Clinical Metal Toxicology

1
Clinical Metal Toxicology

• Introduction from chairman of the Medical
  Scientific Education and Research Committee of
  the International Board of Clinical Metal
  Toxicology

2
Historical Perspective

• Concept of ligand theory proposed over a century
  ago Swiss Nobel physicist Alfred Werner .
• Metal ligand theory foundation for the usage of
  chelating agents to bind heavy metals.
• Dr.Norman Clark usage of EDTA to treat plumbism
  ( lead poisoning ) post WW2 the beginnings of
  chelation medicine.

3
21st Century Perspective

• There exist over fifty years of research in metal
  binding medicine and science arguably the oldest
  and most establish field of medical specialty.
• There exist over a thousand scientific papers on
  one of the chelating agent -EDTA!
• The systemic effects of excessive free radical
  reactions catalyzed by excessive heavy metals
  causing free radical pathology is well
  established.

4
IBCMT

• The IBCMT was set up for the purpose of
  establishing a gold standard for the practice of
  clinical metal toxicology .
• The IBCMT protocol is a comprehensive medical and
  scientific methodology on the optimal clinical
  management of patients in this specialty field .
• Optimization of physiological, biochemical
  ,physical and mental health and precise nutrient
  distribution via detoxification of toxic metals
  and chemicals are fundamental to the desired
  medical outcomes.

5
Environmental Health

• The EPA ( USA ) has sounded the dire necessity of
  addressing the pollution of our environment and
  the serious toxic metal poisoning of the
  community.
• Recent research has shown that accelerated
  age-related degenerative and neuro-degenerative
  diseases are linked to heavy metal poisoning .
• IBCMT and the physician members of the sponsoring
  teaching colleges /chapters are poised critically
  in the position to address the EPA concerns and
  to play a crucial role in metal toxicology public
  health issues .

6
Current clinical tools

• Well established laboratory tests- spot urines
  ,provocative urines ,plasma and cellular
  biochemistry, hair analysis are utilized as
  baseline measurements and monitoring of treatment
  progress.
• Current neuro-toxicity measurements are limited
  to subjective and semi-quantitative psychological
  testing and indirect inference from standard
  laboratory tests.

7
Neuro-toxicity Assessment

• Traditional radiological investigations Plain
  films, CT scan, ultrasound, MRI mainly address
  anatomical issues .
• Functional assessment of brain function is
  clinically critical for the measurement and
  monitoring of medical outcomes .
• The BRC brain function testing involves a
  screening tool the Integneuro assessment and a
  Comprehensive Psychological Test Battery.

8
Memorandum of Understanding

• Milestone signing of MOU between IBCMT and BRC .
• IBCMT agree to adopt the BRC Integneuro system as
  one of the gold standards for the assessment of
  brain function.
• This is an objective measurement of brain
  function based on the Brain Resource
  International Database ( BRID ).

9
Key Factors of the MOU

• The establishment of an embedded research program
  in clinical metal toxicology.
• The availability of touch screen based kiosk to
  carry out screening assessment of brain function.
• The distribution of research funding at the IBCMT
  , college and clinician level based on proceeds
  of brain function assessments.

10
Embedded CPD

• Continuing medical education is crucial to keep
  abreast of any medical field .
• Current IBCMT re-certification requires all
  candidates to attend an advance metal toxicology
  workshop and to discuss two clinical cases of
  merit.
• Participating in the embedded research is one way
  of achieving continue professional development (
  CPD) and will raise the standards of our
  specialty field by another notch.

11
Future of Clinical Metal Toxicology

• The addition of BRC gold standard clinical
  tools and the availability of continued research
  funding at all levels would ensure an optimistic
  future for all concerned.
• The research would yield information on
  specificity of brain function toxicity as caused
  by various toxic metals based on the BRID
  reference population.
• IBCMT would utilize this database to enrich its
  protocol that would assist us in optimal clinical
  management of systemically toxic individuals.