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Elizabeth Brodkin, Ray Copes, Andre Mattman, James Kennedy, Rakel Kling, and Annalee Yassi
Lead and mercury exposures: interpretation and action
CMAJ 2007; 176: 59-63 [Abstract] [Full text] [PDF]
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[Read eLetter] When the medical profession fails: learning from Bhopal
Annalee Yassi   (12 January 2007)

When the medical profession fails: learning from Bhopal 12 January 2007
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Annalee Yassi
UBC, OHSAH

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Re: When the medical profession fails: learning from Bhopal

annaleeY{at}aol.com Annalee Yassi

Having recently returned from visiting the Sambhavna Trust Clinic in Bhopal, India, which cares for people affected by the Union Carbide gas leak of 1984, I wish to add a postscript to the article by Bodkin et al. [1] on which I am a co-author and clinician-in-charge of the cases discussed. We noted that many ayurdevic treatments contain heavy metals [2] and described the case of a gentleman from India who, upon returning to Canada, consequently had to undergo chelation therapy for lead poisoning. An important point I feel should be stressed, which is not explicitly stated in the Brodkin et al. piece, is that, although the research in this area is not extensive, ayurdevic medicine does seem to be of value for some conditions when used carefully.

The Bhopal tragedy was one of the worst industrial disasters in history [3 4]. An estimated 2,000 to 8,000 acute deaths resulted from the release of 40 tons of methyl isocyanate in a densely populated community, and tens of thousands of people still suffer respiratory, ocular, developmental, gastrointestinal, neurological, reproductive, and psychological attributed to the gas leak [5 6]. A large investment from the Indian government, supplementing funds obtained from the sale of Union Carbide’s Indian assets, led to the building of a hospital and several out -patient clinics to treat the affected community. However, many of the victims have been dissatisfied with the care received, with a litany of complaints including inadequate understanding on the part of treating medical practitioners and inappropriate prescribing practices [7]. Sambhavna, which means “possibilities”, was started ten years ago to fill the unmet needs. Offering both “Western” (allopathic) medical care, as well as ayurdevic treatments and yoga, the clinic sees some 110 patients daily from the affected community.

We in the international community can not sit in judgment of the medical professionals in Bhopal. Not only did we fail to insist on protective measures that could have prevented this tragedy, but research on etiology, pathophysiology, natural history and clinical management in occupational and environmental medicine is sorely lacking. That patients have been treated inappropriately both in Bhopal, India [8] and in Vancouver, Canada [1] is a manifestation of this world-wide failure in our medical community.

Staff at Sambhavna are keen to collaborate with international partners not only in advocating preventive policies but also in conducting research to better understanding the pathophysiology and natural history of the toxic-induced illnesses, as well as rigorous randomized controlled trials to assess the relative effectiveness of various allopathic, ayurdevic and/or combination therapies offered to these patients. Should the preventive efforts so needed in this era of globalization to prevent future Bhopals be unsuccessful, resulting in another unfortunate chemical disaster, at the least the international medical community needs to learn from Bhopal and be better prepared. What we can learn will also help in the proper management of patients such as the ones described by Brodkin et al [1]. Let us take up the Sambhavna challenge.

References:

1. Brodkin E, Copes R, Mattman A, Kennedy J, Kling R, Yassi A. Lead and mercury exposures: interpretation and action. CMAJ 2007; 176(1):59-63.

2. Health Canada. Warning: Health Canada warns consumers not to use certain Ayurvedic medicinal products. Ottawa: Health Canada, 2005.

3. Kumar S. Victims of gas leak in Bhopal seek redress on compensation. BMJ 2004;329(7462):366.

4. Dhara R, Acquilla S, Cullinan P. Has the world forgotten Bhopal? Lancet 2001;357(9258):809-10.

5. Broughton E. The Bhopal disaster and its aftermath: a review. Environ Health 2005;4(1):6.

6. Ranjan N, Sarangi S, Padmanabhan VT, Holleran S, Ramakrishnan R, Varma DR. Methyl isocyanate exposure and growth patterns of adolescents in Bhopal. JAMA 2003;290(14):1856-7.

7. Trotter RC, Day SG, Love AE. Bhopal, India and Union Carbide: The second tragedy. J Bus Ethics 1989;8(6):439-454.

8. Hanna B, Morehouse W, Sarangi S. The Bhopal Reader. New York: Apex Press, 2006.

Conflict of Interest:

None declared