It's unclear to me how much damage the pill prevents versus simply delaying it. I didn't see any clear statements on that in the article and there are a few quotes like, "intended to at least buy victims enough time to get to the hospital."
If victims still need anti-venom to prevent serious injury then the drug is much less exciting. As the article points out anti-venom treatments are expensive, unreliable, and hard to access; in other words not that great. Having more time to reach that treatment is better than nothing but is hardly world changing. Also, maybe I overly cynical, but I'm skeptical that this medicine will be affordable and accessible to most of the people in poor rural communities that make up the bulk of dangerous bite victims.
I do a lot of hiking and, like many folks who do the same, have been within reach of venomous snakes more times than I can count. A pill that can prevent serious damage from a bite would be huge; if it's effective and accessible.
This seems to be about India, so I don't know how my local conditions apply to this pill.
For rattlesnake bites the anti-venom has a 3 month shelf life and is expensive. Such snakebites are very rare (at least the local rattlesnake where I live). As such even though most rural areas have more rattlesnakes than humans, the local hospitals don't have anti-venom: most of the time it would expire unused. So if this pill has a better shelf life and gives time to air lift to the nearest large city (which may cover more than one state and likely has other ICU care that small rural hospitals can't provide) it is well worth having around even if it is just a stop gap.
My professor told me a story related to this. Now he was in WV, working on machines for the coal mines. Dead of winter, like a mile underground. Someone gets bit by a copperhead. At some point it must have hitched a ride on something and got brought into the mine. They had to fly the guy all the way to Columbus, OH to get the anti-venom because no one was stocking it during the Winter.
Delaying is already massive seeing as you often cant take anti-venom with you due to refrigeration needs. That delay is likely enough to get you to a clinic.
For the cost aspects, as India has shown life saving generics for people who couldnt afford it anyway are always an option.
edit: Its also worth mentioning that the "accessible by drone" aspect to reduce treatment times is rarely possible in the rain forests where such bites often occur.
Even if antivenom was stable at room temperature, that’s far from the only reason you can’t take it with you. Administration challenges, identifying the snake correctly and i.e. the right antivenom to use, variation in doses needed—which may well be multiple vials, the list goes on.
Further, even with antivenom administered, a person is likely to experience a range of side effects and symptoms that would be life threatening emergencies even in if they were inside an ICU, let alone out in the field. Without the compliment of an equipped medical professional and supportive care, antivenom may well do more harm than good in the immediate aftermath of envenomation.
Far better to get the person out of harms way and follow your local first aid procedure for snakebites. In Australia for example, that’s the pressure immobilisation technique, but in other countries it’ll depend on the venom in question. Rattlesnake venom is often necrotising and a tourniquet may cause more harm. Anything that buys more time is key.
> edit: Its also worth mentioning that the "accessible by drone" aspect to reduce treatment times is rarely possible in the rain forests where such bites often occur.
Given the expenses already involved, it seems to me that single use drones should be on the table. Fixed wing for range, with detachable wings and a hard dense fuselage for penetrating the tree canopy. They'd cost a few thousand a pop.
I didn't see any claims of it being a cure, but I think it still has the ability to be "world changing" for all those who are in need, much the same as a tourniquet doesn't fix loss of limb but can easily save a life when time is the deciding factor.
Went digging a bit. It's a "small molecule" (C21-H20-N2-O5) and commercialy available at $10/mg[1]. Presumably this would come down quite a bit if it were widely stocked.
The studies say they are looking at doses of 10mg/kg[2]. Similar dosing to a pain pill.
On a first read, looks like a partial solution as it only delays onset of venom pathology for a day, tho not sure I'm interpreting that correctly.
Otoh, it looks like the pills can continue to be taken for many days.. so perhaps there's promise for the venom to be slowly metabolized somehow that isn't inhibited. Might also bring down the cost of antivenom if it's now feasible to funnel patients into central treatment over greater distances, so stocks could be better used.
In the US that's still crazy exciting. Most of my hikes (at least, before I moved to the Bay), I'd rarely be within a 3h jog of the closest place a chopper could land, and that's assuming you have a satphone or something to actually contact the outside world.
Plus, in a ton of states, driving is a privilege, not a right. I've lost my license a few times after the judge in question said I was justified but some bureaucrat in "public safety" or whatever didn't care about the life-threatening issues at hand and just yanked that privilege. Bureaucracy is hard to undo, and even if it weren't strictly a matter of improving my chance to live I'd much much much rather take a pill and a slow, safe route to the hospital than spend one more God-forsaken winter biking to work in -20F.
> Plus, in a ton of states, driving is a privilege, not a right. I've lost my license a few times
A few times? How on earth have you been so unlucky? They won't take your license away just for speeding, let alone to a hospital, and even if that happened once to somebody I can't imagine it happening 'a few times' to a single person.
Some places will take your license for much, much, much simpler things than that. 3 tickets of any kind in a year's period is enough to lose your license in Iowa for example.
No, just speeding (and "a few" here means twice [0]). Once only 21mph over (still over 100mph in total), once pretty excessively. It was a fairly automatic extrajudicial process for anyone with enough proof of driving fast enough, regardless of what punishment (if any) came out of the trial.
Choppers don't need to land. Most of the time a rescue chopper would rather not. Winching you up to them is easier/safer than trying to land at an unprepared location. Even without a winch, they would "long line" you to the nearest road where there is room to land.
Notice the cut audio track. Giving these people the legal ability to give pain meds cant happen early enough. Mont Blanc helicopter rescue services also make some great documentaries every few years.
The situation is even worse for a lot of snake bite victims, as you cant get lifted out of the rain forest.
They can't give pain meds in the US? I believe in most of Europe, there's always a doctor on board of rescue helicopters, so they routinely administer drugs on board or on site of the accident.
For more comprehensive history/theory of Varespladib for snakebites, check out "Varespladib in the Treatment of Snakebite Envenoming: Development History and Preclinical Evidence Supporting Advancement to Clinical Trials in Patients Bitten by Venomous Snakes" (2022)[0] by the same Dr. Lewin this article is about. There's some interesting discussion of prior research in pigs where oral Varespladib is lifesaving for much longer time spans than injected antivenom, and a ton of somewhat-comprehensible cited sources.
Statistically this seems much less of a big deal for the US than for elsewhere.
Total number of fatal snakebites per year, worldwide: 138,000 (article points this out).
Total number of those in the US: 5. (Not 5%; 5 people.)
If you can get to any decent hospital within a few hours after a bite, you'll probably live. If you're one of the unlucky 5 who cannot, then yes this pill might be a good idea.
If this pill can stop or slow the damage from the highly toxic protein that is present in snake venoms, then I can see it being useful everywhere, including the US.
You are only considering fatalities, but approximately 400,000 snakebites each year cause permanent deformities or amputation. Even more people are out of commission for months while healing. Having your tissue chemically digested by snake venom is no fun.
I was told in the military that snakes cant bite through a regular
army boots.
Thankfully, I have never had it proven to me.
The snake can bite above the boot, or on other parts of the body so
I am not saying it provies that much protection.
I used to do a bit of hiking in Colorado.
Using advanced open sandals. I can't remember the manufacturer.
I was inches from stepping on a rattlesnake on one hike.
I got out my army boots for every hike after that.
(Far less comfortable)
I hope it is true.
Mind you, I am old now.
I believe the army uses boots that are generations newer than mine.
(They still sell the classics)
I dont know if the new ones are better or worse when it comes ot the
possibility of avoiding a snake bite.
> I was told in the military that snakes cant bite through a regular army boots.
Maybe... I definitely stepped on a honey locust thorn in boots tougher than standard army issue and had it pierce the bottom of the boot, my foot, and the top of the boot. Rattlensake teeth have different geometry and force profiles, so they might not penetrate, but I wouldn't want to prove that fact in person.
Yep, no problem. I was still a teenager, so basically every injury I sustained then is just a tiny scar now, along with a mental note of activities to avoid.
Haha. Yep, except I still have divot scars in my knees from skateboarding - protective gear + concrete. I do have some newer scars on my left hand and scalp from e-scooter + absurd urban Texas traffic "design" including random, worn, unpainted chunks of concrete in random places in the middle of the street because clearly only cars should use streets.
That is why real western cowboys wear cowboy boots: snakes cannot bite through. (of course cowboy boots are in style for non-cowboys, but real cowboys wear those boots because they are functional not because they are stylish)
Venemous snakes come in enough variety of types and sizes that most boots probably provide some partial protection. The venom of a baby rattlesnake for instance is much more potent than that of an adult; footware that can only stop small fangs would still be helpful.
Snakes are almost never aggressive though. A significant portion of snake bites happen to drunk people being stupid. The general guidance is to avoid putting your limbs anywhere you can't see and to leave snakes alone when you encounter them.
I don't know about snakebites but recently I read about a man who ate a Destroying Angel mushroom by mistake. He was given an antidote for the toxin which amazed that me such a thing existed. I wonder how similar if at all amatoxin and snakebite venom are? One is venom and one is a poison so maybe not much.
As I’m mowing the ditch, I go by them three or four times, and I’m like, ‘Man, those look good,’ ” the 55-year-old said, closing his eyes as he remembers the day.
For generations, the Hickman family has foraged for mushrooms. Unlike his great-grandparents, who had to study which ones were safe to eat, Hickman thought he had an advantage: He pulled out his smartphone, photographed the fungi and uploaded the image to a plant identifier.
I can't even begin to fathom how someone would think this was a remotely smart idea. Trusting a photo identification algorithm on some random fuck-knows identifier based on your possibly badly composed phone photos, all because "man those look good".. Mind boggling.
No kidding! I briefly looked into mushroom foraging, but after learning how similar tasty mushrooms and you-will-die-a-quick-painful-death ones looked, I quickly lost all interest. The payoffs are about as asymmetric as it gets. Blindly following a random phone app identificaton makes it even worse.
Quote: "In a 2013 experiment conducted with a team of anesthesiologists in a research laboratory at UC San Francisco, Lewin allowed himself to be paralyzed with derivative of curare, a chemical typically administered intravenously as a paralyzing agent for surgical procedures.
Moments later, he said, “I couldn’t talk, felt dizzy and had trouble breathing.”
The team then administered the nasal spray, and within 20 minutes Lewin had recovered."
So it's a nasal spray, not a pill. Also a pill would take longer to be metabolized leaving the venom to do its damage longer. I'd say nasal spray or inhaler is the way to go. Or better, an epipen.
> Drug trials are being conducted by Ophirex Inc. — a public benefit corporation that Lewin founded with musician and entrepreneur Jerry Harrison in Corte Madera, Calif.
How common is it for a pharmaceutical company to be a public benefit corporation?
>to make that possible we are studying ways to reduce manufacturing costs
Varespladib has a very simple molecule, doesn't it? Kinda resembles indolecarboxamides like AB-BICA or something like that (the kind of things you can buy for $2000/kg).
The best preventative action against snakebite is in fact pre-emptive strike. Don't wait until after being bitten to take anti-venom, it's too late then!
But in case it's not... snakes do not bite me on the average day. Should I take antivenom every day, just in case? That may not be entirely free from side effects.
It's amazing to watch evolution create a biochemical cocktail that substitutes for all the power snakes lose by being limbless slithering rubber hose animals.
If you can condense all the bodily and kinesthetic intelligence and capability that humans (or say Belgian Malamutes) have developed in a single biochemical cocktail that would effectively pay off the tech debt of dispensing with limbs and power...it's pretty incredible to see what that looks like.
Not wishing it on anybody, but a pretty badass way to go out: Felled. By...evolution.
I don't think the tradeoffs really work that away, especially given how many succesful snake species have no venom at all. Biological traits are too conplicated and contextual to boil down to a single stat.
There’s been some interesting self experimentation in that direction. Unclear if the startup Tim Friede was involved with actually has gone anywhere yet, but he was basically dosing himself with a plethora of snake venoms to build immunity.
I thought I heard somewhere that a blood transfusion from someone who was bitten acted as antivenom even. Not sure if that's true or where I even heard it. Very interesting if it is true.
This practice is referred to as Mithridatism. Snake venom injections will help develop an increased metabolic tolerance, but this not quite the same as developing a vaccine. Bill Haast injected himself for years with gradually increasing quantities of snake venom. His blood was able to be used in place of anti-venom.
> he was administered 28 vials of antivenom intravenously at a cost of $3,400 per vial.
As someone who lives in Australia, who grew up with aggressive and deadly snakes, what the actual hell? Nobody is out of pocket in Australia following a snake bite and we have many more species and all of the geographic remoteness of the South Western US. Is this just another case of a side effect of the state of the USA healthcare system?
If you're in Sydney, Australia, head an hour north to visit the Australian Reptile Park. It's a small zoo that additionally specialises in snakes and spiders that can kill you. It is the sole source of the venom that gets used to make Australia's anti-venoms [1].
The Australian Reptile Park may be related to the cost aspect, in that their program provides a ready supply of the raw materials needed for anti-venom.
Incidentally they collect funnel web spiders for venom production and have a collection network, whereby people can harvest funnel web spiders from their backyards and drop them into collection points around Sydney [2].
Cost is a recognised factor in anti-venoms, and there is ongoing research to reduce their cost [3].
That site left too much to the imagination as to how they collect the spider venom. Or is it from a dissection to collect the entire venom containing organ?
Was also smirking that the snake venom collection the visuals were either of a person wearing no gloves or easily punctured latex.
They antagonise the funnel-web until it begins striking and the venom is dripping from its fangs, and then they use a liquid dropper to suck that venom up. It is wild.
Stats from the video: 1 vial of antivenom requires 20 milkings. Worst case, a treatment requires 10 vials. This is part of the reason antivenom is expensive. Seeing this process, one can appreciate the attraction of a manufactured pill.
As embarrassing as that sentence is, it is highly unlikely he left with a $95,000 bill, nor is it likely his insurance company actually paid anywhere near that for the vials. The prices that end up on healthcare bills may as well be in another currency, since they tend to be used as placeholders subject to all kinds of contractual math down the road.
None of which is to say that our healthcare system ISN'T a mess, it is.
Yep, https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-c... points out that 70% of the billed cost of antivenin is hospital markup. This isn't even part of expected profit... it's fully expected that this will be discounted for those that are insured. But you never really know what your insurer will pay and there are stories of people dying from refusing treatment, worried about their out of pocket cost.
Given he’s most certainly on Medicare Advantage at 74, and the context of the article, I think that’s the sticker cost from the manufacturer, not the patient-billed cost. His bill was, most likely, in the hundreds.
Minor nit. Medicare Advantage is an optional thing people can buy into. The standard is Medicare A&B although you can also buy Medicare Supplemental (Medigap)to cover some of the deductibles (and foreign travel) and D for prescription drugs.
Totally! You caught me assuming MA given the baseline enrollment is slightly higher, and that number is also slightly greater in CA, but valid thing to note.
Why don't we do with (problem) snakes what we do with the mosquito, specifically releasing either a) irradiated males who are sterile that produce offspring that do not hatch, or b) males with an installed gene drive that can only sire males for all future generations?
Either case results in a population crash. I don't know if gene drives have been used against wild populations as yet (although there is great interest and substantial justification).
Mosquitos inhabit an ecological niche that is much safer to eradicate than snakes. Mosquitos' predators have many other sources of food so they're not critical to any species and they're not predators that keep prey populations in check. They're just a deadly nuisance to humans without access to plentiful modern medicine.
Snakes on the other hand as mid-level predators are likely keystone species [1] and killing them would wreck their ecosystems by letting rodent populations grow out of control. In California they keep ground squirrel populations in check and provide a source of food for all kinds of raptors.
But mosquitos pollinate plants so eliminating them would not be a harmless act. They are clearly far more deadly than snakes though. The number of deaths per year they are responsible for always impresses me.
Do they pollinate any plant types that only rely on mosquitos, or would mosquitos going away just allow other insects/moths/etc to grow in population size thanks to more available pollen?
Aside from being carriers of disease, mosquitoes have been identified as fulfilling an insignificant biological niche. My knee jerk suspicion is that snakes are more important to an ecosystem.
It depends. e.g. In Australia, the snake most people worry about (the eastern brown - world's second most venomous and common in cities) is native, so yes it's important to an ecosystem in the broader sense. But its numbers around cities have gone up because of mice, most of which are introduced, so it's a non-native part of the ecosystem that's pushing the numbers up. Doing something to bring the numbers back down around urban centres wouldn't seem like such a bad idea. Brown snakes aren't a threatened or endangered species and though cities are large human centres, they're not a large portion of the Australian geography. (And are largely artificially maintained ecosystems anyway - those houses and roads didn't appear naturally.) There are probably other ways for dealing with mice than having the world's second deadliest snake hanging around town.
From a human vulnerability perspective, there is minimal human threat in North America's poisonous snakes, compared to the areas of India, China, Australia, and other nations in this area. Driving down the population for reasons of human risk seems reasonable there, by reversible means.
With Florida's problem of invasive snakes, extreme removal efforts seem likewise warranted as non-native species should be completely removed from the local environment, especially considering their profound negative impact on biodiversity.
99 times out of 100, snakes leave you alone if you leave them alone. Most snake bites occur on the hands or face because they happen when people are messing with them. It's extremely unethical to kill snakes. If you have a venomous snake somewhere on your property that you cannot tolerate it, you should call an expert to come move it for you.
Most of them are men with old fashioned attitudes towards snakes who aren't as young and spry as they used to be, who fuck with the snakes and get rewarded with a bite.
Rattlesnakes are perhaps the most courteous of all venomous snakes; they are named for their instinctual habit of making a lot of noise to warn you away. Unfortunately their rattling often gets them killed by ignorant people (particularly those old people) and so some populations of rattlesnakes are now less inclined to rattle. This puts humans at greater risk, so particularly in the case of rattlesnakes you should leave them alone.
If you step on one that didn't rattle and you kill it after getting bitten then I could forgive you, but killing any random rattlesnake you happen across is an asshole move.
An ad hominem, even against myself, would be fallacious when used to discredit factual statements. You're also inventing a strawman of 'needless' killing.
In any case I've seen small children playing in places I 'formerly' saw a snake, and I'm willing to take all the 'discredit' in the world to not live with the guilt of finding out they were bit not long after I encountered the venomous snake. I don't give a shit about some snake off the beaten path far from where the vulnerable roam, and indeed I leave those alone.
It is not unethical to kill an invasive species. The invasive snakes in Florida would better serve their local biosphere if they ceased to exist, no question.
For the 50k annual human fatalities from snakes, that is a matter of personal opinion.
The invasive snakes in Florida aren't venomous. I'm not aware of any invasive snakes with medically significant venom anywhere in the world, but killing invasive snakes is fine.
The snakes which kill people virtually always fall into one of two categories; native species and pets. These shouldn't be killed except in the most dire of contrived circumstances (e.g. "what if there is a cobra poised to strike my child who cannot run away?"). Leaving the snake alone is always a better choice.
Snakes kill and injure vastly, incomprehensibly fewer people than mosquitos. I’m not clear why we would try to destroy them or why that would be remotely desirable.
Seems fair game to me. How would you feel if you had lost a loved one to a viper, even if they engaged in rock climbing or another dangerous activity? Convictions crumble before personal adversity.
To 1 million deaths by mosquito and exponentially more infected by Malaria. Again, it’s just not close, and it’s going to be vastly fewer when you think about rattlesnakes in the US or whatever in Australia.
And, as above, mosquitoes are largely eco-irrelevant. Snakes are not. Anti-venom seems like the better solution.
"The World Health Organization estimates that 138,000 people are killed by venomous snakes annually."
While that may be irrelevant to you (even in the face of personal affliction), the cost of surviving this interaction is also high:
"During that time, he was administered 28 vials of antivenom intravenously at a cost of $3,400 per vial... They are also species-specific, meaning selecting proper antivenom requires knowing which type of snake bit you... As a result, survivors of rattlesnake bites in Southern California, for instance, get a second painful surprise when presented with hospital bills totaling hundreds of thousands of dollars."
I applaud you for your willingness to undertake this burden for yourself, but I am afraid that I am not.
I don't drive a snake to work. I don't use a snake for my livelihood. I don't take my snake down the hill for groceries. I can't load all my kids and their stuff in the snake to go see family.
Your comparison is lazy and ridiculous. Nonetheless, there are people trying to get cars out of cities (and I wish them luck).
If victims still need anti-venom to prevent serious injury then the drug is much less exciting. As the article points out anti-venom treatments are expensive, unreliable, and hard to access; in other words not that great. Having more time to reach that treatment is better than nothing but is hardly world changing. Also, maybe I overly cynical, but I'm skeptical that this medicine will be affordable and accessible to most of the people in poor rural communities that make up the bulk of dangerous bite victims.
I do a lot of hiking and, like many folks who do the same, have been within reach of venomous snakes more times than I can count. A pill that can prevent serious damage from a bite would be huge; if it's effective and accessible.