Last week, 2005 Nobel Laureate of Medicine or Physiology Professor Barry Marshall visited LKCMedicine and delivered the second James Best Distinguished Lecture.
Professor Marshall came in high spirits. He dined with our faculty members and donors. He met medical students, PhD students as well as young clinicians in the Tan Tock Seng Hospital to share his story of success. He also shared his experience in entrepreneurship and setting up companies for the diagnostic tests in Helicobacter pylori infection, the bacteria that he and Professor Robin Warren discovered in 1983. He shared with our faculty his views on biomedical research. He even brought his Nobel medallion to show us the highest honour that the scientific community had bestowed upon him for his groundbreaking discovery. In all these activities, there were a lot of admiration, a lot of words of compliment, a lot of laughter and celebrations. But how many would realise that behind all these, there were lots of sweat, blood and tears?
I know Barry for almost 30 years. In 1985, I read his paper in the Lancet on discovering a bacterium in the stomach that caused gastritis (inflammation of the stomach). It was then realised that this could also be the cause of peptic ulcer disease and even stomach cancer. However, the discovery was not appreciated, not even accepted as truth, by the medical community. His first abstract submitted to the Australian Society of Gastroenterology annual meeting was rejected! In the letter, the Society said that they received 57 abstracts and they had to reject a few (around 5-6) including his most important finding that bacteria actually can survive the highly acidic environment of stomach.
Gastroenterologists were all brought up to believe that “No Acid, No Ulcer” according to a famous German Pathologist who proclaimed this one hundred years ago. Now Barry said this may not be the truth, or at least the whole truth. A bug in the stomach is the culprit and hence should be treated. In order to prove that he was right, he volunteered to swallow the bacteria (in a disgusting solution) himself. At that time, the cure of H. pylori infection was not confirmed. A few days later, he developed dyspepsia (stomach pain) and endoscopy showed inflammation (acute gastritis) actually occurred in his stomach. Fortunately, his infection was cured by a long course of antibiotics. That was the price he paid for in his first accepted major publication, which eventually led him to Stockholm for the award 20 years later.
When I saw the paper in 1985, I tried to treat patients with peptic ulcer bleeding with bismuth combined with two antibiotics (tetracycline and metronidazole) without using medicine that suppresses acid secretion in the stomach. To our great surprise, in just one week, the bacteria was cleared and the ulcer healed in six weeks, and NEVER CCAME BACK! That was such a big gift to patients who have been taking the ulcer drugs their whole life, as peptic ulcer is a recurrent disease that can lead to life-threatening complications such as bleeding or bowel perforation. When we started the randomised controlled study, the hospital staff was also filled with skepticism. Could antibiotics and bismuth be used to treat an acid-related disease? Would patients actually get further complications and die from it? As for the black stool that patients produced after taking this medicine (actually a result of ingesting bismuth), did it reveal bleeding still occurring inside? Our first paper was also rejected by the Lancet when we first submitted it; then it was presented as a poster in a medical conference. I still remember an elderly scholarly person, whom I never met before, came to my poster and asked a few questions about the study. Then he said, “Young man, where are you submitting this study to?” I mumbled, “I don’t know, sir”. “Try the New England Journal of Medicine.” I thought he was making a joke, sending this paper to a top medical journal. A few weeks later, I received a letter from Professor Marshall Kaplan, one of the editors of NEJM, accepting our paper.
The spirit of Barry Marshall’s story is that SUCCESS NEVER COMES EASY. It is easy to see and celebrate the joy and glory of success but the pain and disappointment before success is often forgotten. In our education, in our research, in our career, and in our entire life for that matter, success comes only after many failed attempts, disappointments and sometimes even humiliation. I remember someone said, “Man needs his difficulties, because that is required to enjoy his success.”
And Winston Churchill once said, “Success is not final; failure is not fatal. It is the courage to continue that counts”.