THE RUSH TO JUDGMENT REVISITED

Soon after the death of Abubakar Tariq Nadama, I wrote about the rush to judgment that was going on by both sides of the chelation debate. There were those that wanted to blame the medical establishment for not fully supporting the admittedly experimental treatments many of us use. On the other side, many proclaimed that the tragedy proved that chelation -- in any form -- was inherently dangerous and anyone who said anything at all positive about such procedures was an accomplice to murder.

What I said back then was:

I still think we in the biomedical movement have a lot of questions to ask ourselves. But before we can even formulate those questions, we need to have more information. Was Abubakar’s death the result of an anaphylactic reaction, hypocalcemia, or some yet-to-be-thought-of reason? If hypocalcemia was the direct cause of death, was it brought on by a failure to replentish the child’s minerals, including calcium, with supplements, or did the doctor use Disodium EDTA rather than Calcium EDTA? Was the proper dosage used? Did the doctor perform all appropriate pre-procedure checks? Was the child properly monitored in between chelation procedures?

When we have the answer to all those questions, we’ll have a better idea of whether anyone needs to bear the blame for this tragedy. In the meantime, let’s try to respect a family that needs to mourn a child. Let’s all shelve our anger for a while. And let’s honor the Nadama family’s mourning by redoubling our own efforts to protect our own children. That includes learning all we can and being equal partners with our doctors.

Unfortunately, those questions remain.

In the last couple of days, the Pennsylvania media’s coverage of the release of findings by the Allegheny County Coroner concerning the Nadama case. The Pittsburgh Post-Gazette reported the following:

The manner of death of Abubakar Tariq Nadama, of Monroeville, has been listed as accidental while the investigation continues.

The findings released by the Butler County coroner’s office don't say whether the treatment itself is dangerous or the child died from the way the treatment was administered.

In layman’s terms, the administration of ethylene diamine tetra-acetate, commonly known as chelation, resulted in a lack of oxygen to the brain as well as irreversible heart damage, said Allegheny County Deputy Coroner Ed Strimlan.

The Allegheny County morgue conducted the autopsy on the child at the request of Butler County Coroner Bill Young.

“We determined there’s a direct correlation between the EDTA and the lack of oxygen to the brain and the heart muscle damage. It’s a total package, based on the autopsy, the histology [tissue sampling] and the toxicology [blood sampling],” Mr. Strimlan said.

Note that the coroner’s report does not state any opinions on the efficacy of EDTA chelation, nor does the media give any details about the manner in which Dr. Kerry performed the chelation prcedure.

Despite the lack of what I would consider pretty important information, a couple of bloggers I have respectfully disagreed with in the past, but both of whom I have a relatively cordial relationship with, have regrettably restarted the parade of anger.

Kevin Leitch had this to say:

Now we know for sure that Chelation did play a role in a young boys death -- a boy who’s dead solely because he was autistic -- I invite commenter’s from an anti-vax, anti-thiomersal, pro-chelation perspective to call for investigations into Dr Roy Kerry under who’s treatment Tariq died and to call for Rashid Buttar to exercise more care.

Okay Kev, you’re on. I’m not sure whether I fit into any or all of those categories, or that those categories are even relevant. Talking about vaccines or thimerosal seems a little off-base because this young man was apparently being chelated for lead rather than mercury. Susceptibility to lead that can arguably aggravate autistic symptoms, may -- and I emphasize the word “may” -- be related to immunological problems that originated with mercury in vaccines, but the connection is indirect. Moreover, I do not advocate any particular therapy because each child’s condition is too unique for there to be a one-size-fits-all protocol. But inasmuch as I’m usually thrown into those groups, what the heck, I’ll issue the calls.

I hereby call for a complete investigation into the circumstances surrounding the treatment of Abubakar Tariq Nadama by Dr. Roy Kerry. We need to know exactly what was in that IV. We need to know what protocol was being followed. We need to know what other factors were present in the patient’s history that might bear on what happened, and whether Dr. Kerry paid enough attention to any such factors. Until we know, however, we’re all just talking though our hats.

And I’ll go even farther than asking Dr. Buttar to exercise care. I call upon every doctor who comes near our children to exercise the highest degree of care humanly possible. But that really has nothing to do with whether chelation should be considered as an acceptable protocol; rather, that call is for practitioners and parents to understand what needs to be done to perform any and all procedures, including chelation, safely.

The other blogger I mentioned was the renowned skeptic, Orac, who was, not surprisingly, more pointed in his post:

No doubt chelation advocates will cry foul, but it looks as though the autopsy definitely indicates that chelation therapy killed the boy. Given the circumstances of the boy’s death, it’s pretty obvious that the cause was almost certainly hypocalcemia due to EDTA leading to cardiac arrest. At the time, I was afraid that the autopsy findings might not reflect EDTA as the cause of death, mainly because deaths from sudden cardiac arrest due to acute electrolyte abnormalities don’t always produce concrete findings that let the pathologist pin down the exact cause. Such a result would have given the chelationists an “out” to claim that it wasn’t the EDTA that killed Tariq. Fortunately, that didn’t happen in this case. Too bad the parents are highly unlikely to sue Dr. Roy Kerry, the ENT doctor turned alternative medicine practitioner, because he wouldn’t have a prayer of winning a malpractice suit against him. (If doctors in this country can be sued and lose for bad outcomes that aren’t their fault, one hopes that someone like Dr. Kerry can be sued for bad outcomes that are his fault.) Maybe a big settlement or a big malpractice judgment against one (or, preferably more) of these autism chelationists would be what it would take to cool their love of this particular ineffective autism therapy somewhat.

I don’t want to argue semantics with Orac, but saying it was chelation that caused this death is way oversimplified. There are so many methods of chelation that the real issue is what was it about this particular instance of chelation that caused the problem.

Let’s focus on IV-EDTA. Among those practitioners using it to chelate for lead in autistic patients, there is a difference in opinion as to whether a push or a more gradual drip is more appropriate. But the one thing nearly every doctor performing the procedure agrees on is that Calcium EDTA should be used rather than Disodium EDTA. This is not exactly news, it has long been known that using the latter can lead to fatal hypocalcemia.

There have been many unverified rumors that Dr. Kerry was using Disodium EDTA rather than Calcium EDTA. I hate to rely on rumors, and with various legal and administrative investigations pending, the facts are not likely to be made public any time soon. That being said, the use of the wrong substance is the most obvious explanation for what happened.

If Dr. Kerry did indeed use Disodium EDTA, the problem is not with the protocol; the problem is a doctor who didn’t follow the protocol. It would be a matter of negligence -- medical malpractice in other words -- rather than a procedure being unreasonably dangerous per se.

If Dr. Kerry made such a basic error as using Disodium EDTA rather than Calcium EDTA, he would, as Orac says, be subject to a lawsuit. (It may be a little off-topic, but I can’t help but observe that Orac’s reasoning that liability concerns may help deter malpractice is similar to the best argument against eliminating liability for vaccine manufacturers.) The choice to take private legal action, however, lies with the Nadama family, and not with Orac or me. Discussing the relative pros and cons of filing a lawsuit would take far too long. I can only trust that Dr. and Mrs. Nadama will make the right choice for their family.

Whenever we discuss personal experiences that lead us to believe in a connection to particular toxic insults, like thimerosal in vaccines, live viruses, or lead exposure and the onset of autism, or when we relate positive experiences regarding biomedical treatments, the response is often that the plural of anecdote is not evidence. It’s funny how the same people that shout out that mantra are now willing to base their argument about the safety of a class of procedures on a single incident.

In an exchange of emails I had today with our friend, Mary Webster, she raised an analogous situation of a transplant surgeon who failed to compare the blood types of the recipient and donor. That failure was fatal to the patient. The failure to follow the simplest and most basic of procedures does not mean that organ transplantation should not be preformed in appropriate cases, but it does underline the need to follow all the right procedures. I think that’s a pretty apt analogy.

I truly hope that the whole story will come out someday, and that we can all learn something. For now, though, we should all resist the urge to pass judgment.