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Your source for personal toxicology information.
The “Ask A Toxicologist” program is part of a growing effort by the College to improve public awareness and education regarding the toxicity of medication interactions, occupational chemicals, new drugs of abuse, venoms and plant toxins. The goal of the program is to provide rational, evidence-based answers to common medical toxicology questions – clearly and concisely. Members of the public are encouraged to submit questions through  for review by a panel of experts in human poisoning, who will post a consensus opinion written by one expert in the field. There is no charge for this service.
Questions relating to an individual’s health concerns cannot be answered, as the program cannot create or replace a doctor-patient relationship. Additionally, we are unable to provide counsel, advice or interpretation for any legal issue. Questions and answers should be of a general nature, and of interest to a wide population. Not all questions will be able to be addressed.

Ask A Toxicologist

I read an article about a medical topic on Facebook. How can I figure out whether or not to trust the information?

posted on 1:40 PM, April 16, 2014

Medical publishing has exploded in the past decade. There are thousands of scientific journals in print and online, but not all journals are held to the same standard. Researchers have a pressure to publish; driven by a desire for promotions, grant funding, and other personal incentives. Publishing companies have responded to this pressure by establishing new journals, some of which charge a fee to publish your research. There have been several high-profile cases of research and publication fraud. The research you read should come from a reputable journal that uses the peer-review process for publication.

Here is how the peer review process works. When someone submits their manuscript (e.g. research, case report, review article, photo, etc.) to a journal, the editor determines if it is suitable for the journal and then forwards it to 3-5 reviewers who have established expertise in that subject. The reviewers will grade the manuscript on design and methods, and study the results to judge that the authors are coming to the appropriate conclusion from their data. This process is a prerequisite to ensure reliability and accuracy.

Articles follow a generally accepted format starting with the title and list of authors. Although all authors are expected to have contributed to the manuscript, the first author is usually the lead researcher, and the last author is the senior researcher. Most articles will provide an abstract or summary of the manuscript; this can be helpful if you are reviewing many articles for a particular question. The introduction provides a background for the research, summarizing what has been done in the area and what questions are left unanswered in the field. Here, the authors will state their objectives. Next, the methods section describes the details of what the authors did and how they did it. Pay attention to what the researchers are measuring, how accurate the measurement is, and how many measurements are taken. Statistical interpretation of these measurements is complex, but in general, the bigger the study group, the better (more significant) the results. Lastly, the discussion section should conceptualize the results into the practical, real world setting. Remember that it is very difficult, nigh impossible, to prove causation. Any positive or negative results from a study should be judged as an association. As they say, falling leaves do not cause winter! Finally, the authors should describe the weaknesses and limitations of the study. A responsibly published manuscript should warn its readers of these limitations before drawing any conclusions.

There is a sea of published research to sort through when searching for an answer to a specific question. Consider the journal you read, its reputation, and what medical specialty it is affiliated with. Look at the authors and see what else they have published on the subject. Check to see what conflicts of interest they may have with the subject. Finally, if you’re stuck for an answer, Ask A Toxicologist!
Mark Neavyn, MD

I live in an area where hydraulic fracturing or "fracking" (natural gas drilling) occurs. Can you tell me what laboratory tests my doctor can perform to determine if I have been exposed to toxic substances as a result of this drilling?

posted on 9:47 AM, March 3, 2014

Due to potential water and air pollution caused by hydraulic fracturing, individuals living within close proximity to drilling areas are appropriately concerned about chemical exposures. The list of chemicals used in the hydraulic fracturing process is lengthy. For individuals living in shale areas, chemicals used in the process are similar, but may have proprietary mixtures that differ slightly. Drinking water contaminated with these chemicals is an undeniable concern for homeowners. Additionally, air contamination stemming from diesel engines, gas releases associated with drilling, and odors from retention ponds are also of concern. Whether the exposure is the result of water or air contamination, a patient may seek laboratory testing from a physician when poisoning is a concern.

Unfortunately, most of these chemicals are not easily measured in human blood or urine. Those that can be measured often have no ‘normal’ range, thus making it difficult to determine whether the presence of such chemicals is harmful. Individuals are constantly exposed to many of these chemicals, even in the absence of hydraulic fracturing, making interpretation of these results complicated. Indiscriminate testing for a long list of chemicals leads to needless concern when an isolated test returns positive without knowledge of a ‘normal’ range. Performing these tests on human samples and then interpreting the results are both extremely difficult.  When concerned about a chemical exposure, it is better to have your water or air tested by a reliable lab. Testing the water and air directly is more prudent than testing blood or urine. This testing can help determine if an exposure may be occurring, and can help direct a physician to provide additional patient-specific testing when necessary. Many times a physician may use laboratory testing that does not include measuring the chemical directly. Due to difficulties in measuring these chemicals in human samples, physicians often use other blood and urine tests to looks for overall indications of toxicity. Often, a local or state health department can help perform air and water testing. The hydraulic fracturing companies may be willing to perform tests, as well.

In many areas where hydraulic fracturing is performed, even in the absence of drilling, the soil and ground water often contain naturally occurring high levels of certain metals such as barium and arsenic. Similarly, if a concern exists for an exposure to heavy metals in ground water, testing the water, rather than the individual, is the better first option to rule out an exposure. Although some metals, like arsenic, have well-documented toxic levels in the human body, other metals such as barium, have no known range. Interpreting metal levels in human samples is extremely complicated, much like the testing performed for other chemicals. Therefore, we recommend first testing tap water to exclude the presence of heavy metals. If water samples have elevated metal levels, a physician can then provide additional, appropriate, and focused testing.

This above approach offers the best way to evaluate whether poisoning has occurred when exposed to toxic substances as a result of hydraulic fracturing. Both you and your physician can consult with a medical toxicologist in your area at any time if you have concerns regarding any chemical exposures.

Anthony F. Pizon, MD

Michael Abesamis, MD, MPH

Division of Medical Toxicology

Department of Emergency Medicine

University of Pittsburgh Medical Center
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