Nobel Laureate pathologist Dr John Robin Warren and his clinician colleague, Dr Barry Marshall, won the Nobel Prize in Physiology of Medicine in 2005 for the discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.
 
In a Q&A session at the inaugural SingHealth Duke-NUS Research Day held on 21 January 2016, Dr Warren shared that their finding was a classic case of bench-to-bedside collaboration, where teamwork between the pathologist and clinician led to that big discovery. If he hadn’t met with Dr Barry Marshall, his discovery would have just remained a published paper.
 
The doctor’s dogged determination led him to swim against the tide, where the accepted medical knowledge at that time stated that bacteria do not grow in the stomach. His determination led to a medical milestone and an eventual Nobel Prize win. 
 
Can you share the discovery process?
I was doing a routine gastric biopsy to examine severe gastritis, when I saw a blue line that looked like a mass of bacteria growing on the epithelium (a basic type of tissue lining the cavities and surfaces of blood vessels and organs). My colleagues simply wouldn’t believe it. After staining it, my colleagues finally believed it, but nobody else would, as they knew bacteria do not grow in the stomach.
 
The important takeaway is that once I started looking for the bacteria, I found them quite easily in about 30-40% of biopsies. The brain works in a funny way, seeing things that it wants to see.
 
In research work, it is important to not only to look at things but to also ask questions about what might be important.  Clinicians and scientists make observations all the time, but it often doesn’t progress beyond that.
 
How did you overcome this barrier?
It’s quite a complicated process. I spent a couple of years just studying these bacteria and pathological specimens. The whole thing would never have gotten much further if I had not met Barry Marshall and broadened the research to a clinical pathological study that also involved microbiologists.   It eventually became recognised by the medical community, and practically every branch of medicine seemed to be looking at Helicobacter. So go step by step.
 
Did your discovery face resistance outside of the medical community?
Our findings were accepted in Australia 10 years after we published our paper, but not in the US. I only understood why when I read a book that showed that the major medical schools and laboratories in America are funded by the drug companies who produce drugs like proton-pump inhibitors, which were some of their biggest money spinners. The drug companies were funding the big laboratories, and just told them not to talk about this or to believe that you can treat ulcers like bacteria.
 
Eventually FDA decided that it is a lot cheaper to treat bacteria than treating the ulcers. So while it took longer in America, they eventually decided on the same thing.
 
How did you stay focused and on course?
I didn’t worry about it, though people kept asking me why I kept talking about bacteria causing ulcers in the gut.  I didn’t care, I did my work in lab, and I have the photos of the bacteria, which I can show to anybody.
 
Can research be planned?
To some extent it can be, but the question is how far it can be planned. A lot of research work is produced by accident or unconventional ideas. It is hard to deliberately have a brilliant idea, especially if it’s on something not heard before. 
 
What are some key challenges that researchers face today?
It is becoming more and more expensive to do research. It depends on what sort of research work you are doing – but medical research is very expensive now.
 
When I started, the average hospital had beds and a few x-ray machines. Now, there are all sorts of equipment like MRI machines, CT scanners, and even the electron microscopes in the pathology department are a million dollars each. Funding becomes extremely difficult for medicine, because everything costs so much.
 
Another challenge is the growing resistance in bacteria to antibiotics. One of the most horrifying things is the large of number of drug resistant tuberculosis bacteria. It was a big killer in 1800s. If we are not careful about antibiotics, we could have people dying from tuberculosis again.
 
What do you think would be the most important development in medicine in the next 10 years?
It’s hard to see into the future, but I think it will be new methods of treatment for cancer. Many are also talking about making people live longer, but I’m a bit skeptical about people who say they want to live forever to 200 or 300 years, because the human body just doesn’t do that.