Nobel Prize 2015: A Victory for Chinese Medicine?

Youyou Tu, Winner of the 2015 Nobel Prize in Physiology or Medicine (image from nobelprize.org)

There has recently been a lot of celebration in the Chinese medicine community about the recent Nobel Prize awarded to Youyou Tu for her work with the Chinese Herb, Qing Hao (Artemisia annua). Her work is undoubtedly a victory for humanity’s struggle against infectious disease, but is this really a victory for Chinese medicine, as some would have us believe? Or is it just another example of traditional healing methods being appropriated by—and assimilated into—biomedicine? Without taking anything away from Tu’s remarkable achievement, I would suggest it is the latter.

Let me begin by saying that I understand the enthusiasm within the Chinese medicine community regarding the positive press surrounding this story. Indeed, many of my colleagues have reported an increased interest in Chinese herbal medicine from both their patients and the medical doctors with whom they work. Is this recent interest in Chinese herbal medicine going to translate into its increased acceptance within the medical field? I doubt it. The fact that people have associated this award with Chinese medicine is certainly a benefit to our community, but let us not confuse this tenuous association with the actual practice of Chinese herbalism. To call the isolation of Artemisinin from Qīng Hāo (Artemisia annua) a victory for Chinese medicine is a bit like calling the isolation of Nicotine from the tobacco plant a victory for Native Americans.

Please forgive my reluctance to celebrate, but I see the news coverage in a slightly different light. To me, the implication of the recent press about Artemisinin is that Chinese medicine will continue to be assimilated into biomedicine, and that pharmaceutical companies will continue to mine traditional herbal remedies for the next wonder-drug, without any respect for the systems of medicine from which they are derived.

Artemisia annua (image from wikipedia.org)

Don’t get me wrong—medicine is medicine, and if the pharmaceutical industry finds some new miracle drug for HIV or Cancer in a plant, that is a victory for all humanity, and one worth celebrating. My contention, simply, is that it is not necessarily a victory for the indigenous systems that initially recognized the medical value of these plants. Despite Tu’s nod to Ge Hong, a 4th century alchemist whose book, Zhouhou beijifang (肘後備急方), mentions the use of Qīng Hāo (Artemisia annua) for the treatment of malaria (疟),¹ many of the news stories describing her discovery subtly imply that the isolation and extraction of certain plant alkaloids is an “improvement” or an “evolution” of these ancient methods. Some even spin this as a triumph for “integrative medicine”.

Nonsense!

In my eyes, this is a one-sided victory for biomedicine, and one that advances the false notion that the value of Chinese medicine can only be accepted in the context of that paradigm. Sadly, this notion is sometimes reinforced by members of our own community, who discard traditional methods of Chinese herbalism (e.g. taste and temperature of an herb) for more modern ones (e.g. alkaloid content and pharmacological properties of an herb).

Artemisinin (from wikipedia.org)

We know our place within the American medical establishment, and the isolation and extraction of a drug from a traditional Chinese herb is not going to change that to any significant degree. Are we, as practitioners of Chinese medicine, going to be able to prescribe these isolated extracts? I don’t think so. In fact, if a Chinese herbalist in America were to create a product with Qīng Hāo (Artemisia annua), and put “for the treatment of malaria” on the label, they would be violating FDA regulations, which stipulate that herbs are dietary supplements—not drugs—and therefore cannot be used to treat specific biomedical diagnoses.²

In the end, as many have suggested, and as I concede, the short-term outcome is that more people are interested in Chinese medicine and Chinese herbs. That is a good thing! I do, however, worry about the potential long-term implications for our field.

Finally, I’d like to extend my congratulations to Youyou Tu for her Nobel Prize—it is, as I have previously noted, a victory for humanity—I’ll just stop short of calling it a victory for Chinese medicine.

Notes and References:
1. Zhouhou beijifang (肘後備急方) : Chapter 3, Section 16
又方 青蒿一握。以水二升渍，绞取汁。尽服之。
Another method [for treating malaria]: take one handful of Qīng Hāo and soak it in two shēng (~2cups*) of water. Wring it to get the juice, and take all of it.

*Translation note: The unit of measure used in the recipe, called 升-shēng in Chinese, has changed over time. In Ge Hong’s time (the Eastern Jin dynasty), one 升-shēng was 204.5mL (~1cup), but in the Ming or Qing dynasty, it was closer to 1L. Most of the translations of this recipe that you see in the news translate “2 升-shēng” as “2 liters,” but it is more accurately translated “2 cups.” So the method described by Ge Hong actually yields a far more concentrated medicinal liquid than many news sources, including the one cited below, suggest. (Many thanks to Leo Lok for initially pointing this out to me.)

Author’s note: I think it is also worth noting that, in Youyou Tu’s own words, it was the reference in Zhouhou beijifang (肘後備急方) that marked the “turning point” in her research—a key part of the story that is often glossed-over in the reporting. Previously, Tu’s results had been inconsistent, but the preparation method described in the Zhouhou beijifang yielded the crucial revelation that the temperature of the modern extraction method was too high and was therefore destroying some of the active compounds. Once she and her team began the extraction at a lower temperature, they “obtained much better activity”. This is from a 2011 article in Nature:

The turning point came when an Artemisia annua L. extract showed a promising degree of inhibition against parasite growth. However, this observation was not reproducible in subsequent experiments and appeared to be contradictory to what was recorded in the literature. Seeking an explanation, we carried out an intensive review of the literature. The only reference relevant to use of qinghao (the Chinese name of Artemisia annua L.) for alleviating malaria symptoms appeared in Ge Hong’s A Handbook of Prescriptions for Emergencies: “A handful of qinghao immersed with 2 liters of water, wring out the juice and drink it all” (Fig. 1). This sentence gave me the idea that the heating involved in the conventional extraction step we had used might have destroyed the active components, and that extraction at a lower temperature might be necessary to preserve antimalarial activity. Indeed, we obtained much better activity after switching to a lower-temperature procedure.

http://www.nature.com/nm/journal/v17/n10/full/nm.2471.html

2. FDA.gov

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© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content. All translations are mine, unless otherwise noted.