Author reply re: Malla BSSM, Kattamreddy AR. A case for banning paraquat in India: A public health concern.

We thank the authors for their insightful letter about our article published in the National Medical Journal of India.¹ The referenced animal studies provide compelling evidence regarding the neurotoxicity of paraquat (PQ). Several recently published studies have clearly demonstrated that PQ exposure is associated not only with Parkinson’s disease but also with a spectrum of other neurological sequelae.² The mechanistic underpinnings of this neurotoxicity, including oxidative stress, mitochondrial dysfunction and dopaminergic neuronal degeneration, have been elucidated in several well-conducted studies, as rightly highlighted by the authors.

There is an emerging consensus in the scientific community that chronic inhalational and dermal exposure to PQ poses a significant neurotoxic risk to humans.³ Epidemiological studies have also indicated an increased risk of Parkinson’s disease among those exposed to PQ.⁴ Another important argument in favour of banning PQ is its potential for increased use in criminal poisoning. The rising number of cases involving the misuse of PQ for homicidal purposes cannot be ignored.⁵ A stark example is the Sharon Raj murder case in Kerala, where an Ayurvedic concoction laced with PQ was used to commit murder.⁶ The absence of an antidote for PQ poisoning is one of the key factors driving its homicidal abuse. Similar incidents have been documented across India, emphasizing a disturbing trend of the criminal abuse of PQ.⁷

Thus, PQ represents a multifaceted public health problem in India. It is high time that alternatives to PQ are actively explored and adopted in Indian agriculture. A comprehensive public health strategy encompassing regulation (including a ban), surveillance, awareness among doctors and public education is essential to mitigate the diverse risks posed by PQ.