LETTERS TO THE EDITOR 349

tary and alternative medicine by cancer patients in Turkey: A DOI: 10.1089/acm.2008.0075

survey. J Altern Complement Med 2006;12:355–356.
6. Algier LA, Hanoglu Z, Ozden G, Kara F. The use of comple- GALVANO-SPA-BATH AND HEALTH
mentary and alternative (non-conventional) medicine in can- RISKS DUE TO INCORPORATION OF
cer patients in Turkey. Eur J Oncol Nurs 2005;9:138–146.
7. Kav S, Johnson D. Complementary and alternative medicine
CHROMIUM, NICKEL, AND PLATINUM
in cancer in Turkey: A literature review. Support Care Cancer RELEASED FROM ELECTRODES
2004;12:378–379.
8. Yildirim Y, Tinar S, Yorgun S, et al. The use of complemen-
tary and alternative medicine (CAM) therapies by Turkish Dear Editor:
women with gynecological cancer. Eur J Gynaecol Oncol Use of the galvano-spa-bath has become rather popular
2006;27:81–85. as an energizer and as a preventive and complementary ther-
9. Navo MA, Phan J, Vaughan C, et al. An assessment of the uti- apy for a variety of diseases. However, potential future
lization of complementary and alternative medication in health risks for users and operators due to chromium, nickel,
women with gynecologic or breast malignancies. J Clin On- and platinum released from its metallic electrodes have not
col 2004;22:671–677. yet been recognized by the medical community. Financial
10. Akyuz A, Dede M, Cetinturk A, et al. Self-application of com- risks could eventually outnumber any savings realized by
plementary and alternative medicine by patients with gyneco-
the National Health Service due to the possible positive
logic cancer. Gynecol Obstet Invest 2007;14;64:75–81.
health effects of galvano-spa-baths.
11. Tascilar M, de Jong FA, Verweij J, Mathijssen RH. Comple-
mentary and alternative medicine during cancer treatment: Be- In the United Kingdom (UK) more than 10,000 galvano-
yond innocence. Oncologist 2006;11:732–741. spa-baths are registered under the brand names Body Detox
12. Swisher EM, Cohn DE, Goff B, et al. Use of complementary and Aqua Detox; in Europe, Asia, and the United States, there
and alternative medicine among women with gynecologic can- are more than 30,000. These are operated by both laypersons
cers. Gynecol Oncol 2002;84:363–367. and nursing staff at alternative medical centers. Galvano-spa-
13. Von Gruenigen VE, White LJ, Kirven MS, et al. A compari- baths are equipped with stainless-steel arrays consisting of
son of complementary and alternative medicine use by gyne- chromium/nickel or platinum electrodes and are operated on
cology and gynecologic oncology patients. Int J Gynecol Can- low-voltage constant DC circuits (12 V, 150 mA), releasing
cer 2001;11:205–209. toxic ions such as hexavalent chromium, nickel, and platinum
into the aqueous solution where the feet are placed. On a DC
Sultan Kav, R.N., Ph.D. circuit the anodic stainless-steel array releases approximately
Gul Pinar, R.N., M.S.N. 200 mg of chromium consisting mostly of highly reactive
Department of Nursing hexavalent-chromium1 and 60 mg of nickel ions into the so-
Baskent University Faculty of Health Sciences lution.2 The uptake of metal ions from the solution of the gal-
Ankara, Turkey vano-spa-bath into the user`s body follows the same electro-
Fatma Gullu, R.N. chemical laws as seen with iontophoresis (i.e., Nernst’s
Tulay Turker, R.N. equation and Coulomb’s law). The current goes from the pos-
Sibel Elibol, R.N. itively charged anode of the array through the negatively
Ministry of Health charged skin of the user and transports the ions along the elec-
Ankara Etlik Training and Research Hospital tromagnetic field generated by the array, according to the Am-
of Obstetrics and Gynecology pere-Maxwell law. This can be confirmed easily by placing an
Ankara, Turkey ampere-meter connecting both hands while the feet are placed
Nevin Dogan, R.N., M.S.N. in the galvano-spa-bath. Because DC current acts similarly to
Lale Algier, R.N., Ph.D. iontophoresis, the penetration of heavy metals through the skin
Department of Nursing is not surprising. After iontophoretic uptake by the body,
Baskent University Faculty of Health Sciences chromium, nickel, and platinum are excreted through urine in
Ankara, Turkey concentrations of 16, 25, and 4 g/g creatinine, respectively.3
Although it is an essential nutritional factor for glucose me-
Address reprint requests to: tabolism, hexavalent chromium is carcinogenic in higher con-
Sultan Kav, R.N., Ph.D., centrations. It is well known in occupational medicine that
Baskent University chromium-(III), nickel-(II), and platinum ions4 can cause
Faculty of Health Sciences, Department of Nursing hand eczema and chronic obstructive pulmonary disease if in-
Baglica Kampusu, haled over an extended period as is the case with regular users
Eskisehir Yolu 20. km of the galvano-spa-bath. Chromium and nickel can be found
06810 Baglica/Ankara during autopsy in cancer tissue from workers exposed to such
Turkey ions over long periods. Platinum ions are also inducers of met-
allothionein, a low-molecular-weight protein regulating pro-
E-mail: skav@baskent.edu.tr tein synthesis. Thus, using platinum arrays in a galvano-spa-
350
bath as complementary treatment in patients suffering from
cancer may nullify chemotherapy with cisplatin, because met-
allothionein neutralizes platinum.5 The pattern of urinary
metallic ions after use of galvano-spa-baths is typical for per-
sons who have been exposed recently to the same elements,2
as has been demonstrated by Griesz-Brisson3 with stainless-
steel, titanium, and platinum arrays.
Not only are users or patients exposed to heavy metals from
arrays of galvano-spa-baths, but nursing staffs or other oper-
ators are also exposed to aerosols of the solution containing
chromium, nickel, or platinum. In addition, while disposing
of the toxic cocktail, nursing staff can come in skin contact
with the metal salts. Traces of the salt can be transported to
other places where they can be ingested accidentally. Oral up-
take of metallic salts through smoking or drinking/eating in
the workplace is a well known route of ingestion in the gal-
vanic industry. Nygen and Lundgren6 reported that nursing
staff caring for patients treated with the anticancer drug cis-
platin have been observed to have an increased concentration
of platinum in their blood, which is in fact half the concen-
tration found in users of galvano-spa-baths.2
Given the number of galvano-spa-baths currently being op-
erated in the UK, one can assume that both users and opera-
tors are affected similarly to the way the entire workforce of
galvano industry is affected. Stainless-steel implants are no
longer used for hip replacement due to the increased health
risks of chromium and nickel. Health authorities, doctors, and
users of galvano-spa-baths equipped with stainless-steel or
platinum arrays should balance carefully the risk of future po-
tential health problems caused by chromium, nickel, and plat-
inum with a not yet proven positive effect on the human body.
Novel alloys releasing elementals already present in the hu-
man body (e.g. sodium, magnesium, or zinc) would be of ad-
vantage. To date, however, such materials are not used as ar-
ray in galvano-spa-baths.
REFERENCES
1. Merritt K, Brown SA. Release of hexavalent chromium from
corrosion of stainless steel and cobalt–chromium alloy. J Bio-
med Mater Res 2004;29:627–633.
2. Zierer O, Griesz-Brisson M. Potential health risks caused by
chromium, nickel, and manganese used in products for elec-
trolytic stimulation in medical and wellness devices. Umwelt-
Medizin-Gesellschaft 2006;19:281–287 [abstract in English].
3. Griesz-Brisson M. Effective detoxification: Physico-chemical
provocation of detoxification of heavy metals with the galvano-
spa-bath of Body Detox® AG, Switzerland CO`MED, an inter-
net journal (article in German). September 2005. Online docu-
ment at: www.hkmed.de/Body/BD-Studie.pdf Accessed April
28, 2008.
4. Hunter D, Milton R, Perry KM. Asthma caused by the complex
salts of platinum. Br J Ind Med 1945;2:92–94.
5. Surowiak P, Materna V, Maciejczyk A, et al. Nuclear metal-
lothionein expression correlates with cisplatin resistance of
ovarian cancer cells and poor clinical outcome. Virchows Arch
2007;450:279–285.
LETTERS TO THE EDITOR
6. Nygen O, Lundgren C. Determination of platinum in work air
and in blood and urine from nursing staff attending patients re-
ceiving cisplatin chemotherapy. Int Arch Occup Environ Hlth
1997;70:209–214.
Address reprint requests to:
Otto Zierer, M.D.
Locum GP with the NHS-UK
31 Mycenae Road
London SE3 7SF
United Kingdom
E-mail: Otto.zierer@gmx.de
DOI: 10.1089/acm.2008.0032
MEDICINAL ANIMALS FOR THE
TREATMENT OF ASTHMA IN BRAZIL
Dear Editor:
Asthma is one of the most common chronic diseases in
modern society, and there is growing evidence to suggest that
its incidence and severity are increasing. In addition to allo-
pathic remedies, there is a high prevalence of use of comple-
mentary medicine for treating asthma, which is supported by
a large archive of information on herbal medicine from many
cultures.1,2 The use of animal-derived medicines as an alter-
native therapeutic in the treatment of asthma has also been
recorded in different parts of the globe, yet little attention has
been paid to the cultural, medical, or ecological significance
of zootherapeutic practices, even in countries where the use
of medicinal animals is well established, such as Brazil.
Particularly, the role played by animals for treating asthma
remains virtually unexplored in the literature, despite the fact
that asthma was the most common type of health complaints
treated using animal-derived remedies in the country.3 As part
of a broader field survey (September 2003–October 2007) of
medicinal fauna, we interviewed 111 traders of medicinal an-
imal and 290 users of animal-based remedies at outdoor mar-
kets in metropolitan areas and at rural communities in more
remote areas of the North and Northeast Brazil. Our findings
revealed that at minimum 113 animal species (34 included in
some list of endangered species) were used in Brazilian tra-
ditional medicine for treating asthma. Materials used in the
preparation of remedies were bone, cartilage, skin, teeth, tail,
fur, nails, head, fish scales, tongue, fat, oil, rattle (from rat-
tlesnakes), and spines, and according to interviewees, there
are different ways of preparing and administering remedies.
Hard parts were sun-dried, grated, and crushed to powder, and
were then administered as tea or taken during meals, while
either fat or oil are ingested. Also, animal products were re-
portedly often used in association with medicinal plants.
Although widely diffused throughout Brazil, zoothera-
peutic practices related to the treatment of asthma remain
virtually unstudied, and so far there has been neither
a demonstration of the clinical efficacy of the popularly used