Thesis
Black Salve Use and its Propensity to Cause Harm
Southern Cross University
Doctor of Philosophy (PhD), Southern Cross University
2023
DOI:
https://doi.org/10.25918/thesis.296
Appears in Recent Faculty of Health Publications
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Abstract
Introduction: Black salve is a controversial complementary and alternative medicine that has been in clinical use since the 1850s. Despite case reports of excessive tissue necrosis, deformity, and skin cancer treatment failures resulting in death, black salve has been minimally studied. The aim of this thesis was to assess the risk of harm black salve poses to patients by quantitatively assessing commercially available black salve, determining whether black salve constituents possess synergistic cytotoxicity, and investigating the pathology outcomes of patients’ black salve treatment sites.
Methods: HPLC-MS and ICP-MS analysis was conducted on 13 black salve products from eight manufacturers. Synergistic cytotoxicity of black salve constituents was assessed using Resazurin assays in the A375 melanoma and A431 squamous cell carcinoma cell lines. A national five-year retrospective pathology case series of black salve treatment sites was undertaken.
Results: Black salve products contained exceedingly high concentrations of cytotoxic alkaloids, with some products having sanguinarine concentrations 900 times greater than the IC50 of normal human epidermal keratinocytes. High concentrations of zinc chloride are present in black salve, refuting claims that they are natural therapies, and the detection of heavy metal contamination that suggests failures in the safety of their manufacturing processes. The alkaloids present in black salve were found to possess synergistic cytotoxicity, suggesting an assessment of individual alkaloid levels may underestimate the potential for tissue necrosis. Black salve’s in vivo effects were also assessed in the largest case series of black salve outcomes ever reported. Assessing the pathology records of 475 black salve treatment sites from 409 patients, it was discovered that persisting skin cancer was present in 28.8% of patients. Patients from rural areas were overrepresented in the black salve treatment group. Concerningly, the rate of black salve pathology presentations had doubled over the five-year period of the study.
Discussion: These findings have substantive public health implications and suggest that current strategies for reducing the use of black salve are failing. Equipped with a greater understanding of black salve’s composition and the high failure rate in those presenting for treatment site review, clinicians may be more effective at discussing the risks of black salve with their patients, while regulators may be prompted to reassess their current approach.
Details
- Title
- Black Salve Use and its Propensity to Cause Harm
- Creators
- Andy Croaker
- Contributors
- Stephen Myers (Supervisor) - Southern Cross UniversityBen Liu (Supervisor) - Southern Cross UniversityGraham King (Supervisor) - Southern Cross UniversityShailendra Anoopkumar-Dukie (Supervisor) - Southern Cross UniversityJohn H Pyne (Supervisor) - Southern Cross University
- Awarding Institution
- Southern Cross University; Doctor of Philosophy (PhD)
- Theses
- Doctor of Philosophy (PhD), Southern Cross University
- Publisher
- Southern Cross University
- Number of pages
- xvii, 369
- Identifiers
- 991013135807002368
- Copyright
- © A Croaker 2023
- Academic Unit
- Faculty of Health
- Resource Type
- Thesis