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Sur Internet, des rem?des ayurv?diques ? risques

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  • Sur Internet, des rem?des ayurv?diques ? risques


    Sur Internet, des rem?des ayurv?diques ? risques


    Utilis?s par 80 % des Indiens et de nombreuses personnes originaires d?Asie du Sud, les rem?des ancestraux de la m?decine ayurv?dique sont aussi de plus en plus populaires aux ?tats-Unis. Or, si l?une des branches de la m?decine ayurv?dique repose sur les plantes, la deuxi?me, rasa shastra, combine herbes et m?taux (mercure, plomb, fer, zinc). Et, depuis 1978, plus de 80 cas d?empoisonnement au plomb li? aux m?decines ayurv?diques ont ?t? signal?s dans le monde. C?est ce qui a conduit des m?decins de l?universit? de Boston, autour de Robert B. Saper, ? tester des produits de ce type vendus sur Internet.

    Les chercheurs, qui publient leurs r?sultats aujourd?hui dans le ? JAMA ?, ont choisi au hasard 230 produits parmi les 673 propos?s sur Internet et en ont analys? 193, venant de 37 fabricants diff?rents. Un peu plus d?un sur cinq contenaient des m?taux potentiellement toxiques (mercure, plomb, arsenic), ? des pourcentages souvent sup?rieurs aux doses journali?res acceptables. Pour le plomb ou le mercure, les quantit?s ing?r?es pouvaient m?me ?tre de 100 ? 10.000 fois plus importantes que les normes.

    En 2006, Robert Garnier et Jo?l Poupon (Fernand-Widal et Lariboisi?re, Paris) rapportaient dans ? la Presse m?dicale ? (vol. 35, n? 7-8) le premier cas connu en France. Un homme de 32 ans avait ?t? hospitalis? plusieurs fois pour des crises douloureuses abdominales paroxystiques, associ?es ? une constipation, une perte de poids, une chute du taux d'h?moglobine et une ?l?vation mod?r?e de l'activit? des enzymes h?patiques. L?enqu?te avait mis en ?vidence un m?dicament ayurv?dique consomm? pendant les quatre semaines pr?c?dant la premi?re hospitalisation. Les auteurs soulignaient l?importance de questionner les personnes ? risque (communaut?s culturelles traditionnellement utilisatrices et voyageurs de retour de pays utilisateurs) sur leurs habitudes th?rapeutiques et d?informer les utilisateurs potentiels sur les risques.

    > R. C.

    Quotimed.com, le 27/08/2008



    L'article de JAMA


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


    Robert B. Saper, MD, MPH; Russell S. Phillips, MD; Anusha Sehgal, MD(Ayurveda); Nadia Khouri, MPH; Roger B. Davis, ScD; Janet Paquin, PhD; Venkatesh Thuppil, PhD; Stefanos N. Kales, MD, MPH

    JAMA. 2008;300(8):915-923.

    Context Lead, mercury, and arsenic have been detected in a substantial proportion of Indian-manufactured traditional Ayurvedic medicines. Metals may be present due to the practice of rasa shastra (combining herbs with metals, minerals, and gems). Whether toxic metals are present in both US- and Indian-manufactured Ayurvedic medicines is unknown.

    Objectives To determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic and to compare the prevalence of toxic metals in US- vs Indian-manufactured medicines and between rasa shastra and non?rasa shastra medicines.

    Design A search using 5 Internet search engines and the search terms Ayurveda and Ayurvedic medicine identified 25 Web sites offering traditional Ayurvedic herbs, formulas, or ingredients commonly used in Ayurveda, indicated for oral use, and available for sale. From 673 identified products, 230 Ayurvedic medicines were randomly selected for purchase in August-October 2005. Country of manufacturer/Web site supplier, rasa shastra status, and claims of Good Manufacturing Practices were recorded. Metal concentrations were measured using x-ray fluorescence spectroscopy.

    Main Outcome Measures Prevalence of medicines with detectable toxic metals in the entire sample and stratified by country of manufacture and rasa shastra status.

    Results One hundred ninety-three of the 230 requested medicines were received and analyzed. The prevalence of metal-containing products was 20.7% (95% confidence interval [CI], 15.2%-27.1%). The prevalence of metals in US-manufactured products was 21.7% (95% CI, 14.6%-30.4%) compared with 19.5% (95% CI, 11.3%-30.1%) in Indian products (P = .86). Rasa shastra compared with non?rasa shastra medicines had a greater prevalence of metals (40.6% vs 17.1%; P = .007) and higher median concentrations of lead (11.5 ?g/g vs 7.0 ?g/g; P = .03) and mercury (20 800 ?g/g vs 34.5 ?g/g; P = .04). Among the metal-containing products, 95% were sold by US Web sites and 75% claimed Good Manufacturing Practices. All metal-containing products exceeded 1 or more standards for acceptable daily intake of toxic metals.

    Conclusion One-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.


    Author Affiliations: Department of Family Medicine, Boston University School of Medicine and Boston Medical Center (Drs Saper and Sehgal and Ms Khouri), Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (Drs Phillips and Davis), Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Research Center, Harvard Medical School (Drs Phillips and Davis), and Environmental and Occupational Medicine and Epidemiology, Department of Environmental Health, Harvard School of Public Health (Dr Kales), Boston, Massachusetts; New England Regional Laboratory, Environmental Protection Agency, North Chelmsford, Massachusetts (Dr Paquin); National Referral Centre for Lead Poisoning in India and Department of Biochemistry and Biophysics, St John's Medical College, Bangalore (Dr Thuppil); and Employee and Industrial Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Dr Kales).


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