Heavy Metals, Chelation and Lupron

The hypothesis of heavy metal poisoning as a cause of autism originates from the idea that mercury in vaccines cause autism. The vaccine/autism issue is discussed elsewhere on this site. Many speakers at AutismOne who promote chelation therapy have, themselves, been allegedly involved in some tragic deaths of patients undergoing unwarranted treatments. This treatment originated from the Autism Research Institute (ARI) and the Defeat Autism Now (DAN) protocol, which is discussed here, here and here.

The problems with chelation have been summed up here by Orac on Respectful Insolence:

Indeed, it is from that concept (that “autism is a misdiagnosis for mercury poisoning,”, which is not supported by epidemiological or preclinical evidence) that flows all sorts of dubious therapies to “remove” the mercury. Foremost among these questionable therapies is chelation therapy, using a chelating agent like EDTA or DMSA to bind to and remove this supposed mercury excess. This therapy is touted as being extremely effective in improving the behavioral abnormalities in autism, but, contrary to what its proponents say, it is neither efficacious nor safe. Indeed, six months ago it resulted in the death of an autistic boy named Abubakar Tariq Nadama at the hands of a quack named Dr. Roy Kerry in a clinic near Pittsburgh. There are many variations of chelation therapy, including Dr. Rashid Buttar‘s famous “transdermal” chelation. Despite the fact that Dr. Buttar has never been able to demonstrate scientifically that his DMSA-laced cream chelates anything or is even absorbed through the skin, parents line up to pay him big bucks to administer this therapy. Not long after Abubakar’s death, I learned of another variant that Dr. Buttar has come up with that involves intravenous minerals, intravenous ozone, and an unnamed “environmental detoxifier,” to treat autism. (One wonders if it’s because even Dr. Buttar is starting to realize that chelation therapy doesn’t do anything for autism.)

Chelation Therapy

A 2015 Cochrane  systematic review of the current evidence on chelation therapy concluded that “no clinical trial evidence was found to suggest that pharmaceutical chelation is an effective intervention for ASD. Given prior reports of serious adverse events, such as hypocalcaemia, renal impairment and reported death, the risks of using chelation for ASD currently outweigh proven benefits. Before further trials are conducted, evidence that supports a causal link between heavy metals and autism and methods that ensure the safety of participants are needed.”

A 2013 systematic review of studies of chelation therapy for autism arrived at similar conclusions.

Perhaps the greatest concern in regards to the selection of chelation treatment for children ASD is the lack of construct validity. In some ways, chelation therapy represents the “cart before the horse” scenario in that the hypothesis supporting of the use of chelation treatment failed to be validated prior to the application of chelation. Chelation treatment aims to eliminate specific metals from the body. However, empirical evidence has yet to support the hypothesis that the core ASD symptoms are caused by the presence of such metals in the body. Because empirical evidence does not support the hypothesis that the core ASD symptoms are associated with specific levels of metals in the body, the use of chelation to remove metals from the body in order to ameliorate ASD symptoms could be seen as unfounded and illogical.

Moreover, even if metal poisoning contributed to the ASD symptoms, it would still be unclear whether chelation treatment would have the ability to reverse existing neurological problems caused by such exposure, or whether it would only be able to prevent further damage (i.e., worsening of symptoms). In other words, even if the metal poisoning theories held true, it does not necessarily lead to an expectation that chelation would ameliorate current communication and social skills deficits and behavioral impairments, rather than prevent additional or more extensive impairments.

Based on the results of this review, evidence to support the use of chelation as a treatment for children with ASD is extremely weak. The weakness of the evidence base, the lack of a sound rationale for use of chelation as an ASD treatment, and the potential negative side effects strongly argue against the use of chelation treatment for ASD.

Dubious medicine: extensive coverage from 2009-2014 in the Chicago Tribune about the use of chelation therapy in and around Chicago by Mark and David Geier, Naperville physician Anju Usman, the now deceased Dr. Mayer Eisenstein and other doctors in his practice

Autism and metals: not a lot of there there (Emily Willingham): critiques a 2013 paper that reported elevated levels of lead, thallium and tungsten in autistic children and finds their analysis lacking

The results of the unethical and misbegotten Trial to Assess Chelation Therapy (TACT) are finally revealed (Respectful Insolence): there are many additional links within, in addition to those included here.

My NCCAM Wish List (Science-Based Medicine): discusses the ethical issues surrounding the TACT study

Should We Study Chelation Therapy for Autism (Science-Based Medicine): also discusses evidence and ethics of studying chelation therapy in autism

Father Sues Doctors Over ‘Fraudulent’ Autism Therapy (ABC News, March 9, 2010): One of these doctors, Dr. Anju Usman is speaking at this year’s AutismOne.

ChelationWatch is a collection of articles and scientific resources about chelation therapy.

Lupron

Lupron is used in conjunction with chelation in a protocol developed by Mark and David Geier, as described here by Steven Novella on the Neurologica Blog.

They claim, in short, that autism is caused by mercury poisoning, primarily from vaccines. Children with autism, especially boys, have high testosterone, which is partly the cause of their symptoms. But also the testosterone binds to mercury, preventing it from being removed from the body by chelating agents.

They have therefore conducted a study with the drug Lupron in addition to chelation. Lupron is a powerful drug that lowers testosterone levels. It is used for rare disorders associated with premature or high testosterone, or to treat prostate cancer in some men. It is also used as a form of chemical castration for sex offenders.

Each component of the Geiers claims are not only not proven, the scientific evidence is against them. It is pretty clear now from multiple studies that there is no association between mercury or vaccines and autism. Autism is not a form of mercury or heavy metal poisoning. Chelation therapy, which itself is risky, is of not benefit in autism. And high testosterone levels do no cause autism.

The scientific community has soundly rejected the Geier’s claims and renounced their practice. Pediatric endocrinologists, autism experts, and neurologists are nothing short of horrified at the abject and dangerous pseudoscience they are inflicting upon their patients.

An 8 part series on the Geier’s use of chelation therapies and Lupron at Respectful Insolence

  1. Why not just castrate them?
  2. Why not just castrate them? (Part 2): The mainstream media finally notices the Geiers’ Lupron protocol
  3. Why not just castrate them? (Part 3): The Eisenstein Homefirst connection
  4. Why not just castrate them? (Part 4): Dan Olmsted has a very short memory
  5. Why not just castrate them? (Part 5) The Geiers’ “Lupron protocol” metastasizes
  6. Why not just castrate them? (Part 6): The State of Maryland finally takes “emergency action” against Mark Geier and his Lupron protocol for autism
  7. Why not just castrate them? (Part 7): The fallout from the suspension of Mark Geier’s medical license
  8. Why not just castrate them? (Part 8): The State of Maryland moves against David Geier

Coverage in The Chicago Tribune (May 21, 2009) about the Geiers and Lupron: ‘Miracle drug’ called junk science

Looking back at two decades of Geier (Left Brain Right Brain)

Mark Geier: Not a Leg to Stand On (Harpocrates Speaks)