NATIONAL PRESS CLUB ADDRESS

Talking science – creating a community conversation

12 July 2006
Professor Barry Marshall FAA
Winner of the 2005 Nobel Prize in Medicine or Physiology

Good afternoon ladies and gentleman. My father Bob is a mechanical fitter and my mother is a nurse. They were groomed for life during World War II in the remote West Australian gold mining town of Kalgoorlie where the humour was dry, and the landscape harsh. Dad has always been extremely proud of my achievements and I was thrilled when he and my mother Marjorie travelled to Stockholm in December last year to attend the ceremony in which my co-winner and collaborator Robin Warren and I received the Nobel Prize for medicine.

It was a frantic few days - Robin and I were literally swept along on the merry-ground of cocktail parties, media interviews and receptions and when it all became too much for dad he sought refuge in the hotel bar or loitered in the lobby. It was there he struck up a conversation with a hotel guest from Spain. He was a man in his 50s and he told dad that he'd travelled to Sweden to meet two of the Nobel Laureates. Twenty years ago his father died of cancer and 20 years before that his grandfather had died of cancer. In all, about half of his relatives had suffered from ulcers or had died from stomach cancer. He told my father how happy he was when 10 years earlier he had been diagnosed with Helicobacter pylori - the bacteria which Robin and I had proved caused peptic ulcers and stomach cancer. Like millions of other sufferers around the world, this man and several of his family members were treated with antibiotics and cured.

'No one in my family will die from stomach cancer again because of these two Australian men; and I have come to Stockholm to shake their hand and get their autograph,' he told dad. But of course everyone in Sweden knows that you can't just have ordinary people turning up out of the blue and shaking hands with the Nobel Laureates, so he had a problem. But Bob said he thought he could help him out on that score and went off in search of Robin and myself. Minutes later, in the lobby of the Grand Hotel I shook the hand of Jose-Luis the mining engineer from Sarasota Spain. It was a powerful moment and a handshake my father and I will long remember.

My father didn't need to understand the world of cytotoxins and bacterial colonisation to be overwhelmed by the way in which our work had touched this man's life and released him from what might have been a death sentence. It was a very human illustration of the power of medical research; a reminder that those who work in the secluded world of laboratories, Petri dishes and test tubes can effect real change. Unfortunately my father's experience is not something that can be replicated every time scientists need to convince decision makers of the potential of a new research project or scientific discovery. Indeed, experience tells me that the road to scientific recognition and acceptance is seldom smooth. It has also taught me that encounters with both the media and politicians can be critical in achieving ultimate success.

So I am grateful for the invitation to address you today. I strongly believe in the need for scientists and researchers to talk with the Australian community through the media about the work being done in a broad range of fields, and the potential value of that work to our nation. In fact, never before has the need for us to start the scientific conversation been so urgent, because never before have the possibilities been so great.

By the time I finish speaking today somewhere in the world someone working on the Helicobacter pylori bacteria may have discovered a new treatment, a vaccine, or a way to treat a common disease, perhaps even cancer. The pace of scientific progress is daunting and requires thoughtful, informed and timely responses from our regulators and legislators. How we value and understand the role of science in our community and how Parliament decides we should manage the medical research and scientific questions confronting us as a nation are some of the issues I would like to address today, with particular reference to the current stem cell debate.

Long before Robin Warren and I took to the stage in Stockholm we were decried as scientific heretics, branded as fakes and frauds by members of our profession. For years established wisdom dictated that peptic ulcers were caused by stress - indeed they were worn as a badge of success by many professionals who took their doctors advice to lay off spicy food, eat very small meals, avoid worry and anxiety, spend up big on antacids and in many cases submit to the surgeon's scalpel for a staggering array of surgical solutions.

But in 1979, while peering down his microscope and examining a stomach biopsy in his laboratory at Royal Perth Hospital, Robin Warren first noticed what appeared to be a thin blue line. The biopsy was taken from a patient suffering gastritis and using a staining technique he had previously perfected, Robin was able to establish that this strange blue line was indeed bacteria. He could not have imagined the years of frustration, rejection and derision that were to follow this discovery - but fortunately for me ignorance is bliss and he was intrigued by his observation.

Because everybody 'knew' bacteria could not survive in the sterile acid bath that is the human stomach, Robin's findings were met with scepticism by his colleagues and for the next two years he was frustrated by his inability to access large numbers of stomach biopsies to continue his investigations. It was then, in 1981, that I had the good fortune to cross Robin's path. I was a young intern looking for a research project while on rotation in the gastroenterology department. Robin was so convincing in his enthusiastic briefing that I readily accepted his concept, thinking that, if nothing else, a new species of bacteria would make a good publication. I could access the stomach biopsies he so desperately needed and so began our partnership - a partnership which I am pleased to say has weathered the tests of time and scientific frustration. To this partnership I brought my own special brand of attention deficit disorder which somehow complemented Robin's obsessional perfectionism.

My medical training told me that ulcers were one of the world's most common afflictions; millions suffered from this often chronic complaint and every doctor was an ulcer expert who knew the cause was stress, genetics or smoking. But if Robin and I could prove these small spiral-shaped bacteria were indeed the cause of peptic ulcers, then the condition could be treated with antibiotics and permanently cured.

It required a revolutionary change of thinking but with every new stomach biopsy which revealed the presence of the bacteria, Robin and I became more convinced that our theory was correct. We studied hundreds of stomach biopsy samples from patients with gastritis or stomach ulcers and found the corkscrew-like helicobacter in almost every case.

At this time I spent a frustrating year trying to convince government, the science community, and the Australian pharmaceutical industry that something exciting and new had been discovered. But I could not get my message through. There did not seem to be anyone listening or looking out for new discoveries. Nobody could tell the difference between say, a plan for a different shaped band-aid, and a potential cure which would supersede the billion dollar ulcer treatment business.

On the strength of our results Robin and I submitted a paper detailing our findings to The Lancet which finally agreed to publish it in June 1984. In the same month I began to lose patience. We were struggling to attract funding for further trials which were crucial to prove the bacteria caused the disease. My wife will tell you that I am at times impetuous and I thought it prudent not to tell her when I opted to follow in the footsteps of Australia's most honoured scientist Sir Frank Macfarlane Burnet. I can clear up a few myths here. I had discussed the idea of a human experiment in general terms in the preceding year with my wife Adrienne but when the time actually came to do the self experiment I decided that forgiveness might be easier to obtain than permission.

I decided it was time to put our work to the test and on a cold winter's morning, I swallowed a whopping dose of live helicobacter - it was a vile tasting brew with an aftertaste not similar to swamp water and a smell like fresh chicken on the last day of its supermarket shelf life. For several days I waited anxiously as I continued to enjoy annoyingly good health until at last I woke up before dawn, seven days after ingesting the bacterial cocktail, and I vomited. This was followed by the glorious symptoms of nausea, headache, raging halitosis, insatiable hunger, stomach cramps and all round irascibility! After several days of severe gastritis we confirmed that my stomach was swarming with spiral bacteria. Hallelujah! I treated myself with antibiotics and much to the delight of my wife, within days my infection was cured.

In my Nobel speech I felt compelled to tell aspiring Aussie scientists, that although Nobel Laureate Macfarlane Burnet gave himself myxomatosis and I drank helicobacter, I could not guarantee that the process of self-induced infection would necessarily result in a Nobel Prize.

After a night spent with Robin Warren and his wife Win, celebrating the publication of our Lancet article, Robin was telephoned by a journalist from the New York Times. While he remained in a champagne-induced haze Robin told the reporter about my self-inflicted ulcer, and the article which subsequently appeared attracted a lot of additional media attention. And I'm pleased to say that on the whole the media response was enthusiastic, positive and accurate. I would be proud if I could say that our first international publicity was in a prestigious publication such as the National Enquirer, but I would be lying - it was actually in a Florida supermarket tabloid called The Star.f.

In the scientific community we continued to confront scepticism, fear and some anger as most doctors clung fast to the prevailing dogmas. Some members of my profession were however, instrumental in implementing the new treatment - responding to patients who had heard of the treatment and eager to see if it could ease their chronic pain.

It was at this time that I made a decision which changed the course of my work and which has become the fundamental philosophy underpinning all that I now do. As a young consulting gastroenterologist in Western Australia it became obvious to me that I could work 14 hours a day, six days a week and only ever treat maybe 50 patients each week. But if I had the opportunity to lecture at a national medical conference to 100 doctors, to present our research data and educate them about the new treatment procedures, I could reach thousands of patients every week. And if I could present a paper at an international conference to 3000 doctors I could affect the lives of millions.

I realized that through education I could effect rapid change and prevent the suffering of patients who would otherwise have gone untreated. And through the media I could reach even more people. In the next few years I gave dozens of interviews to journalists around the world. Testament to the power of the media, I have since learned that one of those interviews conducted with the Readers Digest was translated into 60 languages and read by more than 350 million people.

It was not until 1994 - 12 years after Robin and I first made the connection between H. pylori and ulcers - that the powerful US National Institutes of Health accepted the bacterial causation of ulcers and stipulated that infected ulcer sufferers should be treated with antibiotics. Although I admit to being frustrated during the more than a decade it took the medical community to finally accept our work, I was never really dispirited in my heart because I knew that what I was doing was right and that our work would ultimately be accepted.

Although we didn't have a lot of research publications, Robin Warren and I were always certain of this outcome because we knew that the most successful strategy, that is, a cure, would certainly be first choice for anyone treating ulcers because it would be a single treatment, which fixed the underlying problem, returned the patient to normal, and did not cost as much. We had the truth and our research provided enough data - the tangible, hard evidence to support that scientific truth. That truth could not be changed and it must ultimately triumph over the time-honoured inefficient and false dogma previously attached to ulcers.

This brings me to the current debate surrounding the use of stem cells and research involving human embryos, and the model used by the Legislative Review Committee to produce the Lockhart Review. At the request of the then Minister for Ageing, Julie Bishop, I joined the six-member review committee as a community and science representative, as I have no particular expertise in the area. Other committee members included lawyer and ethicist Loane Skene, neuroscientist Peter Schofield, clinical neurologist Pamela McCombe and clinical ethicist Ian Kerridge.

Our task was to review Australia's Prohibition of Human Cloning Act 2002 and the Research Involving Human Embryos Act 2002. For six months the committee, under the guidance of former Federal Court Justice John Lockhart QC, travelled the nation consulting State and Territory Government representatives, receiving 1035 written submissions and hearing personal presentations by more than 100 individuals. Based on this extensive consultation process we then compiled our findings in a 284 page report and made a total of 54 recommendations covering the two Acts.

The most controversial of those recommendations has proved to be the Committee's support for Somatic Cell Nuclear Transfer or therapeutic cloning. Therapeutic cloning involves culturing stem cells in the laboratory that could become replacement nerves and organs to overcome a range of devastating illnesses.

Embryos contain versatile stem cells that can turn into almost any cell in the body. The Committee has recommended a range of practices which would result in the creation of human embryo clones through the application of cloning techniques, including substituting the nucleus from a human egg with the nucleus of an adult cell such as a skin cell. An embryo which is a clone of the adult cell is created, the stem cells are extracted and the embryo is destroyed in the process.

The Committee accepted that there was overwhelming public support for the maintenance of a strong regulatory framework to oversee the work being conducted under the two Acts, but acknowledged the need for Australian scientists to maintain a leading role in the advancement of high quality and ethically sound scientific research and medical practices. We recommended lifting barriers to allow research on experimental fertilisation techniques to improve assisted reproductive technology and the establishment of a national stem cell bank.

Having worked through the review process I believe that in many ways stem cell research is emblematic of the challenges confronting our community as we seek to write regulations and legislation to keep pace with scientific advances. As with most cutting edge fields the science of stem cell research is complex, highly technical and constantly changing. But the public debate surrounding the science is loaded with emotion and those who gravitate to opposing sides in this debate hold extreme but heartfelt positions. However, in the twenty first century, most of us sit in between the two extremes.

In order for us to achieve outcomes that truly are representative of the community's voice when we review medical science in such a highly charged atmosphere, we must have total confidence in the process we use. It must be a process which is fair and open. A process which fosters a genuine community conversation - a community conversation in which all parties are afforded equal respect and which allows the direct involvement of community members in order to achieve representative change.

It must be a process which is independent, transparent and well resourced. It must be a process able to withstand hijacking attempts by powerful or well resourced groups with vested interests. It must be a process which respects the deeply held beliefs and strong emotions of those who come to the conversation with entrenched and intractable positions - all of whom in my experience are genuinely motivated by the desire to do what they believe is right for the community.

However, let me emphasise this, science is not a democracy - nor is it a religion. No matter how many people support a particular point of view - for example that ulcers are hereditary disease triggered by stress then if we know that ulcers are caused by a bacteria which you catch from your mother - then even if we are the only two people in the world with that opinion, the majority loses, and ultimately all the stressed out people just take antibiotics and get on with their stressful but mostly happy lives.

Similarly, science is not a religion. You all know the true story of Galileo telling the Pope that the earth actually travelled around the sun - not vice versa! - or the continuing saga of Charles Darwin in his theory of evolution. Darwin was a scientist and even a theology student - but facts are facts - people were digging up fossils all over the place and so science won out.

This type of reasoning can also apply to the other debates currently under way regarding the acceptance of GMO products in food. But this must be a process which encourages the participants in the conversation to listen as eagerly as they speak and to be open to the views of others. It must be a process able to value scientific rigor, ethical considerations and public opinion. I believe we have found that process in the model used to produce the Lockhart Review. It was a well-resourced, comprehensive, data-based process harnessing the expertise of eminent practitioners from a range of fields.

The end result is a scientifically authoritative document of international standing. The recommendations are based on sound scientific data, informed by broadly held public opinion and balanced against an ethical framework reflective of our society's values.

And now with the work of the review committee done the report has entered the public domain and we put our faith in the processes of our parliamentary democracy and our nation's media to ensure the public debate is informed, rational and inclusive. At its best 'the media' can provide the forum in which the community conversation can be held. It can engage a wide range of the community players and stakeholders in that debate, air contrasting views, provide detailed analysis, canvas opinion and educate the public. I believe Australia is generally well-served by its media in the reporting of health issues. But members of the media can also stoke the flames of conflict if they choose to over simplify complex issues, apply political pressure or attempt to type-cast players in the debate as good or evil.

It is obvious that the views of some participants in the public debate surrounding stem cell research and therapeutic cloning will never be reconciled. The opponents of therapeutic cloning are opposed to the Lockhart Review recommendations and have every right to express their views. The media can not and should not ignore the obvious conflict between the opposing sides of any debate. However the media can be instrumental in ensuring that above the emotion, passion and human drama of the debate the science is heard.

The quality of the debate is often informed by the underlying scientific evidence. As the quality of the evidence improves so too does the quality of the arguments mounted in opposition. Traditions and beliefs must carry less weight than hypotheses (the very name implying that these can be tested in some way) versus data, which are proven, reproducible, verifiable facts.

Although Robin and I were accepted rather slowly, and most of our colleagues were sceptical, the scientific process still took place. Typically, the first step to 'prove' a new theory is for everyone to try to disprove it. If experiments to disprove a theory are easily done, then the hypothesis is a good one - it is testable. So, one by one, sceptics failed in their experiments and changed sides.

The scientific data resulting from the comprehensive legislative review process should provide the bedrock for the debate and the media has a crucial role to play in ensuring the community at large understands that science.

Nothing is so complex that it cannot be successfully explained by someone who understands it. I believe it is incumbent on the leaders of the Australian scientific community to accept the challenge of becoming educators and seeking a permanent chair at the table when community conversations and national debates are held. My father, as I said is a mechanical fitter, although anyone can call him up and he can give a pretty good free recommendation about modern ulcer treatment. In fact, 15 years ago when he worked at BHP in Kwinana he found out that lots of the Croatians had ulcers and he was having the local chemist ship out packets of my treatment back to Croatia for their relatives.

The nation has been blessed with outstanding science ambassadors including Sir Gustav Nossal, Peter Doherty, Ian Fraser and Paul Davies, but for too long they have been lone voices carrying the weight of the scientific community on their shoulders. Our best scientists and medical researchers must seize the opportunity to speak directly to the Australian people and to engage the media at every level; from scientific journals to talkback radio. We must be available to help educate policy makers and politicians, and ensure that scientific truths are injected into the often emotional and volatile debates that are held.

Scientists must accept the responsibility of working closely with the media to clearly explain the science they understand in a language that is accessible and in concepts that are easily grasped. Because when the media is able to deliver scientific information in a clear, concise and accurate way, the public is given the key to unlock the science and understand any scientific debate. With that understanding comes the ability to develop an informed view.

With the Adelaide Crows sitting on top of the ladder, Neil Craig is proof that you don't need to have played at AFL level to be a successful AFL coach. And our Prime Minister John Howard can attest to the fact that you don't have to have worn the baggy green to get a bowl in the sub-continent. Likewise, you don't have to be a Nobel Prize winner to understand the science of the stem cell debate and hold an informed view.

For many Australians the media will be the only source of information they are exposed to during the stem cell debate. But let's not fall into the trap of thinking that medical scientific debates are just like any other robust exchange in our democracy. This is not a discussion about where we build airports. Behind the pages of statistics, in the research papers and the scientific submissions are the lives of very real people. People who are affected by disease, people who live in pain, people who are desperate for any hope medical science may offer.

And if the politics of conflict are allowed to overwhelm the community conversation or the debate descends into little more than a slanging match, there is the potential to jeopardise lives. So it is at this stage in the process - when the work of the review committee is complete - that the role of politicians and journalists is crucial.

Having invested in the process we have produced an authoritative, data-based report in the Lockhart Review. It is a document already being accessed by countries around the globe; countries grappling with the same issues are looking to the Australian review as a work of authority. And it is now that we in Australia look to our elected representatives to lead an informed debate which produces an outcome which is truly representative of the community's will in a timely and effective manner. We look to Government to ensure the debate is conducted on a level playing field on which every Australian has access to the information. And if, at the end of the democratic process, Government decides that now is not the right time for change, so be it.

In my view it will only delay the inevitable for Australians because the underlying science is good. Experience tells us that in the global community it is impossible to quarantine scientific advances. In the late 1960s and early 1970s, scientists and patients alike were drawn to those medical centres conducting pioneering work in in vitro fertilisation. This week's news included a 62 year old woman with a new baby and some might say, 'Aha! We told you.' But I have to admit that she looked happy to me, so I say good on her.

In the year 2006, scientists will travel around the world to work in their chosen field and in the age of the internet, that work will be available to us all. So if Australia chooses to restrict further stem cell research, we will see those Australians who have the means, seeking treatments abroad. Those without the means will be left behind.

I can't fight everyone else's battles - I have enough of my own. And it does not really affect my life much if there is no stem cell research in Australia; if our young scientists leave for Singapore; if Australians must always wait a few extra years after the USA and Britain already have a new treatment for let's say diabetes. I can always get on a plane and pay thousands for some new cure in California, but most people can't afford that kind of expense.

In Australia and throughout the world as important medical scientific debates occur, politicians and members of the media may be feel it is in their power to ensure one opinion triumphs over the other. But there are not two opinions, there is only the truth. And I believe the scientific truth will ultimately triumph. It may take many years but the truth will eventually emerge and whatever the political outcome of our current debate, we should take some comfort in the knowledge that the work we have done will not be wasted. The review process provides us with a foundation on which we can build our knowledge base and as Government's come and go, and public opinion shifts, the document remains. It provides an invaluable reference point and bears witness to the underlying scientific truth.

As Robin Warren and I waited for the medical establishment to accept what we knew were the facts, researchers across the globe seized on our work. Our discovery prompted the search for microbes as possible causes of other chronic inflammatory conditions. And countless research projects were launched to explore the properties of Helicobacter pylori.

So, after you win a Nobel Prize, what then? Today my research is focused on the potential for H. pylori to be genetically modified and used as a delivery agent for vaccines. I have established a biotechnology company called Ondek which is collaborating with the University of Western Australia and several others around the world. Our research aims to adapt H. pylori - which has proven to be so perfectly at home in the human stomach - to become an effective delivery system. If the harmful genes of the bacteria can be turned off and vaccine molecules for a range of diseases - like SARS, malaria, tuberculosis or avian flu - can be spliced into the bacteria, we could create an inexpensive and very efficient way to deliver vaccines to the Third World. It is a radical new way of thinking about vaccine delivery and of course requires genetic engineering - and you drink it of course - so it comes close to the GMO food issue; yet another scientific frontier the community is debating. But in China and India where people still remember what hunger feels like, they say, 'GMO debate? What debate?'.

I know that in the Yes Minister world of Sir Humphrey Appleby a politically courageous decision was to be avoided at all costs. But in the truest sense of the word, I believe the Prime Minister's call for us to debate the findings of the Lockhart Review is a courageous one. The people of Australia deserve high quality information they can trust. All of the contributors to this important community conversation must embrace this opportunity. We must ALL have the courage to look beyond dogma and open our minds to the possibilities of science. Now is not the time for us to be reactionary, partisan or predictable. Now is the time for a mature, informed and tolerant community conversation. Now is the time for us all to take our roles in the conversation very seriously.

And I guess I am one of the lucky ones. I recently had the enormous pleasure of meeting Jose Luis in his home city of Barcelona where I was presenting a paper to a medical conference. Adrienne and I had dinner with Jose Luis, his wife and their daughters - a lawyer and a doctor. Unlike his forebears he looks forward to a long and healthy life - with no worries about the family curse.

So I come to our community conversation with an understanding of what can be achieved when we put our faith in the truth and have the courage to fight for that truth.

Thank you