MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The Nobel Prize committee has just awarded this year’s prize to a Chinese researcher from the Chinese Academy of Traditional Chinese Medicine (TCM) in Beijing. To be precise, the 2015 Nobel Prize in Physiology or Medicine was given jointly to three scientists from three different institutions, William C. Campbell, Satoshi Ōmura and Youyou Tu, for their work on new anti-malaria drugs. A small excerpt from the press-release of the committee tells us more about the possibility of a TCM connection:

Malaria was traditionally treated by chloroquine or quinine, but with declining success. By the late 1960s, efforts to eradicate Malaria had failed and the disease was on the rise. At that time, Youyou Tu in China turned to traditional herbal medicine to tackle the challenge of developing novel Malaria therapies. From a large-scale screen of herbal remedies in Malaria-infected animals, an extract from the plant Artemisia annua emerged as an interesting candidate. However, the results were inconsistent, so Tu revisited the ancient literature and discovered clues that guided her in her quest to successfully extract the active component from Artemisia annua. Tu was the first to show that this component, later called Artemisinin, was highly effective against the Malaria parasite, both in infected animals and in humans (Figure 4). Artemisinin represents a new class of antimalarial agents that rapidly kill the Malaria parasites at an early stage of their development, which explains its unprecedented potency in the treatment of severe Malaria.

One does not have to be a clairvoyant to predict that this event will now be celebrated by TCM fans as a vindication of TCM. But is this justified?

The antifebrile effect of the Chinese herb Artemisia annua (qinghaosu 青蒿素), or sweet wormwood, has been known 1,700 years ago. Tu was the first to extract the biologically active component of the herb, Artemisinin, and discover how it worked. As a result, Artemisinin could be studied and tested for efficacy. Fortunately these tests turned out positive, and subsequently Artemisinin could be produced on a large scale and made available for those who needed it.

Tu’s achievements are huge, and I do unreservedly and enthusiastically applaud her for getting this prestigious award. But is it an award for TCM?

No!

One could even argue that Tu showed how insufficient TCM can be. Artemisia was not used for malaria in TCM, it was used to lower fever. In fact, the whole plant extract shows not enough activity to be effective for malaria. It was not employed to treat a disease but to ease a symptom. TCM physicians had no idea what malaria was, what its cause was, or how it should be treated effectively. It needed a skilled scientist, modern scientific tools and systematic research to make these discoveries.

So, what does this episode really tell us?

Amongst other things,I think, it shows that medicine is open to discoveries regardless where they come from, that experience alone is normally insufficient to make progress, that China has some good scientists who can do amazing work, that plants contain millions of interesting molecules of which some might be therapeutic, that tenacity and skill is usually required to make an important break-through… WHAT IS DOES NOT SHOW, HOWEVER, IS THAT THE MERITS OF TCM HAVE BEEN AKNOWLEDGED BY A NOBEL PRIZE.

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