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American College of Medical Toxicology Winter 2009 Newsletter |
ACMT members please share with us any news of yourself or ACMT colleagues. We would like to hear about awards, grants, collaborations, moves, promotions, interviews, media interactions, invited national or international presentations or any other accomplishments for incorporation into our quarterly newsletter. Send information to us at newsletter@acmt.net.
Thank you - The Editors
Josef G. Thundiyil
Craig Smollin |
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New and Noteworthy!
Rama Rao, a medical toxicologist at Weill Cornell Medical College in New York, has been named by the American Board of Emergency Medicine to the Medical Toxicology Subboard. She begins her first three year term in December 2009.
Alex Manini, a recent graduate of the NYU Medical Toxicology Fellowship program and now an Assistant Professor of Emergency Medicine at Mt. Sinai School of Medicine received a K23 grant from the NIH's National Institute on Drug Abuse. The grant, entitled "Predicting adverse cardiovascular events in emergencies due to drug overdose," is a mentored patient-oriented research career development award to assist Dr. Manini to become an independent research scientist to study drug overdose.
Edward W Boyer, associate professor of emergency medicine at the University of Massachusetts Medical School, has received a $1 million NIH Challenge grant awarded under a RC1 mechanism. Dr. Boyer teamed with scientists at MIT's Media Lab to develop a novel technology that combines continuous physiology sensing, wireless connectivity, and artificial intelligence. Ultimately, Dr. Boyer and his team intend to identify behavioral states such as drug craving in real time and to deliver drug prevention messages at the moment of greatest need. This Challenge grant is one of three awarded to emergency physicians, and one of 200 awarded nationwide.
Congratulations to Ann Jeannette Geib – her platform presentation on “Case Series of Intravenous Lipid Emulsion Rescue for Drug Cardiotoxicity" was selected as the winner of the AAPCC Best Platform for NACCT 2009!
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President's Column
 | Transitioning An Award . . . A New ACMT Tradition
Erica L. Liebelt, MD, FACMT
President, American College of Medical Toxicology |
The American College of Medical Toxicology has been honoring distinguished medical toxicologists for the past 12 years with the Matthew J. Ellenhorn Award. Dr. Ellenhorn had a distinguished career as an educator and clinician and was the principal author/editor of one of the first comprehensive textbooks on Medical Toxicology. After his death in 1996, the ACMT Board of Directors established this award in his honor. Distinguished recipients of this award have included:
- 1997: Helmut Redetski, MD
- 1998: Lewis Goldfrank, MD
- 1999: William Robertson, MD
- 2000: Frederick Lovejoy, MD
- 2001: Barry Rumack, MD
- 2002: Howard Mofenson, MD
- 2003: Carol Angle, MD
- 2004: Richard Dart, MD
- 2005: Anthony Temple, MD
- 2006: Charles Becker, MD
- 2007: Steven Curry, MD
- 2008: Ward Donovan, MD
- 2009: Steven Marcus, MD
This award/lecture was initially endowed with a generous gift of $10,000 by Mrs. Matthew Ellenhorn in 1997. Unfortunately, this money has been exhausted.
Why are awards given? They are given to recognize contributions, achievements, and successes of people, to bestow merit to someone. Awards should not be about winning or losing or certainly not about being the “best,” as this concept is quite subjective. Many times awards are developed to honor people and their achievements after their death, as was the case with the Ellenhorn Award. Furthermore, there are numerous medical toxicologists, both alive and some who have already passed on, for which it would be most appropriate to name an award to recognize their achievements.
After extensive discussion, the ACMT Board of Directors decided to transition the Ellenhorn Award and start a new tradition – the Paracelsus Award for a Distinguished Career in Medical Toxicology. This award will be given to one of our colleagues who has had a notable and illustrious career in the field of medical toxicology and helped to promote the advancement of our subspecialty. Paracelsus was a unique physician in the history of medicine. He is sometimes credited as “the father of toxicology” and insightfully wrote:
“What is there that is not poison? All things are poison and nothing (is) without poison. Solely the dose determines that a thing is not a poison.”
Certainly, this concept embraces the tenet of medical toxicology and can be extrapolated directly to one of the missions of our College — advancing quality care of poisoned patients. Transitioning this current award to another “named award” in honor of a unique physician who helped to promote the beginning of our subspecialty over 400 years ago has been given much thought. We will continue to honor medical toxicologists like Matthew Ellenhorn and all of the previous and future awardees with this new award designation.
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ACMT 2009
A Year of Growth and Accomplishments
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Membership
ACMT is proud to have over 500 members: 343 full members, 116 Associate Members, 39 International Members, and 16 emeritus members. Become a member and register today!
Educational Accomplishments
7th Annual ACMT Spring Conference: Neurotoxicology Update, in Puerto Rico March 2009 was our most popular Spring Conference to date. This conference featured international speakers Drs. Herbert Schaumburg and Thomas Clarkson. We also paid tribute to the 4th President of ACMT, Dr. Michael Shannon.
ACMT inaugurated the LLSA Review (Lifelong Learning and Self-Assessment Reviews) at our 2009 Spring conference to provide a forum for medical toxicologists enrolled in the Medical Toxicology Maintenance of Certification Program.
ACMT contributes 7 educational/scientific programs to the North American Congress of Clinical Toxicology (NACCT) in San Antonio September 2009 in addition to the full day Premeeting Symposium and the very popular CPC competition.
Under a cooperative agreement with the Agency for Toxic substances and Disease Registry (ATSDR) ACMT has been putting on a series of courses on the medical effects of clandestine methamphetamine laboratories. In 2009, we provided 3 courses to public health personnel, first responders, nurses, and physicians in the Los Angeles area and a tribal course in Fallon, Nevada. Jeffrey Brent, Cyrus Rangan, Paul Wax, as well as a non-ACMT toxicologist Robert Palmer all participated.
ACMT’s 1st Forensic Scientific Symposium was delivered in November in collaboration with the Society of Forensic Toxicology (SOFT). This meeting was a huge success and had over 100 registrants – one came from Hawaii just for the conference! Dr. Marilyn Heustis, internationally known for her research on marijuana, was our featured speaker.
Medical Toxicology Foundation
The Medical Toxicology Foundation (MTF) was officially approved by the IRS as a 501c3 organization in September 2009. The goals of the MTF are to promote the practice, education and research of medical toxicology and increase public awareness thereof. The MTF hopes to raise funds to enhance such efforts by providing grants, scholarships, and other funding consistent with the purpose of the Foundation.
Expertise In Medical Toxicology
Representation at the National Level
Jeffrey Brent, a long time ACMT member and current member of the College's Board of Directors, is a consultant to the US Government on vaccine safety. He recently provided the scientific testimony on the lack of the relationship between thimerosal exposure and autism on behalf of the government
ACMT members were a focus of a recent FDA advisory committee regarding acetaminophen hepatotoxicity. Lewis Nelson, Vice-President of ACMT, chaired the committee, and was joined by ACMT members Neal Benowitz, Paul Dargan, and Ed Kuffner.
ACMT was well represented at the 2009 National Environmental Public Health Conference in Atlanta GA in November by Michael Kosenett, Charles McKay and Paul Wax. |
The 2009 Ellenhorn Lecture
Dr. Steven M Marcus
I stand here honored and humble to have been chosen for this honor. For many reasons I really never thought that I would receive such an honor. In fact, when I was called by Keith informing me of the fact that the college wanted to honor me, my first reaction was, “you have to be kidding.” I never thought that anything I have ever done represented anything particularly innovative, that what I have done all of my life was to simply apply other peoples’ innovations. When I first arrived in New Jersey, I was considered innovative, by simply practicing what I had learned through my experience in my residency and in the Navy. My second reaction was that I had not been totally happy with the organization or the direction the discipline had been going over the past decade and really did not think that I could accept it. I remembered the comment by Groucho Marx, one of my childhood heroes, that I would not want to join a club which would have me. At Keith’s urging, I agreed to discuss it with others and call him back. Among those I called, it turned out, was one of the individuals who, unknown to me at the time of my call, had nominated me for the award. He stated that of everyone he knew in the medical toxicology movement, I was the modern Matthew Ellenhorn. He told me that he felt my style, my actions all represented what Matt Ellenhorn lived. This started some intensive introspection. At some age, and obviously I reached it, one does begin looking back on where you came from, what you have done in your personal and professional life and what you would like to still accomplish. This past year has been very stressful in that I was forced to come to grips with my own mortality by experiencing the sudden death of individuals, friends and acquaintances I knew, often younger then I, and who appeared, obviously only on the surface, more vital then myself. I guess all of us were affected in some way from the death of our colleague Michael Shannon.
To read the rest of the speech, please click here (.pdf link) |
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International Representation
ACMT members have participated in educational programs around the world in 2009 to advance the education, research, and practice of our medical toxicology. - Dubai International Emergency and Catastrophe Management conference April 2009 (Ziad Kazzi and Nadeem Al-Duaij)
- 7th Congress of Toxicology in Developing Countries – Toxicology Society of South Africa September 2009 (Jeffrey Brent and RJ Hoffman)
- Asian Pacific Association of Medical Toxicology (APAMT) October 2009 (RJ Hoffman, Rais Vohra and Paul Dargan)
- XVI Brazilian Congress of Toxicology in Belo Horizonte, Brazil October 2009 (Carlos Fernando [organizer], Cynthia Aaron, Javier Waksman, Lewis Nelson, Paul Wax)
Collaboration With Federal Agencies
ACMT’s course: Chemical Agents of Opportunity for Terrorism - The Medical and Psychological Consequences of TICs (Toxic Industrial Chemicals) and TIMs (Toxic Industrial Materials) is officially approved by the Department of Human Services (DHS). This course, first developed in 2003, has trained over 6000 personnel.
September 2009, ACMT was informed that we have won a new 5 year Cooperative Agreement with ATSDR / CDC for the National Environmental Medicine Education and Consultation Project (NEMECP). A hearty congratulation is extended to former ACMT President Michael Kosnett who has now for the 3rd time engineered a successful 5 year cooperative agreement application for funding to CDC. Bravo!
Research
ACMT launched the first ever Toxicology Investigators’ Consortium (ToxIC) in 2009. ToxIC is a coalition designed to promote multi-center research in Medical Toxicology. The intent is to increase the strength of toxicologic research through numbers. Ann-Jeannette Geib presented the first collaborative project of ACMT’s ToxIC: “Case Series of Intravenous Lipid Emulsion Rescue for Drug Cardiotoxicity” and was awarded the AAPCC Award for Best Platform Scientific Presentation. |
Publications
In June, ACMT announced that Springer Publishing will assume the publishing of our Journal of Medical Toxicology in 2010. This internationally-recognized publishing company will help to attract and disseminate quality content for our journal.
Recognition and Awards
ACMT was proud to recognize the following people in 2009
- Michael Spadafora Travel Scholarship: Fiona Garlich, Emergency Medicine resident from Hennepin County Medical Center Minneapolis, MN
- ACMT Award for Outstanding Contributions to Education: Kevin Osterhoudt
- ACMT Award for Outstanding Service to the College: Paul Wax
- Matthew J. Ellenhorn Award: Steven Marcus (link)
- McNeil Award for Research in Acetaminophen-Related Research: Stephanie Hernandez
Medical Toxicology Fellows-In-Training (MTFITA)
ACMT is proud to have an active and enthusiastic fellows-in-training section. We have accomplished numerous activities for the FITs both at the fall NACCT meeting and at our own Spring Conference. These activities include: research presentations, roundtable discussions and open microphone sessions, and the Fellows-in-Training luncheon. They are a very active group within ACMT and our goal is to continue to foster the growth and professional development of “our future.” |
The Toxicology Investigators Consortium – The First Year
Jeffrey Brent, MD PhD FACMT
As many of you know, ACMT has developed a research network known as the Toxicology Investigators Consortium (ToxIC). This group is composed of 63 sites around the country with active medical toxicology practices caring for patients at the bedside or in the clinic. The purpose of ToxIC is to use this large aggregation of investigators for multi-center studies. We are off to a great start and expect ToxIC to grow considerably over the next several years.
We are very proud that we have already completed one study which has received considerable recognition. This was the largest retrospective case series on the use of intravenous lipid emulsion therapy for the treatment of poisoned patients published to date. The lead investigator for that study was Ann-Jeanette Geib, who along with her co-investigators, Alex Manini and Erica Liebelt, has received the American Association of Poison Control Centers award for the best paper at the North American Congress of Clinical Toxicology in San Antonio.
Currently, there is a study being initiated on the interpretation of pre-four hour acetaminophen concentrations. The principal investigator at that study is David Tanen. A prospective data collection on cases of intravenous lipid emulsion is also about to be launched.
ToxIC is open to all members of the College who provide direct patient care either at the bedside or in an outpatient clinic. This network provides a unique opportunity to do the kinds of multi-center studies that had been talked about for so long, but rarely done, in our field. All toxIC investigators are invited to submit studies and will serve as the principal investigator on their studies.
In conjunction with the College’s Research Committee, headed by Dan Rusyniak, we are offering research consultations for those investigators desiring assistance with either the design of a study or writing grant proposals. Dan is also taking the lead in overseeing the research component of ToxIC.
An endeavor as complex as ToxIC requires operating policies and structure. I am happy to report that Steven Bird has assumed the role of Director of infrastructure for ToxIC. Steve will be recruiting members to assist with the development of policies, procedures, and guidelines; identifying grant opportunities; and working with Paul Wax and the ACMT administration on a web platform and enhanced methods of communication between ToxIC investigators.
For all of you who were at the ToxIC meeting in San Antonio, you may recall that there was considerable sentiment among members for a user friendly case registry. To that end, Curt Kleinschmidt is assembling a committee tasked with developing such a registry which will be available to all ToxIC members who wish to use it. Clearly this kind of registry will be extremely helpful in the generation of retrospective and hypothesis-generating studies.
There are many terrific benefits to being a member of ToxIC. The Consortium provides each investigator with a very powerful tool to do multi-center studies and to serve as Principal Investigators on grants for these kinds of studies. Funding, however, is not a requirement for submitting a study to ToxIC. For those investigators early in their academic career, ToxIC provides a means of doing high quality and important studies. These may serve to not only advance careers but, more importantly, provide a real benefit to our patients.
As many of you know, the current organization of funded medical research in the U.S. is dominated by the National Institutes of Health (NIH). NIH, however, is not structurally oriented towards many of the kinds of problems that we face as medical toxicologists. We believe that ToxIC will help to fill this gap and be a mechanism whereby patient care will be significantly improved.
Remember that the deadline for submission of Abstracts to NACCT in Denver is coming up quickly. It is not too late to do a study that could be presented at that meeting. The case series on lipid emulsion therapy described above was conceived of a mere two months before the deadline for abstracts for the San Antonio meeting. It is also time to start thinking about studies that you may want to present at NACCT in 2011.
If you have any questions, or want to discuss any aspects of ToxIC network with me, please do not hesitate to either call me at 303.765.3800 or e-mail me.
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| Medical Toxicology Foundation |
Medical Toxicology Institute |
The Medical Toxicology Foundation Begins its Work
by Paul Wax
With the recent IRS approval of the Medical Toxicology Foundation as a 501(c)3 non-profit charitable corporation, the work has now begun to establish the Foundation’s first priorities and craft a promising fund-raising strategy. Known also by its acronym MTF, the mission of the Foundation is to support education, research and public awareness in medical toxicology. ACMT is also organized as a non-profit corporation but like many member-focused medical societies, ACMT has a 501(c)6 IRS designation that allows for lobbying but is unable to accept charitable contributions. The ACMT Board of Directors had first discussed the establishment of a foundation in the late 1990s. In recent years it became increasingly evident that the establishment of a Foundation would offer the flexibility to raise money to support the future of medical toxicology. The IRS approval was the culmination of a multi-year organizational effort to get the MTF off the ground.
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Over the next few months the MTF will be rolling out a variety of program and fund-raising initiatives. The MTF will partner with ACMT to produce new educational programs and enhance existing programs. As a public charity, the MTF will also focus on public awareness of medical toxicology. Ultimately it is improving the care of poisoned patients, and primary prevention that remain the core mission of medical toxicologists. Please stay tuned to this newsletter and other announcements regarding updates on the Medical Toxicology Foundation. Further information can also be found at the MTF website or by emailing the foundation.
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Introducing the Medical Toxicology Institute (MTI)
by Paul Wax
Two years ago the ACMT Board of Directors endorsed the concept of establishing the Medical Toxicology Institute. The Medical Toxicology Institute is conceptualized as an umbrella organization designed to ensure life long learning educational opportunities and career growth for medical toxicologists employing a variety of educational approaches. The goal of the Institute is to develop a series of program comparable to a adult education college or university where students (ie ACMT members) will have access to a variety of educational offerings that may enhance and add to their skill set and expertise throughout their careers once they have completed their formal fellowship training. The Institute will employ innovative teaching techniques utilizing one-on-one mentoring and on-line learning as well as more traditional symposia and courses. The Medical Toxicology Institute hopes to target specific skills reflecting the heterogeneity of medical toxicology that may advance member career's both academically and in the practice arena. For more information please on the Medical Toxicology Institute see this site.
The inaugural program of the Medical Toxicology Institute is the Mentorship Program. This program is under the direction of ACMT members Ann-Jeanette Geib and Trevonne Thompson. The Mentorship Program is an informal professional mentoring program open to medical toxicologists at all career stages. The mentorship program is targeting mentees who are early career and mid-career medical toxicologists as well as fellows-in-training who wish to expand and refine their skill set in medical toxicology. This program brings together medical toxicology mentors and mentees for one-on-one apprenticeship opportunities that will provide hands on practical training for skill development and refinement that will enhance their career development. Mentorship has long been known to increase career satisfaction and advancement between both parties involved. The program is now recruiting eager, pioneering members to serve as mentors and mentees in the Mentorship Program. Please click here for further details or contact the program directors. |
 | Greetings from the Medical Toxicology Fellows-In-Training Association (MTFITA)
Chris Rosenbaum, MD
President, MTFITA |
MTFITA is off to a busy start this year, supporting the fellows-in-training via our website and other efforts. At the recent San Antonio meeting, ACMT and MTFITA hosted a fellows-in-training luncheon & lecture on the Sir Bradford Hill Criteria. Afterward, Jeff Brent moderated a panel discussion on possible career paths in research outside of clinical toxicology. Over 40 fellows-in-training from numerous programs around the country attended these events, as well as a social hour at a local restaurant. During these activities, we uncovered important issues to fellows-in-training that may be of interest to you as an ACMT member.
First, NACCT is scheduled relatively soon after the beginning of fellowship in July. Making sense of the many meetings and organizations (AACT, ACMT, AAPCC, EAPCCT, NACCT, and the Spring Conference) in time to prepare submissions for NACCT can be difficult -- especially for junior fellows-in-training. It would be helpful to receive a brief introduction and historical perspective on each of the organizations and conferences at the beginning of fellowship, so as to maximize the opportunities for junior fellows-in-training to contribute.
Also, you will not be surprised to know that the fellows-in-training are apprehensive about their eventual board examination. Aware of the formally published core content of medical toxicology, they ask: “what formal preparation is available” and “what are other fellowship programs doing to prepare for the exam?” In addition to the formal preparatory course and the potential upcoming in-service examination, the fellows-in-training want more preparatory materials.
Lastly, multiple fellows-in-training have asked about study syllabi at different fellowship programs. Everyone recognizes the great variability (as a positive attribute) in fellowship experiences, and some fellows-in-training have asked if there is any way to make the learning experience more uniform. It is my impression that this concern stems less from a belief that individual fellowship-specific educations are suboptimal, and more from a concern about board-exam preparedness.
As we continue to address these and other issues, MTFITA would like to bring together as many fellows-in-training as possible at the upcoming Arizona spring conference for another social gathering. Plans are not final, so please email me with any suggestions.
I hope these topics spark productive conversation between you and the fellows-in-training. At the spring conference, please support the fellows-in-training research forum, poster presentations (for research you may have missed), and open-mic. These activities give the fellows-in-training an invaluable opportunity to present in front of experts and future colleagues.
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| Spring Course 2010 |
Special Poster Session |
The 8th Annual ACMT Spring Conference
Mother Natures' Gift to Toxicologists (pdf)
Exploring the Animal, Botanical & Mineral Toxic World
March 12-14, 2009
Hyatt Regency Resort and Spa, Gainey Ranch, Scottsdale AZ
Day 1 - "Killer Weed" - The Ethnobotany of Toxicology
Keynote: The Ethnobotany of Plants
Walter and Memory Lewis, PhD
Day 2 - "ToxoKnowledgy" - Animal Envenomations
Keynote: The Pathophysiology of Rattlesnake Venom
Steve Curry, MD FACMT
Day 3 - "ToxRocks" - Mining and Metallurgy
Keynote: Eronite, Asbestos and Mesothelioma
Nicholas J. Vogelzang, MD
Hightlights include:
- Fellow-In-Training Research and Open Mike Presentations
- Professional Development Symposia
- Special Session - Research You May Have Missed Elsewhere
- A visual, auditory and tactile stimulus room
- Guided trips to the Botanical Gardens, the Arizona Zoo and more!
- And plenty of time to enjoy the sun . . .
Be sure to go to the ACMT Website to register now.
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Research You May Have Missed at Other Meetings
For work so nice it's presented twice
2010 ACMT Spring Conference Special Poster Session
Saturday March 13, 2010
Daniel Rusyniak, Chair, ACMT Research Committee
As medical toxicology spans the breadth of medicine, some of the most significant research done in our field is presented at meetings not commonly attended by medical toxicologists. In an attempt to provide ACMT Spring Conference attendees an opportunity to interact with cutting edge medical toxicology research, future spring conferences starting with 2010 will include a Scientific Poster Session for Research You May Have Missed at Other Meetings.
Criteria for accepted posters included the following:
- The material must have been previously presented.
- The material must be relevant to the field of medical toxicology.
- Case reports will not be accepted.
- The lead investigator or a co-investigator must attend the meeting to present their work in person.
For further questions or inquires please contact:
Daniel Rusyniak, MD
Chair, ACMT Research Committee
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ACMT's 1st Forensic Toxicology Course In association with The Society of Forensic Toxicologists (SOFT)
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ACMT recently organized its first forensic course on ethanol and marijuana in Baltimore, MD on November 18-19, 2009. Held at the Sheraton Inner Harbor Hotel, the meeting room was packed as 122 registrants and faculty heard over 20 hours of lectures. Over 50 ACMT members and 40 forensic and analytical toxicologists attended the course, which was co-sponsored by the Society of Forensic Toxicologists. Unlike most ACMT organized courses in the past, the faculty consisted of mainly non-ACMT member PhD forensic toxicologists, many who are world renown, including SOFT Past-Presidents Dr. Marilyn Huestis and Dr. Michael Smith.
Focusing in on only two topics, ethanol and marijuana, allowed a much more intensive exploration of these topics than is usually offered in a more survey oriented course. The workshops allowed for lively discussion and much needed practice on calculations both for ethanol extrapolations as well as state of the art techniques to evaluation marijuana impairment.
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Day 1 provided an in-depth exploration of the forensic aspects of ethanol. Barry Levine, PhD from the Office of the Chief Medical Examiner, Baltimore, Maryland spoke on The Role of the Toxicologist in the Post-Mortem Exam, and Interpretation of Ethanol Results including Post-Mortem Generation. Barry Logan, PhD, DABFT, Director of Toxicological & Forensic Services from NMS Labs, Willow Grove, PA spoke on the Pharmacology and Chemistry of Ethanol, the Pharmacokinetics of Ethanol, and Analysis of Alcohol in Blood and Breath. Robert Forney Jr, PhD - Chief, Forensic Toxicologist, Lucas County Coroner’s Office Toledo, Ohio spoke on Impairment by Ethanol - the Experimental and Epidemiological Evidence, and Retrograde Extrapolation and other Ethanol Calculations. Gary Kay, PhD - Associate Professor, Dept. of Neurology, Georgetown University School of Medicine discussed Methods & Findings: Impairment of Driving Related Abilities by Alcohol. Dr. Forney joined ACMT’s own Charles McKay, MD, FACMT to speak about What Are We Asking of Observers - Dram Shop Issues. These lectures were followed by small break out sessions including one session chaired by one of the deans of forensic toxicology, Yale Copeland, PhD. Finally the first day was concluded with a lecture from a DWI defense attorney about Legal Perspectives.
The second day began with a talk by First Sergeant Tom Woodward of the Maryland State DRE (Drug Recognition Expert) Program Coordinator on Law Enforcement Tools for Detecting Drug and Alcohol Impairment. The remainder of the day focused exclusively on marijuana forensic issues. While marijuana is rarely an issue of significant clinical concern about its acute toxicity, the forensic issues are quite complex and is the subject of much new research.
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Fortunately, ACMT had Marilyn A. Huestis, PhD - Chief, Chemistry and Drug Metabolism, National Institute on Drug Abuse, NIH, and Michael L. Smith, PhD, DABFT - Division of Forensic Toxicology, Armed Forces Institute of Pathology both organize and teach this part of the course. Dr. Huestis spoke on the Cannabinoids - Neurobiology, Pharmacology and Pharmacokinetics Following Acute and Chronic Exposure and Dr. Smith spoke on Predictive Models for Estimating Time of Last Cannabinoid Use - Blood and Urine. Finally ACMTs own Jeffrey Brent, MD, PhD, FACMT, Michael Kosnett, MD, MPH, FACMT, and Charles McKay, MD, FACMT moderated a lively lunchtime roundtable discussion on The Integration of Forensics into the Practice of Medical Toxicology.
Feedback from the course was quite instructive and included “Do it again, different location.” In fact ACMT is planning to do just that and will be organizing another course on Ethanol and Marijuana to be held on the West Coast in 2010. Organizing is also well underway for ACMT’s 2nd Forensic Course, also to be held in 2010, that will provide an in-depth exploration of the forensic issues of opioid use both prescription and non-prescription. Announcements regarding the dates and locations of these courses will be forthcoming. We will be using the input from our members to help direct the content of these courses, so please make your thoughts known to Chuck McKay, Lewis Nelson, or Paul Wax.
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| Journal of Medical Toxicology |
The Government and Toxicology |
Exploring the Journal of Medical Toxicology
by Craig Smollin
Does QT prolongation in the setting of acute organophosphate poisoning have prognostic value?
In the December edition of the Journal of Medical Toxicology, Shadnia et. al. explore whether QTC prolongation might predict a more severe prognosis in acute organophosphate poisoning (OPP). The investigators conducted a prospective case-control study of patients admitted to their institution over the course of one year. They measured the QTC of all study participants and defined QTC prolongation as greater than 440 msec. The study found that patients with prolonged QTC had lower cholinesterase levels, higher atropine requirements, longer hospitalizations, and a higher mortality rate, compared to those with normal QTC. The authors suggest that QTC interval prolongation may have prognostic value in OPP, and may predict a subset of patients requiring more aggressive therapy.
See the article here.
Also, follow What's Coming to JMT at the editor's blog.
Read the Press Release regarding the transition of the journal to its new publisher.
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Drug Safety
FDA has begun efforts to enhance postmarket safety, but additional actions are neeed
The U.S. Government Accountability Office (GAO) report highlights the successes and limitations of postmarketing surveillance and the future needs of the FDA Office of Surveillance and Epidemiology to improve upon medication safety. Click here to read more.
Human Exposure to Environmental Chemicals
The CDC released the most comprehensive assessment to date of the exposure of the U.S. population to chemicals in our environment. CDC has measured 212 chemicals in people's blood or urine — 75 of which have never before been measured in the U.S. population. The new chemicals include acrylamide, arsenic, environmental phenols, including bisphenol A and triclosan, and perchlorate. Click here to read more.
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| Healthy People 2009 |
Stories You May Have Missed |
Healthy People in a Healthy Environment
ACMT was well represented at the recent 2009 National Environmental Public Health Conference in Atlanta GA held from October 26-28. 2009. Michael Kosnett, MD, MPH, FACMT, Charles McKay, MD, FACMT and Paul Wax, MD, FACMT traveled to the conference as part of ACMT’s new Cooperative agreement with NCEH/ATSDR. The new CDC Director Thomas Frieden, MD, MPH introduced the conference by outlining five new priorities for CDC including:
- Enhancing surveillance and epidemiology
- Strengthening local and state support functions at CDCStrengthening public health institutions across the globe
- Increasing the impact of health policies
- Addressing the leading causes of disabilities, diseases and death
Of interest, bioterrorism is not on this priority list. Following the introductory remarks, a brilliant and thought provoking plenary was given by Amory Lovins, Chairman, Chief Scientist and Co-Founder, Rocky Mountain Institute about freeing the global economy of its dependence on fossil fuels.
The 3 day meeting was attending by over 1000 involved in the field of environmental public health including physicians, scientists, analysts, geologists and other public health personnel. ACMT presented a roundtable discussion on “Planning a Nation-wide Toxicology Registry: ACMT’s Toxicology Investigators Consortium (ToxIC).” Drs. Kosnett, McKay and Wax were also able to meet with the ATSDR Regional Representatives to discuss upcoming plans for consultation, education and support during this Year 1 of our new Cooperative Agreement. Dr. Eric Lavonas participated in CDC presentations on preventing and identifying carbon monoxide exposures. Dr. McKay was also able to attend some of the presentations at the Pediatric Environmental Health Specialty Units’ (PEHSU) follow-up meeting, at which Drs. Jennifer Lowry, Alan Woolf, and Rob Geller presented on behalf of their PEHSU involvement. Drs. McKay and Kosnett also attended the national biomonitoring planning sessions held by the Association of Public Health Laboratories. All of these activities intersect with the medical practice of toxicology as it relates to potential environmental exposures and prioritizing response. To become involved in ACMT’s ATSDR agreement please contact Chuck McKay, ACMT’s National ACMT-ATSDR Network Coordinator.
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Explore how the media covers stories with a toxicology bent. Check out these recently published stories. If you find anything of interest, please forward them to the newsletter editors. Don't forget to check out the automatically updating Toxicology in the News on the website.
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 | ACMT and International Toxicology
An update on ACMT's Global Initiatives
Robert J. Hoffman, MD and Paul M. Wax, MD |
ACMT Symposium in Africa
The ACMT International Committee co-sponsored a half-day medical toxicology symposium at the 7th Congress of Toxicology in Developing Countries in Sun City, South Africa in September 2009. This ACMT-sponsored session was the only clinical toxicology session in the entire conference and was the first time a session dedicated to medical toxicology has been offered. This was highlighted by medical toxicologists in attendance, by whom we were warmly received.
Given that it was the very last set of lectures on the last day of the conference it was well attended, with approximately 2 dozen attendees from many countries. The lectures presented were Robert J. Hoffman "General Approach to the Poisoned Patient" and Jeff Brent "Is Paraquat Exposure a Risk Factor for Developing Parkinson's Disease?". The audience was interactive and readily asked questions. In particular there were many questions related to GI decontamination and basic management that highlight the various states and stages of development that medical toxicology is at in these various locations. Based on the questions it is very obvious that the routine care of the poisoned patient varies tremendously amongst the geographic locales of the attendees, which was predominantly Africa and the Middle East.
Several ACMT members also gave invited presentations at the Asia-Pacific Association of Medical Toxicology in Beijing. Invited ACMT speakers and their talks included Rais Vohra "US Poison Control Centers: Where are we going?", Robert J Hoffman "Update on Pediatric Toxicology", Tom Martin "Toxic Caustic Injuries", and Chris Holstege "Drug-facilitated Sexual Assault".
ACMT Delegation Attend XVI Brazilian Congress of Toxicology
Four members of ACMT recently attended the XVI Brazilian Congress of Toxicology from October 10 to 14, 2009 in Belo Horizonte, Brazil. Located in the southeastern region of Brazil Belo Horizonte is the capital of the Brazilian state of Minas Gerais and is the 3rd largest metropolitan area with a population of 5.4 million. The central theme of the Congress was “The Multidisciplinarity of Toxicology in the Life Protection.” The Congress attracted over 1000 Brazilian toxicologists from the fields of clinical toxicology, analytical toxicology, forensic toxicology and regulatory toxicology. Faculty included over 25 international authorities from around the world.
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Special thanks to ACMT International Member Carlos Fernando from Sao Paulo Brazil for organizing several of the scientific sessions and hosting the American clinical delegation. ACMT members Cynthia Aaron, Javier Waksman, Lewis Nelson and Paul Wax delivered lectures on organophosphate poisoning, TCA toxicity, evidence based toxicology and arsenic neuropathy. Of interest to the American medical toxicologists, medical toxicology is not yet an “officially” recognized specialty in Brazil. The primary specialties of the physicians who care for poisoned patients include pediatrics, internal medicine or allergy/immunology. At the present time, there is a burning desire amongst those who care for poisoned patients to see that Brazilian medical authorities recognize medical toxicology as an official specialty. Several of ACMT contingent had the opportunity to visit the toxicology services at one of the major public hospitals in Belo Horizonte, the Hospital Joao XXIII. The Toxicology Director at this hospital, Dr. Delio Campolina was also the Congress Organizer. The visit to the hospital was a definite highlight of the Brazilian visit. Over the last 10 years, the census of the toxicology services has averaged about 5000 patients per year. Patients who ingest caustics or organophosphates, or suffer from the effects of scorpion stings are admitted on an almost daily basis to this toxicology service. Despite the lack of recognition of toxicology as a specialty, 17 physicians rotate on the toxicology services – 2 physicians are on call at any one time. The toxicology services also staffs a telephone consult service; this accounts for an additional 1500 consults per year. Thanks to this conference, ACMT had developed important connections with our Brazilian toxicology colleagues. Hopefully in the years ahead we will continue to build bridges to these and other toxicology colleagues from around the world.
Upcoming international courses in medical toxicology
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ACMT Newsletter Photo Caption Contest!
Welcome to the ACMT newsletter contest. No cost to enter! Submit as many times as you want! Win acclaim and prizes!
Rules for caption contest . . . - Email a caption for the picture (to the left) to web@acmt.net
- Do this before February 15th, 2010
- Repeat, as necessary
The winner will be published in the next edition of the newsletter, Spring 2010.
 | Congratulations to our winner . . . Kevin Kent, for his caption "Smoke Chrysiasis Lights" |
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