Episode 951: Snakebite : Planet Money Snakebites are common but antivenom is expensive to develop. So a doctor goes to extreme lengths to find a solution. | Subscribe to our weekly newsletter here.
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Episode 951: Snakebite

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Episode 951: Snakebite

Episode 951: Snakebite

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UNIDENTIFIED PERSON #1: This is PLANET MONEY from NPR.

(SOUNDBITE OF MUSIC)

KENNY MALONE, HOST:

Some medical problems get solved the traditional way - you know, enormous pharmaceutical companies or university labs that have huge budgets and run trials, that sort of thing.

AMANDA ARONCZYK, HOST:

But some solutions to medical problems take a much stranger path; like they start with a tragic tale, lead to an encounter with an '80s rock star and end up with an obsessed neuroscientist putting himself on the operating table to find a treatment.

MALONE: You know, that path.

ARONCZYK: (Laughter) This is that second, stranger kind of story. Do you mind just saying your name?

DAVE CATANIA: My name's Dave Catania.

MALONE: Dave was there for the first part of this story - the tragic tale. This was back in 2001, and Dave was part of an expedition put together by the California Academy of Sciences.

CATANIA: I was the one fish guy on the trip.

MALONE: Dave is an ichthyologist, which is a fancy way of saying he is interested in looking for cool fish specimens on this expedition in the jungles of Myanmar.

ARONCZYK: What was your impression as you started to walk in?

CATANIA: Hot (laughter) - there were leeches there, which were fun. You'd stand in one place long enough, and you'd see them coming towards you.

ARONCZYK: Dave remembers the leeches because, of course, you'd remember the leeches. And he remembers where the expedition stopped after that brutal first week of hiking.

CATANIA: We had pitched our little tents - kind of for mosquito protection and stuff - in a schoolhouse, actually. And so we were kind of - all kind of crammed in there.

ARONCZYK: So you had pitched tents inside...

CATANIA: Inside the schoolhouse, yeah - it worked.

MALONE: So they're all set up. They're ready to start exploring. But this story is not about Dave. It is about the leader of this expedition.

ARONCZYK: A guy named Joe Slowinski. Joe was a herpetologist - a snake guy. And he'd been catching and handling snakes since he was a little kid. He loved snakes. He was already on his way to becoming one of the country's leading experts on snakes.

MALONE: Joe was also on this expedition to look for new species. So after the tents were set up in the schoolhouse, everybody went out looking for their own animals. Dave - the fish guy - of course, he put nets in the water to find exotic kinds of fish. Joe and his snake team - they went out pretty late looking for snake specimens.

CATANIA: Herpetologists will frequently go out at night. And so the next morning, it's - you know, our - it's time to, you know, process some specimens. And there was bags with some snakes. Joe picked one of them up and said, what's in here? And one of his field team said, it's a Lycodon, I think. There's a snake in the genus Lycodon that gets some protection by pretending to be a poisonous snake, even though it's not - it's, you know, completely - Joe reached into the bag and then it - pulled his hand out really quickly, and there was about a 10-inch long snake - little one - with just one fang stuck in his finger, and you couldn't even tell that anything had happened.

ARONCZYK: Someone was wrong. The bag did, in fact, contain the venomous version of the snake - a deadly krait snake. Joe started to feel a tingling in his hand, and he knew it wasn't very likely that the team could get him to a hospital in time.

CATANIA: So he got us all together and explained what was going to happen - explained it very calmly, actually, which is really quite amazing because the venom effects the voluntary muscles. So, essentially, it's kind of - it's paralysis, basically, but you lose the ability to breathe.

MALONE: Now, remember. The team had hiked into the jungle. There are no vehicles. They don't have a satellite phone. So the team sent a couple of runners off to the closest village. And in the meantime, Joe's description of what would happen to him starts to come true.

CATANIA: You know, his speech got slurred. And gradually, he couldn't really respond. And at that point, it's just - we're just talking to him just to kind of keep his mind diverted.

ARONCZYK: The team that had run off for help was trying to get to a village that was about eight miles away. They were hoping there was a radio or a phone or something to call for help.

CATANIA: Well, we were hoping for an airlift to get him out. I think once or even twice, the chopper was coming, but it was turned back by bad weather. And during that time, Joe's heart stopped. And we actually did CPR for a while. And the doctor finally said, he's gone. And so we stopped at that point. And when the chopper did arrive, it was to evacuate the body. We did what we could with what we had available.

ARONCZYK: Was there no one who was going to bring an anti-venom?

CATANIA: No. It needs to be kept refrigerated, and it's not the sort of thing you can lug into the field.

(SOUNDBITE OF MUSIC)

MALONE: There are over 100,000 people who die from snake bites every year. And as with Joe Slowinski, this usually happens in a remote place. And often, the problem is keeping someone alive long enough to get help.

(SOUNDBITE OF MUSIC)

MALONE: Hello, and welcome to PLANET MONEY. I'm Kenny Malone.

ARONCZYK: And I'm Amanda Aronczyk.

MALONE: Amanda, you are our newest host here at PLANET MONEY. You've spent a good chunk of your career covering science, health.

ARONCZYK: Right. And that is why I am starting off with this story about snakebites. There haven't really been any innovations for treating snake bites since anti-venom - or antivenin - which was developed over a hundred years ago.

MALONE: And there hasn't necessarily been a ton of market incentive to find better solutions. There are millions of snake bite victims per year, but most are in poor, rural areas of places like Africa, Asia, Latin America - populations that Big Pharma has tended to overlook.

ARONCZYK: Today on the show, we meet a man who goes to some pretty extreme lengths to find a solution.

MALONE: Ten years after the death of Joe Slowinski, the snake guy on the California Academy of Sciences expedition to Myanmar, the Academy was once again organizing an expedition to a place with a lot of deadly snakes; this time, the Philippines. And they did not want a repeat of what happened to Joe.

ARONCZYK: So the Academy calls up the local hospital. And they ask, you know, do you have a doctor who can help us out? The hospital says, yes, we have got just the guy. He's a scientist. He's an emergency room doctor. He's gone on expeditions before. His name is Dr. Matt Lewin. And preparing for the very worst - it's kind of his thing.

MATT LEWIN: So I often rehearse scenarios in my head before I go into the hospital for a shift. I'll play out in my head, what are the 10 things that can kill people quickly? You could have a cardiovascular collapse. You could have a neurological emergency. You could be bleeding. You could be poisoned. You could be dehydrated. You could drop a lung. You could pop a lung.

MALONE: Pop a lung.

ARONCZYK: (Laughter) I know.

MALONE: Is that a thing?

ARONCZYK: That's a thing. This gives my anxieties anxieties.

MALONE: Yeah.

ARONCZYK: So Matt had treated rattlesnake bites before. He'd also administered anti-venom.

LEWIN: And so naturally, I was preparing for the expedition; getting the medical kits ready and thinking, what would I do if I were in a situation and somebody was bitten and I didn't have anti-venom?

MALONE: Anti-venom is snake-specific, meaning if you're bitten by a king cobra, you need king cobra anti-venom.

LEWIN: If there's 70 different venomous snakes in one place, I can't carry a refrigerator with 70 different anti-venoms.

ARONCZYK: But Matt wants to bring something in his medical kit, so he packs this stuff called Neostigmine, which is sometimes used during surgery to reverse the effects of anesthesia - kind of snaps you back. He figures if someone gets bitten and the venom starts to paralyze them, that the stuff might buy them some time.

MALONE: Matt goes on this trip to the Philippines. And thankfully, nothing bad happens on this expedition - no snakebites. But as scheduled, Matt needed to leave a couple days before a lot of the rest of the expedition. He needed to go back to California. And so he left his medical kit with one of the snake experts.

LEWIN: I was leaving this kit with the drug, with Neostigmine, and explaining to one of the herpetologists how it might be used in a life-threatening situation. And here are this needle and that needle, and mix this with that. And the reception to my mini-course on if you get bitten this might work, good luck, was not all that comfortable.

MALONE: The guy is like, really? It's on me if somebody gets bitten by a snake. I have to use a needle out in the middle of the jungle. I do not want that responsibility. But Matt doesn't see an option, so he leaves the kit with this reluctant researcher and then heads to the airport.

ARONCZYK: Now, a few hours later, he is sitting on the plane, heading back home. He's somewhere over the Pacific, and he's having one of those restless can't-sleep-on-the-plane moments when it hits him.

LEWIN: Well, what if you could just get rid of the needles? And so the idea of - as I was falling asleep on the plane was like, wow, I wonder if you could just shoot this up your nose.

ARONCZYK: Usually, if someone says to you, let's just shoot this up your nose...

MALONE: (Laughter).

ARONCZYK: It is not a good plan.

MALONE: Yes, bad advice.

ARONCZYK: Bad advice - but in this case, it is a surprisingly practical idea. No needles; it's not snake-specific, doesn't need to be refrigerated. Yes, if you are bitten by a snake, you still have to get to a hospital. You're going to need the anti-venom. But the likelihood that you'll make it there is much higher.

MALONE: Once Matt got back to his home in the Bay Area, this idea was all he could think about - nasal spray for snakebites. On his way to work, he's thinking nasal spray for snakebites. On his way home from work - nasal spray for snakebites. He is obsessed. But having an idea for a treatment and bringing a treatment to the market are two totally different things. Like, how would he get a patent? How would he find people to invest in it? Do you just go to a bank? Matt had no idea.

ARONCZYK: Were you worrying about those things at the time or was this - is this more looking back?

LEWIN: I was worrying about it all the time.

ARONCZYK: Ah (ph).

LEWIN: I would say for every hour I spent in the lab, I spent 30 hours worrying about how to get funded and execute it and convince people this might work.

ARONCZYK: At this time, back in 2012, snakebite wasn't considered a pressing global health problem. The World Health Organization didn't even recognize it as a priority.

MALONE: Which means that there was less of a reason for big foundations to tackle the global snakebite problem. And there is also not a lot of market incentive to come up with new treatments for snakebites. The victims are often in poor countries with underfunded health care systems. So when someone like Matt Lewin has a solution, where does he turn to find funding. He needed some kind of bizarre miracle that he'd never even thought of to make that happen.

ARONCZYK: Now, at this point in time, Matt's personal life has gone a little off the rails. He's not really leaving the house. He goes to work, but he doesn't want to be there. So one day, his friend calls him up. And his friend's like, Matt, all you're doing is moping around the house thinking about nasal spray for snakebites. He's like, come with me to this party.

LEWIN: He's trying to get me out of the house. And he's going to this party at his friend's house.

ARONCZYK: It's at a house owned by some guy named Jerry Harrison. Matt's like, fine, I'll go.

MALONE: He gets to the party, and there are, like, maybe 50 people milling around, drinking spritzers. There's music playing. It is a beautiful house with a stunning view of the Bay Area. And Matt - he goes and hides somewhere else.

LEWIN: And I was being a little bit antisocial, hanging out in the kitchen. And there was a little snippet of paper on the side of the refrigerator, and it said, Jerry Harrison makes other people's visions happen.

MALONE: And he's like, huh, that is intriguing.

LEWIN: Some minutes later or half hour later, Jerry says, does anybody have any crazy ideas that are laying - lying - his grammar's perfect. So he either said laying fallow or lying fallow. So I want to quote him correctly.

ARONCZYK: Does he just waltz into the kitchen?

LEWIN: No, he was - it was in the room adjacent to where this little snippet of newspaper was. And I heard him say, does anybody have any crazy ideas lying fallow? And I just figured, well, at this point, nothing's ever going to happen. So I just blurted out, nasal spray for snakebite.

MALONE: (Laughter).

JERRY HARRISON: At that point, then Matt started explaining how enormous the problem of snakebite is.

ARONCZYK: Now, Jerry Harrison, at this moment, can you introduce yourself?

HARRISON: Yes. I'm Jerry Harrison.

ARONCZYK: And what's your - what do you do for work?

HARRISON: Although I do less of it, I'm a musician and a music producer. I was in the band The Modern Lovers and the Talking Heads.

ARONCZYK: Oh, you know, he was just in The Modern Lovers and the Talking Heads - just, like, two bands that defined rock in the 1970s and '80s. Whatever.

MALONE: No big deal - "Burning Down The House," "Psycho Killer."

ARONCZYK: (Speaking French).

(SOUNDBITE OF SONG, "PSYCHO KILLER")

TALKING HEADS: (Singing) Psycho killer, (singing in French).

MALONE: That's him, Jerry Harrison, playing the rhythm guitar.

ARONCZYK: But Jerry, I got to say none of these things seem to have anything to do with snakes.

MALONE: That's true.

HARRISON: No. But what they did do is that when Matt told me this, the first thing I said is, I'm going to get you an IP lawyer.

ARONCZYK: Not so punk rock, the IP lawyer. But since the Talking Heads stopped putting out albums, Jerry Harrison got involved in tech startups. He launched a venture capital fund. He supports sustainable agriculture and solar technologies.

MALONE: Which explains why, at this party, he asks, does anybody have any crazy ideas lying fallow?

HARRISON: I mean, it was very lighthearted. It was not an - it wasn't like we're having a symposium to say, like, everyone discuss, you know, all their ideas.

LEWIN: Jerry said it in a very casual banter, but it was the only thing I heard (laughter) - said, why not see what happens?

HARRISON: Yeah.

LEWIN: And it's really like a miracle.

ARONCZYK: Not long after the party, the two of them get in touch. Jerry Harrison sets Matt up with a pro bono IP lawyer, and the business side of his idea takes off.

MALONE: But the next challenge for Matt is, how do you even demonstrate that a nasal spray for snakebites would work? Are you just going to, like, carry around a bunch of venomous snakes and then see what happens when they bite people? Are you going to carry around the antidote and wait in the bushes, hoping that someone gets bitten by a snake? That's not going to work.

LEWIN: How would you ethically do a clinical trial in a place where every village has a different word for the snake? How would you get consent? Could you hurt more people than you would help by doing a poorly designed clinical trial?

ARONCZYK: At this stage, what he really needs is to just try out the idea, see if it works.

LEWIN: It was not clear to me how to take the next steps. This is very, very far outside my training as a neuroscientist. And so I was talking with my old mentor Dr. Philip Bickler at UCSF. And we were driving to San Francisco, and we were discussing the similarities between cobra venom and curare.

ARONCZYK: Curare is a poison that comes from plants in South America, and it causes temporary paralysis. Drugs that are a lot like curare get used in surgery all the time, and it makes the patient not move during these critical moments.

MALONE: And Dr. Phil Bickler knows all this because he administers these kinds of drugs all the time. He's an anesthesiologist who also happens to run the human studies laboratory, a place where students and doctors can test out all the latest in drugs that sedate and paralyze.

LEWIN: And so we were discussing this, and Phil said, well, we could paralyze you and then see if the nasal spray works.

MALONE: So what Dr. Phil Bickler was proposing was, hey, Matt, what don't you just, you know, drop by my human studies laboratory? And we'll, you know, paralyze you like you've been bitten by a venomous snake, and then we'll spray your drug up your nose and see what happens. What do you think, buddy?

LEWIN: I remember exactly what segment of the Golden Gate Bridge we were on at the moment he said this.

ARONCZYK: Of course, the thing you should do when your buddy says to you, why don't we paralyze you, is to say, no, thank you, then laugh nervously and go and find new friends.

MALONE: (Laughter).

ARONCZYK: But this is Matt. He's been obsessing about this for years. So instead, Matt says this.

LEWIN: Tell me more about this. And it seemed like a very reasonable proof-of-concept experiment. And so that was when this overwhelming drive to test this idea really kicked in.

ARONCZYK: Matt leans into this overwhelming drive to paralyze himself.

MALONE: And videotapes it.

ARONCZYK: After the break.

MALONE: Matt and Phil, the anesthesiologist, spend the next six months getting their big experiment ready. The hope is that when they paralyze Matt just like he'd been bitten by a venomous snake, that they can then reverse the effects of that paralysis without a needle just by using a nasal spray. And if that worked, it would show that, yes, there may be a portable, easy way to help victims and buy them some time before they need to go to the hospital. It would save lives - maybe thousands of lives. But they really were not sure if this would work.

ARONCZYK: They get all of the approvals that they need from the university. They do to run-throughs. And then finally, it is the big day.

LEWIN: Well, I got there very early in the morning with two of the anesthesiologists, and we spent the entire morning setting everything up.

MALONE: Most of the setup is pretty standard stuff for surgery. And for Dr. Bickler, this is totally routine. The weird part, of course, is that Matt is going to be awake through this paralysis.

LEWIN: How do I indicate that I'm in distress? So for me, it was both getting prepared to be the model patient and, also, to make sure that the experiment had the best chance of succeeding because once I was on the table, that's sort of the end of my control of the situation.

MALONE: They set up all these monitors. And if Matt starts have any trouble breathing, they'll stop the experiment. And they decide that they're going to videotape what happens. This is the real recording from that day.

(SOUNDBITE OF MACHINE BEEPING)

ARONCZYK: So at first, they start giving him the drug that will paralyze him.

LEWIN: And so the first thing I experienced was I couldn't see very well. I couldn't make out even the big E on the eye chart.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: A hundred and ten.

ARONCZYK: Then the paralysis starts to spread.

LEWIN: Then it's a little bit uncomfortable to swallow. My voice is changing a little bit.

(SOUNDBITE OF MACHINE BEEPING)

LEWIN: And then I can't lift my head off the bed.

ARONCZYK: His arms and his legs go weak.

LEWIN: And then it started to become a little bit oppressive trying to breathe.

ARONCZYK: He wants to tell them that he's had enough of the paralytic drug, but he can't.

LEWIN: Everybody around me seemed very relaxed and doing their jobs, and I wasn't feeling particularly relaxed.

ARONCZYK: Matt starts to get agitated, but he can't tell them how he feels.

LEWIN: And then, of course, I started thinking, when are they going to give me the drug? I just really wanted the drug now. I want them to give me the drug. Give it to me. Hey, give me the drug (laughter). This is what it feels like to start to suffocate.

(SOUNDBITE OF MACHINE BEEPING)

ARONCZYK: Finally, this is the moment someone reaches for the nasal spray. They put it up to his nose and spray.

LEWIN: The effect of the drug was virtually immediate. I could feel the muscles coming back to life, and then my vision came back really fast. It was like getting punched in the face in - actually, in a good way because I could really feel the muscles tightening up in my face.

ARONCZYK: His whole body just snaps back. Within 30 seconds, he's kind of laughing and crying at the same time. And then it hits him.

(SOUNDBITE OF MACHINE BEEPING)

ARONCZYK: It works.

LEWIN: It was overwhelming.

(SOUNDBITE OF MACHINE BEEPING)

MALONE: It's been a few years since Matt subjected himself to this paralysis experiment. The drug that they used wasn't all that safe. It would have only worked with a few kinds of snakes. It was the wrong drug but the right idea.

ARONCZYK: Since then, he has found a drug that seems much more promising. You don't have to spray it up your nose. It can be taken as a pill with a glass of water. And he is starting clinical trials for it next year.

LEWIN: I feel a lot of relief. And now I feel as if this is one of the most incredible and enjoyable adventures I could have ever imagined. It's really what I envisioned doing when I went in to become a physician and scientist. I could not imagine a better adventure. The drug might or might not work. Only a human clinical trial will tell. But to have the opportunity to get to try something like this that might make a big difference is probably one in 10,000 lifetimes.

ARONCZYK: When Matt started out, he was just a doctor with an interesting solution to a problem. But because his solution was not an obvious moneymaker, he took this very strange path.

MALONE: A path that feels more like a Rube Goldberg machine, really, that could have fallen apart at any moment. But instead, improbably, it has now become an actual business. A couple years ago, Matt and Jerry Harrison, the guy from Talking Heads, started a company together. It's called Ophirex, which roughly translates to king snake.

ARONCZYK: If this drug works well in clinical trials, their plan is to make a low-cost version for the countries that need it and then also to package it to make a profit. They now have four full-time employees, and they got an investment from this unlikely partner; the Department of Defense.

MALONE: A few months ago, the World Health Organization laid out a plan to take snakebites much more seriously. The goal is that by the year 2030, the number of people killed by snakebites will be cut in half.

(SOUNDBITE OF MUSIC)

MALONE: Do you know stories of self-experimentation to solve failures of the market? Let us know. We are planetmoney@npr.org. We're also on Facebook, Twitter and Instagram @PlanetMoney.

ARONCZYK: Special thanks to Elaine Chen, Julia Longoria, Cayce Means, Jillian Weinberger, Tony Phillips and WNYC.

MALONE: This show was produced by Darian Woods. Alex Goldmark is our supervising producer. And Bryant Urstadt edits the show.

I'm Kenny Malone.

ARONCZYK: And I'm Amanda Aronczyk.

MALONE: This is NPR. Thanks for listening.

(SOUNDBITE OF MUSIC)

MALONE: Oh, can I add one more thing? Amanda and I, while reporting this story, went to the Staten Island Zoo. And we met with a very nice snake expert who took us over to the cage of a very dangerous cobra. He opened it up. And then with, like, a robot arm, he held my recorder and put it inside the cage, where the cobra attacked my recorder.

(SOUNDBITE OF SNAKE HISSING)

UNIDENTIFIED PERSON #3: So there you go. That was her.

ARONCZYK: Oh, my God - wow.

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