Arsenic toxicity is a global health problem affecting many millions of people. Contamination is caused by arsenic from natural geological sources leaching into aquifers, contaminating drinking water and may also occur from mining and other industrial processes. Arsenic is present as a contaminant in many traditional remedies. Arsenic trioxide is now used to treat acute promyelocytic leukaemia. Absorption occurs predominantly from ingestion from the small intestine, though minimal absorption occurs from skin contact and inhalation. Arsenic exerts its toxicity by inactivating up to 200 enzymes, especially those involved in cellular energy pathways and DNA synthesis and repair. Acute arsenic poisoning is associated initially with nausea, vomiting, abdominal pain, and severe diarrhoea. Encephalopathy and peripheral neuropathy are reported. Chronic arsenic toxicity results in multisystem disease. Arsenic is a well documented human carcinogen affecting numerous organs. There are no evidence based treatment regimens to treat chronic arsenic poisoning but antioxidants have been advocated, though benefit is not proven. The focus of management is to reduce arsenic ingestion from drinking water and there is increasing emphasis on using alternative supplies of water.

https://pmj.bmj.com/content/postgradmedj/79/933/391.full.pdf

Acute and chronic arsenic toxicity

Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis...

/pdf/clinical-practice-guideline-sudden-hearing-loss-8acwe9fo8a.pdf

Clinical practice guideline: sudden hearing loss.

Objective: To investigate the use of and expenditure on 17 of the most popular forms of complementary and alternative medicine (CAM) by adult Australians, sociodemographic characteristics of CAM users, and communication between CAM users and their doctors. Methods: In May–June 2005, a sample of 1067 adults, 18 years and older, from all Australian states and territories, was recruited by random-digit telephone dialing and interviewed about their CAM use in the previous 12 months. Results: In the 12-month period, 68.9% (95% CI: 66.1%–71.7%) of those interviewed used at least one of the 17 forms of CAM and 44.1% (95% confidence interval: 41.1%–47.1%) visited a CAM practitioner. The estimated number of visits to CAM practitioners by adult Australians in the 12-month period (69.2 million) was almost identical to the estimated number of visits to medical practitioners (69.3 million). The annual “out of pocket” expenditure on CAM, nationally, was estimated as 4.13 billion Australian dollars (US $3.12 billion). L...

Complementary and Alternative Medicine Use in Australia: A National Population-Based Survey

Introduction
Herbal products have gained increasing popularity in the last decade, and are now used by approximately 20% of the population. Herbal products are complex mixtures of organic chemicals that may come from any raw or processed part of a plant, including leaves, stems, flowers, roots, and seeds. Under the current law, herbs are defined as dietary supplements, and manufacturers can therefore produce, sell, and market herbs without first demonstrating safety and efficacy, as is required for pharmaceutical drugs. Although herbs are often perceived as “natural” and therefore safe, many different side effects have been reported owing to active ingredients, contaminants, or interactions with drugs.

/pdf/herbal-medicine-in-the-united-states-review-of-efficacy-4f7fvfoqkt.pdf

Herbal Medicine in the United States: Review of Efficacy, Safety, and Regulation: Grand Rounds at University of California, San Francisco Medical Center

Goodman and Gilman's the Pharmacological Basis of Therapeutics, 8th ed

https://www.amjmed.com/article/S0002-9343(03)00799-X/pdf

Commonly used herbal medicines in the United States: a review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)12227-1.pdf

Adverse events associated with dietary supplements: an observational study

Background. Traditional Chinese medicines (TCM) are popular in the United States and Asian and non-Asian consumers are using the product for disease treatment and health prevention. As more people are using TCM products, there are increased reports on adverse reactions. This review will focus on adverse reactions due to TCM as reported in the literature. Methods. The review is based on MedLine search of literatures using keywords including: herbs, herbal, traditional Chinese medicines with toxicity, adverse effects, death, drug interaction and pharmacokinetic. In addition, specific searches were performed using the above keywords with the common name and the scientific name of the plant product. Results. The causes of adverse reactions associated with TCM are diverse. They include variability in active/toxic ingredients due to growing conditions, use of inherent toxic herbs causing toxicity, overdose of herbs, drug-herb interactions especially with pharmaceuticals that have narrow therapeutic index, coexisting diseases, and idiosyncratic reactions like allergy, hepatitis and anaphylaxis. Other adverse reactions can be due to manufacturing and quality problems causing adulteration, misidentification, substitution of one herb with another, variability in the amount of active ingredients, use of pharmaceuticals without identifying on the labels, improper processing and preparation, and contamination. Conclusions. To minimize the adverse reactions from TCM and protect the public, there must be adequate laws and regulations to ensure that products are manufactured with the highest standards. Manufacturers should be licensed by regulatory agency and manufactured under good manufacturing practice. TCM products must be evaluated for their safety before marketing. Proper labeling and good surveillance systems shall ensure the protection of the consumers.

http://health120years.com/cn/pdf/TCM_US_Adverse.Reactions.pdf

A U.S. Perspective on the Adverse Reactions from Traditional Chinese Medicines

Background
The safety and efficacy of dietary supplements is of growing concern to regulators, health-care providers and consumers. Few scientific data exist on clinical effects and potential toxicities of marketed products. Harmful supplements may not be identified for months or years with existing adverse event monitoring mechanisms. Retrospective review of poison center statistics to capture supplement-associated toxicity also has limitations.

/pdf/dietary-supplement-adverse-events-report-of-a-one-year-1uwt4q4n3p.pdf

Dietary supplement adverse events: report of a one-year poison center surveillance project.

The use of herbs for healing has been documented in the book of Pen T'sao Ching[1] as part of the Asian traditional medicine and culture since 3000 B.C. Medicinal “herbs” used in Asia include botan...

Richard Ko

Papers

Commonly used herbal medicines in the United States: a review

Adverse events associated with dietary supplements: an observational study

A U.S. Perspective on the Adverse Reactions from Traditional Chinese Medicines

Dietary supplement adverse events: report of a one-year poison center surveillance project.

Causes, epidemiology, and clinical evaluation of suspected herbal poisoning.