Podcast Summary
Venomous snake bites treatment: Anti-venom is crucial for treating venomous snake bites but is hard to find and extremely expensive, often costing up to $100 million in the US.
Venomous snake bites, although rare in the US, can be life-threatening and extremely expensive to treat. Dr. Sean Bush, an emergency physician and snake bite specialist, shared his personal experience with his two-year-old son's encounter with a rattlesnake. Bush emphasized the importance of having anti-venom on hand, as it's the only thing that can neutralize the toxins. However, anti-venom can be hard to find and incredibly costly, with treatments often reaching up to $100 million in the US. Despite the risks and costs, there's a dedicated community of doctors, scientists, herpetologists, and enthusiasts who study venomous snakes and their venom to improve treatments and save lives. This community came together for the ninth annual Venom Week in North Carolina to share research and advancements in the field.
Snake behavior and medical implications: Understanding snake behavior and biology, as well as medical implications of their bites, is crucial for preventing snake bites and reducing health risks. Snakes prefer not to bite humans and only do so when provoked or threatened.
Key takeaway from this year's Venom Week event is the importance of understanding the behavior and biology of venomous snakes, as well as the medical implications of their bites. The event covered various topics, from the economics of snake bite care in Nepal to the more technical aspects of snake-induced conditions like thrombotic microangiopathy. Snakes, it turns out, prefer not to bite humans as it's biologically and metabolically costly for them. Out of the over 3,000 snake species worldwide, only around 200 are venomous enough to kill a human. In the US, we have approximately 20 of these venomous snakes, with coral snakes and pit vipers being the most common groups. Dr. Sean Bush, a leading expert in snake venom and the president of the North American Society of Toxinology, emphasized that snakes are primarily interested in their food and will only bite when provoked or threatened. Therefore, education and awareness about these creatures and their behavior can go a long way in preventing snake bites and reducing the associated health risks.
Snake venom properties and anti-venom production: Unique snake venoms can cause necrosis and require immediate medical attention and anti-venom for treatment. Anti-venom is derived from snake venom and can only be produced with raw venom extracted from snakes in specialized facilities.
Every type of venomous snake produces venom with unique properties that can cause various harmful effects if not treated promptly. Some venoms, like pit viper venom, can cause necrosis and digest the victim from the inside out. Misconceptions about what to do in case of a snake bite, such as using a tourniquet or sucking out the venom, can be harmful and ineffective. The only proven method to save a victim is to seek immediate medical attention and receive anti-venom, a drug derived from antibodies that bind to the venom and prevent further harm. To produce anti-venoms, manufacturers require raw venom, and facilities like Agritoxins Venom Production Laboratory in St. Cloud, Florida, play a crucial role by extracting venom from snakes, such as coral snakes, and supplying it to pharmaceutical companies. Extracting venom from snakes is a challenging process, as they are difficult to catch and can only be milked every few weeks.
Snake venom market: Collecting venom from snakes is a valuable but challenging process, with coral snakes being harder to obtain and requiring more animals to produce the same amount as larger snakes. The market for anti-venom is small, so venom producers rely on contracts with larger companies to sell their venom and don't make large profits.
Collecting and selling venom from snakes, particularly coral snakes, can be a valuable but challenging process. While some snakes, like larger eastern diamondbacks, can produce significant amounts of venom, others, like coral snakes, are harder to obtain and require more snakes to produce the same amount. The market for anti-venom is relatively small, so most manufacturers buy only small quantities. Despite the potential for high prices, full-time venom producers typically don't make large profits, and must rely on contracts with larger anti-venom companies to sell their venom.
Snake antivenom production: Snake antivenom production involves complex and costly processes, including milking snakes, infecting sheep, and research and development, resulting in high wholesale prices for the antivenom.
The production of snake antivenom, such as Trophab, is a complex and costly process. Pfizer holds the monopoly for coral snake antivenom production in North America, while there are two options for rattlesnake antivenom: Anavip from Pfizer and Trophab from Serb Pharmaceuticals. Serb sources venom from both private labs and their own facilities, then sends it to Wales for purification before injecting it into sheep in Australia to develop antibodies. After around 18 months, the antibodies are harvested, purified, and shipped back to the U.S. for distribution. The high cost of production, including milking snakes, infecting sheep, and research and development, results in a wholesale price of approximately $3,800 per vial for Trophab. Developing antivenom is an expensive endeavor, with the cost of a single trial ranging from $5 to $10 million.
Antivenom cost challenge: The high cost of antivenom creates a significant financial burden for hospitals and patients, with prices ranging from $15,000 to over $200,000 per vial, often resulting in exorbitant hospital bills for those seeking treatment.
The high cost of anti-venom is a significant challenge for many hospitals and patients. Hospitals, especially smaller ones and urgent care facilities, struggle to afford stocking enough anti-venom to treat even one patient. The cost per vial can range from $15,000 to over $200,000, making hospital bills for snake antivenom notoriously high. For instance, a family in Illinois was billed $68,000 for four vials, and a South Carolina teenager received a $200,000 bill for 12 vials. These charges are often much higher than the wholesale price. Most physicians may not be aware of these costs or feel uncomfortable discussing them with patients. The cost of anti-venom treatment can be equivalent to the cost of a house, and while insurance may cover a significant portion for some, the uninsured bear the full burden.
Snake bite antivenom access: In poorer regions, lack of access to affordable antivenom results in thousands of deaths and disabilities annually, while companies like Premium Serums and Vaccines in India produce close to 1.5 million vials each year to address this issue in high-risk regions
While venomous snake bites are relatively rare and treatable in developed countries like the US, they pose a significant threat and often result in death or disability in poorer regions of the world, particularly in Southeast Asia and Central Africa. The lack of access to affordable anti-venom, due to production being unprofitable for manufacturers, exacerbates this issue. For instance, the World Health Organization estimates that between 80,000 and 140,000 people are killed annually by snakebites, and many more suffer permanent disabilities. Companies like Premium Serums and Vaccines in Pune, India, are making strides in addressing this issue by producing polyvalent antivenoms for multiple snake species in high-risk regions, such as India, Pakistan, Bangladesh, Sri Lanka, Nepal, sub-Saharan Africa, Egypt, Libya, Morocco, and Tunisia. They produce close to 1.5 million vials of antivenom each year.
Affordable anti-venoms for snakebite victims: Organizations like Deshpande's and the Asclepius Snakebite Foundation are making life-saving anti-venoms more accessible and affordable in regions with high instances of venomous snakebites by using polyvalence anti-venoms, sourcing from low-cost manufacturers, setting up local treatment centers, and even covering costs for those who cannot pay.
Organizations like Deshpande's and the Asclepius Snakebite Foundation are working to make life-saving anti-venoms more accessible and affordable in regions with high instances of venomous snakebites, such as India and Africa. These organizations use polyvalence anti-venoms that cover the bites of multiple snake species and keep costs low through various means, including sourcing from low-cost manufacturers and setting up local treatment centers. For instance, the Asclepius Snakebite Foundation's anti-venom costs around $100 for a severe envenomation, and they cover the cost for those who cannot pay. Researchers are also working on more affordable alternatives, such as an anti-venom pill and lab-synthesized antibodies. These efforts are leading to significant reductions in snakebite mortality, with Guinea reporting a drop from 30% to less than 2% after the opening of a snakebite clinic in 2019.
Snakebite treatments: The future of snakebite treatments may involve lab-produced antivenoms, reducing the cost and complexity of production, potentially making current venom collection methods obsolete.
The future of snakebite treatment is likely to involve lab-produced antivenoms, rather than the current method of collecting venom from live snakes. Jack Ficente, a venom collector, believes this shift could make his services obsolete. However, he is optimistic about the potential for increased access to affordable snakebite treatments, as this new approach could reduce the cost and complexity of production. The current process involves using host animals, such as sheep, in countries like Australia, and then purifying and cataloguing the venom. With advancements in genetics and protein research, scientists may be able to reproduce the desired proteins directly, eliminating the need for venom collection. Despite the potential impact on his profession, Ficente supports the progress towards more effective and accessible snakebite treatments.