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Urinary tract cancers related to use of adulterated Chinese formula

Cytoscopic examinations revealed a high incidence of urinary tract cancer in Belgians exposed to Aristolochia fangchi through consumption of Chinese weight-loss pills. The 39 people studied all had end-stage renal nephropathy caused by consumption of the adulterated Chinese formula and agreed to the cancer screening as a preventive measure. Among the patients, the researchers detected 18 cases of urothelial carcinoma; 17 cases of cancer of the ureter, renal pelvis, or both; and one papillary bladder tumor. Nineteen of the remaining participants displayed mild-to-moderate urothelial dysplasia, and two were normal. Total consumption of more than 200 g Aristolochia over time was associated with significantly higher cancer risk. The presence of Aristolochia fangchi in the Chinese formula is believed to be due to a manufacturing error in which the toxic herb was accidentally substituted for Stephania tetrandi. In an editorial published in the same issue of New England Journal of Medicine as the study, former FDA chief David Kessler admonished, "Examples like that described by Nortier et al. should persuade Congress to change the law to ensure the safety and efficacy of dietary supplements before more people are harmed." Nortier JL, Martinez M-C, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). New England Journal of Medicine 2000; 342: 1686-1743.

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