Nobel Prize and Tu Youyou — from Gun Powder to Antimalarial Drug

The Chinese invented gun powder during the Tang dynasty in the 9th century. But while China was perfecting its fireworks, the West was building more powerful gunships to force China to open its door in the modern era. And Alfred Nobel successfully built his fortune on dynamite and the manufacturing of cannons and other armaments. In 1895 he willed his considerable fortune to establish the Nobel Prize. Surprisingly, or not too surprisingly, for over 100 years, China never received a Nobel Prize in science until this year, when Tu Youyou was awarded the Nobel Prize in Medicine (as a co-winner in the Physiology/Medicine category) for the discovery of Artemisinin, a remarkably effective antimalarial drug. And 86-year old Tu traveled from Beijing to Stockholm to receive the prestigious prize at the 2015 Nobel Award ceremony on Dec. 10, yesterday.

The story of how Tu and her colleagues discovered Artemisinin is fascinating, almost like how Cinderella eventually made it to the royal castle (wait, Cinderella had it much easier, really). For many years, Tu was a virtual unknown in the world of science, and hence there was a widely circulated joke that when the Nobel Prize committee announced the winner as “to you you” OR “you you too”, everybody looked around and at each other: “is that you, or you, or you too??” Actually, Tu’s given name came from the ancient “the Book of Songs” that was re-compiled by Confucius around 500 BC. Her name was from one of the songs in the book that mentioned the gentle “you-you” sound of a baby deer, and hence Tu’s name “Youyou”. Furthermore, the song mentioned that the baby deer was nibbling on this brush plant called Sweet Wormwood or Artemisia Annua (or perhaps one of its relatives). As if already foretold by “the Book of Songs”, in 1971, Tu and the Chinese research team discovered that the extract from Sweet Wormwood may cure malaria.

The road to the discovery of this wonder drug is another True Grit story (I have written on this subject several times). In 1967, actually May 23 of that year, a secret project codenamed “523” was started at the direction of Chairman Mao to find a new cure for malaria at the request of the North Vietnamese during the height of the American Vietnam War. With some of the senior scientists having already been purged due to the political upheaval at the time, 39-year old Tu was asked to lead a Traditional Chinese Medicine team in 1969 to try to find a cure. Tu perused volumes and volumes of the ancient texts of Traditional Chinese Medicine, and traveled all over Southern China to find local folk remedies for malaria. In the end, she found that Sweet Wormwood was mentioned several times as a possible cure for malaria. Amazing, isn’t it? The cure was already in her name and in that sweet song from the ancient “the Book of Songs”.

But it was still during the Cold War, and China was embargoed by the Western world. Tu and the Chinese team only had access to some very basic or primitive lab equipment. During the height of Cultural Revolution, they had to use a basement room with poor ventilation and use a bathtub to extract the active ingredient from Sweet Wormwood. And after numerous failures, Tu again reached back into the annals of Traditional Chinese Medicine, and was inspired by Ge Hong (a Taoist and alchemist around 300 AD) to try a low-temperature method to extract the active ingredient. Between 1972 and 1973, Artemisinin and several of its derivatives were developed. After completing some very successful preclinical studies, Tu and two colleagues volunteered to try the drug on themselves to assess its safety and to speed up the clinical trials. The result was a great success. But in China then, it was all about collective work not individual heroism. So Tu always remained anonymous. Also Tu never had a formal advanced degree given the academic situation in the early new China.

China finally opened up after Deng Xiaoping took office. Tu presented the result to the world in 1981. The world was impressed with this new wonder drug against malaria. There are around 200 million people suffering from malaria worldwide. And nowadays Artemisinin is being used as part of a standard treatment regimen against malaria, and has helped to save many, many lives. (But China did not understand the concept of intellectual property protection then and did not file patents on Artemisinin.)

86-year old Tu has osteoporosis and couldn’t walk or stand much these days, and she also has some other health problems as a result of working under poor laboratory conditions at the time. But remarkably she is still doing research part time. When Tu finally got to the podium to receive the Nobel Prize for her contribution in the fight against Malaria, Tu attributed the success to a team that labored and persevered under primitive and harsh conditions, and said Artemisinin is a gift from China and from its treasure of Traditional Chinese Medicine to the world, to the millions and millions of people, especially poor children, all over the world who are constantly at the mercy of malaria. Yes, a Cinderella finally got her day in that esteemed castle of the Nobel Prize, which was originally built upon wealth accumulated on an invention China made over 1000 years ago. That is some sweet song, isn’t it?

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