The 2015 Medicine Nobel Prize is a tribute to drug discovery, chemistry and traditional medicine

It's very gratifying to see this year's Nobel Prize for Physiology or Medicine awarded to three scientists (William Campbell, Satoshi Omura and Youyou Tu) who have contributed to the discovery of novel drug substances that have decided benefited the lives of millions of human beings and animals. The prize was awarded to the discovery of avermectin and artemisinin. Avermectin cured nematode infections in millions of livestock animals including cows and pigs and its derivative ivermectin can cure river blindness, a disease primarily affecting poor people. Artemisinin can halt malaria in its tracks and contribute to substantial reduction of mortality.  It is hard to thing of a discovery which satisfies Alfred Nobel's stipulation of providing the "greatest benefit to mankind" more than this one. 

It's particularly gratifying to see pharmaceutical research being recognized with the prize. The last time the prize was awarded to drug discovery was in 1988, to Gertrude Elion and James Black. Both Black and Elion worked in the private sector. William Campbell who is one of this year's recipients also worked in the private sector at Merck in the 1980s when his team discovered avermectin. The strain of bacterium (Streptomyces) which yielded the drug had been discovered by Satoshi Omura's team in Tokyo. The collaboration was a perfect example of the public and the private sector working together to bring medical benefits to humanity. Campbell's team at Merck also discovered the even more potent derivative of avermetic, ivermectin, and this was discovered purely synthetically. It's also worth noting that Merck made avermectin available for free to treat river blindness in a generous gesture.

Youyou Tu's work on artemisinin in China during the 1960s is another lesson in pharmaceutical discovery. In the 1960s millions of poor Chinese were dying of malaria. The frontline drug, chloroquine, was being increasingly ineffective. Remarkably, Tu found an obscure reference to a document on traditional Chinese medicine written in 340 BC which described the potentially healing antimalarial powers of a herb steeped in cold water. By testing more than 200 extracts Tu discovered artemisinin. The initial paper in 1979 elicited skepticism and smug dismissal (partly because it came from communist China), but over the next thirty years artemisinin turned into a drug of choice for treating malaria.

Both artemisinin and avermectin exemplify the power of old-school chemistry and microbiology, a nexus blazed by antibiotic pioneers like Alexander Fleming and Selman Waksman, and one which has been largely forgotten in the last thirty years. In addition both compounds are natural products, and the prize underscores the value of drugs from nature (which already make up about fifty percent of all marketed drugs). Artemisinin in particular is also a vigorous validation of the potential of traditional Chinese (and other) medicine. This kind of medicine is completely different from homeopathy since it involves the use of actual chemical substances and herbal extracts. The story of artemisinin clearly indicates that we need to pay much more attention to forgotten examples from traditional Asian medicine and subject them to scrutiny.

Let's make no mistake about it: Today's Nobel Prize should thus be a resounding tribute to the power and humanity of pharmaceutical research. These days we are justifiably reluctant to associate that second adjective with anything to do with pharma; we are justifiably indignant at the price hikes, the off-label marketing and the other shenanigans which drug companies and CEOs sometimes indulge in. Yet this prize demonstrates that pharma, even Big Pharma, can do untold good, not just in discovery but in philanthropy. The distinguishing factors which characterized Merck in the 1980s were a strong focus on basic research (when my PhD advisor worked there during that time, people called it the "Merck University") and leadership under CEO Roy Vagelos - a rare, distinguished scientist at the helm who was a member of the National Academy of Sciences. Merck's success and largesse from the 1980s should be a role model for drug companies today- including Merck itself.

Interestingly, today's Nobel Prize is also great tribute to research which is decided non curiosity-driven and non-accidental. As this report on the discovery of avermectin from Campbell and his team says, "The discovery of the avermectin family of compounds was by no means serendipitous" (hat tip: Amanda Yarnell). I am as big a fan of curiosity-driven research as anyone else, but both avermectin and artemisinin were discovered with the express goal in mind of curing human disease. There is much to be said for this kind of deliberate applied research, supported by generous funding and vision at the top.

The recognition is also a tribute to the power of synthetic chemistry to create lifesaving substances that did not exist on earth before. Ivermectin is a purely synthetic derivative of avermectin created by using a chemical reaction (catalytic hydrogenation - itself awarded a chemistry Nobel Prize) that itself did not exist before.

So there it is: A Nobel Prize awarded to the benefits of private and public pharmaceutical research, awarded to the power of synthetic chemistry, awarded to the great potential of traditional medicine, and awarded to a female scientist. There's few Nobel Prizes that present such a happy constellation of qualities in one little package. Alfred Nobel would have been pleased.

Image: Nobelprize.org