The Nobel Prize in Physiology or Medicine is the absolute benchmark of impact in terms of biomedical research today. Whether the award reflects an advance in disease progression or treatment, or innovation of a novel technique, there are few biomedical scientists who won’t owe at least a small amount to the winners. Devoid of the political or cultural manipulations of the literature and peace prizes, it holds the ultimate respect for all life scientists worldwide.
This years winning triad have demonstrated key findings that have led to the generation of anti-microbial agents, which have, and will likely continue, to save millions of lives and improve the quality of life of millions more worldwide. From a research laboratory in a big city hospital it’s very easy to question why cancer and heart disease (my own research interests) aren’t winning everything, and yet the reality for most people on this planet is they are unlikely to ever reach an age where these (more commonly) Western diseases will be fatal.
Worryingly however, there are aspects of this year’s winner (Prof Youyong Tu) that have been seized by “alternative” medicine advocates, which is a risk for the misrepresentation of what the prize is for. Prof Tu used near-ancient texts to uncover that an herbal remedy has been used to treat symptoms consistent with malaria. Naturally, some have therefore assumed that this award is for herbal medicine (specifically Chinese traditional medicine). This is patently not true.
There are a multiple examples of ‘herbal’ remedies still having a place in conventional medicine. The ‘best’ medicines have survived this long because they work, and the best way to establish if a medicine is working is to generate a body of supporting evidence. Although in this case the ‘old hand’ evidence was consistent with the modern day’s, it is in effect a series of anecdotes rather than robust, controlled trial data.
So, why the Nobel Prize? Well Prof Tu worked out how to enrich the extracts and how to ultimately extract the active compound, which was identified to be artemesinin, which is found in wormwood plants. Latterly more active analogues of such a compound can be made, but the starting point was certainly ‘herbal’ rather than ‘pharmaceutical’. It’s an interesting note that aspirin was found in a similar way. So why is this not herbal medicine? Well, not one reasonable scientist will suggest that ‘nature’ doesn’t have compounds that are useful to medicine. Biofishing is essentially taking naturally occurring compounds and screening them for whichever biological readout you are looking for.
My own field of research mixes with people who examine plant extracts to inhibit blood vessel growth. Positive identification of such an agent relies in part on chance, because plant extracts contain multiple (probably thousands) of compounds. To test true function these must be isolated and tested. There is always the chance of isolating harmful compounds too, but a great deal could be entirely non-functional. Using appropriate techniques you will probably rule this out early on in the R and D process.
However, the key point is that the Nobel Prize is not for TCM – it was for the scientific rigour needed to refine, isolate and test beyond doubt that artemesinin was the active agent. Once the active agent is isolated, and the chemical composition and crystal structures elucidated, better versions can be made – more effective or less toxic (everything has a toxic dose). The evidence Dr Tu started with was purely anecdotal (granted it was a multiple occurring anecdote) but it’s essentially an idea, and it’s the starting idea that is the key to meaningful scientific progress. However, because that idea started elsewhere shouldn’t preclude it from being taken on and rationally tested. For every TCM compound that works, there remains an untested tincture that causes kidney failure. The natural world is beautiful and inspiring, but can be fucking nasty if used without appropriate guidance.