe could colonise a healthy stomach and make it sick. He then cured himself with antibiotics. It was a stunt, and a slightly reckless one, but it was also a piece of self-experimentation in a long medical tradition, and it cut through the scepticism as no cautious paper could.
The evidence mounted, trials confirmed that a short course of antibiotics could cure ulcers permanently, and by the mid-1990s the medical world had swung around. Treatment was transformed: a disease once managed for life with expensive drugs and sometimes surgery became, for most patients, a curable infection. Helicobacter pylori was later recognised as a major cause of stomach cancer as well, one of the few bacteria known to trigger a cancer, making its discovery matter far beyond ulcers.
In 2005 Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for showing that ulcers are caused by bacterial infection. The award was, in part, a rebuke to the certainty that had dismissed them, and a reminder of how tenaciously medicine can cling to a comfortable theory. It also gave the world one of its favourite scientific images: a doctor so sure of his idea, and so frustrated by his colleagues, that he was willing to drink a glass of the very germ he was trying to convict.
Quiz nuggets
- Stomach ulcers were long blamed on stress and excess acid, summed up as "no acid, no ulcer," because it was assumed no bacteria could survive stomach acid.
- Robin Warren and Barry Marshall identified the spiral bacterium Helicobacter pylori, first successfully cultured in 1982.
- In 1984 Marshall deliberately drank a culture of the bacteria and gave himself gastritis to prove it caused stomach inflammation.
- Ulcers were shown to be curable with a short course of antibiotics, and H. pylori was later linked to stomach cancer.
- Marshall and Warren won the Nobel Prize in Physiology or Medicine in 2005.