Amended Complaint against Dr. Joseph Mercola (4004)...Read P~tISI-- D r. Mercola Will-Attempt to-.g wzkln Identify the root cause(s) of your illness rather than use symnptomatic

STATE OF ILLINOIS

DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

DIVISION OF PROFESSIONAL REGULATION

DEPARTMENT OF FINANCIAL ANDPROFESSIONAL REGULATIONof the State of Illinois, Complainant

V. )No.2001-04904-1JOSEPH M. MERCOLA, D.O. Respondent)License No. 036-066597)

AMENDED COMPLAINT

NOW COMES THE DEPARTMENT OF FINANCIAL AND PROFESSIONAL

REGULATION *of the State of Illinois, DIVISION OF PROFESSIONAL

REGULATION, by itj Chief of Medical Prosecution, Michael; J. Lyons 4.

and as its Amended Complaint against Joseph MA. Mercola, D.O.,,

Respondent, complains as follows:

CONTi Ir

1. Joseph M. Mercola, D.O. is presently the holder of a

Certificate of Registration as a Osteopathic Physician

in the State of Illinois, License Number 036-06654.-97

issued to Respondent by the Department of Professional

Regulation of the State of Illinois (hereinafter the

"Department"). Respondent's license is currently in

active status.

1LO1

Case: 1:05-cv-04400 Document #: 11-3 Filed: 10/03/05 Page 5 of 18 PageID #:221

2. Respondent caused the publication of false and

potentionally harmful medical advice on the web cite

entitled www.rnercola. corn.

3.. on this web ,site www.mercolaacomm/1999/feb/14/armour

thvrid.ht, Respondent states, "NEJM Study proves

Armour Thyroid Better than Synthroid"f. The title is a

false statemtent and he misstates the conclusion of the

study:'

4. At www.mercola.com/2000/secot/3/exercise ulcers.htm

Respondent states that drinking 12 glasses of water per

day and following the diet and supplementing with

beneficial bacteria seem to resolve ulcers in well over

95% of the people that he cared for with ulcers. This

is a claim of superior care. See ExhibitA attached

hereto and made apart hereof.

5. At www.mercola.com/2000/-iul/23/bDee venon lvme.htm.

Resioondent recommends 0. 5 mml Bee-venom from. Canada; in

2.5 ml Procaine and injects 0.5 ml procain into the

skin. Respondent claim this has an incredible effect in

his Lyme Disease patients. Patients start to fEVi much ~

better very soon, their depression and f atigue lifts-,V

then their pain. Respondent overstates the thoughts

and fails to state the consequences of this treatment.

2

G"oola


6. Chet Day's Health and Beyond printed, "Why I Never Get

Flu Shots," Respdndent agrees and says "IT have heard

some authors state that there is a direct cotrelation

of the number of flu shots one has and the incidence of

Alzheimer's".~ See www.rnercola.com2000lnov/19/vaccine

sids.htm. Respondent states why should't the head of

your local, health department's vaccination program be

ptosecuted for conspiracy to commit murder?

7. Respondent advertises the Most Consistent Form of a

miracle Treatment that I Have Ever Learned. This takes

care of 85 % of most pain problem.. He then lists' 60

conditions from which people have claimed at least

partial relief with NST. For this treatment he charges

.$99.00 at www.mercola.ccim/2000/sept./3/nst.htm.

Respondent misleads the public with 85%. -of most pain

claims.

8. Respondent states that there. are ovet 20,000 pages on

his web site, with over one million visitors per month.

3

6L00O19'


9. These actions or omissions as alleged are grounds for

revocation, suspension, *or other discipline to a

Certificate of Registration pursuant to 225 ILCS (2000)

60/26 (2) (3)& 225 ILCS(2000) 60/22(A)-10, 225 ILCS

(2000) 60/22 (A)5.

WHEREFORE, based on these allegations, the DEPARTMENT OF

FINANCIAL AND PROFESSIONAL REGULATION of the State of Illinois,

'DIVISON OF PROFESSIONAL REGULATION by MICHAEL J. LYONS, i~t"s Chief

of Medical Prosecutions, prays that the Physician& Surgeon

license of JOSEPH M. MERCOLA, D.O. be suspended, revoked, or

otherwise disciplined.

Count 13I

1. Paragraph 1 of Count 1 is realleged as paragraph .1 ot

Coun t II.~

2. Respondent states on the page called "Your First Step

towards Optimal. Wellness and Finding Out If This is the

Ty'pe of Treatment You are Looking For" claims that he

will "identify, the root cause(s) of your illnesk•. rather

then use symptomatic band aids." See Exhibit A

attached and made a part hereof.

4

(A0020


3. Respondent states, one of the most crucial steps you

can do is tA gradually switch all your fluid intake%

over to pure, filtered water. That will mean

eventually stopping all milk, juice and soda.

Respondent overstates the benefits of his practice.

4. Respondent offers Thyroid Profile to every patient at.

$71.00. Thyroid Stimulating Hormone. it is improper to

have every patient take this test.

5. Respondent requires hair Analysis $76.00 See Exhibit A.* -

Respondent claims that this helps with diet anid/or

supplement recormnendations. 'He recomends hai r analysis,

his claims are refuted by recognized meaningftil% , st

studies. See Exhibit B3 attached hereto and made a p&itt ¾:&(hereof.

.6.. Other resources recommended by Respondent:

a. Live Cell test, at $149.00 See Exhibit A,

recommended by"tRespondent; This test is performed~

by James Jordan, JD,, CNC who is described as "Ia

former attorney" who is a' certified nutritional

consultant and is completing his PH.D in.Naslural

GL-0-021


healihg and Doctorate in Naturopathy from the~~k

Clayton School of Natural Healing." See Exhibit C,':

attached and made a part hereof.,Clayton School oft "1 .

Natural Healing is non accredited. This test is

of questionable value.

b. Respondent's therapist See Exhibit A, charges

$99.00 "who uses sophisticated bio energy

techniques to rebalance organ systems that change

as a result of. emotional trauma or 'allergies."

This is an improper claim by.Respondent.

8. These actions or omissidns as alleged are grounds for

revocation, suspension, or other discipline, to, a,

Certificate of Registration pursuant to. 225' ILCS (2000G)

60/26 (2) (3)& 225 ILCS (2000) 60/22(A)-lo,: 225 ILCS

(2000) 60/22 (A)5.

WHEREFORE, based on these allegations, the DEPARTMENT OF

FINANCIAL AND PROFESSIONAL REGULATION of the State of Illinois,

DIVISION OF PROFESSIONAL REGULATION, by MICHAEL J. LYONS, its

Chief of Medical Prosecutions, prays that the Physician & Surgeon

license of JOSEPH M. MEiRCOLA, D.O. be suspended, revoked, .,rl


6

I 22


COUNT III

1. Paragraph 1 of Count I is realleged as paragraph1 of

Count III.

2. Respondent publishes "my Vision"f on his web page at

www.mercola. corn/fccxi/PrinterFriendlv. fccri (See Exhibit

D attached and made a part hereo f) : "I will achieve%

this through Mercola.com by providing you with

comprehensive, clear and researched guidance on theS

best nutritions, medical, emotional therapy and

lifestyle choices to improve and maintain total health.

3. "I invite you to delve into the site for alt its useful

information, to sign up for my twice-weekly newsletter,,,..

and most of all, jo-in me in this guest to transform.

the. medical paradigm to, one where* all med ical:

professionals are truly coimmitted, to their patients; iK24J.health and well-being at the deepest lee."e'.

Exhibit D.

4. The claims in "My Vision" claim superior treatment over

other practitioners.

5. These actions or omissions as alleged are grounds f or

revocation,. suspension, or other discipline to a

Certificate of Registration, pursuant to 225 ILCS

(2000) 60/26 (2) (3)& 225 ILCS (2000) 60/22(A)-10.

7

LC 6023


WHEREFORE, based on these allegations, the DEPARTMENT

OF FINANCIAL AND PROFESSIONAL REGULATION of the State of

bIVISION OF PROFESSIONAL, REGULATION, by MICHAEL J.LYONS, its-Chief

of Medical Prosecutions, prays that the Physician& Surgeon

license of Joseph M.L Mercola, D.O. be suspended, revoked, or


DEPARTMENT OF FINANCIAL ANDPROFESSIONAL REGULATIONof the State of Illinoi~s

DIVISION OF PROFESSIONAL REGULATION' . 2

By: 7 ,.MICHAEL.J-. LYONS' )'.

Chief Of.' medical Prosecutions

Norman J. LaskoAttorney for the Department ofFinancial and Professional Regulationof the State of IllinoisDivision of Ptofessional RegulationSuite 9-300100 West Randolph StreetChicago, IL 60601(312) 814-1690

GL 0024


Tmann You Am. L0ckhnQ Fo

* *Home Pane New Patients rsnlnk

Your First Step Towards.Optimnal Weliness AndFinding' Out If This Is The Type. of Treatment Youi-..-

.Are'Loo'king For

Dr.. Mercola is af D.O.

*Board Certified in Family Practice<aSpecializes in Chronic. Illness*Feels that poor food choices it, usually. what is preventing health

REE eeky Helth Food Chahges are the First Strategy Dr. Mercola Will Use

* IetgrOne of the most crucial steps you can do is-to gradually, switch all your fluid intake over topure, filtered water. That will mean-eventually stopping all milk, juice, and soda.

our.;Emall Address:L Anoz: th importantaction ~is to Fe

These changes do NOT need to be in place before seeing Dr. Mercola, you just heed toIbe willing to work towards- this goal. We have many resources to help you in this area.

Read P~tISI

-- D r. Mercola Will-Attempt to-

.g wzkln *Identify the root cause(s) of your illness rather than use*symnptomatic band aids* Serve as your coach*Serve as director for your-individualized program of healthimprovement,

'Do We, Submit to Insurance Companies?

-We submit to most PPO plans, however, we are only in network for BlueCross BlIueShieldt*-.~-:- .-fPPO..It yo havea PPOinsuanc that is out of network, your % of coverage will most likeI

'be 'lower and you may-also have a separate out of network deductible which needs to be&met before the benefits will be in effect

Youwoud b reuird to pay your %othe entire'visit each time you are here. W~e wll

-submit the other portion and whatever your insuIrance does- not cover we will bill you for.

Howdo knw i I m I orOutof etwrk?-

What.Happens at my First Appointment?

First appointment is 15 minutes with the nurse and ¶ hour with Dr. Mercola.

$200.00 for the New Patient visit

In the visit Dr. Mercola will go over your health appraisal questionnaire which is: one of the~

-forms. you fill out. He will also discuss the program, treatment, and your concerns.-

You will be in our office approximately 2 hours

Usually does bloodwork at this timeE

What Bloodwork Will be Done? 4hupJww~erc~a~onvtnnsn~wr'or~rnl - ~ V P02


Requresa 10nou fas ofwater and prescription meu,.,ations onily. Novtmins orfood

It is a detailed printout on' yur blood.

It shows alI the levels of the blood and the range they shpuld be In. If they are not inthe

correct range it will show what needs to be done to correct the levels tlhroiughwsupplementand/or diet recommendations.

Thyroid Profile $71.00

Thyroid Stimulating Hormone

Thyroid, TS Free

Free Thyro~dne T4 RIA

Hair Analysis $76.00

Your hair is an appendage of your skin and holds a lot of valuable information In thetissues.

Tests -for minerals and metals present in the body

Helps with diet and/or splmnreomendationsr suplemen reco

Note: Additional tests may need to be done depending on each iniiua'eds

When Do I Get My Bloodwork Back?-

Approximately I Week later your results will. be in.

You will be scheduled for an appointment with our Nutritionist Jim. He will go over yourresults with you in detafil.

Wha Hppens Next

Patients usually implement the changes Jim recommends for about a month and then willsee Dr. Mercola for a follow up. 30 minutes $99.00

Dr. Mercola may do a repeat blood test to be sure the changes you've, made are workingcorrectly and to see if anything-else needs to be rhodified.

*A repeat blood test is also a great way to see how the changes you've made are affecting,you.

Other Resources You May Be Referred To:

Live Cell $149.00

A drop of blood is taken from your finger and placed undler a microscope.

Jordan will. be able to see how everything is effecting your digestive system, endocrine

system, and if any parasites are present

Therapist $99

*Many patients benefit from seeing therapists W.~ho use sophisticated blo energy techniques.

to rebalance organ systems that change as a result-of em~otional trauma or allergies..


A pNT$2.t ich is an. overall health optimizing tree n tira for back pain,,Wr,.-.,

Rheumatoid Artnritis, sports injuries, Asthma, TMJ .

How Do I schedule? A4

We mail the forms to you and you fill them out and return them to our office.

Once we receive them we will call on your insurahce and get your information entered intoour system..

You will then be called to set up your appointmeht.

I Appointments a dpnigre available in approximately 3-4 weeks deedn n your availabilityand Dr. Mercola's schedule.:

At the Optimal Weliness Center, you are treated as a Whole per'son and -

not just a symptom. Everyone'is committed to working With you to help.you achieve your goal of wellness.-

7. fybu areint~rested in~further-rihforniation:ptea~se'p5rovide us with the fdou '& 4o.. ,.and we will contadt you as soon as possible..

You can block and copy the following information into an email that will pop up after Youclick an sumnmer(Tmercola.com

Answer the questions and then send your email.

Name:How did you hear about our office?Address:City: State: Zip:Daytime Phone: -

When is the best time to call?

Please also indicate if you have read the entire new patient section and read the NutritlonHelo section? Yes or No

I understand, regardless of the reason for becoriing a patient, that I must agree to worktowards the guidelines as outlined in the Nutrition Help~section. Yes or No

Back to New Patient Information

)m atien Nutr i~ttiontHel Neswnhnzr

~pyrlght 1997-2001 by Joseph M. Mercola; DO. All Rights Reserved. This content may be copied in full, 'with copyright; contact;

on; and Linformation intact, without specific permission, when used only in a not-for-profit format. If any other use Is desired,

ssion In writing from Dr. Merciola Is requzired.

almer - Newsletters are based updn the opinions of Dr. Mercola. They are not intended to replace a one-on-one relationship with~a

led health care professional and they are not Intended as medical advice. They are intdeasahangfkolgendnation from the research and experience of Dr. Mercola and his community. Dr. Mercola encourages YOU to- make your; ownrwheatth,

decisions based upon your research and In partnership with a qualified health care professional.

0(C.0027


A 4 --- 7-7

MSPECIAL COMMUNICATION '

Assessment of Commercial Laboratories

Performing Hair Mineral AnalysisSharon Seidel, PhD Cotx al iea nlssi en sd by health care practitioners and pro-

Richard Kreutzer, MD moted by laboratdries as a clinical assessnient tool and to identify toxic exposures. de-

Daniel Smith, DrPH'. spite a 1985 study that found poor reliability for this test.-7Objective To asseisswhether the reliabilItyof data from commercIalaboratories ad.

Sandra McNeal, DVM vertising multimineral hair analyses, for nutritional or toxicity assessment has, Im-Debr Giliss MDproved sjnce the_1985 study.

S PUUC EALT OF]91A5 I:. of a single healthy volunteer was submitted for analysis to 6 comvnerdailrAS. laboraos-s,- ,,'

~a state health department, we tories, which analyze 90% of samples submitted for mineral analysis in the United States.

were asked by a local health .Main Outcome Measures Agreement 6f test results for each anaye laboatrA officer for assisrance with in- ytla rtoy

* tepreipg esuts fomhairtesing reference ranges, laboratory characteristics, and interpretation of health implications.

.perfcrned onresidents livingnuar ahaz- Results Laboratoryi differences in highest and lowest reported mineral concentrate.* adou wate ireo ases thir pe- tionsfdrthe splltsample exceededlo0-fold forl2 minerals.'and statistically significant~sure tometls.We wre urpise to (P<c05) extreme values were reported for 14 of the 31 mirnerals that were analyzeds

suesr tha an 2500h by 3 or more laboratories. Variations also were found in laboratory sample preparaw' ,9

lean hatanaverage of 250hartion methods and calibration standards. Laboratory designations of nocrmal reference!mineral tests costing $M:6 million are. ranges varied greatly, resulting in conflicting classifications (high, n~ormnal, or low) of.performedyearlyby9laboratoriesinthe nearly all analyzed minerals. Laboratories also provided conflicting .dietaryand nutri-United States (TABLEl1). Some of these tional supplement recommendations based on their results.laboratories included claims in their cli- Conclusions Hair mineral analysis fr om these laboratories was unreliable, and we.cnt brochures such as 'Hair element recommend that health care pracditoners. refrain from using such analyses to assess;analysis. can assist the physician with individual nutritional statujsor su~pected environmental exposures. Problems with thean early diagnosis of physiological dis- regulation and~certlflcation of these laboratories also should be addressed.orders associated with aberrations in es- JAM4A 2001 :28±67-72 www arnaaicni

seritial and toxic element metabolism'In 1985, Barrett' assessd the reliabil-

it'o omrca armnea etr- update Barrett's results. Hypothesizing by the amount of' scalp hair samplessItyo cdommecia thairt riepraltedt re- that there should be no significant varia- .available from the donor. Six laborato--els of most minerals varied considerably tions. between test results on scalp hair ries were selected, based first on labo-

saipe: yesg from a single donor, we performed a ratpry volume of hair analyses andbetween identical sgsmall e u- 1evaluauion of interlaboratory agree-:. second on lower sample weight require-gested that actions taken by the Fed- mn ro glbrtre urnl f et.Te6lbrtre ersn 0

* cral Trade Commission to bar.1 labora- mntaoglbrtrecurnlof met.Te6aoaoisrpeet90tory from making false claimnswould .fening these tests. -of analyses performed and a cross-make it "unlikely that any hair analysis METHODSsetofaatilmthduedbalwilladvrtis diectl totheidentified laboratories. Laboratory char-

laoaoyLaboratory Selection acteristics were identified from labora-public again,' and he encouraged addi- and Characteristics________________

tinloLaetct~tpoeth boratories were identified through Author Affilhatlons Impact Asessnient Inc. for thepublicBecause laboratory methods gern' California local health officers, other in- California Departmient of Health Servime. Envimc-erally have improved since 1985 and be. . etgtrth * adtel mental Health Investigators Branc. (Dr Seklet). and',

ves~iator, th Intrnet andthe abo-Catiforna Departrnent of Health Services. Envinrrn-cause Ath Clinicwal Labortor impr88 ove ratories themselves. A total of 9 US corn- mnental Health InvestigationsBrd.(nket.

Smith, McNeel. and G1111s). Oakland.menulte Actin(cUAas passeding 1988cde to. mercial laboratoriesvere identified that Corresponding Author and Reprinlt Sharon SeidelA

reuaeciia etnw eie o advertised hair mineral analysis-for PhD),CaflfomniaDepartirent of HealthServies. Envl-health asessment prposes. Te num-ronmentui Health Investigatons Brandh, 1515 Cay St.healtheassessmentopurposeseThe num- Suite 1700. Oakland, CA 94612 (e-mail: seiedet

Fo dtra omn ep8. ber of laboratories selected was limited odlhsn.gov).

02001 American Medical Association. All rights rcst (Reprinte4) JAmA. january 3. 200 1-.;Vol 285. No. I 6Et


HAIR ASSESSING MINERAL ANALYSIS

tory client brochures, Intrnetesites, and j'.<x' were treated as,x/2. Differences. ration. The number of hair elements' '

telephone interviews of laboraoroy per- among laboratories, adjusting for thi routinely ariilyzied ranged from 16 roq; 1sonnel. In the interviews, one author differences across elements, were ana- 39. Nineteen elements analyzed by alfP~; > xvi(iS..) asked the technical staff from lyzedbyFriedmananalysgsofvariance laboratories, except laboratroyl (Co,Ni,each laboratory a list oIT open-ended for randoniized blocks,' anonparam-et- and P were riot analyzed). included Al,questions about sample preparation and ric test that compares the ranking of: As, Ca, Cd.Co,.Cr, CujFe, Hg. K, Mg,analysis, data intretretatidn. and qual- each laboratory's vtiues across ele- Mnl, Mo, Na, Ni, P', Pb, Sc., and Zn."ity assurance/quality control' ments. Independence in a cross- Seven laboratories also. calculated a

classified 3 x6table was tested by Fisher number of hair Celement ratios" from..Specimen tireparatlon exact test,' using a search tree algoQ. measured element concentrations (eg,Hair wns.donated by 1 author, agener- rithm implemented in Stata.' The libo' sodiumi/potassium)..ally healthy. 40-year-old white woman, rattories' interpretationsbf health impli- Sbnme differenceswiere found in labo-with untreated brown hair.The hairwits cations were compared qualitatively. ratory samnpl preparation methods thatcut adjacent to the scalp from several at- REULS, cud1otriut to. observed differ-eas of the parietal-occipital regions, us- ences in results. Sample washing mneth-ingcensalesselsssr.aict Laboratory Charactenstcs ods varied greatly amnong laboratorie.rings measu ring 3.2cm. firom the scalp- Characteristics of all 9 identifi~d labo-- including laboratory A that dloes not

*2 eIvi b~dintittedlfiednt weiih .4,j,a ,'#. 4( .D.res~w~rim4tn fkrwshhaii-aples-at~l-Labor4gatoriesa ...t..#*mutrequired W.tad7rttAll'aboratonri~adverdsed~CblA~,eerwtnr.sed lihr~lamlculex.:J%

laboratory, from 0.2.5tol1.0g. Ones slit tification in their client brochures..Fol- emission or mass spectroscopy for mulof the hair sample was sent to each labror low-up with the-Health Care Firhanc- tiple element determination (Table 1).rat~ory, using the Mample envelope pro-. ing Administration (HCFA), .he agency The potential advantage of mass speer.vided by the laboratory. The proceduire that enforces CLIA, confirmed thai troscopy'is its lower limits of detec..was designedto address laboratory criri- laboratory B had misrepresented itself .tion."This may account for part of the-cisrns of the Barrett study,'-thar is, that as CLIA-cerrified. For the remaining variation in detection limits, for ex' . . . .

the hair came fromnmore than l donor, laboratories, CLIA certifications were amplelithium inlTABLE 2 nd TABL.E iit-was; not taken from the scalp; and it. typically in specialty areas, such as ,Laboratories varied.in their calibra-was up to 15.cm long, leadingrto non- chemnistryor toxicology. (There is no tion standards. Some laboratories used-

* homogeneity inflarretts pooled sarrple.: CILIA specialty area forbhair analysis.) only repeat analysis of in-house pooled.All laboratories required bait samnplem hair samples. Others purchased nonz

Comparison of Laboratory Results to be submitted under the signature of. hair mineral standards (fdr examiple~Each laboratory sent a report cobsist- a health care profeisiohal legally au- aqueous standards). Several7 laborato-ing of quantitative results and their thorized to request laboratory tests Cegi ries claimed the use 6f a Chinese com'interpretation of health implications;. a physician or chiropractor). mercial hair standard certified for upThe distributions of reported values for Cost for hair testing ranged fromn$30 to 17 elements.' At the time of this r&ceach element were rested for extreme to $69 per samtrple for a typical analy- port, there were no hair standards cr-~

* (outlier) values.1 Values,.rep6rted as sis, including the laboratory's interpre- tified for all elements analyzed by the

Table 1. Laboratory CharacteristicsSelected Laboratoriesj . Remaining Laboratorles;$

CharacteristIcs Ax .0 0E HI I

Licesed Practitone required yes Yes Yes . yes yes Yes - yes Yes Vesto sultnit satrrqles.-

*CUIA ceutication advertised Yes Yes Yes . Yes Yes .Yes Yes Yes Yes ....Cost to heith aeyepraCtftione.S 49 38 42 48 37 46 69 30 55Prornmilon or sale of brdanam Yes No No .No Yes Yes No ,Yes No

supplerw~tsAnaktkic rstrurTnentation AES AES Ms Ms AES AES AES AES MSHar samples. nnarI No./rro 2500 5co 4000 4000 4000 200D <1W0 1500 <100HairsarrPW -eIait.g . 1 or, 0.25 0.25 0.3 0.5. I 1JElemntfsanakyzad. No. 20 24 . 39 34. 35 .28 1 6 22 24.Elements ratios coaltted, No. .50 9 5 3 27 16 0 1 2- 0-CUA Ltcate CkncW Lae~fly hruorw Act; AES, Wit Sta POCIPOScoor. aid MS.ms 1`1!lwectroscopy.

tSdecte ua~~Os: USboratoin; sded bo our GWflS of split hit iarnbas.tRwrerov Iaaaoriet 0w fstuei entaitiI~ in en urgied Stim

68 JAMA. January 3. 2001-Vol 285. No. I (Reprinted) .02001 American Medical Association. All rights reservcd$'

-01 0029-


- H ~~SSESSING MINERAL ANALYSIS;', ::

.laboratories. Additionally, certified val- indicated that its reference ranges also, Hg, Mni, Mo, Pb, Na, Ni, and Sni). Out-,'ues of several elements in this commer- were based on an alder (unspecified) liers were identified In14 elements'high*cial hair standard eiceed, sometimes by study of 'healthy athletes.' As noted in value(s) as statistically significant.several-fold, the laboratories'.owntref- Table 2, irnerlaboratory differences int (PC.05) extreme values cotnpared with'4 t ,

erence ra es several cases are wide enough that the the same element from the'kiher labo.All laboratories identified a normal reference rauiges do not overlap. ratories. Laboratory B re ported ex

reference range for each analyzed .ele- trerne high values for 13 elementsandmenit. Table 2 summarizes the spread Comparison of Laboratory Results laboratories 0 and E each reported 2of reference ranges across laboratories Table 3 shows results of the split hair elements with extreme high values. Nofor the most commonly analyzed ele- sample submitted to the6iselected labb>- low values tested as significantl a-~ments. inrtelephone interviews 5 of the .ratoriia,for eekmensanalyzed bj3 or treme. focusing on the 19 elementsre.ti6bselected laboratories indicated their ref- more laboratories. Many repbrted val- ported by all selected laboratories, the'erence. ranges represented concentra- ues showed great differences. Twelve nonparametric Friedman analysis oftions round in approximately two thirds elerm.ntns with nonzero repcrted val- variance indicated a significant differ-

..oftheir population,conslstent with typi- ues have an order of magnitude or ence across laboiratorisP-<.OO1),pical clinical reporting methods. Laborar' greiter difference between the highest inarilj' because of laboratory B' s ax-.tory A, the -sixth selected laboratory, and lowest values (ieAs, Ba, B Co, Ge, .treme high values.

-Table 2' Reference Ranges for 31 Elements by..Laborator [.>.- . ,

. -~~~ . . ~~SewetedLab~irkorleW Rn~hgacu~l&- k.t

Element-At B C D0 E F G H IAkr~r. <9 8-28 <7 .. <8 . <10. <17 '<17 <8 <15

* Mtrnony NA NA <0.05 , <0.03 , <0.7 NA NA NA NA*Amenwc <4 0.4-2:8. <0.06 <0.1 <1 <1.12 <0.6 <2 <6Barkium NA N 0.6-3 <1.5 <4 . <4.43 M A NA <10Berylilms NA NA <0.02 .. NA -<0.04 <0.13 NA NA NABoron NA 10-36 0.3-2 ~77 1.1-3.5 0.4-2.6 0.1-4. NA NA. >. <100Cadmrurn. <0.3 0.2-1 <0.1 . <0.15 <0.4 <0.75 <4......<0.2> x <0.8Calci-xn . .280-800 400-800 300-1200 . 260-1130 . 280-560 220-160 200-20D 20D-750 20D.1000CIhvomnm ag-i.e. 0.4-0.8 0.2-04 0.65-1.55 0.3-1.3 0.01-0.63 0.1-4.1 0.2-0.5 0.2-3cobal 0.30.06 2.4-6 0.013-0.06 0.01.0.0 <0.1 0.02-0.45 NA - 01.5 .5-7

Copper 15-32 14-32 12-35 10.5-25 15-36 5;48-40 4-25 12-35. 7-40Germnawnx NA .0.4-2.4 0.D45-0.065 NA 0.2-0.4 .0.02-0O5 NA 0.1-5 NAlron - 21-46. 20-40 5.4-14 10-18 10-34 5.46-13.7 5-17 '3-15 .20-200

Lead . <8 2-20> <1. <0.8 <6 <5 <15 <3 <4Utltn, 1.25-3 NA 0.007-0.023 0.0035-0.025 <0.08 <0.53 NA 0.1408 <1lM~agnesimrr. 40-120 60,100 35-120 .31-92 40-80 20-130 15-130 25-115 28.100Manganese 1.2-2.4 0.6-1.8 0.15-065 0.08-0.29 0.7-2.5 .0.07-1 0.1-2.1 . 0.1-1U 0.2-4M bdttd&IrnT 0.6.1.7 1.2-4.4 0.028-0&056 0.04-0.102 0.02-006 . 0.02-1 0.02-0.49 0.1-1 . <1:5Mercury. <2 0.2-2.8 <1.1 <0.95 <1 < 1.3 < 1.5 <0.5 <1liNickel D.70-1.5 0.6-2.4 <0.4 <0.5 1-3 <1.1 - NA <0.5 . <5 -ti

Phiosphorus 130-190 120-180. 160-250 115-170 100-220 134-240 NA 7 .100-170 89-350~Potassium 50-180 30-160 8-38. 4-22 50-150 , 5-40 . 2-39 2-28 30-200Seleniumn 125-2.3 10-30 0.95-1.7 0.5-1.5 .0.4-1.2 .0.21-5.46 0.2-1:4 1-3 . 5-30Slier NA NA <0.15 <0.1- 0.1409 MA, NA NA MA ,Sodium 130-450 50-250 12-9O 6-50 . 120-360 10-130 15-150 10-50 50-350 ~ .

Strontksrn NA NA- 0.5-7.6 0.566 . 0.5-5.9 . 0.29-5.41 NA NA <3Sulliir NA NA 44 500-52 OO 4850D-55500 13200-43700 NA MA NA NATin NA 0.6-1.8 <0.3 . <0.25 0.3-2.1 NA NA NA NArtharUmi NA NA 'ci 0.45-1 0.3-3.7 NA NA NA NAVaniadium NA 0.4-1.2 0.018.0.065 0.014-0.08 0.02-0.1 0.01-0.55 NA 0.1-0.5 0.3-3Zinc . .140-260 140-220 140-220 . 105-173 13D-270 142.248 100-280 IOD-250 90-265'*Reference reign Iu 8011011 fl4y~ed or 3 a nnoe swedeti Ioaboneus Seacted ~ra US Iboratonjes ssece lor flyst ol we hr SWtOM. Rrnaiturvg lson,

toiles: etms iftn~l.d US WbOQUtaie; NA KC klates nn1 was ra n6YZe by latorBIy. Al vahts rWaf as porn . .

ITrwrisatec kma WgtahW daM PrOvO by l&atraroY.

02001 American Medical Associadlon. All rights nrservcd.- (Reprinted) JANLA, January 3. 2001-V~ol 285, No. 14O9t

LL0030O


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