However, there are some safety considerations, including the following: Use of an alternative approach to treat a life-threatening disorder that can be effectively treated conventionally (eg, meningitis, cancer) —perhaps the greatest risk of alternative medicine, rather than the risk of direct harm from a specific therapy Toxicity from certain botanical or supplement preparations (eg, hepatotoxicity from pyrrolizidine alkaloids, Atractylis gummifera, chaparral, germander, greater celandine, Jin Bu Huan, kava, pennyroyal, or others; nephrotoxicity from Aristolochia; adrenergic stimulation from ephedra) Contamination (eg, heavy metal contamination of some Chinese and Ayurvedic herbal preparations; contamination of other products, such as PC-SPES and some Chinese herbs, with other drugs) Interactions between CAM therapies (eg, botanicals, micronutrients, other dietary supplements) and other drugs (eg, induction of cytochrome P-450 [CYP3A4] enzymes by St John's wort, resulting in reduced activity of antiretrovirals, immunosuppressants, and other drugs), particularly when the drug has a narrow therapeutic index As with any physical manipulation of the body (including mainstream techniques such as physical therapy), injury (eg, nerve or cord damage due to spinal manipulation in patients at risk, bruising in patients with bleeding disorders) Current alerts about harmful dietary supplements are available at the FDA web site (Safety Alerts and Advisories).