From Abracadabra to Zombies
reader comments: chelation therapy
26 Oct 1997
The Skeptics Dictionary is very necessary and contains some good information about all forms of medicine etc. The only problem I see is that there is no critical overview given about CABGS and angioplasty, it is assumed that these are THE standard of care for ASHD, and are in the neighborhood of 90% curative.
reply: Who assumes that bypass surgery or angioplasty are 90% curative? This seems rather high to me, but you may be right. The "standard treatment" for vascular diseases would depend, I would assume, on the condition of the patient and would be determined by the physician. You make it sound like anyone with a vascular problem will be advised to have bypass surgery or angioplasty. You're creating a straw man argument by distorting the practice of "standard" medicine to make it appear foolish.
The very arguments presented against chelation therapy can be used against bypass surgery and angioplasty, i.e. double blind, cross- over, placebo controlled studies have not been done. If these studies have been done, might we be given same?
reply: I would assume that you know the purpose of control studies: to test causal hypotheses. Your comparison of chelation therapy to bypass surgery and angioplasty is a false analogy. You ought to compare it to a new form of chemotherapy, whose causal efficacy is in question. As a physician, I imagine you are familiar with the setting of broken bones. Are you troubled that there are no double-blind, cross-over, placebo controlled studies showing that people with broken bones are more likely to heal better than those whose bones are not set? If there is no good reason to suspect causal efficacy, tests of causal hypotheses are unnecessary. Our knowledge and experience, including that gained from experimentation on animals, as well as basic knowledge of physiology, anatomy, biochemistry, etc., often provide sufficient evidence for establishing the reasonableness of certain medical procedures. I assume, as a physician and as someone with some scientific training, that you are well aware of this and bring up the false analogy in order to enhance your straw man caricature of "standard" medicine.
It is stated that Medicare does not pay for chelation therapy, but nowhere does it mention that Aetna does pay. John Hancock insurance also pays for CT. Would it be possible for you to tell the public why these companies pay for the therapy?
reply: I can't answer for the insurance companies, but I can tell you why I would pay for chelation therapy if I were an insurance company: it would save me bundles of money. I would much rather have my clients choosing a cheaper therapy. However, I wouldn't sell these same people life insurance.
A discussion of mortality statistics for these forms of therapy would also be of great benefit, as well as costs for them.
reply: in theory this sounds reasonable, but before mortality statistics for two therapies should be compared, it would have to be established that the patients receiving the therapies were very, very similar. This may be easy to do in terms of age, gender, weight, smoking, etc., but may not be feasible in terms of general health or actual state of disease. I would like to see a study with a large number of patients involved which takes patients recommended for a bypass and divides them into two groups: those who refuse the bypass and go for chelation therapy and those who have the bypass. If the groups were large enough, studying their mortality figures would be very useful. I think it would be ethical as well, since the only patients one would send for chelation would be those who refused surgery. Maybe someday such a study will be done.
Ask physicians who have used chelation therapy about their results, not people who have only read about it or heard about it, but ask those who have actually experienced the use of it. All that is asked, is, be fair, leave off the hype (both sides), and the talk of "bozoid" therapies etc. It is my belief that this therapy is headed for universal approval very soon. Chelation therapy does indeed work, albeit much to the chagrin of the scalpel & balloon proponents, not that they aren't needed, they are, just not as first line therapy.
reply: I have read material from physicians who use chelation therapy and I am not as convinced as they are of their results. Their scientific studies are not well conducted. Their anecdotes are not scientific evidence, their correlations often illusory.
Here is something to ponder, if CT does work 90% of the time, and is used first, before cabgs, then cabgs would drop in this country from $30 Billion / yr. to $3 Billion/ yr. Is it not reasonable to think that the loss of $27 Billion / yr. would affect the thinking of most? What is the saying? Money talks?
Ron Davis, M.D.
reply: $30 billion!! I don't know where you got your numbers but I can see why you would like some of that CABGS money thrown your way. As Sen. Dirkson once said, a billion here, a billion there, pretty soon it adds up to a lot of money!
17 Jul 1996
Just a clarification for your edification... Chelation is a chemical process by which a large molecule such as EDTA binds smaller minerals. The form of the chelating agent can be designed to bind various valences (e.g. calcium ions carry a charge of +2 and are easily bound by disodium EDTA as is Lead). The substances chelating agents bind must inherently be in solution, for they only bind ionized or solubalized substances. Therefore, it seems rather bizarre that anyone should claim EDTA can bind a precipitate such as a cholesterol plaque. (Cholesterol is a lipid... thus.... nonionic, carrying no charge, thus not bound by a chelating agent)
--S. Durrenberger MD, also registered Pharmacist
reply: it may seem bizarre to you and me, but one common feature
of alternative health practitioners is that they have some bizarre ideas
about science. One common theme is belief in notions which ignore established
scientific facts and theories.
28 Jul 1996
I have enjoyed your Skeptic's Dictionary. I have used your resources with some of my patients. I am an internist at a rural hospital in upstate NY. I found your piece on chelation a nice concise view--as a skeptic would see it. The new addendum by S. Durrenberger MD, however, changed the article from being skeptical to bizarre.
At our hospital we are investigating the concept of Complementary and Alternative Medicine Program and I have been getting material for presentation to the Medical Staff. Nowhere in the all the readings of Free Radical pathology, anti oxidation, and chelation literature did I come across claims that EDTA can bind a precipitate such as a cholesterol plaque.
[The writer recommends:
"Free Radical Pathology in Age-Associated Diseases: Treatment with EDTA Chelation, Nutrition and Antioxidants," JOURNAL OF ADVANCEMENT IN MEDICINE, vol. 2, Nos. 1,2, spring/summer 1989 by E.M.Cranton, J.P.Frackelton. This issue is in print and available through Human Science Press, inc., 233 Spring Street, New York, NY 10013-1578.]
Before you post any other assumption you owe it to your readers to check the sources. In the world of innovation it is easy to slip from innovative therapies to snake oil. Also beware it is just as easy or more easy to be myopic and prejudicial with rhetoric of a skeptic to mask the deception. Please accept this critical analysis in the spirit it is given.
My respects to you for tackling a large field.
All the best and I hope to benefit by your dictionary.
reply: I think my readers are intelligent enough to know that what
is printed as a reader comment is to be read just as critically as anything
I write. I hope no one reads this or any other material on these subjects
thinking that someone else has done all the checking on sources so they
don't have to think about it.
15 Nov 1996
Two years ago my mother, age 85, went to a doctor for an analysis of a problem with her feet. She had developed horrible open sores all around her toes. The physician determined that she had no pulse or circulation in her lower legs and feet, had gangrene, and said that the only solution was amputation of both legs.
My sister and I went for a second opinion. We went to a physician who used chelation therapy in his practice. After a consultation, we permitted him to started chelation intravenous feedings immediately, twice a week at first, then once a week for about three months. Very soon we saw results. First a pulse returned, then color returned, the sores started to heal, then the gangrene disappeared. My mother's complexion improved significantly, she started feeling healthier than she had felt in years. Her hair became so dense that my sister had trouble cutting it. Now, two years later, when my sister and she go to the mall, my sister (age 45) gets tired before my mother (age 85).
The bottom line is that the licensed physician who used chelation is the healer. The licensed physician who recommended amputation is terribly ignorant, he is the snake oil practitioner. But they both are licensed physicians. What do they call the student who graduates at the bottom of the class in medical school? Doctor!
p.s. The cost of the chelation therapy was $3,000, paid for out of her savings. Medicare would have paid for the amputations.
2 Dec 96
Just a short clarification: the "claw" that chelation refers to in its Greek roots is seen in the shape of the molecule. Unfortunately, I can't represent it real well with this simple text editor, but it does look like a crab's claw. That is also how it works. Ionic (i.e., atoms with an electric charge) atoms can be held in the cage and transported around.
EDTA does work real well in a chemistry reaction in a test tube. But there are hundreds of thousands of reactions that work in a test tube and not the human body.
It's most unfortunate that test tube reactions can't be easily done in the body. It would be so much easier to develop all sorts of medications.
And as has already been pointed out, cholesterol and plaque are non-ionic
molecules. They cannot be chelated.
03 Jun 1997
I am pleased to see the issue openly discussed. As a cardiologist in an open-minded research environment (Johns Hopkins) we welcome new ideas and concepts, but those ideas must then be tested both by the originators and by independent centers as well. ONE MUST NOT ACCEPT ANECDOTES TO ALTER THE PRACTICE OF MEDICINE. Let me explain: If upon leaving my home each morning, I first walked around the fire hydrant three times before getting into my car to drive to work, I might then make some observations. If after six months of this repetitive behavior I never had a car accident (and I never even came close), I might conclude that walking around the fire hydrant three times prevents automobile accidents. Clearly this is ludicrous as the entire world knows you only have to walk around fire hydrants TWICE to prevent car accidents. (Facetious, of course!)
Testimonials are useful for sales and marketing, but they have no place in a dispassionate scientific evaluation.
The data on Chelation Therapy emphatically demonstrates NO VALUE WHATSOEVER! I urge the strongest caution in evaluating the training, credibility, licensing and disciplinary record of those who are "Marketing" such therapy. I urge your readers further caution regarding any practitioner from any discipline who is more involved in the business of medicine, rather than in the practice of same.
With the managed care and cost considerations of 1997 medicine, if insurance companies had one iota of credible evidence that this therapy could prevent expensive surgery ( Carotid Endartarectomy, Coronary Artery Bypass, or Aorto-Femoral Bypass) or even treat or prevent heart attacks, strokes or prevent additional hospitalizations, they would be first in line to do so! They emphatically are not! No company pays for chelation therapy because it doesn't work for cardiovascular disease. Its only clinical utility is in the treatment of lead poisoning.
CAVEAT EMPTOR! (Let The Buyer Beware!)
I would be pleased to entertain questions or comments, and thank
you for your attention.
David A. Meyerson, M.D.
Cardiology - Johns Hopkins