Urinary organic acid analysis article criticized

Townsend Letter for Doctors and Patients, Jan, 2005

Editor:

As a reader and supporter of the Townsend Letter for over 20 years, I am greatly disappointed in its publication of the article on "Urinary Organic Acid Analysis" in the October 2004 issue. This season of election news coverage has highlighted one sad fact: anyone can say anything to support a bias--true facts are obscured by self-interest, politics and statistics. In the scientific arena, however, experimental design, the peer review process, and disclosure of conflict of interest serve as standards to minimize bias. The Townsend Letter, by choosing to publish this unpaid advertisement as a scientific document, has supported self-serving pseudoscience that only confuses and obscures the tremendous progress being made in clinical laboratory science for Integrative Medicine.

Metametrix has pioneered quantitative organic acid testing and invested more time, energy and resources in developing the assay over the past 15 years than any other clinical laboratory in our industry. We know the strengths and limitations of available methods. Because of the limitations of the existing GC/MS method when applied to the clinical laboratory setting and the broad spectrum of analytes reported, we have developed a superior method using LC/MS/MS. To imply, as the article does, that a 25 year-old method cannot be improved upon with the tremendous advances in technology that have occurred since it was originally developed, demonstrates a reactionary, Luddite mentality and fundamental lack of technical expertise. We are preparing a detailed explanation of why the LC/MS/MS method is an improvement over older methods, and it will be available on our Website in the near future. It will also address the many points of misinformation, errors and omissions in the Townsend Letter article.

The article basically raises the issues of accuracy and reproducibility. How are these assessed in a clinical laboratory setting?

* Accuracy is determined through proficiency testing administered by an independent and unbiased institution which sends blind samples with known values to clinical labs for measurement. Metametrix participates in several proficiency testing programs, including those offered by New York State and the College of American Pathologists for organic acids and other tests. In New York, if the lab cannot accurately measure the analyte in the proficiency test, it loses its license to do that test.

* Reproducibility is determined by split samples submitted under carefully controlled conditions. This is done internally and is part of the licensing process with state and federal examiners. Metametrix also offers a split-sample program that provides a credit to our customers on the second test performed on a blind split sample. This way the customer can prove to himself if the lab generates reproducible results.

Metametrix is staffed with doctoral-level experts with decades of experience in the clinical laboratory setting. We serve as a reference laboratory for some of the largest clinical labs in the country and participate in research projects with universities around the country. We have federal and multiple state licenses including, New York state, one of the most difficult licenses to qualify for.

We welcome all newcomers to the field of organic acid testing since we truly believe, based upon our 15-year experience offering this test, this assay has great value for patient care. Laboratories offering these tests should be able to demonstrate accuracy and reproducibility according to these industry standards of proficiency testing and customer split-sample programs. I suggest you make sure the lab you are using does.

J. Alexander Bralley, PhD, CEO

Metametrix Clinical Laboratory

4855 Peachtree Industrial Blvd.

Norcross, Georgia 30092 USA

Editor's Comment: The article in the October 2004 issue, entitled "Urinary Organic Acid Analysis: A Powerful Clinical Tool" by Newman, Gordon and Suen is rightfully criticized by Alexander Bralley. An analysis of laboratory technologies done by a competing laboratory has a bias which prejudices meaningful comparisons. Although the Newman, Gordon and Suen article cites relevant literature, there is a bias to report literature validating their laboratory's technology at the expense of competing laboratories' technologies. As a rule, the Townsend Letter prefers to avoid competitive laboratories presenting papers and experimental data attempting to prove their technology supercedes other lab technologies. We do invite Bralley to present data in the future discussing the validity of his laboratory's methodology.