Tu Youyou Is the First Chinese National to Win Nobel Prize in a Scientific Field

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Update 10/9: The New York Times interviewed Dr. Tu after her win.

The 2015 Nobel Prize in Physiology or Medicine was awarded on Monday to Drs. William C. Campbell and Satoshi Omura, who jointly share one-half of the award “for their discoveries concerning a novel therapy against infections caused by roundworm parasites”, and Tu Youyou (屠呦呦), who won the other half “for her discoveries concerning a novel therapy against malaria”.

Tu, chief professor at China Academy of Chinese Medical Sciences (formerly known as China Academy of Traditional Chinese Medicine), is recognized for role in for identifying, extracting, and showing the efficacy of a compound named artemisinin in treating malaria.  Her inspiration for discovering and isolating this compound came from traditional Chinese medicine’s use of sweet wormwood (青蒿素) to treat fevers, which can be indicator of malaria.   Medicines and treatments created from artemisinin have saved millions of lives, and she was previously honored in 2011 for her achievements with the Lasker DeBakey Clinical Medical Research Award, often called a pre-cursor to a Nobel win.

The Nobel Foundation explains “When used in combination therapy, it is estimated to reduce mortality from Malaria by more than 20% overall and by more than 30% in children.  For Africa alone, this means that more than 100 000 lives are saved each year.”   The World Health Organization estimates that more than 1 billion artemisinin-based treatment courses have been administered and that the Nobel prize for artemisinin is “a tribute to the contribution of the Chinese scientific community in the fight against malaria.”

Born in Ningbo, Zhejiang Province in 1930, Tu graduated from Peking University School of Medicine in 1955 and worked as a researcher at China Academy of Traditional Chinese Medicine.  In 1969, during the Cultural Revolution, she joined a secret military program named Project 523 commissioned by Mao Zedong himself two years earlier to find a cure for malaria which afflicted thousands in southern China and Northern Vietnamese Communist soldiers fighting in the mosquito-infested jungles of China’s southern neighbor.   Shielded from the chaos of the time, one group investigated 40,000 known compounds, while the other searched traditional Chinese medicine and folk medicine for potential treatments.

This photo released by Xinhua News Agency on Monday Oct. 5, 2015 and taken in the 1950s, shows Tu Youyou, right, a pharmacologist with the China Academy of Chinese Medical Sciences in Beijing, working with professor Lou Zhicen to study traditional Chinese medicine. Three scientists from Ireland, Japan and China won the 2015 Nobel Prize in medicine on Monday, Oct. 2015 for discovering drugs against malaria and other parasitic diseases that affect hundreds of millions of people every year. Tu of China was awarded the prize for discovering artemisinin, a drug that has helped significantly reduce the mortality rates of malaria patients. (Xinhua via AP) NO SALES

Tu Youyou, right, a pharmacologist with the China Academy of Chinese Medical Sciences in Beijing, working with professor Lou Zhicen to study traditional Chinese medicine. Photo: Xinhua News Agency

She and her team belonged to the second group and began by reviewing 2,000 Chinese herb preparations and identified 640 with potential antimalarial activities.  Testing more than 380 extracts obtained from approximately 200 Chinese herbs, they discovered an extract from sweet wormwood was effective in inhibiting malaria in mice but were unable to consistently reproduce the results.   Scouring the literature for an explanation, they found a relevant use of sweet wormwood in Ge Hong‘s (葛洪) 1,600 year old treatise A Handbook of Prescriptions for Emergencies 《肘后救卒方》 and realized that the heat used during the extraction process may cause the active compound to decompose.  In 1972, after modifying the process, they found the new extract to be 100% effective for treating malaria in mice and monkeys.

She volunteered to be the first human subject.  “As the head of this research group, I had the responsibility,” she explained.  In a more heroic statement perhaps in line with the times, she also said, “The work was the top priority so I was certainly willing to sacrifice my personal life.”   After experiencing no ill-effects, the compound was tested on malaria-afflicted people, and within 30 hours their symptoms subsided.

It wasn’t until 1977 that a paper on the work was published, but artemisinin’s journey to being included on the World Health Organization’s list of essential medicines had just begun.  Despite English-language scientific articles about artemisinin appearing in 1979 and Tu presenting her research at an international meeting sponsored by the World Health Organization and the United Nations Development Bank, political disarray in China, a lack of interest from pharmaceutical companies resulting from a lack of patent protection in western countries and apathy towards the poor countries where malaria is mostly like to be spread, impeded the development of treatments.  The World Health Organization did not endorse use of artemisinin until 2000, and it was not widely available until 2006, thanks to the Bush administration’s President’s Malaria Initiative.

As the compound became the central component of malaria treatment worldwide, organizations sought to recognize its discoverers.  However, from the very beginning, it was not clear that Tu should be solely credited with the discovery.   In 1996, The Qiu Shi Science and Technology Foundation (求是科技基金会) recognized 10 scientists, including Tu, for their contribution to “the understanding of artemisinin and its derivatives”.   In 2009, the European Patent Office bestowed a “European Inventor of the Year” award to Zhou Yiqing, another Project 523 scientist who helped discover artemisinin and later worked with pharma company Novartis to develop Coartem, the first fixed dose artemisinin-based combination therapy to meet the World Health Organization’s pre-qualification criteria for efficacy, safety and quality.

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Chemical structure of artemisinin

When Tu won the Lasker Award in 2011, the simmering of some Chinese and Western scientists who did not think the discovery should be solely credited to her came to a boil.  Throughout this 30-year controversy, Tu insists it was her insight into the extraction method that led to the successful isolation of the compound.  She says that “she was one of the four anonymous authors of the initial 1977 paper” and that in 1978 was “chosen to accept the Chinese government’s overall award to Project 523”.  However, after winning the Lasker Award, she sought to placate critics, telling Xinhua News, “I think the honor not only belongs to me but also to all Chinese scientists.”

Nobel rules do not allow more than three winners in a category.

“I don’t have special feelings [about winning the award]…I was a little bit surprised, but not very surprised,” she was quoted as saying by Zhejiang Evening News about her Nobel win, which she learned about through television news.  “Because this is an honor not only for myself, but also for all Chinese scientists. We all did decades of research together.”   In her interview with CCTV, she recognizes her whole team and talks of national pride.

The pharmacologist told the Nobel Foundation in a telephone interview, “I am very glad that the new anti-malaria drug, artemisinin, has earned international recognition from the Nobel Prize committee.  Chinese people have wished to win the Nobel Prize for a long time.”  People’s Daily heralds her as a savior of Chinese science: “Tu saved the confidence of Chinese scientists, who will care less about whether a Chinese scientist be awarded the Nobel Prize in the future.”

She is the first Chinese scientist to win a Nobel Prize for work done in China, China’s first Nobel laureate in medicine, and only the 12th female laureate in the category in the 106 year history of the awards.  Defining a winner’s country by his or her birthplace and not counting Taiwan or Tibet to be part of China, the Nobel Foundation now counts 11 winners from China.   Wikipedia uses a different definition for its 16 “Chinese Nobel Laureates” that categorizes them as “Han Chinese laureates”, “Non-Han Chinese minority ethnic group Laureates born in China”, and “Non-Chinese Laureates born in China”.   The Chinese government, on the other hand, considers Mo Yan, who won the Nobel for literature in 2012, to be the first Chinese winner.

Tu has been called the “Three Withouts Scientist” for having achieved international recognition without a doctorate degree, without studying abroad, and without membership in the Chinese Academy of Sciences.  Before suggesting the need for a more flexible system to assess and reward scientists, People’s Daily says of her modest pedigree:

“The fact that Tu has none of these three backgrounds also reminds us that science should be more accessible to all. One shall be able to become a scientist no matter what kind of background he or she comes from, as long as one devotes into scientific research. There have been discussions on people who really love science are never aiming the awards. They might not achieve much during their whole lives. But their contributions are infinite. They work so hard to prove the wrong way so that the future researcher will be closer to the right one.”

While the state-sponsored newspaper sees the win as proof that anybody can achieve success in the sciences and contributing is its own reward, Wang Yuanfeng (王元丰) a professor at Beijing Jiaotong University, believes “the win showed the need to overhaul the academy, which has been criticized for putting political connections before research achievements.”  Continuing from The New York Times‘ Sinosphere blog:

‘Tu Youyou’s winning of the Nobel Prize can provide impetus for further reform of China’s science and technology system,’ Professor Wang wrote in an online commentary.

‘Also, I think that Tu Youyou’s prize should lead to deeper reflection about China’s scientific efforts,’ he wrote. ‘It’s undeniable that, despite the quite vigorous reforms over the past two years to national science and technology planning and management, and to the system of academicians, there are still many problems in the system and institutions of China’s scientific endeavors. The prize for Tu Youyou has raised questions precisely about this.’

Lan Xue (薛澜), an innovation-studies specialist at Tsinghua University believes Tu could be an inspiration to singularly focused young Chinese scientists who are encouraged to go overseas, produce good research, and get published in prestigious journals: “Tu doesn’t fit into any of the trends today, and yet she gets the Nobel because of the originality of her work. It couldn’t have been a better choice in terms of the lessons it offers Chinese scientists.”

While Chinese Premier Li Keqiang’s congratulatory letter to Tu said her award “marks a great contribution of traditional Chinese medicine to the cause of human health,” Juleen R. Zierath, chairman of the Nobel Committee for Physiology or Medicine emphasized in an interview with Xinhua that the award was for Tu’s scientific process.  “[W]hat was really critical was that Tu Youyou identified the active agent in that plant extract,” Zierath said, adding “there was a lot of modern chemistry, bio-chemistry attached to this to bring forward this new drug.”

The win is sure to bolster interest in TCM and its the $60 billion a year industry.  Marta Hanson, an assistant professor of history of medicine at Johns Hopkins University believes that this award will be a turning point for traditional Chinese medicine and says Tu “embodies, in both her history and her research, what [she] calls medical bilingualism – the ability not only to read in two different medical languages but to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.”

Quartz reporter Akshat Rathi hopes this medical bilingualism will help combat what he calls the “single worst practice of traditional Chinese medicine”.   Signing an open letter to Tu as “A rationalist”,  he implores Tu to spread the role of modern science in TCM and to help bring an end to unproven pseudoscientific practices of Traditional Chinese Medicine which profess the healing powers of animal parts — often obtained from illegal poaching of endangered species — such as elephant tusks, rhino horns, and nearly every part of the tiger.  Tu is already one step ahead of Rathi.  In a 2011 article for Nature in which she discussed the discovery of artemisinin and its development internationally, Tu identified other TCM treatments that were shown effective through scientific study.