Show Notes
Stomach Full of Courage: The Self-Experiment That Proved H. pylori Causes Ulcers
What drives a doctor to drink a flask of bacteria, knowing it could make him violently ill? In the early 1980s, Dr. Barry Marshall and Dr. Robin Warren stood against the medical establishment to prove that most ulcers were not caused by stress or acid, but by a spiral-shaped bacterium called Helicobacter pylori.
This discovery overturned decades of dogma, reshaped ulcer care, and ultimately won them the Nobel Prize. But it came at a cost: ridicule, resistance, and the risk of self-experimentation when no one else would listen.
In this episode of Tribulations, Dr. Ravi Kumar guides you through a story of persistence and courage that changed medicine. You will explore:
- A personal story of suffering and cure with antibiotics against H. pylori
- How Warren’s chance observations and Marshall’s tenacity opened a new understanding of ulcers
- The legendary self-experiment where Marshall infected himself to prove the point
- Why medicine resisted the idea for years, leaving patients to suffer
- How eradicating H. pylori cures ulcers and lowers gastric cancer risk
- The lesson for all discovery: curiosity plus persistence can topple entrenched beliefs
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References & Resources
Attempt to fulfil Koch’s postulates for pyloric Campylobacter
23 years of the discovery of Helicobacter pylori: Is the debate over?
Epidemiology of peptic ulcer disease
Peptic Ulcer Disease
Estimates of the worldwide incidence of eighteen major cancers in 1985
HELICOBACTER CONNECTIONS
Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori
Transcript
[00:00 –> 00:37] Welcome to the doctor Kumar Discovery podcast. My name is doctor Ravi Kumar. I’m a board certified neurosurgeon and assistant professor at UNC. Today, I’m bringing you another episode of tribulations where I share stories from the past that give us new perspectives on the present, especially how medical science and convention have been shaped by discoveries that changed everything. This episode is about Helicobacter pylori, also called h pylori, and how two physicians changed the course of history by looking where no one else would and by having the courage to stand against a chorus of voices saying they were wrong.
[00:37 –> 00:57] They proved their discovery to the world even when it meant sacrificing their own bodies to do it. So to start off, I wanna share a personal story that shows how this discovery changed lives. My father-in-law was born in Korea in the nineteen fifties. From the age of 17 and on, he suffered with stomach pain. For years, it was manageable.
[00:58 –> 01:26] But by his thirties, this was in the early nineteen nineties, the pain had progressed into a bleeding stomach ulcer. The pain was so severe, it would bring him to his knees. And I’m talking about a very tough guy who never complains about anything. He was an officer in the air force, supporting a family of five children, working a stressful job, and trying to push through this constant pain. He carried a pocket full of antacid pills everywhere he went, and he ate them like candy just to dull the burning in his stomach.
[01:27 –> 01:54] He drank Maalox in the evenings, had bloody stools, and felt sick all the time. His doctors tried the standard treatments of the day, but nothing worked. Eventually, an upper endoscopy showed a bleeding ulcer and his surgeon offered him a gastrectomy, which was cutting out the ulcerated part of the stomach. His surgeon warned him that if he didn’t do the surgery, the ulcer might burn through his stomach into a major artery and kill him. But surgery wasn’t without risks.
[01:54 –> 02:24] Another surgeon that he saw as a second opinion warned that even if surgery succeeded, the ulcer might come back and he could be left as a gastric cripple, unable to enjoy food or maintain a healthy weight for the rest of his life. Scared of surgery, my father-in-law chose to live with the pain. He kept up the routine of pills and chalky antacids day after day. Then by chance, he came across an article in Reader’s Digest. It described two Australian physicians who had discovered that a bacterium, H.
[02:24 –> 02:46] Pylori, caused most stomach and duodenal ulcers. They reported that the ulcers could be cured with antibiotics and bismuth. Reading that, he instantly recognized his own story in their description. He brought the article to his military doctor, but his doctor brushed it off and said, I know the treatment for ulcers. Reduce acid, change your diet, and stay on medications for life.
[02:47 –> 03:12] But my father-in-law pressed him to read the article. And because my father-in-law outranked the doctor, and this was the military, he had a fighting chance at getting this doctor to listen. Reluctantly, the physician flipped through the article and said that he was skeptical, but he agreed to test for h pylori antibodies. Ten days later, the results came back strongly positive. At that point, the doctor prescribed bismuth and two antibiotics.
[03:12 –> 03:29] And within ten days of starting treatment, my father in law’s pain was gone. It was exactly as the article had promised. He was cured and a repeat antibody test came back negative, proving that the treatment had worked. That was more than thirty years ago. He’s never had another problem since.
[03:30 –> 03:54] This was right at the turning point in medical history. The Aussie scientists discovery was already published in journals and even in the popular media. Yet most of the medical community still resisted the adoption of this concept and treatment. For patients, that lag in acceptance meant years of unnecessary suffering. It would take more than a decade and ultimately a Nobel Prize before the idea was fully embraced.
[03:55 –> 04:15] These two researchers were Barry Marshall and Robin Warren. And here’s how they ended up changing the whole world of ulcer management and eventually winning the Nobel Prize. It all started in the early nineteen eighties. Robin Warren was a pathologist in Australia and he was looking at stomach biopsies from patients with ulcers. He began noticing something unusual.
[04:16 –> 04:38] Under the microscope, he kept seeing these spiral shaped organisms. They weren’t sitting on the ulcers themselves. But if he looked just a few centimeters away, the stomach lining was covered with them. That caught his attention and he started to wonder, could these bacteria have something to do with ulcers? Warren talked about it with Barry Marshall, who at the time was a young medical fellow at the hospital.
[04:39 –> 05:01] They decided to study it more formally. So they set up a prospective study of 100 patients checking biopsies from stomachs in patients with ulcers and counting how often they found these spiral bugs. Again and again, they saw the same thing. People with ulcers had stomachs loaded with these bacteria. The next step was to figure out exactly what the organism was.
[05:01 –> 05:20] They sent samples to the microbiology lab, but at first, nothing would grow. Every plate just came back empty. It looked like a dead end. Then came Easter weekend of 1982. The lab was so tied up with dealing with a methicillin resistant staph aureus outbreak that nobody checked Marshall and Warren’s cultures for several days.
[05:20 –> 05:49] Usually plates were thrown out after two days if nothing grew. But because they sat forgotten in the incubator for five days, when someone finally looked, there they were, colonies of spiral shaped bacteria covering the plates. The accident of a long holiday weekend gave them the breakthrough they needed. They originally named the bacteria Campylobacter pylorus, and later, that name would be changed to Helicobacter pylori. When Warren and Marshall pulled together their results from the 100 patients, one finding jumped off the page.
[05:50 –> 06:10] Of the thirteen patients who had duodenal ulcers, all thirteen, every single one of them, were infected with this bacterium. Think about that. Thirteen out of thirteen. The odds of flipping a coin and getting 13 heads is very low. Seeing h pylori in every single case was a powerful clue that they were onto something big.
[06:10 –> 06:48] With this new discovery in hand, Barry Marshall decided to call up The Lancet, one of the leading medical journals in The UK. He spoke with David Sharp, the editor who told Marshall and Warren to send in two short papers, one describing Warren’s observation of the spiral shaped bacteria in patients with ulcers, and another showing their clinical data linking the infection with duodenal ulcers. Those papers were published as letters in The Lancet. In them, they suggested something radical, that peptic ulcer disease and even gastric cancer could be caused by infection with the spiral shaped bacterium now called Helicobacter pylori. The pushback was immediate.
[06:48 –> 07:12] Even their colleagues pushed back. Ulcers, they said, were caused by acid, stress, smoking, maybe genetics, but non infection. To suggest otherwise seemed almost laughable. Their careful observation and data were completely dismissed. To prove that an infection was the cause, they needed to satisfy something called Koch’s postulate, the classical criteria for linking a microorganism to a disease.
[07:12 –> 07:32] There were four criteria. First, the bacteria must be present in every case of the disease. Marshall and Warren had shown that in their study, all thirteen duodenal ulcer cases were positive for h pylori. Second, the bacteria had to be isolated and grown in pure culture. They had done that too after figuring out it needed at least five days to grow.
[07:32 –> 07:51] The third step was the hardest. You had to take that pure culture, give it to a healthy host, and reproduce the disease. And then the fourth criteria, recover that bacteria from the experimentally infected host. Marshall tried first with four piglets. He grew h pylori in broth and fed it to them, but nothing happened.
[07:51 –> 08:08] He tried again, still nothing. The piglets didn’t seem to get sick and didn’t seem to harbor the bacteria at all. It looked like a dead end. So at this point, Marshall had checked off two of the four criteria, but he was stuck on the last two. If he stopped here, the discovery might fade into obscurity.
[08:08 –> 08:28] Patients would keep suffering with ulcers and even dying of stomach cancer, while the real cause went unrecognized and untreated. Honestly, I think most researchers would have stopped there, but not Barry Marshall. If you read his Nobel Prize lecture, you get a sense of his tenacity. He wasn’t willing to let the idea die. So what did Barry Marshall do?
[08:28 –> 08:42] How did he prove the last two criteria of Coke’s postulate? Well, he asked a gastroenterologist friend to scope him and take a biopsy of his stomach. The results showed his stomach was normal. No gastritis, no h pylori. He was clear.
[08:42 –> 09:07] Next, he asked his bacteriologist colleague to culture a flask of h pylori. At the time, Marshall had four children at home and a wife recovering from a car accident with broken ribs. Life was chaotic, but he was on a mission. His colleague handed him the flask of broth teeming with cultured h pylori and likely said, don’t tell me what you’re gonna do with this before walking the other way. And then Marshall shrank the whole thing down.
[09:08 –> 09:24] That evening, he told his wife what he had done. From doctor Marshall’s recounting, you get the sense she was very supportive, but also probably exacerbated. Four kids, broken ribs, and now a husband deliberately infecting himself. For the first few days, he felt fine. Then he started noticing stomach fullness.
[09:24 –> 09:42] One night, he woke up sweaty and nauseated, vomiting repeatedly. Over the next several nights, he had bouts of mucousy vomit, strangely low in acid. Soon his colleagues and his wife noticed his breath. It was foul, offensive, and impossible to miss. On day 10, he returned to his gastroenterologist friend.
[09:42 –> 10:02] This time, the scope showed a stomach lining inflamed with pus cells and covered in spiral bacteria. He had developed acute gastritis. By day fourteen, the symptoms started to fade. Without antibiotics or treatment, he spontaneously cleared the infection and a repeat scope confirmed it. But by then, the point was made.
[10:02 –> 10:39] Marshall had satisfied all four criteria of Koch’s postulate. The bacteria was present in disease, it was cultured, It produced disease in a healthy host, which was his own stomach, and it was recovered from his stomach and grown in culture. He had proved it in one of the most famous stories of self experimentation in medical history. Now you’d think the world would have laid down the red carpet for this desperately needed discovery, but unfortunately, that’s not how the world works. You can make the most amazing discovery ever, and unless you broadcast it to the world and overcome skepticism, it will never matter.
[10:39 –> 11:03] Medical discoveries are like any other product. If you can’t market it, it will never have an impact. So to really ensure that their discovery had impact, Warren and Marshall needed two things, funding for a clinical trial and publicity. Luckily, around this time, a physician and medical writer for the New York Times named Larry Altman was writing a book on self experimentation. He heard about Marshall and called him.
[11:03 –> 11:38] Marshall agreed to an interview and Altman published the account of Marshall’s drinking the flask of h pylori, getting sick, and linking h pylori to ulcers. Shortly after that, a tabloid called The Star interviewed Robin Warren. Their story broadcast the discovery beyond journals, reaching patients and non specialist doctors. It briefly put the spotlight on Warren and Marshall with their unconventional self experimentation and a discovery that could potentially improve the health of half of the world. And then soon after that, Marshall and Warren published their case of self experimentation in the Medical Journal of Australia.
[11:38 –> 11:52] Both men admitted they were nervous about the ethics of self experimentation. But Marshall’s reasoning was simple. He was the only subject and he gave his own consent. Why would he need an ethics board for that? Still, he confessed later that he was uneasy about it.
[11:52 –> 12:23] Fortunately, the paper was accepted and it gave their work even more credibility. Next, they needed to apply for funding from the National Health and Medical Research Council, the main agency supporting medical research in Australia. Despite the compelling evidence from their 100 patient study and the dramatic self experiment that he had done, the council only gave them a single year of conditional funding. The budget was tiny, barely enough to cover Marshall’s salary and not even enough for him to buy a computer. But it was something, and Marshall ran with it.
[12:23 –> 12:56] He moved to Royal Perth Hospital where he enlisted the help of the local media to help bring in volunteers for a randomized controlled trial. That trial had four arms, each designed to untangle whether healing came from acid suppression, from protective agents, or from actually eliminating the bacteria. The results were decisive. Bismuth combined with an antibiotic had by far the highest eradication and cure rate. For the first time, a controlled study showed that eliminating h pylori not only healed gastritis and ulcers, but prevented them from coming back.
[12:56 –> 13:22] This clinical trial was the nail in the coffin, and this discovery would go on to change the world. At the time, about fifty eight percent of people globally were infected with h pylori. Nearly all of them had gastritis, though some of them and many of them were not symptomatic. And h pylori caused about ninety percent of duodenal and gastric ulcers. When an ulcer eroded through the stomach, it could rupture a blood vessel and cause sudden fatal bleeding.
[13:22 –> 13:43] And this was not rare. At the time, thousands of Americans would die every year of their ulcers. The constant inflammation also led to stomach cancer. Back then, gastric adenocarcinoma was the second leading cause of cancer death worldwide. Later, trials showed that eradicating h pylori lowered the risk of gastric cancer by about half.
[13:43 –> 13:58] Their discovery didn’t just change ulcer management, it changed global health. And yet, it wasn’t the smooth path you’d imagine. They didn’t publish and get applause. Instead, they were told they were wrong. Then they brought more proof, and they were told they were still wrong.
[13:58 –> 14:22] Then Marshall drank the bacteria himself, got sick, and proved the point in a way that no one could ignore. That self experiment put them on the radar with the New York Times and the Star, which finally started to turn the tide. The public actually understood it first. Only after that did the skeptics in medicine begin to shift their ideology. The clinical trial wrapped up in 1985 improved the cure.
[14:22 –> 14:51] Still, in the early nineteen nineties, patients like my father-in-law were still suffering because many doctors had not yet adopted this new knowledge. If my father-in-law had not outranked his doctor, he might have suffered for many more years with a stomach ulcer. Finally, in 02/2005, Marshall and Warren received the Nobel Prize in Physiology and Medicine. Their work overturned the dogma that ulcers were stress driven and incurable without lifelong acid suppression or surgery. Instead, ulcers were revealed to be a curable infection.
[14:52 –> 15:15] The Nobel Committee recognized their work as a true paradigm shift. Their persistence had reshaped the landscape of gastroenterology and given people around the world a new lease on their health. Their story is a perfect example of how new discoveries almost never get welcomed with open arms. People resist change. Protocols, beliefs, and careers are often tied to old ways of thinking.
[15:15 –> 15:39] So if you make a discovery or push an idea that can make the world better, expect pushback. Don’t expect immediate accolades. There’s a good chance you’ll be ignored, ridiculed, or dismissed before the world is finally ready. But if your methods are sound and you know what you have, you have to keep going. Your curiosity is king, and persistence is its necessary companion.
[15:39 –> 15:50] There’s a famous phrase that sums it up pretty well, and it goes like this. First, they ignore you. Then they ridicule you. Then they attack you and want to burn you. And then they build monuments to you.
[15:50 –> 16:20] Robin Warren and Barry Marshall lived through the first three stages, and today, they stand in the monument stage. It makes you wonder how many discoveries that could have changed the world were lost because someone didn’t survive those first stages of resistance. We’ll never know, but for ulcers and gastric cancer, thanks to two curious and stubborn doctors, we do know, and the world is better for it. I hope you enjoyed this episode of tribulations. Next week, I’ll be back with a deep dive into male hormone optimization.
[16:20 –> 16:58] If you’ve ever wondered whether there’s a way to feel younger despite the unstoppable tick of time, well, there’s no fountain of youth, but there’s a real measurable change in a man’s body that can be modified with lifestyle and medication. A 25 year old man feels strong, heals quickly, and has great energy largely because of his testosterone levels. As you enter your forties and fifties, those levels trend much lower, and the changes show up in energy levels, body composition, and recovery potential. So the question is, is it reasonable to take an older man’s hormones and restore them to the levels of a younger man? Do the benefits outweigh the risks?
[16:58 –> 17:06] That’s the question we’ll tackle in the next episode. So until then, stay curious, stay skeptical, and stay healthy. Cheers.