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A new approach to death by snake

There is something that sets those who are fascinated by snakes apart from other animal lovers. That’s not to say that all snake collectors are odd. But snakes have always been more than just another pet or another creature of the wild. There was a snake in the Garden of Eden. As a symbol of medicine, there’s a snake wrapped around the rod of Asclepius, the Greek god associated with healing. “Snake oil” is usually a potion that claims to have healing powers, but doesn’t. Cleopatra died from the bite of an Asp.

But despite their notoriety, snakes — according to some enthusiasts — aren’t getting the attention they deserve, especially when they bite people, which they do with more frequency than I ever suspected. In the course of preparing a report on snake bites for the PBS NewsHour, I found that the World Health Organization estimates that between 94,000 and 125,000 people die every year from snake bites, to say nothing of 400,000 amputations and other severe health consequences.

You would think that with those casualty figures, snake bites would be high on the list of world health problems. But they aren’t. In the U.S., fewer than 10 people die of snake bites a year; the big numbers are in rural areas of Asia, Africa, India and Central and South America. The WHO considers snake bite a “neglected tropical disease,” though a WHO spokesman says his organizations doesn’t neglect it. For one thing, it distributes anti-venom around the world.

Still, investigators into snakes and their biting habits claim that foundations have all but forgotten about snake bites when it comes to grants, and as a result, there’s not much research in the field. And that’s why an emergency room doctor from the San Francisco Bay Area — a guy who keeps a 12-foot (well-fed) boa constrictor in his house — decided to jump into the fray. Matthew Lewin wanted the world to know that snake bite deaths need more attention. So he wrote an op-ed, which the New York Times published on Sunday, April 12. In it he recalled how a researcher from the California Academy of Sciences was bitten by a venomous krait more than a decade ago, while working in Myanmar, and died because the venom caused him to stop breathing.

Lewin also works at the Academy as the director of the Center for Exploration and Travel Health, and he’s worried about snake danger on research trips to underdeveloped countries, as well as about the local populations. He believes that one reason so many people die from venomous snakes is that they can’t get to a hospital soon enough after a bite, where they can be treated with anti-venom (at $1000 per vial). In the field they could be saved with an inexpensive drug called Neostigmine which temporarily counteracts the neurotoxins — toxins that paralyze — found in the venom of cobras, kraits and other snakes. But that drug is usually unavailable in the wild, partly because it’s dangerous to inject.

Lewin had the idea that the drug could be administered safely and cheaply using a nasal spray, the way anti-seizure medicine is often administered in ambulances and emergency rooms. But how to test his idea? There isn’t much research money around, he reasoned, and the population of people who get bitten by snakes is generally very poor. Not much of a market for a drug maker.

So Lewin went out on his own, with a few colleagues — also snake people. Fortunately most of them had ties to the University of California San Francisco — the big medical center. They got official academic permission to try out Lewin’s idea at the med center — on somebody. That somebody turned out to be Lewin himself. He found a drug that was very similar to curare (used in poison darts) and was also very similar to cobra venom, in that it induced paralysis in its victim. So under careful supervision he was injected with the poison, and he developed the symptoms of a neurotoxic toxic snake bite: blurred vision, difficulty in swallowing and paralysis which could have stopped his breathing. Before he was too far gone a fellow doc administered the Neostigmine via a nasal spray, and Lewin came out of his stupor wildly enthusiastic: “It worked,” he roared. A colleague filmed the entire experiment, and the NewsHour used some of it in our report on Wednesday.

Since then, he and others have published papers describing the experiment and others that lead them to the conclusion that a nasal spray — or even an EpiPen, with the right drug — could save many lives in the wild where death is far too common. They say many of those deaths are the result of snakes whose venom contains neurotoxins that affect the brain. But other researchers say bites from only a few species would be affected by the drug, since many venomous snakes inject poisons that cause bleeding and tissue disruption, and don’t affect the brain.

In any case, Lewin is going full speed ahead with his project with or without foundation funding, which he would love to get. He’s hoping to reduce that terrible toll of snake bite deaths that hardly anyone seems aware of in the developed world.

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