The Fascinating Folly of Some Physicians and Scientists Regarding Gd toxicity. Explanation is found in the Prince by Machiavelli. A look at Gd and the Perception of Safety.

It is fair to say that all of us have engaged in folly over our lives, and much of history has been created on the basis of some level of folly. Yet  I find fascinating folly about interpretation of medical or scientific facts or observations. Machiavelli describes this observation as follows (English translation):

Men are so blinded by their own self-interest that they often cannot see the contradiction in their actions.

I want you to consider two observations and interpretations. We start with the scientifically known premise that Gd is a heavy metal is toxic.

Proposition 1.

1. Gd is present in the nuclei of neurons in 40% of random people who have undergone MRI. There is no way to get Gd out of anywhere in your body that works or is safe. But GBCAs are perfectly safe, don't worry.

Proposition 2.

1. Gd is deposited throughout the body, the great majority is in extracellular tissue and not cells themselves. 1 in 10,000 individuals will experience persistent sickness from GBCAs. But, Gd can be removed from circulation, tissue spaces, and cytoplasm of cells through chelation and natural movement of Gd by physical principles, le Chatelier's principle. Gd is safely and effectively removed using a mirror reflection approach of how Gd was put in your body in the first place through chelation with DTPA. Upwards of 90% can get back to near normal if they receive enough chelation., which is as effective as anything in medicine. It is not clear the mechanisms that are present that can remove Gd from nuclei ,likely through lysosomes, but the total amount is likely extremely small in nuclei of neurons. GBCAs are useful, and only a few people get sick from it. The most critical thing is if someone has shown that Gd has made them sick, that they should never get another GBCA injection again.

   
   

The critical point to know is neurons are the brain cells. These are the cells involved with thinking, movement, breathing, etc. everything that the brain does.

So considering these two propositions, which of the two do you find extremely frightening and think that not only you, nor anyone else, should ever get a GBCA injection.

I am assuming rational people are reading this blog and the rational thing to do, and I hate to have to say this, recognizing that physicians can be wrong if their self-interest is involved, is if you think that you have a 40% chance of having a toxic metal stuck in your brain cells, in the actual brain (nucleus) of the brain cell, and no Gd can come out, you would literally have to be out of your mind to think this is safe or to trust anyone who tells you this is safe. I hate to say this, but I understand why there is a huge public distrust of doctors.

Yet it has been suggested to me, that most radiologists believe in proposition 1, which has been made by one of the premier radiologists in the academic community. If you fully believe the 40% stuck in nuclei of brain cells with no way out, that proposition 1 entails, you would have to think I would never want to get this substance. Yet apparently many radiologists believe this and also that Gd is perfectly safe. In actuality, believe that it is only a minority of radiologists that accept this double-speak.

I however have developed and espouse to this day proposition (theory) 2, which I have developed over 9 years of intense work, as the leading peer-reviewed expert on the value of using GBCAs in humans. Gd, although a small amount is stuck in your body, probably forever, is safe for the majority of people. In other blogs I have described where the risk becomes 1 in 100 or so and not the blanket number of 1 in 10,000. But importantly: the great majority of the symptomatic Gd can be removed safely with chelation. BUT Flare reactions can be harsh. Only people sick from Gd experience Flare, so this is an important diagnostic finding. Some people, in the range of 5%, adequate treatment requires more than DTPA chelation with steroids/antihistamines, and this has not been fully elucidated as yet.

If you believe the parts of science of Pt 1, the rational person would say: "do you think I am that crazy that you tell me 40% of people will get Gd in the nuclei of neurons in their brains, a toxic metal, that is permanently there, no way to get any Gd out, and you expect me to believe that it is safe". Actually I would not believe it, and I am the published world authority on the broad subject of safety in Radiology. No thoughtful radiologist should also believe that. This is the premise then that apparently academic radiologists (other than me and the radiologists who work with me) believe the following: i) Gd gets into the nuclei of neurons (by extension all cells); ii) Gd stays for a long time in the body (not necessarily permanently); iii) there is no effective or safe way to get it out.

If you however believe my thoughtful approach, a scholar in the top 0.05% of all scholars on all subjects, that has involved years of research, then you realize: i) there are risks; ii) the risks for the majority are small; iii) who are at greater risk; iv) the benefits often out-weigh the risks, when a proper risk-benefit analysis is done; v) a small amount of Gd does stay, likely permanently (unless removed) in the body; and vi) Gd can be removed, if necessary. Then most people would accept that risk. This gives the patients the necessary respect to provide them with actual up-to-date knowledge.

There is another category of scientists/physicians, often those who have GDD themselves, who believe GBCAs should never be used, could and do point out that at least 40% of people have Gd in nuclei of neurons, and also the toxic profile is unacceptable, and no one is fully asymptomatic.... I would have to agree the neuron issue is a problem. In my opinion, the neural supportive cells take up most of the Gd that goes to cells to protect the mother ship. And maybe the mechanism of lysosomal entrapment and possibly other mechanisms render Gd removal from nuclei possible, and possibly le Chatelier's principle is also in effect causing passage of Gd between membranes, and eventually out of cells. I could be wrong about these safe-guarding aspects. If I find that I am wrong I will post it. So I do believe there is still a role for GBCAs, and at times an important role. But we do need to keep looking for safer alternatives, and I do like the work on iron nanoparticles. WHat I am also aware of, that many are not, that alternative imaging procedures can be even more risky and dangerous.

Patients already accept the risks of acute hypersensitivity reaction (if explained to them), so point 2 really does not add additional risk beyond what they have accepted for years, hence acknowledging theory 2 should not decrease the number of MRIs performed or the number of GBCAs injections made. The improbable proposition 1, supposedly believed by many academic radiologists should signal to every patient to never get a GBCA injection, and by extension not trust any radiologist about doing any MRIs, and by extension anything else.

I do adhere fully to proposition 2. I also adhere to the belief that the great of radiologists do not want harm to come to their patients, but I do believe insufficient numbers of them are fully aware of what I have written in short above, proposition 2, and the subsequent writing. At this point in time I considerable that unacceptable, and worse the misinformation conveyed is entirely unacceptable, and those purveyors should be held to account.

I think very few radiologists are hard line believers in proposition 1, most accept theory 2. And if we talk of the medical community at large, near 100% of integrative physicians and environmental physicians ascribe to theory 2.

Richard Semelka, MD