Author Interviews, Pharmacology, Toxin Research / 04.10.2017

“Pills” by Victor is licensed under CC BY Interview with: Tony Wing Lai Mak , MBChB, MBA, FRCPath, FRCPA, FHKCPath, FHKAM(Path  Hospital Authority Toxicology Reference Laboratory Princess Margaret Hospital, Hong Kong What is the background for this study? What are the main findings? Response: Proprietary Chinese medicines (pCMs) and health products are generally believed to be natural and safe. However, the safety of pCMs and health products has been compromised by the illicit practice of adulteration with undeclared drugs. Such adulteration can have serious and even fatal consequences. Previous reports of pCM and health product adulteration were mainly routine surveillance data or case reports/series with a small number of affected patients. The present study in Hong Kong, to our knowledge, is the largest case series that reports an overview of the use of various adulterated Proprietary Chinese medicine and health products and the resulting adverse effects. From 2005 to 2015, we have identified 404 cases involving the use of 487 adulterated pCMs or health products with a total of 1234 adulterants detected. The adulterants consisted of approved drugs, banned drugs, drug analogues and animal thyroid tissue. The six most common categories of adulterants detected were nonsteroidal ant-inflammatory drugs (18%), anorectics (15%), corticosteroids (14%), diuretics and laxatives (11%), oral antidiabetic agents (10%), and erectile dysfunction drugs (6%). Sibutramine, an anorectic that has been withdrawn from the market owing to its association with increased cardiovascular events and strokes, was the most common adulterant identified. A significant proportion of patients (65.1%) had adverse effects that were attributable to these illicit products, including 14 severe and two fatal cases. These illicit Proprietary Chinese medicine and health products pose severe health hazards to the public. (more…)
Author Interviews / 04.03.2016 Interview with: Amina Salamova PhD School of Public and Environmental Affairs and School of Public Health Indiana University Bloomington Bloomington, Indiana What is the background for this study? Dr. Salamova: Flame retardants are industrial chemicals that are added to a wide variety of commercial and consumer products to slow the spread of fire and delay ignition. These chemicals are used in electronics, furniture, building insulation, textiles, and many other products.  While flame retardants serves a purpose of saving lives in the case of fire, the extensive use of these chemicals has resulted in a widespread environmental contamination.  These chemicals can escape the products in which they are used by evaporation or weathering off of the product. Flame retardants have been found in indoor and outdoor air, water, soil and sediment, plants, animals and people around the world. There is some evidence that some of the chemicals are toxic. Number of toxicological reports suggest that these chemicals are toxic to our reproductive and neurological systems and that exposure to these chemicals is associated with learning disabilities, obesity, and endocrine disruption. Despite these findings there are still many unknowns about the adverse health effects of these chemicals on human health. Large and long-term biological monitoring programs are needed, in which large populations are monitored in terms of exposure to these chemicals. However, one of the difficulties in conducting long-terms biomonitoring programs is the lack of an easy, convenient, and cost-effective biological marker of exposure.  Biological marker of exposure is a measurement of a specific chemical or its metabolite in a specific tissue in the human body, which accurately reflects the level of exposure to the chemical of interest. Conventionally, most of the studies on flame retardants in human tissues have focused on measurements in milk, blood and urine. But using these tissues is either limited in terms of population, or collection – the tissues are invasive or complicated to collect. In fact these problems are often cited as common reasons for people’s refusal to participate in the study and donate tissues. This is especially significant for the most vulnerable populations, such as children, pregnant women and elderly. This is important, because it has been shown that children are at higher risk of exposure to flame retardants as concentrations found in children’s blood are higher than those found in adults. Clearly, there is a need to find a convenient noninvasive biomarker of exposure to flame retardants and that was the goal of this study. The discovery of an easily available biomarker should ease the way for further research to determine the human impact of these chemicals commonly found in the environment. Human hair and nails are good examples of noninvasive biomarkers. Compared to other tissues, these samples are easy to collect. Collection is also less expensive – anyone can do it at home. In fact, that is what we asked the participants in our study to do – they collected nails at home and mailed the samples to us. Also, these matrices are stable, so you don’t need anything special for their transport to the lab and storage. These are slowly growing tissues, thus they can provide information on both past and present exposure. In order to examine hair and nails as biomarkers of exposure to flame retardants, we collected hair, fingernail, toenails, and blood samples (simultaneously) from 50 residents of Bloomington, Indiana, mostly students. We wanted to know if we would be able to see any flame retardants in hair and nails, and if the levels in these samples would be correlated with the levels in blood.  (more…)
Author Interviews, Endocrinology, Toxin Research / 05.02.2015

Dr. Andrea Gore PhD Gustavus & Louise Pfeiffer Professor University of Texas Austin/Div of Pharmacology/ Interview with: Dr. Andrea Gore PhD Gustavus & Louise Pfeiffer Professor University of Texas Austin/Div of Pharmacology/Toxicology Editor’s Note: Dr. Gore, Editor-in-Chief of the Journal Endocrinology, has graciously answered several questions regarding the recent concerns of environmental chemicals linked to both early puberty and early menopause. Medical Research: How can chemicals found inside the home impact onset of menopause? Dr. Gore: It is important to clarify that the cause-and-effect relationship between chemicals and menopause is not established. The timing of menopause in women is due to a variety of factors including genetic traits, nutritional status, and general health or chronic disease. Some research on humans, including the recent study by Grindler et al., also suggests that environmental chemicals may contribute to the timing of earlier menopause. Animal models also suggest an advance in the timing of reproductive failure following earlier life exposures to endocrine-disrupting chemicals (EDCs). [See references below]. The question of exactly how chemicals may change the timing of menopause is therefore unresolved, but based on animal studies it is likely that the mechanisms include effects of endocrine-disrupting chemicals on the expression of genes and proteins involved in ovarian function that may lead to premature loss of follicles (eggs). Because the control of reproduction involves the brain and the pituitary gland, as well as the ovary, it is possible that endocrine-disrupting chemicals also impair how these organs regulate reproductive hormones.
  1. Gore AC, Walker DM, Zama AM, Armenti AE, Uzumcu M. Early life exposure to endocrine-disrupting chemicals causes lifelong molecular reprogramming of the hypothalamus and premature reproductive aging. Mol Endocrinol. 2011;25:2157–2168.
  2. Shi Z, Valdez KE, Ting AY, Franczak A,GumSL, Petroff BK. Ovarian endocrine disruption underlies premature reproductive senescence following environmentally relevant chronic exposure to the aryl hydrocarbon receptor agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin. Biol Reprod. 2007;76:198–202.
  3. Akkina J, Reif J, Keefe T, Bachand A. Age at natural menopause and exposure to organochlorine pesticides in Hispanic women. J Toxicol Environ Health A. 2004;67:1407–1422.
  4. Cooper GS, Savitz DA, Millikan R, Chiu Kit T. Organochlorine exposure and age at natural menopause. Epidemiology. 2002;13: 729–733.
  5. Hatch EE, Troisi R, Wise LA, et al. Age at natural menopause in women exposed to diethylstilbestrol in utero. Am J Epidemiol. 2006;164:682–688.
  6. KnoxSS, Jackson T, Javins B, Frisbee SJ, Shankar A, DucatmanAM. Implications of early menopause in women exposed to perfluorocarbons. J Clin Endocrinol Metab. 2011;96:1747–1753.
  7. Farr SL, Cai J, Savitz DA, Sandler DP, Hoppin JA, Cooper GS. Pesticide exposure and timing of menopause: the Agricultural Health Study. Am J Epidemiol. 2006;163:731–742.
Medical Research: What are the primary sources of exposure to these chemicals? Dr. Gore: Endocrine-disrupting chemicals exposures come from a variety of sources, including plastic containers (e.g. water bottles) and other products, certain foods, personal care products, pesticides, and many others. (more…)
Author Interviews, Pediatrics, Toxin Research / 11.11.2014

Marcel J Casavant MD FACEP FACMT Chief of Toxicology, Nationwide Children's Hospita Medical Director, Central Ohio Poison Center Clinical Professor, The Ohio State University Colleges of Medicine & Pharmacy Columbus OH USA Interview with: Marcel J Casavant MD FACEP FACMT Chief of Toxicology, Nationwide Children's Hospita Medical Director, Central Ohio Poison Center Clinical Professor, The Ohio State University Colleges of Medicine & Pharmacy Columbus OH USA 43205-2696 Medical Research: What is the background for this study? What are the main findings?  Dr. Casavant: Laundry detergent pods reached the US market shelves in early 2012; almost immediately parents started calling poison control centers about their children’s exposures to these products. Since then the CDC, the CPSC, the American Association of Poison Centers, and others have issued warnings about these products. Several papers and numerous abstracts have described injuries to various groups of children; we therefore chose to analyze and describe what happened to all US children with exposure to one of these products reported to a poison control center in 2012 and 2013. The main finding: these products are dangerous to children! Over those two years we found more than 17,000 young children exposed to pods, more than 6,000 seen in an emergency department, more than 700 admitted to a hospital, and among these, more than half required intensive care. Two young children died, both in 2013. Our study was published online on November 10, 2014 ( and will appear in the December 2014 print edition of Pediatrics (volume 134 number 6). (more…)
Author Interviews, Diabetes / 20.08.2013

Leonardo Trasande, MD, MPP  Departments of Pediatrics, Environmental Medicine,  Population Health, and  Medicine, School of Medicine, and  Wagner School of Public Service, and  Steinhardt School of Culture, Education, and Human Development, Department of Nutrition Interview with Leonardo Trasande, MD, MPP Departments of Pediatrics, Environmental Medicine,  Population Health, and  Medicine, School of Medicine, and  Wagner School of Public Service, and  Steinhardt School of Culture, Education, and Human Development, Department of Nutrition What are the main findings of the study? Answer: We detect associations of urinary phthalate metabolites in a cross-sectional study of US adolescents.  The association is highly robust to multiple sensitivity analyses, and specific to phthalates commonly found in food.  Further, longitudinal study of dietary phthalate exposures is needed. (more…)