Introduction

Organophosphate pesticide poisoning is a leading cause of morbidity and premature loss of life in many developing countries of the Asia-Pacific region. The efficacy of current antidotes is largely unproved, and many other potential antidotes have been developed but are yet to be tested in humans. Meanwhile, preparation for the terrorist use of organophosphate nerve agents is leading to the stockpiling of large amounts of these unproved antidotes to treat mass poisoning. An international collaboration of academia, industry, and military is needed to make a concerted effort to develop and test new treatments that would benefit both groups of patients.

A problem shared is a problem halved?

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 …