What is the common thread between Socrates, Cleopatra, Hitler, Marilyn Monroe, and Michael Jackson? They all died from poisoning, deliberate or accidental. Socrates was sentenced to death and forced to drink an infusion of poison hemlock (Conium maculatum), Cleopatra from the bite of an asp (or Egyptian cobra - Naja haje), Hitler used cyanide. On the other hand, Marilyn Monroe and Michael Jackson both died from an overdose of prescribed medication: pentobarbital and the anaesthetic agent propofol, respectively.
So, what makes a poison a poison? It was the Swiss physician, Paracelcus, who asserted in 1538, “All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison”.
Thus, everything can theoretically be poisonous. We are surrounded by poisons that people can eat, swallow, breathe and which can come into eye or skin contact. In Malta, hundreds of cases of intentional or accidental poisoning are reported every year. Ninety per cent of these cases involve overdoses which are due to prescribed or over-the-counter medicines or else due to illicit drugs. The other 10 per cent are overdoses related to the ingestion of household chemical products and industrial product-related toxicity.
A poison is a substance which, when absorbed by a living organism, results in harm or death. Toxicologists study the presence and effects of all types of potential toxins on humans, whether they are prescribed medicines, drugs and other chemicals (household, environmental pollutant, industrial, agricultural). Poisoning can be acute, subacute or chronic, and its intensity, signs and symptoms can vary from person to person. Toxicologists are also experts in the detection, prevention and treatment of poisonings.
A poison is a substance which, when absorbed by a living organism, results in harm or death
There is a huge need for more toxicologists in Malta. They are needed to work in the new Malta National Poisons Centre which is being set up within the Ministry for Health as well as in forensic labs, the pharmaceutical industry, regulatory agencies as well as in the clinical setting. As a career, toxicology provides the excitement of science and research, while also contributing to the well-being of current and future generations.
The Department of Clinical Pharmacology and Therapeutics at the University of Malta is offering a part-time evening Master’s degree programme in pharmacotoxicology, which will provide the related expertise in this subject. It provides a unique opportunity for those who are already working in the area and wish to become more proficient in the subject. Lectures are delivered by an international group of world-renowned top international experts in this area.
This course is particularly relevant to medical, clinical, pharmacy, nursing and other healthcare staff working in accident and emergency medicine or acute medicine and related disciplines; personnel working in poisons centres, drug information services, clinical toxicology hospital services; scientists working in toxicology laboratories and scientists working in the pharmaceutical or chemical industries, forensic labs as well as with the Malta Competition and Consumer Affairs Authority.
More details on this new MSc and entry requirements can be found here. For more information, contact the course co-ordinator Janet Mifsud on janet.mifsud@um.edu.mt.
Janet Mifsud is head of the Department of Clinical Pharmacology and Therapeutics, University of Malta, and Mark Lawrence Zammit is visiting senior lecturer in the same department as well as member of the executive committee and former general secretary, European Association of Poisons Centres and Clinical Toxicology.
Sound Bites
• Poisoning is a significant global public health problem. The World Health Organisation (WHO) estimates that, in 2016, unintentional poisoning caused 106,683 deaths and the loss of 6.3 million years of healthy life (disability-adjusted life years). In many countries, poisoning is one of the main causes of emergency attendance at hospitals. Poisoning is a time-dependent emergency and, like infectious diseases, may require a specialist for appropriate diagnosis and treatment. WHO has recently published guidelines for establishing a poison centre. Mark Lawrence Zammit was one of the invited contributors to this seminal WHO document.
• An artificial intelligence (AI) “ToxNet”, a machine-learning based computer-aided diagnosis (CADx) system, is being developed which aims to predict poisons based on patient’s symptoms and metadata from Poison Control Center (PCC) data. With further research, it might become a valuable aid for physicians in predicting unknown substances and might be the first step into AI-use in poison control centres.
For more soundbites, listen to Radio Mocha www.fb.com/RadioMochaMalta/.
DID YOU KNOW?
• Malta’s first Malta National Poisons Centre is being set up under the aegis of the Office of Clarence Pace, director general (Health Care Services) within the Ministry for Health. It will be within the Life Sciences Park. It will provide a key source of information for the treatment of all types of poisoning and is to be managed by a multi-disciplinary team specialised in the care and treatment of poisonings, which also includes two consultants in emergency medicine specialised in clinical toxicology – Robert Chircop and Jeffrey Bonnici.
• We may not have venomous snakes dangerous to humans in Malta but we do have poisonous plants. The colourful oleander plant, found in many roads, contains the toxin oleandrin.
• Botulinum toxin injections, such as Botox, used in cosmetic interventions actually contain one of the strongest toxins known – botulinum neurotoxin (BoNT) – which is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. However, the dose used in these injections is very small and safe if used by qualified medical staff for approved licensed indications.
• Reducing the dose reduces the effect of the toxin. Thus, in most cases of a chemical spill, immediate instructions are simple: remove any clothing, shoes or jewelry that came into contact with the chemical, and wash the skin well with soap and water.
• Medicines are the leading cause of accidental poisoning in children. These incidents are generally with medication prescribed to adults, which is left within the child’s reach. All medicines should be kept in a safe place.
For more trivia, see: www.um.edu.mt/think.