The Joint American-Israeli Medical Toxicology Conference, held last month at Rambam, gathered the most important names in the field worldwide. Conference participants discussed subjects including medication and safety errors, use and abuse of OTC opioids and paracetamol, novel synthetic drugs and the appropriate response to various toxins

 When Keynote Speaker Prof. Lewis R. Goldfrank took the stage at Rambam to address the Joint American-Israeli Medical Toxicology Conference, the excitement in the room, and the respect accorded him by his audience of   physicians, nurses, clinical toxicologists, pharmacologists, researchers and lab technicians were palpable.

Prof. Goldfrank, editor and lead author of the eponymous Goldfrank's Toxicologic Emergencies, has spent his career in the public hospitals of New York City, and has practiced in such far-flung places as Jordan, India, Samoa, and South America. At Rambam, he addressed "The Importance of Toxicologic Research in Global Health." He said that per year, an approximately three million acute severe poisonings occur globally, 90% of these in low to middle income countries, and that in over 77% of these cases, pesticides are the culprit.  "There should be an international standard for public health pharmaco-vigilance that can be applied to the local community," he said.
 
The conference took place at Rambam under the auspices of the American College of Medical Toxicology (ACMT) and the Israel Society of Toxicology. It attracted large contingents from Israel and the USA and drew additional professionals from Brazil, Canada, Germany, Russia, and the United Kingdom. In the ebullient welcoming words of host and co-organizer Prof.  Yedidia Bentur, director of the Israel Poison Information Center on the Rambam campus, the event brought together "the most important people in the world."
 
It's a new, small world.  Medical toxicology only received formal recognition as a subspecialty in 1993, the same year that ACMT was established. In 2000, the Accreditation Council for Graduate Medical Education (ACGME) began to certify fellowship training in the discipline. In 2009, the Toxicology Investigators Consortium (ToxIC), a multicenter researcher group dedicated to toxico-vigilance, was founded. In the United States today, there are 60 poison control centers, 26 toxicology fellowship programs, and approximately 600 medical toxicologists.

The wide range of presentations explored  medication and safety errors in pre-hospital and hospital settings;  the use and abuse of OTC opioids and paracetamol; the pathology and epidemiology of novel synthetic drugs  (whose basement chemists have merely to tweak their compounds to bypass dangerous-drug ordinances); and preventive and therapeutic strategies in response to such environmental, occupational, and battlefield hazards as fresh water algal toxins, environmental obesogenes, organophosphates, and sulfur mustard.

The Israeli picture was filled in by Rambam's Dr. Yael Lurie, attending physician, Israel Poison Information Center, and Dr. Ehud Wolf of the Identification and Forensic Science Division of the Israel Police. Dr. Lurie reported on an outbreak of PMA and PMMA (hallucinogenic synthetic substituted amphetamine) poisonings in 2007 fatal to 22 "recreational drug" users, commenting grimly: "In a country of Israel's size, it's an epidemic."