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War, Malaria, and the Nobel Prize by GEORGE W 16 Musings of a Cancer Doctor War, Malaria, and the Nobel Prize BY GEORGE W. SLEDGE, JR., MD oncology-times.com • obel Prize season finished mold, tree bark, and sea sponges. It isn’t States” (Studies in American Political last month with the Awards the origin of the drug that matters. If it Development 2012;26:125-162). Ceremony on Dec. 10, and passes rigorous scientific tests (so-called DDT also earned its discoverer, the once again the Swedes have “Western medicine”) demonstrating Swiss Dr. Paul Muller, a Nobel prize in Nfailed to recognize my many contribu- clinical utility, I am happy to prescribe 1948. The Swiss shared Muller’s discov- tions to peace, medicine, literature or it. The scientific method doesn’t care ery with the United States in the midst physics (OK, the last one is a bit of a if you are Chinese or American, nor of World War II, and the U.S. military stretch). I watched my cell phone for whether your drug is a natural product rapidly introduced it into war zones, January 10, 2016 • days, but no phone calls from country or a synthetic chemical. It doesn’t even dramatically reducing deaths due to code +46. What is with those guys? care if it is a drug. malaria, typhus, and the panoply of But as happens every year, a Nobel But the artemisinin story interested other insect-borne disease, not just for Prize has an interesting story, and a me for other reasons. The first was the soldiers but for civilians. GEORGE W. SLEDGE back-story behind that story. And this long history of tropical medicine, par- But the larger back-story is the con- JR., MD, is Professor story has to do with malaria and war. ticularly malaria, and the Nobel prize. nection between war and scientific of Medicine and Chief The prize for Physiology or Medicine One of the very first Nobel prizes for progress in general, and medical prog- of the Division of (its quaint name) went to three investi- Medicine (in 1902) was given to Dr. ress in particular. Alfred Nobel himself Oncology at Stanford gators, with the common theme of trop- Ronald Ross for his discovery of its personifies this connection. Nobel, as is University. - Oncology Times ical disease. Satoshi Omura and William transmission via the mosquito. Five well known, made his riches through His OT writing has C. Campbell received half of the prize years later Dr. Alphonse Laveran re- the creation of dynamite, which he been recognized with “for their discoveries concerning a novel ceived the prize for his discovery of hoped would be used for peaceful pur- an APEX Award for therapy against infections caused by the malarial protozoan. Both the poses only. His subsequent recognition Publication Excellence roundworm parasites” Englishman and the of, and his horror over, the co-option and a FOLIO: Eddie and the delightfully French doctor served of his discovery for lethal military pur- Honorable Mention named Dr. You-You Tu their overseas colonial poses led to his creation of the Peace award. received the other half empire. In 1897, the year Prize. Comment on this for her discovery of Ross published his work, Alexander Fleming’s discovery of article and previous the anti-malarial drug approximately one- penicillin languished until World War postings on his OT artemisinin. third of British troops in II, when two British scientists rediscov- blog at bit.ly/OT-Sledge It was the malaria the Indian Raj were in- ered it and brought it forward to treat story that caught my at- capacitated by malaria. wounded soldiers, the work supported tention. Dr. Tu received Malaria represented by infusions of cash from the British the prize for the discov- an endemic disease in and American governments. ery of artemisinin. During the Vietnam the American South for much of the One can make too much of these War, our Vietnamese opponents suf- first half of the 20th century. While connections, of course. No malaria pa- fered horrendously from malaria. common wisdom holds that the prob- tient cares that artemisinin came out of Chairman Mao, a fan of traditional lem was solved through liberal dousing a nasty jungle war. No one in a doctor’s Chinese medicine, encouraged studies with DDT (another outcome of war), office getting any of penicillin’s follow- of Chinese herbs as treatment for the in fact it began its retreat during World on antibiotics cares that the antibiotic disease. War I. With large numbers of American revolution was a byproduct of history’s Dr. Tu examined the Chinese herbal soldiers receiving basic training in bloodiest war. They just want to be “The essential tradition and found that compounds Southern cities, the U.S. Government treated and cured, and not re-infected. derived from the sweet wormwood was concerned that they would con- But it seems inescapable that the tension embodied plant could treat the disease in mice. tract malaria before shipping overseas link between medical progress and war She then isolated artemisinin from the to France. is a real one. Trauma medicine had its by the Nobel prizes, herb, and an exceptionally important origins in military surgeons, and even with their celebration antimalarial was born. Today over half the DaVinci robot so prized by urologic of malaria worldwide is chloroquine-re- Extra-Cantonment Zones surgeons caring for prostate cancer pa- of life paid for by sistant. Artemisinin is the lifeline for pa- The government’s response was to set tients had its beginnings in a DARPA tients suffering from resistant malaria. up so-called extra-cantonment zones, contest to create a battlefield-ready au- the archetypal As an undergraduate I had a class- areas within which it assumed respon- tomatic surgeon. merchant of death, mate who had served as an infantryman sibility for public health. Mosquito And cancer patients, as we all learn in Vietnam. He had come home with eradication, the techniques for which early in our training, owe a debt to war: continues to vex us.” what I would now recognize as quartan had been pioneered in the Spanish- the first effective chemotherapy agents malaria, with recurrent fevers and chills American War and its aftermath, was were discovered as a result of a ship and just the most miserable feeling on used in a widespread fashion for the full of poison gas blowing up in Naples earth. He had that far-away look of first time in the American South, con- harbor in 1944. In short order the lym- someone who had spent too many days siderably reducing malaria incidence phopenic sailors served as the model for seeing things 19-year-olds shouldn’t and setting the stage for the subse- treating leukemia in children. see. But it was the malaria that dragged quent New Deal-era near-eradication Someday, one hopes, such expensive him down. (pre-DDT) of malaria in the United advances, paid in the blood of inno- States. cents as well as the gold of governments, For anyone interested in this story, will no longer prove necessary. But for ‘Whatever Works’ read the definitive account by Daniel the moment, the essential tension em- Patients often ask what I think of com- Sledge, my political scientist son, of bodied by the Nobel prizes, with their plementary and alternative medicines. whom I am very proud: “War, Tropical celebration of life paid for by the arche- My answer is always the same: whatever Disease, and the Emergence of National typal merchant of death, continues to O works. I prescribe drugs derived from Public Health Capacity in the United vex us. T.
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