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President's Perspective

Charles McKay writes his final article as president of ACMT—

I have been impressed by several things about our College during my time thus far on the ACMT Board of Directors. I would like to use my last column as President to thank all of our members who have offered their time, suggestions, and donations to help the specialty of Medical Toxicology. Even as immediate past president, I will still be sitting on the Board for another two years; and remain active on the board of the Medical Toxicology Foundation (so you aren’t rid of me yet!) 

Some of the things that I think make us special – and at the same time – potentially misunderstood or under-appreciated are noted below. If you agree with my musings, keep working with ACMT to keep the specialty viable. If you disagree with something, let me know. I would be happy to bring your concerns or proposals to the Board’s attention. 

We are one of the few medical specialties, other than perhaps Pathology, where our patients often don’t know us or interact with us in the usual doctor-patient relationship. Whether altered, impaired, or just deluded/angry, this relationship has not helped our specialty to become essential to our patients. I think this is changing as more individuals take on expanded roles in outpatient clinics and addiction medicine practices, but we need more efforts here.

We are perhaps the only specialty without a procedure or test that distinguishes us. Perhaps Infectious Disease or Rheumatology were similar, but given the unfortunate prevalence of AIDS and AIDS-related infectious conditions, ID is now the master of those conditions’ treatments and antibiograms, etc. Rheumatology has greatly benefited from increased understanding of auto-immunity and the resulting testing for serious “achiness.” Our ability to appreciate some of the limitations of analytical testing procedures and extensive experience interpreting diagnostic tests, particularly those related to trace elements, are areas that are to our patients’ benefits; but we compete in this sphere with the fraudulent practice of a variety of “chelating” practitioners. Perhaps the area of personalized medicine is ripe for medical toxicology involvement, given the multiple disciplines interested, and the complex medication regimens of the typical chronically ill patient. 

Above all, I think that our role in many areas is a collaborative one. Whether it is in the area of the opioid epidemic, where we are in the crowded field of addiction psychiatry, pain management, addiction medicine, harm reduction groups, and others; or public policy related to chemical terrorism preparedness, where we are interacting with law enforcement, public health agencies and laboratorians across a spectrum of jurisdictions, and others – we bring important expertise and insight to the discussion…but we are not the lead. This is OK, but we need to continue to present the important perspective of a specialty that recognizes both the possibility of toxicity from any given substance, but also the perspective that hazard and risk are separate, though related concepts. If I summarize the forgotten side of the “precautionary principle” briefly, it would be: “a decision to avoid something is also a decision to accept exposure to something else.”

Finally, I have been impressed by the breadth and depth of practice and knowledge of individual toxicologists within ACMT. Whenever a question or problem has been raised on conference calls, the Forum, or national case conference, and on-site, the overwhelming likelihood is that someone – or more than one of us – has a significant scope of experience in dealing with that issue or similar topic. I would encourage all of you to bring that expertise to ACMT to both expand the scope of practice for our trainees, as well as increase the visibility of the specialty as a whole. If you can incorporate ACMT into the activities that you are pioneering in your own region or academic center, we can all benefit and expand the visibility and availability of medical toxicologists.

Thank you for the privilege of serving as your President these last 2½ years.