Foreign medication kills California woman
Key Takeaways
A woman died after using a “miracle” hemorrhoid cream that she ordered through Facebook. The product, which comes from Vietnam, is called Cao Bôi Trĩ Cây Thầu Dầu.
The ointment contains 4% lead, which is dangerous to human health. Physicians who suspect their patients could have used the same ointment should immediately perform a venous blood lead test.
Patients should be encouraged to buy their products in person from reputable institutions or stores and to ask their providers for help distinguishing whether an item is safe.
A woman from Sacramento, CA, died after using lead-contaminated hemorrhoid ointment that she purchased through Facebook. The ointment, which was sold as an herbal remedy, is called Cao Bôi Trĩ Cây Thầu Dầu. It was mailed to the patient from a family member in Vietnam.[]
According to a Facebook post published by Calaveras County Public Health,
the product is “marketed primarily through Facebook groups in Vietnamese as a ‘miracle’ treatment for hemorrhoids with suggested intra-rectal application.”[]
The California Department of Public Health issued an alert to healthcare providers, saying that the “highly dangerous” product had been tested and found to contain 4% lead (39,000 ppm). The Department advised patients who have used the ointment to immediately receive a venous blood lead test.[]
Lead is a potent neurotoxin that can be found in anything from paint and furniture to pipes in older homes. Among adults in the United States, the mean blood lead level should be less than 1 µg/dL.[]
In adults, clinical manifestations of lead toxicity can be vague, although they can lead to the risk of hypertension, fertility issues, peripheral neuropathy, and arthritis. More severe cases may cause encephalopathy, confusion, headaches, or seizures. “Generally, such severe lead toxicity does not occur in adults from occupational exposures but rather from unusual exposures such as large ingestions of contaminated folk remedies or contaminated moonshine,” according to StatPearls.[]
Many key sources of lead have been “significantly diminished” in the US through the 20th century, according to the Journal of Blood Medicine. However, lead still poses a real threat to human health. A study by Pure Earth—an organization focused on developing evidence-based solutions to mercury and lead poisoning—found that out of 5,010 household products and food samples, 18% contained lead levels exceeding reference levels for the product types. The lead-contaminated items included everything from foodware and paint to cosmetics and toys.[][]
How does lead get into healthcare products? It’s not unusual to have trace amounts of chemicals in certain products, especially those produced in a large factory, David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, tells MDLinx. When water is involved, he says, leaded pipes may be the culprit.
How to stay safe when buying products on the Internet
Dr. Cutler says that the online sale of supplements or treatments has been a major issue for some time. For many people, he says, the Internet offers tempting prices or items that aren’t available in the US.
Dr. Cutler refers to the US Dietary Supplement Health and Education Act of 1994, which established minimal regulations around vitamins and supplements. “Anything could be marketed as a supplement,” he says, “if it didn't make health claims.” This leads to people buying supplements and treatments online without knowing all the associated risks and benefits. In these cases, he says, “the buyer has total responsibility around being aware of what's in the things [they’re buying].” What’s scary, he notes, is that “many supplements, foods, and non-food items include something that's not on the label.”
Although the woman in question bought the ointment through a Facebook group, many patients also purchase medications through a myriad of websites or online pharmacies, including those posing as legitimate ones.
“Not all websites are the same. The U.S. Food and Drug Administration [FDA] warns that there are many unsafe online pharmacies that claim to sell prescription drugs at deeply discounted prices, often without requiring a prescription. These internet-based pharmacies often sell unapproved, counterfeit or otherwise unsafe medicines outside the safeguards followed by licensed pharmacies,” the FDA states. Patients should be encouraged to check the FDA’s BeSafeRx campaign, which can help them learn how to safely buy prescription medicines online.
Emergency physician Jared L. Ross, MD, Founder and President of EMSEC, says that patients need to be careful when purchasing supplements or herbal remedies online—from both domestic and international sources. For example, he notes, “Dietary supplements and herbal remedies marketed in the US are not required to show efficacy or undergo premarket approval. These products are generally manufactured in much less controlled environments, especially overseas in less developed countries.”
Not all overseas pharmacies or websites are bogus, though, says Dr. Ross—especially those from industrialized nations. For patients who import medications, he encourages them to research the supplier and make sure that it has a strong safety record and appropriate oversight. “Be extremely careful with any medication that is forbidden by the US, Canada, or European Union due to safety regulations,” he says.
Dr. Cutler says that patients can never be 100% sure of what they’re getting but that physicians should encourage them to buy through recognizable institutions and stores that have a reputation for safety. He also says that it’s better to purchase these products in person. “It is much more difficult to buy online because you don't know the manufacturer or distributor of the product,” he says.