Saturday, June 25, 2005

On the uselessness of chelation therapy for autism

In my recent blog frenzy (1, 2, 3, 4) about thimerosal in vaccines and autism brought to the forefront by RFK Jr.'s deceptive and biased article, Deadly Immunity, a fair number of comments and e-mails came up about whether chelation therapy is useful in treating autism. In this regard, there is no evidence whatsoever that it does any good or improves the symptoms of autism. However, there are parents out there who are utterly convinced that it helped their child enormously. Such cases are hard to deal with for the simple reason that no matter how much you point out that it is mechanistically implausible for chelation therapy should help autism or ASDs and that there is no evidence that it does anything good whatsoever for these neurodevelopmental disorders, they tend to remain utterly convinced that it helped their children. And, because the nature of medicine and science is such that impossible ever to prove a negative, you can never rule out 100% that chelation may have helped in this one case, chelation therapy lives on, and the quacks continue to profit off of preying upon the hopes of desperate parents who want to do something to help their children.

As dubious as intravenous chelation therapy is for autism, though, there is a newer form of "chelation therapy" that is even more dubious. That is the so-called "transdermal" chelation therapy championed by Dr. Rashid Buttar (what an utterly appropriate name, given that it's been called the "Buttar treatment," and the cream could be said to look a bit like butter). Dr. Buttar claims that TD-DPMS can do wonders for autism. Unfortunately, he presents no data. He can't even present pharmacokinetic data to show that the active chelating agent is actually absorbed through the skin in sufficient quantities to chelate anything. Yet he treats children with it.

Fortunately, Kevin Leitch is on the case, writing this fantastically sarcastic letter to Dr. Rashid Buttar. Money quote:
Such an important scientist as yourself must surely have peers flocking to review your work. As such an august scientist you are no doubt aware of the most basic scientific precept of subjecting your scientific work for review so that others may critically appraise your work and replicate it. I was surprised therefore to discover that a search of www.pubmed.gov – the site that lists all scientific articles in peer-reviewed scientific literature – and found nothing when searching for ‘Rashid Buttar’. Did you submit your thesis under a pseudonym perhaps? I’m positive this must be an oversight and that the safety and efficacy of a product that you regularly use on children has been regularly tested and re-tested by both yourself and your peers as to do otherwise is tantamount to admitting one is afraid to submit one’s work for peer review – I’m certain that can’t be the case for you!
Alas, such is not the case. Perhaps Dr. Buttar will use the "too busy taking care of patients to get published" excuse that alties frequently use. I wish I could get away with that one when I come up for my yearly review. Somehow, I don't think my division chief would buy it.

22 example(s) of insolence returned:


At 6/25/2005 12:24 AM, Blogger Prometheus said...

Not only has Butthar's Butter not been demonstrated to be effective for autism, it probably isn't even absorbed through the skin. DMPS (di-mercaptopropane-1-sulfonate) is a polar, easily ionized molecule and, as such will not readily diffuse through the skin. Drugs that are successfully adminstered transdermally are highly fat-soluble (e.g. estrogen, fentanyl, nicotine) - DMPS is not.

It is interesting to note that one claim Dr. Butthar has NOT made is that the DMPS these hapless parents are smearing on their kids is being absorbed. Funny, since that would be very easy to test by measuring the amount of DMPS excreted in the urine after using the cream. The cynic within me (a part of me that just keeps on growing) says that the reason he hasn't done this simple test is that he knows what the answer will be.

In the absence of data to the contrary, it has to be assumed that DMPS cannot be absorbed through the skin and Dr. Butthar's Butter is doubly useless. Not only has DMPS never been shown to help autism, it hasn't even been shown to be absorbed through the skin.

Prometheus

 

At 6/25/2005 2:19 AM, Anonymous HCN said...

Okay, now all together now:

BUTTAR CREAM !!!

I am assuming most of you are not gastronauts (definition: foodie folk... people who like to cook and EAT!). Buttercream is a type of cake frosting that is made with butter, powdered sugar with (if you want it REAllY good!) egg or egg white as an emulsifier.

From Google:
http://www.cooks.com/rec/search/0,1-0,vanilla_buttercream_frosting,FF.html

or
http://www.cooksrecipes.com/cake/best_buttercream_frosting_recipe.html

 

At 6/25/2005 2:36 AM, Anonymous ebohlman said...

prometheus mentioned attempting to measure the amount of DMPS excreted in the urine after using Buttar's cream. I remember reading somewhere (sorry, I can't remember where) that one of the parents who were big supporters of Buttar felt that his cream was working better than the previous method of administering DMPS because, get this, their kid's urine stopped stinking when they switched! (DMPS excreted in the urine is very smelly) Translation: it wasn't getting absorbed, but then "absorbed" has a completely different meaning in the Altiverse than it does in the reality-based community (I love vitamin promos that claim that their products are "better absorbed" and therefore don't turn your urine yellow).

 

At 6/25/2005 3:29 AM, Anonymous Michelle Dawson said...

Very competent NYT mercury autism article http://www.nytimes.com/2005/06/25/science/25autism.html in which there are "cures":

"In one case, a doctor forced children to sit in a 160-degree sauna, swallow 60 to 70 supplements a day and have so much blood drawn that one child passed out."

and Geiers:

"Dr. Geier has called the use of thimerosal in vaccines the world's "greatest catastrophe that's ever happened, regardless of cause."
"He and his son live and work in a two-story house in suburban Maryland. Past the kitchen and down the stairs is a room with cast-off, unplugged laboratory equipment, wall-to-wall carpeting and faux wood paneling that Dr. Geier calls "a world-class lab - every bit as good as anything at N.I.H.""

and threats:

"Another e-mail message, sent to the C.D.C. on Aug. 20, said, "I'd like to know how you people sleep straight in bed at night knowing all the lies you tell & the lives you know full well you destroy with the poisons you push & protect with your lies." Lynn Redwood of SafeMinds said that such e-mail messages did not represent her organization or other advocacy groups."

Oh, of course.

 

At 6/25/2005 3:56 AM, Blogger Autism Diva said...

Dr. Rashid "Butter wouldn't melt in his mouth" Buttar, sigh.

What a man.

He can cure a girl's cellulite with mesotherapy and then cure her sugar daddy of middle-aged saggy muscles (with transdermal growth hormone?) and then cure her aunt Matilda's advanced lung cancer also with chelation and vitamins and intervenous ozone or something, and then cure granny's Alzheimer's. And after all that -- cure her nephew of autism. You can get it all conveniently on one bill.

And then he can sell you a water purifier.

Does anyone know how expensive it would be to test for dmps in urine? Like: if a person were to go for something a little more scientific than the sniff test?

Autism Diva would gladly be a guinea pig for this experiment.

It's really funny how the chelation crew have this idea of what goes in and out of skin. Autism Diva read 2 posts to the autismmercury Yahoo! group where people were discussing whether or not the little black flecks left in the bathtub after a soak in a miracle chelating bath product were mercury that had been pulled from the bather. Why black flecks? Why not little silver globs?

 

At 6/25/2005 4:05 AM, Anonymous Anonymous said...

today's NYT article that Michelle Dawson referred to.

money quote: a Dr John Laddler says powdered Rhino horn cures autism... the rhinos are in even greater danger now.

Something like that... :-)

Experts reject some therapies:

"Practitioners are using nutritional supplements, sauna baths and powerful "detoxification" drugs to treat autism in the belief that it is caused by thimerosal, a vaccine preservative that contains mercury. But health experts say such therapies are not effective and can be harmful.

Dr. Susan Swedo of the National Institutes of Mental Health said the use of drugs to remove metals from the body, called chelation, could cause liver and kidney damage and other problems.

It "isn't responsible to prescribe" chelation for autism, Dr. Swedo said.

Chelation is approved by federal drug regulators only after blood tests confirm acute heavy-metal poisoning. Yet some doctors say they skip the tests for autistic children.

"We try not to waste people's money on tests," said Dr. John Kucera, a physician in private practice in Colorado Springs. "Some are of the opinion that everyone deserves a chance at chelation therapy whether they show the signs or not."

One of the first to advocate treating autism with chelation and other therapies was Dr. Stephen Edelson of Atlanta.

Dr. Edelson said in an interview that he stopped practicing medicine last year after the state medical board censured him for abusing prescription drugs and parents filed lawsuits contending that their children had regressed under his care.

Dr. Edelson said he placed children in 160-degree saunas as part of their treatment. Some children fought to get out of the sauna and kicked out its window, an assistant said in a sworn statement.

The doctor said he also used chelation and prescribed 60 to 70 supplements a day, causing some children to vomit. Children had so much blood taken for tests - often 20 vials in a sitting - that one child passed out, a parent claimed in a lawsuit.

But many parents are desperate. Dr. Jim Laidler, an anesthesiologist in Portland, Ore., said that after he learned that his two sons had autism, "if someone had e-mailed me that powdered rhino horn worked, I would have gone off on safari."

Dr. Laidler said he and his wife decided to try a restricted diet, nutritional supplements and chelation.

But he said that his wife secretly stopped the treatments and waited to see if he noticed a difference. He did not. The children's behavior worsened and improved independent of the therapies.

Dr. Laidler now thinks that most such therapies are harmful.

"These parents are addicted to hope," he said. "They need it to survive, and there are people who are willing to sell it to them." "

 

At 6/25/2005 3:32 PM, Anonymous HCN said...

Actually Michelle was referring to a different article in NY Times. It is a three page article (I have no idea the url tags work!):
http://www.nytimes.com/2005/06/25/science/25autism.html

Note that the last part of the URL is "25autism", not "25treat"

 

At 6/25/2005 3:52 PM, Anonymous Anonymous said...

Oh,

There were 2 articles!

Apparently, Dr. Laddler didn't get into the other one. The Geier's did though. So cute.

Tweedle-Dum comes to mind for some reason when I think of Dr. Mark Geier.

I don't have an Alice in Wonderland character for his son.

Maybe the mock turtle?

According to someone who claims to have met her... the Baton Rouge, Lousisiana, doctor who was told by a Catholic priest that it was vaccines that cause autism and that god told him so -- is Dr. Stephanie Cave.

She asked the priest. . . "what is it in the vaccines that is causing autism?" --it's sad that "god" didn't tell the priest, because if he had said, "measles" well we wouldn't be wasting all our time on mercury!

The priest said, "god says you'll figure it out . . .", or words to that effect. Now, if we can only get Paul Offit to go to a priest and ask him to get a message from god saying that it's not thimerosal . . .

 

At 6/26/2005 10:00 AM, Blogger James said...

Since it's a source of a little bit of confusion here, specifically for me, I'd like to point out the following:

"money quote: a Dr John Laddler says powdered Rhino horn cures autism... the rhinos are in even greater danger now."

Laddler is actually Laidler, who's quoted later in the same post saying:

"But many parents are desperate. Dr. Jim Laidler, an anesthesiologist in Portland, Ore., said that after he learned that his two sons had autism, "if someone had e-mailed me that powdered rhino horn worked, I would have gone off on safari."

and at the end:

"These parents are addicted to hope," he said. "They need it to survive, and there are people who are willing to sell it to them."

So there's no Laddler advocating rhino horn, and Laidler is in agreement that there are fallacious "therapies" out there which doctors and whomever are using to take advantage of parental desperation. I only bring this up because a "Laddler" has been mention in two posts and from what I've been reading in the Times, etc., I'm reasonably certain that this is a misspelling and that no one has stated anything about the efficacy of rhino horn, though likely rhinos are in trouble because someone facetiously did mention them in the Times.

 

At 6/26/2005 3:29 PM, Anonymous Anonymous said...

Anonymous made a spelling error... he did quote the entire NY Times article that mentions Dr. Laidler.

Dr. Laidler is in charge of the http://www.autism-watch.org/ webpage, he posts frequently on the Healthfraud listserv, he has commented on one of Orac's postings earlier this week... and he has discussed his time as a parent trying everything here:
http://www.autism-watch.org/about/bio2.shtml

 

At 6/26/2005 3:30 PM, Anonymous HCN said...

Oops, forgot sign myself in for consistency... I wrote the above.

HCN

 

At 6/27/2005 9:27 AM, Anonymous Anonymous said...

Actually, if one were to try chelation therapy, IV glutathione followed by a fecal metal test would be the preferred method.

 

At 6/27/2005 11:09 AM, Blogger Prometheus said...

A couple of points about the comment above (by Anonymous, natch).

[1] Glutathione is not a chelating agent, it is an anti-oxidant - one of many produced by mammalian cells. It has no specific affinity for mercury or other metals.

[2] The "fecal metals test" is worthless. Mercury or other metals in the feces come from two (2) sources:

[a] Metals ingested and not absorbed
[b] Metals excreted in the bile

Unless you can control for [a], which is possible but requires a formal research laboratory kitchen, you have no way of knowing [b]. The "fecal metals test" is almost diagnostic of quackery, since it inevitably gives higher numbers than actual net metal excretion.

Also, the labs that do these tests are "maximizing their profits" by lumping several tests together and charging a very high fee. Most people who are scurrying to do these tests are interested in, at most, two or three metals (mercury, lead, cadmium) but are forced to pay an exorbitant fee for ten or twenty tests. These test, by the way, if they are done on a ICP-MS (as many advertise) will yield all ten or twenty results on one pass, so it costs the lab as much to test for twenty metals as it does to test for one.

This "panel" of metals results allows unscrupulous or ill-informed medical practitioners to "fish" for a high result in order to justify their treatment of choice - "Ah, you see Mr. Jones, little Johnny doesn't have high mercury, but his aluminum is off the scale. We need to treat this with my patented chelating butter."

Finally, fecal metal results are not "normed" - meaning that the results have not been validated by testing a large group of "normal", "healthy" people (however you might define those terms) of a variety of ages in a variety of locations. In addition, the "normal range" reported is often only one standard deviation from the the mean, instead of the more accepted two standard deviations. This means that, instead of 5% of "normal" people having false-positive results, over 25% of "nrmal" people will have results that are in the "abnormal" range.

Caveat emptor.

Prometheus

 

At 7/05/2005 8:17 AM, Anonymous Anonymous said...

Dr Buttar cured his son, he formulated this cream for him.

 

At 7/05/2005 9:08 AM, Blogger Orac said...

You wouldn't happen to have any scientifically verifiable evidence to support that claim, would you?

I didn't think you did.

 

At 7/20/2005 12:45 PM, Anonymous Anonymous said...

As the parent of a little boy with autism, I can identify with the desperation of the parents who have chosen to use chelation for their kids. I suppose most of your vitriol is reserved for doctors who may be using dubious treatment, but I can't help but feel that some of your scorn is directed at the parents too. Sarcasm is easy and cheap. However, if you have suggestions for other, more reputable therapies, please let us know.

 

At 7/20/2005 1:02 PM, Blogger Orac said...

Please don't misunderstand my scorn as being directed at the parents. My scorn is directed at the quacks who take advantage of the natural desire (and in some cases desperation) of parents to do something for their autistic children to sell them expensive and ineffective therapies. The reason they can do it is because at present there is no effective therapy that reverses autism.

 

At 7/26/2005 10:36 PM, Anonymous Anonymous said...

Prometheus-

Is there any test which accurately measures heavy metal excretion from the body? Maybe urine?

Thanks in advance for your response.

 

At 7/26/2005 10:37 PM, Blogger Jim said...

Prometheus-

Is there any test which accurately measures the amount of mercury being excreted from the body? A urine test possibly?

Thanks in advance.

 

At 7/28/2005 3:05 AM, Anonymous HCN said...

Read:
http://www.neurodiversity.com/chelation.html

 

At 7/28/2005 9:12 AM, Blogger Jim said...

Thanks for the link. Some very good information. I am still looking for an answer as to whether any effective test can be done to measure excreted mercury. Anyone?

 

At 7/28/2005 3:59 PM, Anonymous HCN said...

Try at www.medlineplus.gov -- put in a search term like mercury, etc. OR... call up a hospital local to you (note that Dr. Laidler says that many have labs that do that). Or try www.pubmed.gov with the search terms "mercury chelation", there you will find case reports of some serious mercury poisoning cases. Like:
http://ehp.niehs.nih.gov/members/2004/6798/6798.html
and:
http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=12793883
and:
http://www.cmaj.ca/cgi/content/full/168/2/201

 

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