The Brutal Chelation Therapy Wars

So you can read this health tip without stumbling over a key word, it’s pronounced kee-LAY-shun. Genuinely Controversial with a capital “C,” chelation therapy (are you saying it correctly in your head?) is a series of 30 intravenous infusions that can legally be administered only by an MD or a DO. For performing it, they’re classified by their peers as “alternative,” “integrative,” or any of an assortment of far less polite names.

Chelation therapy is believed by its advocates to reduce the calcified cholesterol plaque lining the blood vessels of people who’ve had a heart attack, who have angina pectoris as a result of coronary artery disease (narrowing of the arteries), or who have blocked blood vessels in the legs (peripheral vascular disease). Chelation therapy’s detractors think it’s quackery, pure and simple.

To come up with a way to cleanse blocked arteries without surgery certainly seemed like a good idea in the mid 1950s, long before concepts like “heart bypass graft” or “stent insertion” entered the world’s vocabulary. Chelation therapy proposes that a molecule called a chelator binds itself like a claw (chele means claw in Greek) to some toxic substance in the body, inactivates it, and removes it safely via the kidneys. One chelating substance, EDTA, has for many years been safely used to treat lead poisoning.

Then, in 1956, a few studies showed that EDTA could safely remove calcium from cholesterol plaques and that multiple infusions of EDTA could act as a sort of roto-rooter, cleaning out arteries. In the1970s, cardiac surgery was in its infancy and patients were rightfully a bit nervous about having their heart stopped and placed on a heart-lung pump while a surgeon transplanted one or more of their veins to bypass blockages. As a result, alternative doctors began opening chelation centers and, within a few years, tens of thousands of patients found themselves sitting back comfortably in reclining chairs, chatting with fellow patients or reading books like Bypassing Bypass Surgery, The Chelation Way, or even Forty Something Forever: A Consumer’s Guide to Chelation Therapy and Other Heart Savers.

In the meantime, not unlike Evangelicals picketing abortion centers, outside chelation centers conventional medicine was preparing for all-out war. Virtually every state medical society voted to encourage their state’s department of professional regulation to investigate these centers and pull the medical licenses of the physicians who ran them. The chelating physicians naturally cried foul, accusing their accusers of having a motive more financially driven than scientific.

Back in the 70s, cardiac surgeons performing bypass surgeries were the new Gatsbys, and to the chelating physicians every successful chelated patient meant one less surgical “victim.” Moreover, patients were delighted with chelation. It was painless and, sitting with others having the procedure, also quite social.

Did chelation therapy actually work?

To be honest, in 1993 when I opened what would later become WholeHealth Chicago, the noise from the chelation wars was so loud you couldn’t get a straight, unemotional, reasonably scientific answer from anybody. Moreover, chelation therapy wasn’t just intravenous EDTA. Chelation patients were told to stop all tobacco and met regularly with a nutritionist. Many took up exercise and stress reduction. And there was this: along with the EDTA, the chelation IV bottle contained a virtual bouillabaisse of high-dose antioxidant vitamins and minerals. For all anyone knew it was the combined effects of the lifestyle changes and antioxidants that were responsible for the benefits of chelation therapy.

However, when conventional medicine seriously wants a competitor or an outlier to disappear, it’s as powerful as Tony Soprano. In the past, conventional medicine virtually eliminated homeopathic physicians, would have rendered chiropractic extinct had not the Supreme Court intervened, quashed acupuncture for years, and currently has colon therapists in its crosshairs. When compared to chiropractors, who fought back in an organized way, chelating physicians were an easy mark. No physician can survive if his home state pulls his medical license.

The Wikipedia article on chelation therapy mainly demonstrates what’s wrong with Wikipedia itself–opinion masquerading as fact. The article is so vehemently opposed to chelation therapy that I’m pretty sure it was written by Stephen Barrett, MD, the retired psychiatrist who runs quackwatch.com, America’s anti-alternative medicine website.

To give you a sample of the war tactics, at the recommendation of medical organizations, the FDA tried to block EDTA use for any heart disease (EDTA is now sold through compounding pharmacies). Later, before the website of the newly organized association of chelating physicians (American College for the Advancement of Medicine, ACAM) could get up and running, someone in the dirty tricks department registered acam.com and linked it to a porn site (ACAM uses acam.org. instead). More recently, ACAM was told by the FDA to remove any recommendations for chelation therapy from its website or face legal battles they could not afford, though if you click around, you’ll still see plenty of information on the site.

WholeHealth Chicago offered chelation therapy for quite a few years, and honestly, although the patients seemed to do well, I was never sure if their improvement was due to the dramatic lifestyle changes, the EDTA infusions, or a combination of the two. I became discouraged with EDTA when CT scans of the coronary arteries before and after chelation showed no change in the amount of calcium present. Any clinical improvement, I figured, must have been due to lifestyle changes, which we could promote without all the bother of mixing IVs.

Which brings us to the present day

The March 27, 2013, issue of JAMA reported the results of the multiyear Trial to Assess Chelation Therapy (TACT), performed under the auspices of the National Institutes of Health and several leading medical centers. The study enrolled 1708 patients, 50 years and older, who had already had a heart attack. It was a double-blind, placebo-controlled study (neither investigators nor patients knowing if they were getting chelation therapy or merely intravenous sugar water). The goal was to determine if chelation therapy reduced the risk of a second heart attack, stroke, rehospitalization for heart disease, or death. Not surprisingly, the very prejudiced Wikipedia entry locates someone who calls the TACT study “unethical, dangerous, pointless, and wasteful.”

Just about everybody in conventional medicine hoped that TACT would be the study that finally would wipe chelation therapy off the map. Patients who asked about chelation could honestly be told, “An NIH study finally proved…don’t waste your money.”

Instead, the researchers got what one cardiologist has dubbed “inconvenient evidence.”

The results were what no one expected: recipients of chelation therapy did better than those who were receiving the placebo. Nothing dramatic. Not blown-out-of-the-water better, but there were fewer new heart attacks, fewer rehospitalizations, and better mortality rates. There was also 18% less return of angina in the chelated group.

Even the researchers couldn’t deal with this. Rather than say something rational, like “Hey guys, we were wrong. So sorry we’ve been trying to yank your licenses for the past 30 years,” instead they end the article with the pathetic and pusillanimous (one of my favorite words–been waiting for years to use it in a sentence) “These results provide evidence to guide for further research but are not sufficient to support the routine use of chelation therapy for treatment of patients who have had an MI” (myocardial infarction). What wimps!

There are two accompanying editorials in the same issue of JAMA. The first relates the agony of getting this complex study together, analyzing the data, and coming to conclusions, all the while being victimized by catcalls from the conventional medical audience. The second editorial is not at all timid. The author provides the catcalls, and castigates the research, analysis, and conclusions.

A more intelligent position comes from cardiologist Harlan Krumholz, MD, writing in Forbes Magazine, who had never heard of chelation therapy during his training. He asks us all to reflect on our attitudes toward “inconvenient evidence” and notes the 18% reduction in angina with very few adverse events merits serious consideration for further research. He adds, “Even the authors, who are quite esteemed, seemed surprised…(but) they seem unable to make a strong recommendation—as if they have some uncertainty how to act on what they found.”

The irony, Dr Krumholz adds, is that if the pharmaceutical industry had numbers like these, they’d be celebrating. “We have billion dollar drugs like niacin and fenofibrate…that have less evidence than chelation therapy does now.”

In other words, we can’t simply ignore results we don’t like.

There are lots of clickable links in this health tip, but if you have time for just one I recommend Dr Krumholz’s piece for its clear-headed reasoning.

Rest assured the chelation wars are not over. In fact, this JAMA study promises the opening of a brand new front.

Be well,

David Edelberg, MD