The Nobel Prize for Medicine and Physiology is always well deserved but can be arcane. Awarded usually for intimate, elegant things that are sub-molecular. I have not too often discussed with patients the hot-of-the-press Nobel Laureate. To be honest, never, until a month or so ago.
Early October and a youth presents with anxious dad — miserable chronic upper respiratory tract congestion completely resistant to all our therapeutic efforts so far; quiescent asthma, family history of peptic ulceration. On whim checked H. pylori antigen status, positive on stool specimen. So we re-convened to discuss whether eradication therapy might be worth a shot.
I told them what I knew about H. pylori. I'd heard of Barry Marshall, a slightly unhinged Australian gastroenterologist, for the first time in the early 1990s. With a Perth colleague, the pathologist J Robin Warren, he'd spotted the bug in gastric aspirates, then an association with duodenal ulceration, so set out to confirm Koch's Third Postulate re causation. No animal models available so Barry drank a beaker-full of beasties, endoscoped himself every day for a month, duly cataloguing the destruction of his own gastric mucosa. The rest is history. Eradication therapy, a revolution in the management of peptic ulceration — all the time we'd spent as medical students swotting up on Bilroth 1s and 2s could have been spent altogether more usefully.
‘Did he win a Nobel Prize for that?’ asked dad. ‘No he didn't,’ I replied. ‘But he should have.’
A month later they returned for review. I vaguely remembered an item that I'd seen on the BBC news website late the night before. Had I been dreaming? So as they walked down the corridor I googled ‘Barry Marshall Nobel Prize’. A millisecond later, http://nobelprize.org/medicine/laureates/2005/press.html. That very weekend Barry had got his gong from the King of Sweden — see http://nobelprize.org/medicine/laureates/2005/marshall-photo.html. And read his Nobel address — the most important lesson for any aspiring scientist is uncompromisingly Australian — ‘Always be nice to Swedes!’
A celebratory consultation followed. The Very Stuff of general practice!
- © British Journal of General Practice, 2006.
