On Scorpion Envenoming Syndrome. Problems of Medical Ethics and Accountability in Medical Research in India

K. RADHA KRISHNA MURTHY(1)

(1)Department of Physiology, Seth G. S. Medical College & K. E. M. Hospital, Parel, Mumbai 400 012, India.

ABSTRACT: Extent of the Problem. Death due to scorpion envenoming syndrome is a common event in the world in general and especially in tropical and subtropical countries. Venom from scorpions all over the world that belong to Androctonus, Buthus, Centruroides, Leiurus quinquestriatus, and Tityus species of the Buthidae family is highly toxic. India itself harbors 99 species [out of about 600 species in the world] of scorpions and 45 of these species of scorpions are considered as having the most highly toxic venom. All these 45 species belong to the Buthidae family, as against most of the other countries, which harbor far less number of venomous scorpion species. The consequences of scorpion envenoming syndrome have been underestimated in health statistics of developing countries due to inadequate detection and/or data entry of cases. There is not even a “guess estimate” regarding the number of deaths due to the “nocturnal visitors”. Moreover, most standard textbooks of Medicine or Cardiology dismiss scorpion envenoming in a few lines. This is probably why the problem of scorpion envenoming syndrome has overall been either ignored or neglected by the scientific community of developed countries. Being aware of and concerned about this problem, I read with great interest Karnad’s article (18), and the responses and opinions of Deshpande and Alex (10) and the Bawaskars (5-9) in national (from India) and international publications. Therefore, a need to review some of the views and practices in the field of scorpion envenoming research from an ethical point of view was perceived.

Consider the Bawaskars’ opinion, “Human scorpionism is entirely different from experimental” (6,8). One must consider the international opinion in this context to evaluate the opinion of the Bawaskars’.

Statements like “Animal experimentation differs from human envenoming” or Experimental considerations are different from clinical situations,” cannot be accepted. “Some of the most important information about haemodynamic effects of scorpion envenomation was obtained from Dr. Gueron’s work on experimental animals,” Ismail (16,17).

“The therapeutic agents should not be used for treatment of scorpion stings unless previous laboratory tests indicated their safety and effectiveness”, Stahnke (36).

“Experimental treatment protocols are required to check the value ofEdrugs in the treatment of scorpion envenoming”, Ismail (16,17).

Human and experimental animal studies are required in order to verify the assumption that interleukin-6 and other cytokines are involved in the pathogenesis of scorpion envenoming syndrome (35).

About the use of newer drugs and scorpion envenoming syndrome

Although newer drugs were recently used in the management of scorpion venom-induced hypertension, in particular, hydralazine, prazosin, and nifedipine the selection of these drugs was based mainly on some recognized merits of the drugs rather than a deeper understanding of the action mechanisms of scorpion venom (16,17).

KEY WORDS: scorpion envenoming syndrome, India, Androctonus, Buthus, Centruroides, Leiurus quinquestriatus, Tityus species.

CORRESPONDENCE TO:

K. Radha Krishna Murthy, D. Sc., D., M. N. A. M. S., Professor & Head, Department of Physiology, Seth G. S. Medical College & K. E. M. Hospital, Parel, Mumbai 400 012, India. Email krdhakrishnamurthy@yahoo.com