A big first for both China and Ancient Chinese Herbal Medicine this past week. The Nobel Prize for Medicine was awarded to three scientists for their work on parasitic diseases. One was Tu Youyou, an 84 year-old pharmacologist with the China Academy of Chinese Medical Sciences in Beijing for her work that led to the drug artemisinin, humankind’s best defense against mosquito-borne malaria, a disease that kills 450,000 people each year – mostly babies and the poor.
And the key to her discovery? An extract from the plant, Artemisia annua, or sweet wormwood, first used in China to fight malaria 1600 years ago.
She was the first Chinese to receive a Nobel Prize in the sciences and this was the first instance of Traditional Chinese Medicine (TCM) playing a role, although it was Tu’s ability to combine the knowledge of TCM with the rigors of modern pharma science that was the ultimate key.
Traditional medicine that relies on the extracts of plants and animals of all kinds has largely been ignored by the Nobel Committee over the years. Virtually all of their attention has been focused on modern scientists and pharma companies that build drugs from the molecule up.
The benefit of this latter scientific approach is that the effective component is known from the beginning, allowing for large-scale clinical trials where results are consistently replicable and can be interpreted with statistical certainty. When plant and animal extracts are involved there can be dozens of molecular substances involved that vary in relative quantity from batch to batch. That makes it very difficult to isolate the effective component and thus meet the standards of the modern day clinical testing required by developed Western governments and doctors.
During the Vietnam War in the 1960’s the North was losing as many soldiers to malaria as bullets. The parasite that caused malaria had developed a resistance to chloroquine, the historical standard used to treat the disease. The North turned to Mao Zedong for help.
The Chairman agreed and turned the search for a new malaria drug into a military project, code-named Mission 523, to which he assigned more than 500 scientists, including Tu. The researchers were broken down into two groups. One screened more than 40,000 known chemicals to find the cure. The other, which included Tu, turned to ancient Chinese medical literature and sent researchers out to remote villages in search of possible cures that had been passed down by word of mouth.
As Tu described in 2011 (qz.com – Quartz), her group investigated more than 2,000 traditional herbal preparations and found 640 possible candidates. Of those, 380 extracts of 200 different herbs were evaluated against a mouse model of malaria but no significant results emerged.
But Tu persisted and ultimately found an ancient text revealing a method for extracting artemisinin from sweet wormwood (qinghao in Chinese). It didn’t work. But Tu continued to tinker with the method of extraction and was ultimately successful.
Unfortunately, her success came during the Cultural Revolution, when Mao had banned all clinical tests as part of his attempt to strip China of any Western influence, including science and other Western academic disciplines. Tu, therefore, tested the extract on herself and her team and it was successful, opening the door to wider clinical testing.
Only then the Vietnam War had ended and it took the World Health Organization nearly 30 years to finally endorse the drug. That gave the green light to Western pharmaceutical companies who went on to make the drug one of an arsenal of drugs that doctors can now use to fight the disease at every stage of development, reducing the death rate from malaria by 60% over the last fifteen years.
This story holds many inspirational treasures. One is the sheer perseverance of Tu. Another, of course, is the idea that traditional medicine may hold more future success stories. And some prestigious Western medical institutes are starting to take steps to recognize this potential.
The problem is that traditional medicine is largely inductive. Practitioners went with what worked without really knowing why it worked. And given the chemical complexity of plants and animals, it is often difficult to isolate root cause and thus create predictably repeatable success, the cornerstone of modern medicine.
Guesses can result in quackery, a potentially profitable outcome given that people with disease are often desperate for a cure and everyone wants to live a longer and healthier life. The US Food and Drug Administration often challenges non-traditional herbal supplement providers to back up their claims and medical quackery remains a serious problem in less developed parts of the world where there is less stringent oversight of what is sold on what basis.
Tu, however, bridged the two worlds, and that is, perhaps, her greatest contribution. Both sides (some practitioners of traditional medicine in India, China, and elsewhere do not believe traditional remedies should be held to the same clinical standards as the drugs developed by modern research methods) can learn – must learn – from her example.
There is also a business angle to this story that is very telling of China’s economic challenge as it attempts to modernize its economy and a potential omen to Western companies who have not considered Chinese competitors to be a serious global threat. As soon as the news of Tu’s award was announced, investors, who are largely driven by rumor and speculation in China, began to salivate over the potential impact Tu’s recognition would have on the stock price of the five public Chinese companies who produce artemisinin.
The markets have been closed for the National Day holiday in China so the ultimate story is yet to play out. As one analyst noted, however, these companies generally occupy the lowest rung of the global supply chain for the drug, selling it in bulk to Western pharmaceutical companies who are much stronger in patent management, R&D, and, most importantly, marketing. And it is in these downstream segments of the supply chain where all of the profit is made. The bulk suppliers of the raw materials that occupy the first rung generally earn very thin margins due to their perceived lack of added value and lack of differentiation.
This is precisely why the Chinese government is currently putting so much emphasis on Manufacturing 2025, a state-manufacturing strategy that targets 10 attractive industries for Chinese domination from the beginning to the end of the supply chain by 2025. As every businessperson knows, it is not enough to be the biggest manufacturer in an industry. The spoils go to the strong that control the supply chain and can extract the biggest profit margins.
To me, however, there is one lesson to come out of this story that is most important of all and applies to all of us, no matter where we live or what we do. There is an old saying that even a blind monkey could conceivably sit at a keyboard and type out the Bible. No one, of course, believes that would ever happen. As Tu so effectively showed us, however, we must never stop pushing at the walls of our box. As Confucius might have said, we can’t know what we don’t know unless we try.
Note: The views expressed in this post are strictly those of the writer acting in a personal capacity.
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