Medical Toxicology Education and Global Health: It is Still a World of Limited Resources in Low- and Middle-Income Count
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EDITORIAL
Medical Toxicology Education and Global Health: It is Still a World of Limited Resources in Low- and Middle-Income Countries Natalie R. Neumann 1
&
Trevonne M. Thompson 2
Received: 21 February 2020 / Revised: 19 May 2020 / Accepted: 20 May 2020 # American College of Medical Toxicology 2020
Keywords Toxicology . Global health . Poisoning . Developing countries . Medical Education
Poisoning is a worldwide problem. In 2015, a previous editorial in this journal highlighted the importance of medical toxicology education globally [1]. The data on global poisonings are no better now than they were then. While statistics are difficult to compile, the estimates are noteworthy: intentional pesticide ingestion alone causes roughly 370,000 deaths per year worldwide [2]. Approximately 100,000 fatalities and considerable morbidity result from an estimated 5 million annual snakebites, which occur predominately in low- and middle-income nations [2–5]. In 2012, an additional 193,000 individuals are thought to have died of unintentional poisoning in developing countries [2]. To treat these exposures, there are a total of 312 poison centers worldwide, but nearly half of them (44%) are in North America and in Europe [6]. Furthermore, as of 2011, only 21 of the world’s 193 countries reported having medical toxicologists [7]. Keeping in mind that many low- and middle-income countries have fewer workplace and environmental regulations, less access to modern medical resources, and increasing prevalence of drugs of abuse, these figures create a stark picture: one in which many poisonings occur in places with few resources to care for the poisoned patient [8]. The contrast with North America is profound. Medical toxicology is admittedly a small specialty—there being only several hundred board certified medical toxicologists Supervising Editor: Mark B. Mycyk, MD * Natalie R. Neumann [email protected] 1
Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Suite 600, 1391 Speer Boulevard, Denver, CO 80204, USA
2
University of Illinois College of Medicine at University of Illinois at Chicago, Chicago, IL, USA
in the USA. Still, its practitioners are highly trained and readily accessible. Medical toxicologists must complete two years of dedicated training after finishing training in a primary specialty, pass a certifying examination, and maintain accreditation through a program of continuing education. They frequently operate in concert with the US poison center network—organized by the American Association of Poison Control Centers—which allows laypeople, healthcare facilities, and individual physicians easy access to poisoning information and medical toxicology consultations. This model enables a small number of highly trained medical toxicologists to participate in the care of the estimated 3.5 million yearly toxicologic exposures in the USA, only 1500 of which result in death [9]. Given the obvious disparity in care between North America and developing nations, one might wonder why poi
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