Nobel For Traditional Medicine Of China, Meanwhile In India. . .

While research on traditional knowledge of medicine in China gets a boost from the Nobel, in India, researchers making steady progress on ayurgenomics have to suffer a defamation campaign run by sections of the media.

Nobel Prize for medicine, 2015 has been shared by three people of whom Youyou Tu has attracted high attention. She is neither a ‘doctor’ and nor does she hold an academic PhD. Her research is in traditional Chinese medicine (TCM). Her achievement was that she isolated anti-malarial principle artemisinin from a well-known Chinese herb, sweet wormwood, Artemisia annua.

The interesting story begins with Vietnam.

It was during the US occupation of Vietnam. Initially, China was in support of Vietnam (but a day would come when US would attack Vietnam while Mao was shaking hands with Nixon in China, but that was later). Mao saw in his support for Ho Chi Minh a counter to Soviet expansionism. Stalin, very reluctantly, had agreed to accept Vietnam as a Communist state. When Ho visited Moscow in February 1950, Stalin was not exactly enthusiastic.

Ho had a demand. Malaria was killing his soldiers in the jungles of Vietnam. More than to the enemy bullets it is to malaria that the Vietnamese soldiers were getting lost. So he requested the USSR to supply him with the anti-malarial drug, quinine. USSR was already an established manufacturer of the drug. Stalin, who had not even recognized Ho’s visit as an official one, obliged him by sending, ‘ridiculously small amount of one-half ton’. (1)

Mao perceived in this a lot of things. Soviet Union could not be trusted with life-saving medicine. And with Vietnam War happening in his own border, Chinese soldiers too would have had to enter the Vietnam jungles at any time . So he ordered a search for an anti-malarial drug. The search also included looking into TCM which was considered in the Chinese progressive circles as ‘feudal superstition’. Though the Communists relied on TCM during their ‘long march’, when they came to power they imposed strict standards against it. According to Heiner Fruehauf, Mao reversed his anti-TCM policies because he did not want to be dependent on Soviet Union on the vital necessity of life-saving drugs. There are differing views on this. (2)

But what is relevant here is that Mao’s combat teams against Malaria also comprised of TCM physicians and researchers. Youyou Tu was one such person.

In 2011, an octogenarian Tu recounted in Nature how she searched for the anti-malarial principle in traditional formulations.

“During the first stage of our work, we investigated more than 2,000 Chinese herb preparations and identified 640 hits that had possible antimalarial activities. More than 380 extracts obtained from ~200 Chinese herbs were evaluated against a mouse model of malaria. However, progress was not smooth, and no significant results emerged easily”.

At last they hit upon the Artemisia annua L. extract which showed some promise. But there were problems of replicating it in subsequent explanations. However Tu discovered the reason in an 1800 years old Chinese medical manual. She says:

“A handful of qinghao immersed with 2 liters of water, wring out the juice and drink it all” 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”. (3)

The extract was obtained in 1971. But the conditions in Maoist China would not allow any clinical trials and Tu took the testing on herself. In 1972 they had identified the colorless, crystalline anti-malarial substance as having the molecular formula of C15H22O5. By 1977 the molecular structure of artemisinin had been identified by the team.

But the Chinese conditions prevented these discoveries to be reported beyond the Chinese language journals. ‘Fortunately’ writes Tu, ‘ in 1979, the China National Committee of Science and Technology granted us a National Invention Certificate in recognition of the discovery of artemisinin and its antimalarial efficacy.’. Maoist serendipity!
Then in 1981, the fourth meeting of the Scientific Working Group on the Chemotherapy of Malaria, sponsored by UNDP, WHO and World Bank, was held in Beijing and the presentation she made there took the discovery to the outside world. (4)

Chinese premier Li Keqiang has quickly positioned the Nobel prize as reflecting China’s ‘comprehensive national power and the uninterrupted rise of China’s global influence’. (5)

And that brings us to India. Had an Indian won the Nobel for medicine for similar reasons, and such statement been made by Modi, it would have been called ‘jingoistic’ by sections of the left-dominated Indian media.

Each time India takes forward her traditional knowledge into the realm of science, there has been a concerted effort from the Indian media to ridicule and negatively portray it. Ayurgenomics provides a case study in this regard.
Michael Heinrich and Anna K. Jäger in their textbook on ethnopharmacology define it thus:

“In Ayurveda the therapeutic regimen is designed according to the prakruti of individual patients and individual characteristics governed by what is today termed ayurgenomics. …Ayurgenomics focuses on understanding the possible relationship between prakruti and genome.” (6)

This is a bold new framework to use human genome for individualized medicine. With individualized medicines being positioned as the future of genome based medicine, this can really make India an unique leader in the field. Even if the exploratory approaches fail, our knowledge of human genome and our knowledge of Indic traditional medical system will be benefitted.

And the results are encouraging.

In March 2014, Nature (India) reported one such study online. It was done by a team that included Dr.Thelma, the head of Delhi University’s genetics department:

“They designed a study involving 350 patients diagnosed as amvata (the Ayurvedic equivalent of rheumatoid arthritis) alongside 376 controls. … The scientists also found that genes linked to inflammatory pathways influenced arthritis in the vata group but in another sub-group (pitta), genes involved with oxidative stress showed up. This meant different gene interactions and mechanisms led to the arthritis condition, and in turn needed different treatment approaches. “(7)

In 2010 a CSIR study, has been peer-reviewed and published in PNAS (Proceedings of National Academy of Sciences), in which ‘identification of a gene and a genetic marker (EGLN1) linked to high altitude adaptation and hypoxia responsiveness’, through genetic analysis of extreme constitution types as defined in Ayurveda’ has been reported.(8)

In any other society such a successful, scientifically rigorous, traditionally rooted and medically useful study would have been hailed and celebrated in popular science discourse. If one looks at New Scientist or Scientific American, one finds regular enthusiastic reporting of such studies, even if they later turn out to be not-so excitable as they were when originally reported. That is how a popular culture of interest in science is created. And in this case till 2015 there has been a steady progress and piling of success stories. For example in the case of EGLN1 identified in 2010, the same team has now reported ‘molecular differences that contribute to systemic attributes of Prakriti that would be relevant in predictive marker discovery’. (9)

But this is India.

Let us just take the report made by the newly-revived leftwing magazine Caravan on the subject. Titled ‘What on earth is “ayurgenomics” anyway?’ Caravan calls the term a word with ‘newfangled oxymoronic timbre’. The context is also important here. In 2014, the Modi-led NDA has stated in its manifesto that it would support ayurgenomics and that has provided the leftists enough provocation to do a hatchet job on this exploratory scientific approach. So Dr. Mitali Mukerjee a Senior Principal Scientist at the CSIR Institute of Genomics and Integrative Biology and the woman scientist at the forefront of Ayurgeomic exploration is made to ‘plead’ ‘innocence of its political implications’.

Though Dr.Mukerjee and her team have published their findings in international, reputed peer-reviewed journal, Caravan reports that ‘although they may sound path-breaking, Mukerji’s findings have not provoked any debate among her genomics research peers.’ Then it goes on to claim that it made ‘an online search for the word ayurgenomics’ and it threw up ‘Mukerji’s own articles, papers based on her study and sympathetic articles by ayurvedic physicians or researchers who have collaborated with her.’

After this allegation, it gleefully reports ‘a blistering attack on scienceblogs.com’ which ‘rubbishes her study as an “abuse of genomics,” challenging her claims, such as the one that ayurveda had “fueled many drug discovery approaches.”’. Then the article throws the most unkindest stab of them all – Hindu revivalist label:

“In (Ayurgenomics’) defence, (Dr.Mukerjee) cited ancient medical texts by Charaka,… perhaps unwittingly echoing the declamations of Hindu revivalists” She is also reported to have ‘suggested’ (note the carefully avoided word ‘said’) ‘that “in all probability the pioneers of ayurveda knew about modern concepts such as genes, proteins and microbes.”

In short make the scientist look like a fundamentalist and make her run for cover from the lynch-mob journalism of socialist variety. The Caravan hatchet job comes with an ominous warning: ‘While the BJP’s stamp of approval may yield more resources for her to pursue her ideas, her future work could also run the risk of being damaged in the crossfire between the left-wing groups and the Hindu right.’

The shape of things to come are hinted at in the end. While assuming an air of neutrality the reporter says that while it is ‘too early to celebrate Mukerji’s hypothesis’, it is ‘perhaps a little premature to condemn it as pure bunkum.’ (10)

In other words, a stern warning, we are waiting to catch you, defame you and damn you.

However has the Caravan reporter done his homework properly? He states that an online search yields only Dr.Mukerjee’s own works, of that of her co-workers and her sympathizers. Yet the work by Dr.Thelma has been already reported in 2012 and has been available online.(11) It is a peer-reviewed paper and published in PLOS. Then it was reported in Nature (India) online in March 2014. The scientific conference in which she presented the findings was in February 2014. And in this paper Dr.Mukerjee is not a co-author. Yet the Caravan reporter could not find these references.

Caravan reports with an unhidden enthusiasm that the scienceblogs.com website has been ‘challenging her claims, such as the one that ayurveda had “fueled many drug discovery approaches’. But it so happens that barely two months after the Caravan story, Scientific American published an article that details the work of scientists studying the herbal solutions, and it states that ‘their approach, called reverse pharmacology, was inspired by the efforts of Indian scientists hunting for new drugs from ancient Ayurvedic medicine.’(12)

In other words, Scientific American could see what the Caravan in India could not.

Today, there are advices to India to ape Chinese success with regard to the use of traditional medicine: ‘Do not talk just old pride; be scientific; look at China.’ But in reality Indian scientists are doing a fine job in such a synthesis of standardizing, validating and preserving the ancient Indian scientific knowledge with modern scientific tools. They are also going the extra mile of using Indic approaches to knowledge to expand and deepen the existing scientific paradigms. However, it is a section of the Indo-phobic Indian media that is creating the real hurdles, and of course the Nehruvian mindset that devalues everything Indian.

One should remember that it was the Communist mindset that delayed the discovery of Tu reaching the world. And in an Indian context, the caricatured Stalinist and Maoist mindset of Indian media is creating the same hurdles. It is this mindset and media manipulation that has to be removed if India is to become a scientific civilization harmonizing the ancient knowledge system with modern science.

References available on next page

References:

(1) Dieter Heinzig, The Soviet Union and Communist China 1945-1950: The Arduous Road to the Alliance, Routledge, 2015, p.304

(2) Heiner Fruehauf, “Science Politics and the making of ‘TCM’ Chinese Medicine in Crisis.”, Journal of Chinese Medicine no.61, 1999, p.7

(3) Youyou Tu, The discovery of artemisinin (qinghaosu) and gifts from Chinese medicine, Nature Medicine 17, 1217–1220 (2011)

(4) ibid.

(5) Gwynn Guilford, The Chinese government is cranking up the nationalism after its Nobel win, url: http://qz.com/518337/the-chinese-government-is-cranking-up-the-nationalism-after-its-nobel-win/

(6) Michael Heinrich, Anna K. Jäger, Ethnopharmacology, John Wiley & Sons, 2015, p.286

(7) T.V.Padma, ‘Ayurgenomics’ unravel new rheumatoid arthritis genes, Nature India, Published online 25 March 2014

(8) Aggarwal et al., EGLN1 involvement in high-altitude adaptation revealed through genetic analysis of extreme constitution types defined in Ayurveda, PNAS, vol. 107 no. 44, 18961–18966

(9) Aggarwal et al., Combined genetic effects of EGLN1 and VWF modulate thrombotic outcome in hypoxia revealed by Ayurgenomics approach, Journal of Translational Medicine (2015) 13:184

(10) Rakesh Kalshian, What on earth is “ayurgenomics” anyway?, Caravan, April 12 2014

(11) Ramesh C. Juyal et al, Potential of Ayurgenomics Approach in Complex Trait Research: Leads from a Pilot Study on Rheumatoid Arthritis, PLOS, September 26, 2012

(12) Brendan Borrell, Seeds of a Cure, Scientific American, June 2014.