Quack-busting is dangerous work

First, I'd like to thank you all on commenting on the weekend's de-lurking post. I really appreciate your taking the time to leave a note. While I write what I feel like, it's nice to get an idea about what sort of things people are reading. For various reasons, I've preferred to write on diverse topics, and it turns out that this attracts readers with diverse interests.

Now down to some serious business. I'm sure that many of you remember the Simon Singh case. Simon is a well-known and well-respected science journalist in England. Last year, the British Chiropractic Association sued him for libel. They weren't too happy when a story of his pointed out that many of their practices are bogus. This was a terribly expensive and presumably traumatic event for Simon, but against all odds (at least those set by English libel laws), he prevailed.

Here in the U.S. we like to think that our saner libel laws give us a bit more protection, and they do, but only to a point. It is still very expensive to mount a defense against a bogus libel allegation. Dr. Paul Offit, one of the leading experts on vaccination, was sued earlier this year by a seemingly unhinged antivaccination activist. This infectious disease promoter, Barbara Loe Fisher, felt that a single phrase he uttered about her during an interview---"She lies"---was terribly damaging to her. Given that she spends an inordinate amount of time making a fool of herself, it's hard to see how anyone else can make her look worse, but she was upset and sued. Her case was thrown out, but I can only imagine what Paul went through.

Last week I learned of similar bad news that hits close to home. Dr. Stephen Barrett has been a tireless crusader against quackery. He has for years maintained the website Quackwatch, which along with several associated websites serves as a remarkably comprehensive repository for data on various medical scams and illegitimate practices. In a series of articles, Dr. Barrett (who is vice president of the Institute for Science in Medicine, of an organization that I am also involved with) explained the trouble with urine toxic metals tests. Doctors Data Labs was mentioned in some of these stories and in a vaguely worded bizarre set of letters, essentially demanded that Barrett not publish anything negative about them. When he asked them to point out specific content to which they objected, they declined and instead sued him. This suit is unlikely to be successful, unless they outspend him enough to break him. Barrett is taking donations for his legal defense. The more cases like this that succeed at trial or by default, the less safe all of us are to combat health fraud.

But what's the big deal about this lab? They offer, among other things, urine toxic metals tests. These tests are promoted as a way to find "toxins" hidden in the body, and are a common tool by those offering chelation therapy. Chelation is an unethical use of dangerous medications, and is used frequently by so-called alternative practitioners to treat nearly anything.

Here's what Doctors Data says about their test:

Urine toxic and essential elements analysis is an invaluable tool for the assessment of retention of toxic metals in the body and the status of essential nutrient elements. Toxic metals do not have any useful physiological function, adversely affect virtually every organ system and disrupt the homeostasis of nutrient elements.

Among the flaws pointed out by Barrett is that this test measures urine metal levels after the patient takes a chelating agent, a drug which scavenges any heavy metal molecules it can find and drags them to the urine. And as a reference range, they use urine levels that are considered high in people who aren't chelated. In other words, the test purposely boosts urine metal levels and them calls the levels "toxic".

The company offers many more tests not offered by labs with more (in my opinion) legitimate reputations. For example, Quest Diagnositics offers several different urine metal tests, none of which are "chelation-provoked".

This is a nuisance lawsuit, but it may be enough of a nuisance to have a significant chilling effect on those of us who are using ethical, science-based practices to help people. To offer unconventional and at best unproven diagnostics or therapeutics, and then sue people who criticize you is unethical, immoral, and dangerous.

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Barrett is taking donations for his legal defense, something that was invaluable to Simon Singh.

Small correction: actually, Simon didn't take donations, wanting to fund his defence himself.

By Dave, London (not verified) on 06 Jul 2010 #permalink

Though there is a donation page to reform libel laws in England and Wales. Since the Libel Reform campaign was spurred on by Simon Singh's case it may be confusing.

I note that Libel Reform is being supported by English PEN, Index on Censorship and Sense about Science. Since Singh is associated with the last group, it is again a source of confusion. (when you click on the above link, please also click to "Sign the Petition")

And as a reference range, they use urine levels that are considered high in people who aren't chelated.

Shouldn't that be "low in people who?"

By D. C. Sessions (not verified) on 06 Jul 2010 #permalink

The difference is that the standard heavy metal urine tests are measuring acute poisoning like sudden occupational exposure and the chelated tests are measuring long term, low dose exposure, where the metals are no longer in the blood stream and easily accessible but in the tissues and need to be drawn out to be measured. If it were me and I thought heavy metals were an issue I would do both the acute and long term tests and compare. I realize most doctors don't believe that long term exposure to anything can damage anyone because "the poison is in the dose" but that is a naive attitude when it comes to cummulative poisons like lead or mercury that can be stored in the fatty tissues, bone marrow, etc for long periods of time. Surely the concept isn't that difficult to grasp. If after a short chelation period your urine measures enough metals to be considered abnormal even using a non chelated test range I think that would be cause for some concern, especially if symptoms were indicating such a problem.

Why disparage a useful tool to measure long term, low dose heavy metal exposure when there aren't many other safe ways to measure that type of poisoning? Same principal is used for H Pylori breath tests, allergy tests, and all kinds of other medical tests where an antagonist is used. Why would long term heavy metal poisoning be any different?

HvyMetlz--

You ask "why disparage a useful tool to measure long term, low dose heavy metal exposure?" The problem is that this isn't a useful tool. The provoked tests described will produce large numbers of false positives. If your position is that everyone has low-level lead poisoning, there's no need to put people through dangerous chelation to confirm that; if you think that it's a problem only for some people, accuracy in testing is important.

Assuming that long term low dose exposure is a health problem, one of two things are going on. Either the metals are accumulating in the body, in which case the ordinary tests should detect them, or they are causing damage before being excreted. If that's the case, the metals won't be there to be tested: looking for symptoms would make sense, but an accurate test wouldn't find the metals in the person's system.

For an analogy, think about radiation. A nuclear worker can wear a film badge to detect/measure exposure at the time. If someone doesn't have that badge, and a year later you suspect radiation damage, you can't go back and test to see whether they were exposed. You can ask about their activities, but the main thing you're going on is the actual health effects/damage to the body. If low-level exposure to certain metals is like wandering around on sunny days without sunscreen—I don't expect a burn, or even a tan, from the limited time I'm spending outdoors in this heat—watching out for effects makes sense. The described "tests" don't.

"The provoked tests described will produce large numbers of false positives."

That isn't even possible, as the test results are typically compared against historical patient averages using the same chelator for the same amount of time, and don't have a +/- result.

They are many provocation tests, not sure how this one is any more 'quack' than any other as they all deliberately induce a pathological condition. Are you saying all provocation tests are 'quack'?

HvyMetlz @7:

If you follow the links, you'll see that this lab is not comparing against historical patient averages. They are testing a patient once, and comparing against "reference values" which were defined based on non-provoked tests.

I am not a doctor, and don't know whether all provoked tests are useless. But it seems pretty clear from what Orac and Barrett have said that these tests, as run by this lab, are not useful to the patient.

If they are using a non provoked reference range to determine the results from a provoked test then that isn't correct. I don't know about this lab in particular and how they do things, but the reference ranges would have to be adjusted accordingly or not used at all, or at the very least, the physician who ordered them should know how to interpret them correclty. Nonetheless, I don't think because this lab is doing things incorrectly that all metals testing is bogus.

Btw, the "Institute for Science in Medicine" is just a website with no certification of any kind, and in reality is just a group of people with strong opinions. If I craft a website and call it some prestigious sounding name like "The Institute for Truth in Science and Medicine" will that make my opinions more sciency? I think not...

HvyMetlz: As far as I can see, nobody is claiming that all metals testing is bogus.

The assertion is specifically that these tests, run by this lab, are bogus. In response, rather than offer evidence that their tests are good for some medical purpose, the lab is trying to use lawyers to silence their critics. When Barrett wrote back demanding to know what statements were false so he could examine them and decide whether to leave them up, the lab/their lawyers couldn't or wouldn't name any, but repeated the demand that he remove his criticism of their tests.

The existence of legitimate provoked tests does not prove that this lab's tests are legitimate, any more than the existence of the British monarchy is evidence that I am the rightful queen.