Hub of liver flukes.

A Thai cancer doctor told me that liver cancer is one of the three most common cancers she treats (the other two being breast and cervical) and that most was traced to the liver fluke parasites in pla ra somtam. Here's a somewhat recent NY Times story on it: http://www.nytimes.com/2011/04/26/world/asia/26iht-thailand.html

Never knew about this before. Thanks for the info.

Only cooked fish for me.

Make sure your chicken and pork is cooked through as well. No pink bits!

Pink bits you can get elsewhere

No problem with the chicken and pork being cooked. It's the Lab Nua that they eat raw that's the problem. I really enjoy it but the GF now cooks it for me and it's just as nice if not better. I don't fancy intestinal worms.

<deleted> stuff gave me the parasite 2 years after moving to Isaan - very unpleasant flash fevers. So now any time I do bloods or have a CT scan I have to remember to ask the medics to give the liver a thorough once over for potential onset of liver cancer.

It took the top guy at the UK's top tropical diseases hospital to look down the microscope and pronounce "Opisthocarsis" after it had passed by a couple of Thai (non-Isaan) doctors and infectious disease specialists in a large regional UK hospital.

It's a misnomer to call palaar (or pla rah) "fermented" fish. If it was fermented at all properly the flukes would not survive. The problem is that palaar is cheap $hit that every local market throws its fish waste into without any thought whatsoever for public health.

My extended Thai family's reaction is typical. They know the full story but still laugh as they give me a non-palaar version of somtam (usually 'dam thai', but there are many variants - all equally delicious IMO) and then set about scoffing bucket loads of the potentially lethally dosed-up stuff themselves. Every afternoon between 2:30 pm and 4:00pm - it's the Isaan equivalent of a must-have 'cup-o-tea'.

More fool them

AVOID at all costs. [Laap Plaa too unless the fish has been cooked].

Often they will boil the "Pla Ra" as part of the process of making it, which can make it "safe", or at least safer, they usually do this in Bangkok and the more upmarket Thai restaurants I think, but Isaan people often feel that the non boiled version has a better taste.