Countries in the developed and developing world seem to have different priorities in dealing with the public health problem of poisoning. Yet both are making slow progress and ignoring common links. These common links indicate that a collaboration would be of immense benefit to both and that its lack is a needless wasted opportunity.
Western nations are most concerned about terrorist use of chemicals. The sarin nerve gas attack on the Japanese subway and the anthrax postal episode showed how vulnerable we are to terrorist (or military) attack using chemical or biological weapons. A great effort, involving expenditure of around $1bn (£550m, €800m) in the United States alone, is now underway to reduce the risks and consequences of future attacks.1
A major concern is the organophosphate chemical weapons or nerve gases, such as sarin, tabun, and VX, which were developed in the middle of the 20th century.2
They are extremely toxic, with some causing death within minutes of exposure. The proportion of people who die in any future attack will depend on the gas used and the form and level of exposure. Large numbers of poisoned patients are likely to require intensive supportive care, high dose antidotes, and close observation over a prolonged time. These demands will stretch any available health services.
The reasons given for the lack of clinical research on preparing for such an attack have ranged from optimism to denial. Statements such as: “Standard, effective treatment methods for such acute effects are available. The prognosis for patients surviving the initial acute effects from most [organophosphate] nerve agents is very good, suggesting little incentive for research on treatments”
show an amazing degree of complacency.3
Others have argued, however, that the threat is such a concern that new antidotes for chemical weapons should be approved by the US Food and Drug Administration without human safety or efficacy data.4
The few randomised controlled trials in organo-phosphate poisoning that have been done suggest that efficacy in animals does not translate into efficacy in humans.5
Much of this massive expenditure on preparation for nerve agent attacks may be misplaced.
Meanwhile the developing world is coping with a largely hidden tragedy. Poisoning is seldom mentioned as a priority for health research in the developing world. Yet, in some Asian countries, poisoning is a leading cause of premature death.6
Every year, hundreds of thousands of people are dying from pesticide poisoning.7,8
Millions more are being treated in overstretched health services, and a substantial number are left with long term disability. Research or programmes to tackle the problem of poisoning in developing countries has been insufficient, particularly for pesticides.9
Organo-phosphate poisoning is an important issue for developing countries, accounting for most deaths and disability after exposure to pesticides.7
The sarin attack in Japan produced many casualties