The Case of Mushroom Soup and Medical Hoops

Through all the years of economic development that turned my tiny hometown from dairy country into an overdeveloped bedroom community at the far end of the T-line that feeds commuters into Boston, the woods behind my grandparents' house miraculously remains untouched. It's our own little Kampong Buangkok, where time stands still. Where unripe wild blueberries iridesce in the green light of the sugar maple canopy, lady slippers nod ladylike among fragmented breezes, and intoxicating vapors of moist decay rise from the forest floor. Intoxicating, indeed. For its seemingly enchanting surroundings, it's one of the deadliest places on earth if we're talking mushrooms.

My grandmother loved that the woods gave her easy access to mushroom picking, just like her mother did in Italy when she was a little girl. She fit the profile of the picker most likely to misidentify mushrooms: people from Europe or Asia who go after look-alikes from their homeland. Mercifully, she didn't cook amanitas phalloides, or Death Caps, into a soup and feed them to her grandchildren like the 72-year-old woman from Ithaca, NY, did right here in Marin County the day after Christmas last year. According to my mycology-buff neighbor Dave, amanitas, one of the deadliest of mushrooms for its unstoppable and swift sabotage of the body's organs, does not grow back East but looks like edible varieties that do. On the other hand, a quick tour of mycology blogs and websites after the recent incident revealed a common code of survival for anyone who picks mushrooms anywhere other than the produce section of the local Safeway: don't ingest from a source you haven't picked before without having the fungi tested. You might as well play Russian roulette or chase funnel clouds with low gas tanks. Precise identification is to mushroom picking what mesh hoods are to bee keepers and gloves are to snake venom extractors. The problem, I learned from the blogs-o-sphere, is the only experts to identify your mistakes all are employed at poison control centers --the folks who only enter the picture when it's too late.

We read these stories in the local papers at least once a year. The most recent headlines featured death caps picked in Santa Cruz and on Mount Tamalpais in Marin County. The families survived solely by luck and circumstance. And two small miracles: one at the FDA and one at the California Poison Control. The Santa Cruz Sentinal reported that a local doctor happened to attend a presentation at a European toxicology conference in Seville, Spain in which he learned about silybinin, a milk thistle extract. A German drug maker formulates silybinin into an intravenous preparation as a treatment for mushroom poisoning. After obtaining emergency FDA approval for a one-time use to save the Santa Cruz family in 2007, the doctor, Todd Mitchell, landed on the radar of the California Poison Control. This is an organization that stays on top of every development for every poison known to man and staffs a team to address hundreds of thousands of life-saving phone calls but, according to my friend, Patrick Finley, a psychopharmacologist at UCSF, has to appeal to the state for its funding every year. When the Ithaca grandmother and her grandchildren contacted Poison Control, it remembered Dr. Mitchell and called him to help contact the German company.

This is the part about jumping through medical hoops: It so happens that back in Seville, Mitchell met the toxicologist considered the worldwide authority on the medical implications of amatoxin poisoning -- who happened to live in Munich. They happened to email at least once in the past. So for case of the death cap soup, when Mitchell couldn't reach the German drug maker because it was closed for the holidays, and when he couldn't reach the Munich toxicologist, also likely on holiday, to help pave the way, that archived email just happened to contain the office phone number for a colleague who happened to be in his office after 6 p.m. in Munich during a time when all of Europe shuts down for two weeks. The colleague obtained the drug and arranged for Lufthansa to bump a wait-list passenger so that it could accommodate a courier delivering the silybinin. In the meantime, even though Mitchell could not use the same FDA emergency identification number for the Mt. Tamalpais case, the notoriously understaffed behemoth FDA managed nimbly to turn around a new number within an unprecedented few hours. The vials of silybinin arrived within 24 hours of Poison Control's first call to Mitchell, but fewer than expected. Because children have higher mortality rates to mushroom poisoning, Mitchell administered the proper doses to the children and what was left to the grandmother.

Historically in the U.S., only expensive and rare emergency liver transplants save the lives of people who mistake death caps for nostaligic fungii from other lands. Basically, unlikely survival. But the two families treated with silybinin made complete recoveries and went home with their own livers. It is a no-brainer, making such a drug easily available in the U.S., but according to the Santa Cruz Sentinal article, the FDA hasn't approved it because the costs -- for research and clinical trials -- is too high for the small market of mushroom poisoning here versus in Europe. A small market. Granted, it's all about funding and taxes and, eventually, the economy. But there's something about the "m" word that strikes a discordant note when it comes to simple plants that can save lives.