In Thailand, Love of Food Carries Deadly Risks

It can be a fatal attraction, medical researchers say. The raw fish that is so avidly consumed in the stilt houses that sit among rice paddies and wetlands of the country’s northern provinces contain parasites that can accumulate in the liver and lead to a deadly cancer. Known as bile duct cancer, it is relatively uncommon in most parts of the world but represents the majority of the 70 liver cancer deaths a day in Thailand, according to Dr. Banchob Sripa, the head of the tropical disease research laboratory at nearby Khon Kaen University.

“It’s the most deadly and persistent cancer in the region,” Dr. Banchob said.

For the past three decades, he has led an unsuccessful campaign against the parasite, known as a liver fluke and which is also endemic in Cambodia, Laos, Vietnam, parts of China, the Korean Peninsula and Siberia.

Dr. Peter Hotez, the president of the Sabin Vaccine Institute, a nonprofit organization in the United States that researches neglected tropical diseases, describes liver flukes as one of “the most important infectious causes of cancer that no one has ever heard of.”

Cooking the fish would eliminate the risk of infection. But the battle against liver flukes is being undermined in Thailand by a deeply ingrained love of the sour and smoky-tasting fermented dishes that generations of villagers have relished.

Some villagers just cannot break the habit, said Nutcharin Yanarangsri, a volunteer at a government health clinic in the village here who spends her days walking from house to house with a singular message: “Say no to raw fish!”

“We tell them, ‘If you really want to eat it, you’d better boil it or cook it,”’ Ms. Nutcharin said during one of her rounds through the village. “But they tell me, ‘Eating it raw is so delicious. I can’t stop. I love it!”’

Whether it is a green papaya salad with just the right mix of sweet and sour or a duck curry swimming in spices, the cuisine of Thailand is a national passion. The country’s 65 million people seem to spend their waking hours either talking about food or consuming it.

But the Thai love of food has a masochistic side. It is not uncommon for office workers to lunch on searingly hot chili-laced dishes only to rush to the bathroom a few hours later with a bad case of Bangkok belly.

The love of fermented foods, especially in northeastern Thailand, is the extreme version of this gourmand obsession — and that love is often heedless of the consequences.

One popular dish in northeast Thailand is called pla som, or sour fish, which is made by mixing raw fish, garlic, salt, steamed rice and a pinch of seasoning powder. The mixture is shaped into egg-size portions, put into plastic bags and left to sit in the tropical heat for three days. That is not nearly long enough to kill the parasites, which die only after at least six months of fermentation.

Liver flukes are present only in fresh water, but they are not found everywhere. The rate of infection in Bangkok, a five-hour drive away, is close to zero.

Transmitted through feces, the parasites thrive in rural areas without proper sanitation, and they rely on snails, fish, cats and humans as hosts. Yet villagers do not see fermented fish as a dangerous thrill.

This is not analogous to the tradition in Japan of eating fugu, the puffer fish that is potentially toxic when prepared the wrong way.

The deadly effects of eating parasite-infected raw fish accumulate over decades, in the same way that drinking large amounts of alcohol over a lifetime can damage one’s liver. (Heavy drinking increases the chance of bile duct cancer for those infected with the parasite, Dr. Banchob said.)

Somewhere between 1 percent and 5 percent of people infected with the parasites contract liver cancer.

Laos, Vietnam and Cambodia also have high rates of liver cancer, according to statistics from the United Nations. Dr. Banchob estimates that about 10 percent of the population in Laos is infected with liver flukes.

Dr. Hotez of the Sabin Institute said that the parasite is similar to other worms and ailments that get less attention because they rarely afflict wealthy urban populations. “Even though Thailand is a middle-class country, there are still pockets of intense poverty — and with that poverty come high rates of neglected tropical diseases,” Dr. Hotez said. “We’ve got the technology to make vaccines. But we don’t have the funding.”

Dr. Cherdchai Tontisirin, a surgeon in Khon Kaen who has operated on liver cancer patients, blames the Thai government for the persistence of the disease. More could be done to make sure villagers stop eating raw fish, he said.

“The government has never taken this seriously,” Dr. Cherdchai said. “This is a disease that affects only the north and the northeast, and these are regions that have been

Risks Aside, Ticket-Fixing Has Persisted for Decades

 

Three years later, an inquiry uncovered 100 officers who had sidestepped the summons altogether: they sold $10 courtesy cards that motorists could flash and go free, according to the police and the Brooklyn district attorney.

Between those two scandals, reformers hatched what was thought to be an incorruptible solution: Gov. Thomas E. Dewey proposed redesigning the summons books that officers carry, with ticket slips consecutively numbered, each in quadruple form. A newspaper report called it “a system of non-fixable tickets.”

It didn’t quite work out that way.

In 1987, a veteran police officer, Robert Hanes, was dismissed from the force after a departmental trial found he had persuaded another officer to give false testimony that let a motorist evade a fine for speeding. In 1996, a federal judge sentenced William Caldwell, a former police captain and president of the Housing Police Superior Officers Association, to a year in jail for fixing thousands of parking tickets. His scheme often involved false paperwork claiming the cars had been stolen or were disabled at the time the ticket was issued.

In pleading guilty, Mr. Caldwell said, “Some of these things I did were for friends of mine, some were for profit.”

Over the years, the headlines, court cases and wrecked careers put generations of officers on notice about the professional risks involved in fixing a ticket. Yet the practice persisted. Now it has become the focus of a major multiprecinct investigation, the largest focused on ticket-fixing since the 1950s.

Some are wondering what took so long. Hundreds of officers could be disciplined by the time a grand jury in the Bronx finishes its work, including roughly two dozen officers who could face criminal charges, officials and others briefed on the case have said. The inquiry began when the Police Department’s Internal Affairs Bureau, in an unrelated investigation, taped an officer in mid-2009 trying to have a ticket fixed.

The scheme centers on union delegates and trustees. Officers wanting to make a ticket disappear — or following orders to do so — would seek out union officials who seemed plugged into a network for doing it safely.

On Friday, Mayor Michael R. Bloomberg said the ticket-fixing should have been stopped sooner. “There seems to be a lot of evidence that there was a practice that should not have taken place,” he said during his weekly radio program on WOR.

The police commissioner, Raymond W. Kelly, citing the grand jury’s work, said through a spokesman that he had no comment.

“Whenever an allegation of ticket-fixing came to the commissioner’s attention, it was pursued by I.A.B.,” said the spokesman, Paul J. Browne, referring to the Internal Affairs Bureau. “And no, he never fixed a ticket or was party to fixing one.”

Over the years, discipline meted out in ticket cases has been focused mostly on officers characterized by superiors as rogues, including some who had been caught accepting a bribe. When officers have been found to have fixed tickets, the department has come down hard, handling it as a career-ending offense and holding internal trials, but leaving it there.

Many active and retired officers said they could not recall any departmentwide measures to curb the practice. Several current and former prosecutors said it was extremely rare for Internal Affairs to bring ticket-fixing cases to a district attorney’s office. One former assistant district attorney who supervised and prosecuted police corruption cases said he could recall only one such instance; several others could recall none.

“This stuff has been happening since the beginning of time,” the former prosecutor said, “and it’d be like picking off ducks in a barrel. Anytime anyone wanted to, they could make a big case, so they just haven’t wanted to.”

While ticket-fixing was a regular practice, many rank-and-file officers dreaded receiving such requests. “Most guys spend their whole career hoping this does not blow their way,” said one officer who insisted on anonymity, referring to ticket requests.

A law enforcement official, in defending the Police Department, noted that it was the department that brought the case to the office of the Bronx district attorney, Robert T. Johnson.

Rae Downes Koshetz, a former Police Department deputy commissioner of trials who presided over administrative hearings of officers, said a handful of such cases came her way. “Anytime one of those cases came before me, it was a firing offense to fix a ticket,” she said. “It’s corruption. Sometimes it involves bribery, lying, and the department is supposed to have a zero-tolerance policy for lying.”

She added: “I was there for 14 years. We weren’t clogged with ticket-fixing cases.”

William K. Rashbaum and Jack Styczynski contributed reporting.

 

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