The Breakspear Hospital and Jean Monro v the ASA and the GMC

May 16, 2012 at 12:20 pm (Activism) (ASA, Autism, Breakspear, Breakspear Hospital, CFS, CFS/ME, Chelation, Chelation Therapy, Dr Jean Monro, Dr Monro, GMC, Jean Monro, ME/CFS)

In October 2011, I wrote that the Breakspear hospital was offering chelation therapy for coronary and cerebrovascular disease, CFS, autism, and for “preventative medicine” and “anti-ageing”. The page on chelation that I linked to now redirects to a page on treatments that does not mention chelation.

I complained to the ASA, who found that the chelation therapy had not been proven to be an effective treatment for the health conditions listed and that the claim that chelation therapy could help with those listed conditions was not substantiated and therefore misleading. The ASA determined that the claim must not appear again in its current form and asked the Breakspear not to imply chelation therapy could help treat the listed conditions. See the adjudication here: link.

In the meantime, the GMC received (and ruled on) a complaint about Dr Monro of the Breakspear. You can see their judgement here: PDF. It is important to note that, regardless of any opinion one might have of the GMC, Dr Monro admitted several of the charges. The following charges were admitted by Monro:

Monro did not measure the patient’s blood lead concentration, did not refer them to a specialist in toxicology or lead poisoning, and did not seek the advice of the National Poisons Information Service; the doctor did not explain to the patient or their GP that the DMSA challenge test alone has no demonstrated benefit in the diagnosis of lead toxicity compared with analysis of the patient’s blood lead concentration, or that the challenge test had been performed using a substantially greater dose of DMSA than was either necessary or appropriate; she did not advise the patient’s GP of the possible complications from chelation therapy or that chelation therapy is available free of charge from the National Health Service if clinically required.

The patient also received chelation therapy at the Breakspear Hospital subsequent to Monro being notified by the GMC of the complaint against Dr Monro.

The amount of sodium calcium edetate administered to the patient during the course of chelation therapy was substantially below the BNF recommended dose for patients with lead poisoning. The treatment recommendation was made despite Dr Monro not having specialist training or expertise in clinical toxicology or the investigation and treatment of lead poisoning.

So, to sum up: we have a failure to measure blood lead concentration, use of a challenge test that alone has no demonstrated benefit in diagnosing lead toxicity, an inappropriate and unnecessarily high dose of DMSA, a dose of sodium calcium edetate substantially below that recommended for lead poisoning, and a lack of specialist training and expertise on the part of Dr Monro.

These are the charges that were admitted to by Dr Monro and found proved. Dr Monro did not dispute any of these charges.

The GMC also found that the treatment recommendation was based on inadequate evidence, and potentially harmful – though Dr Monro did not admit to these charges. The GMC issued a formal warning, and stated that:

Further, you must not carry out any procedures which are inconsistent with the unequivocal guarantee that you have publicly given to this Panel, namely pre and post urine challenge testing and chelation therapy.

As Dr Monro has apparently guaranteed to refrain from carrying out chelation therapy, it seems that the ruling that the Breakspear may not advertise chelation therapy for the conditions that were listed on their website may be redundant.

More

From my original post on the Breakspear:

The Quackwatch website has a page on chelation therapy that looks at some of the claims around coronary disease. The idea that chelation therapy can aid CFS is entirely new to me – and I could find not a single study on Pubmed that addressed use of chelation for CFS. The use of an unsafe and unproven treatment such as chelation for “preventative medicine” or as an “anti-ageing” therapy? The mind boggles.

The mistaken belief that mercury is a cause of autism has led some to claim that chelation can aid ASD. Let’s take a look at some of the available evidence. This abstract notes that some of the ‘treatments’ touted for autism “have safety concerns without demonstrated efficacy, such as chelation therapies.” A study looking at concentration of metallic elements and autism found that “A meta-analysis including the present and previous similar studies excluded any association of autism with hair concentrations of mercury, cadmium, selenium, lithium and copper.” The Mayo Clinic has a nice summary: “Chelation therapy is not an effective autism treatment, and it may be dangerous.”

See also the Quackometer blog on Breakspear and Monro: here & here.