Last week, the Nobel Prize Committee gave out the 2015 Nobel Prize for Medicine to three researchers, including Youyou Tu (see note 1), for her novel work in developing a medicine to treat malaria. Dr. Tu was the first Nobel Prize winner in the natural sciences from China, so she is a groundbreaking scientists in many ways.
Because Dr. Tu found the potential cure through research into Chinese herbs, many people have proclaimed that traditional Chinese medicine has now been “proven.” But not so fast.
What is the relevance of the Nobel Prize and Traditional Chinese Medicine – is there any importance at all?
Let’s take a look at Traditional Chinese Medicine, in general, and Dr. Tu’s work itself. The story is quite a bit more complicated, nuanced, and scientific than you might have read.
What is Traditional Chinese Medicine?
Traditional Chinese Medicine (TCM) encompasses a group of medical beliefs that have been developed in China over the past 2000 years. It includes diverse forms of complementary and alternative medicine including acupressure, acupuncture, reflexology, herbal medicine and other forms of beliefs.
TCM is based on the qi (or chi) principle of energy. Qi is said to be channelled through a complex system of meridians in the body. There is no evidence whatsoever that qi or meridians exist anywhere, it is just a form of fantastical medicine, like homeopathy, that is based on beliefs rather than evidence.
Much of TCM is worthless to science-based medicine. Acupuncture, probably the best known TCM “therapy,” does not work in most cases. No, it doesn’t work. Seriously, it doesn’t work.
Yes, some people can cherry pick a few published articles that support acupuncture here and there. But anyone with a critical mind can see that the studies do not do anything close to confirming acupuncture’s clinical usefulness.
People who support TCM tend to use the pejorative, “Western Medicine,” to describe the difference between TCM and all other medicine. It is a method to make it appear that the mystical properties of TCM are beyond Western understanding.
But there’s an old saying, attributed to Tim Minchin (but I’ve heard it said differently by others,
[infobox icon=”quote-left”]By definition (I begin), alternative medicine (I continue) has either not been proved to work or been proved not to work. Do you know what they call alternative medicine that’s been proved to work? Medicine.[/infobox]
Which leads me to Dr. Tu’s research.
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Why did Dr. Tu get the Nobel Prize?
I don’t claim to be an expert on the Nobel Prize. But it’s well known that there’s a certain amount of politics behind the prizes, often preventing good people from getting it (Jonas Salk never got the Nobel Prize for the polio vaccine) or allowing undeserving people to get it.
But in the case of Dr. Tu, she probably deserved it. The story behind her research is fascinating.
During the Vietnam War, Ho Chi Minh, the leader of North Vietnam, asked Chinese Premier Zhou Enlai for help in developing a malaria prevention or treatment for North Vietnamese soldiers who were marching down the Ho Chi Minh trail to South Vietnam to engage their enemies. Unfortunately, a majority came down with a form of malaria which is resistant to chloroquine, the common treatment for malaria.
In addition, malaria was also a major cause of death in China’s southern provinces (the diseases vector, a species of mosquito, prefers tropical environments), Zhou Enlai convinced Mao Zedong to set up a secret drug discovery project, named Project 523 after its starting date, 23 May 1967.
Dr. Tu asked to join the project (“asked” may not have been the way it was actually done) and was ordered to go to Hainan where she studied patients who had been infected with the disease.
As a little background, scientists worldwide had screened over 240,000 compounds as treatments to malaria without success. In 1969, Dr. Tu had an idea of screening traditional Chinese herbs for their efficacy in treating malarial infections.
She investigated old manuscripts and books about Chinese medicine, and visited TCM practitioners across China. She gathered all of her findings which summarized about 640 different prescriptions, 2000 recipes, and 380 herbal extracts. All of which were then tested in mice.
Through all that work, she discovered artemisinin (also known as qinghaosu) and dihydroartemisinin, which is now used to treat malaria worldwide. Yes, the basis of this treatment is from someone, long ago, writing about making a qinghaosu tea. But she discovered that boiling it destroyed most of the two active ingredients, so she used real science to isolate those ingredients and then to purify them without destroying their activity.
Sure Chinese herbal medicine gave us the treatment. But it took Dr. Tu’s real scientific research methods to find the one cure out of the 3,020 claims. So if you believe in cherry picking one success out of 3,019 failures or confirmation bias, sure Dr. Tu’s work “proves” TCM is real.
Dr. Tu’s real work
As I mentioned above, paraphrasing Tim Minchin, TCM that works is just called medicine. Most of it doesn’t work.
It’s hysterical that naturopaths (another pseudoscience), jumped on board with this tweet:
— AANMC (@AANMC) October 5, 2015
Others have criticized the proclamation that this Nobel Prize in medicine is confirmation that TCM, or specifically Chinese herbal medicine, is “right,” so I wanted to take a look at it differently. Let’s look at what makes real drug research.
Here’s how real drug discovery is done:
- Find a chemical compound that treats a specific clinical condition. It doesn’t matter where it’s found, ancient Roman or Chinese texts, Native American traditions, luck, or logical analysis of the target and potential synthetic molecules. No one cares where it arises.
- Find the active ingredient. Just because some plant may give some medical benefit, that’s just a small step to a real drug. The active ingredient must be found and isolated, so that dosage and purity can be controlled.
- Test the isolated compound for toxicity. Create a dose-response curve.
- Test the isolated compound for efficacy. Create a dose-response curve.
- Test the isolated compound for efficacy and toxicity in an animal model.
- Develop a method to get the drug to the target, in this case, the malaria parasite. This isn’t easy. Maybe the drug is toxic at one level, but kills the parasite at a lower level, so how do you deliver it that way? Maybe it’s eliminated from the body quickly, before it has an effect, how do you prevent that? It’s not simply grinding up the plant, then consuming it.
- Test the isolated compound for clinical efficacy in randomized clinical trials.
- Develop a manufacturing system that includes purification of the target compound in economically viable amounts.
- Get approval from regulatory agencies.
Just nine easy steps to drug development. Except, they aren’t easy. Dr. Tu examined over 3000 compounds for malaria treatment. Each one probably got to step 5 before she could accept or reject it. That took decades.
In fact, Dr. Tu’s initial results weren’t published until the 1980s, 15 years after she started. And it took more than that. The researchers had to develop a derivative of the active ingredient, artemisinin, so that the drug would stay in the body long enough to actually work against the malaria parasite.
But at that point, the drug still wasn’t available to anyone. Big Pharma had to step in at that point to bring Dr. Tu’s treatment to everyone:
[infobox icon=”quote-left”]A Swiss company, Novartis, finally broke the logjam. It bought a new Chinese patent on a mix of artemether, an artemisinin derivative, and lumefantrine, another Chinese drug, and took out Western patents, planning to sell it under the name Riamet at high prices to tourists and militaries; in 2001, it agreed to sell it nearly at cost to the W.H.O. under the name Coartem.
The money to buy the drug on a large scale became available with the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002 and the Bush administration’s introduction of the President’s Malaria Initiative in 2005. Now, about 150 million doses of several combinations are bought for poor countries each year.[/infobox]
it was a partnership between Novartis, one of the largest Big Pharma companies, WHO, governments across the world, and the Chinese patent to bring this drug to everyone.
Nobel prize has no relationship to TCM
The relationship between the Nobel Prize and traditional Chinese medicine is non-existent. Yes, the original claim that qinghaosu might treat malaria was found in some ancient text. But it did it wrong. And there were over 3000 failed ancient treatments to the one that worked. That’s not even good random luck.
So, if you’re going to make some claim that Dr. Tu’s research somehow confirms Traditional Chinese Medicine – don’t. Because it doesn’t. It took a brilliant medical researcher using scientific research skills and Big Pharma to bring one, and I mean one, Chinese herbal drug to the market. And it took 30 years. And unknown amount of money.
There is no Western medicine that’s somehow worthless compared to Traditional Chinese Medicine. There is only medicine, supported by vast amounts of evidence, or there’s magic, belief, and nonsense, supported by nothing.
The Nobel Prize for medicine given to Dr. Youyou Tu is a confirmation of her dedication to real biomedical research. That’s it, nothing else.
- Li GQ, Arnold K, Guo XB, Jian HX, Fu LC. Randomised comparative study of mefloquine, qinghaosu, and pyrimethamine-sulfadoxine in patients with falciparum malaria. Lancet. 1984 Dec 15;2(8416):1360-1. PubMed PMID: 6150365.
- In China, Dr. Tu would be known as Tu Youyou, as the family name comes first. To reduce confusion, I have Westernized her name to Youyou Tu.