In Reply: We endorse the call by Drs Mao and Desai for rigorous pharmacoepidemiology studies of Ayurvedic medicine use. We speculate that the use of Ayurvedic medicines, particularly those deliberately containing metals, is an independent risk factor for elevated toxic metal burdens. Measuring appropriate biomarkers of lead, mercury, and arsenic and controlling for important covariates of exposure (eg, occupation, air and water metal concentrations, micronutrient status) should be done. Special attention should be given to vulnerable populations, including pregnant and lactating women, children, and workers involved in the manufacture of Ayurvedic medicines.
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