On 12 September, 81-year Tu Youyou, a retired research fellow at Beijing-based China Academy of Chinese Medical Sciences, recieved the 2011 Lasker-DeBakey Clinical Medical Research Award for her previous work to extract artemisinin from the herb Qinghao  (Artemisia annua). 

The Lasker Award, with over 50 Nobel laureats amongst its 200 awardees, is highly recognised in the internationally and Tu is the first Chinese scientist to be given this honour.  

Despite the recognition, however, Tu’s award also highlights controversies in her native country, such as who should be honoured for the extraction life-saving artemisinin extraction. 

A hidden history 

Born in 1930 in Zhejiang Province’s Ningbo, Tu studied pharmaceutical chemistry from 1951 to 1955 at Beijing Medical College (now Peking University Health Sciences Center). 

In 1969, Tu, then an assistant scientist at Beijing-based Institute of Traditional Chinese Medicine, received an urgent order to join a secret p roject. Project 523 was launched on 23 May 1967 by the order of Chairman Mao Zedong to concentrate national scientific strength on identifing anti-malaria drugs to assist the Chinese and North Vietnamese armies fighting the US troops in Vietnam As soldiers from both sides suffered heavily from pandemic malaria in the field. More than 500 Chinese scientists from 60 institutions were convened to screen candidates ranging from chemical compounds to traditional herbs. 

When Tu joined, she concentrated on traditional Chinese medicine (TCM) and collected hundreds of ancient herbal prescriptions that were recorded as treating malaria symptoms. Gradually, Tu and colleagues focused on Qinghao  , which was reported by Ge Hong (AD 284–about 364), an ancient Taoist and doctor, as having a curative effect after sinking into water.  

But the research was halted because scientists could not identify effective curative compounds after using conventional high-temperature extraction. But, Tu realised that the high-temperature extraction could be wrong. ‘The high temperature could have destroyed the effective ingredients,’ she recalls. Tu then tried to make the extraction in ether solution, which has a low boiling temperature. 

On 4 October 1971, after 190 failures, Tu led her team to successfully extract an effective ingredient, which is now called artemisinin. The compound showed 100 per cent effectiveness against malaria in rats and monkeys. 

Soon after the result, Tu and her team members took the artemisinin themselves to test its safety. They then went to malaria epidemic zones in southern China to test the compound in patients. The curative effect is much better than Chloroquine, the conventional anti-malaria drug suffering rising drug resistance.  

In 1972, Tu reported her experimental results to a national work meeting of Project 523, and the result was hailed as the right direction. 

Controversial attribution 

Despite Tu’s success, her name was soon buried. Project 523 was a national secret and the extracted and purified artemisinin was sent to Vietnamese battlefield, strengthening Vietnamese soldiers and their Chinese allies.  

In addition, at the time of the discovery, China was experiencing the Cultural Revolution (1966–76), which had led to persecutions of millions of intellectuals. There was no normal channel for academic publications.  

But controversy also remains around who made the greatest contribution to the discovery of artemisinin. After the news that Tu extracted an effective compound from Qinghao   spread, several independent research teams affiliated to the Project 523 tried different extractions, and some extracts had better purification and curative effects. On the other hand, the Institute of Traditional Chinese Medicine (now Chinese Academy of Chinese Medical Sciences) where Tu was employed did not successfully develop the extraction of artemisinin at a large scale.  

Yet according to neurological scientist Rao Yi, dean of the College of Life Sciences at Peking University who has been studying the history of artemisinin for years, although many scientists have made unique contributions to the discovery, Tu’s trial of using ether solution to extract the effective ingredients is the most crucial step.  

TCM modernization 

Tu’s award has once again aroused support for TCM in China.  

But while strong supporters of TCM claim the medicine could partially replace modern Western medicine, TCM remains as a complementary or alternative remedy in most Western countries, despite decades of research and investment , mainly from the Chinese government. TCM’s ingredients are still hard to define and its efficacies remain difficult to evaluate. 

‘In my opinion, TCM is a great treasure, but the only way to bring its full values to the society is the modern science and drug discovery technologies,’ says Lu Bai , vice-president of Biology in GlaxoSmithKline’s Research & Development Center in Shanghai, China. 

Zhiguo Xu and Hepeng Jia