THE SMON FIASCO
Il fiasco
SMON - Con Ellison Bryan & Peter
Duesberg - Inventare il virus del AIDS 1996
Dare la colpa delle malattie ai
microbi è
avvenuto molte volte in passato.
C’era stato, prima dell’Aids, un altro Aids poco
conosciuto in Europa, e chiamato
SMON, con 11 mila vittime
in Giappone, con gente che si guardava con
sospetto, con gente che girava con la mascherina
al naso e alla bocca, con amanti che si
spalmavano la lingua di micidiale antibatterico,
e facevano uso del triplo preservativo. Alla
fine, dopo anni e anni di terrore, venne trovato
il colpevole.
Non era un virus, ma erano due farmaci. Si
trattava dell’Enteroviaform
e dell’Emaform (successivamente ritirati dal
commercio), diuretici contenenti il Coaquinol,
prodotti dalla Ciba-Geigy, che i giapponesi,
forti ed impenitenti consumatori di pesce e di
sale, di delfini e balene, assumevano con
eccessiva disinvoltura.
Vennero pagate, per la prima volta nella storia,
penali miliardarie per sanare le vittime della
strage SMON.
Tutta questa storia è stata accuratamente
insabbiata, per non disturbare gli imbrogli
Aids.
Nascosto nei documenti in lingua straniera e
nelle note delle fonti oscure, si trova la
storia di SMON, una malattia spaventosa epidemia
che ha colpito il Giappone, mentre la guerra
alla polio stava accelerando nel 1950.
In molti modi, SMON ha anticipato piu’ tardi,
l'AIDS.
Per quindici anni la sindrome è stata mal
gestita dall'Istituto di Scienza Giapponese,
dove praticamente sono stati concentrati tutti
gli sforzi di ricerca da parte di “cacciatori di
virus”. Ignorando la forte evidenza del
contrario, i ricercatori hanno continuato ad
credere che la sindrome era contagiosa ed hanno
cercato un virus dopo l'altro.
Anno dopo anno l'epidemia è cresciuta,
nonostante le misure di sanità pubblica per
prevenire la diffusione di un ipotetico agente
infettivo.
E alla fine, i
medici sono stati costretti ad
ammettere che il loro regime aveva
effettivamente causato SMON in primo luogo.
Una volta che la verità su SMON non poteva più
essere ignorata, l'episodio si e’ risolto in
cause legali per le migliaia di vittime
rimanenti.
FINE della BUGIA sull'AIDS +
L'altra storia dell'Aids +
Hiv
virus inventato
Questa storia è rimasta al di fuori del
Giappone, ignorato in quanto troppo imbarazzante
per i “cacciatori di virus”.
E merita di essere
raccontata per intero in Inglese:
THE SMON FIASCO -
By Bryan Ellison &
Peter Duesberg - Inventing the AIDS Virus 1996
Blaming non-infectious diseases on infectious
microbes has occurred many times before. Hidden
in foreign-language materials and the footnotes
of obscure sources lies the story of SMON, a
frightening disease epidemic that struck Japan
while the war on polio was accelerating in the
1950s. In many ways,
SMON anticipated the later AIDS epidemic.
For
fifteen years the syndrome was mismanaged by the
Japanese science establishment, where virtually
all research efforts were controlled by virus
hunters. Ignoring strong evidence to the
contrary, researchers continued to assume the
syndrome was contagious and searched for one
virus after another. Year after year the
epidemic grew, despite public health measures to
prevent the spread of an infectious agent. And
in the end, medical doctors were forced to admit
that their treatment had actually caused SMON in
the first place. Once the truth about SMON could
no longer be ignored, the episode dissolved into
lawsuits for the thousands of remaining victims.
This story has remained untold outside of Japan,
ignored as being too embarrassing for the virus
hunters. It deserves to be told in full here.
The patient was middle aged,
suffering from a mysterious nerve disorder that had
already paralyzed both her legs. Reisaku Kono was there
to observe the victim because of his work studying
poliovirus, which in a few infected individuals would
break into the central nervous system, causing
progressive paralysis and sometimes a slow, miserable,
death. While the condition he examined that day in 1959
was not polio, it bore a certain resemblance to it. And
the suspicion was growing that this, too, could be the
result of some undiscovered virus, perhaps one similar
to poliovirus.
Kono was visiting the
patient at the hospital affiliated with Mie University's
medical school. Hiroshi Takasaki, a professor of
medicine at the university, told Kono about a number of
these cases he had recently seen at the hospital. They
now realized they were facing an outbreak of something
new, not just a minor mystery that doctors would catalog
and forget. Just the previous year, medical Professor
Kenzo Kusui had published a report of another such case
in central Japan:
The patient had suffered a similarly strange combination
of intestinal problems, manifesting as internal bleeding
and diarrhea, with symptoms of nerve degeneration. This
illness, stomach pains or diarrhea followed by nerve
damage, had been noticed in a few isolated cases as
early as 1955, but was now turning into a local epidemic.
More published reports began
accumulating after Kono's visit to the hospital. The
next five years saw seven major regional epidemics of
the new polio-like syndrome, with the annual number of
new cases increasing from several dozen in 1959 to 161
victims by 1964 - an alarming rate for those small areas.
Scientists jumped to conclusions, believing they had
every reason to assume the disease was infectious. Just
its sudden appearance was enough evidence to convince
them. The disease also broke out in clusters around
specific towns or cities, and clusters were seen within
families.
The first person to develop the condition in each of
these families was followed by a relative within several
weeks.
Many outbreaks were centered around hospitals, places
notorious for spreading disease. The annual peak of new
patients occurred in late summer, hinting at possible
spread of the disease through insects. Those scientists
who first thought the disease might be related to some
noncontagious occupational hazard were quickly dissuaded
once the data showed that the disease lacked the
expected preferences. Farmers, for example, who would be
more easily exposed to pesticides, had a
lower-than-average incidence. Medical workers, on the
other hand, had a rather high rate of this condition -
further suggesting it was contagious.
However, the scientists
investigating the epidemic did notice some important
contradictions. For instance, the disease had an odd,
amazingly consistent bias for striking middle-aged women,
but was less common among men and could hardly be found
among children, who normally transmit virtually any
infectious disease. Careful medical inspection showed
that the symptoms did not coincide with those typically
expected for an infection. Blood and other bodily fluids,
which usually circulate a virus throughout the body,
showed no abnormalities, nor did the patients manifest
any fevers, rashes, or other signs of fighting off some
invading germ. These important pieces of evidence should
have raised doubts about the viral hypothesis.
The virus hunt pressed
onward. Scientists were expecting to find a virus that
primarily induced diarrhea, as was the case in polio.
Looking back on this period, Kono has since become
admirably frank about his early biases, shared at the
time by his fellow virologists: "I was at that time
engaged in poliovirus research, so I suspected such a
virus to be the cause."(1) Despite years spent searching
for the elusive virus, he never could isolate a single
one from any patient. Kono patiently reported his null
results as he plodded forward.
Meanwhile the epidemic was
growing and the 1964 Olympic Games were approaching.
Ninety-six new cases had been diagnosed the previous
year, and the increased number of cases was being
accompanied by new symptoms.
Some victims, for example, were now suffering
debilitating blindness. Preparing to host tourists from
around the world for the 1964 Olympics, Japan could ill
afford to have an uncontrolled plague. To make matters
worse, forty-six new patients suddenly appeared around
the city of Toda, one of the locations for Olympic
events. Embarrassingly dubbed the "Toda disease," this
outbreak directly threatened Japan's reputation and
tourist industry while focusing public fear on the
epidemic.
Etsuro Totsuka, later to become a lawyer for victims of
the disease, summarized the public mood at the time: "Even
I was quite worried at the time, as a university student
studying physics. The general public, including me, was
extremely worried; we didn't know how to prevent it, and
there was no cure."(2)
In May of 1964, at the 61st
General Meeting of the Japanese Society of Internal
Medicine, the disease was raised as a formal topic.
Kenzo Kusui, one of the first doctors to report patients
stricken with this condition, chaired that session. The
participating researchers gave the disease a formal name,
Subacute Myelo-Optico-Neuropathy (SMON), and they agreed
on a standardized clinical diagnosis. The Japanese
Ministry of Health and Welfare quickly provided a
research grant and launched a formal commission to
investigate the epidemic under the leadership of
Magojiro Maekawa, a medical professor at Kyoto
University. Kono was one of several virologists named to
the commission, thereby establishing its mandate as a
formal search for a virus.
The same year brought the
first sign of a possible breakthrough. Masahisa Shingu,
a virologist at Kurume University and a fellow member of
the commission, announced his discovery of a virus in
excretions from SMON patients. The virus was classified
as an echovirus - an acronym for enteric cytopathogenic
human orphan virus.
The viruses were called orphans because they had been
discovered accidentally during polio research but caused
no disease. Echoviruses were known for infecting the
stomach or intestines, and Shingu found evidence of
infection in various SMON sufferers. He excitedly drew
the conclusion that this orphan virus had finally been
matched with a disease. Perhaps, he speculated, this
virus could also occasionally break into the nervous
system, much like poliovirus. He published the finding
in 1965, unabashedly boasting he had isolated the
syndrome's cause.
But Kono, knowing the
potentially disastrous results of blaming the wrong
microbe for the disease, took a more cautious attitude.
In 1967, after three years of research trying to confirm
Shingu's claims, Kono could only report to a SMON
symposium that he had not isolated the virus from
patients, nor could he find even indirect evidence that
the patients had previously been infected. Kono's better
judgment saved Japanese science from stampeding in the
wrong direction. He was fully vindicated four years
later when other researchers announced the same lack of
evidence to suggest any danger from Shingu's virus.
In the midst of this
fruitless investigation, the Maekawa team made a
surprising observation that was tragically brushed aside.
According to surveys of hospitals, about half the SMON
patients had previously been prescribed a
diarrhea-fighting drug known by the brand name
Entero-vioform, and the other half had received a
compound marketed under the name Emaform. Both drugs
were prescribed for problems of the digestive tract -
the early symptom of SMON. The suspicion naturally arose
that these drugs might play some role in the syndrome,
but the commission, intent on the viral hypothesis,
bowed to the consensus view of SMON as contagious and
quickly dismissed this, noting that two different drugs
should not cause the same new disease.
Had the commission researchers checked further, however,
they would have discovered that the two drugs were
merely different brand names applied to the same drug, a
fact that did not surface for several years.
The SMON commission
dissolved in 1967, a failure. The cumulative total of
reported SMON cases had meanwhile reached nearly two
thousand by the end of 1966, a significant but not
terrifying number. If not for the quiet growth of the
disease epidemic, the floundering virus hunt might have
killed public interest in SMON research altogether.
Almost immediately after the
official commission was dissolved, two rural areas in
the Okayama province began reeling from a new explosive
outbreak of the syndrome. Dozens of elderly women, and
some men in their thirties, began filling the nearby
hospitals, totaling almost 3 percent of the local
population by 197I. Scientific attention was again
focused on SMON, with the specter of a resurgent
epidemic recharging the virus hunt.
Two researchers issued
reports in 1968 describing a new virus found in tissues
of SMON patients, stirring a wave of excitement. The
agent fell under the classification of "Coxsackie"
viruses, a type of passenger virus known to infect the
digestive tract and originally discovered as a
by-product of polio research. It was another false alarm:
The virus proved to be an accidental laboratory
contamination.
In 1969 the Japanese
Ministry of Health and Welfare, anxious about the
expanding epidemic, again decided to form an official
investigating body. With more than ten times the funding
of the old 1964 commission, the SMON Research Commission
became the largest Japanese research program ever
devoted to a single disease. Its first meeting was held
in the heavily affected Okayama province in early
September. The consensus view among Japanese scientists
had completely focused on some unknown virus as the
probable cause of the disease. The naming of Kono,
Japan's most respected virologist, as chairman
symbolically established the new commission's priorities.
So far, after more than a
decade of persistent research, the virologists had come
up painfully empty-handed. Kono, though himself a
virologist, now saw the need to explore alternative
hypotheses. Kono divided the commission's work into four
sections, each led by top Japanese medical officials. An
epidemiologist was put in charge of a group conducting
nationwide surveys on the extent, distribution, and
associated risk factors of the disease. Kono himself
headed the virology group. A pathologist headed a group
focused on analyzing autopsy results, and a neurologist
led a group classifying neurological and intestinal SMON
symptoms. Altogether, forty top scientists participated
in the commission during 1969.
Although Kono had opened the
door for alternative research directions, the virus hunt
accelerated - for just at this time, some key scientific
claims by English and American virologists were
beginning to have a profound impact on virus research
worldwide, and particularly on SMON research in Japan.
The first came in the early 1960s from virologist
Carleton Gajdusek of the American National Institutes of
Health, who reported finding evidence of the first "slow
virus" in humans. (A slow virus is a virus alleged to
produce a disease long after the original infection,
that is, after a long "latent period.") He believed it
to be the cause of kuru disease among New Guinea natives.
Kuru was a slowly progressing neurological disease that
led to the debilitation of motor skills. The patients
presented with symptoms of tremor and paralysis similar
to Parkinson's disease.
Gajdusek claimed to have found the kuru virus, but his
methods were highly unusual by any scientific standards.
He had never actually isolated a virus but instead had
ground up the diseased brains of dead kuru victims and
injected these unpurified mixtures into the brains of
living monkeys. When some of the monkeys showed deficits
in motor skills, Gajdusek published his findings in the
world's oldest scientific journal, Nature, and was
lauded by his fellow virologists. The second alleged
discovery came from London's Middlesex Hospital in 1964,
directly inspired by Gajdusek's claims. Two researchers
found a virus that was believed to cause the childhood
cancer, Burkitt's lymphoma. It was the first virus ever
claimed to cause human cancer and the first known human
virus thought to have an incubation time between
infection and disease measured in years, rather than
days or weeks.
These claims were made by
very large and respected research establishments;
therefore, Kono could not afford to ignore them. Other
medical experts on the SMON commission warned him that
the SMON symptoms did not resemble those of standard
virus infections, suggesting the condition was not
contagious. Kono, however, brushed aside this advice,
arguing that if scientists were unwilling to consider
the possible existence of nonclassic viruses then "Dr.
Gajdusek could not have established a slow virus
etiology for kuru."(3) Imitating Gajdusek's methods, he
injected unpurified fluids from SMON patients into the
brains of experimental mice and monkeys, hoping to cause
the disease and isolate the guilty virus.
Frustrated, but not willing to give up, he decided the
American researchers were better equipped to find such a
virus. He mailed the same fluid samples directly to
Gajdusek, who repeated the inoculations into the brains
of his own chimpanzees; after three years, they, too,
remained perfectly normal. With that, Kono finally
abandoned the search for a "slow virus."
With their virus research
faltering, a few of the investigators began looking for
bacteria. One lab found that SMON patients had
imbalanced levels of the beneficial bacteria normally
growing in everyone's intestines, but it could not
isolate any new invading microbe. Kono's own lab, as
well as two other researchers, did notice unusually
large amounts of a mycoplasma, one type of bacterial
parasite, in disease victims. However, since mycoplasma
are found in a large percentage of human populations and
are usually known for being either relatively harmless
or causing some pneumonias, Kono and his fellow
researchers decided against pursuing this further.
By 1970, one fact stood out
more agonizingly than any other: Twelve years of microbe
research into the SMON epidemic had yielded nothing but
dead ends. Yet the pressure continued to mount as the
death toll rose. The year 1969 alone claimed almost two
thousand new SMON victims, the worst toll ever. Kono and
his commission were running out of options.
Fortunately for the Japanese
people, several researchers on the commission were not
virus hunters, and these scientists actually
rediscovered the evidence for a toxin-SMON hypothesis.
The Drug Connection
As the race to find a SMON
virus was capturing all the attention, other scientists
were turning up some important clues to the mysterious
syndrome. One pharmacologist, Dr. H. Beppu, visited the
hard-hit Okayama province in 1969 to investigate the
increasing outbreak and independently discovered the
same coincidence the Mackawa group had years earlier -
that SMON victims had taken certain drugs to treat
diarrhea. Unlike the Maekawa group, Beppu investigated
and found that Entero-vioform and Emaform - the
diarrhea-fighting drugs found present in an earlier SMON
study - turned out to be different brand names for a
substance known as
Clioquinol,
a freely available medical drug used against some types
of diarrhea and dysentery. Beppu fed the chemical to
experimental mice, hoping to see nerve damage like that
in SMON, but was disappointed when the mice merely died.
He missed the significance of his own results.
Clioquinol was sold because it was believed not to be
absorbed into the body, instead remaining in the
intestines to kill invading germs. The death of Beppu's
animals, however, proved that the drug not only entered
the body, but could kill many essential tissues in the
animal. His experiment led the SMON commission to
rediscover this clioquinol connection the following year.
"He later confessed to feeling stupid, because he gave
up the experiment when the animals died," Totsuka
explained of Beppu. "He wanted to prove a neurological
disorder, but only proved the drug's severe toxicity."(4)
Meanwhile the SMON
commission's first priority lay in conducting a
nationwide survey of SMON cases reported since 1967,
gathered by sending questionnaires to doctors and
hospitals throughout Japan. In the fall of 1969, shortly
after the commission began analyzing survey data, the
head of the clinical symptoms section came across
several SMON patients with a strange green coating on
their tongues, a symptom unnoticed before nationwide
data were gathered. At first other researchers on the
commission suggested that this new symptom might be
caused by Pseudomonas bacteria, which can release
colorful blue and green pigments. One of the
investigators did isolate such a bacterium from some
patients but not from others, and the inexplicable
symptom merely became a part of the revised SMON
definition. The green tongue observation achieved new
importance in May of 1970, when one group of doctors
encountered two SMON patients with greenish urine.
Enough of the pigment could be extracted to perform
chemical tests. Within a short time the substance was
determined to be an altered form of clioquinol, the same
drug previously found by the Maekawa commission and by
Beppu.
This raised two very
troubling questions. Clioquinol had been marketed for
years on the assumptions that it only killed amoeba in
the intestinal tract and could not be absorbed into the
body; its appearance on the tongue and in the urine now
proved this belief wrong. Could the medicine therefore
have unexpected side effects? And why would SMON
patients manifest the drug by-products so much more
obviously than the rest of the population? This latter
question particularly bothered one neurology professor
at Niigata University, Tadao Tsubaki. Making an educated
guess, he openly formulated the hypothesis abandoned by
earlier investigators - that SMON might be the result of
clioquinol consumption, not of a virus.
As expected, the
interpretation of SMON as a noncontagious syndrome did
not become popular among the virus hunters. And the
suggestion that clioquinol might be guilty met even
stronger resistance, for the drug was being used to
treat the very abdominal symptoms found in SMON. Doctors,
naturally, were reluctant to believe they were
exacerbating these abdominal pains and thus adding the
severe insult of nerve damage to the injury. Totsuka
recalled that "doctors and scientists wanted to believe
in a virus, because they prescribed clioquinol. One of
the drug's main side effects was constipation and
abdominal pain. Now because the drug caused pain,
doctors again prescribed the drug."(5) Doctors, ignorant
of clioquinol's side effects, assumed the stomach pains
resulted from the primary sickness and kept increasing
the dose in a vicious cycle.
Tsubaki knew he had to
gather strong evidence before they could shoot down the
virus-SMON hypothesis. Pulling together several
associates, Tsubaki arranged for a small study of SMON
patients at seven hospitals. By July of 1970 he had
already compiled enough data to draw several important
conclusions: 96 percent of SMON victims had definitely
taken clioquinol before the disease appeared, and those
with the most severe symptoms had taken the highest
doses of the medication. The number of SMON cases
throughout Japan, moreover, had risen and fallen with
the sales of clioquinol.
This clioquinol hypothesis
explained all the strangest features of the SMON
syndrome, such as its preference for striking middleaged
women, its absence in children (who received fewer and
smaller doses of the drug), and its symptomatic
differences from typical viral infections. It also shed
new light on the supposed evidence that SMON was
infectious: its tendency to appear in hospital patients,
to cluster in families, to afflict medical workers, and
to break out more heavily in the summer - all of these
reflected the patterns of clioquinol use. The epidemic
itself had begun shortly after approval for
pharmaceutical companies to begin manufacturing the drug
in Japan.
In 1970 there were
thirty-seven SMON cases in January and nearly sixty more
cases during the month of July. The Japanese Ministry of
Health and Welfare decided not to wait any longer, and
promptly released the information about clioquinol to
the press. The news of Tsubaki's research reached the
public in early August, and the number of new SMON cases
for that month dropped to under fifty, presumably
because some doctors stopped prescribing clioquinol to
their patients. On September 8 the Japanese government
banned all sales of the drug, and the total new caseload
for that month sank below twenty. The following year,
1971, saw only thirty-six cases. Three more cases were
reported in 1972, and one in 1973. The epidemic was
over.
For the next few years, the
commission's research focused on confirming the role of
clioquinol. In 1975 it released a comprehensive report.
Systematic epidemiological surveys matched use of the
drug with outbreaks of the syndrome, and experiments
were performed on animals ranging from mice to
chimpanzees. As it turned out, the drug induced
SMON-like symptoms most perfectly in dogs and cats.
Meanwhile, the investigators began uncovering individual
case reports of SMON symptoms from around the world,
wherever clioquinol had been marketed. Totaling roughly
one hundred cases, the published reports ranged from
Argentina in the 1930S to Great Britain, Sweden, and
Australia in more recent times, often with the doctor
specifically pointing out the association with the use
of clioquinol or similar compounds. Ciba-Geigy, the
international producer of the drug, had received
warnings of these incidents years before the Japanese
epidemic, a fact that later became the basis of a
successful lawsuit against the pharmaceutical company.
Clioquinol, often marketed
under the brand name Enterovioform, has been available
for decades throughout many countries in the world. But
while doctors outside Japan have published a few reports
of SMON-like conditions, no real epidemic of the disease
has ever broken out in Europe, India, or other countries
with widespread use of the drug. Much of the difference
lies in the heavier consumption of clioquinol in Japan,
where the stomach, rather than the heart, is considered
the seat of the emotions. The general over-prescription
of drugs in that country further worsens the problem,
such that many SMON victims had histories of using not
only clioquinol but also multiple other medications,
often at the same time. Government health insurance
policies have encouraged this over-medication, paying
doctors for every drug prescribed to the patient. As a
result, the proportion of the Japanese health insurance
budget spent on pharmaceutical drugs grew from 26
percent in 1961 to 40 percent in 1971, a level many
times higher than in other nations. By the time the
Japanese government decided to ban clioquinol, many of
the hardest-hit SMON patients had each consumed hundreds
of grams over the course of several months. And whereas
the outside world mostly used clioquinol to prevent
diarrhea when traveling abroad, the Japanese usually
received the drug as hospital patients, having an
already weakened condition.
Years later, at a 1979
conference, Reisaku Kono asked, "Why had research on the
etiology of SMON not hit upon clioquinol until 1970?"
The question has two answers; both pointed out by Kono
himself:
There were at least two
occasions when physicians suspected that clioquinol
might have something to do with SMON. I know of a
certain professor rebuking one of his staff physicians
for connecting clioquinol with SMON. In 1967 the study
group of the National Hospitals on SMON reported as
follows: Entero-vioform (clioquinol's brand name),
mesaphylin, Emaform (home producer of clioquinol),
chloromycetin and llosone were often prescribed to SMON
patients, but no link was found between Entero-vioform
and SMON. This report referred to Entero-vioform in
particular so that clioquinol must have been suspected
by someone in the study group. Dr. Tsugane, who was
responsible for the survey, said that the survey was not
thorough enough to unearth clioquinol as a causative
agent. One of the reasons could have been that
clioquinol had been used as a drug for the intestinal
disorders of SMON, and it was hard to believe that
clioquinol was toxic rather than a remedy. (6)
Referring here to the
tentative fingering of clioquinol by the Maekawa group,
Kono observed that too many medical doctors refused to
recognize the possibility of an iatrogenic disease (one
caused by the doctor's treatment). They understandably
disliked the idea that a drug might cause some of the
very symptoms for which it was prescribed in the first
place.
Another, more fundamental,
reason for overlooking clioquinol lay in the prevailing
attitude of the virologists. As expressed by Kono, "We
were still within grasp of the ghosts of Pasteur and
Koch!"(7) SMON, a vaguely polio-like syndrome, had first
appeared in the midst of a war against polio. The polio
virologists, Kono included, were naturally inclined to
search for a new virus as the cause of the new disease.
The Japanese government, having funded poliovirus
research, simply kept up the momentum by funding the
same virologists to study SMON. Thus, the virus hunters
received the lion's share of research moneys and
attention, and with that the power to direct the SMON
research program. Had it not been for Kono's foresight
in also appointing nonvirologists to the commission, the
epidemic might have lasted much longer.
At least the epidemic had
ended, with the truth universally recognized. The
virologists had learned their lesson, and the search for
SMON viruses was over.
Or was it? Incredibly,
against all evidence, the SMON virus hunt suddenly came
back to life within weeks of the epidemic's end. The
fight over the cause of the syndrome was to drag on for
several more years, with the virus hunters simply
ignoring the fact that SMON itself had disappeared after
the ban on clioquinol.
The Virus Hunt Revived
In February of 1970, while
the SMON Research Commission was still scrambling to
find the cause of the epidemic and a few researchers
were just beginning to notice the greenish pigments in
some patients, Assistant Professor Shigeyuki Inoue at
Kyoto University's Institute for Virus Research claimed
discovery of a virus in the spinal fluid and excretions
of SMON patients. He added the extracts to laboratory
culture dishes of hamster tumor cells and found that the
new agent killed the cells. With more experimentation,
Inoue classified the microbe as a new herpes virus. He
was able to isolate this particular virus from nearly
all SMON patients he tested, more than forty in all, and
found antibodies against the virus in other victims.
Reisaku Kono moved promptly
to test these new observations. He used Inoue's own
virus isolate and cell cultures, and within three months
of Inoue's first report found that the virus could kill
some cells. These particular cells, however, were
extremely sensitive, prone to spontaneous death even in
the uninfected cultures. Kono began to suspect the virus
was harmless. He also could not isolate the virus from
any SMON patients, unlike Inoue's lab. Perhaps, he
openly wondered, the alleged virus might not exist at
all.
A number of scientists sided
with Kono, insisting they could neither find the virus
in SMON victims nor cause cell death in culture dishes
by adding virus samples from Inoue's lab. Nor could
Inoue's extracts induce symptoms when injected into mice.
Indeed, Kono and some of these other investigators could
never even find the virus at all, reinforcing the
growing question of whether it truly existed. The virus
could not even be detected in the samples sent them from
Inoue. An occasional mouse injected with Inoue's
supposed virus would become sick, but the symptoms did
not resemble those of SMON. Kono won allies among his
peers when many of them could not reproduce Inoue's
observations. a troubling problem for any scientific
claim.
Nevertheless, Inoue had
meanwhile rapidly achieved celebrity status for his
"SMON virus" during 1970, before the clioquinol
announcement that August. The Japanese news media had
prematurely publicized his results, creating the
widespread impression that the cause of SMON had been
determined. Hysteria over the contagious plague swept
through much of the country, causing frightened family
members of SMON patients to avoid contact with their
"infected" relatives, and leading many of the victims to
commit suicide. "Patients were isolated, many committed
suicide, and there was national panic," reflected
Totsuka on the horror he witnessed. "I met families who
lost relatives. I heard from most or all of my goo
clients; most of the patients said they very much feared
and dreaded the disease. Everybody told me about that,
about those sufferings. Once they found out about the
drug, they were somewhat relieved, because it was not
infectious."(8)
The new virus-SMON
hypothesis had indeed achieved a life of its own,
causing a few scientists to Jump on the Inoue bandwagon;
months after clioquinol had been banned and the epidemic
had virtually disappeared, several labs excitedly issued
reports claiming they could reproduce Inoue's findings.
Inoue himself further insisted he had caused SMON-like
symptoms in mice - including weight loss, paralysis, and
nerve damage - either by injecting the virus into their
brains or feeding the virus to other immune-suppressed
mice unable to fight off the infection. Inoue and a
collaborating scientist also both claimed to have
photographed the virus directly with electron
microscopes, although Inoue's colleague eventually
retracted his own report as having been mistaken.
A meeting of the SMON
Research Commission was finally held in July of 1972 to
resolve the controversy. Until that time, Inoue's
results had received attention and concern equal to the
clioquinol research. But based on the inability of many
scientists to produce the same results, which must be
done for any scientific hypothesis to be accepted, the
members at the meeting decided not to focus any more
research efforts on the Inoue virus. Samples were frozen
for future study, and the group thereafter devoted its
resources to studying clioquinol.
Despite the absence of
confirming evidence, and despite the disappearance of
SMON following the ban on clioquinol, Inoue and his
supporting colleagues continued to publish reports of
evidence for the virus hypothesis. This publicity
carried the Inoue hypothesis overseas, leading the 1974
edition of the Review of Medical Microbiology, an
American textbook, to incorporate the Inoue virus
hypothesis of SMON.
Shocked and angered by the
favorable publicity surrounding Inoue's hypothesis, Kono
wrote a letter to the British medical journal Lancet;
the letter was published in August of 1975. The
international popularity of virus research had whetted
scientists' appetite for Inoue's hypothesis, but Kono
also knew he was battling a nearly complete ignorance of
the SMON episode outside Japan:
Inoue et al. published
several papers on SMON virus, and a standard textbook
adopted Inoue's virus theory as confirmed. However,
research in the laboratories of the SMON Research
Commission in Japan failed to confirm Inoue's results.
Unfortunately, this negative information has not been
published in English.(9)
The epidemic's toll had
officially ended in 1973 with 11,007 victims, including
thousands of fatalities. Angered upon learning of
Ciba-Geigy's disregard of previously reported clioquinol
toxicity, many of these patients filed a lawsuit in May
of 197I against the Japanese government, Ciba-Geigy of
Japan, fifteen other distributors of the drug, and
twenty-three doctors and hospitals. The ranks of the
plaintiffs soon swelled to some forty-five hundred, with
legal action initiated in twenty-three Japanese district
courts. The largest group of SMON victims sued jointly
in the Tokyo District Court. When frustrations mounted
over the slow and indecisive actions of their lawyers,
nine hundred of the plaintiffs broke away to form a
second group. The aggressive investigations conducted by
this new legal team reinvigorated the case, bolstering
the positions of the plaintiffs in parallel lawsuits.
Etsuro Totsuka, one of the thirty members of this legal
team, has described the fight:
We were the only team
gathering information outside Japan, inviting foreign
experts to testify in Japanese courts, discovering the
United States FDA had restricted clioquinol ten years
before Japan, and waging an international campaign
against Ciba-Geigy...
We found many foreign
doctors who had reported clioquinol side effects before.
They were contacted by Ciba-Geigy, and except in one or
two instances were persuaded not to help us. By the time
I saw the doctors, they had already been contacted by
the other side. They had been invited on trips, some to
Ciba-Geigy's headquarters... We felt they were already
compensated, under the condition not to tell us anything.(10)
The two sides slugged it out
for several years, but the testimony by members of
Kono's SMON Research Commission proved devastating, and
a string of legal victories followed in the courts.
Today most scientists and
laymen outside Japan have never heard of the virus-SMON
controversy, even in the face of the lawsuit against the
distributors of clioquinol, television documentaries in
Germany and England on clioquinol, and two conferences
during the 1970s on iatrogenic (medically caused)
disease. The story that SMON research had ignored the
evidence of a toxic cause for fifteen years and had
sacrificed thousands of human lives to a flawed virus
hypothesis is too embarrassing to the virus-hunting
establishment to record. *
The above article has been
extracted from: Peter H. Duesberg, 'Inventing the AIDS
Virus' Regnery USA 1996, 720 pages, ISBN 0-89526-470-6.
References:
1. R. Kono, "The SMON Virus
Theory," Lancet, ii (1975): 370-371; I. Shigematsu, H.
Yanagawa, S.I. Yamamoto, and K. Nake, "Epidemiological
Approach to SMON (Subacute Myelo-Optico-Neuropathy),"
Japanese Journal of Medicine, Science, and Biology, 28
Supplement (1975): 23-33
2. E. Totsuka, personal
communication, 1 May 1992.
3. T. E. Soda, Drug-lnduced
Sufferings: Medical, Pharmaceutical, and Legal Aspects
(Amsterdam: Excerpta Medica, 1980).
4. Totsuka, personal
communication, 1 May 1992.
5. Ibid.
6. Soda, Drug-lnduced
Sufferings.
7. Ibid.
8. Totsuka, personal
communication, 1 May 1992.
9. Kono, "SMON Virus Theory,"
370-371.
10. Totsuka, personal
communication, 1 May 1992.
11. Soda, Drug-lnduced
Sufferings.
"Il paziente malato di
Aids NON muore a
causa del virus
dell'HIV ma
per alterazioni dell'assorbimento intestinale
e
quindi per ipoalimentazione (malNutrizione),
dovuta a una grave
micosi." (By Dott.
Gerhard Orth, Leuthkirch)