Director's Message
Except for forensic medicine, toxicology remains a neglected area in the medical curriculum. This is despite the fact that every medical facility, be it a primary health center or the most well-equipped tertiary care hospital, gets to see poisoning cases on a daily basis. The biggest reminder is the Bhopal Gas Tragedy where thousands died in December 1984 due to the release of methyl isocyanate from the Union Carbide plant. Mass poisonings are frequently reported from the consumption of illicit liquor. After the Bhopal Gas accident, regulations were made more stringent and the government decided to set up Poison Information Centers.
However, till date, toxicology services are yet to become a part of India's healthcare system. These services have to be developed as a specialty because no single medical discipline can fully put a claim on the vast subject of toxicology.
To be a medical toxicologist, one needs to have a broad knowledge base that encompasses clinical medicine, pharmacology, analytical chemistry, occupational medicine, epidemiology and practical experience in emergency medicine. Many of the aforementioned skills are acquired only through experience. Even in countries like the USA, ABMS (American Board of Medical Specialties) recognized medical toxicology as a subspecialty after a lot of effort; the first ABMS-recognized examination in medical toxicology was offered in 1994.
In western countries, acute poisonings due to drug overdose and household chemicals are common. In contrast, acute pesticide poisoning is the most common form of poisoning reported from all over India and many other developing countries of South East Asia. This is due to the easy availability of toxic pesticides in spite of stringent regulations. The Insecticide Act in India makes it is mandatory to report all cases of pesticide poisoning. Unfortunately, most of the cases go unreported and official figures do not reflect the gravity of the problem. Social stigma of self poisoning and medico-legal issues ensure that relatives are ready to pay a price to the medical person/facility for not reporting such cases. On the other hand, many poverty-stricken people end their lives by consuming poison.
In India, chronic toxic exposures from environmental and occupational sources are also being reported very frequently, both in the media and in scientific publications. Toxic metals like lead and mercury in ayurvedic medicines, arsenic in drinking water, food adulteration, river pollution due to industrial effluents, indoor and outdoor air pollution and pesticide residues in food and water, continue to affect the health of millions. Awareness on the health effects of toxic substances is limited only to the educated classes, with most people either ignorant or too poor to bother about chemical-related health hazards.
It is in the last decade that a lot of research has been done on pesticide poisoning. The credit for this mainly goes to our neighboring country, Sri Lanka, where clinical toxicology has received a big boost under the banner of SACTRC (South Asian Clinical Toxicology Research Collaboration). Sri Lanka also deserves credit for banning a number of toxic pesticides which were responsible for very high morbidity and mortality. New guidelines are being published on the management of pesticide poisoning. We can learn a lot from these studies since the poisoning scenario is similar in both the countries.
Fortunately, due to the personal efforts and dedication of a few individuals in India, medical/clinical toxicology is slowly making its presence felt in emergency medicine. There is good research work being done by some individuals and institutions. A country as big as India should streamline the teaching and training of medical/clinical toxicology and also encourage research, as huge data on human toxicology is available and needs to be scientifically studied for preventing health hazards due to toxic agents.