What is Medical Toxicology?

Of the thousands of “toxicologists” working in the United States fewer than 400 are physicians board-certified in Medical Toxicology.

American College of Medical Toxicology (www.acmt.net)

  • Medical Toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning/toxicity and other adverse health effects due to medications, chemicals, occupational and environmental toxins, and biological hazards. Medical Toxicology is officially recognized as a medical subspecialty by the American Board of Medical Specialties (ABMS).

Institute of Medicine

  • The IOM report “Forging a Poison Prevention and Control System” (2004) makes the following distinction on the first page of the Executive Summary:
    • “The term toxicologist is a general description of an individual dealing with any aspect of acute or chronic poisoning, and it does not have a specific definition or implication with regard to training or job description.  For example, this term may be used to describe individuals whose activities range from molecular biology to epidemiology, as long as they deal in some way with the toxic effects of chemicals. The term clinical toxicologist implies a more clinical orientation, but likewise has no specific definition or implications. Medical toxicologists are physicians with specific training and board certification in the subspecialty of medical toxicology, which focuses on the care of poisoned patients.”

American Board of Emergency Medicine

  • The Core Content for training programs in Medical Toxicology lists all of the knowledge elements essential for passing the board certification examination.

Federal Judicial Center

  • In the Reference Manual on Scientific Evidence, Second Edition, published in 2000, the chapter entitled “Reference Guide on Toxicology” by Bernard D. Goldstein, MD and Mary Sue Henifin, JD, MPH, on page 416 states:
    • “A proposed expert should be able to demonstrate an understanding of the discipline of toxicology, including statistics, toxicological research methods, and disease processes. A physician without particular training or experience in toxicology is unlikely to have sufficient background to evaluate the strengths and weaknesses of toxicological research.[41] Most practicing physicians have little knowledge of environmental and occupational medicine. Generally, physicians are quite knowledgeable about identification of effects and their treatment. The cause of these effects, particularly if they are unrelated to the treatment of the disease, is generally of little concern to the practicing physician. Subspecialty physicians may have particular knowledge of a cause-and-effect relationship (e.g., pulmonary physicians have knowledge of the relationship between asbestos exposure and asbestosis), but most physicians have little training in chemical toxicology and lack an understanding of exposure assessment and dose–response relationships. An exception is a physician who is certified in medical toxicology by the American Board of Medical Toxicology,** based on substantial training in toxicology and successful completion of rigorous examinations.”
    • **The American Board of Medical Toxicology was replaced by the Sub-Board in Medical Toxicology in 1992.

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