It didn’t take long for Benjamin Herzel to see the snake problem. In the first day of his field research on snake density in India, the 2014 Union College graduate saw professional snake catchers capture, count and release 120 snakes—mostly Indian cobras and Russel’s vipers—in four hours.
Herzel, who recently completed a master of science in global health program at the University of California at San Francisco, was awarded the John L. Ziegler Award for Outstanding Student Capstone for his thesis research: “Treatment Strategies for Venomous Snakebites in Southern India: A Cost-Effective Analysis.”
The study compared the cost-effectiveness of two major treatment options used in India for snake bites. Using antivenom is extremely expensive for individuals and the health system at large. Herzel explained that snakebites are an often overlooked global health issue in terms of the amount of attention and funding it gets compared to the mortality and morbidity it causes.
“I conducted my research in the Indian state of Tamil Nadu, in the far south of India,” said Herzel. “I spent half of my time in Coimbatore, and half of my time in a smaller town called Krishnagiri, not too far from Bangalore.” Most of Herzel’s days were spent at hospitals collecting data from patients’ billed records, hospital chargemasters, and accounting reports. The information was collected in an economic model that helped Herzel determine which strategy was more cost-effective. Herzel observed victims of snakebites throughout the entire treatment process, talked to physicians and other experts as well as with the patients themselves.
Herzel’s research points to the effectiveness of a less expensive alternative treatment to snake antivenom such as a small molecule inhibitor. “Hopefully, this will encourage drug developers, who are already in the late stages of discovering a new class of snake antidotes, to increase their focus on likely candidates, while putting less focus on improving the quality and quantity of antivenom supplies,” he said.
The idea has been pioneered by Herzel’s capstone mentor, Matthew Lewin, an emergency room physician and neuroscientist in San Francisco. Lewin has promoted the idea of using a nasal spray containing drugs to counteract the neurotoxins commonly found in the venom of cobras and other Asian snakes.
“Seventy-five percent or more of the patients who die from snakebites are never treated in the hospital,” said Lewin in a 2014 interview with Spencer Michels on PBS NewsHour. “If you make it to the hospital, you will probably do quite well.” Lewin believes an inexpensive spray could greatly reduce fatalities by allowing victims to make it to medical care—especially in remote areas of India.
The firsthand research in India made a big impact on Herzel’s own view of global health issues. “The study made me acutely aware of the burden of disease attributed to snakebites in the world,” said Herzel. “It is one thing to read papers containing statistics and figures, and it’s entirely another thing to stand by the bedside of a six-year-old girl and watch her suffering only minutes after she was bitten by a viper.”
Herzel graduated from Union College in 2014 with degrees in biomedical science and international rescue and relief. “Union’s community is the strongest I’ve ever experienced,” said Herzel. After finishing his master’s program in August he began working full-time at UCSF for both the Department of Global Health and the Institute for Health Policy Studies. He plans to work in global health economics for the next year or two before entering medical school.
“I chose Union for the IRR program,” Herzel explained. “I couldn’t find any other program like it.” He also found his biomedical science degree laid the foundation for the skills and knowledge he needed to complete his master’s degree.
“My biggest advice for students is to have a very specific and practical plan for their degree,” Herzel said. “Many IRR students may not be afraid of dangling from a cliff or jumping into a powerful current at midnight, but perhaps they are more likely to be afraid of using statistical software or searching a journal database. Don’t be afraid to explore the unknown, even if it doesn’t look like you expected.”
By Megan Wehling, student writer