American College of Medical Toxicology and The American Academy of Clinical Toxicology
View all recommendations from this societyReleased March 26, 2015
Don’t perform hair or nail testing for “metal poisoning” screening in patients with nonspecific symptoms.
The proper clinical assessment for potential exposure to metals must consider the precise exposure, symptoms, signs, route of exposure and dose. Hair and nail testing are rarely required, frequently unreliable and provide limited utility after metal exposures. A patient should undergo tailored testing for a specific metal exposure based on an appropriate evaluation. Non-specific hair and nail testing for multiple metals subjects patients to potentially harmful diagnostic mislabeling and subsequent detrimental therapy.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American College of Medical Toxicology’s (ACMT’s) Board of Directors established a Choosing Wisely® work group in 2013 to develop a list of items for the Choosing Wisely® campaign. Members of the work group were chosen to represent various practice settings within the field of medical toxicology, including ambulatory, acute and population-based practice. Work group members included the President of the College, the Chair of the Practice Committee, the Chair of the Positions and Guidelines committee and other academic leaders within the medical toxicology community. All work group members also represented the American Academy of Clinical Toxicology (AACT). The first list was released by the work group in 2013 and in 2014, the work group reconvened to develop a second list of items for the campaign. A second preliminary list was disseminated to all members of ACMT and AACT for review, commentary and potential additions. Additional feedback was solicited from leaders within the field of medical toxicology. The work group reviewed all responses, and narrowed the list to the final five items based on a review of scientific evidence, relevance to the specialty and greatest opportunity to improve care, reduce cost and reduce harm to patients.The final list was approved by the ACMT Board of Directors and the AACT Board of Trustees.
The ACMT and AACT disclosure and conflict of interest policies and be found at www.acmt.net and www.clintox.org respectively.
Sources
Calabrese EJ. Hormesis is central to toxicology, pharmacology and risk assessment. Hum Exp Toxicol. 2010 Apr;29(4):249-61.
Frisch M, Schwartz BS. The pitfalls of hair analysis for toxicants in clinical practice: three case reports. Environ Health Perspect. 2002 Apr;110(4):433-6.
Seidel S, Kreutzer R, Smith D, McNeel S, Gilliss D. Assessment of commercial laboratories performing hair mineral analysis. JAMA. 2001Jan;285:67-72.
Steindel SJ, Howanitz PJ. The uncertainty of hair analysis for trace metals. JAMA. 2001 Jan 3;285(1):83-5.
