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The Post-Chelation Urinary Toxic Element Screen
One of the disheartening aspects of practicing integrative medicine is the occasional incident of a medical board's disciplining a physician. At the end of March 2016, our local Washington State Medical Quality Assurance Commission ordered a practitioner to cease treating patients for heavy metal toxicity with chelation therapy following a disciplinary action by the Oregon Medical Board. The doctor had been under investigation in Oregon for treating patients who were diagnosed with heavy metal toxicity. Oregon's administrative board stipulated that "according to the American College of Medical Technology a diagnosis of metal toxicity based on provocative urine testing … has not been scientifically validated, has no demonstrated benefit, and may be harmful when applied in the assessment and treatment of patients in whom there is concern for metal poisoning." Unfortunately, the aforementioned practitioner is not the only physician being disciplined for diagnosing heavy metal toxicity. Approximately 10 doctors in different states are being sanctioned for using provocative urinary toxic element testing. Clearly this diagnostic approach poses a risk for the integrative practitioner.
The laboratory testing is straightforward. A urine specimen is collected following administration of oral or parenteral chelation. The urine is assessed for levels of lead, mercury, arsenic, cadmium, and other toxic elements. Unfortunately, while toxic levels for these elements have been established for an unprovoked urine collection, there are no accepted standards for post-chelation toxic levels. Compared with unprovoked urine specimens, essentially all post-chelation specimens will demonstrate increased toxic elements. Based on arbitrary standards, post-chelation urine samples reveal very high, moderately high, or slightly elevated levels of toxic elements. However, there is generally a poor correlation between blood levels and post-chelation urinary toxic elements. Hence, it is not unusual for a patient to have a normal blood lead and mercury level while having elevated post-chelation urinary levels. In this scenario can one make the diagnosis of lead and mercury toxicity? No. What about a diagnosis of lead and mercury burden? Yes. Lead and mercury are measurable and exert toxic effects on the body. However, the diagnosis of toxicity should not be made or coded on insurance statements.
Oregon is stipulating that patients should not be treated for metal poisoning if blood testing does not confirm toxicity. However, patients would benefit by diminishing their toxic element burdens. Hence, practitioners should not be sanctioned for recommending that patients undertake chelation for increased toxic elements diagnosed by provocative urine testing.
Holistic Doctor Deaths
Over the past 15 months, a number of natural health writers have made the case that an inordinate number of holistic doctors have died under suspicious circumstances. The doctors share a commonality of practicing some form of alternative medicine, be it medicine, osteopathy, dentistry, chiropractic, naturopathy, nutrition counseling, physical therapy, and more. Many of the doctors were found dead in circumstances that appear to involve foul play. Others were deemed to have died from natural causes but the circumstances remain suspicious. Perhaps the writer who has devoted the most efforts to listing and following the holistic doctor deaths is Erin Elizabeth, editor of the Health Nut News.1 The following is a partial listing of doctors who have died:
Jeffrey Bradstreet, an integrative doctor who was vocally opposed to vaccinating children, was found dead in a river from a "self-inflicted gunshot wound" on June 19, 2015. On June 21, two chiropractors, Dr. Hendendal, DC, PhD and Dr. Holt DC were found dead with no specified causes. On June 29th Theresa Sievers MD was found murdered. Also on that date, Jeffey Whiteside MD, a pulmonologist, has vanished. On July 3 Patrick Fitzpatrick MD also went missing and has not been found. On July 10 Lisa Riley, DO was murdered; her husband was charged with the homicide. On July 19 Ron Schwartz, MD, a gynecologist, was found shot to death, an apparent murder.
Included on Elizabeth's list is Dr. Nicholas Gonzalez, MD, integrative cancer physician, who died suddenly on July 21, 2015 of an apparent heart attack, but he was of good health and no autopsy confirmed causes of death. Coincidentally on July 21, Dr. Abdul Karim, DDS, died following a heart attack while practicing for an upcoming marathon. On July 23 Dr. Jeffrey Whiteside's body was found and later deemed a suicide. On August 12th, Mary Bovier, DO was found "slain" but no one has been charged.
On Sept. 16, 2015 Dr. Mitch Gaynor, MD, author and holistic MD, committed suicide. On Oct. 11, Dr. Marie Pass was found dead following a suicide. On Oct. 29 Jerome Block, MD died after jumping from his New York City apartment window. On Dec. 28, cancer researcher Alan Clarke, MD "accidentally died" despite his body found hanging from a tree.
On Jan. 15, 2016 Ron Floyd, DC was found dead. On Jan. 23 John Marshall MD was found dead in a river. On Feb. 1 Paige Adams, FNP was also found dead. On Feb. 14th, HIV researcher, Cheryl Deboer, PhD was found dead with a plastic bag covering her head. On March 23, 2016 Dr. Henry Han and his family were all murdered. On April 6, Dr. Harsh, MD was killed while riding her bicycle. On May 16, Dr. Suutari, a holistic doctor, took his own life. On June 17, 2016 Tiejun Huang MD, PhD was killed by an assailant.
Elizabeth makes the case that too many holistic and integrative doctors are dying. She suggests that many of the deaths deemed as suicides involved foul play and were possibly murders. Elizabeth thinks that these deaths are not being investigated satisfactorily. Moreover, she suspects that most of these deaths involve doctors who had been targeted. However, there is no definitive evidence to substantiate that the deaths are part of a conspiracy against holistic doctors. The murders appear to be typical of all murders – a jilted relationship, a bad business deal, domestic violence, or a psychopath's delusional behavior. The suicides frequently follow similar scenarios, including financial loss, divorce, or serious illness.
Holistic doctors and practitioners are not immune from the turmoil and tragedies of life and frequently act out in irrational ways, including taking their own lives. The fact that the aforementioned individuals died from suicide, murder, and other natural causes does not mean that there is a conspiracy afoot. It means that holistic doctors are human and die for the same reasons that befall all humans. Elizabeth and other similar-minded writers need to provide the evidence for whom these actors are in this evildoing conspiracy and what exactly they are doing. Until she does, this holistic doctor death series is simply a listing of holistic doctors who coincidentally died – nothing more.
The Cure for Alcoholism?
While the government and media have focused much of their attention this year on the epidemic of opioid abuse and addiction, alcoholism remains a major concern in the US and internationally. The illicit use of alcohol by high school students is not a new trend, but despite greater police scrutiny of stores illegally selling to minors, underage alcohol use continues to escalate. College campuses have become a venue for 21-year-olds (and younger peers) to drink without limits; students routinely engage in marathon drinking sessions, not infrequently becoming drunk and then passing out from alcohol excess. It is little wonder that among young adults, alcoholism is considered acceptable behavior as long as the drinking starts after work and individuals are sober before the start of the workday. Of course, it is a little questionable whether these individuals are truly sober in the a.m., and not a few are already drinking with their lunch meals. Despite the fact that many manage to curtail their alcohol use to only a few evening drinks, a large number maintain heavy daily drinking and are unable to lessen their consumption. Among those drinking heavily, many become unable to control their alcoholic behavior, interfering with their marital and family lives and work performance. Alcoholism is additionally the precursor to liver and pancreatic disease as well as a factor complicating other health problems.
Many alcoholics would like to bring their alcohol habit under control but are unable to manage long-term reduction of their drinking. Despite the fact that authorities frequently punish them after driving under the influence, alcoholics are generally unable to stop consumption. Twelve-Step programs, as offered by Alcoholics Anonymous (AA), are very helpful and provide insight that the alcoholic is not "the cause of his alcoholism," nor can he/she "control or cure the alcoholism." AA contends that only a higher power can intervene in the alcoholism and that the alcoholic must let the higher power change the addiction. For many alcoholics and their families, these words provide great encouragement, and combining AA with treatment plans, the alcoholic not only may become sober but also maintain sobriety. However, not a few alcoholics are unable to maintain sobriety despite adherence to a Twelve-Step program and undergoing recovery treatment. The problem is that for many alcoholics, willpower and camaraderie at AA meetings is not sufficient to overcome the intensive urges to drink again, to just have that one little drink. The lack of willpower is not because the alcoholic is too feeble to master his cravings – it is because his/her neurochemistry has not been appropriately "de-addicted" from alcohol.
In the book The Cure for Alcoholism, by Roy Eskapa, PhD, the Sinclair method for de-addiction to alcohol and other addictions is explained.2 In a nutshell, alcoholics physiologically enforce their habitual drinking by the endogenous production of endorphins with each drink of alcohol. Before the individual developed an alcoholic habit, there would be a limited stimulation of opioid receptors by drinking alcohol. As the individual consumed greater quantities of alcohol, opioid receptors would dramatically increase in activity, providing a tremendous release of endorphins with alcohol consumption. When an alcoholic becomes sober, the neurochemistry has not yet changed and opioid receptor activity remains overactive, signaling the need to consume alcohol. That signaling is very strong and eventually overcomes the thinking to not drink. In the Sinclair method, a drug agent, naltrexone, is administered prior to ingestion of alcohol. As an opioid receptor antagonist, naltrexone dampens the positive feedback that the alcoholic experiences when drinking alcohol. Less endorphins are produced. As days and weeks proceed, with continuing use of naltrexone taken within 1 hour of drinking, the opioid receptor activity is inhibited to a great degree, and the positive reinforcement that an alcoholic experiences with drinking alcohol is partially if not completely eliminated. Eventually, through ongoing use of naltrexone when drinking, the alcoholic has de-addicted from his habit – the craving to drink alcohol disappears chemically. Willpower is no longer required to remain sober.
Is this just a great hypothesis? Hardly. Eskapa provides an extensive review of the clinical studies of naltrexone (or similar agents) used to treat alcoholism. Many of the studies done in the US and internationally are double-blind, placebo-controlled studies. The evidence for these studies shows a success rate of approximately 80% in those patients who used naltrexone. Note: the naltrexone must be used in patients who are still drinking alcohol; if the patient is already not drinking, naltrexone treatment should not be employed. Patients who are suitable for naltrexone treatment should not have liver or kidney disease or evidence of liver function abnormality.
It was unexpected to read that perhaps the most successful treatment for alcoholism is done while the patient continues to drink alcohol. The Sinclair method should be considered a first-line approach for alcoholism and it may be successfully done without additional counseling.
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