A Nobel Prize in Physiology or Medicine for 2015 to Dr Tu You You Tu of China is perceived as a recognition of the Traditional Chinese Medicine (TCM). It has raised hopes in India and among Indian Vaidya-Scientists for Ayurveda, a millennia-old system of healthcare and a goldmine for the roots of many modern drug discoveries, also can receive the same recognition and honour. In fact, it deserved it when reserpine was derived from Rauwolfia serpentina-Sarpagandha, a drug used in Ayurveda, feel experts. The work by Dr Gananath Sen and Dr Kartik Bose, on R serpentina, in the early thirties was the foundation of a watershed of the future drug discoveries in hypertension, Parkinson’s disease, depression, prolactinoma etc. Dr Rustom Jal Vakil did receive, much later, the American equivalent of a Nobel Prize viz. the Lasker Award.
Dr Tu is the first Chinese woman to receive the honour for discovering artemisinin, a drug to fight malaria and it is also the first Nobel to China in science. As an undergraduate in pharmacology Dr Tu was sent to work on a cure for malaria at the behest of Chinese leader Mao Zedong. She studied ancient texts and finally came upon information that in 400 AD, people used sweet wormwood to treat malaria with some success. She studied more, worked on her recipe, and finally made a discovery that led to atremisinin that kills malaria-causing parasites. The drug is used worldwide and is credited with saving millions of lives. Dr Tu graduated from the Pharmacy Department at Beijing Medical University in 1955. From 1965 till today she has been working at the China Academy of Traditional Chinese Medicine in different capacities, from 2000 being the Chief Professor.
Dr Tu found the drug by examining more than 2,000 Chinese herbal preparations and filtering out a shortlist of 40 and also referring to ancient Chinese texts that spoke about different plants’ medicinal properties. She had described how she was able to find the answer in a book written in 340 BC by Ge Hong. Like Chinese texts, ancient Indian literature also dates back some two millennia, if not more, and to its credit has advanced many of the great ideas that have shaped oriental health traditions. Some of the world’s earliest treatises on surgery and medicine like Charak-Samhita and Sushruta Samhita describe malaria in its diverse forms and their non-drug and drug management, say experts. There are reviews and monographs available on the medicinal plants and formulations useful in malaria too. These hits and leads hold keys to drug discovery and development of new anti-malarials through the Trans-disciplinary Path of Reverse Pharmacology.
T h e press release, announcing the prize to Dr Tu said, “Dr Tu was the first to show that this component, later called Artemisinin, was highly effective against the Malaria parasite, both in infected animals and in humans. Artemisinin represents a new class of antimalarial agents that rapidly kill the malaria parasites at an early stage of their development, which explains its unprecedented potency in the treatment of severe malaria.” In the past, Dr Ashok Vaidya, in a lecture on Reverse Pharmacology of Ayurvedic antimalarial plants at the National Institutes of Health in the past, had stressed how there were tales of missed opportunities of decades and centuries lost before a traditionally use natural product is looked at seriously and a chemical molecule emerges as a drug. He had illustrated this point with both quinine and artemisinin.
The Nobel Committee’s stamp of selection on the TCM has excited as well as disappointed at the same time the Vaidya-Scientists, Chemists and Pharmacologists in India and abroad, particularly those dedicated to medicinal research from the system of Ayurveda and natural herbs. The excitement is because it is considered as recognition to an Asian traditional health system, though it is from China, and the disappointment is because of Ayurveda not receiving the status and honour it deserves. Notwithstanding the grumbles, this prize has raised the hopes that like TCM even Ayurveda will get a well-deserved recognition from the Nobel Committee in the future.
“The prize makes us proud as pharmacologists who worked on medicinal plants. At the same time we are disappointed that no Indian has been thought of even being nominated, even though they have done very similar work, over several decades,” said Dr Ranjit Roy Chaudhury, a very senior leading pharmacologist, a medical educationist and a health planner for the nation.
“Certainly, recognition to artemisinin discovery should act as a morale booster to Indian researchers of the traditional system like Ayurveda. This could have happened in India as well but barring few Indian scientific community had hardly put faith in value of our traditional knowledge nor did they looked at it seriously,” commented Dr Bhushan Patwardhan, Director, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University.
Expressing similar sentiments, Dr Mukund Chorghade, a medicinal chemist of world repute and a Member of the Medicinal Chemistry and Drug Development Committee of International Union of Pure and Applied Chemistry (IUPAC), said, “Nobel Prize in Medicine is extremely interesting as it validates Observational Therapeutics and Reverse Pharmacology. It should serve as a wake-up call to our AYUSH scientists. With efforts, we can put India discovered drugs in the market.” Unfortunately, though AYUSH is a separate ministry with a sizeable budget, there is a total neglect of the new paths and leads of Observational Therapeutics, Ayurvedic Pharmacoepidemiology and Reverse Pharmacology.
Dr Ashok D B Vaidya, Research Director, Kasturba Health Society, and the father of Reverse Pharmacology, commented, “The mentality that drug discoveries can only come from the west and that drug expenditure of around $1.3 billion is essential has to be dropped.” He added that natural products do offer a vast potential for new drug discoveries from Ayurvidya. There are hits and leads in malaria, filariasis, tuberculosis, dengue, AIDS and Hepatitis C. These have not been pursued to their logical conclusion by an expert nationwide R&D team, with vigour, passion and excellence. Several nations have taken up Reverse Pharmacology seriously from new drugs from the TCM and other traditional drug usage.
The Nobel Committee, however, has specifically mentioned that it was not honouring Chinese medicine even though for centuries Artemisia has been in continuous use to fight malaria and other fevers, and even though Dr Tu claimed she figured out the extraction techniques by reading classical works. Instead, the committee said it was rewarding Dr Tu for the specific scientific procedures she used to extract the active ingredient and create a chemical drug. It appears that the cultural prejudice against the ‘alien’ system continues unabated and goes unchallenged most of the time.
A phase of rejection and harsh criticism was also faced by TCM in China, almost similar for Ayurveda some years back. However, Chinese leader Mao Zedong declared that “Chinese medicine and pharmacology are a great treasure house” but it must modernise. Hence, TCM hospitals, schools and research facilities were set up with heavy investments. In Mao’s era rural health care workers, known as ‘barefoot doctors’, were often traditional practitioners, who raised the usefulness profile of TCM. After Mao’s demise, China too gave much more importance to the western medicine. As a result, according to the New York Times, today, China has 1.1 million certified doctors of western medicine as against 1,86,947 traditional practitioners. It has 23,095 hospitals, 2,889 of whom specialise in TCM.
When it comes to Ayurveda it also passed through the same phases of rejection and criticism that like TCM. But, now it has a larger recognition among the people in India and also at institutional level. Ayurveda has also gained global attention with its official recognition, in some countries. There are a large number of Ayurvedic degree colleges and even some exclusive universities. A large number of students get admitted and pursue practice in Ayurveda as many patients have faith in Ayurveda and a repugnance to the drug toxicity of the allopathic drugs. The Government of India has also set up a Ministry of AYUSH. But, there is a fear that the fundamentalists in Ayurveda may hamper the development rather than bring the cutting edge science to Ayurveda and the rich concepts of Ayurveda to Life and Health Sciences. “The research under AYUSH has been more revivalist rather than ushering a renaissance in integrative Ayurveda. Besides AYUSH, the other Indian funding agencies too are often negative or lukewarm to the research in Ayurveda,” regretted Dr Vaidya.
Citing some examples, Ashok Vaidya said, “ICMR did not consider to grant a year's more support for the extension for the lead in malaria -Nyctanthes arbour-tristis (Parijat), which in a crude form is as active as Artemisia plant. The outstanding hepato-protectives plants for drug or viral hepatitis have been dropped prematurely. We did several useful meetings of a committed and expert group on well-defined leads and precise indications. Even a minimal support to prepare the high impact research proposals could not be obtained.”
“Today we see a Nobel prize awarded for work in traditional Chinese medicine. This raises the question why Ayurveda is not afforded the same consideration, not only worldwide but also in India,” asked Dr David Frawley, American Vedic teacher and ‘Vaidya’ (Ayurvedic Doctor), in his recent article on website ‘Open to Opinion’. There are many leaders in healthcare and research in the west who share the same feelings with Dr Frawley. The new Ministry should have a major policy-advisory meeting to chalk out the fast-track paths for research in Ayurveda which could have a major impact on global health, suggest experts and add in the past some meetings were held but the recommendations are in some files shelved long back.
In case of Ayurveda, the views similar to Mao about Chinese medicine are expressed by some experts in India. It is often stressed that during the millennium of the foreign rule Ayurveda remained fairly static and did not incorporate the epoch-making discoveries of physics, chemistry and biology into its fundamentals. Several times attempts were made so that Ayurveda gets modernised. But the resistance of the purists was formidable. The aesthetic charm of the DNA helix, the development of monoclonal antibodies, the access to the body organs through endoscopy and imaging techniques and glory of genetic engineering were kept alien in Ayurvedic education, said Dr Vaidya.
Two words which are constantly used in relation to Ayurveda are evidence and standardisation. When these get incorporated in the daily Ayurvedic education and research, bedside serendipitous and planned discoveries will certainly emerge and the contributions of Indian healing wisdom will help the world, even without Nobel prizes!
“Our traditional practitioners, however successful they are with their own practices have no appreciation or understanding of modern methods of validation of their products,” complains Dr Mohan D Nair, a leader in drug discovery and a former consultant to Arya Vaidya Sala, (AVS), Kottakal. Referring to the concerns the medical fraternity has regarding the inability to convert our traditional knowledge and practices to meaningful remedies for ailing humanity, Dr Nair added, “None of the institutes in the country as of now has total capability to develop a drug based on our traditional systems of medicines and meeting the international standards often applicable to the new chemical entities”.
Echoing the views, Dr Patwardhan said, “Ayurveda fraternity has remained engrossed in past glory and self-pride. They were not empowered to undertake rigorous scientific research. As a result we had very sporadic superficial work on Ayurveda in a project mode.”
Suggesting an improvement over that, Dr Asmita Wele, Professor, Department of Rasa Shastra & Bhaishajya Kalpana, Bharati Vidyapeeth, said, “Systematic recording and periodic (short, every 2/3 months) analysis of clinical outcomes (auditing) at each AYUSH clinic and hospital should be done by adopting participatory approach of successful renowned practitioners. This would create evidence for treatment/therapy. It would boost confidence of AYUSH practitioners as well.” She added that the new findings, whether good or bad, should become parts of textbooks.
Still, Dr Nair is optimistic that the model of drug discovery followed by Dr Tu, based on knowledge of TCM, can be developed in our case as well. “Most of us have been talking about it for far too long without taking it to a logical and positive conclusion in the form of new drugs,” he regretted.
He pointed out that there was no institute in India similar to the Traditional Chinese Medicines Institute which can undertake such studies. However, the larger traditional companies such as AVS, Kottakal or Arya Vaidya Pharmacy (AVP), Coimbatore are willing to cooperate with any group which wants to take up such studies, he added.
According to Dr Patwardhan, for Ayurveda to reach to the status of Nobel, “we need to move from the project mode to mission mode.” Explaining what he meant, Dr Patwardhan said, “We need 'National Mission' on Ayurveda inspired Natural Product Drug Discovery. This should involve carefully chosen passionate scientists and top laboratories. For instance, a mission on promising medicinal plants like Ashwagandha or Guduchi could lead to major discoveries and lead to success stories like artemisinin. Such mission should be fully empowered with all resources and freedom.” In Dr Patwardhan’s 'Mission' strategy is much better proposition than continuing 'me too' or aimless research that has hardly produced any breakthrough or new drug in last several decades. There was no deficiency or scarcity of talent or resources. “What is needed is 'strategists of talent' - Yojaka tatra durlbhaha,” he added.
Elaborating on the opportunity that is available now Dr Chaudhary said, we have a clinical pharmacologist as the Director General of Indian Council of Medical Research (I C M R) and a scientist who worked on the discovery of streptokinase as Director General of Council of Scientific and Industrial Research (C S I R). We have a person like Dr Harsh Vardhan as Minister of Science and Technology. If we do not do strategic planning and implement it now, we would have lost another opportunity.
He has suggested that young people around the thirties should take the leadership backed up by senior persons who could provide the experience and contacts when needed. A big contribution by seniors would help to identify a group of such people and put them together and get funding for them to ask them to go forward.”
Dr Nair suggested that a network programme within the country could identify and mobilise all the needed inputs for total drug discovery and development programmes. Expressing similar views, Dr Vaidya said a strong teamwork was needed for taking Ayurveda to Nobel level of research output. Some of the problems in that journey are that the industry is not supporting research in Ayurveda and even AYUSH does not recognise
“But, if AYUSH forms a transnational mission for drug discovery this can become reality in five years. I am confident of at least five major drugs and 15 high impact papers are possible within that period. We are ready to take up the challenge,” said Dr Patwardhan.
Supporting the concept of transnational mission, Dr Wele suggested, “Drug development, both in typical Ayurveda - manner and similar to herbal drug development manner, should happen at institutional levels with industry partnerships.” She added that regulatory mechanisms need to be strengthened and sector specific. Mere copying of bio-medicine approach does not suit.
According to Dr B Dinesh Kumar, President, Indian Pharmacological Society (IPS) ‘Reverse Pharmacology’ approaches in a way is the key tool in Tu Youyou winning the Nobel Prize in traditional Chinese medicine (TCM). He says, “this indeed is an eye opener to all the Indian scientists. Time has come for the government to establish an independent organisation consisting of experts (middle level scientists preferred) from various organisations with the primary objective of compiling the data on history and use of traditional medicines, documentation of research studies, identifying the grey areas which need more evidence and scientific validation so as to rapidly translate them into therapeutic products acceptable globally.”
Referring to some sanctions and the progress reports which she has gone through, Dr Wele said, “The prospect of discovery is hampered due to 'all are same' type approach. Case to case strategy for the disbursement of R&D funds, a strong mechanism of monitoring of timely deliverables and appropriate mid-course corrections in research protocols are prerequisites for excellence in Ayurvedic research in India.” Even Dr Patwardhan felt the same when he said such high impact research could not be done in a typical 'project' mode that follows a routine path with small and short term objectives. “In most of the cases project mode funding has led to 'me too' and non-imaginative research that does not help either science or traditions,” he commented.
The importance of Ayurveda is getting more and more underlined, though it still requires a lot of support from the authorities to raise its status worldwide. Efforts are required from the practitioners too for its modernisation and standardisation.
Dr Wele suggested two concrete points to begin at this point of time with full vigiour - clinical data recording and analysis and drug development. Dr Patwardhan summerised what was needed to be done for changing the status of Ayurveda. “For success on this path, modern biomedical scientific community needs to take onus and lead,” he concluded.