Of Nobel, tradition and rigour

By honouring Dr Tu Youyou, Nobel prize has for the first time recognised someone working in traditional medicine

Last week’s Nobel prize to Chinese scientist Dr Tu Youyou for her work in extracting the widely used anti-malarial drug, Artemisinin, from sweet wormwood represents many firsts. It is the first time a science prize has gone to China. It is also the first time the Nobel prize in medicine recognised the efforts of someone who worked in traditional medicine. However, the prize has also created a serious debate within China about traditional medicine and its future.

The history of the prize is one that involves secrecy, intrigue and the heat of the Cold War. Dr Tu worked as part of a secret mission, called project 523 (named after the date it started on May 23, 1967) started by Mao Zedong. The project was started in response to the request by North Vietnamese soldiers who were dying in large numbers due to malaria during the Vietnam war. Chinese soldiers themselves were finding it hard to cope with malaria in south China. Dr Tu was part of a team that was assembled to find a new drug against malaria. She travelled across the country and analysed hundreds of traditional Chinese remedies. Her research identified sweet wormwood as a potential therapeutic target. This herbal remedy had been recorded in ancient Chinese texts dating back thousands of years. But her real discovery and contribution was how she was able to extract the key drug Artemisinin from this herb. Her work was followed by rigorous animal models, double blind studies and detailed analysis of drug efficacy.

Since the discovery, there have been plenty of other twists in the story, including little recognition of her work within China, the deportation of her husband to forced-labour camps during the Cultural Revolution and poor initial reception of her work elsewhere. Today, however, Artemisinin is one of our most potent tools against malaria and saves millions of lives every year.

It is important to recognise that while the source of the drug comes from ancient Chinese remedies, the approach used by Dr Tu is not at all different from that of other scientists and drug companies (in China and elsewhere) that routinely mine natural products for new drugs. Thus, while the traditionalists are celebrating an award to one of their own, the work for which the award is given is at odds with the practices of traditional medicine. In traditional Chinese medicine, multiple herbs and minerals are provided to heal, with the amount and the routine changing weekly based on the condition of the patient. Extraction of key molecules or drugs is a practice that is alien to the practitioners. In an interview with The New York Times, Dr Liu Changhua, a professor of history at the Academy of Traditional Chinese Medicine, expressed both elation at the award and sadness for the future prospects of the traditions of Chinese medicine.

There are important lessons for us in Pakistan in this remarkable story of dogged pursuit. Like China, we have a long history of herbal remedies, many of them, I am sure, may have tremendous potential for addressing important health challenges. There is, however, little interest in seriously mining this knowledge. Instead, lack of education, absence of rigour and analysis, combined with fabricated tales of bombastic successes in yesteryear have allowed frauds and charlatans to prosper in this domain. Blind faith in herbalists and other fraudsters, who have no rigourous training, leads to worsening of the condition, morbidity and even death of the patient.

This is a routine occurrence in both urban and rural parts of the country and remains unchecked. What is even more problematic is the suspicious insistence of these traditionalists on not embracing rigorous methods of testing, analysing and identifying how these herbal remedies can be made more efficient and scaled up for broad impact. But it does not have to be this way. Dr Tu’s story is a reminder that mining of traditional knowledge, combined with inquiry, observation and rigourous analysis can find cures for our greatest ills. The next Artemesinin that can save the lives of millions of rich and poor every year may not be that elusive. Only if we cared to look.

Published in The Express Tribune, October 13^th, 2015.

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