Autism Complementary and alternative medicine Medicine Quackery

Dr. Buttar has a new protocol

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgWhile I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts, most of which are more than a year old.) These posts will be interspersed with occasional fresh material. This post originally appeared on November 22, 2005.

A couple of months ago, there was a minor dust-up here regarding an unfortunate autistic boy who died while undergoing chelation therapy in an altie clinic near Pittsburgh. In my article, I pointed out that the vast majority of the clinical evidence indicates that mercury in vaccines does not cause autism; that there is no convincing (or even suggestive) scientific or clinical evidence that chelation therapy does anything to improve the symptoms of autism; and that giving IV EDTA was dangerous.

A certain commenter infested the comments section of these two posts with impassioned defenses of a certain chelationist by the name of Dr. Rashid Buttar, a man who uses a “transdermal” form of chelation therapy to “treat” autism, posting long (and lame) justifications for why Dr. Buttar can’t seem to be bothered to do some very basic tests to demonstrate that his transdermal DMPS (TD-DMPS) actually gets absorbed through the skin into the blood, much less chelates any mercury (as he claims it does), much less “cures” autism. There was a lot of dancing around by this commenter relaying responses from Dr. Buttar when I and others pointed out that, if the DMPS is not absorbed through the skin, then it couldn’t possibly chelate anything and further pointed out that, if it doesn’t chelate mercury, then, by Dr. Buttar’s own belief that chelating mercury can “cure” autism, TD-DMPS couldn’t possibly work! At that point, Dr. Buttar changed his tact to claiming he had “empiric” evidence that TD-DMPS helped autistics and emphasizing that DMPS was safer, both in IV form and his “transdermal” form, at one point saying:

It is a “SAFETY” issue I’m talking about….I don’t care to prove a damn thing to those people that you have been dueling it out with. The NIH has said our treatment and DMPS specifically is DANGEROUS….so I will take DMPS intravenously to show that it is NOT dangerous. That’s why I want the media….to show the world how safe DMPS is. And if it’s safe to take intravenously, then it’s OBVIOUSLY safer to take it transdermally.

Of course it’s “safer” to take it transdermally, given that it’s almost certainly not absorbed transdermally. (At least, Dr. Buttar has not produced any evidence that it is.) Earlier, Buttar’s defenders had spouted even lamer justifications:

It is well known that whatever is placed on your skin is absorbed. If you swim in a chlorinated pool, the skin will absorb a certain amount chlorine, right? You are concerned that there is no measure for how much DMPS is entering the skin. I say who cares if they have not yet done randomized, double-blind, placebo studies to determine how much DMPS is entering into the bloodstream through the skin? That costs money and why do a big expensive study on a substance that is already approved by the FDA? What they do know is that heavy metals are being removed without any other explanation as to why, other than TD-DMPS.

Buttar did admit to using IV chelation sometimes, but one of his main selling points for his TD-DMPS that makes it attractive to the parents is that it is supposedly “safer.” (Again, in my opinion, the very reason it is “safer” is because it is not absorbed and therefore chelates nothing.) Dr. Buttar also seemed to be arguing that IV DMPS was safer compared to IV EDTA. Apparently, however, Dr. Buttar is changing his tune (and his favored treatment) about EDTA. Thanks to a tip from a reader, I’ve been directed to a link suggesting that Dr. Buttar is now “treating” autism using a new regimen that includes IV EDTA (the chelator that killed Tariq), ozone, and minerals to remove “persistent organics” and asking other parents what they thought of it:

Dr Buttar’s office has asked us (after being on TD DMPS for about 11 mos) to come on IV EDTA/ozone protocol over a two month period every two weeks. TD DMPS and TD EDTA will continue on a Mon, Wed, Fri schedule after the IV’s

Every 2 weeks our son will get IV EDTA and ozone (which will be infused in his blood and given via IV) and on the second day he will get minerals. The reason given for ozone is to reduce persistent organics in his system. There is no test being recommended to determine if the child will be a good candidate for ozone. Apparently, some children are seeing good results and Dr Buttar is trying this treatment on older children (greater than 7). Dr Buttar’s office has provided some research on ozone done by a MD researcher in NY whom we spoke with. The immediate reaction of this researcher was that there has not been any study with children while ozone therapy is safe and has been used on millions of people in Europe. The researcher was not aware of Dr Buttar or his protocol on children and said that one needs to establish first if ozone therapy is needed.

Oooh boy. “Trying his treatment on older children”? Where to start? To the credit of some of the mothers on the list, they weren’t totally buying into this, with one even saying that she “would not want to be first in line” and another saying:

I think IVs of EDTA (or any other chelation agent) are a BAD idea. I wonder what possible rationale he has for this, since I think it is such a bad idea. Besides being the most dangerous form of chelation, IVs are also really expensive, in case they need another strike against them.

Indeed. Once again, I emphasize that there is no evidence that chelating mercury or anything else improves the symptoms of autism. Unfortunately, this same mother was rather credulous about the ozone therapy, suggesting that the first mother instead should purchase her own ozone setup. Then, in a followup, I also became aware of another discussion of new “protocol” on a different discussion group. In this discussion, one mother stated that, for children over 7, Dr. Buttar was recommending an IV drip of DMPS and glutathione, followed by ozone, minerals, and some sort of “pesticide remover” or “environmental detoxifier.” Moreover, as the discussion unwound, it was stated that Dr. Buttar charges $2,000 a session plus a charge for supplements, with a total of four visits being required, leading to a complaint by another that “only the rich” can afford his therapy. Another person was unhappy that Dr. Buttar was not planning on making his new protocol public and lamented that he was charging $17,000 to other doctors to take a 7 day course in administering this new protocol. I don’t know how accurate this characterization of Buttar’s new protocol is or his pricing structure is (it may be a second- or third-hand account), but, if true, it sounds like some serious quackery to me. The reports I’ve been able to glean from the discussion thus far are conflicting about whether Dr. Buttar now uses IV EDTA or DMPS, but they all appear to agree that he is now using IV chelation of some kind with glutathione, minerals, ozone, and some sort of “environmental detoxifier.”

You know, sometimes I think I’m in the wrong business.

One thing that struck me about this new protocol is how much it resembled another form of autism quackery that I wrote about a while ago. Indeed, it appears to be an unholy union of a different form of “oxygenation” therapy other than hyperbaric oxygen “therapy” for autism I used EneMan to poke fun at earlier this month and that favorite dubious therapy of the mercury/autism activists, chelation therapy. Unfortunately, the intravenous injection of ozone hasn’t been shown to be effective for any condition that I can find. Ozone therapy may be somewhat useful, as hyperbaric oxygen therapy is useful, in treating chronic wounds, but not much else. Even so, it is not generally used as a treatment for chronic wounds. That doesn’t stop a lot of quacks from touting it as a treatment for everything from cancer to AIDS. Here is what happens when ozone is administered intravenously:

When ozone is introduced into blood, it reacts with water in red cells producing hydrogen peroxide. This aqueous decomposition of ozone also produces bactericidal and membrane-damaging free radicals [21]. Ozone used for treatment [24] is prepared by creating an electric spark in a chamber of pure oxygen. The final mixture contains between 0.l and 5.0% ozone, concentrations that are equivalent to from l.0 ppm to 50 ppm ozone in pure oxygen.

Ozone generated this way has a half life of 45 minutes at room temperature, and under ideal conditions of sterility, dryness, and cleanliness, it must be prepared on site each time it is used. A two-hour exposure to 1200 ppm ozone is needed to kill microorganisms on open surfaces and in water [25]. Concentrations of ozone recommended are: for topical treatment of superficial wounds, 70 to 100 ppm; for slow-healing ulcers, between 40 and 70 ppm; and when oxygenating effects are needed to treat diseases associated with hypoxia, from l to 40 ppm [26].

One has to wonder how “ideal” or “sterile” Dr. Buttar’s conditions are or why one would want to let loose so many free radicals to damage one’s blood cells. In any event, ozone is a highly reactive, oxidative gas with many industrial applications, with OSHA recommended guidelines for safe exposure of less than 0.10 ppm. There is no evidence that it is any good for treating cancer, HIV, or autism. (A PubMed search failed to turn up a single reference that suggested ozone might be good to treat autism.) Indeed, at least as of 1999, ozone was not FDA-approved for the treatment of any condition, and the FDA has even arrested and prosecuted people for selling ozone generators and making claims that it can treat medical conditions:

Proponents of medical ozone generators believe ozone can kill viruses and bacteria in the body. While ozone is used as a germicide in the cleaning of manufacturing equipment, FDA is not aware of any scientific data that supports the safety or effectiveness of ozone generators for treating medical conditions. In fact, the agency believes that at the levels needed to work effectively as a germicide, ozone could be detrimental to human health.

“These devices keep popping up,” says Bob Gatling, a biomedical engineer and director of the program operations staff in FDA’s Center for Devices and Radiological Health. “We always tell their makers”: ‘Show us some data,’ but no one ever pursues it.”

The bottom line is that, as is the case for chelation therapy, there is no scientific evidence that IV ozone, either alone or with chelation therapy, does anything therapeutic for autism. It is rather interesting, however, that, with his inclusion of ozone to rid the body of “persistent organics” and the addition of some new “environmental detoxifier,” Dr. Buttar is apparently now broadening his approach to more than just mercury. Perhaps he is starting to realize that the mercury mania that has come to the fore this year is without basis and that he needs to expand to eliminating the vague “toxins” alties are so fond of blaming for various diseases. (Certainly he has never presented any scientifically valid “empiric evidence” that his transdermal therapy does anything other than make his patient’s skin greasy, anyway.) Given that he seems to be offering this new “protocol” to older children, many of whom have already been on his TD-DMPS, I can’t help but speculate that perhaps, just perhaps, TD-DMPS is not all Buttar claims it is, leading him to come up with a “second line” treatment.

Given that my source of information thus far consists of online discussions, I would love more substantive confirmation. I would also love to ask Dr. Buttar or his defenders these questions:

  1. Is Dr. Buttar indeed using IV chelation therapy, ozone, and and “environmental detoxifier” as a new protocol to “treat” autism, as is being discussed in these groups?
  2. If the answer to #1 is yes, does this mean that perhaps his transdermal chelation wasn’t as effective as he has claimed it was in the past?
  3. If the answer to #1 is yes, which chelator is Dr. Buttar using, IV DMPS or EDTA? If EDTA, why, given that Dr. Buttar has in the past pointed out that DMPS is much safer than EDTA?
  4. If the answer to #1 is yes, what is the scientific basis for this new “therapy”? What clinical trial evidence does he have that it does anything to improve the symptoms of autism?
  5. If the answer to #1 is yes, what is the scientific rationale for the addition of ozone? What is the evidence (preclinical and clinical) that ozone has any value in treating autism?
  6. If the answer to #1 is yes, what, exactly, is this “environmental detoxifier” these parents say that Dr. Buttar is now including? (Some sort of “magic mixture,” perhaps?) What “toxins,” specifically, is this “detoxifier” removing and what is the evidence indicating (1) that these toxins have anything to do with autism and (2) that this “detoxifier” actually removes them?
  7. If the answer to #1 is yes, why isn’t there anything on Dr. Buttar’s website about this new protocol or anywhere else that I can find other than on these discussion groups?
  8. If the answer to #1 is no, why are these parents posting to various groups fairly detailed accounts stating that Dr. Buttar is now recommending IV chelation therapy, minerals, ozone, and an “environmental detoxifier” to treat their autistic children? Is it all just a misunderstanding?

Inquiring minds want to know!

If these reports are indeed true, it sounds as though Dr. Buttar may be going down the pathway of Dr. Stephen B. Edelson. I have to wonder if some of Dr. Buttar’s most vociferous defenders will continue to defend him. At the very least, they should put his feet to the fire and make him answer some questions.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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