Nov 16 2012
Two scientists walk into a bar
The first one says “I’ll have some H2O.”
The second one says, “I’ll have some H2O too.”
Then he dies.
I have come to believe in my own version of The Secret.
The Secret describes the law of attraction as a natural law that determines the complete order of the universe and of our personal lives through the process of “like attracts like. The author claims that as we think and feel, a corresponding frequency is sent out into the universe that attracts back to us events and circumstances on that same frequency.
Obviously not true as I have yet to win Powerball. But a variant of the Secret is kind of creepy. As soon as I learn about a new concept, in medicine or life, I start to see it. All the time. Perhaps my learning a new concept causes it to spring forth like Athena. I would have said instantiate, but I got all sorts of grief when I used that word last time. For example, shortly after reading a review of infections in patients with Osler-Weber-Rendu, I saw a case. Creepy. As I drive from hospital to hospital I listen to Audible books and it is equally creepy how often I see a word in my visual field that is identical to the word I am listening to.Two weeks ago I reviewed the SCAM (supplements, complementary and alternative medicine) that is UV irradiation of the blood. I had never heard of the therapy before, and within the week of the blog I receive a brochure from ACAM, the American College for Advancement in Medicine, who modestly refers to themselves as “the voice of integrative medicine.” Somehow I imagine they speak in the voice of Sylvia Brown, but that’s probably just me. The brochure concerns their fall conference and trade show where you can learn Oxidative Medicine in a one day workshop including ultraviolet blood therapy for somewhere around $649, as well as workshops to learn chelation and hyperbaric oxygen.
I didn’t know that by writing about UV irradiation of the blood that the universe would provide me the opportunity to learn more about it. I think the universe is twisted.
Part of the oxidative therapy course is learning to perform intravenous hydrogen peroxide therapy. I had never heard of that one either, and I write this with trepidation since, given the universe’s current malicious intent, I might end up a bleached blonde. So here goes. Wish me luck.
I have mentioned in the past my fundamental bias: that at level of humans we have a good understanding of how the world works. But, I guess, that applies to the world in which I live. The many worlds interpretation of quantum mechanics suggests that every possible event that could happen has happened, resulting in a parallel universe we can neither see nor measure. I think they are partly correct. There are multiple universes that have split off from functional reality, the reality I inhabit. We can see the alternative reality, measure it, but oddly despite being able to interact with these realities, we cannot alter them. More terrifying, but not as dull, as the shrimp worlds are the alternative worlds of SCAM, where all the known rules of by which we understand the natural world need not apply. Like the world that uses hydrogen peroxide as a therapeutic intervention.
Why hydrogen peroxide?
The one true cause of all diseases is inadequate oxygen (there are two situations that violate the Pauli Exclusion Principle. One is The One True Cause of All Disease, of which there may be too numerous to count occupying the same ‘unique’ position. The other is newborn babies, all of whom are simultaneously the most adorable human. Ever). There are forms of SCAM where a little nugget of truth is magnified out of all proportion to its significance. This is one of Dr. Oz’s modus operandi. For example, some tumors and infections grow in a relatively oxygen poor environment. Therefore the cause of disease is low tissue oxygen. Not just cancer and the occasional Bacteroides abscess, but all diseases have a component that is due to a lack of intracellular oxygen. To overcome that deficiency, give oxygen intravenously as H2O2, aka hydrogen peroxide. There are other ways oxygen can be given to those in need: ozone therapy, hyperbaric oxygen, drinking H2O2, peroxide enemas, soaking in peroxide and withdrawing blood, bubbling O2 in it and reinfecting (funny, that is what the automatic spell check gave for my mis-type of injecting. My Mac may have more AI than suspected) the patient. So give oxygen, but not the old fashioned way: breathing.
The purpose of the H2O2 is to oxygenate the blood and thence the unoxygenated tissues. The chemical reaction is simple: H2O2 → H2O + O-. There is your free oxygen.
Practically, how is peroxide given? Hydrogen peroxide 0.0375% or lower concentration is added to a saline solution and infused in doses of 250 ml , slowly over a period of 1 to 2 hours. Another therapist gives 5 cc of three-percent hydrogen peroxide in 500 cc five percent glucose in water as a carrier solution which is infused or 100 ml aliquots of sterile l5% hydrogen peroxide infusion solution made from 30% “food grade” hydrogen peroxide then diluted with 5% dextrose to give the final 0.075 % product.
This makes me wish I was a bit closer to my chemistry days: I don’t have the time or wherewithal to calculate how much oxygen such a process would add to the human body compared to taking a deep breath. Others have made the calculation and it suggests that the oxygen provided, relative to breathing, is nearly homeopathic:
Under normal conditions, hemoglobin in blood leaving the lungs is 98% saturated with oxygen. The hemoglobin in one liter of blood can carry about 200 ml of oxygen, and about 50 ml of this is extracted each time it passes through tissue capillaries. The metabolism of a normal 60 kg adult requires delivery of between 200 and 250 ml of oxygen each minute . Since the amount of hydrogen peroxide that is infused into a patient during one “oxidative therapy” session, yields a total of 100 ml of oxygen per day, the treatment can make no significant contribution ones oxygen requirements .
Or 288,000 mls a day of O2 is used by the body. Add the 100 mls from hydrogen peroxide and you up your O2 delivery by 0.03472%, which is approximately zero.
If the hydrogen peroxide makes it to the arterial side before undergoing degradation, there is essentially no unsaturated hemoglobin to take up the oxygen and plasma can at best dissolve 20 ml of O2; the rest will have to form bubbles that have the potential to cause gas emboli. So the best you can say about using peroxide as a mechanism for oxygen supplementation is that the amount generated is infinitesimal and is offered in a form that could cause the most mechanical damage. And I would fret about the fastidiousness of those taking a bottle of peroxide and preparing it for injection. One lapse in focus and the you could inject a higher concentration of peroxide than intended with terrible consequences. Compounding pharmacies have a long history of occasional lapses that lead to death. I always wonder about the environment of the clinic where providers make up their own concoctions for patient use. I have in my mind the same conditions as the production of gin.
Is there any reason to suspect that there is biologic plausibility behind the therapy?
Nope. At least not that I can find. Peroxide is used to kill bacteria. It is found in white cells where it is localized to the phagolysosomes and is rapidly degraded by catalases. In the blood hydrogen peroxide is also rapidly degraded and there can be no H2O2 in the blood at levels to kill bacteria, as demonstrated in an animal model. As best I can find, the normal concentration of H202 in the blood is at most 35 micromolar. Like many potentially toxic molecules, the body keeps H2O2 tightly segregated so it cannot cause harm. Futher, there is no reason to suspect that low oxygen is a cause of any medical condition except suffocation.
When you look at a list of diseases treated with peroxide (everything of course) it is hard to see where either O2 or H2O2 could have any benefit on the underlying pathophysiology. One list included.
1. Asthma, 2. Emphysema, 3. Chronic Obstructive Lung Disease (COPD), 4. Cardiovascular Disease, 5. Cerbrovascular Disease, 6. Alzheimer, 7. Peripheral Vascular Disease, 8. Arrhythmias (Irregular heart rhythms), 9. Influenza, 10. Herpes Simplex (Cold Sores), 11. Herpes Zoster (Shingles), 12. Temporal Arteritis, 13. Migraine headaches, 14. Cluster headaches, 15. Vascular headaches, 16. Coronary artery spasm with angina, 17. Chronic Epstein-Bar Virus infection, infectious, mononucleosis, 18. Diabetes Type H, 19. HIV Infections, 20. Hepatitis, 21. Parasitic infections, various, 22. Fungal infections, various, 23. Bacterial infections, particularly chronic unresponsive, infections, 24. Candidiasis, 25. Chronic pain syndromes, various, 26. Pain of metastatic cancer, 27. Environmental allergies, 28. Early multiple sclerosis, 29. Rheumatoid arthritis
The data in my current reality convening treatment with iv hydrogen peroxide? None. Proponents note it is a natural product of metabolism (it is, like formaldehyde) but fail to note the importance of concentration and location of the molecule as well as systems to scavenge H2O2. I don’t know why those who feel getting patients properly oxygenated do not give them supplemental oxygen, except, of course, they can’t charge for that.
There are rare deaths reported with hydrogen peroxide and are attributed to bubbles of oxygen causing obstruction and tissue damage, a gas embolism. It is also of interest that hydrogen peroxide can lead to red cell hemolysis, especially in vitamin E deficient individuals. and perhaps other anemias as well.
Another example of the Secret: last week grand rounds was on the adverse physiologic effects of hemolysis presented by Mark Gladwin from University of Pittsburgh and it was fascinating. The basic physiology is free hemoglobin is extremely toxic and kept tightly sequestered or immediately scavenged by haptoglobin when released. When free it rapidly and irreversibly binds to NO in the vascular tree leading to multiple physiologic derangements, depending on amount released and chronicity. For example, it is one of the causes of pulmonary hypertension in sickle cell and part of the derangements seen in severe malaria. I would wonder when I read the reports of the H2O2 deaths if hydrogen peroxide induced hemolysis was the major cause of the pathophysiologic derangements that killed the patient, especially if it were accidentally given at too high a concentration. But that is pathophysiologic speculation. Regardless of the mechanism, it can kill the occasional unlucky recipient.
To sum up: non potest fungebantur, non fungebantur, occidere potest (cannot function, does not function, can kill, at least according to google translate)
* These opening paragraphs are logical fallacy central and are intended as humor.
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