https://www.remnantmd.com/p/the-15-year-smon-epidemic-of-japan
Pharma's Alibi | The 15-Year S.M.O.N. Epidemic of Japan
An Epidemic swept through Japan from 1959 to 1973, but how come you have never heard of it? And what happened to the virus that caused it? This story is a reminder to keep our heads on straight.
In the Wake of Polio
In the 1950s, Japan was in the middle of a “war” on Polio. As such, there was a very active and well funded virological community - not unlike our own NIH.
In February 1962, Abraham Kaplan (Professor of Philosophy) gave a banquet speech at a conference of the American Educational Research Association held at UCLA. In June of the same year the Journal of Medical Education highlighted a comment by Kaplan on choice of research methodology. Referring to Kaplan’s Law of the Instrument:
Give a boy a hammer and everything he meets has to be pounded.
And so, this story begins.
The S.M.O.N. Epidemic
Reisaku Kono was studying poliovirus, which he had observed that in a few infected individuals would result in symptoms involving the central nervous system causing progressive paralysis and sometimes, death. In 1959, he observed the case of a middle-aged woman suffering from a mysterious illness that had paralyzed both of her legs. His suspicion was that this too may be the result of an as of yet unknown virus.
Hiroshi Takasaki, a professor of medicine at the university hospital caring for this woman, mentioned that he had recently observed a number of cases that were similar. In the previous year, professor Kenzo Kusui published a report of a similar case in central Japan. This patient had a combination of intestinal problems, bleeding, diarrhea, and nerve degeneration. This pattern was noticed in a few isolated cases in 1955. Kono now realized they were facing an outbreak of something new.
In the next five years, 7 major regional outbreaks of the new syndrome were observed. By 1964, 161 cases were identified. The observed growth had all the makings of an infectious outbreak.
Although the scientists who thought the disease might be related to an occupational hazard were dissuaded of the notion, some noticed important contradictions to the virus hypothesis.
the disease had a bias towards middle-aged women
less common in men
could hardly be found in children
Blood and bodily fluids showed no abnormalities
patients did not manifest systemic signs like fever, rash
To his credit, Kono noted “I was at that time engaged in poliovirus research, so I suspected such a virus to be the cause.”
However, with the 1964 Olympic Games approaching, the lack of isolated virus was little comfort to Japan. 96 new cases were diagnosed the previous year, and some people had new symptoms - like blindness.
That same year, during the 61st General Meeting of the Japanese Society of Internal Medicine this disease was given a formal name: Subacute Myelo-Optico-Neuropathy AKA SMON. The Japanese Ministry of Health and Welfare provided research grants, and launched a formal commission to investigate the epidemic, with Kono as one of several virologists named to the commission.
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Virus Hunt begins
Shortly after, Masahisa Shingu announced his discovery of a virus in excretions of SMON patients - classified as an echovirus. Enteri Cytopathogenic Human Orphan Virus. Orphanbecause they had been discovered incidentally during polio research, but caused no disease. He speculated that like polio, this enteric virus could breakthrough into the nervous system. He published his finding in 1965.
After three years of research trying to confirm Shingu’s claims, Kono could only report to a SMON symposium that he could not isolate the virus from patients. Moreover, he could not even find indirect evidence that the patients had previously been infected.
During this period of investigation, the team made a rather surprising observation. About half of the patients with SMON has previously been prescribed a diarrhea medication called Entero-Vioform. Another half of the patients had received a drug named Emaform. Both drugs were prescribed for early symptoms of SMON - digestive problems. This was brushed aside, as two different drugs should not cause the same new disease - plus it was a virus anyway, for sure.
The commission dissolved in 1967, without an identified pathogen. Shortly after, two rural areas saw an outbreak in Okayama province. By 1971, almost 3 percent of the local population had developed it.
If at First you don’t succeed…
In 1969, the Japanese Ministry of Health and Welfare formed yet another investigative body. This time with more than 10x the funding of the original 1964 commission. SMON research became the largest Japanese research program ever devoted to a single disease. This time, Kono was named as Chairman.
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