Nicholas White: Gairdner Global Health Award — Transcript

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1. 0:00joining us now is dr. Nicholas white he
2. 0:03is the winner of the Canada gairdner
3. 0:05global health award and comes to us as a
4. 0:07professor of tropical medicine from my
5. 0:09own University in Bangkok Thailand here
6. 0:12a long way from home yes I thank you for
7. 0:14being here you have before we get into
8. 0:16what you did and why you're rewarded
9. 0:17I've got a I've got to get the history
10. 0:20down right here you obviously you're
11. 0:22from the UK but you've spent the last 30
12. 0:25years living two months a year in the UK
13. 0:27teaching at Oxford yes and 10 months in
14. 0:30thailand yes does that work exactly well
15. 0:32I think it works well I my main my job
16. 0:36is as a professor of tropical medicine
17. 0:38sigh I conduct research in into tropical
18. 0:42diseases mainly nasty infections but for
19. 0:45two months I am an ordinary hospital
20. 0:48doctor in England do you still feel
21. 0:49British yes I do I know you're in
22. 0:52Thailand most of your life now yes I'm
23. 0:54very fond obviously of Tyler and
24. 0:56otherwise I wouldn't have stayed there
25. 0:57so long and I I really like being there
26. 0:59but I I feel British I'm afraid it's
27. 1:02it's incurable well welcome to the
28. 1:04colonies thank you i should say okay
29. 1:07let's get into this what did you win for
30. 1:09i won the gardener award for research
31. 1:13into a remarkable drug to treat malaria
32. 1:16it's it comes from a plant in China a
33. 1:20herb traditional Chinese medicine in
34. 1:22fact and was discovered by the Chinese
35. 1:25in the early 1970s what's a call in
36. 1:29Chinese it's called Jing hal su and we
37. 1:32called it artemisinin it's very very
38. 1:34rapidly acting and it has very few side
39. 1:37effects and it it's become now the
40. 1:39treatment of choice all over the world
41. 1:41for malaria how did we find out in the
42. 1:43first place that it would have some kind
43. 1:45of impact on malaria well the story
44. 1:48starts with with ho chi minh in Vietnam
45. 1:51having concerned that his forces in the
46. 1:54impending conflict in the in the late
47. 1:581960s would have problem would be would
48. 2:01have malaria soldiers would have malaria
49. 2:03so he asked help from the Chinese and he
50. 2:04are so in life and so in like basically
51. 2:08ordered scientists for
52. 2:10many different parts of China to examine
53. 2:14existing treatments and to find new
54. 2:16treatments for malaria and this part of
55. 2:19this program led to a re-examination of
56. 2:22the old traditional medicines and some
57. 2:25rather skillful chemistry and laboratory
58. 2:29work identified an extract of this plant
59. 2:31and showed that it was was working in
60. 2:34the laboratory and very quickly they
61. 2:37went into animal studies in humans and
62. 2:40published all this in a remarkably brief
63. 2:43paper of about six pages which I happen
64. 2:46to read while I was working on the
65. 2:48thai-cambodian border in about nineteen
66. 2:50eighty and it seemed remarkable so i
67. 2:55went to china in 1981 and the i spoke
68. 3:01with the Chinese scientists who done
69. 3:02some of this work and was actually given
70. 3:05some samples and at that time we were
71. 3:09dissuaded from doing any more with them
72. 3:11the World Health Organization felt that
73. 3:13the quality of the product wouldn't be
74. 3:15good enough and that they would produce
75. 3:17a proper high quality product and we
76. 3:19could evaluate that but towards the end
77. 3:21of the 1980s the countries in Southeast
78. 3:24Asia are having a real problem with
79. 3:26malaria particularly that the malaria
80. 3:28was not respond to the existing drugs it
81. 3:30was resistant so they were forced to
82. 3:32turn to these Chinese medicines and I
83. 3:35was part of that exam early examination
84. 3:39and we did the first studies in Africa
85. 3:41and then started to evaluate them in
86. 3:44patients in Thailand and have you been
87. 3:46researching this plant all that time all
88. 3:49that time really for almost 30 years now
89. 3:51yes and then eventually we introduced
90. 3:55the idea of combination treatment we
91. 3:59treat quite a few of the infection the
92. 4:01important infections like tuberculosis
93. 4:03and HIV AIDS with a mixture of drugs and
94. 4:06so we introduced the idea of mixing the
95. 4:09Chinese medicines with other
96. 4:11anti-malarial drugs and it's that
97. 4:12combination treatment which we call
98. 4:14Artemis ling combination treatment or a
99. 4:16CT that's now recommended so it's a
100. 4:18cocktail in some respects that it's a
101. 4:20cocktail huh do you know everything
102. 4:22about the
103. 4:23potential combinations of this drug that
104. 4:25you need to know yet oh no well you
105. 4:27asked a researcher whether we know
106. 4:29everything that you need to know the
107. 4:30answer is invariably no but we do know
108. 4:33enough to know that they're there highly
109. 4:35effective everywhere in the world very
110. 4:37safe well tolerated and we also know
111. 4:41that not enough people who need them get
112. 4:43them so I think whilst there's a lot
113. 4:46more to do in terms of the scientific
114. 4:48discovery we the real challenge now is
115. 4:51to get them out there to the people who
116. 4:52need them to treat malaria costs about
117. 4:55one Canadian dollar or less because most
118. 4:59people who have malaria almost people
119. 5:01who are going to die from malaria
120. 5:02children so the actual cost as much
121. 5:03smaller smaller so it is indeed very
122. 5:06frustrating that that we still have a
123. 5:09huge mortality what about the logistics
124. 5:12on all of this I presume given where it
125. 5:14is it's difficult to collect it process
126. 5:18that turn it into something you know
127. 5:19that you could put in a bottle and you
128. 5:22know is that the case it's a plant so it
129. 5:26has to be sown and reaped and extracted
130. 5:29yes but it's an annual it's an annual
131. 5:32plan to you you have a two year cycle
132. 5:34you plant one year and you harvest the
133. 5:36next I don't think that's the main
134. 5:38impediment I mean there's enough
135. 5:40capacity globally to be well to produce
136. 5:42much much more than the world needs so
137. 5:45no it's more a problem of distribution
138. 5:48the drug in difficult parts of a
139. 5:50tropical world a lot of the tropics
140. 5:53particularly in Africa where most of the
141. 5:55deaths from malaria occur a lot of the
142. 5:57countries are have conflict going on or
143. 6:00they're difficult access so and that's
144. 6:03where there's a lot of malaria but is it
145. 6:05the case that drug companies are not
146. 6:07that interested in this because it's
147. 6:08poor people that are getting this
148. 6:09disease and they don't have money to pay
149. 6:12for drugs yes and no I think big pharma
150. 6:17the multinational pharmaceutical
151. 6:18industry has in the past being
152. 6:22disinterested in poor country diseases
153. 6:25poor people rapport with infectious
154. 6:28diseases obviously one there's not going
155. 6:30to be any profits made there but I think
156. 6:33in the last decade there's been an
157. 6:35increased awareness
158. 6:37of global responsibility and we do see
159. 6:41multinational farmer dedicating a small
160. 6:45part of not inconsiderable resources
161. 6:48towards if you like a loss late the
162. 6:50loss-making avenue of treating poor
163. 6:54country diseases i know for example 2x
164. 6:56US presidents Jimmy Carter and Bill
165. 6:59Clinton are both very heavily involved
166. 7:00in you know trying to find cures for
167. 7:02various diseases are they involved in
168. 7:04this one at all well the Clinton
169. 7:05Foundation is very active in malaria and
170. 7:08and we we have benefited recently from
171. 7:14quite a considerable increase in global
172. 7:17awareness for international health and
173. 7:20and with that has come considerable
174. 7:22increase in funding although I'm not
175. 7:25sure how long that's going to last given
176. 7:27the current global economic downturn so
177. 7:29world leaders I haven't actually say the
178. 7:33word malaria and it comes up in g8
179. 7:36summit meetings and so on which is
180. 7:40justified and there's a good a good case
181. 7:42for saying that negative economic growth
182. 7:45in Africa can be attributed entirely to
183. 7:47malaria so it's actually makes economic
184. 7:49as well as humanitarian sense to really
185. 7:52have a go at this disease intro we've
186. 7:53been so long since anybody in Canada had
187. 7:56it we may want to remind people how you
188. 7:58get it in the first place how is it
189. 8:00contracted it's a little parasite that's
190. 8:03contracted by being bitten by a certain
191. 8:06species of female mosquito well certain
192. 8:09species of mosquito and it's a female
193. 8:10that bites from the moment you are
194. 8:13inoculated the mosquito there's a about
195. 8:15a week in which you are perfectly well
196. 8:18and during that period of time the
197. 8:20parasites are actually developing in
198. 8:21your liver after about a week they come
199. 8:24out into the blood there's only a few of
200. 8:26them so you feel all right so it's two
201. 8:29weeks before you start to feel ill and
202. 8:32then the progression can be quite rapid
203. 8:35in it could take several days before
204. 8:38death but in some circumstances
205. 8:40particularly children in endemic areas
206. 8:42where malaria is common the child can be
207. 8:45slightly ill in the morning and dead by
208. 8:47the next morning and it's pace
209. 8:49organs shut down yes yes you thumb
210. 8:54you've spent 30 years on this and you
211. 8:57could have spent 30 years on anything
212. 9:00why this it's a real challenge malaria
213. 9:04but for the reasons you said earlier the
214. 9:07fact is it's tractable I mean you don't
215. 9:09have malaria in Canada you don't have
216. 9:11malaria United States you have a lot of
217. 9:12malaria in the southern United States so
218. 9:15you can really do something about it and
219. 9:17so I it's a fascinating biological
220. 9:20problem but it is it's tractable so and
221. 9:23for your done you'd like to see this
222. 9:25cured I would really like to see it
223. 9:27cured I mean I believe that it's
224. 9:29possible to eliminate malaria complete
225. 9:32from the world from the world whether we
226. 9:35have the strength of purpose to do that
227. 9:38I doubt unfortunately we seem to have
228. 9:41the strength of purpose to come up with
229. 9:43some fake remedies there's a big black
230. 9:45market i'm told for for taking your
231. 9:47product and abusing it somehow can you
232. 9:50explain how that happens yes this is
233. 9:53well to say it's unfortunate is mild I
234. 9:57mean this is murder basically this is
235. 10:01people manufacturing something which is
236. 10:06a counter which looks like a genuine
237. 10:07medicine and distributing this often in
238. 10:14areas where it's are the most vulnerable
239. 10:15people the poorest people who have very
240. 10:17little money very little understanding
241. 10:19of what's of what is a quality product
242. 10:22and what is not so about fifty percent
243. 10:26we estimate of all drugs in the
244. 10:29marketplace which is the main place
245. 10:30people get drugs in the developing world
246. 10:32are either substandard that means the
247. 10:34quality isn't as good as it should be or
248. 10:37just outright fakes and and one of the
249. 10:40very distressing things is that the
250. 10:42Artemis min drugs have been targeted by
251. 10:45the counterfeiters particularly the
252. 10:47tablets and they were in the past in
253. 10:51Southeast Asia there were places where
254. 10:52nearly all the drug was simply was
255. 10:55counterfeit and this is this is to kill
256. 10:58somebody for about 50 cents profit I
257. 11:00mean it's just
258. 11:01scrotal people are taking it they think
259. 11:03they're getting better and it's having
260. 11:04no impact at all yeah and they're
261. 11:06definitely kill people it's definitely
262. 11:07kept because malaria as we mentioned it
263. 11:11doesn't take very long it takes a few
264. 11:13days between feeling ill and dying and
265. 11:15if you if you waste a couple of those
266. 11:17days it could be too late now I guess
267. 11:20you'd call this herbal medicine but that
268. 11:22we're looking at right now right and
269. 11:23that has a kind of a connotation in some
270. 11:26western you know some parts of the
271. 11:28Western world but that does does you're
272. 11:30getting this award lend a kind of a
273. 11:32credence to herbal medicine that it
274. 11:33maybe doesn't have in some circles right
275. 11:35now you can't call it herbal medicine
276. 11:39but then still quite a lot of the
277. 11:41medicines that we use are herbal
278. 11:44medicines I mean aspirin derives from
279. 11:46the willow bark the previous the drug
280. 11:48that is that Artemis and is taking over
281. 11:51from is as Queen or maybe sake why no
282. 11:55why no why no no this side of the pond
283. 11:58but quinine comes from the bark of a
284. 12:01Peruvian tree plants are complicated
285. 12:04they the amount of these ingredients
286. 12:07that they produce very interesting
287. 12:11example comes from the this drug
288. 12:13artemisinin so G the seeds there was a
289. 12:16famous episode where the seeds of the
290. 12:19plants in China were taken to the United
291. 12:22States and sown along the Bob the banks
292. 12:24of the Potomac River climb through
293. 12:26beautifully there's no dragging it take
294. 12:30those seeds from the back from the new
295. 12:32plants on the Potomac River take them
296. 12:33back to the edge of where they came from
297. 12:35in Asia the drug is there so the
298. 12:37environment was very important and I
299. 12:40think they're the same scientific rigor
300. 12:44has to be applied to develop to herbal
301. 12:48medicine there's any other medicine it's
302. 12:49medicine congratulations on getting what
303. 12:52I guess some people call the baby Nobel
304. 12:54the gardener prize for Canada and we're
305. 12:56grateful that you could spare some time
306. 12:58for us here at evo dr. White's good to
307. 13:00meet you thank thank you very much thank
308. 13:01you