Death by chelation

Orac recently posted an update on the story of Abubakar Tariq Nadama and noted that the wheels of justice are finally turning as Dr. Roy Kerry faces charges in the death of the 5 year old autistic boy. I join Orac and others in the hope that justice prevails. But, while lacking any legal training, I am bothered about this case. One of the roles of the execution of criminal justice is to set examples and thereby send appropriate messages to society. If this case plays out as it has so far the wrong message will be sent. Dr. Kerry may “go down” but justice will not have been fully served.

What’s wrong with the case? From The Washington Post (italics mine):

A doctor was ordered on Thursday to stand trial on charges he caused the death of a 5-year-old autistic boy by incorrectly administering a controversial chemical treatment.

Dr. Roy Kerry, 69, used the wrong drug and administered it incorrectly while trying to use chelation therapy on Abubakar Tariq Nadama…

As I pointed out in some detail over a year ago, this is not a case of the wrong drug or the wrong method of administration. No, it’s a case of total woo. In that post I called it a matter of “wrong indication”, implying merely off label use, but it’s really much worse than that. Most off label use is evidence based to some degree. The use of chelation as a treatment for autism is even worse than non-evidence based---it isn’t based on anything.

If chelation for the treatment of autism is baseless in the first place how can you talk about the wrong drug or even the wrong method of administration? There has to be a right alternative before you can talk about a wrong drug. Logically, at least, the prosecution appears to be on thin ice in pursuing this line.

The Nadama family’s attorney in praising the judge’s decision to order Kerry to stand trial displays his misunderstanding of the issue in stating “He did something no doctor in the world would do”. But, truth is, the non-indicated non-evidence based non-anything based use of chelation is widespread, and it’s apparently done without rhyme or reason as to the choice of chelation agent.

A little background on the two chelation agents--- Endrate, the drug apparently used by Dr. Kerry, has two indications: hypercalcemia and digitalis toxic ventricular ectopy. Versenate, the other available chelation agent, has one indication: lead poisoning. Although the prosecution’s expert witness seems to be following the CDC’s faulty analysis of the case in implying that Versenate would have been the “right” drug, neither drug can be applied to the treatment of autism on any basis other than absolute and total woo.

Endrate, the purported “wrong drug”, is frequently administered by chelation practitioners for the bogus indication of atherosclerosis and is in fact the agent being used in the NCCAM sponsored Trial to Assess Chelation Therapy. In a recent post to the Health Fraud List, quackbuster Robert S. Baratz, MD, PhD, DDS noted that “Chelationists regularly conflate Endrate (R) (disodium EDTA) and Verseanate (R)”. Something “no doctor in the world would do”? Uh huh. And if the indoctrination of current medical students is any indication, the woo based use of chelation may become more widespread. Here’s what the American Medical Student Association’s Complementary Therapies Primer says on page 20 about chelation:

Since it improves blood flow, it is also helpful in gangrene, intermittent claudication caused by peripheral vascular disease, and poor memory due in part to insufficient cerebral blood flow. Reduction in metal ions reduces inflammation caused by free radicals, and makes chelation therapy helpful in arthritis, scleroderma, and lupus. Chelation therapy has also been used to normalize cardiac arrhythmias, improve vasculogenic vision loss, reduce cancer mortality, protect against iron poisoning and detoxification of snake and spider bites.