Toxicology Societies Release List of Commonly Used Tests and Treatments to Question As Part of Choosing Wisely® Campaign

The American College of Medical Toxicology and the American Academy of Clinical Toxicology encourage physician and patient conversations about evidence-based medicine by identifying five treatments or tests to question.

The American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) jointly released their second list of five specific treatments, tests and procedures that are commonly used, rarely necessary, and potentially harmful as part of the Choosing Wisely campaign, an initiative of the ABIM Foundation. This list builds on the initial five areas of overuse published jointly by the organizations in September 2013. The new list published today identifies five additional targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.

The joint ACMT and AACT list identified the following five recommendations:

  1. Don’t use phenytoin or fosphenytoin to treat seizures caused by drug toxicity or drug withdrawal.
  2. Don’t recommend “detoxification” through colon cleansing or promoting sweating for disease treatment or prevention.
  3. Don’t order tests to evaluate for or diagnose “idiopathic environmental intolerances,” “electromagnetic hypersensitivity” or “mold toxicosis.”
  4. Don’t perform hair or nail testing for “metal poisoning” screening in patients with nonspecific symptoms.
  5. Don’t perform fasciotomy in patients with snake envenomation absent direct measurement of elevated intracompartmental pressures.

According to Leslie Dye, MD, President of ACMT, “As a professional, nonprofit association of physicians with expertise in medical toxicology, we recognize the importance of the education of health care providers and patients in making responsible decisions. Use of healthcare resources is most effective and efficient when recommendations are made based on solid research and evidence based knowledge.” Karen Simone, PharmD, President of AACT adds, “As a not-for-profit multi-disciplinary organization of scientists and clinical toxicologists, the American Academy of Clinical Toxicology recognizes the need for guidance in the responsible and appropriate use of diagnostic tests, as well as in the management of pharmaceutical and environmental poisonings and exposures.  Such guidelines improve patient care, save money and help healthcare providers, patients and families focus on the most beneficial and cost-effective tests, diagnoses and therapies.”

The ACMT and AACT joint list was developed after careful consideration and review of the most current evidence about diagnosis, management, and treatment options in toxicology care. List development was led by a Choosing Wisely® Work Group, with members representing various practice settings within the field of Medical and Clinical Toxicology, including ambulatory, acute, and population-based practice. The Work Group solicited input from members of both societies, as well as from leaders within the field. All feedback was reviewed and the final list determined based on a review of scientific evidence, relevance to the specialty, and the 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 release of this list kicks off the American College of Medical Toxicology Annual Scientific Meeting, where specialists in clinical toxicology and poisoning treatment will gather to review the latest scientific research and developments in diagnosis, treatment, and prevention of human poisoning. The conference will be held in Clearwater, Florida at the Hilton Clearwater Beach.

For more information on the ABIM Foundation’s Choosing Wisely campaign, including lists from more than 70 medical specialty societies, visit


ACMT is a professional, non-profit association of physicians with recognized expertise in medical toxicology. The ACMT mission is to advance quality care of poisoned patients and public health through physicians who specialize in consultative, emergency, environmental, forensic, and occupational toxicology. For more information, visit, or follow on Twitter @acmt.

AACT is a multidisciplinary organization uniting scientists and clinicians in the advancement of research, education, prevention, and treatment of diseases caused by chemicals, drugs, and toxins.