Alternative Medicines

Thomas Kearney
San Francisco General Hospital
San Francisco, CA

Int J Med Toxicol 1998; 1(2): 11

An overarching theme at the 1997 North American Congress of Clinical Toxicology scientific meeting in St. Louis, MO. was the historical and toxicological significance, and now reemergence, of alternative medicines and use of "natural" products. While extremely enlightening and intriguing to us and our colleagues, it raised some very disturbing take-home lessons for us to ponder and served, metaphorically, as Paul Revere's ride and our wake-up call.

Our history is clear about the impact of sentinel toxicological disasters on heightened public awareness and guiding public policy concerning safeguards of our food and drug supply. Most notable are the sulfanilamide and thalidomide tragedies which led to the formation of the FDA and assurances of product quality, purity and safety. Furthermore, as toxicologists, we have enjoyed the benefits of reliable and specific product labeling and the availability of information resources containing product listings to assist in the assessment and management of poisonings.

We now find ourselves in a phenomenal alternative medicine revolution involving the American public, which is circumventing our system of safeguards for food and drug products, and we are less equipped with reliable information sources to manage exposures to these products. This revolution is being fueled by a billion-dollar industry able to promote these products as panaceas without the burden of scientific proof. Highly sophisticated marketing techniques are used that permeate the lay media and,ironically, foster the public perception that "natural" products are synonymous with safety. The industry providing and profiting from these products has landed a preemptive strike with the passage of the Dietary Supplement Health and Education Act. This legislative act has provided a cloak of immunity from FDA regulatory scrutiny.

The evidence is mounting that a significant portion of our society is utilizing these products and becoming concerned about their acute and chronic hazards. We are aware that these products have significant pharmacologically active constituents and adverse effects are possible from their misuse, abuse, drug and disease interactions, idiosyncratic reactions and contamination.

At this juncture we must proceed with the premise that these products may represent a significant public health hazard and warrant oversight. As Toxicologists, we have the professional obligation to further characterize and quantify this risk through scientifically sound and defensible epidemiological and surveillance techniques. This could include Poison Control Center (PCC) case reports, summaries through the national PCC Toxic Exposure Surveillance System database, as well as encouraging the development of other more detailed and targeted active surveillance programs. As history has taught us, the truth must first be unveiled and the alert sounded to activate our system of safeguards and public trust.

Int J Med Toxicol 1998; 1(2): 11

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