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In Reply: We endorse the call by Drs Mao and Desai for rigorous pharmacoepidemiology studies of Ayurvedic medicine use. We speculate that the use of Ayurvedic medicines, particularly those deliberately containing metals, is an independent risk factor for elevated toxic metal burdens. Measuring appropriate biomarkers of lead, mercury, and arsenic and controlling for important covariates of exposure (eg, occupation, air and water metal concentrations, micronutrient status) should be done. Special attention should be given to vulnerable populations, including pregnant and lactating women, children, and workers involved in the manufacture of Ayurvedic medicines.

We disagree with Mao and Desai's claim that historical use of these medicines in India without apparent toxicity is evidence supporting their safety. India's known toxic metal burden is quite substantial: 51% of children and 40% of adults in Indian cities have blood lead levels of 10 µg/dL or greater.¹ Lead exposure in India may go unrecognized due . . . [Full Text of this Article]

Robert B. Saper, MD, MPH
robert.saper@bmc.org
Department of Family Medicine
Boston University School of Medicine
Boston, Massachusetts

Stefanos N. Kales, MD, MPH
Environmental and Occupational Medicine and Epidemiology
Department of Environmental Health
Harvard School of Public Health
Boston, Massachusetts

Venkatesh Thuppil, PhD
National Referral Centre for Lead Poisoning in India
Department of Biochemistry and Biophysics
St John's Medical College
Bangalore, India

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Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet
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