Lessons from Ms Tu

Integrate traditional knowledge, rational methods

The 2015 Nobel Prize in Medicine honours three people who developed useful drugs to counter dangerous parasites. Half the award was shared by Satoshi Omura and William C Campbell, who jointly discovered Avermectin, a drug used to treat roundworms. The other half went to Tu Youyou for developing an effective anti-malarial, artemisinin, from a traditional Chinese remedy. The recognition for Ms Tu comes over a century after the Nobel was first awarded for malaria research in 1902, to Sir Ronald Ross (1857-1932), for identifying the malaria parasite and its vector, the anopheles mosquito. The Almora-born Ross was the first person born outside Europe to receive a Nobel; Ms Tu is the first citizen of the People's Republic of China to receive the Medicine Nobel for work done entirely in China. Nor is the 84-year-old pharmacologist a PhD - rare for science Nobelists.

In 1967, Ms Tu was a researcher with the Chinese Institute of Materia Medica and one of a small band that knew both western pharmacology and traditional Chinese medicine. Chinese soldiers posted in Vietnam suffered from malaria, which was endemic to the region. On May 23, 1967, Chairman Mao Zedong launched "Project 523", which aimed to find an anti-malarial drug. By that stage, over 240,000 drugs had been tested globally without an effective specimen being discovered. Ms Tu led a team tasked to screen traditional medicines. It was the height of the Cultural Revolution; scientists, indeed anybody with education, were being treated with suspicion. Her husband had been exiled. She had to leave her four-year-old daughter behind in Beijing for months on end as she went on field trips. Her team discovered wormwood - "qinghao" - had been used as an anti-malarial drug, circa 340 CE. After some experimentation and missteps, she successfully isolated and identified the active ingredient, named artemisinin, since it is most abundantly found in Artemisia annua, or yellow-flower wormwood. Artemisinin worked on rats. But the Chairman was in a hurry; so, Ms Tu cut short normal trial processes and tested the drug on herself and her team. Luckily, it did not have major side-effects and it was rapidly introduced by the People's Liberation Army. The research was initially classified but to their credit, the Chinese shared it, with papers being written up anonymously in 1977. It was only in 2005 that Westerners discovered Ms Tu's role. There is controversy in China as to whether she deserves the entire credit for a huge research effort.

Artemisinin has an unusual crystalline structure, with a critically important peroxide bridge. It remains the most effective anti-malarial drug. The World Health Organisation estimates that there are about 198 million cases of malaria worldwide annually and around 584,000 deaths, with most of the fatalities being young children. Artemisinin reduces mortality by over 20 per cent overall, and by over 30 per cent in children. It has saved millions. Nowadays, the drug is used in combination with one other drug to slow mutation of drug-resistant strains. Even so, it is likely to become ineffective in another five to ten years. In Cambodia, over 10 per cent of malaria cases are resistant to artemisinin. New anti-malarial drugs will soon be needed but an understanding of how artemisinin works may help to find them.

In this case, traditional medicine provided a clue. But Ms Tu and company used modern scientific methods to first identify a potentially effective drug via statistical analysis, then to extract the active ingredient, and test it in controlled experiments. Project 523 forced the Chinese to shelve the ideological imperatives of the Cultural Revolution. It may indeed have inspired the subsequent U-turn and the drive to educational excellence. China now boasts of possessing 57 of the world's top-ranked universities, second only to the US in number. There is a lesson there for the votaries of "Ayush" in the amalgamation of modern science with traditional medicine.