Dr. V.V Pillay is a Chief of Poison Control Centre & Head of Analytical Toxicology and Professor & Head of Forensic Medicine & Medical Toxicology in Amrita Institute of Medical Sciences (AIMS), Cochin, Kerala.

The Poison Control Centre of AIMS is listed in the Global Directory of Poison Control Centres of the World Health Organization. The Analytical Toxicology Laboratory attached to it is a nationally accredited clinical toxicology laboratory and receives samples from poisoned victims from all over the country. Till date, it has analysed over 70,000 samples.

He has completed MBBS and MD from Gandhi Medical College, Hyderabad. Over the period of time, he has published more than hundred publications in national and international scientific journals, of which 29 in PUBMED.

He is the author/editor of several books, including the first-ever Indian textbook devoted to toxicology (Modern Medical Toxicology, now in 4th edition) an exhaustive reference book (Comprehensive Medical Toxicology, now in 3rd edition), and a textbook on Forensic Medicine & Toxicology (now in 19th edition).

He has also contributed a section on toxicology for Oxford Textbook of Medicine, published by Oxford University Press, UK which consists of API Textbook of Medicine, published by the Association of Physicians of India, Textbook of Emergency and Trauma Care, published by Jaypee Brothers, India and Tandon’s Textbook of Cardiology, published by Wolters Kluwer, India.

He is also the Editor of the Journal of Indian Society of Toxicology (2005-2014). He is a referee on toxicology for the Journal of the Association of Physicians of India (for which he won the ‘VR Joshi Best Referee Award’ in 2006), and the National Medical Journal of India. He has contributed to several monographs on analytical toxicology for the World Health Organization. He is an External Reviewer for the new edition of Guidelines for Poison Control published by WHO (2021). He is also a working Group Member of the WHO’s Guidelines for Poison Control Network, Edinburgh, UK.

He founded the Indian Society of Toxicology in 2004, of which he was the President for 8 consecutive years. He has been awarded the SOT (Society of Toxicology, USA) Travel Award – 2018 at the 57th Annual Meeting in San Antonio, Texas, USA (11-15 March 2018).

He was editor of the Journal of Indian Society of Toxicology (2005-2014). He was a Referee on toxicology for the Journal of the Association of Physicians of India (for which he won the ‘VR Joshi Best Referee Award’ in 2006), and the National Medical Journal of India. He has majorly contributed to several monographs on analytical toxicology for the World Health Organization. He was an external reviewer for the new edition of Guidelines for Poison Control published by WHO (2021). He has been part of working Group Member of the WHO’s Guidelines for Poison Control Network, Edinburgh, UK. He founded the Indian Society of Toxicology in 2004, of which he was the President for 8 consecutive years. He was Awarded the SOT (Society of Toxicology, USA) Travel Award – 2018 at the 57th Annual Meeting in San Antonio, Texas, USA (11-15 March 2018).

1. What inspired your interest in Forensic Medicine & Toxicology? Tell us about your journey from MBBS student to a Chief of Poison Control Centre & Head of Analytical Toxicology; and Professor & Head of Forensic Medicine & Medical Toxicology in Amrita Institute of Medical Sciences (AIMS), Cochin, Kerala.

Well, it is a long story, but I’ll keep it short! I was actually not very interested in pursuing a medical career; I wanted to be a journalist. But somehow circumstances forced me to take a different path and to be honest, I have not really regretted what transpired over a period of time. During my medical student days in Hyderabad (where I was born and raised), I must confess I was not a very dedicated pupil. Somehow, though I tried to interest myself in hospital postings, patient care, and so on, my heart was not in what I was doing. By the time I came to the end of the course and started my internship, one thing was clear in my mind: I was not going to choose a clinical specialty for my post-graduation. I had always been a great fan of crime fiction and scientific detection of crime and was an avid reader of novels that dealt with such themes, as also an enthusiast of films of the same genre. I realised that the closest I could get to my area of interest was to become a specialist in forensic medicine. Therefore when it was time for me to choose my specialty, I had no hesitation whatsoever in picking forensic medicine, even though my parents were disappointed and my friends were shocked! Bu more than three decades down the line I am very happy with my decision and feel a great sense of fulfilment and professional satisfaction. Over a period of time, my focus did shift a little, from forensic pathology to toxicology due to some personal reasons, but as the two are closely linked, I feel that I have never really lost my moorings.

2. How do you stay up-to-date with your information in your area of expertise? How do you keep yourself relevant in your field?

When your heart is in the field you are working in, and you are passionate about your job, constantly updating yourself comes very naturally. You don’t really have to put in any extra effort; it is an automatic process. Being in a field that is evolving and changing rapidly, I am aware that I need to keep reinventing myself to stay relevant, and I make it a point to do that. I read a lot, and attend scientific programs and events relating to my specialty regularly, and even organise such events every now and then. These are activities that bring me great pleasure because I enjoy what I am doing in my professional life.

3. What is in your opinion the greatest advancement in toxicology since its inception?

Toxicology is one of the most dynamic specialities in the field of medicine, and it is sad that it had been neglected for a long time. Things have started changing however, and increasing interest is now being shown by the powers that be, to elevate the importance of this specialty to a status that it deserves. I have been very closely involved with this particular component of the overall specialty of forensic medicine for more than two decades, and have succeeded to some extent in highlighting its importance to my colleagues and students. Today we have specialised centres called Poison Control Centres being established in major medical colleges and hospitals all over the country that are instrumental in vastly improving the quality of management of poisoned victims. I myself head one of the premier centres that is attached to Amrita Institute of Medical Sciences in Cochin, and I am proud to say that it is today among the most full-fledged centres with state of the art resources in poison information and analytical services.

4. What are some of the legal issues in a medicolegal case where poisoning is involved? What are some of your recommendations on such cases?

Every case of poisoning is a potential medicolegal case, and one must be always aware of that. Even a case that appears to be straightforward, for instance an incident arising out of accidental exposure to a toxin, can take very unexpected turns. This has happened in quite a few cases that I have handled, and that is why I am always alert and cautious. My recommendation to all doctors and professionals engaged in the field: take nothing at face value, and nothing for granted. Always be alert to the possibility of foul play; poisoning is not always accidental or suicidal.

5. Kindly describe in brief a case handled by you, which is very close to your heart? (Excluding any personal identifiable information)

There are innumerable such cases as I have been involved in this field now for more than 20 years. A recent case that comes to mind which is unique is with regard to an IT professional from Bengaluru who was poisoned periodically with arsenic by his wife via his food. They were having marital problems and she wanted to have a divorce which he was not agreeing to. After visiting several hospitals and doctors in Bengaluru for his periodic illness, he was finally referred to our Centre as a suspected case of poisoning. My daughter who was pursuing her medical post-graduation at that time here in Cochin, helped me tackle the case. We narrowed the possible agents down to heavy metals and performed a metal screen in urine which was positive for arsenic. Subsequently we confirmed it by a quantitative screening in his blood sample. The matter was reported to the police who recovered a small bottle of white powder from the home where the couple was staying. Upon testing, it turned out to be arsenic trioxide. The wife was arrested, interrogated, and confessed to the crime. The husband recovered fortunately, while the wife is in police custody and the case is in progress. Just goes to show that homicidal poisoning is not uncommon and doctors must always be alert to the possibility of poisoning in unexplained illnesses, especially of a chronic nature.

6. What are some of the most interesting (and morbid) cases of poisons and poisonings that you have encountered especially when you have received forensic samples to analyse? What are the challenges encountered by you while handling cases related to forensics? How did you deal with the same?

We normally do not accept viscera or body fluid samples from dead bodies for forensic toxicological analysis, as ours is a clinical toxicological laboratory. However, we have done a few on special request. The Kalabhavan Mani case of Kerala is one example (he was a famous character actor in Malayalam films). There was a lot of controversy and sensationalism around the case as people were claiming that he was deliberately poisoned. But we could prove that there was no poison involved and he passed away due to natural causes, by a detailed toxicological evaluation.

7. How do you handle high-profile cases that go beyond the medicolegal limits? What kind of research do you do to give a final opinion?

I handle all cases with the same approach, and do whatever is required without fear or favour. To me, a victim of poisoning is just a victim, and it does not matter to me what strata of society he belongs to, or whether he is a celebrity or an ordinary citizen. Complicated cases with regard to identification of the exact cause of poisoning are handled with due diligence, and we consult our excellent toxicological databases for help and guidance in solving them.

8. Most of the professionals working in the Forensic Medicine & Toxicology domain across the world are overburdened by casework. But you managed to indulge in research work and publish around 100+ publications, author/editor to several textbooks, member of the Editorial Board, and reviewer for many Journals in spite of all this. How did you make it possible? How important is it to indulge in research work and collaboration with other persons in the field?

When you love your work, you find that it thrills you each time you come across interesting cases. In a field like toxicology, there is no dearth of fascinating cases. I am devoted to the field of toxicology and therefore spend most of my time working. It gives me a great deal of professional fulfilment, and I do not consider the workload, that can be pretty heavy at times, stressful at all. In order to keep myself constantly updated, I read a lot of research publications on toxicology, and also undertake research of my own, besides attending conferences, workshops, etc.

9. What advice would you give to young researchers who wish to publish their research work in reputed journals?

First of all, the quality of the research work must be good, and the topic itself must be relevant. It must be original work, and duplicating research already done, even if it is elsewhere, must be avoided. One must be careful of predatory journals, and only publish in reputed journals that are abstracted in authentic indexing agencies with a high impact factor.

10. You are the author/editor of several books. What is your motivation to write your very first book ‘Modern Medical Toxicology’?

My foray into the field of toxicology (and a slight shift away from my parent discipline of forensic medicine) arose out of a personal near-tragic incident. My daughter who was then only about a year old got accidentally poisoned, partly because of my own negligence. Fortunately she survived, and today is a physician herself, and is based currently in London. When the terrible incident happened I realised how ignorant doctors (including myself) were with regard to effective diagnosis and management of poisoning in India. After my daughter recovered, I took an oath that I would do anything that was in my capacity to improve the status of toxicology in India. And that is how I managed to accomplish so many things over a period of time, beginning with writing the first ever Indian textbook on toxicology containing only current and correct concepts. Subsequently I have written several other books also, including the most comprehensive reference book on toxicology which is now in its third edition: Comprehensive Medical Toxicology.

11. As an Adjunct faculty at the School of Forensics, Risk Management & National Security, RRU what are your key principles in training and educating the next generation of scientists?

I am an adjunct/guest faculty on forensic medicine and toxicology for several universities and organisations, including the one that you mention. My focus is always on highlighting the importance of this very crucial specialty, and stimulating the interest of scientists, doctors and students in taking up this field and develop it into world class status.

12. What are some everyday tips or tricks that you use to keep yourself motivated?

I read a lot, not only academic works on toxicology, but also crime fiction, especially books relating to criminal poisoning, besides also watching documentaries and films having toxicological content! All this is in addition to the routine work that I perform every day, as also the research projects that I involve myself in. These are but a few of the ways in which I keep myself engaged in the specialty that has given me so much satisfaction in my professional career.

13. What are some of the most important things you’ve learned in your career? And what advice would you give to someone who would like to pursue a career in Forensic Medicine & Toxicology?

I have learnt that there are no short cuts to success, and one can achieve a lot only through genuine hard work and sincere effort. Any student who would like to pursue a career in forensic medicine or toxicology must first familiarise himself/herself with what the field is all about and make sure that it is something that he/she would like to take up as a full time career. As I have already stated, if your heart is in it, work becomes pleasurable and fulfilling. Never take up a career that is not of interest to you, even if it appears glamorous or remunerative. That is a pitfall, and eventually your entire professional life will become a boring, mechanical routine. Even today, so many decades down the line, I am so excited to go to my office everyday and immerse myself in work, and it is only because I love the field I have chosen. That is how it should be.

Wishing all budding students and professionals all the very best!