The most annoying thing though was the vague instruction to "drink plenty of water" given by the MRI tech on the way out. No, you do not drink "plenty of water". You drink something like 1L above your normal fluid intake in the first hour(?) after the procedure. You should also go in well-hydrated.

I swear the quality of medical care in the US just keeps going down, and I'm in a "quality" health system in a rich coastal city.

> She said that the FDA's plan doesn't go far enough.

> "It's hard to dismiss an anecdotal report when you are the anecdote. When a patient is finally tested and found to have gadolinium retention, there's no FDA-approved antidote. So what does the patient do?"

And I want to reiterate that she was "the" no not "a" no. I don't know if her vote alone is what's caused more research into this. But it's probably the thing I brag about her the most. Even though everybody else said it was fine or abstained, she stood strong. If you look up the articles from the time of the panel (2017) you'll see a lot of articles about this panel and how she was the sole no vote. Included in that was a public post from Chuck Norris praising her. He was going to come out to meet us but I think it was a bad Texas hurricane season so that fell through

> Chuck and Gena Norris filed a lawsuit against several medical companies in 2017, alleging that a gadolinium-based contrast agent used in Gena Norris's MRIs caused her to develop a condition called gadolinium deposition disease and resulted in debilitating symptoms like cognitive issues, pain, and muscle wasting. In January 2020, the Norrises, along with their attorneys, voluntarily dismissed the lawsuit with prejudice, meaning it cannot be refiled. The dismissal was made without a settlement payment, and each party paid their own legal costs.

It might give a glimpse into his worldview to mention that during the COVID pandemic Mr Norris shared an article on social media that claimed that the COVID vaccinations killed millions of people. [0]

[0] https://m.facebook.com/story.php?story_fbid=870953857718632&...

People are told that the authorities have it all under control and the experts can be trusted. Then they discover that the experts are human, fallible, and sometimes incompetent or corrupt.

Since the original message was one of unqualified absolute faith in the experts, the backlash is to flip over to believing that the experts are satan incarnate and pure evil and always wrong.

It reminds me psychologically of the arc of an immature relationship. First they’re perfect, everything about them is perfect, they’re going to be your soul mate forever. Then you catch them in a lie or they do something embarrassing. Then you get the screaming breakup. Everything about them is the worst now and you never want to see them again.

I can’t go outside in mildly brisk weather without a tissue as it’s a constant stream, and I get debilitating headaches that are almost like migraines with the pain situated right at the bridge of my nose. Also found the procedure enlarged my sinus opening for no particular reason, something my teenage self wasn’t aware of.

It seems to be getting worse over time, and I have localized pain in the area periodically. I can tell you from first hand experience, it will skew your view of medicine and the field, and I have plenty of MDs in the family.

Some people just take it a little too far.

Ha, yeah, doctors say that about just about everything that's a bit abnormal just to get you out of their office. Was told similarly for two conditions I still have. It sounds better than "Uhh I have no idea what that's about, there's 68 patients waiting in line, good luck".

The way I see it, medicine is about trying to fix a black box with absurd levels of complexity that does not follow any sensible design, where every body is not even arranged in the same way. All that without a manual and only rudimentary tools. They mostly just guess based on statistics and hope for the best, they have no idea what they're doing and if at all possible they try to let your body resolve the issue on its own because it'll do less damage.

Still usually beats the alternative though (i.e. nothing).

Ha, "just keep waiting", knowing we all have timeouts that'll expire when we drop dead...

As long as that is true it seem naive to believe that nuanced institutions can exist as dominant entities in human societies.

Saying sincerely "we are not yet sure if Covid spreads by touching surfaces" etc. would have gone a long way.

I am not even touching the dirty topic of "practise societal distancing unless you go to an anti-racist demonstration, because racism is worse than Covid". That alone probably sunk the levels of trust for a generation in the US, especially among people right of the center. Politicizing science is suicidal.

Back to normal uncertainty. It was the same with various dietary recommendations. Older people remember several major overhauls thereof (are eggs fine or not, and in which amount?), and again, these were presented with a level of certainty that does not correspond to the actual - somewhat fuzzy - state of nutritional science.

You can only do this so long before unleashing an epidemics of distrust.

After my SO got her first COVID vaccine she lost her period. It had been rock steady for many, many years and suddenly gone and hadn't come back for a few months. She had a GP appointment, and I accompanied her as I often do as my SO struggles with recalling important details.

My SO told the GP about her missing period, and the GP quickly tried to reassure her it wasn't something to worry about and it would come back soon enough.

Well, I had just read published studies about this and knew the medical establishment had no idea why the vaccine caused a lot of women to lose their period.

So I challenged the GP and asked if she knew what the mechanism was that caused my SO to no longer have her period, and of course she didn't know.

"Well, if you don't know the mechanism, how can you say it's fine this time?", I asked sincerely.

She admitted she was just going off what usually happens when women lose their periods, which can happen due to various kinds of stress. I wondered why it was so difficult to lead with that, instead of confidently stating it would be fine.

My SO did eventually get her period back, but to this day, almost 5 years later, it's still highly unregular.

That reminds me of someone called Chatgpt.

It wouldn't have, uncertainty creates general panic as well, that soon turns into disarray of chaotic recommendations among the masses.

A disarray of chaotic recommendations from on high is preferable, I guess?

I especially enjoyed viewing the early covid health department stickers later on. While masks were mandatory, there were health department stickers everywhere from a couple months earlier telling us that they were unhelpful.

I know nuance is hard, but it is entirely understandable that many people have distrust in authority when the message seemed to be high confidence do A(t) and A(t) was often contradictory to A(t-1). At that point, people pick the A(t) that had the advice they like.

When there were things like tell people masks are ineffective because they actually are effective but in limited supply, that also breeds distrust. I don't know how you solve that one, other than having a functional pandemic response logistics chain, and I don't think we ever had that; we did some supply warehousing after SARS but without a process to refresh the stock, it was not effective for COVID. I suspect there's no effort to build that up again, but I'd love to be wrong; my impressions are that the US healthcare and disease control ecosystem has not learned anything from COVID, again, I hope I'm wrong. Maybe acceptance of mRNA based vaccination and some amount of deployment of genetic identification of infection from patients.

I don't like the "common people are too stupid to be told the truth" attitude (which includes uncertainities).

It is both too smug to work, and unworkable in today's networked world, where those same people will notice really fast that someone is treating them like idiots, and react with resentment and loss of trust.

That’s what most authorities believe and there is good reason to believe it.

People in groups are irrational and tribal in ways people are not if you speak to them one on one. We don’t scale well, cognitively speaking. A whole bunch of “game of telephone” distortions happen and a bunch of legacy instincts from when we were little squirrel looking things take over.

If you look at how militaries operate it’s basically a giant set of procedures and customs designed to suppress all that shit and allow people in groups to behave somewhat more rationally. At least for a while, or in a limited domain. It kind of works. But we don’t want all of society to operate like that because it also suppresses art, invention, experience, play, etc.

The results of this belief seem to be pretty catastrophic. Trust against authorities has evaporated all over the world.

"People in groups are irrational and tribal in ways people are not if you speak to them one on one. "

Sure, but why precisely do you believe that lies / deliberate misinformation will work better in such situations?

Is anybody able to craft such misinformation so soothing and so believable that the vast majority of the population will accept it indefinitely?

If not, what happens when it becomes obvious that someone in a position of authority communicated dishonestly to the public?

It’s also why some people gravitate towards overly-confident narcissists. They feel a sense of comfort when someone seems to have all the answers, even if they don’t.

Assuming by default that (government|any) humans are working on a selfless incentive structure is arguably insane behavior.

And normally I wouldn’t really even bother acknowledging that that extreme stance exists. If you look hard enough you can find an extreme stance on anything. But the sheer percentage of the US population that has embraced an almost entirely skeptical/dismissive view of doctors and experts of any kind… it’s kind of horrifying

Do you think most people are capable of understanding why an expert could be wrong about gadolinium but right about vaccines? Medical advice is all seen as equivalent to most.

What is the equivalent when it comes to medical advice? Using vaccines as an example, one concern people have is the mercury content. The FDA, doctors, and drug manufacturers have said that the mercury is safe. The same doctors, manufacturers, and FDA has said that MRI contrast containing another heavy metal, gadolinium, is safe. It turns out that, no, it is not safe.

Given these facts, is it really surprising that people would turn away from the FDA and doctors just like people would turn away from a car manufacturer after receiving a lemon? While I personally trust the FDA, I can see the logic in the distrust after events like this.

Try

People are told that the authorities have it all under control and the experts can be trusted. Then they discover that the authorities and experts, in the name of “the greater good”, actively suppressed debate, knowingly mis-represented uncertainties, pretended reports of serious adverse reactions to vaccination were not only impossible but simply fear-mongering from the uneducated, and then pressured social-media platforms to take down factual information when it threatened the official narrative.

This without even touching on the fact that the WHO, who has one damned job, refused to even declare a pandemic and spoke against any travel restrictions or public health measures outside their lazy guidance until the virus was confirmed to be spreading out of control in nearly every nation on earth.

This made more sense to me when people still believed that the shots meant getting covid was very unlikely. It's easy to find people who got lots of shots, it's hard to find people who didn't get covid.

It always seemed implied that p(shot cardio issues) < p(covid cardio issues), and nobody ever talks about p(shot cardio issues) + p(covid cardio issues).

Did anybody rigorously demonstrate that a vaccinated covid case doesn't have these risks?

It did work to some extent. It’s there in the numbers. But it was not the resounding success that, say, the smallpox or polio vaccines were. It attenuated the disease a little.

That might change some of the calculus. Or it might not. It’s hard to tell the difference between myocarditis caused by the vaccine or from COVID or from other factors.

Imagine it’s you who gets to make the call. Whatever call you make will be roundly criticized and you might be wrong. If you’re wrong more people will die.

I’m not a Covid truther, anti-vaxxer, or anything of the sort, but let’s be honest here. Mainstream urban society will absolutely attack anyone who doesn’t adhere to the consensus view on covid (among many other topics). It’s an overreaction stemming from years of dealing with bad-faith trolls. But the net result is an enforcement of a specific political orthodoxy.

A billion billion billion times this.

It makes me wonder about the inquisition. There’s a subset of Catholic inquisition apologists who argue it was an overreaction to social breakdown and an explosion of cults, some of which were very harmful. Having seen the rise of mass social media I am no longer able to dismiss this argument as easily. Still don’t quite buy it but there is, as you’d say in criminal law, reasonable doubt.

We have a very flawed class of experts who do know things but sometimes fuck up or are sometimes corrupt.

We have a few good faith critics of said experts.

We have a vast number of cranks and con men and trolls.

Category three vastly outnumbers and out-volumes category two, to the point that to most people it looks like there’s only two categories.

A ton of other topics are like this: climate change, anything anywhere near gender or sexuality, etc. The more politically charged something is the more the middle is excluded and the more people circle the wagons against bad faith actors.

That was for clinical myocarditis in the overall population, but the rate of subclinical cardiac damage among young males was significantly higher, around 1% with abnormal ECGs post vaccination: https://link.springer.com/article/10.1007/s00431-022-04786-0 .

It's literally people arguing not to wear seatbelts and pointing at cases were people lived because they were ejected from the car. Ignoring all the people who lived because they were wearing seatbelts.

The correct framing is "How many young people didn't get myocarditis because they got the vaccine?"

- both wearing seatbelts and getting in an accident have a significant chance of causing x

- you are almost definitely going to get in an accident

- are your chances of x greater or lesser given car accident while wearing seatbelt?

I think your framing is correct (though it'd be better to just say were better off in general), but I haven't seen anyone give a convincing answer to that question in favor of the shots.

One also needs to understand that myocarditis is not uncommon, and especially common after viral including COVID itself. Also "subclinical" means that this includes mild cases and here the 0.1% also included arrhythmia. Looking at the other paper above, they found 1 (!) person with subclinical myocarditis while screening for it in a population of 4928. Also interesting to put this in perspective: "Underlying disease was present in 109 (2.2%) of the patients, with simple congenital heart disease in 33, mitral valve prolapses in 36, arrhythmia in 36, Kawasaki disease in 11, and previous myocarditis in 2"

Your idea that excess mortality is caused by the vaccine rather than COVID itself seems far fetched to me.

And it's things like this that destroy trust. Because we're already speaking of an unacceptably high rate of severe side effects, based on this single one (amongst many possible), for that demographic. Typical rate of severe side effects from vaccines are in the 1:1,000,000 rate. So why was this recommended, and defacto mandated, for that age group, again? And where's the accountability for those that made this decision, and for the trials that failed to make clear such extremely high rates of side effects?

I realize I'm going on a slight tangent instead of arguing my rather extreme claim. The point I'm making here is that the messaging on these vaccines has not been carried out in good faith, and that they do have clear and severe side effects that should have made them a non-starter for at least certain demographics. And as we continue to see excess mortality rates that are comparable to what it was mid-pandemic (during the lulls between spikes), the possibility of longer term side effects seems to me to be, at the minimum, viable.

With people still being re-infected by COVID, despite the pandemic being "over," could a COVID infection, itself, cause conditions which lead to increased mortality (for people who don't die from acute infection)?

I'm not proposing this as an either/or; I'm just saying that the vaccine wasn't the only change since 2020 :)

And finally, you can't compare the two studies because they are looking at fundamentally different things. The 3 excess cases per 100,000 doses comes from looking at millions and millions of health records, so it will only show cases that were actually diagnosed in the real world. The paper you cite performed an ECG on everyone in the study - so of course they are going to find vastly more cases, because they are doing vastly more testing. But that study is not performing ECGs on anyone who gets COVID but has not been vaccinated. If you did that, you would also see myocarditis, because viral infection is the leading cause of myocarditis.

You cannot conclude anything from the study that you cite about the relative cardiac risks of the vaccine - it's just not a study that's designed to do that.

A chemist gave a great talk about this at a big MRI conference (ISMRM) in Paris 10ish years ago. His explanation was that gad behaves a lot like iron does in the body. It deposits where iron does and like iron it lacks a metabolic route for removal (though menstruating females lose iron).

He stated that deposition was entirely predictable. However the harm caused is still debated.

The article here says ‘ Dr Wagner theorized that nanoparticle formation could trigger a disproportionate immune response, with affected cells sending distress signals that intensify the body’s reaction.’

Emphasis on ‘theorised’.

Deposition is discussed in the below link, and the comparison with iron is briefly mentioned.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10791848/

You're making me feel lucky about what was otherwise a very unpleasant experience!

So this reveals to me two issues

1. In general side effects of the contrast agent are not communicated properly. If I knew, I might have asked - hey can you do the analysis without the agent?

2. There’s no recommendation to avoid vitamin C prior and right after the MRI, heightening the risk.

Pretty much just diluting it out of your system.

I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions.

This paper isn’t saying that MRI contrast agent is high risk in general.

There’s a risk in misinterpreting these niche papers to overstate their relative risk. This is a common mistake when people start reading medical papers and begin overweighting the things they’ve read about as the most significant risks.

But yes cts are cheaper.

I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive.

Willful ignorance is one thing, but people who genuinely attempt to do the right thing at worst just need to be steered slightly differently.

There's a big difference between perfection and "Statistical Literacy Among Doctors Now Lower Than Chance"[1]. I don't think their intentions are bad, but they are woefully incompetent at many basic things.

[1] https://slatestarcodex.com/2013/12/17/statistical-literacy-a...

As it happens, the daily practice of medicine does not require interpretation of p-values. Indeed, medicine existed before the p-value.

The people who create studies that ultimately guide policy decisions are specialized (much like people who write GPU drivers are different from those who run inference)

Explaining to a parent the fact that their child did in fact not have a rare, deadly and incurable multi-system disorder even though an antibody which is 98% specific for it showed up on the antibody assay, that we took for an entirely different reason, is the kind of thing thats hard to explain without understanding it yourself.

If you use the centor criteria before resting for strep, is that worse than getting out a piece of paper and researching background population prevalence?

The OP is being dogmatic about doctors needing to know things he does which is obviously silly.

Edit - but yes, I agree that we should think about sensitivity and specificity, I just don’t think you need to be a statistician, just to have a helpful script and resources for patients who wish to know more.

A year ago, one insisted vehemently—to the point of yelling—that I shouldn't be supplementing Vitamin K because my potassium levels were fine.

OTOH Vitamin K can cause blood clots.* I assume you know this and are being appropriately attentive to the issue.

* The K comes from Koagulationsvitamin which it was called in Danish when first discovered.

https://en.wikipedia.org/wiki/Not_even_wrong

> "What you said was so confused that one could not tell whether it was nonsense or not."

That's why we don't give MRI's out the wazoo. We actually gatekeep them a lot, and most research will tell you that investigative MRIs without chief complaints are a bad idea and we don't do them.

I had cancer. I had no MRIs, but multiple CT and PET scans. CT scans and PET scans have risk - they don't just do those for kicks. But you know what else has risks? Cancer. So there's a calculus here.

Every single medical procedure, down to getting your blood drawn, has this calculus. Nothing is risk free.

Why? What are the risks of MRIs without contrast?

However, I do think the reason MRI aren't used more often is because they are fucking expensive to operate. They need to run more or less 24/7 to be economical, which means they are commonly not scheduled with slack for "optional" investigations.

They’re also loud and can give patients a sense of claustrophobia or panic.

These types of MRIs often cause anxiety and can lead to riskier medical procedures that are not necessary. This is because imaging is actually not perfect. There is always a risk you see something there that is not a big deal, or that you misinterpret the image. That potentially means unnecessary surgery or medicine. That can kill you.

That's why if you go to any doctor in the US and say "I want an MRI, no, nothing is currently wrong with me" they won't do it.

https://www.linkedin.com/posts/gunnmartin_ranzcr-activity-72...

Here in Germany you have to sign something if they give you "stuff" informing you of possible risks. Something that always exists.

But given our track record, a little humility would go along way.

When a highly educated doctor tells you that something is safe, a person is going to assume that means that someone somewhere has proven that the substance is safe. If what they really mean is that no one really knows, but so far, no experiments have been able to prove danger, then we should say that instead.

Contrast agent has been widely studied and determined to be reasonably safe. You’re not going to be administered any routine procedures or compounds that are known to be dangerous without an examination of the risks and benefits.

> If what they really mean is that no one really knows, but so far, no experiments have been able to prove danger, then we should say that instead.

“No experiments have been able to prove danger” is too generic to be usefully different than saying that it’s understood to be reasonably safe.

Even this paper isn’t saying that contrast agent is bad or dangerous in general. It’s exploring a potential effect that we can now detect and study.

Every procedure has some negligible risk, and doctors are trained to mitigate major risks to peoples' health with screenings, medications and surgeries that are of lesser risk than the alternative of inaction. "Safe" is a reasonable explanation for the vast majority of laymen they have to communicate with.

We shouldn't have to clarify that everything is only 99.999% safe and assume that everything carries some form of risk even if small.

Which is strong evidence that the danger is very small, very rare, or takes a very long time to develop.

You don't need a large clinical trial to prove that being shot in the head is harmful; you do need a very large trial to detect that, say, a drug increases the risk of cardiovascular disease by 4% in a specific sub-population.

You can’t prove a negative.

But when a person who doesn’t spend their time nerding out on science goes to the doctor and hears, “the substance is safe”, it is not a guarantee that they know that you can’t prove a negative. If you can’t be sure that your audience knows that it’s not possible to prove a negative, then you should be pretty cautious with your words.

Tylenol is safe. Tylenol can also permanently damage your kidneys.

Walking is safe. Walking can also permanently damage your cartilage.

Food is safe. Thousands of people die from choking.

We all know this, colloquially. When it comes to medicine, it is as if one's brain hops and skips right out of their ear. It's not magic, it works like everything else on Earth works.

These people are then dishonest, because they know, deep down in their heart of hearts, this is absolutely not what safe means.

Again, everyone agrees eating an apple is safe. It's even good for you! But they also know every time they take a bite, there is a risk that they can choke and die. They know that. I know that. You know that. Everybody knows that.

Colloquially, even to the most naive, we know that zero risk does not exist, and that "safe" merely means "an acceptably small amount of risk". If we are changing our definitions based on the context, for example, everything on Earth and then medicine, that is dishonesty. If we are dishonest to ourselves, then we are delusional.

Going for a test itself via car has a quite significant risk itself, should the doctor say that you shouldn't move out of this room, it's not safe?

Like even regularly used medicine has some slight chance of an adverse reaction, that's how minuscule side effects multiplied to human population times the number it's taken results in.

Guess what often has many orders of magnitude greater risk? Continuing having the disease you went to the doctor with in the first place, or having it lie undiscovered.

I've only had a couple with contrast. My understanding is that contrast highlights abnormal stuff and some tissue sorts more than without contrast. Specifically, they use it in MS to get a better look at an active lesion in the brain. You can still see the lesion without the contrast, though, so most of the MRIs are taken without contrast and then another with contrast if necessary. They have known about various side effects of contrast for some years (allergies, etc).

With MS, active lesions enhance and old, inactive ones don’t.

There are a lot uses for contrast in brain imaging and it is very helpful.

Gadolinium deposition obviously isn’t great.

The concentrations outside of the injection site are vanishingly small. And I would consider 48 hours to be pretty quick. If it was still around after a week I would be concerned. Not really sure what I'm supposed to take away from this.

mRNA vaccination stimulates robust GCs containing vaccine mRNA and spike antigen up to 8 weeks postvaccination in some cases. https://www.cell.com/cell/fulltext/S0092-8674(22)00076-9?rss...

The vaccine mRNA was detectable and quantifiable up to 14–15 days postvaccination in 37% of subjects. The decay kinetics of the intact mRNA and ionizable lipid were identical, suggesting the intact lipid nanoparticle recirculates in blood. https://pubs.acs.org/doi/10.1021/acsnano.4c11652

A significant number of those who died within 30 days post-vaccination had detectable vaccine in their lymph nodes. All patients with detectable vaccine in their heart also had healing myocardial injury, which started before or at the time of their last vaccine dose. https://www.nature.com/articles/s41541-023-00742-7

mRNA vaccination stimulates robust GCs containing vaccine mRNA and spike antigen up to 8 weeks postvaccination in some cases. https://www.cell.com/cell/fulltext/S0092-8674(22)00076-9?rss...

The vaccine mRNA was detectable and quantifiable up to 14–15 days postvaccination in 37% of subjects. The decay kinetics of the intact mRNA and ionizable lipid were identical, suggesting the intact lipid nanoparticle recirculates in blood. https://pubs.acs.org/doi/10.1021/acsnano.4c11652

A significant number of those who died within 30 days post-vaccination had detectable vaccine in their lymph nodes. All patients with detectable vaccine in their heart also had healing myocardial injury, which started before or at the time of their last vaccine dose. https://www.nature.com/articles/s41541-023-00742-7

Every square inch of my body was hives for 2 weeks

My kidney function was abnormal for 2 weeks as well and later I was like urinating out goop

I’ve given MR contrast to patients a lot of times (probably tens of thousands) and have seen hives and rashes a handful of times but vastly more often with iodinated contrast in X-ray procedures (usually CT).

https://www.frontiersin.org/journals/toxicology/articles/10....

> Lead author Dr Brent Wagner told Newsweek he personally avoids vitamin C when undergoing MRI with contrast, citing its potential to increase gadolinium reactivity. “Metabolic milieu,” including high oxalic acid levels, could explain why some individuals experience severe symptoms while others do not, he said.

Avoiding high-oxalic foods for a few days before the MRI also seems like a good idea. Just check the diet for calcium oxalate kidney stones.

Tinnitus.

"After ingestion, bismuth is primarily found in trace amounts within organs such as the kidney, liver, spleen, and, in rare cases, the brain, where it accumulates intracellularly—especially in lysosomes and nuclear membranes—and extracellularly in basement membranes of blood vessels.[1-4] In normal therapeutic use, the amount of tissue-bound bismuth is extremely low and is not associated with adverse effects. Potential consequences of tissue-bound bismuth are generally negligible at standard doses, but chronic or excessive exposure can lead to toxicity, most notably neurotoxicity (bismuth encephalopathy).[1][4-6] In cases of bismuth intoxication, histochemical studies have shown accumulation in neurons and glial cells, particularly in the cerebellum, thalamus, and hippocampus, with clinical manifestations including confusion, myoclonus, and encephalopathy.[1][4-6] However, these effects are reversible upon discontinuation of bismuth exposure, and recovery is typically complete within weeks.[5-6] Animal studies confirm that bismuth binds to proteins such as ferritin and metallothionein, and is retained in lysosomes, nuclear membranes, and myelin-associated proteins.[2][4][7] The kidney is the primary site of accumulation and excretion, and tissue levels decline after cessation of exposure, with little evidence of permanent retention at therapeutic doses.[2-3] In summary, permanent tissue binding of bismuth is minimal and clinically insignificant with standard use, but chronic high-dose exposure can result in neurotoxicity and other organ effects, which are reversible after stopping bismuth.[5-6][8-9]"

1. Autometallographic Tracing of Bismuth in Human Brain Autopsies. Stoltenberg M, Hogenhuis JA, Hauw JJ, Danscher G.

Journal of Neuropathology and Experimental Neurology. 2001;60(7):705-10. doi:10.1093/jnen/60.7.705.

2. Metallobiochemistry of Ultratrace Levels of Bismuth in the Rat II. Interaction of Bi With Tissue, Intracellular and Molecular Components. Sabbioni E, Groppi F, Di Gioacchino M, Petrarca C, Manenti S.

Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (GMS). 2021;68:126752. doi:10.1016/j.jtemb.2021.126752.

3. Distribution of Bismuth in the Rat After Oral Dosing With Ranitidine Bismuth Citrate and Bismuth Subcitrate. Canena J, Reis J, Pinto AS, et al.

The Journal of Pharmacy and Pharmacology. 1998;50(3):279-83. doi:10.1111/j.2042-7158.1998.tb06861.x.

4. In Vivo Distribution of Bismuth in the Mouse Brain: Influence of Long-Term Survival and Intracranial Placement on the Uptake and Transport of Bismuth in Neuronal Tissue. Larsen A, Stoltenberg M, Søndergaard C, Bruhn M, Danscher G.

Basic & Clinical Pharmacology & Toxicology. 2005;97(3):188-96. doi:10.1111/j.1742-7843.2005.pto_973132.x.

5. Bismuth Encephalopathy- A Rare Complication of Long-Standing Use of Bismuth Subsalicylate. Borbinha C, Serrazina F, Salavisa M, Viana-Baptista M.

BMC Neurology. 2019;19(1):212. doi:10.1186/s12883-019-1437-9.

6. Bismuth Subgallate Toxicity in the Age of Online Supplement Use. Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K.

The Neurologist. 2017;22(6):237-240. doi:10.1097/NRL.0000000000000144.

7. Bismuth Tracing in Organotypic Cultures of Rat Hippocampus. Locht LJ, Munkøe L, Stoltenberg M.

Journal of Neuroscience Methods. 2002;115(1):77-83. doi:10.1016/s0165-0270(02)00004-3.

8. Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?. Gonçalves Â, Matias M, Salvador JAR, Silvestre S.

International Journal of Molecular Sciences. 2024;25(3):1600. doi:10.3390/ijms25031600.

9. Review Article: Safety of Bismuth in the Treatment of Gastrointestinal Diseases. Tillman LA, Drake FM, Dixon JS, Wood JR.

Alimentary Pharmacology & Therapeutics. 1996;10(4):459-67. doi:10.1046/j.1365-2036.1996.22163000.x.

Some sad advice: don't ask doctors about this, my experience is that it will cause them to write you off as a crazy person no matter how you bring it up. Many of them lump this in with what they see as "influencer illnesses", whether fairly or not.

And maybe more practically, if you really need an MRI, whatever you might have is much more likely to hurt you.

Unfortunately, the article isn't much better. It has as an underpinning, a corrected paper: https://doi.org/10.1093/ndt/gfl294

2. I fail to see how the previous study is an “underpinning” of the new paper. The new paper is a chemistry paper about dissociation of GBCAs in the presence of certain chemicals. Maybe people care because it is a potential explanation for toxicity, but the paper is very focused on the chemistry findings.

I’m not a specialist so I can’t comment on how significant that is.

We generally don’t use the compounds that cause NSF, which is one reason why the 2006 paper link you provided may not reflect the agents under current study.

Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply.

What is the alternative to the status quo that you would propose?

Like Gd, Mn is toxic, but unlike Gd, Mn is naturally present in the body (and also in pineapples) which means that long-term accumulation is less likely. The main difficulty is the lack of strong enough complexing agents because of the tendency for zinc (naturally present at relatively high concentrations in the body) to steal the ligand from Mn, a problem currently being studied:

https://onlinelibrary.wiley.com/doi/full/10.1002/ange.202115...

I had a couple of MRIs recently and got curious about gadolinium contrast. Again, there is a non-zero risk, but if you eliminate the cohort with reduced kidney function and those getting regular repeated MRIs, the risk is comparable to the use of an I/V, which is how it’s administered.

The only thing that upset me was that the staff didn’t ask me verbally about kidney issues to double-check. They also didn’t remind me to drink a bunch of water to flush it out of my system. (Some articles recommend administering a diuretic.)

For that matter they didn’t check me properly form metal fragments either!

Similarly, I’ve had vaccinations administered where I had to remind the doctor to clean the area with alcohol first and to tap the syringe to get rid of the bubbles.

Bad procedures are more dangerous than the drugs being administered!

I got familliar with this condition by a random persons blog who go affected by this during normal MRI and also didn't expect to be part of 1-2%. Unfortunately the blog is now gone, and that post now only lives inside my RSS reader.

My dad was in this industry when nsf first came out. We would be dragged along to after hours family things at conferences. Doctors openly said they gave contrast off label at dosages not approved by the FDA for organ systems not approved by the Fda. Even children. I'm sure they had their reasons, but I'm also sure they never disclosed the possibility of nsf and just told parents their kids needed it, because they admitted it.

I don't know how the risk is actually communicated to patients. I imagine it varries by country. However, normal medical ethics would be to explain risks to the patients. Is there a reason to believe that isn't happening?

It seems an odd fixation of just MR contrast when the same could be said of all drugs. Does your doctor/surgeon go into the minutiae of all drugs and possible consequences? By this line of thinking, saline is not without risks, should they go into depth about that?

People already poorly retain information or even comprehend it at appointments or interventions, is there any point adding more burden onto their attendances?

> There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario

I don't see anything wrong with the GP's comprehension skills.

Anyway, every procedure has risk - and no procedure is recommended if there is not an offsetting clinical benefit. There are clear guidelines for when gadolinium is to be used for an MRI and the guidelines factor in risk for 'NSF'.

Clevland Clinc says "There haven’t been any new reports of NSF in almost 15 years" [1]

[1] https://my.clevelandclinic.org/health/diseases/17783-nephrog...

When my wife was under cancer treatment she had them frequently. Risking some minor reaction, which in her case was disclosed many times, was well worth the value in managing the acute and long term treatment plan.

I was never communicated about gadolinium pollution. Not once.

And yes, on my recent MRI, I explicitly asked why there was metal particulate in my joint. "I dont know, sometimes it happens'... No you fucking tool of a doctor. Its gadolinium.

And I finally find out here.

The Cleveland Clinic has a good overview[1]. Since there have been no reports of NSF in 15 years, I don't think it's rational to avoid MRIs based on gadolinium retention concerns.

[1] https://www.ormanager.com/briefs/study-mri-contrast-agent-ca...

https://my.clevelandclinic.org/health/diseases/17783-nephrog...

Like somebody else mentioned, they swore up and down it's perfectly safe.

The reason these publications exist is that this is new knowledge

> Like somebody else mentioned, they swore up and down it's perfectly safe.

I am positive that you were not told that '[gadolinium] is perfectly safe' because there is a well-known complication of gadolinium administration. It's rare, but it's mentioned in every consent form.

Consent is not "Sign this cause its the only course of treatment". And thats what happens almost every time.

And yes, I too have gadolinium retention in my joint. 3 MRIs. And no, was not told this was a complication... But I'm sure the papers I signed included weasel words to that effect.

The presence of the gadolinium is not a complication. At best, it is an unintended side effect whose clinical significance is not known.

A complication is an unexpected/non-routine, negative outcome. We now have learned that the deposition is something to expect. There is no new information around clinical changes that one can attribute to gadolinium.

Making every future MRI worse is of large concern, especially if there are other nonmetallic contrasts.

I am sure this is true - and it also occurs in people who get braces, certain piercings, people who have had implants or (unfortunately) gun shots.

These aren't complications in any sense of the word.

I thought the problem was with older agents there were single bonds that could be broken in the chain and that's what can cause the build-up.

But I was under the impression those were phased out over a decade ago.

So is this saying even the strong double-bonded ones are somehow building up in some way we don't understand?

It's also been known forever that these agents are riskier in patients with kidney failure, and that's directly factored into the algorithms doctors use and has been forever.

So.... what's the point of this? Is it rage-bait?

Gadolinium is toxic so contrasts trap it with protective molecules that hold the gadolinium until it leaves the body (most leave via the kidneys, but some also leave via liver/gallbladder). Some fraction of gadolinium escapes depending on the structure of the protective molecules. After the problems with the older contrasts were found kidney function became important (impaired kidney function allows more time for gadolinium to escape) and later new contrasts were designed that are much more stable. The gadolinium contrasts we use today are much more stable than the ones we used previously and there haven't been any cases of the sorts of things this article is about in over ten years. But there are a lot of people alive who received the old agents many times and in higher doses than we use today.

I don't want to diminish the concerns (and frankly I think this is important to understand what happens to gadolinium in the body), but the exposure and accumulation are significantly lower today than they have been in the past because reducing exposure has become a major focus of design safety for gadolinium contrast and the worst offenders have been voluntarily withdrawn from the market.

Anyway if my kid needed contrast for accurate diagnosis, I'd do it. I work at a pediatric hospital and generally the way it works is if contrast might be needed its ordered and consented so that it's an option. During the scan radiologists check the images and decide whether contrast is needed to answer the clinical question (although in general that's more a question of time management if the question has already been answered, there's no reason to keep imaging).

So, first off, this is not new. The linked publication here mainly seems to be explaining a potential mechanism of how it might happen.

Some quick notes to aid in a constructive discussion - bear with me, it's been a while and I've left research and since worked as a software developer, chuckle:

- Different gadolinium agents have vastly different "buildup" characteristics - some are better, some are worse. Biochemically, the ones where the gadolinium was trapped in harder "complexes", those were more stable (less accumulation). I suck at biochemistry, so all of those words may be wrong.

- If you'd want to over-engineer this, you could indeed select your MRI hospital / practice based on which gadolinium agent they use.

- Unless you're getting a ton of MRIs (think multiple sclerosis monitoring etc.), you probably won't be affected.

- Most MRIs are without contrast agent anyway, so you probably won't be affected.

- The last I heard was that the clinical implications were still being investigated - like, yeah, you do see a buildup of gadolinium in patients who 1) get certain gadolinium agents and 2) have a ton of MRIs, but what does that mean they'll suffer any clinical consequences from this? Not sure. I heard that there was a paper (.. somewhere) which at least showed a correlation with worse MS outcomes of people who had a high buildup, but then again, cause-effect here is not clear as people with worse MS tend to have more MRIs, too (correlation != causation).

[1] https://pubs.rsna.org/doi/full/10.1148/radiol.2015150337

I found this related article: https://www.research.va.gov/currents/1024-Metal-in-MRI-contr...

A dose of ibuprofen could give you Stevens–Johnson syndrome or TENS and you end up in a burn war for months.

Patients should be made aware of all the risks for any treatment, but it would be impossible to avoid they edge cases even with relatively basic medical care.