28. Chelation Therapy

Chelation therapy has some substantial and important claims made for its effectiveness in many serious conditions. The reality of this will be examined.
This part is divided into the following sections:

If you wish to go directly to any topic, click on the heading in blue.

Chelation therapy originated in the USA around 1955 and from there moved to Europe. Its advocates claim great success in a very wide range of conditions, a fact which should inspire scepticism. Only a few of the claims to cure diseases will be assessed as there is such a spectacular lack of evidence from peer-reviewed research. Unsubstantiated testimonials are no substitute.

What is Chelation?

Chelation involves attaching chemicals to substances, usually metals, so that they are more easily excreted from the body. The scientific basis of chelation is well established.

The body’s balance of iron is kept in equilibrium by controlling the amount of iron that is absorbed. The body has little or no ability to excrete iron. Thalassaemia is a disease in which abnormal haemoglobin is formed and this causes severe anaemia so that it must be treated with blood transfusions.1Thalassaemia The result is an excess of iron in the body that can cause cirrhosis and other problems. Deferrioxamine is a chelating agent that is used to mobilise the iron to aid excretion to prolong life and health. In haemochromatosis there is too much iron absorbed but this is usually treated by periodic bleeding rather than chelation.

Wilson’s disease is a genetic disorder that is associated with an excessive amount of copper in the body.2Wilson’s Disease This can cause cirrhosis, diabetes and problems in the brain and eye. This is treated with the chelating agent penicillamine which is related to penicillin.

Sometimes aluminium may accumulate in the body, especially when dialysis is needed for kidney failure. Chelating agents may be used to treat poisoning from heavy metals such as lead or mercury.3Chelators as antidotes of metal toxicity This is a considerable problem in some parts of India where industrial pollution is out of control. Substances commonly used include ethylene diamine tetra acetate (EDTA) and ethylene triamine penta acetate (ETPA).

EDTA captures metallic elements and they are easier to excrete.

Sometimes people who promote chelation therapy will give a test dose of EDTA and then take a urine sample to show that an excessive amount of toxic metals are found to justify the need for a full course of treatment. However, the reference range of normal is based on urine that is obtained without a dose of EDTA.4How the “Urine Toxic Metals” Test is Used to Defraud Patients The infusion increases excretion by a factor of about two for iron, five for aluminium, lead and manganese, and 15 for zinc.5Effects of an EDTA infusion on the urinary elimination of several elements in healthy subjects In short, this is fraud.

A British company advertises chelation therapy with the following claims:

Broadly, chelation therapy can be used to help with:

  • coronary and cerebrovascular disease
  • autoimmune conditions
  • chronic fatigue syndrome
  • autistic spectrum disorders
  • allergic disorders
  • neurological conditions and neuropathies
  • preventative medicine and anti-ageing

A PubMed search for most of those topics yielded nothing, suggesting that there is no evidence to substantiate the claims. For those that did yield results, let us examine some of these claims and see how the evidence stands.

Chelation Therapy for Coronary Artery Disease and Other Arterial Disease

Chelation therapy is the giving of substances, usually EDTA, to chelate and supposedly to improve the health of the patient. I turned to http://www.holisticonline.com to find more. They explained it as, “One way to think about the chelation process is to compare it to the way we unclog our drains. We add a chemical to our drain. It dissolves the blockage. The resulting compound is removed from the drain using the existing plumbing system. Chelation process works in a similar manner on our body.” 6Chelation therapy. Introduction Does this mean that it unclogs blocked arteries? Apparently this is the claim.

Returning to the website holistic online:

“Chelation therapy is widely used for the treatment of atherosclerosis and other chronic degenerative diseases involving the circulatory system. It also has other benefits. Many scientists suggest that the beneficial effect of chelation treatment is from the removal of metallic catalysts that causes excessive free radical proliferation. This reduces the oxidation of lipids, DNA, enzyme systems and lipoproteins. The chelation halts the bad effects and initiates the body’s healing process, often reversing the damage. It removes the calcium and copper anions from the blood stream. The plaque lining the artery walls are made porous and brittle. Eventually they may get dislodged. Even if only a microscopic layer of the plaque is removed, it, along with a smoothening of the artery wall due to the healing of the cells that line the arteries, can improve the blood flow to the artery muscles substantially. This can prevent artery spasm and minimize or prevent angina pain. Many patients who could not walk due to muscle pain or angina pain have reported that they can walk without pain after chelation therapy.”

This is a startling claim. Most drugs in conventional medicine would aim to slow the rate of deposition of atheroma and so a technique to reverse it is of enormous importance. As coronary heart disease is the commonest cause of death in developed countries with stroke third, this has massive consequences for health and is of great economic importance. It could take the place of coronary artery bypass grafts and angioplasty to unblock coronary arteries. It should be rather safer than operating on the carotid artery to prevent stroke or on major arteries such as the aorta or arteries of the leg to prevent loss of a limb from poor circulation. It would also reach smaller arteries that are too small for operation. It would save many millions of pounds a year spent on statins and such drugs to reduce atheroma. This is a claim that cannot be ignored. It would be worth billions of pounds to the NHS as well as the economic implications of preventing disease. This is radical. It just needs to be tested.

Let us look at how disease of arteries forms. The first stage is hardening of arteries, called atherosclerosis, and then deposits form causing narrowing. This is called atheroma. Atheroma can form unstable plaques and with inflammation a thrombus forms and this occludes the vessel. If it affects a coronary artery, the heart muscle supplied by that artery will die and we call it a heart attack or myocardial infarct. The process is also known as myocardial infarction. If it occludes an artery to the brain, there is a stroke. Sometimes a thrombus flies off from part of an artery in the neck and lodges in the brain or it may arise from the heart. This is called an embolus and the process is embolism. It also causes a stroke. If chelation therapy dislodges part of a thrombus, as suggested by the article, an embolus will move down to a smaller vessel and block that causing a heart attack or a stroke depending upon where the embolus lodges. About 20% of strokes are due to haemorrhage into the brain. The other 80% are due to thrombosis or embolism.

The same process can cause narrowing of the aorta, the main artery out of the heart as it divides in two in the abdomen to supply the pelvic area and the major arteries of the legs. When muscles work harder they require more blood and if the blood supply cannot match the demand a gripping pain results. This is called angina if the muscle with inadequate blood supply is the heart and intermittent claudication if it is the muscles of the legs. In both cases stopping exercise will enable the blood supply to catch up with the demands and the pain will go.

The concept of oxidative stress in the pathology of atheroma is well accepted.7Antioxidants and CVD The role of metals in exacerbating or reducing oxidative stress also seems to be in keeping with current thinking.8Advances in metal-induced oxidative stress and human disease However, some metals are good and some are bad. How sure can we be that chelation will clear the bad metals and not the good too or instead? Whether or not the theory seems plausible, the test must be to see if the results justify the claims.

This advertisement shows the amazing and unsubstantiated
claims made for chelation therapy.

Because of the fear of being inundated with papers about chelation for treating poisoning from heavy metals or from dialysis or work on chelation for iron overload or Wilson’s disease, I searched first for “chelation therapy atherosclerosis”. This produced just 36 papers. One called “Management of peripheral arterial disease of the lower extremities” immediately struck me as most relevant to the claims to cure such disease.9Management of peripheral arterial disease of the lower extremities However, having mentioned many aspects of management that should be followed he wrote, “Chelation therapy should be avoided.” There was no expansion on why it should be avoided but this was only an abstract and presumably the explanation would have been in the full text that required payment for access. Another paper, looking at peripheral artery disease in women states, “Chelation therapy should be avoided as it is ineffective.”10Peripheral arterial disease in women This is by the same author.

EDTA is the usual chelation agent and a review from India, where they are usually quite encouraging about CAM, concluded that controlled trials are very few and tend to suggest that any benefit is placebo only.11Role of EDTA chelation therapy in cardiovascular diseases A Cochrane review was highly critical of the quality of evidence and said that it was impossible to draw any conclusion based on it. There were only five studies in their group. Mortality, non-fatal events (heart attacks or strokes), and cerebrovascular events (strokes) were not reported in any of the studies. Four of the studies, with a total recruitment of 250 participants, showed no significant difference in the outcomes.12Chelation therapy for atherosclerotic cardiovascular disease A review from the Canadian College of Naturopathic Medicine also said that it could not recommend chelation therapy for cardiovascular disease because of shortage of adequate evidence.13EDTA chelation therapy for cardiovascular disease: a systematic review This reference permits free access to the full text.

It may seem strange that conditions such as angina and intermittent claudication, with such a clear physical basis, should be susceptible to the placebo effect. They are susceptible and this has marred some trials from the 1950s but, in addition, moderate exercise, going up to the pain but not pushing through the pain, is beneficial. Exercise is recommended by NICE as part of the management of this condition. It seems to aid the formation of collateral or bypass channels.

This coronary angiogram shows clearly a narrowing of a coronary artery

There appears to be no good evidence that chelation therapy is effective in terms of improving symptoms. The claim that was made was “One way to think about the chelation process is to compare it to the way we unclog our drains”. Does it really unclog the arteries?

Before anyone has surgery on arteries, whether coronary arteries or arteries in the legs, an angiogram is performed. This involves injecting a contrast medium into the artery and x-rays are used to give an outline of the vessel. This can demonstrate narrowing or occlusion of arteries. We need some “before and after” chelation therapy angiograms. They could be assessed by a radiologist or surgeon who does not know which is “before” and which is “after” to give a blind assessment. Angiography is an invasive and potentially dangerous technique although in experienced hands adverse events are few. There are other techniques that are not invasive such as Doppler blood flow studies. An easy way to assess problems with arteries in the leg is to measure the blood pressure in the arm in the usual way and also at the ankle. The difference gives an indication of the degree of disease. Can chelation therapy improve this?

Blood flow to the right leg is very poor. We can see the blocked artery as it is calcified.

Calcium is deposited in the walls of arteries and sometimes in severe disease arteries are visible on plain x-rays because of this. The first part of the pathological process, as we have seen, is atherosclerosis or hardening of the arteries. This means that as the heart pumps blood into the circulation with each beat it is less readily absorbed into an elastic system and so the blood pressure will rise. This is more marked in the systolic, the higher pressure, than the diastolic, the lower pressure. Thus, instead of a blood pressure of perhaps 140/80, it is 200/80. Can chelation therapy improve the systolic pressure, perhaps to 150/80?

I have managed to find a paper that examined findings at angiography with regard to arterial disease in the legs.14Arteriographic findings in EDTA chelation therapy on peripheral arteriosclerosis It was a randomized, double-blind, controlled study. There were 153 patients with claudication (muscle pain on walking) who were each given either 20 infusions of EDTA (chelation) or 20 infusions of saline (placebo of salt solution). Walking distances and blood pressure difference between arm and ankle were measured before, during, and after treatment. In 30 patients, angiograms were obtained before, during, and after treatment. The patients’ subjective evaluations of the effect of treatment were also recorded. It was concluded that EDTA chelation therapy has no effect in patients with intermittent claudication in the legs caused by arteriosclerosis. This was a good study, of double blind nature using a number of parameters, including the objective evidence of angiograms. The number of patients recruited was quite impressive.

A Canadian paper about why people turn to chelation therapy is very interesting.15Opinions on chelation therapy in patients undergoing coronary angiography A full text is available free of charge. It gives several interesting references at the end. Some, including the one above, are objective assessments of chelation therapy that find it to be useless. It includes a systematic review from 2000 which says that not only is it ineffective but because of “the potential of chelation therapy to cause severe adverse effects, this treatment should now be considered obsolete.”16Chelation therapy for coronary heart disease: An overview of all clinical investigations Nevertheless, a paper in Alternative Therapies in Health and Medicine is enthusiastic about it.17EDTA chelation therapy should be more commonly used in the treatment of vascular disease The abstract says:

“EDTA chelation therapy is safe, effective, and more economical than commonly used surgical treatments for vascular disease. This article includes evidence of effectiveness, mechanisms of action of EDTA, a discussion of studies that have been done regarding the therapy, and some brief case reports. The conclusion is that EDTA chelation therapy should be a therapeutic option for vascular disease, either by itself or in conjunction with standard protocols.”

There is obviously a considerable difference of opinion about what constitutes scientific evidence and safety. As for being more economical, a treatment that does not work is uneconomical and a complete waste of money.

The conclusion has to be that this is a useless but potentially dangerous way of dealing with a very serious condition. Firm action should be taken against those who promote it.

Chelation for Multiple Sclerosis

I did a PubMed search for “chelation therapy for autoimmune conditions” and had just two results. One was about acute mercury poisoning presenting as fever of unknown origin, and so was irrelevant. The other, from the USA, was called “Iron chelation and multiple sclerosis” and was far more promising.18Iron chelation and multiple sclerosis

It was a small study of just 12 patients. They were careful about the treatment as they acknowledged that it can be dangerous. A number of patients seemed to benefit but with the remitting and relapsing nature of the disease they advised caution. The conclusion of the paper was cautious, reflective and contrary to the unbridled claims and enthusiasm we have seem from others.

They noted that studies have shown that in multiple sclerosis (MS), there is deposition of iron in the brain, but that does not mean that it is the cause of the symptoms or disease. Patients with MS do not have general iron overload, and so they recommend using lower doses of chelating agents. They also recommend care if other drugs for MS are being used. They note that levels of iron in the brain can be monitored by MRI scans. They advise that chelation therapy can have side effects, some of which can be severe and require close monitoring. It is not clear which type of MS would be most likely to benefit from chelation therapy, when administration should begin, or for how long.

The MRI shows the plaques of sclerosis in a brain with MS.

Despite the claim that chelation therapy is effective for autoimmune conditions, all I can find is that it may possibly be of benefit in multiple sclerosis, but trials are in the early stages and care should be used as the treatment could be dangerous.

Chelation Therapy for Autism and
Autistic Spectrum Disease (ASD)

Autism is not a single entity but a spectrum of problems of varying severity. Therefore, it is often called autistic spectrum disease or ASD. The mild form is sometimes called Asperger’s syndrome but as explained in Basic Maths in Medical Research and Decision Making in the section “What’s in a name?” it seems that Asperger was a Nazi who sent about 800 “unsuitable” children to death camps and so there is a move to change the eponym.

The number of new cases diagnosed each year has escalated considerably since about 1980. Most experts believe that the vast majority of this is due to greater awareness of the condition and with it, greater willingness to make the diagnosis. Whilst this may explain most of the new cases, there is probably an increase in true incidence too.

I loved this cartoon so much I had to put it in.

Back in the 1980s, clinical psychologists and child psychiatrists who saw children with autism would meet the parents and they often noted that they seemed a little odd. It was perhaps one or both parents but the father more often than the mother. They were autistic too. It was clear that there was a familial component and the condition affects males more often than females. My wife was a child and adolescent psychologist and I once asked her, “What is Asperger’s syndrome?” She said that basically they are the train-spotters. A few days later the mother of one of my patients with Asperger’s syndrome told me that her husband was taking their son train-spotting with him to get him more social interaction. There was obviously another undiagnosed train-spotter. Whilst genetics is an undoubted component of ASD, it is thought to account for about 50% of this diverse disorder.

Hence, there are other contributory factors to the disease and, if there is a true rise in the incidence, it needs explanation. As discussed in the chapter Fake News and Vaccine Scares, one thing of which we can be certain is that it has nothing to do with the MMR vaccine.

One suggestion has been that mercury is associated with the disease but as we have seen in Cohort or Longitudinal and Epidemiological Studies in the section “Association and Causation”, just because two things may be associated, dose not mean that one caused the other. However, 19 The relationship between mercury and autism: A comprehensive review and discussion suggested that the preponderance of the evidence indicates that mercury exposure is either the cause or a contributor to the condition. A similar conclusion is drawn for another paper in the same journal, called 20 The association between mercury levels and autism spectrum disorders: A systematic review and meta-analysis.

Even if mercury is involved in the pathogenesis (causation) of ASD, it is a mighty leap to assume that chelation therapy will cure or even improve the condition. We need evidence from proper trials as described in the chapter Randomised Controlled Trials. There is a Cochrane review of 21 Chelation for autism spectrum disorder (ASD) which concluded, “This review included data from only one study, which had methodological limitations. As such, 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 (low blood calcium), renal (kidney) 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 PubMed search confirms a severe shortage of adequate clinical trials.

If you are wondering whether to take a child with ASD for the miracle cure of chelation therapy, then in the immortal words of Eliza Doolittle, I would say, “Not bloody likely!” However, if your local child and adolescent mental health service (CAMHS) offers you a chance to participate in a trial, that is a different matter. It will be conducted with care, having had ethics committee approval as explained in the chapter Ethics in Practice and Research and this is a very different matter from letting a chelator loose with a potentially dangerous and unproved therapy.22Chelation therapy and autism The use of chelation therapy in ASD has been widely criticised.23Commentary on the Abuse of Metal Chelation Therapy in Patients with ASD

Chelation Therapy for Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a much better term that myalgic encephalitis (ME) as it describes the condition and does not assume inflammation of the brain, for which there is no evidence.

I did a PubMed search for “chelation therapy for chronic fatigue syndrome” and received two hits, neither of which was relevant. One was in German but the abstract in English was about the many promises made about chelation therapy and the absence of any evidence to support them. The other was case reports and not about chelation therapy but treatment which included “eating the evolutionary correct stone-age diet”. Chronic fatigue syndrome will be discussed in a later chapter.

Chelation Therapy for Cancer

There are two different claims here. One is that chelation therapy gives a general, non-specific protection against cancer for years after it was given. No specific types of cancer are mentioned. The other is that chelation therapy can be used to treat cancer.

A Bing search (I prefer it to Google but results are similar) was rather concerning with many sites claiming that chelation therapy is an effective treatment for cancer and, in some cases, encouraging people to stop their chemotherapy in favour of chelation. They make great claims for the “scientifically proven” benefits of chelation but I am unable to find these claims substantiated in any reputable journal.

A PubMed search for “Chelation therapy and cancer” received 610 results but they were about using chelating agents in the diagnosis of cancer and to attach drugs. I found nothing that seemed to relate to what is called chelation therapy. However, two papers by the same authors were interesting. As they are so similar I cite just one.24Iron chelators in cancer chemotherapy

It states that iron chelators may be of value as therapeutic agents in the treatment of cancer. They may act by depleting iron which is a necessary nutrient for tumour growth. It continues, “Alternatively, or additionally, they may form redox-active metal complexes that cause oxidative stress via production of reactive oxygen species, damaging critical intracellular targets and thereby eliciting a cytotoxic response.” Before you get totally bamboozled, a little explanation is necessary here.

You have heard of anti-oxidants. They occur in many substances including fruit and green tea and they are generally held to be of great benefit to health. In vitro (in glass) experiments in the laboratory have suggested that anti-oxidants give protection against heart disease and cancer. However, in vivo (in life) experiments on animals or humans have failed to confirm this and high levels of anti-oxidants may even increase the risk of cancer. This will be discussed much more in the chapter on nutrition. This absence of evidence of benefit from high doses of anti-oxidants and even possible risk from them, has not dampened the advertising of foods and drinks “high in anti-oxidants” and even calling them “super foods”. “Redox-active metal complexes that cause oxidative stress via production of reactive oxygen species” is exactly what anti-oxidants are supposed to oppose.

The abstract goes on to say, “Animal studies have confirmed the anti-tumour activity of several chelators. Dexrazoxane has been approved for use in combination with doxorubicin (a well known anti-cancer drug), and its effectiveness in allowing higher doses of doxorubicin to be administered is, in part, based on the interactions of both drugs with iron. Clinical trials of the anti-tumour activity of chelators have been largely limited to desferrioxamine, which has been extensively studied as a consequence of its approved use for treatment of iron overload. While the modest anti-tumour effects of desferrioxamine are encouraging, it is likely that more effective iron chelators may be identified.”

This and similar papers all come from the early 2000s. They refer mostly to in vitro work rather than on animals or people and the lack of later papers makes me think that the work has not lived up to the initial promise.

I had not heard of dexrazoxane, so I looked it up in the British National Formulary (BNF). It is classed as a iron chelator. It is approved for prevention of damage to the heart caused by doxorubicin or epirubicin treatment (anti-cancer drugs) in advanced or metastatic (with secondaries) breast cancer patients. It is used after a certain total dose is reached. It has a great many rather nasty side effects that are classed as “common or very common” and uncommon complications include acute myeloid leukaemia. The molecule is related to EDTA and is not licenced outside the treatment of advanced beast cancer. It seems to work as an iron chelator and considerable caution is advised for its use. This applies especially to the risk of new malignancies.

There is a great deal of difference between damaging lines of cancer cells in tissue culture and curing cancer in a human being. In the tissue culture, the desferrioxamine or other iron chelator acts directly on the tumour cells, but in a body the actions may be far more complex. The literature mentions desferrioxamine or other chelators of iron but most chelation therapists use EDTA, which is not so effective for iron.

It may be that iron chelators have a part to play in cancer chemotherapy in the future but there is no evidence that letting someone give you a chelating agent will either protect you against cancer or cure it.

Conclusion

In cases of iron overload or poisoning with heavy metals the role of chelation therapy is established in mainstream medicine, although it is not without some risk. The same is true of chelation therapy in Wilson’s disease in which there is too much copper in the body because of a lack of a protein called caeruloplasmin. The theory behind chelation therapy to reverse atheroma is unsubstantiated. Metals may play a part but it is not possible to determine that the EDTA will chelate only the “bad” metals and not the “good” ones too. This is rather like the theory in homeopathy that water “remembers” the beneficial things but not the bad ones.

The claims made for the ability of chelation therapy to reverse arterial disease are spectacular and if there was any truth in them there would be a very important form of treatment. However, the facts are that scientific trials are very few and often of poor quality. This is so often the case with CAM. Properly controlled trials show no benefit of treatment over placebo and trials to show objective evidence of improvement such as angiography and changes in blood pressure have been similarly negative. The conclusion must be that it does not work. Furthermore, using it may delay or prevent other interventions that have been proved to be of value. There are adverse effects, including kidney failure and death from its use and so the recommendation must be that it is not employed.

In scientific medicine, different chelating agents are used according to which metal is the target. I get the impression that in chelation therapy, it is always EDTA.

A common claim is that mercury in amalgam teeth fillings is a cause for concern. There is no evidence that it produces discernible toxicity.25Toxicological aspects on the release and systemic uptake of mercury from dental amalgam

According to a paper from Germany in 1998,26Chelation Therapy “The dubious promise was to maintain that the chelation therapy eliminates or alleviates symptoms in the case of the following illnesses: Alzheimer’s disease, senility, schizophrenia, rheumatoid arthritis, osteoarthritis, gout, renal calculus, apoplectic coma, gallstones, multiple sclerosis, osteoporosis, chronic fatigue syndrome, varicose veins, hypertension, failure of memory, scleroderma, Raynaud’s disease, digitalis intoxication, intermittent claudication, diabetic ulcer, disturbance of the blood supply, ulcer on the legs, snake poison, impotence, emotional difficulties, defective hearing, vision disorder. There is not the slightest proof of effectiveness for any of the listed indications. The burden of proof lies with the supplier. Even in the case of the relatively often examined peripheral atherosclerotic changes (claudicatio intermittens) there is no proof that EDTA has a greater effect than placebo. For coronary heart disease too there is no evidence for any usefulness of the chelation therapy beyond that of a placebo effect. Only controlled studies can help to improve the therapy in the sense of ‘Evidence-based medicine’. Retrospective investigations on thousands of patients cannot ‘prove’ anything, although this is maintained again and again.” The paper is in German but PubMed gives an English translation of the abstract.

The use of a urine sample after a test dose of a chelating agent and comparing it to a reference range without chelation has been mentioned earlier. An American paper in the Journal of Medical Toxicology confirms this practice. It suggests that in such cases, do further testing using legitimate methodology or simply dismiss the results of the improper testing. It also says that unnecessary chelation therapy is expensive, can cause significant acute adverse effects, and may be associated with long-term consequences.23Commentary on the Abuse of Metal Chelation Therapy in Patients with Autism Spectrum Disorders

Most forms of complementary and alternative medicine are useless but at least are unlikely to cause harm. This is different. It is both ineffective and potentially dangerous.

Further Resources

A search on the NHS Evidence or NICE website for “chelation therapy” will direct to a number of Cochrane reviews. Some are about chelation as used in mainstream medicine but here are some of the others:

In addition, the following may be of interest:

References

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    https://www.nhs.uk/conditions/thalassaemia/
  2. Wilson Disease. OMIM
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    http://www.ncbi.nlm.nih.gov/pubmed/16305472
  4. Barrett S. How the “Urine Toxic Metals” Test is Used to Defraud Patients. Quackwatch
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  24. Buss JL, Greene BT, Turner J, Torti FM, Torti SV. Iron chelators in cancer chemotherapy. Curr Top Med Chem. 2004;4(15):1623-35.
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  25. Ekstrand J, Björkman L, Edlund C, Sandborgh-Englund G. Toxicological aspects on the release and systemic uptake of mercury from dental amalgam. Eur J Oral Sci. 1998 Apr;106(2 Pt 2):678-86.
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  26. Meyer FP. ber die laquo;Omnipotenz der Chelattherapie. Forsch Komplementarmed. 1998;5(6):266-271.
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Site Index

This website is now completed, although I shall continue to do updates. The following list shows the sections or chapters. Just click on the topic in blue to go to that part of the site.

1 Introduction
2 A Very Brief History of Science And Medicine
Fundamentals of Medical Science
3 Finding Good Medical Advice and Evidence Based Medicine
4 Randomised Controlled Trials
5 Cohort or Longitudinal and Epidemiological Studies
6 Qualitative Research
7 Basic Maths in Medical Research and Decision Making
8 How Good is the Evidence?
9 Ethics in Practice and Research
Public Health Issues
10 Screening Programmes
11 Fake News and Vaccine Scares
12 Electronic Cigarettes (E-Cigarettes)
13 Motor Vehicle Emissions, Air Pollution and Health
COVID-19
14 COVID-19. What You Need to Know
15 Who is at Risk from COVID-19
16 What we Must Learn from the COVID-19 Pandemic
Nutrition
17 Basics of Nutrition
18 Exercise, Obesity and Diets for Weight Loss
19 Diets and Nutrition for Health and Fitness
20 Supplements
Complementary and Alternative Medicine
21 Introduction to Alternative Healthcare
22 Homeopathy
23 Acupuncture
24 Manipulation of the Spine
25 Reflexology
26 Herbal Remedies
27 Other Natural Products
28 Chelation Therapy
29 Hypnosis
30 Other Modalities of Complementary and Alternative Medicine
Some Controversial Diseases
31 Fibromyalgia
32 Chronic Fatigue Syndrome (CFS) or Myalgic Encephalitis (ME)
33 Systemic Candidiasis and Leaky Gut Syndrome
34 Mobile Phones, Masts, Wi-Fi and Electro-sensitivity
The Environment
35 Global Warming and Climate Change
36 Alternative Energy
Some Final Thoughts
37 Still Searching for the Age of Reason