Saturday, October 17, 2015

Drug from TCM, TCM researcher wins Nobel Prize, TCM advocates claim victory.

Dr Tu conducted research in the 1970s, at the height of China's Cultural Revolution, that led to the discovery of artemisinin, a treatment based on traditional medicine - a herb called sweet wormwood or Artemisia annua. This is now a treatment for malaria and she won the Nobel Prize (well half of the prize) for Medicine. 

Advocates of TCM immediately claimed a victory and validation of TCM.

Well, they would like to think that it is.

Turning point for traditional Chinese medicine

Oct 11, 2015,

Sharing of Nobel Prize with TCM researcher shows slight change in Western science's view of alternative medicine
Marta Hanson

I am sure I am not the only one surprised by the announcement that half of the 2015 Nobel Prize in Physiology or Medicine has gone to a researcher who spent her entire career researching traditional Chinese medicine (TCM).

Based at the Chinese Academy of Traditional Chinese Medicine in Beijing (now the China Academy of Chinese Medical Sciences) since 1965, scientist Tu Youyou, her colleagues, and home institution may well be just as stunned as I am. Being granted the Lasker Award is often a good predictor of Nobel Prize prospects. Dr Tu received one in 2011 for her discovery of artemisinin as an alternative malaria cure to the standard chloroquine, which was quickly losing ground in the 1960s due to increasingly drug-resistant parasites.
Scientific research on the pharmaceutically active properties of traditional Chinese medicinals, however, has never been a predictor for such widespread international recognition.

Traditional medical knowledge anywhere in the world has not even been on the radar for Nobel Prize prospects. Until now, that is. So how should we interpret this arguably seismic shift in international attention on TCM?

[It is not.]

In the question-and-answer session after the announcement at the Karolinska Institute, which awards the Nobels, one of the panellists emphasised not just the quality of Dr Tu's scientific research, but also the value of recorded empirical experience in the past.

The antifebrile effect of the Chinese herb Artemisia annua, or sweet wormwood, was known 1,700 years ago, he noted. Dr Tu was the first to extract the biologically active component of the herb - called artemisinin - and clarify how it worked. The result was a paradigm shift in the medical field that allowed for artemisinin to be both clinically studied and produced on a large scale.

Dr Tu has always maintained she drew her inspiration from the medical text of fourth-century Chinese physician Ge Hong (circa 283-343).

His Emergency Formulas To Keep At Hand can best be understood as a handbook of drug formulas for emergencies. It was a book light enough to keep in one's sleeve, where Chinese men sometimes carried their belongings. We can discern from Ge's astute description of his patients' symptoms that people then suffered not only from malaria but also from other deadly diseases, including smallpox, typhoid and dysentery. Beyond recording the fever-fighting qualities of Artemisia annua, Ge also wrote about how Ephedra sinica (red Realgar) effectively treated respiratory problems and how arsenic sulphide helped control some dermatological problems.

Just because a compound has natural roots and has long been used in traditional medicine is no reason to take it lightly.

In 2004, the US Food and Drug Administration actually banned ephedra-containing dietary and performance-enhancing supplements. They had been the cause not only of serious side effects but also several deaths. The ban remains in effect in the US. Related drug ephedrine, however, is used to treat low blood pressure and is a common ingredient in over-the-counter asthma medicines.

As for Realgar, its toxicity was well-known in both ancient Greece and Chinese antiquity. In Chinese medical thought, though, skilfully administered toxins may also be powerful antidotes for other toxins. Realgar thus continues to be used in Chinese medicine as a drug that relieves toxicity and kills parasites. Applied topically, it treats scabies, ringworm and rashes on the skin's surface; taken internally, it expels intestinal parasites.

Although biomedicine does not currently use Realgar or its related mineral arsenicals in treatments, Chinese researchers have been studying their anti-cancer properties for some time now. In 2011, a Johns Hopkins University researcher, Dr Jun Liu (with other colleagues), also discovered Chinese medicinal plant Tripterygium wilfordii Hook F is effective against cancer, arthritis and skin-graft rejection.

Dr Tu's groundbreaking work on artemisinin, in fact, can be seen as the tip of the iceberg of the extensive and global scientific study of pharmacologically active Chinese medicinals, including another successful anti-malarial Dichroa febrifuga that has roots in the new scientific research on Chinese medicinals in 1940s mainland China.

It was validation of this traditional drug as an anti-malarial in the 1940s, in fact, that set the foundation for Chinese leader Mao Zedong's directive two decades later in the late 1960s to find a cure for malaria. Indeed, Dr Tu's research is best understood within the complex politics and history of top-down support from the Chinese government of Chinese medicine in mainland China during the long period of the 20th century, and not just in the Maoist period.

Even outside mainland China, though, such research has yielded results. In the 1970s, for example, US and Japanese researchers developed the statin drugs used to lower cholesterol from studying the mold Monascus purpureus that makes red yeast rice, well, "red".

Empirical evidence of the medical efficacy in the rich Chinese medical archive from centuries earlier similarly influenced the initial direction of this research.

So is this Nobel Prize for Dr Tu's discovery a signal that Western science has changed how it perceives alternative systems of medicine? Perhaps, but only slightly.

One of the Karolinska Institute panellists acknowledged there are many sources from which scientists draw inspiration to develop drugs. Among them, we should not ignore the long history of experiences from the past. As he clarified, such sources may be inspirational, but the old herbs found there cannot be used just as they are. Do not underestimate the sophisticated methods Dr Tu used to extract the active artemisinin compound from Artemesia annua, another one of the panellists concluded.

So the Nobel Prize is not only acknowledging this complete transformation of a Chinese herb through modern biomedical science into something powerfully efficacious, but also the millions of lives saved because of its successful application worldwide.

But there is something else that marks Dr Tu as extraordinary vis-a-vis both her two fellow Nobel laureates for medicine, Dr William Campbell and Dr Satoshi Omura, and her more Western medically oriented colleagues in pharmacology. She 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 also to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.

This medical bilingualism is a quality that current researchers mining the same fine line between the empirical knowledge of traditional medical traditions and the highest level of modern biomedical science would be lucky to share with Nobel laureate Tu Youyou.

The writer is Associate Professor of the History of Medicine at Johns Hopkins University

This article first appeared on The Conversation US, a website of analysis from academics and researchers.

3 scientists share Nobel Prize in medicine

Oct 6, 2015,

Their work led to creation of powerful new drugs to fight parasitic diseases

STOCKHOLM/LONDON • Three scientists from Japan, China and Ireland, whose discoveries led to the development of potent new drugs against parasitic diseases such as malaria and elephantiasis, have won the Nobel Prize in medicine.

Irish-born Dr William Campbell and Japan's Dr Satoshi Omura won half of the prize for discovering avermectin, a derivative of which has been used to treat hundreds of millions of people with river blindness and lymphatic filariasis, or elephantiasis, a parasitic infection that can lead to swelling of the arms and legs.

River blindness is an eye and skin disease caused by a parasite, and which can lead to loss of sight.

China's Dr Tu Youyou was awarded the other half of the prize for discovering artemisinin, a drug that has slashed malaria deaths and has become the mainstay of fighting the mosquito- borne disease.

Some 3.4 billion people, most of them living in poor countries, are at risk of contracting these parasitic diseases.

"These two discoveries have provided humankind with powerful new means to combat these debilitating diseases that affect hundreds of millions of people annually," the Nobel Assembly at Sweden's Karolinska Institute said. "The consequences in terms of improved human health and reduced suffering are immeasurable."

Today, the drug ivermectin, a derivative of avermectin made by Merck & Co, is used worldwide to fight roundworm parasites, while artemisinin-based drugs from firms including Sanofi and Novartis are the main weapons against malaria.

Dr Omura and Dr Campbell made their breakthrough in fighting parasitic worms, or helminths, after studying compounds from soil bacteria. That led to the discovery of avermectin, which was further modified into ivermectin. The treatment is so successful that river blindness and lymphatic filariasis are now on the verge of being eradicated.

"I humbly accept the prize," 80-year-old Dr Omura, a professor emeritus at Kitasato University, said in an interview with the Nobel Foundation, thanking the "many, many researchers" who had contributed to his findings.

Dr Tu, 84, is the first female Chinese national to win a Nobel prize in science. She turned to a traditional Chinese herbal medicine in her hunt for a better malaria treatment, following the declining success of the older drugs chloroquine and quinine. This led to the isolation of artemisinin, a new class of anti-malaria drug.

Dr Tu has been chief professor at the China Academy of Traditional Chinese Medicine since 2000. She conducted research in the 1970s, at the height of China's Cultural Revolution, that led to the discovery of artemisinin, a treatment based on traditional medicine - a herb called sweet wormwood or Artemisia annua.

"We now have drugs that kill these parasites very early in their life cycle," said Professor Juleen Zierath, chair of the Nobel Committee. "They not only kill these parasites but they (also) stop these infections from spreading."

The 8 million Swedish kronor (S$1.4 million) medicine prize is the first of the Nobel prizes awarded each year.

The Nobel awards week continues with the announcement of the prize for physics today, chemistry tomorrow, and literature on Thursday. The peace prize will be awarded on Friday, with the economics prize next Monday.


Nobel Prize a boost to TCM

Oct 8, 2015

There are many things significant about China's Dr Tu Youyou's win of the Nobel Prize in medicine ("3 scientists share Nobel Prize in medicine"; Tuesday).

Besides being the first woman Chinese national to win a Nobel Prize in science, she is also the first Chinese national educated entirely in China and conducting research in a Chinese institution to win the prize in science.

Previous Chinese nationals who did so conducted their research in foreign institutions.

This is an important milestone for Chinese science. Dr Tu's achievement should be an encouragement to traditional Chinese medicine (TCM) universities that have struggled to gain world recognition for their scientific work.

Hong Hai (Dr)

Tenuous link to Nobel Prize win

Oct 14, 2015

Contrary to the views of Dr Hong Hai ("Nobel Prize a boost to TCM"; last Thursday) and others ("Turning point for traditional Chinese medicine"; Sunday), Dr Tu Youyou's contributions to medicine that won her the Nobel Prize have nothing to do with traditional Chinese medicine (TCM).

Many Western drugs, such as morphine, atropine, quinine, reserpine and vincristine, originally came from plants.

With the progress of Western sciences, the chemical formulae of many of these drugs have become known, and synthesis can be carried out.

Dr Tu's discovery of artemisinin in 1967 came about after her team combed through more than 200 plants.

It was due to her perseverance as well as the incidental reference to a 1,600-year-old Chinese text that the drug was found.

There are tens of thousands of similar mentions in ancient Chinese medical books regarding cures that are completely untrue.

Indeed, artemisinin seems to be the only credible drug that has emerged from Chinese herbs in the past century.

Without Western scientific laboratory methods, Dr Tu would never have been able to achieve her well-earned success.

It is not related to the practice of TCM.

Ong Siew Chey (Dr)

TCM still not a proven science

Oct 15, 2015

Dr Ong Siew Chey's views strongly resonate with my own ("Tenuous link to Nobel Prize win"; Oct 14).

Dr Tu Youyou's Nobel win is well deserved, but to perceive it as a validation of traditional Chinese medicine (TCM) is erroneous.

Dr Tu's efforts in drug discovery lie in the realm of pharmacognosy, the rigorous application of the scientific method in searching for potential drugs in natural compounds.

Concepts in the world view and philosophy of TCM such as "qi" and "meridians" are not demonstrable, nor can they be quantified or measured.

The dichotomy between "Chinese" and "Western" science and medicine is a false one.

There is simply good and bad science, and medicine that works and medicine that does not. TCM falls into the latter of both categories.

To those who charge that I am using "Western" standards to pass judgment upon an "Eastern" discipline, I agree.

The scientific method as it is currently practised and applied is the only and best yardstick we have in deciding whether or not a treatment works.

Whatever herb that is validated by science as an effective treatment for an illness stems from the fact that active chemical compounds within the herb achieve the desired therapeutic outcome.

The herb, in its purified form, automatically ceases to be "traditional" medicine and instead, simply becomes "medicine".

The fact that there are active ingredients in the herb has nothing to do with the pseudoscientific concepts of alternative medicine.

Dr Tu's win will be misinterpreted by many. I am confident that the Ministry of Health will not bow to bad science, and will resist calls to subsidise it at the expense of science-based ones.

Oon Ming Liang (Dr)

[Note: Comments on this story is closed. If you comment, it will go to moderation, and I will most likely delete it. Please see "Before you Comment" before you comment. My current position on TCM is that it placates and pacifies. Any effect is placebo effect. TCM is unlikely to harm, but gives the human body time to heal. Sometimes, the best thing a doctor can do, is nothing. But patients want something done. Enter TCM. The art of doing something while doing nothing. It's very zen.]

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