1960s Japan; The Bizarre SMON Epidemic

1960s Japan; The Bizarre SMON Epidemic.pngWhen a young Japanese woman first reported symptoms to doctors in 1967, they were mild. She suffered some diarrhea, nothing a little medication could solve even back then.

But, the young woman and the doctors knew exactly what would follow if they didn't act quickly. Doctors prescribed the standard medication, but it was too late.

A year later, she could no longer walk or see, permanently paralyzed and blind.

What happened to her was part of a larger epidemic that ravaged the island of Japan, mostly. Other countries suffered too, Australia included but Japan took the brunt of the pain.

By the end, some 11,000 Japanese people would give up their lives for what doctors labelled SMON, Subacute myelo-optic neuropathy. It was a disease of the nervous system, which affected around 30,000 people starting in 1955, carrying on to 1970.

The craziest thing about this disease wasn’t the advanced symptoms, paralyzed legs, blindness, and the occasional report of a green hairy tongue and green urine [yes, really].

Fewer than five percent of those diagnosed died, but there were cases. The craziest thing was how devastatingly simple was the cure. They needed to stop treating the patients. We'll come back to that in a minute...

The SMON incident remains one of if not the most bizarre epidemics in history, a cautionary tale for modern clinicians, but one many don’t know.

 

Diagnosis

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At first, researchers found many head-fakes for the disease, a case of echovirus, another suffering Coxsackie, and others still with herpes. None of those theories stood up to review.

What researchers couldn’t figure out was the vehicle for the disease. Did it travel through the water like a pathogen from a fecal infected source or was it a result of some chemical outbreak?

A number of scientists were sure it was from pesticides. Then another group of researchers pinned down antibiotics as the cause. They were grasping at straws.

One by one, each theory failed to prove itself the cause of the outbreak. For two decades, not unlike the 1980s and ‘90s with AIDS, the best researchers were unable to figure out from whence SMON came.

At least they knew AIDS came from sexual encounters and blood exchange. The only thing Japanese doctors could do for SMON was prescribe the best medicine.

 

Clioquinol

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For SMON, there was only one best treatment, a treatment for amoebic dysentery, Clioquinol (CQL).

Doctors in Japan prescribed massive amounts of CQL, more than any other country. It was their go-to prescription for abdominal pain, especially when connected to traveller’s diarrhea.

Japan wasn’t the only country to prescribe CQL, but they particularly revered it as a cure.

In February 1970, when doctors reported greenish urine and stool in patients, they suspected it might be iron chelate in the CQL. If this was the case, the delivery system of CQL was not working the way they thought it was.

Everything should have absorbed long before reaching the bladder and lower intestines. Fearing that they were prescribing some kind of neurotoxic medicine, the Japanese government banned the drug.

Almost immediately, the national epidemic came to screeching halt. Nary a case of SMON remained a month after the ban.

 

What Happened

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When patients showed up in doctor’s offices in the 1950s complaining of stomach yuckies, doctors grabbed the best stuff on the shelf to cure their pain. 

When the symptoms worsened, they didn’t assume the drug was the problem, they upped the dosage, started prescribing it to their family and friends as a preventative.

As those people started to show SMON symptoms, their circles of family and friends would also go the doctor for a prescription of CQL. What was a, in fact, a drug epidemic—not because anyone was getting high or having a good time—appeared to be an infectious outbreak.

The madness didn’t end with patients. Doctors and nurses, fearful that exposure might affect them too, took CQL proactively then came down with SMON symptoms.

When the first cases of green tongues showed up in 1963, nobody flinched. This was clearly a symptom of SMON.

 

So What

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Before this turns into a bash on drugs in general, it deserves to be said that this was a somewhat isolated incident.

Humanity has plenty of cases of misdiagnosis, and it’s not the first time a drug was the wrong plan for a cure. It’s also not the first time a drug needed to retire. For every case of SMON, however, one could produce endless success stories of drug treatments.

In the case of SMON, however, the Japanese doctors received royalties for every prescription of CQL. With so many cases of SMON to treat, who would bite the hand holding out the paycheck?

One can’t blame Japan, either. There was a case of SMON detected in Sweden in 1966. That doctor, pediatrician and neurologist Olle Hansson, assessed that CQL could be the problem, lobbying for a ban immediately.

Despite his efforts and those of others, CQL stayed on the shelves until 1985.

In 1978, a Tokyo court ruled against the manufacturer of CQL, Ciba-Geigy, as the cause of the SMON outbreak. The company issued a public statement accepting responsibility and apologizing for the full scope of chaos.

Sources: ncbi.nlm.nih.govundark.org

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