CLINICAL MATTERS

The popularity of intravenous medications for beauty enhancement illustrates how our country still has a long way to go in terms of following sound, evidence-based medicine. Despite no compelling evidence that intravenous vitamins in otherwise healthy individuals is of any medical benefit, many people continue to take these pseudoscientific treatments along with other sketchy supplements. Sadly, there are many healthcare professionals who, having set aside their Hippocratic oath, peddle such dubious medications for profit. 

Despite repeated efforts by the FDA and the Department of Health to crack down on some of these purported “health and wellness” clinics and spas, many people continue to patronize these establishments. Misled by paid testimonials touting unrealistic and improbable results, there are those who are so desperate to cosmetically enhance their appearance and look like the latest trendy influencers that they will believe and try anything. Unfortunately, some of those who avail of these unauthorized and downright dangerous treatments end up paying for it with their lives.

The intravenous route is usually a last resort for giving any kind of medication. While home intravenous infusions are being used more often for long term antibiotics and for nutritional upbuilding in chronically ill individuals, these procedures are only recommended when medically necessary and when there is no other reasonable choice. Rapid intravenous hydration of people dehydrated from severe diarrhea or vomiting can be lifesaving but should probably occur with close medical supervision and in a hospital or emergency room setting. Intravenous infusion of any drug carries many risks, some of which may be fatal. 

The act of accessing the bloodstream through a vein increases the risk of bacteria and other pathogens entering the body, especially if sterile procedures are not properly followed. A direct route to the bloodstream for these bugs when proper aseptic technique is not followed can result in overwhelming infection which can be fatal. Moreover, the infusion of nutrients which the bacteria can easily grow in further increases the risk of overwhelming infection if proper measures are not taken. 

The drugs being infused need to be exceedingly pure and sterile and should not contain any impurities. Unauthorized drugs sourced from the black market may be fake or adulterated. Infusion of cocktails of chemicals can cause a severe allergic reaction and long-term health consequences. For instance, some fake vials contain talcum powder, which when infused into a vein deposits in different parts of the body, causing scarring and organ malfunction. Vitamin A in large doses can accumulate in different organs and lead to poisoning.

Improper infusion techniques can lead to cardiac arrest from air embolism and cause other complications. A big volume of air inadvertently introduced into the vein interrupts the flow of blood to vital organs and can cause organ failure. Another potential complication is excessive bleeding from the puncture site, especially if someone is on blood thinners. The infused agents can also interact with drugs that someone may be taking for medical problems and cause severe side effects.

What is particularly troubling is that many of the people who promote and take unproven medications are the same people who attack scientifically sound and safe interventions such as vaccines. While many of these so-called advocates for natural immunity conflate miniscule side effects and adverse events from the vaccine trials involving thousands of patients, they are sometimes the first to push unproven treatments which are known to be hazardous to health. For instance, many anti-vaxxer groups deceptively decried mRNA vaccines as unsafe while pushing alarmingly high and toxic doses of ivermectin for prevention of Covid-19. There is no compelling evidence that ivermectin at any dose can prevent or cure Covid-19, while vaccines have clearly saved millions of lives. There is so much intellectual disconnect between these arguments that one has to suspect that there are other ulterior motives, such as for profit, from the proponents of these harmful treatments.

Compounding the problem is the promotion of these unsafe treatments on social media. Many businesses employ celebrities and influencers to promote their products, even if these products have no real scientific evidence supporting their efficacy. Worse, the lack of evidence makes these companies use misleading and dubious testimonials with absolutely no way to check the veracity of the information.

The government needs to do better in enforcing the current rules and it must try to close regulatory loopholes. In the case of intravenous infusion, only licensed clinics or hospitals should be allowed to administer medications under strict medical supervision and with clear, evidence-based indications. Another part of the problem is that off-label use is being abused for non-medical indications. Off-label use, where a drug that has a regulatory indication for one use but is used for another purpose is typically left to the discretion of doctors since sometimes new evidence for efficacy is generated and it takes a while to make its way into the regulatory language. Unfortunately, this is also used to administer drugs like IV glutathione for cosmetic whitening when the only approved indication for glutathione is to reduce the toxicity of certain types of chemotherapy. It is never a good idea to legislate the practice of medicine since it is a very dynamic field, but professional societies and regulatory boards should have more power to exact accountability among its members who deviate from evidence-based practice.

One of my pharmacology and toxicology teachers once quipped in class that the only difference between a drug and a poison is the dose. It sounds extreme, but there is a lot of wisdom in that quote. For instance, even water can be deadly if there is too much of it—you can drown. Oral medications are one thing, but infusing the wrong drug at the wrong dose via the intravenous route exponentially increases the dangers of a bad outcome. When properly done, intravenous treatment has saved countless lives. In the wrong hands, it can kill.