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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Friday 25th November 2011

Prof Arthur Grollman has been kind enough to send me a copy of the published paper following on from his presentation to the annual meeting of the American Society of Clinical Oncology in June. The paper, which is already available online, will appear in a future edition of ‘Kidney International’, the official journal of the International Society of Nephrology. The full paper, entitled ‘Aristolactam-DNA adducts are a biomarker of environmental exposure to aristolochic acid’, is restricted to members and subscribers but you can see the abstract.

The significance of this new paper from Grollman and his associates is that the final sentence of the abstract states, ‘Thus, in genetically susceptible individuals, dietary exposure to aristolochic acid is causally related to endemic nephropathy and carcinomas of the upper urinary tract’. Aristolochic acid (AA) is a component of plants in the Aristolochia genus, such as Aristolochia clematitis, birthwort.

Aristolochia clematitis, birthwort

Aristolochia clematitis, birthwort

Generally, scientific papers are full of caveats; the authors write about ‘risk factors’ and ‘possibilities’ not least because they know the peer reviewers who scrutinise papers will not permit claims that cannot be substantiated. This apparent hesitance can lead to non-scientists claiming that black is white because they say that even the scientists don’t know.

It was this that caused so much of a problem with getting people to accept the MMR vaccine after the erroneous suggestion that the vaccine caused autism. Science was able to demonstrate that there was no such link but would not go so far as to say that no-one would ever be harmed by the vaccine. That enabled the deniers to claim that if science wouldn’t say MMR was harmless to every child that must mean it could be harmful to every child.

To date, Prof Grollman’s work on aristolochic acid has had the same problem. By not being able to say that there was a causal link between AA and chronic kidney disease and upper urothelial cancer (UUC), it remained possible for people, especially those involved in selling Traditional Chinese Medicine (TCM) remedies containing AA, to deny that the substance caused any problems. Now that it has been demonstrated that, for those with a genetic predisposition, AA will cause CKD or UUC, such denial should no longer be possible.

But, as I wrote back in June, ‘the debate about TCM versus ‘Western’ medicine rapidly becomes political’ and these political difficulties may well continue to prevent a sensible approach to dealing with this poisoning.

Arthur Grollman tells me he is organising a scientific meeting in Taipei, the capital of Taiwan, for the 7th January 2012 ‘focussed only on aristolochic acid nephropathy and its associated cancer’. By lucky chance, the Taiwanese health minister became aware of the meeting and asked for the opportunity to make a welcoming address to the delegates.

Perhaps, that increase in the profile of the issue will help to raise awareness of the number of people who have already suffered illness and death due to AA exposure and the ticking time bomb that arises from the increase in the use of TCM around the world.