Is Chelation the New H pylori?

Those who cannot remember the past are condemned to repeat it.
George Santayana (1863-1952)

Clearly, those of us in the medical field are slow to learn from our past.  For instance, we ignored Semmelweis over 170 years ago when he recommended washing hands to prevent puerperal fever.  In fact, we laughed him out of medicine.  To this day, men still leave the washroom w/o washing their hands!  More recently, we ignored Marshall & Warren's 1982 discovery of H pylori as the causative microbe behind peptic ulcer disease.  Just 2 decades later, we swallowed our collective prides & awarded them the Nobel Prize in Medicine.

Now, I will be the first to tell you that I am more Westernized than I am Easternized (is there such a thing?), having been born & raised here.  I am also an ardent believer in science which includes the statistics necessary to make sense of the data.  In fact, I'm one of those guys who paraphrase Jerry McGuire famous quote as "Show me the science".  So while I'm not against alternative medicine per se, I just need proof.  Because without science, it becomes your word against mine.

And yet, here we are, "It's deja vu, all over again", as Yogi Berra would say.  Why?  The findings of the Trial to Assess Chelation Therapy (TACT) were just announced yesterday at the annual meeting of the American College of Cardiology.  TACT is a 2x2 study of chelation vs high dose vitamins vs placebo in high risk patients.  1,708 participants who'd already had some cardiac event were randomized to chelation vs placebo AND to high dose vitamins vs placebo and then followed for 4 years.  In other words, some received neither chelation nor vitamins while others received one or the other and the remaining few received both.  Make sense?

Well, those who received one or the other therapy showed no improvement compared to placebo.  However, in a surprise finding to the authors, those participants who received both chelation & high dose vitamins had a statistically lower rate of composite events compared to placebo (26% vs 30%).

Despite this scientific glimmer of hope that boosts an alternative medicine regimen into sniffing distance of traditional medicine, my cardiology colleagues greeted this news with dismay & embarrassment as they had fully expected a negative result.  One even went on record stating that he would not change his practice based upon this study when it was announced last November at the American Heart Association's annual meeting.  How closed minded!  Don't get me wrong.  I'm not recommending that we throw caution to the wind and chelate every cardiac patient.  But given recent studies linking calcium supplementation to heart disease, it seems reasonable that chelation to remove calcium (and other heavy metals) might decrease vascular events, no?  So let's keep an open mind and look deeper into the science of this alternative medicine regimen.  Who knows?  Chelation may become a standard routine of cardiology in a decade or so.

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