May 08 2008

Charges Dropped in Chelation-Autism Death

Dr. Roy Kerry, who is an ENT surgeon (ear, nose, and throat specialist) decided that he would extend his practice to treating children with autism by giving them chelation therapy for presumed heavy metal poisoning. In other words, he decided to completely abandon the scientific and ethical standards that should guide the practice of medicine. Back in the day, states actually took it upon themselves to enforce reasonable standards, but the world today is swept up in a collective delusion – often referred to as complimentary and alternative medicine (CAM) or “integrative” medicine – the essence of which is the wholesale abandonment of the standard of care in favor of wishful thinking and magic.

As economist Paul Krugman observed, in a different context (and I am paraphrasing), “When the public believes in magic, it’s springtime for charlatans and con-artists.”

In the case of Kerry, his medical shenanigans lead directly to the death of 5-year-old Abubakar Tariq Nadama in 2005. The story is tragic: Abubakar had autism. His parents, reasonably and lovingly wanting to do everything they can for their child, apparently became caught in the web of misinformation claiming that autism is associated with mercury poisoning. The scientific evidence does not support this contention, nor is there scientific evidence that treating autistic children with chelation to remove mercury is of any benefit. That such misinformation is out there is an unavoidable consequence of free and readily available information in an open society. But it is also a symptom of a scientifically illiterate society grappling with scientific medical issues, and the current atmosphere of distrust of the medical establishment combined with the allure of anything “alternative.”


Abubakar’s parents reasonably sought the advice of a trained, licensed professional – Dr. Kerry. Unfortunately for Abubakar, Dr. Kerry’s advice and practice do not reflect the respect that his profession has bestowed upon him. Dr. Kerry was acting outside of his specialized area of training – something which is specifically noted to be unethical behavior in most state statutes dealing with the ethical guidelines for physicians. Then – practicing a specialty for which he was not trained – he decided to give a treatment that was not indicated based upon a theory that is rejected by the consensus of opinion of actual experts in the relevant field. Such behavior can only be described as overwhelming (and deadly) hubris. Beware someone who presumes to know better than the experts in another legitimate field of study.

Unfortunately, Abubukar suffered a cardiac arrest and died while in the office of Dr. Kerry after receiving EDTA (a chelation drug) by IV push. There is some dispute about some of the details of the story – whether or not the proper form of the drug was used, and whether or not it is advisable to give the drug quickly by IV push vs slowly by IV drip. These details are certainly important in determining if Dr. Kerry was criminally negligent, but they are not important to the bigger issue, and that is Dr. Kerry’s use of chelation to treat autism. Dr. Kerry had been charged with negligent manslaughter, but these charges were recently dropped.  I don’t want to comment on the legal aspects of the criminal case, because often legal details get in the way of the bigger issue.

Chelation therapy is not a legitimate treatment for autism. This is the overwhelming opinion, based upon significant evidence, of the medical community. If a physician goes against the current standard of care the burden is on them to provide adequate justification. In this case, there simply is no adequate justification, and this is worsened in Kerry’s case because he was practicing outside his specialty.  Any risk from chelation is therefore not justified.

Clinical practice is based largely on the calculation of risk vs benefit. Treatments do not have to be without risk (and few are), they simply must provide more than enough potential benefit to justify that risk. This is true even for clinical research, although here there are significant unknowns (by definition) and so proper informed-consent and ethical oversight must be given. The treatment given by Dr. Kerry was not done as part of an approved study, and the evidence does not support the risk of chelation. Therefore what Dr. Kerry did was both substandard and unethical, in my opinion.

The even larger context is more distressing.  There is now a subculture of those who believe that they know better than the consensus of scientific medical opinion. This subculture includes private citizens who just want answers and either don’t trust the establishment or don’t like the answers they are giving, it includes lawyers who are happy to make money off the whole thing, journalists who are happy to make a career out of hysterically misinforming the public, and most alarmingly it includes doctors who are willing to practice unscientific and unethical medicine (for whatever reason).

Further, an infrastructure has arisen to support the whole enterprise. It’s like a separate health care system existing in fantasy land. Of significance to this case, there are labs that are happy to make money by providing worthless clinical tests to support the quack notion of the month. They either use tests that have not been validated, or that are virtually designed to provide false positive results.

I occasionally encounter such lab tests in my practice, often brought in by unsuspecting patients who have no reason to think that the results are not legitimate. By coincidence very recently I was brought such a lab test that was performed on a patient with dementia. The ordering physician suspects (without reason) that the dementia may be due to mercury or other heavy metal poisoning. Standard blood tests were negative, but this outside lab found a significantly positive result. I looked over the lab report and found that it was a “provoked” urine test for lead and mercury. “Provoked” means that prior to collective the urine a chelating agent was given to draw lead and mercury out of the tissue so that it could be excreted in the urine. However, at the bottom of the lab sheet was a small disclaimer admitting that the reference range was based upon normal values for an unprovoked urine level (which should be much smaller than a provoked level). In other words – this test was worthless, and worse it was designed to produce a false positive test. And yet the patient was being chelated to treat the fake diagnosis made by using an invalid test, while the valid test was negative.

This is exactly what is happening in this subculture of autism and mercury  – provoked urine tests are being used to validate the a priori belief in mercury toxicity, then chelation is given to treat the fictitious cause. Then, of course, subjective validation and the placebo effect come into play (as well as normal development – autistic children still develop and can improve as they age), giving the appearance that the chelation had some benefit.

What we have is an internal belief system that is completely cut off from external falsification. Conspiracy theories are used to deflect any criticism, any lack of confirming evidence, or the presence of any disconfirming evidence. The trappings of modern medicine have cropped up to lend a patina of legitimacy to the whole enterprise – and is sufficient to fool, or at least profoundly confuse, the general public.

All of this is happening at a time in history when the normal scientific and ethical standards that should keep this from happening are being systematically eroded and undermined in the name of “alternative” ideologies and clever marketing under the banner of “health care freedom”.

Dr. Kerry is not an isolated case  – he is representative of a systemic problem in our society. Abubakar is not an isolated victim. But hopefully cases like this will draw attention to the insanity that underlies them.

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27 responses so far

27 Responses to “Charges Dropped in Chelation-Autism Death”

  1. jonny_ehon 08 May 2008 at 1:32 pm

    I’m surprised more skeptics don’t speak out against chelation. When my email was read on the SGU a couple years asking about it, most of the panelists had never heard of it. I hope this is changing, you’re excellent article will hopefully make a difference.

    Wasn’t there a guest on the SGU podcast recently that named it the number one dangerous CAM treatment? Unlike some treatments like acupuncture and homeopathy, chelation can kill. It’s also extremely expensive and fleeces the elderly under the false promise of an extended life. It’s aimed at society’s most vulnerable, kids with autism, and the elderly.

    Chelation makes me sick.

  2. themightylearton 08 May 2008 at 1:49 pm

    I wonder how much money is there in chelation “therapy” for an ENT surgeon to delve into it. It can’t be much, because by definition all these quackeries are cheap, that’s one of the ways they reel people in, it’s their slogan.

    If money was not an issue, how can a doctor, who’s trained to look at the evidence fall for such debauchery? And other doctors are doing it as well? Really wild stuff!

    The problem of course is how does the public, who’s not trained in medicine, tell real medical advice from BS advice if all is coming from a doctor? How do you protect yourself from such charlatans? Are we really to start Google-ing everything a doctor recommends? That’s only going to make matters worse as there’s all kinds of crap floating on the internet, and we go back to the old question of how do we separate good information from bad information.

    Damn, why didn’t I go to medical school!

  3. superdaveon 08 May 2008 at 2:19 pm

    Sadly it is just human nature to overestimate how difficult it is to obtain expertise in something. How many baseball fans do you know who are positive they can mange the local team better than someone who has spent 30 years in professional baseball? Unfortunately when it comes to medicine the stakes are much higher than baseball.

    The PGA had an ad campaign a few years ago with the slogan “These guys are good”. It was designed to fight the stereotype that pro golfers are not real athletes. Doctors need the same campaign. The only way to fight the armchair doctors is to prove that doctors really do know what they are doing, and that there is no way the lay person can compete. WebMD might be doing disservice, by making it appear that all of medicine can be boiled down to surveying symptoms. We need to show that doctors are more than that.

  4. superdaveon 08 May 2008 at 2:25 pm

    umm, obviously i meant underestimate there.. Oops

  5. Steven Novellaon 08 May 2008 at 2:37 pm

    chelation therapy can be given as an in-office procedure. There is actually a lot of money to be made doing this.

  6. Oracon 08 May 2008 at 3:21 pm

    It’s not just autism. There’s a mistaken belief that chelation therapy will reverse the blockage of arteries caused by atherosclerotic disease, be it atherosclerotic coronary artery disease or atherosclerotic peripheral vascular disease, both indications for which chelation therapy is equally worthless (although probably less dangerous because it is being given to adults, who are not quite as sensitive to the hypocalcemia that it can cause), as several randomized trials have shown it to be no better than placebo and no trial has ever shown objective evidence that it decreases the size of atherosclerotic plaques. It’s around $100-$150 a dose, too, and most courses of treatment take around 30-40 doses. A pretty tidy profit center.

    Another puzzling aspect of this case it that, I recall, they brought their child from England to see Dr. Kerry because one Dr. Usman told them Tariq would benefit from chelation, and Dr. Kerry in essence did what Dr. Usman told him to do. Moreover, I believe the father is a physician; so he really should have known better.

  7. isleson 08 May 2008 at 3:50 pm

    Orac, I agree – as in Nadama’s case, the doctor doesn’t even have to be in the room when the drug is given, so it’s very scalable, as they say in business school.

    One nitpick on this column – I think I wouldn’t say there was any question of whether “the proper drug” was given – since there was was no proper drug in this scenario.

    Generalized kudos and admiration to you, Dr. Novella, for your brave, erudite, and insightful blogging, not to mention your other activities that support critical thinking.

  8. AutismNewsBeaton 08 May 2008 at 4:01 pm

    Dr. Usman reported that the boy’s aluminum levels were too high, and referred him to Kerry. Then Kerry chelated him for lead, even though Tariq’s blood lead levels were not all that high.

    None of this makes sense.

  9. Ms. Clarkon 08 May 2008 at 4:04 pm

    I would add that the culture created by the false belief in an “autism epidemic” and the false belief in behavioral and biomed “cures” for autism were a huge part of what happened to Tariq Nadama. His parents were caught up in a belief system that says, “act now, be willing to spend your last dollar and your last bit of energy and you can save your child from a lifetime of (nightmare, hideous, devastating, disastrous…) autism. And they believe that there are thousands of parents who are in the same boat and most of them are “recovering their kids”… even thought they are not.

    This boy was not a nightmare, but his parents didn’t want a disabled child, they wanted a normal child and the freaks and con-artists who have been promoting chelation, alternative medicine, high doses of vitamins (and behaviorism) for autism say that this stuff can give them “back” their normal child that was “robbed” from them. Add to that the fact that they think they are going to sue someone and get reimbursed for the insane therapies eventually.

    I have no idea how Tariq’s father could approve of this. I have to think that his wife was keeping hin in the dark to some extent, either that or he just totally suspended disbelief and all rational and critical thinking.

    I would bet that the lab test you say, Dr. Novella was from “Doctor’s Data Inc.” I bet it had red, green and yellow stripes on it.

    These people are con artists. No telling how much money they have made off of selling these insanely misleading lab tests. If people want to read more about this Prometheus has some good articles on his blog about “mercurial” labs. Google DDI or “Doctor’s Data lab” and “autism” and you’ll probably find some I have written about them, too. They aren’t the only lab that does this. “Great Plains laboratoris” has a similar reputation.

  10. The Autism Treatment Subcultureon 09 May 2008 at 1:03 am

    [...] alternative medical practices used by parents on their autistic children in the May 8th’ Neurologica blog. Among those practices is chelation, in which medications are administered to remove “heavy [...]

  11. badrabbion 09 May 2008 at 2:00 am

    I agree that giving chelation therapy for autisms, because of this procedure’s lack of efficacy – may constitute medical malpractice. The parents of this child should sue this doctor and recover damages.

    But criminal manslaughter? Really? What is this country coming to?

    I am glad that the charges were dropped.

  12. ellazimmon 09 May 2008 at 5:12 am

    I have an adult friend in the Seattle region whom was given chelation treatment to “prove” that they had evevated mecury levels.

    Will some one get this fradulent behaviour into the national media please! In fact Dr Steve, isn’t it the duty of the AMA to publically and loudly decry such practices? If it has already been done then clearly it needs redoing.

  13. Steven Novellaon 09 May 2008 at 7:41 am

    The AMA does not regulate medical practice in any way. Since the 1980′s, when they were sued by chiropractors, the AMA has been gun-shy about attacking CAM treatments, institutions, or practitioners. As far as I can tell, they are useless in this area. In fact it seems that they have been infiltrated by ideologues.

    The American Academy of Pediatrics has already put out position statements against the whole mercury-autism thing.

  14. Oracon 09 May 2008 at 8:53 am

    Steve’s right. The AMA has become so gun-shy that it’s useless in this area. Moreover, if you look at some of the more conspiratorial “alt-med” websites, the AMA is painted as the root of all evil, the all-controlling entity that suppresses any “alternatives.”

  15. badrabbion 09 May 2008 at 9:26 am

    It sounds like the doctor gave disodium EDTA instead of calcium disodium ETDA. Apparently the 2 drugs look the same (and they certainly sound the same!). The former is a more dangerous drug.

    So the doctor made a mistake.

    But now he was going to be prosecuted criminally? WOW!

    So every time there is an adverse effect of a treatment, or a negligence of some kind is committed, the doctor has to worry about going to prison?

    Terrible!

  16. DevilsAdvocateon 09 May 2008 at 10:14 am

    Given the risk/benefit ratio (risks = great, benefits = none) of chelation as a treatment for autism, and given that he apparently even botched the nonsense treatment by giving the wrong drug, and given the patient died as a direct result…. yeah, I’d think criminal charges are tenable.

    In that pseudoscientific schtick is often cyclical – a given tx will be thoroughly debunked only to rise again years later – I keep waiting to see shark cartilage held up as a cure for autism.

  17. [...] NeroLogica, Dr. Novella explores the reasons that myths regarding vaccinations causing autism are still around [...]

  18. daedalus2uon 09 May 2008 at 1:06 pm

    I hope that when there is a civil lawsuit, that the jury recognizes the danger that Kerry poses and the inability of the criminal justice system to deal with such dangers. I hope they take the appropriate action, such that he is never able to practice again.

  19. badrabbion 09 May 2008 at 1:08 pm

    Devil;

    Are you saying that 1) there is a high risk of EDTA?, and 2) EDTA has no efficacy?

    I suggest that you are wrong. I am not an expert on EDTA, but from what I was reading, fatalities are extremely rare from this medication, as are morbidity rates. So why do you say “risks = great”?

    I also am aware of much anecdotal evidence that chelation has some efficacy. I am aware of a number of qualified ophthalmologists in FL, for example, who were routinely giving chelation therapy for macular degeneration. These doctors presented their findings at respectable meetings. A prospective randomized trial was undertaken which showed no statistically significant efficacy in this disease (but a positive trend), but the study has been widely criticized. There remains an albeit minority of physicians, who are otherwise competent, who continue to use this therapy.

    Now, suppose they are wrong. Let us grant that they even have misread the data and have misapplied their experience. Let’s even grant that they are motivated in part by greed. In this cases, they are perhaps guilty of medical malpractice.

    But manslaughter?

    Give me a break!

  20. Steven Novellaon 09 May 2008 at 1:31 pm

    I think that these matters are best left to civil (malpractice) and regulatory courts. The family should be compensated, and he should have his license taken away. I think the bar for criminal charges for physicians who are simply incompetent should be very high – would have to show depraved indifference, for example.

    IV EDTA in children is a moderate risk statistically, but that risk includes the possibility of death – it is reasonable to say “high” risk based upon the possibility of death.

    Because there is no proven efficacy for autism, and no scientific justification for it, that’s risk without benefit, and I would argue that any deaths are unacceptable because they have bought nothing in terms of health benefit to anyone.

    Chelation therapy, however, does work for what it is supposed to do – it does chelate heavy metals and is an approved treatment for legitimate heavy metal poisoning. Other uses may also be found. But each indication must stand on its own evidence – it matters not if it is useful for anything else, it is worthless for autism.

  21. Steve Pageon 09 May 2008 at 1:52 pm

    badrabbi,

    From wikipedia:

    Involuntary manslaughter, sometimes called criminally negligent homicide in the United States, gross negligence manslaughter in England and Wales or culpable homicide in Scotland occurs where there is no intention to kill or cause serious injury but death is due to recklessness or criminal negligence.
    I’d say that that’s an accurate summation of what happened to that boy.

    Off-topic (off at a tangent, anyway), I once had a conversation with someone who was attempting to impose himself as the alpha male. Whilst regaling me with his tales of machismo, he said that he’d been held on remand for attempted manslaughter. :)

  22. DevilsAdvocateon 09 May 2008 at 5:18 pm

    When an educated, trained, and licensed physician says, in essence, “I have no evidence but a strong belief that chelation will cure autism. There are risks, even of death, but my belief is so strong I’m willing – for a fee – to risk your son’s death on it…” yeah, I think manslaughter or similar applicable charge is tenable. Is he guilty? By tenable, I mean the case is sufficient for trial, for consideration, before a judge or jury, defendant’s choice. They decide, after hearing the evidence.

    And the above is the best case scenario – a self-deluded but otherwise well-intended physician. But, if he has knowingly defrauded this family by providing and charging for treatment he knows has no case for efficacy, well… I’d favor maximum sentencing too.

    As a health care consumer who tries to stay in the real world, I expect perfection out of no doctor, no clinician, but I do expect them to professionally manage these risk/benefit ratios, in fact, am paying for their expertise to do just that. That’s as it should be and I am certain few doctors would disagree – the medical field is to be respected for its adherance to high ethics, and I am gratified to see so many ‘fight the good fight’ against whatever serves to lower those ethics, Dr. Novella absolutely among them. They have my full support.

    Ours (US) is a large country and the set called “medical practioners” is large enough and open enough to have its ethical and philosophical fringe. Without negative consequences for unethical or even criminal acts, the hurtful aspects of their practcing go unchecked, rewarded even.

    But this guy? Action ought to be brought. Such practice needs review.

  23. DevilsAdvocateon 09 May 2008 at 5:20 pm

    Um, I’ m including Dr. Novella among the good fighters, not the lowerers. Heh. Vague wording. Sorry.

  24. kim spenceron 18 May 2008 at 9:32 pm

    when are you going to get down and dirty on the new monkey study? waiting on your opinion on how this could be wrong….
    http://www.ageofautism.com/2008/05/pediatric-vacci.html

    can’t wait for your explanations!!!

  25. [...] and measuring various neurological outcomes. Here’s mine – Kim Spencer left this comment on my recent post about the chelation related death case: when are you going to get down and dirty on the new monkey [...]

  26. [...] “unprovoked” reference results is explained better than I can do it by Steven Novella here. I also guess Kirby’s not aware of the 2007 paper published in ‘Clinical [...]

  27. People Say Vaccines Cause Autismon 03 Jun 2009 at 4:47 am

    [...] NeroLogica, Dr. Novella explores the reasons that myths regarding vaccinations causing autism are still around [...]

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