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

The American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) jointly released a list of 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. The list identifies five 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 homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.
  2. Don’t administer a chelating agent prior to testing urine for metals, a practice referred to as ‘provoked’ urine testing.
  3. Don’t order heavy metal screening tests to assess non-specific symptoms in the absence of excessive exposure to metals.
  4. Don’t recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples.
  5. Don’t remove mercury-containing dental amalgams (fillings).

According to Suzanne White, MD, President of ACMT, “Through its quality educational programs and support of board certification, ACMT has been a leader in promoting the highest standards of evidence-based care for all patients. By joining the Choosing Wisely campaign, we hope to spark thoughtful conversations between patients and their physicians about unnecessary tests or treatments. This is key to protecting the public from practices that are harmful or inappropriate.” Robert S. Hoffman, MD, FAACT, FACMT, FRCP Edin, President of AACT adds, “As Toxicologists, we strive to provide the best possible evaluation and treatment based on existing scientific evidence and share in our responsibility to limit skyrocketing health care costs. We favor the right care over more care and hope these five statements will allow patients to have more informed conversations with all of their health care providers.”

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 North American Congress of Clinical Toxicology annual 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 meeting will be held in Atlanta, Georgia at the Hyatt Regency.

For more information on the ABIM Foundation’s Choosing Wisely campaign, including lists from more than 30 medical specialty societies, visit

ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology. The College is dedicated to advancing the science and practice of medical toxicology through a variety of activities. 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.