Global traditional medicine news is overflowing with multiple reflections on the meaning of the award of the Nobel Prize in Medicine to Chinese scientist Tu Youyou. The award followed the discovery by Tu and her team of the usefulness of a drug based on sweet wormwood (Artemesia annua) to combat malaria. The discovery has saved tens of millions of lives. Artemisinin-based drugs are still “routinely used by pharmaceuticals giants like Sanofi and Novartis in the fight against malaria.” All the Nobel awards, as reported here at Nature, stimulated dialogue in the Twittersphere, yet it was Tu “who inspired much of the online discussion.” Here are some of the intriguing themes in these media accounts, with some commentary built in. The announcement of the award is here.
A Turning Point for Traditional Medicines?
One of the themes is whether this acknowledgement of the power of an herb will be part of a turning point for traditional medicines, from China and elsewhere. In Fortune, a writer speaks to the surprise with which the award was greeted: “Traditional medical knowledge anywhere in the world has not even been on the radar for Nobel Prize prospects. Until now, that is.” Then the question: “So how should we interpret this arguably seismic shift in international attention on traditional Chinese medicine?” In another piece the writer asks, “Traditional Chinese Medicine Wins Nobel Prize 2015; Western Science Ready to Embrace Alternative Medicine?”
Most people raised in a medical culture dominated by big pharma and surgery are disconnected from awareness that a significant percentage of drugs are based on, or synthesized from, natural agents. The Nobel to Tu is a blunt lesson on the lifesaving power of one herb, processed correctly. Members of the Nobel committee shared views—see video here—that it is the potential power of traditional medicines as paths to new drugs that was their interest, rather than as herbal medicines themselves. A writer at The Conversation is cautious: “So can we hope to find new remedies by studying ancient medical texts, as Tu did so successfully? The answer to that question is complex and unfortunately cannot be an unmitigated, resounding ‘yes’.” Time will tell whether this highlighting of a traditional medicine might, for instance, boost interest in the four African herbs that former US Ambassador to the United Nations Andrew Young was urging exploration at this recent press conference.
Victory for China in its Global, Cultural Exportation of TCM
Readers of the Global Integrator Blog will know that medial evidence of the Chinese government’s commitment to exporting their traditional medicine appears routinely. In recent weeks, for instance, stories emerged of Chinese government-backed initiatives in Australia, Malta, Central Europe, multiple nations in Africa, and elsewhere, about this medico-cultural-industrial campaign. The award of the Nobel well certainly be a door-opener for the Chinese, where parties are wary, and a likely booster for initiatives already underway. The South China Morning Post characterized the award as “giving traditional Chinese medicine a shot in the arm.”
While lobbying is well known to happen for the Nobel Peace Prize, I have not seen any report that explores the extent to which China may have actively lobbied for Tu’s award. Given the importance of their global TCM campaign, that would not be surprising. The Telegraph of London quotes one Li Chenjian, a vice provost at Peking University: “This is indeed a glorious moment. This also is an acknowledgement to the traditional Chinese medicine, for the work began with herbal medicine.” An Indian science writer notes, “Chinese premier Li Keqiang has quickly positioned the Nobel prize as reflecting China’s ‘comprehensive national power and the uninterrupted rise of China’s global influence’.”
The Multiple Firsts in this Nobel Award: What, No PhD?
Much has been made of the award being the first Nobel to a Chinese woman, and the first award of a Nobel in Medicine to a Chinese national. The award was also remarkable for its elevation for a lowly-herb amidst the rarified “omics” in the modern era of genetic exploration. It is also likely the first award for a contribution to scientific advancement from Mao’s China.
Yet perhaps even more remarkably, the award went to a person who does not have a doctoral degree. A Japanese account notes that Tu Youyou “is a ‘scientist with none of three key factors,’ namely the title of ‘master scholar’ presented to a scientist of highest caliber in China, doctoral degree and experience in overseas study.” There has been reportedly feverish interest in Tu in China. Her given name “Youyou” reportedly “derives from ‘phrases’ in the Classic of Poetry, which means ‘dear feeds on grass in the field, shedding tears.’”
Tu, however, as one writer asserts, “embodies, in both her history and her research, what I call medical bilingualism—the ability not only to read in two different medical languages but to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.” Remarkable at every level. A two-minute video of Tu is here. A look at her past is in this article entitled “The home, the herbalist and the high school: Feverish interest in Nobel Prize-winner Tu Youyou’s background.”
A Product of Maoist Science Stimulated by a War in Vietnam; Global Education Later
Multiple accounts place this increase of knowledge squarely in the zone of war-time discoveries with peace-time applications. Mao had a war in Indochina on his hands and “malaria became the number one affliction compromising Vietnamese soldiers’ health.” In this article, the writer describes how Mao initiated a covert operation entitled Project 52 that was “headed by a young Chinese medical researcher by the name of Tu Youyou.”
Interestingly, “the Chinese conditions prevented these discoveries from being reported beyond the Chinese language journals” because of the wartime environment. The breakthrough for the world came in 1979 when the China National Committee of Science and Technology, in Tu’s recollection, “granted us a National Invention Certificate in recognition of the discovery of artemisinin and its antimalarial efficacy.” Two years later, at the fourth meeting of the Scientific Working Group on the Chemotherapy of Malaria, in Beijing, sponsored by WHO and World Bank among others, the discovery reached the outside world.
The Remarkable Path of Discovery in a 1700 Year of Text
Tu’s Chinese team reviewed “systematically screened the well-documented texts and sifted through more than 2000 herb preparations of traditional Chinese herbs and from these identified 380 herb extracts and tested them on mice being infected by malaria parasites.” Sweet wormwood was a common denominator in many.
The breakthrough for the researchers came when Tu encountered the medical text of a fourth-century Chinese physician and alchemist named Ge Hong (circa 283-343). Ge Hong briefly described his primitive means of processing the herb: “A handful of qinghao immersed with 2 liters of water, wring out the juice and drink it all.” Tu Youyou comments: “This sentence gave me the idea that the heating involved in the conventional extraction step we had used might have destroyed the active components, and that extraction at a lower temperature might be necessary to preserve antimalarial activity. Indeed, we obtained much better activity after switching to a lower-temperature procedure.” Tu has reportedly “always maintained that she drew her inspiration” from Ge Hong.
Wake Up, India (and Japan)
A short article in The Hindu begins, “The success story of Tu Youyou, whose work was based on herbal pharmacology of ancient China, should serve as a spur to researchers in Indian traditional medicine.” Another Indian writer complains that “each time India takes forward her traditional knowledge into the realm of science, there has been a concerted effort from the Indian media to ridicule and negatively portray it.” An Indian writer suggests that the message for India is to link its traditional practices with modern sciences.
Another Indian writer uses the prize to make a “call for unification” of India’s distinct traditional system. He is prompted to an unfavorable comparison of India to what he found in visits to China: “In China, one can see two hospitals standing side by side. One would be practicing traditional medicine while the other would provide modern treatments. After the disease is diagnosed, traditional treatments get more preference. Allopathy is tried as a last resort. Patients are given the option to select his or her treatment mode and most would opt for traditional treatments.” He adds, “Let the achievement of Youyou invigorate the traditional system of medicine in India.”
The Japanese account, noted above, looks at Mao’s plan with TCM as compared to the way Japan responded to the West’s medicines: “At the first national health and hygiene meeting in 1950, late Chinese supreme leader Mao Zedong established the principle that ‘Chinese medicine must combine with Western medicine’ as one of the four principles in health. The measure is contrasted with Japan’s decision to discard traditional medicine when it introduced Western medicine through the Meiji Restoration.” Notably, the Indian writer above similarly opines that the “Indo-phobe” perspective from India’s Nehru era was at least partly responsible for retarding the advance of traditional medicine in his country.
Meantime, in Jamaica, this article characterizes the Nobel as “encouragement for local scientists.” For instance, “We see similar research being done by the likes of Dr Henry Lowe, who, along with his team over the past 10 years, has made significant headway in the battle against cancer and other chronic diseases through the development of therapies from Jamaican plants such as ball moss.”
Conclusion: A Collision in Time, Space, Politics and Culture
The elements of this story are outrageous: a war in Vietnam, Maoist medicine, a well-known herb, a 1700-year-old “recipe” and a researcher with relatively little formal education but with a curiosity toward and grasp of two medical cultures. One writer at ExtremeTech characterized the breakthrough of Tu and her team this way: “An ancient version of science managed to find the general location of this drug, but the modern version of science is what nailed it down.” Notably, it was also an ancient means of extraction that allowed the modern scientists to release the potency of anti-malarial properties.
Ray Yip, the former China director for the US Centers for Disease Control and Prevention and the Gates Foundation quipped as follows in this account: “The impact on traditional Chinese medicine could also be mixed, My. Yip said. While most advocates would welcome the exposure, it would irritate the purists, he said: ‘A lot of Chinese traditional medical practitioners actually hate this approach of extracting chemical compounds from a plant. They believe you need to take the herbs all together.’” The discovery may never have been made were the research direction left to such purists. Yu’s award honored a basic form of medical integration.