The war against disease is an ever-evolving battle, with the organisms responsible for an illness constantly evolving traits that make them resistant to our drugs. In the late 1960s, the world was losing that battle to malaria, with the one effective drug, chloroquine, rapidly losing its efficacy.
From somewhere in China, an answer emerged: a new treatment called artemisinin derived from the sweet wormwood plant, Artemisia annua. The first paper describing the new treatment was published in Chinese in 1977, but no researchers were identified — doing so would have gone against both the group-before-individual ethos of Chinese society and the fact that the drug was discovered by a secret military project.
But a detective effort by researchers that began in 2007 uncovered the name of the woman primarily responsible for the project, Tu Youyou. “Until now,” The New York Times reported, “China’s scientific establishment had treated [Tu] somewhat dismissively.” She had never pursued a doctorate or international study.
In the end, her work spoke for itself.
On October 5, Tu was awarded the 2015 Nobel Prize in Physiology or Medicine for her discovery of a new way to battle malaria. She shares the prize with William C. Campbell and Satoshi Ōmura, researchers who discovered a new way to fight infections caused by roundworm parasites.
A discovery rooted in ancient Chinese medicine
Drug-resistant malaria began flaring up in the south of China and in Vietnam after attempts to eradicate the disease in the region failed in the 1950s. Malaria was killing more Vietnamese soldiers in North Vietnam than the war itself.
Even though China banned scientific publication at the time as part of the “Cultural Revolution,” the malaria problem was desperate, and on May 23, 1967, Mao Zedong launched a secret research project called 523 to try to find a cure. But as Phil McKenna explains at New Scientist, a few years testing hundreds of thousands of synthetic chemical compounds came up with nothing. The US also had zero luck.
So the Chinese government turned to Beijing’s Academy of Traditional Chinese Medicine. They selected Tu, a pharmacologist who had studied Western medicine but had also taken a training course in traditional Chinese medicine, to lead the search for a new drug.
In 2011, Tu wrote in Nature Medicine that the traditional course “guided me to the wonderful treasure to be found in Chinese medicine.”
Her research group pored over old texts and identified more than 2,000 potential herbal treatments. They extracted 380 compounds from more than 200 herbs and began testing them in malaria-infected mice.
Eventually, they had some luck with a derivative of sweet wormwood, qinghao in Chinese, but soon their potential discovery stopped working.
Tu delved further into the ancient texts, and as she explains it, they found a clue in the wonderfully titled “A Handbook of Prescriptions for Emergencies,” written by Ge Hong in the year 340. The instructions read: “A handful of qinghao immersed with 2 litres of water, wring out the juice and drink it all.”
She realised that they were potentially destroying the active ingredient in the plant by heating it to extract it, and so they switched to an alternative, lower temperature process.
It worked: first in mice, then monkeys. She then tested it for human safety on herself, according to McKenna. Then, they tested the drug on workers who’d contracted malaria in the jungle. Again, it worked.
Important weapons in the ongoing battle against disease
While Tu’s search of ancient herbal cures may sound like a strange course of action, there’s good reason to think that useful chemicals can be found in herbs, plants, vines, corals, and microbes all over the world. Rigorously testing hunches about natural compounds has led to countless lifesaving treatments.
The very first modern antibiotic, penicillin, comes from a fungus, and the vast majority of drugs used to fight infections and cancer have some root in the natural world. Very few medicines are fully synthetic.
Searching ancient recipes was a perfect way to find unique chemical compounds that there was some reason to think may have some efficacy, and in this case, it worked: Tu found something with a unique chemical structure that careful testing showed could kill the parasite that causes malaria.
“This was really important since only a new compound can resolve the drug resistance problem,” she told The Lasker Foundation when she was awarded their prestigious medical award in 2011.
Tu’s discovery of artemisinin, which could fight drug-resistant malaria, has significantly reduced the mortality rate of the disease, which more than 3.4 billion people are at risk of contracting every year.
According to the Nobel committee, her work saves more than 100,000 lives in Africa alone every year. The World Health Organisation says modern malaria treatments — which include some form of an artemisinin — have saved more than 3 million lives since 2000.
The battle to fight disease is never over though, and strains of the malaria parasite that are resistant to artemisinin have started to emerge. Now it’s usually used alongside another drug to help prevent the emergence of drug-resistant strains.
Perhaps more secrets for fighting other illnesses, caused by parasites or anything else, are hidden in old herbal cures — just waiting to be tested using modern scientific methods. “It is my dream that Chinese medicine will help us conquer life-threatening diseases worldwide,” Tu wrote in 2011.
As she told the Nobel committee, it’s searching for a new, old, or just unexpected method that’s needed to solve problems. “As a scientific worker we need innovation spirit to find new things,” she said.
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