Beating Malaria Nicholas White and Franois Nosten have shown that drugs in combination with artemisinin are 90% effective at fighting the scourge of the world. So why isn't everyone using it? MERRILL GOOZNER travels to Thailand and China to watch Nosten and White at work.
ARTICLE EXTRAS
A military outbreak spurs research In September 2003, the US 26th Marine Expeditionary Unit entered Liberia for a brief peacekeeping operation.
Slideshow:
photos from Goozner's travels, including a stop at a clinic conducting artemisinin
trials
Nicholas White and François Nosten were not the first clinicians to
use artemisinin in a human trial. That honor belongs to Li Guoqian, now a senior
professor at the Guangzhou University of Traditional Chinese Medicine (GUTCM).
Military necessity has always been a major driver of antimalarial therapeutic
advances, and when Vietnam president Ho Chi Minh asked Chinese Community Party
leader Mao Zedong for help in combating a disease that was disabling more of
his soldiers than were American bombs during the Vietnam War, traditional Chinese
medicine, especially qinghaosu, seemed like a good place to start. (At the
time, both Vietnam and China were cut off from global supplies of chloroquine,
then the drug of choice for treating malaria.)
"Chloroquine was the fastest drug, but even it took 12 hours before you
saw a change in parasite load. So, I didn't check the patient until the following
day. I couldn't find the parasite! This I had never seen." He tried it
on a second patient with the same results. Within 48 hours, the parasites and
the fever were gone.
Mao, in the midst of unleashing a Cultural Revolution that would temporarily
destroy schools that taught western medicine, asked Zhou En Lai to establish
a military research project on malaria that utilized China's schools of traditional
medicine. Committees were soon established at every school, according to Li.
A first organizational meeting was held at a Beijing restaurant on May 23, 1967,
and they became known as the 523 committees.
The Beijing 523 committee discovered a method of isolating the active ingredient
in qinghaosu, which they named qinghaosu. It took about four years to
stumble on a low-temperature method of extraction, thus confirming the wisdom
of a 1,600-year-old recipe: In 340 A.D., medical author Ge Hong wrote in Zhou
Hou Bei Ji Fang (Handbook of Prescriptions for Emergency Treatments) that
soaking a handful of qinghaosu in about a liter of cold water and then straining
and drinking the fluid would provide relief from fever. Further, in 1596, one
of China's most renowned herbalists, Li Shizhen, recommended the plant's extract
specifically for malarial chills and fever.
Dr. Li Guoqian, 70, professor at Guangzhou University of Traditional Chinese Medicine. Dr. Li first tested artemisinin in patients in 1971 in Yunnan Province along the Burmese border.
The first batches of the drug were sent to Li Guoqian, who ran the largest
523 committee in southern China in Guangzhou. The son and grandson of traditional
practitioners, Li graduated from GUTCM in 1955 and eventually gravitated toward
malaria research. While the other 523 committees raced to discover drug candidates,
he established clinics in the malaria-infested jungles of the southern province
of Yunnan, which runs along Burma's northern border. He remained there from
1971 to 1974.
Li, now 70, recently recalled for me the first patient he treated with artemisinin.
"He was 13 years old, a primary-school student. He had very severe malaria
symptoms. I gave him an oral tablet - 100 milligrams." The results, he
says, amazed him.
He eventually tested it in 18 patients, 14 of whom had Plasmodium falciparum.
He compared them to six patients he treated with his limited supplies of chloroquine.
"The parasite decreased more than 95 percent after 16 hours with artemisinin,"
he said. "To get the same results with chloroquine, it took 40 hours."
He never published the research. "It was a military secret," he laughs.
It wasn't until 1979 - the same year Deng Xiaoping traveled to the United States
and kicked off China's rush to modernization - that People's Daily, the main
organ of the Chinese Communist Party, announced the results of the 523 research
program. It was too late for Vietnam's soldiers (who by that point were fighting
China on their northern border), but the world had a new weapon in the war against
malaria.
This is simply a fascinating and well-written story, showing that the author understand the science and Chinese culture. In turn, this story has made a Chinese scientist in US very happy.