Professor Barry Marshall, gastroenterologist

Barry Marshall was born in the mining town of Kalgoorlie, W.A. in 1951. Marshall gained his undergraduate medical degree at the University of Western Australia in 1974. He then completed his internship and residency years at the Queen Elizabeth II Medical Centre. In 1979 Marshall moved to the Royal Perth Hospital (RPH) where, in 1981 during a gastroenterology rotation, he met Dr Robin Warren. Marshall began to work with Warren in studying bacteria in the stomach. In 1982 Marshall took up a senior registrar position at Fremantle Hospital, Perth and continued his study of Helicobacter pylori infections and treatments. In 1984 he was able to prove that H. pylori infections caused peptic ulcers and it is for this body of work that Marshall and Warren were awarded the Nobel Prize in 2005. Also in 1984, Marshall moved back to RPH.

In 1985 Marshall began a successful partnership with US drug firm Proctor and Gamble and in 1986 moved to the USA to join the University of Virginia as a research fellow. A significant milestone for Marshall came in 1994 when the National Institutes of Health accepted that the key to treatment of duodenal and gastric ulcers was eradication of H. pylori infection. Marshall returned to the University of Western Australia in 1996 to set up his research laboratory. He still sees patients at the gastroenterology department at Sir Charles Gairdner Hospital.

Interviewed by Dr Norman Swan in 2008.

Content

Childhood leanings toward risks and engines

Thanks for doing this interview, Barry. What’s your most dominant memory of your childhood?

Probably the days I spent in Kalgoorlie when I was aged four, five and six, in the first couple of years at school. I think that stamped me with a certain flavour – I suppose, as someone who likes to live dangerously. We don’t like kids to do that these days!

Tell me about your life as a preschool or early school-aged kid.

Well, you were more or less left on your own. My mother had another child and my father worked during the day. We lived at the hotel my grandfather ran in Kalgoorlie. He had a TAB as well, right next door, altogether a pretty successful business.

In the daytime, if you were a bit bored as a little kid you could follow the yardman around (his name was Bertie, I recall, and he was a pretty heavy drinker) and you would be cutting the heads off chooks or raking up the yard or looking around the beer garden for dropped 10-bob notes, stuff like that. You’d have a base at the pub, and venture out with your mates to go to different places within a few hundred yards around the neighbourhood. We’d be shooting things with gings [catapults] and bows and arrows and riding our bikes around. And once a year, on Guy Fawkes Night, all the kids would be down the shop buying crackers and then letting them off.

Was that country life or just a big town life?

I think it was a big town life. These days, I suppose, in Geraldton or even in Kalgoorlie you could probably still live that life, but you’d be a bit more cosseted.

Did you learn to be a risk taker, or did you watch other people taking risks?

I learned to be a risk taker. But I knew that it would always be risky and things could go wrong. Amongst other things in the neighbourhood, you had to watch out which kids you insulted, or who you won marbles from. And you had to look out for bad dogs. [laugh]

Wasn’t there a pretty strong ethnic mix among the kids in Kalgoorlie at that time?

Well, you got the mix of everybody all in the same place – a lot of Italians, Europeans, I suppose. I guess they and the English would have been the only immigrants.

What sort of kid were you – one of the crowd or just stand-offish?

I was simply a little kid who was always on the receiving end of punishment, that’s my recollection. For example, on my first day at school I won some marbles off a kid, but halfway home he thumped me and took his marbles back. I said, ‘Playing marbles is not all it’s cracked up to be! You need to have some strong friends.’ So I guess I had an exciting life in those first few years.

We moved down to Perth when I was about seven, and that was a bit of a shock for me. In Kalgoorlie I had been one of the top two kids in the class, always competing with a girl whose father was the bank manager, about as high as you could get in Kalgoorlie society, whereas my father was a tradesman. And I remember that a kid in Kalgoorlie, at 17 or so, won a scholarship to medical school. Everybody said, ‘He’s a genius. He’s going to medical school.’

But that was in the days when people had a lot of confidence in public schooling.

I guess they did, though I don’t know whether he went to a public school. I went to the nuns’ Catholic school. I always thought that Catholic school kids were punching-bags for the state school kids; again you had to be a bit careful there.

So competition at school got a bit more fierce when you moved into the big smoke?

That’s right. Suddenly I was only one of many, and there was more than one class – the top class and the not-so-top class. And in the top class I was just in the middle. It was much more competitive academically. But I could still do all the things that I liked to do out of school hours, because my father was a tradesman. He was a fitter, but he had worked on the whaling boats as a marine engineer, and then he was a refrigeration engineer. So we always had acetylene, oxyacetylene, electrical gear, machinery in our garage.

By then I had two brothers, and finally, 10 years younger than me, as the youngest one in the family, was my sister. As I was the eldest of this little team, if you like, I could rule the roost and pick what we were going to do each day.

Suppose I asked your brothers or your sister, ‘What was Barry like?’ What would they say?

They would tell you terrible stories of how we tied them up and then forgot about them, so when we came back six hours later they were still there. Or they would, on my instructions, jump out of a tree with a cape on and break their arm – stuff like that!

What school did you go to next?

I went to Marist Brothers in Subiaco. We ended up living very close to them, near the railway tracks. There were a lot of scrap metal yards around, and that was pretty interesting on weekends. The coincidence is that people have since sunk the railway line, got rid of all the scrap metal yards and built a new neighbourhood on top of it, and I live there now, about 300 yards from where I lived as I was a kid in Perth. It’s great.

What was the fascination with scrap metal?

Again it’s engines. The scrap metal yard company (which is now Sims Metal, a mega multinational company) used to have scrap from the Army, so you could find old torpedoes, beautiful little motors, ack-ack guns – you would sit there and wind the handles on them. It was pretty amusing for kids in the afternoons.

Family influences

You spoke of ‘moving down’ to Perth. Had you been born there?

I was born in Kalgoorlie Hospital.

So you were born in Kalgoorlie, left Kalgoorlie and then returned to Kalgoorlie?

Yes. In Perth we lived in Scarborough, near enough to the beach. From about 12 or 13 years old I used to go surfing by myself, but I could never afford a big surfboard so I was just bodysurfing and snorkelling, things like that.

Were your parents from Perth originally?

No, both from Kalgoorlie. My mother’s family had come from Victoria in the Depression. The folklore is that my Mum’s dad was a bit of a pool shark: he worked on the mines, but as a young bloke during the Depression he could always make a few bob playing pool.

My father was a top tradesman, and still is. (He’s retired now.) He did his trade in [Kalgoorlie] School of Mines, and he could have got a job anywhere.

The story is that not long after I was born the parents moved right over to Carnarvon, where there was a big whaling station. Actually, Dad had a possible job at Rum Jungle in the Northern Territory digging uranium, which was the big thing in those days, but as they were heading up the coast in a model T Ford or something they had a flat tyre and went in to the whaling station at Carnarvon, and Dad became a tradesman there. My memories from back there are a bit fuzzy.

Would you say your childhood was tough to begin with but a bit more affluent as your father got into his own business?

Yes. He ended up being the chief engineer at a meat packing-chicken-refrigeration factory. Kentucky Fried Chicken was new in Perth, and within a few years this factory was producing 40,000 chickens a day. It became a major industry. We never had any shortage of red meat, chickens or ice-cream in our house.

Is your mother still alive?

She is, and she too is retired now. My mother was a nurse, but did only about a year of nursing after she left school. She went back to it, though, soon after I started medical school. I think a few things had changed a lot, and she wanted to find out if these new things were true. We used to have a lot of arguments about what was really true in medicine. She would ‘know’ things because they were folklore and I would say, ‘That’s old-fashioned. There’s no basis for it, in fact.’ ‘Yes, but people have been doing it for hundreds of years, Barry, therefore there must be some use in it. That can be true.’

And you were compromising, you met her in the middle?

If there was a cake on the table or I needed pocket money, I was very compromising to my parents! But once I had a full stomach and a few bob in my pocket, then I was off.

If I were to ask your parents about Barry in those days, what would they say – a pain in the neck or the apple of their eye?

Well, my mother said I was always a know-all – which is what happens, I guess, when you start high school. All of a sudden you probably know more than your parents, because their knowledge is based a generation earlier. And you’re not necessarily interested in the same things or the same careers. Also, I was very general: I had a bit of an interest in medicine, but also a broad interest in engineering, electronics, electrical stuff, anything to do with science.

My Dad used to get me afternoon and weekend jobs washing trucks (at his chicken factory, by then) and I used to meet some pretty strange people who were washing trucks and hadn’t got any further in their careers. That made me realise that although life in the outdoors is healthy and interesting and you’re getting plenty of sunshine, such a hard physical life was not what I wanted. It egged me on to head for university, if I could make it.

Developing core values

Some people say that somebody influenced them strongly when they were at school, changed their life. There is a bit of mythology about that sort of thing, but was there somebody like that for you?

I suppose that would be the Marist Brothers. The head of the school was Brother Gordon, from Victoria, I think, who might have been forty-ish. The Brothers seemed to be sort of a religious group, but they were just regular guys and they were still enjoying life. We used to be amazed that there seemed to be a lot of beer bottles stacked out at the back of their residence.

Brother Gordon taught us chemistry and physics, and sex education – that was a big hit for the boys at Marist. But the Brothers taught us all the basics at that time, when we were about 12 or 13 years old. There was always an emphasis on science and mathematics in that school, so it just seemed the natural thing to do those. We also used to do Latin.

But we never did our homework, so at any time half the class would be getting a couple of cuts on the hand. The Brothers used to carry canes around in their cassocks, and if they had one hand in a pocket you never knew whether or not a cane was there as well. The pocket had a hole in the side, I think, so they could very quickly pull the cane out and give you a couple if you were playing up. It was a good discipline – if painful.

Are you religious? Do you still see yourself as a Catholic?

I’m a very bad Catholic, my mother says, but I’ll go to church with her a few times a year.

Do you ever go by yourself?

Sometimes I do, actually, especially when I am travelling around the world. Maybe I’ve landed in San Francisco on a Saturday but I don’t start work till Monday, so what am I to do? If I go to the Catholic church at, say, 8.30 on the Sunday morning they’ll have Communion. They’ll have fantastic opera singers, if you go to the right Mass in San Francisco. And you see a bunch of people who are probably of Irish descent and ended up in San Francisco, where they are all doing exactly the same thing as you are used to ’cause the Pope says everyone has to do that. You can go to any country and find it’s very similar. Then you feel, ‘Hang on, America’s not as weird as I thought. There are normal people here, same as in Perth.’ So I have that advantage. I guess it’s like going back to your roots.

But I don’t really go along with all the Catholic stuff. I find that Catholics who went to nuns’ schools in their primary years and had the Catechism hammered into them, and all those rules, have done that religious stuff so intensively that when they grow up they say, ‘I’ve been there, done that. I can take it or leave it.’ By contrast, I feel that people who have never had any religion hammered into them think it’s exciting and new. My mother used to say, ‘Watch out for the converted Catholics. They’re much more staunch than the regular Catholics.’

As somebody who was pugnacious, who was willing to take on his parents and argue, ‘I’m right, you’re wrong,’ do you believe in God?

Ah, I’m neutral on it at the moment. [laugh] Actually, I like the stories about the Catholics who call the priest on their death bed: if you play your cards right you can possibly get it both ways. But I do think these days that there are reasons why you don’t commit crimes and why you do the right thing by people. I’ve learned over the years that, as life goes on, the thing that’s very valuable to you (although you don’t appreciate it as a young person) is your reputation. And your reputation for honesty, being able to do a deal on a handshake or over the phone, say, can really accelerate your career. People don’t feel they have to continually check up on you.

What would you say are the core values you’ve taken from your childhood and adolescence, from your parents and your peers around you, into the rest of your life?

The only thing you can do is to assume that most people are like you – I guess most of us are in the middle of a normal distribution – and so ‘do unto others as you would have them do unto you’. And you remember not to make enemies if you don’t have to. I learned that on the first day at primary school, from the guy who took his marbles back. Business people tell you this as well; the ideal business negotiation is one from which both people come away thinking they’ve had a fair deal. You know, ‘You do your bit, I’ll do my bit, and together we’ll be a team.’

Very early on I helped someone do some research, and in the middle of something that might have just been an abstract or a poster they put my name as one of many authors. I said, ‘Hahh, my first publication. Isn’t that great! I’m a scientist.’ Remembering that, quite often as my career has gone on I have wondered how many authors you should put on your paper. I don’t mind putting on a couple of extra authors who gone out of their way to help us, even if they are not in science or they weren’t expecting it. It is an issue of authorship, I suppose.

What was that first paper?

I can’t remember now, so maybe what I’ve been talking about is mythology. I suppose our first publication was a couple of abstracts about Helicobacter. I probably had a couple of abstracts as well, but I don’t really remember them.

Mixed experiences at medical school

Let’s go back. You went into medical school at the University of Western Australia.

Mm. I was going to do medicine or electrical engineering – the things I was interested in. I chose medicine instead of engineering because I didn’t think I was good enough at math. Now I think I am good at math but just lacked confidence. During my second last year of high school, just as we were starting various kinds of high level trigonometry and calculus, I had a bad flu and for the first two weeks into this new course I was at home, sick. I never caught up.

Doing medicine instead of engineering turned out to be a good choice. And once I got into medicine and started doing math and statistics, although I wasn’t all that great at it and I was still not confident I really did enjoy it. But my career might have been quite different if I hadn’t had the flu when I was in high school, 16 years old. (One of the things I’m working on now is flu vaccines, by the way!)

People often find that medicine is a bit of a grind, uninteresting. You’ve got to learn a heap of facts, and often lecturers are uninspiring. How did you find medical school?

It was very exciting. I hadn’t had the chance to do biology at high school – the Brothers didn’t have enough biology classrooms, so if you did chemistry and physics you couldn’t do biology. I was very interested in cells and anatomy, physiology, so at medical school I was in heaven.

I found I had a knack for making things work. A couple of times a week in medicine you’d do chemistry prac class in the afternoon, you’d do physics prac, and then you might do an anatomy prac, biology prac – practical classes with gadgets. I love gadgets. In the pracs we’d be measuring the blood pressure on a frog, or connecting up electric volts and making a frog leg twitch, for example. Typically, a lot of the medical students came from professional families, with dads who were lawyers or doctors or professors, and they’d never ever had a chance to play around with an electrical device or tubes or pipes and pressure and things like that. I felt that I was in demand, and straight away I could see that I was able to get things going.

What were your favourite subjects?

Ah, in first year, chemistry (I wasn’t brilliant at it, though; I found it hard work) and physics, and probably math as the third. You didn’t do anatomy until second year. I liked anatomy, and it helped that I had rather skinny legs – as I moved, I could actually see all the muscles in my legs and feet. If ever I was in an exam it was like having an open book: you could just look at your own anatomy and draw it and remember the names of things.

Are you sociable, or a bit of a loner?

Pretty sociable. Actually, in first year medicine I was a bit of a loner, in that I hung around with some guys who were repeating medicine that year and were a bit older than me, had girlfriends, et cetera. I didn’t have anybody at that stage, so I used to dream about having a girlfriend. But the main thing was passing medicine.

Some people were confident of passing and could slack off a bit, spend time in the coffee shop and be a bit more sociable. I didn’t have much money, and the main aim in my life was to pass first year medicine, because they culled a lot of the first year students. After first year it was okay, because then they only culled 10 students per year. I think we were down to a hundred. And they culled 10 and let five repeat, so five dropped out. That meant that instead of trying to be top of the class or to get an A, you could just look around and make sure there were 10 people you could beat! Being above that threshold was far more important than the actual pass mark. You didn’t really know what that was.

Were there any subjects you excelled at in medical school? Did you get a university medal or anything like that? Or did you keep in the ‘safe’ region?

I didn’t get any medals. I think I kept in the safe region. I’ve found that in academics the law of diminishing returns applies. You can do 50 per cent effort and get 80 per cent, and then if you do 75 per cent effort you might get 85 to 90 per cent. If you put in 100 per cent effort you might get 91 per cent. You ask yourself how much do you value your spare time, and what are your plans then? So in second year medicine I started being a bit more sociable and having a bit of luck on the social side of things.

Also, we felt a bit of pressure was off then. The med students became a bit more normal; they were not spending all the time in their books, and it was fun to do things that were more related to medicine – physiology, blood pressure, dissections on animals and human beings, anatomy. I liked all those kinds of things.

Is there a patient you remember from your medical school days?

Well, you first start seeing the patients in the third year, and I do remember a few pretty incredible ones. My first patient spoke no English, and was demented and very elderly. I was told, ‘Go and take a history from this patient,’ but the patient wasn’t speaking to me or anybody else. I was thinking on that day, ‘Gee, is this veterinary medicine that I have here, or human medicine?’ (I suddenly realised that in veterinary medicine you couldn’t get the history, and so it was probably a lot harder than human medicine.) You’ve then got to go back to basics: take the blood pressure, listen to the heart, listen to the lungs, grab the patient and move the patient around – be hands on.

That was a good lesson for me, that in the worst case scenario you can still put hands on the patient, examine the patient. And a lot of people feel that they haven’t got a proper consultation unless the doctor’s manipulating them, moving them around, being hands on. I still think that’s one of the basic tenets of medicine. A certain bond develops when a ‘stranger’, the doctor, comes and lays hands on your body. If he feels confident, the patient is immediately reassured. You've got over some kind of rapport threshold, and after that it is very easy and the patient has a lot of faith in you, if you’ve done a proper physical examination.

The other patient that really spooked me was a girl I met when I was doing psychiatry. She had schizophrenia or something, I wasn’t sure, and she was quite glamorous. She was very promiscuous, and was sitting on the bed and coming up close to me, and I thought, ‘My God! I’m getting out of here.’ I was very insecure with women in those days, and probably still am. I’d say, ‘Excuse me, I’ve got to go home to my wife’, or something like that. ‘Where’s my wedding ring? I’ll put it back on.’ [laugh] So it spooked me a bit, and I wasn’t particularly interested in psychiatry after that.

Acquiring a wife and children

So when did you start going out with girls?

End of second year. I met Adrienne, my wife, in third year.

Was your wife in your class?

No, she was in psychology. The psychology girls were a lot more interesting, I thought in those days. We met at Rottnest, an island off Perth, at the end of third year medicine, and all because I used to scuba dive and catch crayfish, lobsters.

We used to have something like the American Beach Week after the final exams, when everyone would get on the ferry in Perth and go to Rottnest. All you could do over there is walk around, ride bicycles, lie on the beach and drink beer – if you were old enough or had an ID card.(Actually, people can start drinking at age 18, so after the first year in university you can drink beer. Maybe that’s why things became more sociable.)

I used to catch lobsters but I couldn’t eat them because I was allergic to them. I could trade these lobsters, however, for practically anything. One tent had a lot of psychology girls in it, and I visited them and said, ‘Do you guys want some lobster?’ Well, I was fed with sausages, and all the girls in the tent had lobster. Eventually they could see some value in that, and they all came over to our card party. And apparently that is where my wife and I first met.

I was just an innocent bystander on the card game, but I did have a lot of beer. So when she came up and spoke to me on the beach the next morning, I thought it was my lucky day – I didn’t remember her! Anyway, it was then ‘love at first sight‘. We got married a year later, while I was still in medical school.

When did you first have kids?

Just nine and a half months later. I think a lot of my friends, and perhaps even my children, suppose it was a shotgun wedding: we were married at Christmas time 1972, during the holidays after fourth year medicine, and when people saw me again at university the following year I had a new bride and she was obviously pregnant.

How many kids have you got now?

Four. The second, my son, was born during fifth year medicine. As a student you could get an extra $5 a week living allowance if you had a baby, so that was an incentive for us. But it was a crazy idea: we didn’t realise we’d be paying $5 a week in just the baby’s soap powder. And then we had another one when I was in my internship.

Did you have time to spend with the first baby, in particular, given that you were still at medical school?

Well, we did, because we had no money. You’d be surprised at how much time you have on your hands when you have no money to spend. You can’t go out, you can’t go to the pictures much. We used to run out of food on Friday, and so at the weekend we would go to my parents’ place or Adrienne’s parents’ place and trade the babysitting of the first grandchild in the family for a few free meals. Those were a very interesting and successful couple of years. We had a fantastic life.

Some people who have kids while at university decide to take the easy course and go into general practice, to earn money fast and get some financial stability. Did that go through your head?

Obviously, money was a big concern for us; even during my internship we already had several children. And at one point Adrienne was also working in psychology, as a child assessment psychologist for the education department, so we had busy years with childcare. That can get pretty chaotic, as you leave your work to pick the kids up and take them home, after getting them there early. I was doing some heavy clinical work and also would volunteer to do other people’s on-call to earn a few hundred dollars over a long weekend, for instance.

Drawn to become a specialist physician

During medical school people often consider three different specialties, without a clue what they really want to do. What was your track?

I was a generalist; I didn’t have a vision of what my career was going to be. But I didn’t see research as something I was interested in. I wanted to get my ticket as quickly as possible and be out there looking after patients.

I used to do crazy university stuff on the side, a bit of shenanigans such as at the Prosh parade in Perth, when the uni students raise money for charity. I remember that for some reason we were up on the back of a truck, doing an ‘operation’ and squirting fake blood all over the crowd in Hay Street. I can’t remember what we made that out of, but I’m sure it would have stained their good clothing.

I had some ups and downs in medical school. I got through every year but didn’t do brilliantly; I had a supplementary once. I made some enemies, when I didn’t like the pathology course one year. At the end of the year a questionnaire was put out for all the med students to fill out anonymously, and I gave the Pathology people Fs in everything, wrote a whole page of insulting comments at the back of it, and handed it in.

Well, they traced my handwriting. And so we came to the final pathology exam, a week later, where you sit down and a CSI-type forensic pathologist on the other side of the table hands you a plastic bottle with a heart in it and says, ‘What’s that, Dr Marshall?’ So they did a bit of this with me.

Actually, they did decide I had passed that year. After that they said, ‘Okay, now we’re going to nail him.’ So they handed me my questionnaire, asking, ‘Have you ever seen this document?’ and had a go at me over that. The head of Pathology in my year was Len Matz. He’s retired now, but he became a big supporter of me years later when Robin and I were writing our papers and doing the Nobel work. So I made an enemy but a transient one.

Was Robin Warren one of the teachers you moaned about?

No, Robin’s off the hook! When I was a medical student he was a pathologist at Royal Perth, so I would have seen him in pathology sessions. But we didn’t have a relationship until about 10 years later.

Tell us about your internship and what happened as you moved into the hospitals.

Once I was in the hospitals, again I found that my practical ability was very useful. I could have done surgery or medicine, but things like putting in a tube, a catheter, a drip – doing a procedure on a patient, anything – or getting the ECG machine going, were all pretty easy for me, whereas a lot of young doctors didn’t feel confident with gadgets and equipment. And so quite often I could finish work rather early. Also, I had the idea of just getting to the heart of the problem, not beating around the bush but focusing on the diagnosis and getting the patient’s management pretty well wrapped up quickly. I was one of the interns that always got their afternoon off; others never finished their work and got an afternoon off.

And they thought Marshall was inefficient, or a slacker?

Well, I wasn’t perfect as far as diagnosis was concerned, but I made enough rare diagnoses and did enough important things, and saved enough lives, to be confident I was on the right track.

Once I really got into dealing with patients in the hospital I decided that hospital work was where I wanted to be, because these patients were seriously sick and it was life and death. Every time I did a six-month term I would come home and say, ‘This is it. This is what I want to be.’ Whether it was rheumatology, haematology, cancer – any of those medical things – I really loved it. And it seemed a lot more challenging than surgery. I could do surgery, but I felt that once I could take out an appendix, a gall bladder and whatever else, which was most of the surgical work, unlike medicine it would be the same, year in year out.

So you started to do a specialist physician’s training?

Yes. I was interested in endocrinology, diabetes, things like that – although, I have to admit, again it was a bit threatening because you used to meet ladies with hormone problems and you would have to ask them personal questions. Maybe my Catholic upbringing was welling up again, but I remember that once my boss, Don Gutteridge, sent me in to a patient who was a Marist Brother with a testosterone problem. So I had to ask this Marist Brother about his libido! I could do it nowadays, but that was a very difficult day for me.

You imagined the cane coming out of his cassock?

I did! But I think Don had warned him: ‘Oh, be gentle with the new intern. He has to ask you personal questions.’ Of course, if you’ve got a hormone problem and you’re on testosterone, say, you get those questions every time you go to the doctor.

An absorbing new bacterium

Many people have said you are one of the most unlikely Nobel Laureates – no track record in research, essentially, and then boomp! Take us along the way to the ‘boomp’.

When you were training you had to do a research project on your patients each year and report it to the College of Physicians. I did a few interesting research projects, including one on heat stroke, where I worked out why marathon runners collapse about a mile before the finish line. (Heat stress is pretty relevant to Australia, so I could have gone into environmental medicine.)

While I was doing that, I did gastroenterology as one of the six-month terms. I had a number of different possibilities but, as a fluke, my boss showed me a letter from Robin Warren saying, basically, ‘We’ve got 20 patients with bacteria in their stomach, where you shouldn’t have bacteria living because there’s too much acid. Is there a doctor in gastroenterology who wants to work with me on this and find out what’s wrong with these people?’

I was curious, because the bacteria Robin had seen were called Campylobacter-like organisms; they looked like Campylobacters, which cause a common infection you can catch off chickens. As my Dad worked in a chicken factory, I knew a bit about that, and this seemed the most interesting thing I could get involved with.

Also, it would involve taking samples, trying to grow bacteria. I was interested in bacteria and infectious disease, because I knew of heroic stories such as that of John Hunter, the ancient professor who thought that syphilis and gonorrhoea were the same disease and infected himself with these bacteria. He ended up getting gonorrhoea but also syphilis, and that killed him years later.

So off I went to work with Robin. I had enough confidence in my ability to say, ‘If this has never been cultured before, I should try and I should be able to get it going.’ Although there was a lot of hocus-pocus – ‘It’s all very difficult and you have to have your microbiology licence,’ et cetera – I was never fazed by that. I felt there was nothing out there that I couldn’t do, if I had a go at it and learned enough about it. Within a week Robin had taught me everything there was to know about the stomach biopsy and the histology in gastritis. And then together we learned everything about bacteria related to the stomach, or the gastrointestinal tract.

Together, because he’s a pathologist, not a microbiologist?

That’s right, though actually he liked looking at bacteria. One of his favourite hobbies is looking at bacteria in different tissues. But nobody ever looked for bacteria in the stomach, and any seen there were thought to result from contamination. People who had seen them had always washed them off to look at the stomach cells underneath, and just ignored the bacteria stuck all over the surface.

So it was a different thing for us to look for bacteria. We were not looking for the cause of ulcers. We wanted to find out what these bacteria were, and we thought it would be fun to get a nice little publication, New Bacteria. We were saying, ‘Maybe this happens only in Perth. Maybe this is Australian, and you catch the bacteria from kangaroos or wombats or quokkas.’

Robin had not yet made the link to gastritis, to inflammation of the stomach?

Actually, he had seen that the bacteria were linked to gastritis and it was inflammation. But if you studied the literature on gastritis you found it was a mish-mash. Dozens of people were publishing on gastritis, but there was no disease connected with it except, maybe, cancer of the stomach. Most of the people who were studying gastritis believed that you just got it as you became older. They said, ‘Oh, spicy food, dirty food, too much alcohol, anti-inflammatory drugs, it runs in families, some countries have it, some don’t.’ There was no logic to it. But we were interested in whether it might result from bacteria. Other people were just studying the gastritis and in most of their papers they would not say anything about bacteria.

Did you manage to grow the bacterium at that point?

Robin and I started culturing it – this took over my life, because it was quite exciting to look at it under the microscope – but we couldn’t grow it for eight months or so, until in 1982 we started doing a culture from every single patient. After about 35 patients that year, suddenly we grew it.

What was the difference?

It was a bit of luck, with a lot of hard work. We were doing the right things; we were using the right culture media. But we didn’t realise our laboratory technician was getting so busy with other epidemics in the hospital that he or she would just look at our culture after two days and, if there were no new bacteria on it, throw it in the bin. But if you have got a new bacterium you really don’t know how long it’s going to take. Then, after we took a biopsy on the Thursday before Easter, the technician didn’t look at it two days later, on the Saturday, because he was too busy. (He was on call, not the regular technician.) He left it in the incubator, and it wasn’t looked at until after five days, on the Tuesday morning. And there were these unusual colonies, the first culture of Helicobacter.

Once we knew that one factor, that it takes five days, things took off. We cultured it from lots of people after that. Then we could say, ‘We know which antibiotic kills these bacteria.’ We figured out how they could live in the stomach and we could play around with it in the test tube, do all kinds of useful experiments.

Bold action to establish an essential link

By that time did you have a suspected causative link with gastritis?

When we were just testing patients randomly we couldn’t see any link. But then we tested every single patient until we had 100 patients, of whom 13 had a special kind of ulcer called duodenal ulcer. And all those 13 patients had the bacteria. We said, ‘Sure, that’s only 13, but it’s quite a coincidence,’ and so we looked at more.

At that stage, looking at the literature and thinking that maybe the bacteria caused gastritis, as Robin believed, suddenly I had the idea that you had to have gastritis to get ulcers. That is, perhaps the bacteria caused gastritis, and gastritis caused ulcers. That would explain why some people got ulcers all their life: they had the bacteria, which were damaging the stomach. It also explained why ulcers came and went: maybe the immune system was getting stronger or weaker at different times. You could heal the ulcer but you got it back because you didn’t get rid of the bacteria. Randomly some people with ulcers suddenly went into remission. Also, of course, people were getting treated with antibiotics by their GPs so they were getting cured. It explained so many different things about ulcers.

But then you had Koch’s postulates to fulfil?

Yes. The sceptics would say, ‘Oh, Dr Marshall, Dr Warren, we think that people with ulcers catch the bacteria. You have the weakness of the ulcer, then you catch the bacteria, and that explains why these bacteria are so common.’

That is the line the drug industry was taking. They didn’t want to lose their sales.

Well, yes. In retrospect, by then the ulcer drug business, globally, was worth three to five billion dollars. It was the first billion-dollar drug, if you like. The companies were selling a lot of this drug to ulcer patients, and they had all their shareholders to worry about. As far as they were concerned, people had ulcers all their life, and so their projection was, ‘If we start you on drugs for your ulcer you will need to spend $1 a day or $3 a day for the next 10 or 20 years to keep your ulcer under control.’ If suddenly ulcers could be cured and it became unnecessary to take ulcer drugs all the time, the share value would go down by three-quarters. So they didn’t want to support us, and they did all kinds of other research trying to prove that bacteria did not cause ulcers. They would be very sceptical.

We did some animal experiments, but we could not make the human bacteria infect animals such as rats or pigs. So I said, ‘I have to test it out on a human.’ (By this time I was at Fremantle Hospital, running my own mini-lab working on these bacteria.)

Where was the money for this research coming from?

We were doing it on the side! I had a little bit of money from some of the drug companies that made antibiotics, and a guy in Sydney, with one of the ulcer drug companies but a bit of a rebel, supported me. But when he presented my work in Philadelphia they told him to go away. They didn’t want to know about it.

Basically, in those days you could do research within the medical system, on hospital patients, provided you didn’t have private patients. You could do all kinds of testing, and if the pathologist on the other end didn’t raise a bill either, you could do it all for free – although obviously it was costing Fremantle Hospital thousands, because everyone would be working harder. There was also the advantage that you could write a paper and put someone’s name on it. (I realised how important it was for somebody who was helping you, doing you favours, to have their name on a paper. Occasionally I have been remiss and have accidentally left people off a paper, and I have always regretted it.)

Anyway, I decided that I was going to have to drink the bacteria myself. I thought I would just be having no symptoms for a few years, after which I would have an ulcer. And then, halleluiah, it’d be proven.

Actually, I was very shy about this experiment; I didn’t tell anyone, not even my wife or Robin, until afterwards. I might have said at some point, ‘We might have to get a human volunteer,’ and I had written it in my thesis proposal that I was going to use volunteers. But that was some other volunteer. Eventually I decided to do it on myself, because by then it was a very important experiment. If it was successful and I did develop an ulcer or stomach problems from the bacteria, that would prove they were harmful and indicate that possibly I was right, they could cause ulcers.

If nothing happened, my two years of research to that point would have been wasted. I would probably be wrong, and I was going to be a private practitioner, a physician or whatever.

Fulfilling Koch’s postulates

Did you do it properly? Were you documented as not having Helicobacter already?

Yes. I asked my boss in Gastroenterology, Ian Hislop, to do an endoscopy on me one day. As he put the scope down me he was saying, ‘Barry, I’m not going to ask why I’m doing this.’ And, from around the tubing, I gritted out, ‘Just take the biopsy.’ So he took some biopsies from me, and they were all clear. No bacteria.

Then I infected myself with bacteria that I’d cultured from a patient who did not actually have ulcers, just indigestion and gastritis. I was able to eradicate his infection with some antibiotics, so already I knew that I could if necessary take a treatment which worked on this bug. I had some safety features built in, I thought.

Then this locomotive hit you?

You could say that. I drank the bacteria and at first I was okay. But instead of being perfectly well and having a silent infection, after about five days I started having vomiting attacks. Typically at dawn I would wake up, run to the toilet and vomit. And it was a clear liquid, as if you had drunk a pint of water and regurgitated it straight back. Not only that, there was no acid in it. I remembered from my medical student days that if you have a meal where you drink so much beer that it’s coming back up straight away, it doesn’t have any acid in it. I knew there was something unusual about vomiting and not having acid.

Yes, it’s normally quite bitter and unpleasant. Did you have a lot of pain?

There was not really pain, but each evening I was feeling very full after the evening meal. I was starting to take sips of water halfway through my meal to help get it down. I noted that, but it was a very vague kind of a symptom. And this is just one experiment on yourself and you say, ‘Am I imagining this?’ Until I had another biopsy I couldn’t know for certain that I had the bacteria. Finally, after 10 days, I had the biopsy, had another endoscopy – and the bacteria were everywhere.

In the lining of my stomach there were absolute millions of the white cells that we call pus cells, polymorphs. There was no acid being produced by my stomach. I was very uncomfortable with that endoscopy, gagging and throwing up, but I’d proven that the bacteria could infect a healthy person and cause gastritis. I’d proven Robin’s disease.

Robert Koch, who discovered TB and for whom Koch’s postulates are named, had had a similar problem: people didn’t believe TB was causing tuberculosis. They said, ‘It’s so common – whenever we see any kind of pneumonia we find these TB bugs.’ He said that to prove it’s a pathogen you have to culture it, put the culture into an animal and wait for the animal to get the same disease, and then culture the bacteria from that disease. So I had done that; I had developed the disease gastritis and cultured the bacteria from myself. I had fulfilled Koch’s postulates for gastritis, though not for ulcers.

Have they ever been fulfilled for ulcers with Helicobacter?

They were fulfilled 10 years later, using a gerbil, an animal rather like a big mouse. Gerbils get human diseases, and if you infect them with the human bacterium Helicobacter, 50 per cent of them will develop a stomach ulcer in six months. And about 20 per cent get stomach cancer after, say, a year.

Working toward vindication, and beyond

I remember the days when you still had eminent gastroenterologists opposing you. How did you reach the point where your finding was accepted?

A big battle was still going on. I went to America to fight the battle there, because unfortunately the American medical profession was extremely conservative: ‘If it hasn’t happened in America, it hasn’t happened’. We needed people in the United States to take the treatment which we had developed.

We had some drugs we could use in Australia, and very quickly doctors around this country started using Robin’s and my treatment for their most severe patients. They would say, ‘I can’t think of anything else to do except surgery. But hang on a minute, before you have surgery and we take your stomach out, let’s just try this antibiotic.’ So I was happy with the Australian situation. At least people were not having permanent disability from surgery or being disfigured gastric-wise with things that couldn’t be undone. But when I went to America they would not even try antibiotics as a last resort, because they didn’t have the same brands as we had.

Presumably you had no randomised trial evidence either?

No. Well, to convince people in other countries you have to duplicate the study and get the same data. So in the US they tried research products and played around a bit, as we had done. And after four years they had a treatment they could use there. Then they did a double-blind study and got exactly the same results as we had in Australia – in fact, better.

But that study was not totally blinded, because the doctors knew which treatment was the good one or not the good one, even if the patients didn’t. It could still be said that this was a psychosomatic illness, that the patient could get positive vibes from the doctor and know that he was getting the best treatment. Of course his ulcer would heal, because he would be happier.

It wasn’t settled until people did a truly double-blind study, using an acid blocker and also amoxicillin and a third antibiotic called tinidazol. All of those antibiotics could be given in a placebo, so one group of patients could take the ‘real’ antibiotics and the others would take antibiotics that were absolutely identical but were ‘fake’, and even the doctors didn’t know which patient was getting which treatment. That trial was done in Austria and was then published in America, in the New England Journal [of Medicine], which would have the most stringent criteria for medical research.

One year later, at a big think-tank in Washington to which I was invited, it was declared proven: ‘The treatment for ulcers is now antibiotics.’ That was vindication, in effect. The implication, once you say that in the United States and the NIH [National Institutes of Health] or somebody like that puts a document out and everyone accepts it, is that you have to follow it. In 1994 there were thousands of professors and scientists in the US making a living off Helicobacter.

What were you doing by then?

I was the same! I was well and truly on the bandwagon. I had been on the lecture circuit for a few years, and having this same argument in debates at medical conferences for years. Now we were pushing the envelope – testing out new treatments, new cultures, finding out how the bacteria could live in acid, evaluating blood tests.

I had invented a breath test, and we were working with a pharmaceutical company in the US to bring that to market so that when the GPs started treated Helicobacter they could do a simple test on the patients and not need to have endoscopy every time. Endoscopy in the US was then costing about $700, and if you had had a new treatment which really cost antibiotics plus $700, it would be hard to use it: a lot of people who would have to pay that $700 would prefer to stay on the old drugs. They wouldn’t take the new ones and get followed up. The breath test was crucial.

So I worked on the development of the breath test, plus being a professor at the university and whatever else. I worked in the US for 10 years.

How different was that from Australia?

Well, it was good to see the two systems. In Australia you could do all kinds of research for free, so things could happen quickly in an embryonic stage. You wouldn’t have to apply for a research grant and be delayed by one or two years. If you have an idea which requires research funding, you’ve got to write an application and then get your funding, so it may be 18 months before you can actually start the research. If you can do it for free, you can start it next week, provided your mates are doing you a favour.

In the US you could not do any research unless there was money changing hands, because the pathologist had to pay salaries and he had to run his department at a profit. As soon as I got there I realised that I had to worry about funding and continually be working for funding a year or two in advance, so that each year I’d have some research assistants and I’d be doing my breath test and I’d have a salary – if you didn’t have a research salary you would have to spend all your time seeing patients in the clinic and you couldn’t do any research. Ideally, you want to be doing about 30 per cent clinic, because then you can test out your research on your patients. And you do only as much research as you have funding for.

By the way, where did the idea for a breath test come from?

I saw a breath test for something else, for malabsorption – you can basically give a chemical and see something coming out in the breath. By then I had a urease test on Helicobacter. We knew that probably the bacteria survived in the stomach by making lots of ammonia, which neutralises the acid. But, on the other side of the equation, it makes bicarbonate and CO2. So I said, ‘According to my reading of the literature you should be able to give somebody a urea and measure the CO2 coming out of their breath. If it’s coming in the first five or 10 minutes it must be coming from the stomach, it must be from the bacteria.’ I went to the nuclear medicine physician, Ivor Surveyor, who gave me his textbook, and as I read it with new eyes, if you like, I said, ‘This actually proves what I thought.’

As I recall it, the first person we did the breath test on was one of the nuclear medicine physicians, Agatha van der Schaaf. She was the first guinea pig, and I think she was negative. But I tested a few gastroenterologists and they were all positive. And, of course, that made sense.

They caught it from the patients!

A nasty battle won

What did it feel like when you were sitting in that Washington meeting room and realised that you’d crossed the threshold forever?

Well, people would always say, ‘Dr Marshall, do you feel vindicated?’ By then, Robin Warren and I had been fighting the battle for 10 years. And we’d say, ‘We won.’ But we knew we were going to win, because we had the truth and the best treatment. In medicine, the correct treatment, the correct strategy and the most efficient strategy will eventually win, whatever happens – but it may be delayed.

How nasty did the battle get?

[laugh] It did get quite nasty, but of course you have your troops around you and if there is nastiness going on you don’t always have to be there. America is big enough that you don’t actually have to see your enemies every single day!

Nevertheless, I found out that the first paper I tried to submit in the US had been rejected because people higher up in the US gastroenterology world had decided, as a policy, that this thing was too new and radical, too ‘out there’, and they weren’t going to accept any of those papers. In the year when I arrived in the US there were hardly any papers on Helicobacter.

The second thing was that my paper on the diagnosis was being rejected. The medical journal was just about to send it back to me with a rejection letter. But I happened to be sitting at the bar with a guy who turned out to be the editor of that journal, and telling him about it over a beer. He said, ‘You know, Barry, our reviewers said that was terrible. Maybe I’ll have another look at it.’ Then it was accepted, and it was a brilliant little diagnostic paper ‑ won a prize.

Did all this ever get personal?

It did. The personal stuff was usually said behind my back, and my wife used to catch a bit of it. For example, I was at a conference, presenting our work. By then I had a few converts, who would be saying, ‘Oh, Barry, this is exciting. What are you going to do next?’ So they would talk to me, but 90 per cent of the audience wouldn’t know enough about it. And my wife would be on the bus tour with all the other wives, sitting in behind some of them. One wife would be saying to another one, ‘My husband said he couldn’t believe it. They had that guy from Australia talking about bacteria in the stomach. What a load of rubbish. This drug company’s reputation is mud’ ‑ because that company would be funding the bus tour at the conference. So things like that used to go on behind the scenes.

After I won the Nobel Prize a lot of people told me, ‘Such-and-Such used to say that,’ and, ‘I went to this meeting where you were absolutely rubbished and the quality of your science was criticised.’

How did you take it?

By then I was pretty thick-skinned. In fact, the worst day in the whole lot of it was the day we had a rejection letter from the Australian gastroenterologists. Robin and I were keen to submit a paper at the Australian meeting of gastroenterology which was held in Perth that year. In those days $500 was a lot to spend on an airfare to Melbourne or somewhere like that, but if the meeting was in Perth we had a vision of presenting our amazing discovery about the cause of ulcers. But it was rejected.

We thought, ‘Oh, no!’ and I went to my boss at Fremantle Hospital, the microbiologist David McGechie. He was culturing the bacteria as well and he could see that they were real, even though he wasn’t in the ulcer business. He said, ‘Don’t worry about it, Barry. This is a hot subject. I know it’s going to go somewhere,’ and he called up someone in Europe and had my paper accepted for an international meeting. And a few crazy guys down at Fremantle, thinking-out-of-the-box type people who were not really trained scientists but were doing clinical research, said, ‘Barry, we’ll give you some money from the Fremantle hospital specialists’ special private practice fund’. So my wife and I went to Europe, where it was the top presentation at the whole meeting. After that we came back very thick-skinned; we had risen above it.

But you were seen as an outsider?

Yes, I was an outsider at that point. By the end of that year, Robin and I knew so much about ulcers and we knew the truth; we could see a pattern to it all, so we could make sense of it.

You weren’t card-carrying gastroenterologists, however.

That’s right. And nobody could tell us anything about ulcers, because we had an answer for every single sceptic.

Do you think you’re still seen as an outsider, despite having the gold medal?

Well, I am a bit. And I know I’m not good at writing research grants. If you look at, maybe, 100 publications listed in my CV, you see that they might include 30 or 40 good ones and 70 that are not so highly rated. By comparison, someone else in their fifties, who’s had a big career in research, might have 200 or 300. And I know that is because they have built up a lab with five scientists who each publish five papers a year. You can easily get your numbers up that way; that is really how you could be a professional researcher of professional standing.

I don’t want to denigrate that, but that is a research career. It is very hard, and I was never particularly good at it because I was interested in too many other things. I was interested in patients and interested in diagnostic methods and treatments. (It was my mechanical ability that brought me into the diagnosis part of it.) Also, thinking out of the box can be a good idea. Sometimes it’s better not to know all the dogma, all the things about a very difficult disease. If it’s very difficult, that means people have been working on it for years and they haven’t figured out the cure, which means they haven’t figured out the cause. So having all that knowledge that’s been accumulated in the last 10 or 20 years is really not an advantage, and it’s quite good to go and tackle a problem with a fresh mind when no-one else has had any luck.

What do you think now about that question, ‘Dr Marshall, have you been vindicated?’

Well, it was true, but although the vindication at that meeting was okay, it wasn’t the most exciting day in my life. That was the day Robin and I suddenly realised that we had discovered ulcers. And that was way back, probably in the first quarter of 1983.

Was there an ‘ah-ha’ moment or did it just come as a slow realisation?

For me there was an ‘ah-ha’ moment. When we had been cogitating over this for three or four months, I left Royal Perth, went to another hospital and tested out the theory on some new patients. At that other hospital the ulcer patients had the bacterium as well, and I started treating it and figuring out what the treatment could be. That locked it all in: ‘It works! I’ve got a treatment that works.’ And, lo and behold, things which we knew occasionally could cure ulcers, would kill the bacteria. So the secret behind the successful ulcer treatments was that they were also antibiotics.

Current work

Do you still see patients?

I do one session a week of the endoscopy, which is half a day, and a session of looking after their prescriptions, talking to them on the phone and a few things like that. Plus I get emails from all over the world, typically with a heartbreaking story such as, ‘Dear Doctor, My daughter has Helicobacter and she has ulcers and she has a bad breath and she’s always throwing up and we’ve tried every antibiotic. Can you help?’ You really have to do something about those emails, and we try to figure out something for that.

What are you working on now?

Well, thinking out of the box, I wondered, ‘What else can we do with Helicobacter?’

There are thousands of people doing research on this and sure, it causes ulcers and gastric cancer. But the other side of the coin is that 80 per cent of people with Helicobacter have no symptoms. Half the world’s infected without even knowing it. So, in some respects it’s harmful – if you have it all your life you may get cancer – but in other respects it’s controlling your immune system. It’s in there and you cannot get rid of it. I thought, ‘Hang on, why don’t we use it for something? We’re all worried about controlling the immune system. Helicobacter already does that. It lives in your stomach, and if your white cells become too vigorous it poisons them with a toxin and they all back off a bit, and then everything goes quiet for a while.’

I developed a theory that the reason you get ulcers is that your immune system is too vigorous and the white cells knock a hole in your stomach and cause the ulcer in the first instance. But the Helicobacter doesn't want you to have an ulcer so it keeps the white cells under control. Maybe we can use that.

It fits with the theory, for example, for why Jews didn’t get a lot of tuberculosis but did get a lot of ulcers, that they had some sort of protective mechanism against infection through the gut.

There are a lot of such theories. The big one right now is that if you’re too clean, your kids get asthma. You need to let your kids crawl around on the floor and so on, to get an immunity.

So how are you applying this knowledge?

We are taking Helicobacter and removing all the harmful bits, taking out the toxin that we don’t want, making it a bit weaker, and we’re cloning in a vaccine. The first thing we’re working on is influenza – maybe because I remember how sick I was and how influenza probably changed my career when I was in high school. I think that if you figured out how many billions of dollars are wasted because all of us are getting sick every few years, just with this really severe illness out of all the diseases in the Australian community, you would say there is a lot of value in making an influenza vaccine.

Are you assuming this would be a mucosal immunisation which would spread to the respiratory tract?

If we can make this Helicobacter weaker so that it lasts in your system for only a few weeks, and if we put an influenza vaccine in it, you could be drinking Helicobacter exactly as I did. And remember I wasn’t absolutely certain that I had it. If we could weaken it a bit, maybe you could drink it, you could have a temporary infection for a few weeks where you were not really sure there was anything going on, and meantime your immune system would become aggravated and fight against the Helicobacter and against the influenza vaccine stuck on the side of it. So, lo and behold, two weeks after drinking something you’d have had a vaccination against influenza. How great would that be!

As long as the Helicobacter didn’t hang around.

Yes, we have to get rid of the Helicobacter. There’s a lot of tricks involved with that; it’s very high technology to actually make a bacteria come and go as you wish. So that is the main thing that I’m working on; that is the big problem. Vaccination we think we’re going to have some success with.

The future of vaccination might be that you would just see the vaccine in the supermarket. Instead of buying your normal yoghurt or whatever you take – for instance, you might be taking various probiotics with all sorts of vague claims to promote general health, a healthy gut, et cetera – you would say, ‘Oh, there’s the influenza one. Why don’t we take that this week?’ The whole family would take it. You wouldn’t have to go to the doctor so you’d have saved $50 right there, with no time off or anything. You wouldn’t have to have the needle. If you ask people, ‘How much is it worth not to have a needle?’ they tell you, ‘About $50.’ You could have the vaccination for the same price, but you could, effectively, save everybody $50 if it was a food product. Everyone would have it, and not worry about influenza ever again.

New horizons

Did you ever think, in your wildest dreams, even when you’d crossed the threshold and everybody accepted your idea, that you’d get the Nobel Prize for it?

I have to be honest there. [laugh] Robin and I took our wives out after our first publication in the Lancet in 1984. It was only about two weeks after I’d drunk the bacteria, and I said, ‘Robin, I’ve got to tell you a secret about this experiment I’ve done.’ So we were discussing it over a few wines. Then Robin’s late wife, Win Warren, said, ‘You know, you guys could win the Nobel Prize.’ Robin said, ‘Hmm, when do you think it’ll be, Barry?’ and I answered, ‘Oh, 1986. I reckon it will take a couple of years for this to catch on.’

We didn’t win it until just over 20 years later, in 2005 – exactly 100 years after Robert Koch won the Nobel Prize for his experiments with tuberculosis, describing how you would prove that a bacterium was a pathogen and discovering TB. So he had three anniversaries which, coincidentally, we duplicated 100 years later. (Some people believe that the Swedish professors at the Karolinska Institute were waiting for the 100th anniversary of Robert Koch, saying, ‘Tuberculosis was the 19th century disease; Helicobacter, that’s the 20th century disease.’)

Nobel Laureates often say, when they are honest with themselves, that they can’t believe how they are suddenly considered experts in everything, with some aura around them.

That’s true.

Since the Nobel, have any amazing experiences taken you out of your comfort zone?

Well, at that point you need some minders. My wife and my office manager keep an eye on me. Obviously, if you think too far out of the box, you’re very fringe – and I say the only difference between a genius, eccentric, and someone who’s mad is that someone who’s eccentric has money. With the Nobel Prize you get nearly a million dollars and so, luckily, you have the advantage of not having to worry too much about paying the bills. But you’ve got to be careful, you’ve got to have your friends around you and stay with your roots, and not start getting too full of yourself.

Over my career I have made mistakes and I’ve thought, ‘I’m too full of myself, I’m too confident. I need to pull my head in, work a bit harder and think about things a bit more instead of quick-response shooting from the hip.’ I still like to do that, and it is probably why I’ve been successful in a lot of areas. But you can’t be an expert in everything.

I do read a lot. I’ve always been addicted to the Internet – before other people had even heard about it, I had my own Internet sites – and so a lot of news just comes to me, and from surfing the web I know a lot of things that are going on. I have formed opinions about politics and health because I’ve seen two countries’ systems. If you ask me to give an opinion on health, I’m pretty good. If you want to talk about politics, I’m average.

So what are your politics?

I’m pretty conservative. I used to vote Labor when I didn’t have any money, and when I had some money and started earning a living I started worrying about tax, and I started voting conservative. It used to drive me crazy in those 10 years in America that I couldn’t vote here ; it would drive me nuts. The years between 1986 and 1996 were an exciting time in politics in Australia: the Labor Government was in and there were different Prime Ministers, et cetera. A lot of things were happening that I couldn’t be party to, and I felt I was missing out.

Are you happy being back in Australia?

I’m very happy back in Australia. (I’ve been back 10 years now.) When I left here, Australia was really getting me down. It felt very small. There were not enough experts who knew the global picture, and everybody was leaving to work overseas.

While I was away, the Internet developed, travel became cheaper and, basically, you could not do science or medicine or research without going to conferences and international meetings and everything. So when I came back I felt that here in Australia you could live the academic life that had been normal for a few years in the US. Australia, I felt, was three to five years behind when I first went to the US, but by the time I came back it was more like three to six months behind. And nowadays we actually get some technology and stuff like that before the US, because we’re very close to Japan, Taiwan et cetera.

Also, we live near where I grew up and we’ve got our friends around us. My wife and I were keen to come back because our parents, though still in good health, are getting older. It’s fun to have the family around. My problem is that I’ve always got some work to do when there’s some family gathering, and oftentimes I can’t relax because I’m worrying about some deadline on Monday – or about doing an interview with the famous Norman Swan!

Barry Marshall, thank you very much.