Intended for healthcare professionals

Education And Debate

Overcoming apathy in research on organophosphate poisoning

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1231
  1. Nick A Buckley (, director of clinical pharmacology1,
  2. Darren Roberts, PhD student1,
  3. Michael Eddleston, Wellcome Trust career development fellow2
  1. 1 South Asian Clinical Toxicology Research Collaboration, Department of Clinical Pharmacology and Toxicology, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
  2. 2 Ox-Col Collaboration, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
  1. Correspondence to: N A Buckley
  • Accepted 20 September 2004

High rates of pesticide poisoning in developing countries and increasing risk of nerve gas attacks in the West mean effective antidotes for organophosphates should be a worldwide priority


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 …

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