This review provides published data on so-called alternative medicine (SCAM)-related liver injuries (DILI) in Asia, with detail on incidences, lists of most frequently implicated herbal remedies, along with analysis of patient population and their clinical outcomes.

Its authors conclude that SCAM use is widely prevalent in Asia and is associated with, among other adverse effects, hepatotoxicity. Both proprietary as well as non-proprietary or traditional SCAMs have been implicated in hepatotoxicity. Acute hepatocellular pattern of liver injury is the most common type of liver injury seen, and the spectrum of liver-related adverse events range from simple elevation of liver enzymes to the very serious ALF and ACLF, which may, at times, require liver transplant.

SCAM-related liver injury is one among the major causes for hepatotoxicity, including ALF and ACLF worldwide, with high incidence among Asian countries. Patient outcomes associated with SCAM-DILI are generally poor, with very high mortality rates in those with chronic liver disease. Stringent regulations, at par with that of conventional modern medicine, are required, and may help improve safety of patients seeking SCAM for their health needs. Regional surveillance including post-marketing analysis from government agencies associated with drug regulation and control in tandem with national as well as regional level hepatology societies are important for understanding the true prevalence of DILI associated with SCAM. An integrated approach used by practitioners combining conventional and traditional medicine to identify safety and efficacy of SCAMs is an unmet need in most of the Asian countries. Endorsement of scientific methodology with good quality preclinical and clinical trials and abolishment of unhealthy publication practices is an area that needs immediate attention in SCAM practice. Such holistic standard science-based approaches could help ameliorate liver disease burden in the general and patient population.

I congratulate the authors to this excellent paper. It contains a wealth of information and is well worth reading in full. The review will serve me as a valuable source of data for many years to come.

4 Responses to Drug-induced liver injuries after SCAM: a new and most valuable review

  • To spare those who are interested in the full article text some searching:
    (It can also be found via the journal’s Web site, see )

    I see a lot of disturbing findings, with perhaps the most tragic of all the fact that we now KNOW that a lot of those traditional and alternative ‘medicines’ are seriously harmful, without any evidence of therapeutic effects, yet that large numbers of sick(!) people get administered and prescribed these substances anyway.
    Even the best scientific knowledge of clear and present danger seems to lose out against tradition and beliefs.

    One absolutely shocking finding is this one:
    “In the study by Philips et al.[26], almost 40% of CAMs retrieved from patients with CAM-DILI were proprietary Indian Ayurvedic herbal medicines in the form of bottled branded decoctions, pills, tablets, and powders. One-third of the CAMs were unlabeled polyherbal mixtures, prescribed by traditional Ayurvedic healers. On chemical and toxicology analysis, lead was detected in 73% (maximum detected: 7318.1 mg/kg), mercury in 64% (751.5 mg/kg), and arsenic in 58% (111 mg/kg). Apart from heavy metals, multiple volatile organic compounds and industry grade chemicals were also detected in the more than 70% of the samples analyzed. (emphasis added)

    So ayurvedic ‘medicines’ may contain thousands of times the maximum daily intake limit of heavy metals set by the FDA.
    And please don’t forget that this form of ‘medicine’ has an official status, and is sanctioned and even promoted by the Indian government. I would almost call this criminal negligence on behalf of the Indian government.

  • Perhaps you folks on the east side of the pond didn’t get the memo…. don’t consume products made in China.
    Not even garlic is safe.

    I would add to that, don’t consume the pills or herbs.

    • Unfortunately your links aren’t very easy to follow. The first one is to a legal blog where the blogger is quoting from an article in Time magazine. Unfortunately when I followed his link I got this:

      To continue reading: Subscribe or Log-In

      Clicking on your second link led me to this:

      Due to GDPR compliance, LifeBuzz is currently unavailable in your country.

      So unfortunately no, we didn’t get the memo.

  • Dr. JMK

    The links work fine on my side of the pond…. but I believe you.

    The reason I posted the links is to point out that products made in the US and Europe can and are being questioned about the ingredients, and the safety and toxicity levels of consumable products. How much more those made in China India countries ?

    Food products exported from China that are typically known be healthy foods to eat…. fish ginger and garlic have been called into question when grown in China. Like I said previous, pills and herbs are suspect also.

    Rather than automatically question homeopathy as being the culprit for high toxin levels detected, I would question the source of the products being consumed in these treatments.

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