As I worked my way back through the list of things that happened while I was on an involuntary hiatus from producing new material as I frantically transferred content from Respectful Insolence, Mark 2 to this new version of Respectful Insolence, I realized something last night. I missed something that had caught my eye to the point that I had thought of treating it on my not-so-secret other blog. I was reminded of it when I saw it pop up again yesterday on the ever-quacky RealFarmacy.com website in the form of an article entitled “I Saw Death in Her Eyes.” Chuck Norris Warns About a Common Medical Procedure That Almost Killed His Wife, yet Millions of Americans Undergo It Every Year. Yes, that title is a major bit of clickbait. Unfortunately, it worked, at least for me. Fortunately, it provided a bit of blogging material, namely a new dubious health claim that I had not heard before: Chuck Norris thinks that the gadolinium-containing contrast agent used for an MRI almost killed his wife Gena. Here’s the scoop:
Gena has been struggling with rheumatoid arthritis and was instructed to get three MRIs in one week to evaluate her condition. Magnetic resonance imaging (MRI) is a medical test that most people go through at least once in their lifetime. What the Norris’s family did not realize is this test has a serious but little-known side effect.
Right after the third MRI, Gena ended up in the emergency room for six nights in a row. She was bombarded with mysterious health symptoms that left the E.R. medical staff feeling clueless. She was tested for cancer, Parkinson’s, amyotrophic lateral sclerosis and many other conditions, but none matched her symptoms.
“What’s wrong with you?” the doctors asked, and all Gena could say is: “I’m burning. That’s all I can tell you is I’m burning all over. I feel like I have acid everywhere in my tissue…I’m on fire.”
Not surprisingly, everybody’s favorite antivaccine reporter, Sharyl Attkisson, has latched on to the issue, doing a report on it:
In case you’re not familiar with it, rheumatoid arthritis (RA) is an autoimmune disease, a chronic systemic inflammatory disease which can involve tissues and organs other than its usual target, the joints. It can cause skin rashes and nodules, vasculitis, Raynaud’s phenomenon (constriction of the blood vessels in the hands), and neutrophilic dermatoses. A burning sensation in various parts of the body, particularly the joints, is not an unusual symptom of RA. So are a variety of other health issues and symptoms aside from the classic symptoms of pain and decreased range of motion in the joints, usually the primary target of RA. Naturally, seeking correlation, Gena Norris “did her own research,” which is usually a bad sign with respect to the medical accuracy of a conclusion:
Through pain, Gena took researching into her own hands, looking through published medical literature and patient accounts until she what caused her suffering – a toxic heavy metal called gadolinium that is used an pre-MRI injection to enhances the test images.
The next night that she ended up in the hospital, Gena pleaded with her doctors to look into what she found.
“I’m only going to be able to tell you this one time and I need you to listen to me very closely. I have been poisoned with gadolinium and we don’t have much time to figure out how to get this out of my body or I am going to die,” she told the medical staff.
Gadolinium is a contrast agent that is commonly used for MRI scans. It’s a metal ion that’s used in MRI contrast agents because gadolinium enhances and improves the quality of the MRI images, increasing the clarity and detail that can be achieved. Gadolinium contrast agents all consist of a gadolinium ion linked to a chelating agent that, as all chelating agents used in the body are intended to do, aids in the excretion of the gadolinium metal ion in the urine, thus obviating the toxicity of the naked gadolinium ion. In patients with normal kidney function, 90% of the gadolinium contrast medium is eliminated via the urine within 24 hours.
Are gadolinium-based contrast agents (GBCAs) more toxic than previously thought, though? That’s the crux of the story and the question raised by it. GBCAs have been used for a couple of decades with very few reports of problems and have an excellent safety record. However, more recent studies suggest that small amounts of gadolinium can be retained in some tissues, including the brain. Is it this gadolinium that is causing problems in people like Gena Norris? More on that later and whether that retained gadolinium causes harm.
First, what I do know is that the story about Norris’ wife that’s been circulating the last couple of weeks has a number of red flags, not the least of which is how it demonstrates that there is a whole cottage industry of quacks who prey on people like the Gena Norris and try to “detoxify” them of their gadolinium toxicity. Norris describes this phenomenon, without even realizing it:
Her hospital in Houston, Texas was of no help, so her husband took her to a clinic in Reno, Nevada (and later to China) where an intensive alternative treatment was administrated.
At the time Gena could not swallow. Her arm was drawn up in a severe cramp. And there were many other bodily issues. Her whole body was simply not properly functioning.
The substance that poisoned her, gadolinium, is thought to leave the body immediately after the procedure, but as the tests showed, Gena’s body contained dangerous amounts of this heavy metal long after the MRIs took place. This heavy metal injury left her fighting for her life for months.
Modern medicine was powerless to fix the problem that it caused. Thankfully, the Norris family found alternative methods of detoxification. It took a while, but the search was well worth it (after all, what’s more important than health?).
Gena laid in bed for five months, hooked on IVs. Later, she purchased a hyperbaric chamber to aid her brain’s healing.
Finally she started recovering, and then Gena slowly returned to life.
Vague symptoms that don’t fit a diagnosis? Check. Possibly (likely, even) confusing correlation with causation regarding symptom onset? Check. Quack treatments like hyperbaric chambers, which, seemingly, can cure everything that ails you? Check. “Detoxification” fixed the problem? Check. You get the idea. It doesn’t help that the Norrises are suing several medical device manufacturers, claiming harm. The lawsuit seeks $10 million in damages, a sum that Norris claims is necessary to cover the medical costs that his wife faces.
When I read about the lawsuits, my first thought is that that sounded like a hell of a lot of money for medical expenses, which brings us to another red flag that I found while researching this post. I found this red flag in a Change.org petition that popped up in Google searches about the case from an entity called the MedInsight Research Institute that claims a staggering cost to the Norrises for Gena to recover from her “gadolinium toxicity.” This is a cost that caused even my jaw to drop. Let’s just put it this way. It’s far higher than any cost I’ve seen associated with patients seeking out cancer quack Stanislaw Burzynski. Basically, if this Change.org petition is to be believed, it cost the Norrises over $2 million to treat Gena. No, I’m not kidding. I’m not exaggerating. I mean it. We’re talking $2 million:
Fortunately, Gena found a clinic in Reno, Nevada and then one in China who treated her successfully, but it was expensive (spending $1.18 million in 2014 alone), took 5 months of intensive IV therapy, and she was bedridden the entire time. When she returned home she bought a hyperbaric chamber, which helped. Gena is now sharing her story with the world to raise awareness about the potential ill effects of gadolinium.
In Attkisson’s report, the Norrises shared their tax records showing medical expenses of $821,000 dollars in 2013, $1.18 million in 2014, and $293,000 in 2015. I got an idea of just what sorts of quackery, besides purchasing a hyperbaric oxygen chamber were being used to treat Gena Noris through a shot of her at the Chinese clinic, where she is portrayed undergoing acupuncture, with a man in the background obviously undergoing cupping.
Yes, so many red flags, and apparently $2 million is only the start of what Chuck and Gena Norris think they need to treat Gena. Continuing my research, I also can’t help but note that MedInsight Research Institute, while appearing to champion little known medical issues, also raises a few red flags of its own. For instance, it’s a champion of low dose naltrexone, which, if you believe its advocates, is another cure-all. Of note, MedInsight Research Institute published a recent review article. While it presents a lot of in vitro and animal data, the best it could come up with for human data was this:
The results of a patient advocacy group-initiated survey of 17 patients (Gadoliniumtoxicity.com) show the onset of a group of symptoms within a month of their last MRI (Gadolinium Toxicity: A Survey of the Chronic Effects of Retained Gadolinium from Contrast MRIs 2015). These symptoms range from neurological, musculoskeletal, to dermal, including pain (reported by 100 % of patients surveyed), muscle symptoms reported by 88 %, and ocular symptoms (reported by 76 %). For each additional symptom category (e.g., dermal, cognitive, ENT), more than 50 % of those surveyed reported symptoms in each of these and other categories. Notably, 15 of the 17 patients surveyed had urinary gadolinium levels above expected levels for patients with normal renal function (reference range is 0.0–0.4 mcg Gd/24-h). This information can serve as a guide for retrospective and prospective studies to determine associations between multiple GBCA administration and adverse health effects.
I went over to GadoliniumToxicity.com. It, too, has a lot of red flags. There are self-reported descriptions of the horrors of gadolinium, but precious little in the way of actual science. There are dubious treatment options touted, such as chelation therapy (shades of mercury in vaccines!), infrared saunas, and supplements. There is the aforementioned survey of a 17 patients that is gussied up to look like a real research article but is clearly not an article published in the peer-reviewed medical literature. Then there are passages like this:
A wellness doctor or a naturopathic doctor will be the best source for having urine testing conducted by Genova Diagnostics or Doctor’s Data independent clinical laboratories. These labs do their testing for Gadolinium as part of a toxic metals panel that is typically used by the doctor to determine if Chelation might benefit the patient.
Doctor’s Data is doing gadolinium testing? Of course it is. Who else would be doing it, but the same company who offers provoked urine testing for heavy metals, tests that are, by design, almost always positive, a company known for abusive lawsuits against critics like Stephen Barrett, who has pointed out how pseudoscientific its heavy metal urine tests are? Indeed, if you look carefully at Attkisson’s report, specifically the scene where she is looking at her lab reports, you might just notice the Doctor’s Data logo on top of multiple pages.
Then there’s this:
The Genova Diagnostics urine test for Gadolinium is also available through several online services. The collection and testing process is exactly the same as if done through a local doctor except that the report is sent directly to the patient. Genova Diagnostics has two test panels that include the Gadolinium test. You should get either the Toxic Elements Clearance Profile or the Comprehensive Urine Element Panel.
Here’s a hint. Any time you see a panel called the Toxic Elements Clearance Profile, be skeptical. It’s probably a dubious or unproven (at best) test, if not out-and-out quackery.
This is a good time for me to point out that, contrary to what various antivaxers and alternative medicine mavens who detest me claim, I’m not so trusting of conventional medicine to assume automatically that GBCA are perfectly safe and that there’s no way they could be causing the harm claimed by Gena Norris and the people who started GadoliniumToxicity.com. I highly doubt that that’s the case here, given the level of testing and the 20 year history of GBCA use for MRI with a generally excellent safety record. However, I leave myself open to the possibility that all is not well and there might be a rare reaction to GBCAs producing symptoms like Gena Norris’ that hasn’t been described in the medical literature yet.
After all, we do know one rare and serious reaction to gadolinium. This reaction was reported over a decade ago in patients with severe preexisting kidney disease, dubbed nephrogenic systemic fibrosis (NSF), also known as nephrogenic fibrosing dermopathy (NFD), and found to result from the use of GBCAs. NSF is a rare and debilitating disease that is characterized by skin contractures (or localized skin thickening and tightening) and internal organ damage. In brief, it’s a disease resembling scleroderma, at least clinically. Such patients can develop large areas of indurated skin with fibrous nodules and plaques, as well as joint contractures with accompanying limited range of motion. Most patients who develop NSF are on dialysis. Evidence for a link between gadolinium-containing contrast agents for MRI and NSF was first described in a case series of 13 patients, all of whom developed nephrogenic systemic fibrosis after being exposed to gadolinium. Basically, NSF always occurs (with rare exceptions) in patients with renal insufficiency who have had imaging studies using gadolinium. That gadolinium can on rare occasions trigger this condition in patients with severe renal disease is now accepted science.
Here’s the thing, though: Contrary to the insinuations of conspiracy to cover up a link between gadolinium and disease in Gena Norris and other patients with similar vague symptoms, when reports of NSF began to surface, scientists investigated, and ultimately major radiology societies changed their practice guidelines on how gadolinium contrast was used for MRI imaging in patients at risk for NSF.
As I read the stories about Chuck Norris and his wife Gena, I kept wondering how on earth they could have racked up such high medical bills to treat his wife’s condition. Obviously, the methods they were using must not have been covered by the presumably very good health insurance that Norris and his wife almost certainly must have. Otherwise, they wouldn’t have been able to deduct them on their taxes. This suggests strongly that the treatments were all of the unproven variety for which insurance doesn’t pay. So which clinic, exactly, in Reno is treating patients for “gadolinium toxicity.” Fortunately, there is Facebook, where patients were more than willing to out the clinic. Basically, it appears to be someone named Bruce Fong at the Sierra Integrative Medical Center in Reno, Nevada.
Dr. Bruce Fong was introduced to natural medicine and homeopathic medicine as a young child and continues with that tradition today. He has followed in the family footsteps of medicine and is rooted in the belief that we must heal and prevent human disease and suffering. Optimal health may be achieved by determining and remedying the root cause of illness.Dr. Fong has been at the forefront of alternative therapies for immune related diseases, including special treatment plans which combine the best options from a broad array of homeopathic, internal, Chinese and traditional medicine.As Medical Director at Sierra Integrative Medical Center, Dr. Fong is focused on solving root causes, not treating symptoms or masking issues falsely with compounded prescriptions.
In other words, he’s a quack. I mean, look at the list of services Dr. Fong offers. There are a lot of quack treatments there. True, the average person might not recognize them as such, but I do, and I’m sure that the vast majority of my readers will too: chelation therapy, homeopathy, lymphatic massage, “detox” footbaths, and more. Once I knew this, I was able to find Chuck Norris’ own account (which, truth be told, I should have found before):
This revelation about the source of her condition led us to Dr. Bruce Fong at the Sierra Integrative Medical Center in Reno, Nevada, a facility known for its success in combining conventional and alternative therapies in confronting illness. He quickly was able to confirm our theory. Tests revealed that the gadolinium, which was supposed to be gone from her body hours after each MRI, had remained at levels that were literally off the charts. Once Dr. Fong’s initial treatment restored Gena’s health to the point she was able to travel, we returned to Texas and the care of Dr. Alfred Johnson, a doctor of internal medicine with special interest in the area of chronic illness and environmental medicine. Dr. Johnson helped direct a course of treatment that would ultimately lead to her recovery.
In fairness, there are now newer tests that can detect gadolinium in the urine, and mass spectrometry on biopsied tissue specimens has been used to demonstrate that gadolinium can remain in tissues. Its accumulation doesn’t appear to be tissue-specific, but rather throughout the body. The question, as always, is: Does this tiny amount of gadolinium cause disease, particularly a disease with the symptoms described by Gena Norris?
Google searches for Dr. Alfred Johnson show him popping up in a lot of alternative medicine sites. His website shows quite unequivocally (in my opinion, at least), indicates that Dr. Johnson is a quack. Don’t believe me? Check out his list of services, which, of course, includes The One Quackery To Rule Them All, homeopathy. He also touts breast thermography, which is about as reliable an indication of a quack as I’ve ever seen. He shows up prominently in Attkisson’s report as well.
Again, in fairness, just because a whole lot of quacks, particularly (but not limited to) naturopaths and “holistic” practitioners have jumped on the bandwagon of blaming gadolinium for every ailment under the sun doesn’t mean that there might not be something bad going on here. However, it is far more likely that there isn’t. The symptom complexes reported by patients to be associated with gadolinium are inconsistent; other than chronic pain and “brain fog” (both very nonspecific symptoms), there doesn’t seem to be an identifiable syndrome. Nor does there appear to be a consistent relationship between gadolinium exposure and the symptoms reported, with some reporting severe symptoms after one MRI and others after multiple MRIs. The timing between MRI and symptom onset varies widely as well.
It also turns out that the FDA spent two years looking at the question of whether GBCAs are associated with health issues and on May 22, 2017 published an update to its original 2015 report, concluding:
A U.S. Food and Drug Administration (FDA) review to date has not identified adverse health effects from gadolinium retained in the brain after the use of gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI). All GBCAs may be associated with some gadolinium retention in the brain and other body tissues. However, because we identified no evidence to date that gadolinium retention in the brain from any of the GBCAs, including GBCAs associated with higher retention of gadolinium, is harmful, restricting GBCA use is not warranted at this time. We will continue to assess the safety of GBCAs and plan to have a public meeting to discuss this issue in the future.
A recent review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) also identified no adverse health effects with gadolinium retention in the brain, but that Committee recommended suspending the marketing authorization of certain linear GBCAs because they cause a greater retention of gadolinium in the brain compared to macrocyclic GBCAs. The Committee’s recommendation is currently undergoing an appeal, which will be further reviewed by the PRAC and subsequently by the EMA’s Committee for Medicinal Products for Human Use.
We are continuing to assess the safety of GBCAs. FDA’s National Center for Toxicological Research (NCTR) is conducting a study on brain retention of GBCAs in rats. Other research is also being conducted about how gadolinium is retained in the body. We will update the public when new information becomes available and we plan to have a public meeting to discuss this issue in the future.
That public meeting was held in September, and as a result the FDA did add a warning regarding gadolinium contrast agents that gadolinium can be retained in human tissues and that minute traces of gadolinium may occur in slightly greater amounts with linear GBCAs, compared with macrocyclic agents/ The FDA also recommended strategies to minimize gadolinium retention for certain patient populations that may be at greater risk.
Is it possible that gadolinium caused the symptoms experienced by Gena Norris and others? Sure. Is it likely? My assessment, based on existing scientific literature, is that it is extremely unlikely that Gena Norris’ symptoms were caused by a GBCA used for the MRIs that she underwent and that it’s also incredibly unlikely that GBCAs are causing the health problems attributed to them (other than the now well-accepted condition of NSF in rare patients with severe kidney disease, of course). I do, however, remain open to evidence and science, and if future well-designed studies provide stronger evidence of a link I will revise my opinion accordingly.
Based on currently existing evidence I definitely think it’s way premature to propose a new conditition, “gadolinium deposition disease,” as Richard Semelka did in a 2016 paper to describe patients “with normal or near normal renal function who develop persistent symptoms that arise hours to 2 months after the administration of GBCAs.” The reason is that neither a distinct syndrome nor causation by gadolinium has been conclusively demonstrated yet—or even strongly suggested. I also note that Semelka based his proposal entirely on the survey of the 17 patients posted at GadoliniumToxicity.com, plus some in vitro and animal studies and the studies that identified NSF as a complication of gadolinium. As Dr. Robert McDonald put it in a Medscape interview:
First, we have already conducted the “experiment”: We’ve given 400 million doses to a few hundred million people, and have not seen any convincing evidence of systematic symptoms after exposure.
Controlled scientific data will come soon and should help clarify things. There was a study in JAMA last year that suggested no increase in Parkinson disease in patients from Canada.
We already have some clues that this is probably safe, but I think we still have to do due diligence as physicians and scientists and prove that it is safe. The burden of proof is on us, and the community is working as fast as it can.
He also notes that most people don’t get many (or any) MRIs and this:
The patients getting 30 or 40 doses of gadolinium are generally pretty sick. They need their gadolinium-enhanced imaging because it provides critical diagnostic information. In the case of brain tumors, it absolutely helps us to understand whether or not the tumor is stable, growing, or reacting favorably (ie shrinking) to therapy.
Just let me be clear: If GBCAs were removed from clinical practice, we would be set back 20-30 years in terms of our diagnostic capability. The same is true in cardiac MRI.
Gena Norris, for instance, was getting so many MRIs in a short period of time because she was sick with a chronic health condition. So were the vast majority of the 17 patients who answered the survey at GadoliniumToxicity.com
As we wait for more science, what do I see is a tragedy in which patients who are suffering from symptoms not well addressed by medical science at the moment are being preyed upon by quacks. they really believe they were harmed by gadolinium and that the quackery to which they are being subjected will help them. Listening to the blandishments of the quacks, these patients, like Gena Norris, are wasting huge sums of money (to them) for treatments that are incredibly unlikely to help them.