Clinical Metal Toxicology Introduction from chairman of the Medical Scientific Education and Research Committee of the International Board of Clinical Metal Toxicology 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. st 21 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. 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. 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 . 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. 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. 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 ). 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. 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. 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.