Venom, Anti-venom and Alternative Medicines by Kedar Bhide

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I have been tagged, asked for comments and emailed by friends asking about the Pinak tablet- the first Ayurveda anti-venom medicine. I have great respect for Ayurveda and I believe it may be helpful as a supportive treatment for patients who are recovering from a venomous snake bite. But at this moment there is no conclusive data on it.

Disclaimer: Picture has been downloaded from the internet

But before I share  my personal views on these tablets, let me share some basic information about snake venom and its action on our body.

Snake venom is nothing but a complex structure of proteins (enzymes, non-enzymatic polypeptide toxins and non-toxic proteins). These include either activators or deactivators of physiological processes such as blood clotting, nerve transmission and mitochondrial activities like energy production. Some of these enzymes break down membranes to promote the spreading of venom while some others increase vascular permeability causing oedema, blistering, bruising and necrosis at the site of bite.

The action of venom on our body depends on the quantity of venom injected at the site of bite. This is variable depending on the species of snake, size of snake, the mechanical efficiency of the bite, whether both fangs penetrated the skin, whether there were repeated strikes. Either because of the mechanical inefficiency or the snake’s control of venom discharge, a good number of snake bites by venomous snakes do not result in the injection of sufficient venom to cause clinical effects. Literature and studies show that about 50% of viper bites and 30% of cobra bites do not result in any symptoms or signs of envenomation.

I had a reason for sharing this slightly complex scientific information. Whenever any studies are done on snake bite patients, you will never get a group of people who have similar envenomation and show the same symptoms which would enable researchers to perform comparative studies of any alternative medicine. Without such a group, it is  impossible to claim better efficacy of certain medicines.

Anti-venoms are prepared by hyper immunizing horses with snake venoms and then extracting ready antibodies (Anti-venom) from their blood to be effectively used to neutralize the snake venom. This is direct and only antidote available to neutralize these complex structures of proteins. At the moment we have only this Polyvalent Anti-venom available as a proven antidote for neutralizing snake venom in snake bite victims. Anti-venom treatment can be expected to neutralize the free circulating venom, prevent progression of envenomation and allow recovery.

I do not think any other alternative remedies can neutralize this free circulating snake venom; they may help in slowing down effect of venom on our body or slowing down destruction of tissues. Take a case in hand-  the  Pinak tablets. Let me present some facts and then leave you   with some questions.

The Pune based Sasoon Hospital’s   study of these tablets clearly states that they are not an alternative to anti-venom serum. The study also shows that the group which was administered PINAK tablets showed faster recovery and required lesser number of anti-venom vials as compared to the other group. But, as I said earlier, these were random samplings and without any baseline comparison of envenomation and therefore taking such data as conclusive of efficacy of Pinak tablets may lead to erroneous treatment protocol.

The story circulated by the   media of a woman in Satara district is   data deficient.  According to the media report an old woman who was bitten by a Krait (which is highly venomous) had only 20 minutes to live as per the doctor and in the absence of anti-venom, they administered Pinak tablets. We don’t know if the snake was really a Krait and whether the woman was showing symptoms of venomation and not that of shock and the claim that she had only 20 minutes to live was the doctor’s perception. In such a case, I would not like to give any credibility to this incident.

I was also wondering whether oral intervention (like tablets) acts fast enough to reach the target site to neutralize the venom which gets absorbed rapidly in our tissues.

So we have the following questions to answer -

Do we have any alternative to Anti-venom?

Do we take some incomplete study as a proven treatment for snake bite?

Do we take all media reports at a face value and promote such alternative treatments?

OR

Do we continue to use Anti-venom as a primary and priority treatment for snake bite victims?

As for myself I will continue  using  anti-venom as the primary and the only treatment available at this moment and in case of shortage I believe we need to work towards increasing the availability of Anti-venom rather than looking at alternatives (unless there is robust data to prove otherwise).

 

About the Author:

Kedar Bhide is a post graduate in Applied Biology and a researcher with an affinity for reptiles. To his credit are the first report of the Sindh Awl Headed snake and Kaulback’s viper in India. For almost 25 years, Kedar has been conducting snake awareness workshops for adults and children. He is an ace photographer, macros being his forte.  Kedar believes in sustainability whether related to progress or exploitation of natural resources. He believes that the challenge we face as a species in terms of dwindling resources versus increase in population, coupled with myopic conservation methods are causing conflicts between nature and mankind.