Angry Doctor

Monday, February 26, 2007

Waiting for Edta

An interesting letter to start the week on:


Drug-eluting stents - benefits outweigh the risks

I refer to the report, 'Drug-eluting stents - benefits outweigh the risks' (ST, Feb 22).

Success of the drug eluting stents (DES) and procedure depends on patient selection, clinical progress and stage of the disease, presence of co-morbidities, strict adherence to a healthy lifestyle, taking appropriate medication and vitamins and nutritional supplements.

It is a shame that many of the cardiac patients, while waiting for bypass surgery, have never been informed of an additional procedure that has been shown to be equally effective in the treatment of cardiovascular diseases involving the heart, brain, legs and other parts of the body where there is insufficient blood flow.

Nevertheless, some of these patients, who are in the know and against their attending doctors' instructions, have flocked to neighbouring countries for this treatment with success and at a lower cost.

I refer to the treatment which consists of an intravenous infusion consisting of the synthetic ethylenediaminetetraacetic acid, (EDTA) and magnesium salt and multi-vitamins and trace elements.

In short, this is the chelation therapy which our mainstream medical practictioners have dismissed, based on four short studies (which were later found to be biased, flawed and underpowered) and multiple editorials and comments (again based on these four studies) in mainstream medical journals.

There are doctors who have seen the benefits and efficacy of EDTA/multivitamins infusion in their cardiac patients (they have sought this treatment overseas). The costs were also lower. The number of patients in Singapore who will suffer from obstructive vascular diseases is going to increase and so will the costs, suffering and loss of productivity.

I suggest that this EDTA procedure be offered to cardiac patients while they are waiting for their bypass surgery.

From those patients who have gone through this procedure in the US, Europe, Australia and New Zealand, a significant number did not have to undergo bypass surgery when their operations were due.

For those mainstream medical practictioners who want proof of EDTA efficacy, I propose that the National Heart Centre do a double-blinded placebo controlled trial, recruiting those patients on the waiting list for bypass surgery, like what the National Institute of Health in the US (www.nih.org) is doing now.

I will end by quoting Associate Professor Tan Huay Cheem of the National University Hospital: 'In real practice, we can't always wait for clinical trial data.'

Dr Tan Soon Kiam


angry doc is not familiar with chelation therapy (except in the context of treatment for autism, but that's another story...), but a quick search on Pubmed reveals that there are more than four studies regarding the efficacy of EDTA chelation therapy for cardiovascular disease, and the results are not exactly encouraging.

In fact, even NIH, in this editorial on the the trial on chelation therapy mentioned by Dr Tan above, acknowledges that the current available evidence do not support the use of chelation therapy in cardiovasuclar disease, and that contrary to what Dr Tan has stated, chelation therapy is expensive; Dr Tan also omitted the fact that chelation therapy can have potentially 'serious side effects'.

In angry doc's opinion, the quote: 'In real practice, we can't always wait for clinical trial data' is not really appropriate in the context of EDTA therapy for cardiovascular disease; while absence of evidence of efficacy is not evidence of absence of efficacy, evidence of absence of efficacy *is* evidence of absence of efficacy. angry doc is more inclined to use this misquote:

'Nothing happens, no evidence efficacy is produced, no evidence of inefficacy is acknowledged, it's awful!'

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9 Comments:

  • NEJM has just published a series of articles on drug eluting stents, hope the ST reporters have digested them (or indigested).

    By Anonymous Anonymous, At February 27, 2007 9:01 am  

  • Chelation therapy has been around for a long time.

    Dangers of using IV Magnesium EDTA are all documented. Usage of the drug requires certain parameters cleared eg renal function before it is given.

    Let's wait for the NIH study and see what happens.

    Interestingly, the countries around us have been providing Chelation therapy to patients for some time now. Whereas this is banned in Singapore.

    It is rumoured that a large restructured hospital wanted to start this service in Singapore but this proposal met with lots of resistance despite the support of a prominent medical figure.

    Which brings the question. If something is so bad and so dangerous and so unequivocally useless and ineffective, then why is there still a demand for it?

    I would suggest that angry doc read the studies that are often quoted to "prove" that Chelation does not work and analyze them carefully. While the studies cannot prove that it works, you will find that there are glaring discrepancies eg poor blinding, poor study design and even contradictory data in many of the studies.

    More studies need to be done. In any case, if the NIH study proves to be positive in any limited way, the billion dollar stent industry would be very concerned.

    Politics.

    By Blogger Dr Oz bloke, At February 27, 2007 9:44 am  

  • "Let's wait for the NIH study and see what happens."

    Do check out Dr RW's blog and his entries of the NIH trial.

    "If something is so bad and so dangerous and so unequivocally useless and ineffective, then why is there still a demand for it?"

    One might ask the same of a whole host of ineffective therapies. Specifically for chelation therapy, the option of a non-invasive treatment is definitely more attractive to open-heart surgery.

    Chelation therapy isn't dangerous for most patients treated, but in very few cases severe side effects can occur. One can of course say the same for all other types of therapy, but here we are also looking at the risk-benefit ratio.

    "I would suggest that angry doc read the studies that are often quoted to "prove" that Chelation does not work and analyze them carefully."

    I looked up the more recent reviews and analyses on Pubmed after reading the letter yesterday, but even those from journals supportive of alternative medicine conclude that there is no good evidence.

    "In any case, if the NIH study proves to be positive in any limited way, the billion dollar stent industry would be very concerned."

    If you look through the list of centres participating in the NIH/NCCAM study, you will notice that chelation therapy is big business too.

    By Blogger angry doc, At February 27, 2007 5:50 pm  

  • "I looked up the more recent reviews and analyses on Pubmed after reading the letter yesterday, but even those from journals supportive of alternative medicine conclude that there is no good evidence."

    What I meant was looking at the papers that showed that chelation was ineffective and analyzing them to see if the strength in disproving chelation was strong enough.

    Certainly the strength in proving chelation is not there at the moment but is it really as useless as we say it is?

    Chelation is big business simply because mainstream doctors reject it so vehemently. If everyone was doing it, it would not be so expensive. There would be no premium on it. EDTA's patent has long expired.

    From what I've seen, because it is so condemned by western doctors, and some people are so willing to try it, they are agreeable to pay premiums for what is actually a rather cheap drug and simple procedure.

    Seriously.

    By Blogger Dr Oz bloke, At February 28, 2007 1:25 pm  

  • "What I meant was looking at the papers that showed that chelation was ineffective and analyzing them to see if the strength in disproving chelation was strong enough."

    It's hard to prove a negative...

    But don't make me do all the work! Why don't you look the papers up and do a post on your blog? It's been a while since you updated...

    "From what I've seen, because it is so condemned by western doctors, and some people are so willing to try it, they are agreeable to pay premiums for what is actually a rather cheap drug and simple procedure."

    Like coffee up your rear-end in Mexico? :)

    By Blogger angry doc, At February 28, 2007 5:12 pm  

  • Coffee enema is part of the Gershon therapy that is so popular in Europe!

    Have you read what it is about? It's not cleaning the colon. It's cleaning the liver!

    Quite interesting and the people who do it swear by it!

    But of course no evidence based lah

    My blog? Aiyah nobody goes there anyway. And I just want to discuss with you. :)

    By Blogger Dr Oz bloke, At March 01, 2007 1:49 pm  

  • Yes; you also have to convert your homeinto a vegetable warehouse.

    By Blogger angry doc, At March 01, 2007 5:36 pm  

  • Hi oz bloke

    I visit your blog now and then to check if you've updated. No comments does not equate to no one reading it. :)

    palmist

    By Anonymous Anonymous, At March 09, 2007 11:40 am  

  • Any recommendations on chelation theraphy in Singapore?

    By Anonymous Anonymous, At September 02, 2011 11:21 pm  

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