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Chelation Frustration

One day in the Fall of 2000, DrRich asked for advice from forum members on his policy regarding individuals who post poorly-disguised advertisements on the Heart Disease Forum.  This "innocent" question led to a long series of exchanges with Fremo, a member who is (to say the least) sold on both chelation therapy and vitamin C.  Some of the more interesting give-and-take is featured here:


From:HeartDisease.Guide
To: All,

I need some advice from members and guests of this forum.

From time to time individuals are posting messages on this forum that are barely disguised advertisements for substances that (it is claimed) prevent or treat heart disease by nontraditional methods. These posts invariably contain links to websites that promote and sell such substances. Chelation therapy is the most commonly touted.

My inclination (and my practice so far) has been to let these advertisements stand without comment. That is, I haven't been deleting them.

I need to make sure, however, that my letting these posts remain is not construed as an endorsement (even a tacit endorsement) on my part, and that you don't object to this policy.

Those of you who have read some of my posts, know that I am not afraid to take positions that most of my colleages in the medical profession would object to. And as one who has coronary artery disease in his family, I personally would have a lot to gain by therapy that a) works, b) is safe, and c) avoids the wear, tear, risk, incredible inconvenience and sometimes dehumanization of tradional medical therapies. If I thought chelation worked (or any of the other stuff that is being pushed) I would not only tell you, I would be using it myself.

Can I prove chelation is bunk? No. Is it possible it is effective? Yes, I suppose so. But only in the way that it's possible that, say, barking at the Pategonian moon on the 4th of July might be effective. (Well, it might be. It hasn't been systematically studied, either.) The theory is weak, and the data (aside from hundreds of testimonials - which, if you gave me a few weeks, I could also produce for the Pategonian moon treatment) is non-existent.

Do I object to those who are pushing chelation therapy (and other non-regulated treatments)? Yes and no. I find it unfair to push false hopes (to my mind, at least)on people whose judgment may be clouded by having to face serious heart disease. But fundamentally, I believe that as long as people are spending their own money and are of reasonably sound mind, they ought to have the choice of buying chelation therapy, laetrile, or cruises to Patagonia.

That's why I have been letting these posts stand without comment. (Without comment prior to this post, at least.)

In any case,I would certainly appreciate your feedback on this policy. This, like all other policies, can be changed.


From:Hensylee
To:HeartDisease.Guide

I do not object to the "ads" but certainly recognize them for what they are. Early on I went into one of the sites posted and realized that there are those who will jump right in wherever they might be able to make a buck, without consideration for the folks who might be reading it. Some of us in here might even be able to use some of their stuff. All who write seem to be folks who can discern. Besides, we trust that you certainly will make comments if you deem it necessary - or delete if it is harmful.


From:Fremo
To:HeartDisease.Guide

Hi Dr Rich,
I also read the plight of desperate people on forums and wonder why as soon as someone mentions non traditional vitamin therapies that they get banned from the forum but had noticed your tolerance and applaud you for it.

I believe that in order for patients to make informed decisions about their heart conditions they need to be in possession of as many facts as possible. Judging by the letters in this and other forums traditional medicine is failing miserably. The sad thing about it is they have had first bite of the cake and made a real mess of it.

I tried Chelation therapy and credit it with unblocking the arteries in my legs which had given me pain for the preceeding 11 years. I had also given up smoking 6 months earlier so maybe that played a part as well.

What pleased me most in my 18 month research of heart disease was an understanding of my own failures and my discovery of the attempt by the medical establishment to deny access to the public of a link between heart disease and Vitamin C deficiency. I have enjoyed your analysis of the medical system and think you are 100% correct so would appreciate what your thoughts are regarding the claims made on this page http://www.paulingtherapy.com/

I do appreciate your willingness to allow alternative medications and healing possibilities into the forum. As do most of my fellow forum members, I feel certain you would delete or refute anything you consider remotely dangerous. I am one who believes that herbs have a place in modern medicine, though I do think if you're a heart patient, it is best to run any supplements past your cardiologist PRIOR to taking anything. As I stand by helplessly and watch my father lose his fight against heart disease, and as one of its newest victims, I understand well the desperate search for anything that will provide a lifeline. I would hope that the forum's readers make decisions based on fact and not emotion.


From:HeartDisease.Guide
To:Fremo

Thanks for your post.

I have thought about what you've said, and looked at the website you recommended. I have the following comments:

1) Traditional medicine has not failed in the treatment of heart disease, as you assert. Indeed, amazing advances have taken place in the past 25 years that have completely changed the dismal prognosis of millions of patients with heart disease. I'm not going to list them all here (covering what works and what doesn't is the long-term mission of my http://heartdisease.about.com site.) What hasn't worked well is the health care SYSTEM, which has become bogged down in the systematic covert rationing of health care, leaving patients to fend for themselves in trying to learn about and gain for themselves the advantages of medical progress. But as far as the benefits of recent technological advances in cardiac care, they are unquestionably remarkable, and will become more so over the next several years.

2) I have followed the claims of Linus Pauling, a man I admire for many reasons, since I was a medical student in the early 1970s. His argument supporting megadoses of Vitamin C are cogent and sound very convincing. The problem is, despite the claims listed on your website, sound scientific research has, so far, failed to confirm these arguments. Here's the scoop:
- recent scientifically collected data suggests that, instead of preventing heart disease, megadoses of Vitamin C may worsen heart disease, especially in smokers.
- these data have prompted new "upper limits" to be set on daily Vitamin C doses (2000 mg/day).
- randomized trials of vitamin C versus placebo are ongoing, and more scientifically sound data will be available within a few years.
- My personal experience is that cardiologists worldwide are watching the vitamin C story carefully, and are ROOTING HARD for vitamin C. There was widespread disappointment among the cardiologists I know when the recent data was reported (showing no benefit, and possibly harm from megadoses of vitamin C). There is absolutely no conspiracy against vitamin C in the medical profession. Indeed, the opposite is true. Asserting a conspiracy to hide the truth is the classic ploy of those who want to espouse an unproven medical therapy, usually for their own gain.

3) I am personally very happy for you that your peripheral vascular disease improved after chelation therapy. But again, in a randomized trial, chelation showed no benefit over placebo for patients with just this kind of disease. If chelation (or vitamin C, or any other "easy" solution to heart disease) worked anywhere near as well as it is claimed, then proving benefit as compared to sugar pills should be a cakewalk. Not to diminish your own personal experience, the problem with "testimonial" data is that testimonials are easy to obtain for any "therapy" you'd care to imagine.

4) As far as I'm concerned, people should be free to spend their own money on any alternative therapy they wish. My goal is to give people an objective idea of the data that exists or does not exist, so that when they make their purchasing decisions they have the opportunity to make those decisions with eyes wide open.

5) The "placebo effect" is extremely powerful, and probably a physiological event rather than a psychological event. But it confounds scientists when trying to tease out the real, actual, measurable benefit of a drug or procedure. Unless a therapy is specifically studied in comparison to placebo, its real benefit is often little better than a guess. Many well-accepted medical therapies have never been tested against placebo, 'tis true. But failure to so test is a nearly universal characteristic of alternative therapy. This is what makes health care such an interesting field to try to figure out.

I will be posting an article later this week on how the placebo effect has apparently led cardiologists and the biotech industry far astray in an apparently promising new therapy - transmyocardial laser revascularization. It will be interesting to see whether the vested interests in the medical establishment will do what the data suggests - to abandon their multimillion dollar efforts - or whether they will behave as they accuse the alternative medicine community of behaving, to push on despite good data to the contrary. As a student of human nature, I have high hopes, but don't pretend to know what will really happen.


From:Fremo
To:HeartDisease.Guide

Dear Dr Rich,
To reply to the specific points you raise:

We will have to agree to disagree on traditional medicine. Whereas there have been some amazing developments going on ie.miniature heart pumps,vgef trials etc. there has been an overwhelming use of surgical techniques with dubious benefits to the patients but overwhelming fiscal gains to the proponents.
"The millions of people told that they needed immediate surgery to save their lives actually had a 98.4% chance of surviving without surgery!" [CASE study published by the New England Journal of Med., 1983]

Julian Whitaker says it better.
"There is no scientific justification for the use of angiography, balloon angioplasty and bypass surgery to treat most cardiovascular disease. A good example of this is angioplasty, in which a balloon on the tip of a catheter is used to open blockages. In my opinion, there is never a reason for anyone to have an angioplasty. It is a dangerous procedure looking desperately for validation. Whenever it is compared to a non surgical therapy -- and there have been very few of these studies -- patients treated with angioplasty virtually always fare worse. There is a higher death rate, higher heart attack rate and, in general, a higher repeat surgery rate. This procedure will, in my opinion, always be an unproven, expensive and dangerous gimmick that became an accepted therapy based on self-serving "presumption" only.

"Several studies over the past two decades, involving over 6,000 patients with heart disease, have shown that patients funneled into surgical procedures to do significantly worse than those treated with noninvasive techniques. "Noninvasive" refers to the use of medication, not diet, exercise and multiple vitamin supplements, which can be quite beneficial." Bypass surgery may be helpful for some patients, but it should not be used as the first treatment, and clearly not in mild heart attack patients. Medication, dietary and lifestyle changes, plus nutritional supplements are more effective approaches"

"Other than their cost, the only thing definitely known about these procedures is that they do kill people. Roughly one in 25 patients having a bypass and about one in 65 undergoing angioplasty die from the procedure. Frankly, if we took all of the bypass surgeons and catheter-pushing cardiologists, tied their thumbs together and locked them in a closet, we would save close to 30,000 lives and over $50 billion ever year." Julian Whitaker, Health & Healing, Sep 98, Vol 8, No. 9

2:You say there is no sound scientific research supporting Vit C supplementation. Well what about this:

{Numerous citations given  here - DrRich}

"There are more than ten thousand published scientific papers that make it quite clear that there is not one body process (such as what goes on inside cells or tissues) and not one disease or syndrome (from the common cold to leprosy) that is not influenced -- directly or indirectly -- by vitamin C." [Dr. Emanuel Cheraskin, Dr. Ringsdorf and Dr. Sisley from THE VITAMIN C CONNECTION, 1986]

The most compelling argument for Vitamin C must surely be this fact
1970 Linus Pauling publishes his first book on vitamin C.
1970s Vitamin C consumption in the U.S. rises by 300%. Mortality from heart disease decreases by 30% in the U.S.-the only country with a significant drop in heart disease fatalities.

It really is time for America to give credit to this man and end all this nonsense.


From:HeartDisease.Guide
To: Fremo

If you're looking for an argument about the efficiency and the nobility of the medical profession, you've come to the wrong place. Less than a year ago I quit a professorship and a lucrative medical practice at a relatively young age (and with young kids still at home, no less) because I could no longer abide the things I was being asked to do with (and to) my patients. Some of my former colleagues would consider me a compatriot of your friend Julian Whitaker - another disaffected physician.

And I'm not going to argue that there really aren't too many bypass operations and angioplasties being performed. Clearly, there are.

But none of this negates the facts. In appropriately selected patients (Dr. Whitaker notwithstanding), both bypass surgery AND angioplasty have been clearly demonstrated to prolong survival. If you - wait, I forgot, you take Vitamin C - let's say if your best friend showed up in the emergency room one hour into a massive myocardial infarction, and the cardiologist offered to open up the occluded artery with an angioplasty catheter, I hope your friend would have the good sense to accept this proven lifesaving procedure, and not opt instead for a cocktail of EDTA and vitamins.

Traditional medicine, though systematically abused, can offer miracles in some settings.

I also don't want to argue too much about Vitamin C. As I said, I am particularly sympathetic toward this substance, and even toward those who promote it. Unlike most unproven therapies that are "pushed" online and elsewhere, there is a fair amount of theoretical support for Vitamin C; and it is probably harmless if taken in doses of 1 or 2 grams per day. I merely say that, despite the testimonials, guinea pig experiments, and epidemiological evidence you provide, there is no placebo controlled study that shows that it actually helps in preventing heart disease. It might help, but there's no proof.

Regarding your "most compelling argument" (i.e., Pauling publishes his Vitamin C book in 1970; consumption of Vitamin C increases 300%; mortality from heart disease decreases by 30%), I say this:

Bypass surgery procedures are widely introduced during the 1970s; bypasses explode in the 1980s; mortality from heart disease decreases by 30%. Or this:

Home Box Office is introduced to American families in 1978; watching HBO movies on cable explodes during the 1980s; mortality from heart disease decreases by 30%.

All of these examples are true, true, and unrelated.

Finally, the notion that cardiologists are engaged in a huge conspiracy to withhold the truth about vitamin C (or chelation, or any of the other purported cures for heart disease) is patently absurd - even if you don't accept the essential goodness of cardiologists. Any true student of human nature knows that broad and sustained conspiracies (anything more complicated than, say, cheating at bridge) are virtually impossible. And especially today, in the era of the Internet, the notion that knowledge can be suppressed by a cabal of interested parties is particularly ridiculous.

Come on in! The forum's fine!

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