One of the questions addressed in this space is, “what makes a particular condition susceptible to quackery?” Some of the common features we’ve seen over time are:
- Diverse and protean symptoms: fatigue, “brain fog”, diffuse pain, and other vague symptoms are often used as diagnostic criteria for controversial entities such as morgellons and chronic Lyme disease.
- Lack of diagnostic certainty: there are no definitive tests to make the diagnosis of chronic Lyme disease or morgellons (or fibromyalgia for that matter) making objective diagnosis difficult.
- Children affected: autism affects children (and of course their parents) and our natural desire to protect children makes us vulnerable.
There are a number of ways that quacks can churn out their product using just these three trends. When a patient suffers from generalized fatigue or malaise but a good work up fails to reveal a specific problem, a real doctor will listen carefully and take a cautious wait-and-see approach. A quack will rush into action, applying unproven treatments and even making up their own diseases.
Making up a disease may sound easy but if you want people to really buy it, you need to follow a few principles. You have to make it sound plausible to lay people, and you have to create the best kind of lie—the one based on a nidus of truth.
It helps if you have tests—everyone loves tests. Diagnostic testing is a complex field. Tests need to be validated in several different ways so that any test’s characteristics are well understood. For example, if I want to use a hemoglobin A1C level to diagnose and follow diabetes, I need to know how results are distributed across the population of interest, I need to know how well the test itself technically works, and I need to know how well it works statistically. Without this information, the test result is meaningless. Quacks get around this in a few different ways: they make up their own tests; they misinterpret tests by, for example, re-define the normal range in proven tests or giving a result meaning that it does not have; they send tests to labs with less “stringent” quality controls; they use tests that have not been proven to show what they claim.
All this is by way of introduction to another crappy piece in the Huffington Post. The piece, “Why Lead Poisoning May Be Causing Your Health Problems,” is by Mark Hyman, a doctor and non-toxicologist. The title seems to imply that lead poisoning is common and causes just about everything. Hyman claims that “[n]early 40 percent of us have toxic levels of lead in our bodies.” If this is true, this is potentially one of the greatest public health problems we have ever faced.
Lead exposure affects children and adults unequally. The reason so much effort is focused on young children and lead is that lead has a devastating affect on a growing, developing child. Lead intoxication in kids leads to all sorts of serious problems including anemia and abnormal cognitive development. Although childhood lead levels in the U.S. are declining, there is still reason to be concerned. In the last reporting period (1999-2004) about 1.4% of American children had lead levels above 10 mcg/dL, the level usually considered problematic. Recent research is giving us reason to be less sanguine about lower lead levels as well (see references). Even blood levels below 7.5 mcg/dL are correlated with decreased intellectual function, although the data are a bit murky.
In adults, the effects are less clear. Leaving aside occupational lead exposures, there is some evidence that environmental lead exposures cause cognitive problems in adults and may also contribute to hypertension and other common problems, but it’s hard to draw conclusions about causation. Differentiating chronic and acute lead exposure and its effects is a significant problem in adults. States are responsible for collecting data and use different cut-offs but according to the data that are available (2005), the average rate of elevated blood lead levels in U.S. adults is about 8.7/100,000. To get a more complete picture, we would have to use other measurements for adults in addition to blood. But even a worst-case scenario of adults plus children brings us nowhere near the 40% figure
cited by asserted by Hyman.
While Hyman’s alarmist statistics may not be anywhere near accurate, one of his basic premises is: lead is dangerous to children and too adults, even at levels lower than traditionally measured. After that, he flies right off the rails.
He describes very much overplays the state of the research into adult lead toxicity. It appears to be correlated with a number of common health problems, but that’s where it ends for now. There is not yet convincing data to show a strong causal relationship between low lead levels and common health problems. The data is certainly concerning enough to continue reducing human lead exposure, but beyond that, things are murky. For some reason, after describing the potential damage caused by lead exposure he states seemingly out of nowhere:
Wow! Take a moment to digest that. Chelation therapy saves lives and billions of dollars. But your doctor probably isn’t offering this as standard treatment, because, as I have said many times, doctors don’t learn two of the most important things in medical school: How to help people improve their nutrition and how to deal with environmental toxins.
Chelation for lead poisoning is indicated only when lead levels are very high. At lower levels, avoiding the source of the lead is the treatment of choice. There is no evidence that chelating adults or children with low lead levels leads to positive outcomes. With avoidance alone, children with elevated lead levels get better. There is no evidence that, as Hyman enthusiastically suggests, chelation “saves lives and billions of dollars.” I’m also not sure what his medical education was like, but we certainly learned about nutrition and environmental toxins. What I learned, however, was based on actual evidence.
Hyman then gives six tips to “getting the lead out” which are also curiously devoid of evidence. While I won’t torture you with all of them, I do suggest you read it for the giggle-inducing shoe suggestion. His first suggestion is the worst of them. He recommends to be screened for lead toxicity through chelation-provoked testing. The American College of Medical Toxicology specifically recommends against this practice:
It is…the position of the American College of Medical Toxicology that post-challenge urinary metal testing has not been scientifically validated, has no demonstrated benefit, and may be harmful when applied in the assessment and treatment of patients in whom there is concern for metal poisoning.
Hyman has done a good job of using a kernel of truth around which crystalize and entire diagnostic and treatment fiction. He encourages people with vague symptoms to undergo unproven medical tests and to then subject themselves to potentially dangerous treatments. He should be ashamed.
But of course, he has no shame.
Jusko, T., Henderson, C., Lanphear, B., Cory-Slechta, D., Parsons, P., & Canfield, R. (2007). Blood Lead Concentrations Environmental Health Perspectives, 116 (2), 243-248 DOI: 10.1289/ehp.10424
Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, Canfield RL, Dietrich KN, Bornschein R, Greene T, Rothenberg SJ, Needleman HL, Schnaas L, Wasserman G, Graziano J, & Roberts R (2005). Low-level environmental lead exposure and children’s intellectual function: an international pooled analysis. Environmental health perspectives, 113 (7), 894-9 PMID: 16002379
Hu, H., Shih, R., Rothenberg, S., & Schwartz, B. (2006). The Epidemiology of Lead Toxicity in Adults: Measuring Dose and Consideration of Other Methodologic Issues Environmental Health Perspectives, 115 (3), 455-462 DOI: 10.1289/ehp.9783
Shih, R., Glass, T., Bandeen-Roche, K., Carlson, M., Bolla, K., Todd, A., & Schwartz, B. (2006). Environmental lead exposure and cognitive function in community-dwelling older adults Neurology, 67 (9), 1556-1562 DOI: 10.1212/01.wnl.0000239836.26142.c5
Liu X, Dietrich KN, Radcliffe J, Ragan NB, Rhoads GG, & Rogan WJ (2002). Do children with falling blood lead levels have improved cognition? Pediatrics, 110 (4), 787-91 PMID: 12359796