Itai-itai disease


Itai-itai disease was the name given to the mass cadmium poisoning of Toyama Prefecture, Japan, starting around 1912. The term "itai-itai disease" was coined by locals for the severe pains people with the condition felt in the spine and joints. Cadmium poisoning can also cause softening of the bones and kidney failure. The cadmium was released into rivers by mining companies in the mountains, which were successfully sued for the damage. Itai-itai disease is known as one of the Four Big Pollution Diseases of Japan.

Symptoms

One of the main effects of cadmium poisoning is weak and brittle bones. Spinal and leg pain is common, and a waddling gait often develops due to bone deformities caused by the cadmium. The pain eventually becomes debilitating, with fractures becoming more common as the bone weakens. Permanent deformation in bones can occur. Other complications include coughing, anemia, and kidney failure, leading to death.
A marked prevalence in older, postmenopausal women has been observed. The cause of this phenomenon is not fully understood, and is currently under investigation. Current research has pointed to general malnourishment, as well as poor calcium metabolism relating to the women's age.
Recent animal studies have shown that cadmium poisoning alone is not enough to elicit all of the symptoms of itai-itai disease. These studies are pointing to damage of the mitochondria of kidney cells by cadmium as a key factor of the disease.

Cause

Itai-itai disease was caused by cadmium poisoning due to mining in Toyama Prefecture. The earliest records of mining for gold in the area date back to 1710. Regular mining for silver started in 1589, and soon thereafter, mining for lead, copper, and zinc began. Increased demand for raw materials during the Russo-Japanese War and World War I, as well as new mining technologies from Europe, increased the output of the mines, putting the Kamioka Mines in Toyama among the world's top mines. Production increased even more before World War II. Starting in 1910 and continuing through 1945, cadmium was released in significant quantities by mining operations, and the disease first appeared around 1912. Prior to World War II, the mining, controlled by the Mitsui Mining & Smelting Co., Ltd., increased to satisfy the wartime demand. This subsequently increased the pollution of the Jinzū River and its tributaries. The river was used mainly for irrigation of rice fields, but also for drinking water, washing, fishing, and other uses by downstream populations.
Due to the cadmium poisoning, the fish in the river started to die, and the rice irrigated with river water did not grow well. The cadmium and other heavy metals accumulated at the bottom of the river and in the water of the river. This water was then used to irrigate the rice fields. The rice absorbed heavy metals, especially the cadmium, which accumulated in the people who consumed the contaminated rice.
When the population complained to Mitsui Mining & Smelting Co. about this pollution, the company built a basin to store the mining waste water before leading it into the river. This proved ineffective, and many had already been sickened. The causes of the poisoning were not well understood and, up to 1946, it was thought to be simply a regional disease or a type of bacterial infection.
Medical tests started in the 1940s and 1950s, searching for the cause of the disease. Initially, it was expected to be lead poisoning due to the lead mining upstream. Only in 1955 did Dr. Hagino and his colleagues suspect cadmium as the cause of the disease. Toyama Prefecture also started an investigation in 1961, determining that the Mitsui Mining and Smelting's Kamioka Mining Station caused the cadmium pollution and that the worst-affected areas were 30 km downstream of the mine. In 1968, the Ministry of Health and Welfare issued a statement about the symptoms of itai-itai disease caused by the cadmium poisoning.
The reduction of the levels of cadmium in the water supply reduced the number of new cases; no new case has been recorded since 1946. While the people with the worst symptoms came from Toyama prefecture, the government found patients with itai-itai disease in five other prefectures.
The mines are still in operation and cadmium pollution levels remain high, although improved nutrition and medical care has reduced the occurrence of itai-itai disease.

Etymology

The term itai-itai disease was coined by the affected locals for the severe pains that people with itai-itai disease felt in the spine and joints. In Japanese 痛い itai is used as an adjective meaning "painful" or as an interjection equivalent to "ouch".

Treatment

Any person with Cd-Poisoning must seek immediate medical help. Detoxification of Cadmium with EDTA and other chelators is possible. Clinically available chelators include EDTA, DMPS, DMSA, and British Anti-Lewisite. BAL is more toxic than its derivatives, DMPS and DMSA, and is seldom used clinically. EDTA, DMPS, and DMSA increase urinary excretion of Cd. Studies in vitro and in vivo suggest that EDTA is superior to DMSA in mobilizing intracellular Cd. As EDTA is approved by the FDA for lead and other heavy metals, and has a long history of safe use, it is most widely accepted for clinical use. Use of such chelators as has been seen as therapeutically beneficial to humans and animals when done using established protocols.

Society

Legal action

Twenty-nine plaintiffs, consisting of 9 people with itai-itai disease and 20 of their family members, sued the Mitsui Mining and Smelting Co. in 1968 in the Toyama Prefectural court. In June 1971, the court found the Mitsui Mining and Smelting Co. guilty. Subsequently, the company appealed to the Nagoya District Court in Kanazawa, but the appeal was rejected in August 1972. The Mitsui Mining and Smelting Co. agreed to pay for the medical care of the people who had been affected, finance the monitoring of the water quality performed by the residents, and pay reparations to the people with the disease.
People who believe that they have itai-itai disease have to contact the Japanese Ministry of Health, Labor, and Welfare to have their claims assessed. Many people with itai-itai disease were not satisfied with government actions and demanded a change in the official procedures. This caused the government to review the criteria for recognizing a patient legally; the government also reassessed the treatment of the disease.
A person is considered to have itai-itai disease if he or she lived in the contaminated areas, has kidney dysfunctions and softening of the bones, but not related heart problems. One hundred and eighty-four patients have been legally recognized since 1967, of whom 54 were recognized in the period from 1980 to 2000. An additional 388 people have been identified as potential patients, those who had not been officially examined yet. Fifteen people with itai-itai were still alive.

Economic costs

The cadmium pollution had contaminated many agricultural areas. Heavy metal pollution affected many areas in Japan, and as a result the Prevention of Soil Contamination in Agricultural Land Law of 1970 was enacted. It ordered planting to be stopped so that restoration of the soil could be enacted to areas with 1ppm of cadmium or more contamination in the soil. Surveying in Toyama Prefecture began in 1971, and by 1977, 1500 hectares along the Jinzū River were designated for soil restoration. These farmers were compensated for lost crops and for lost production in past years by the Mitsui Mining and Smelting, Toyama Prefecture, and the national government., only 400 hectares remained contaminated.
In 1992, the average annual health expense compensation was ¥743 million. Agricultural damage was compensated with ¥1.75 billion per year, or a total of annually ¥2.518 billion. Another ¥620 million were invested annually to reduce further pollution of the river.
On 17 March 2012, officials concluded the cleanup project of the cadmium-polluted areas in the Jinzū River basin. Eight-hundred and sixty-three hectares of topsoil had been replaced since the cleanup began in 1979 at a total cost of ¥40.7 billion. The project had been financed by the Japanese national government, Mitsui Mining, and the Gifu and Toyama prefectural governments.