A Critical Look at "Dr." Paula Bickle
Stephen Barrett, M.D.
For many Paula Ruth Bickle hosted the 5-day-a-week hour-long, Internet-based "Dr. Paula" radio show, during which she gave detailed (but usually incorrect) medical and nutrition advice to people who called about serious health concerns. She advised most people to treat themselves with products from American Longevity, a multilevel marketing company for whom she and her husband were leading distributors. The company's products were promoted during commercials that occupied about half of each show. Bickle frequently advised people to distrust prevailing medical opinions and to use specific products to treat themselves. American Longevity was founded by Joel Wallach, DVM, who is best known for his deceptive promotion of colloidal minerals. The last time I listened to one of her poragsm was in 2007, but her now-defunct Dr. Paula.com Web site promoted the show for about ten more years.
Bickle described herself as a qualified nutritionist, a nutritional biochemist, a distinguished educator, a groundbreaking researcher, a consumer advocate, and an authority on many health matters. In reality, she was none of these. Yet for several years, home page stated:
Ever met someone you instantly liked? That's Dr. Paula Bickle. She has earned the respect of her listening audience as the kindest, yet most informative and honest host on the radio today. When it comes to health, nutrition and plain common sense, there is simply no one like Dr. Paula. She looks at every listener as a member of her own family with a deep concern for their health and welfare. With her unique background in nutrition, research and as a medical educator, she is well equipped to handle any listener's question. Dr. Bickle has a long history of helping people get to the source of their health problem .
Her Web site provided additional hype:
Dr. Paula Bickle started her career as a dental hygienist in Portland, Oregon. During her dental practice she started to question the safety of root canals and commonly used dental materials including mercury and fluoride. She realized that the oral cavity was not disconnected from the rest of the body. Many diseases show themselves in the oral cavity, furthermore some diseases may originate in the oral cavity and certainly the patient's nutritional status affects it all.
This lead [sic] Dr. Bickle to pursue a Masters Degree in nutrition followed by her Doctorate (Ph.D.) in nutritional biochemistry. She then founded her own alternative/complimentary [sic] medical clinic employing MDs, NDs, chiropractors, and nutritionists. The philosophy of the clinic was to find the source of the patient's problem and to find the best treatment to fit the individual patient's needs.
Since the patient's needs were of primary concern and neither conventional nor alternative medicine seemed to have the correct answers, Dr. Bickle began her research projects. Her research interests have included but not been limited to autism, female hormone replacement, allergy diagnosis and treatment, weight loss, sports injuries, heavy metal toxicity, and the necessity/effectiveness of childhood vaccinations. Her latest achievement was the completion of the FDA trial moving DMPS (a chelating agent used for mercury and arsenic) to the allowed list of bulk compounds that can be used in the United States.
Dr. Bickle is an outspoken critic of the current drug/surgery/HMO mentality that seems prevalent in conventional medicine. Every patient is an individual and needs to be treated as such. Seven years of heavy metal toxicity research has led her to believe that many people with chronic diseases have been miss-diagnosed [sic]. The correct question your physician should ask is "are you sick, toxic, nutritionally deficient, or all three?" All patients referred to her clinic for detoxification has [sic] their previously diagnosed disease improve or disappear after being treated for toxicity and nutritional deficiencies.
Dr. Bickle is also a well-known speaker to professionals and the general public. She has trained physicians and dentists from 33 States and 6 foreign countries on heavy metal toxicity and nutritional biochemistry. She hosted her own radio show in the greater Portland market for 10 years .
Bickle's curriculum vitae lists many educational, work, research, and teaching experiences as well as publications, honors, and organizational memberships. People who don't know the significance of these items might be impressed by them, but I am not.
Questionable Training and Credentials
Bickle's CV stated that from 1973 to 1975 she attended Portland Community College where she trained as a dental hygienist and acquired a 2-year Associate of Arts degree. The Oregon Services Web site indicates that she was licensed as a dental hygienist from 6/13/75 through 9/30/99, at which time her license expired. Bickle's "Ph.D." comes from Columbia Pacific University, a nonaccredited correspondence school that was shut down by a California court because the school awarded excessive credit for prior experiential learning to many students, failed to employ duly qualified faculty, and failed to meet various other requirements for issuing Ph.D. degrees . Her CV does not state where she got her master's degree, but since accredited universities normally do not issue graduate degrees to people who have only two years of college, it is safe to assume that her master's degree is no more legitimate than her "Ph.D."
Bickle's CV lists 16 "research experiences," but it does not identify any formal training that would qualify her to design, conduct, or supervise human research. On May 9, 2004, I searched Medline and found no articles authored by "Bickle P," which means that she has never had a research report published in a significant medical journal.
Bickle's CV also states that she "interned" with Lendon Smith, M.D. in 1987. It does not state how long she was with Smith or what she did that would constitute an "internship." Smith was a pediatrician who promoted many irrational ideas. As far as I know, his primary activity was writing and he saw few or no patients. In 1987, he permanently surrendered his medical license rather than face medical Board action on charges of insurance fraud. According to press reports, the trouble arose because he had signed documents authorizing insurance payments for patients he had not seen. The patients had actually been seen by chiropractors, homeopaths, and others whose treatment was not covered at "nutrition-oriented" clinics in which Smith had worked .
Bickle's claim that her research resulted in the "moving DMPS to the allowed list of bulk compounds that can be used in the United States" is not true. DMPS (dimercapto-1-propanesulfonic acid) was included on a proposed list of substances for use in pharmacy compounding, but the proposal has not been implemented. The FDA has warned that it may initiate enforcement action against drugs compounded from bulk active ingredients that are not approved by the FDA for use in drugs for clinical or experimental use . DMPS had not been approved and thus remains illegal to market for the prevention or treatment of any disease.
Bickle's CV states that from 1988 to 2000, she was a "nutritional biochemist" at the Cascade Park Health Group in Vancouver, Washington. In 1996, however, the Washington Department of Health charged Bickle with practicing medicine without a license. The relevant documents indicate:
- In 1988, Bickle was certified to practice as a health assistant.
- Bickle owned and operated the clinic, which was supposed to be directed by a licensed physician.
- Bickle had independently diagnosed, treated, and/or ordered laboratory tests for three patients.
- For at least six patients, Bickle had submitted insurance bills which indicated or created the impression that the patient had been seen by the supervising physician, when none had actually been seen on the relevant dates.
- In 1996, Bickle had refused to provide patient records requested by a Department of Health investigator.
- Bickle settled the charges in a 1998 consent agreement under which her health assistant status was placed on probation for five years, during which she was not permitted to see any patient who had not been seen and evaluated by a licensed physician who would be primarily responsible for the patient's care.
- Under the agreement, Bickle could provide various types of nutritional counseling but could not diagnose or prescribe a course of treatment for any disease.
- Bickle was also assessed a $5,000 fine . However, records from the Washington Department of Health's online database indicate that she did not pay the fine and that, as a result, her health care assistant certificate was "indefinitely suspended" on April 2, 1999 .
Bickle's CV also stated that she practiced as a "biochemist - nutritionist" at the Cascade Health Group, in Portland, Oregon from 1994 through 2000. However, in 1998, the Oregon Attorney general charged her with practicing medicine without a license . Affidavits in the case state that Bickle had assessed and diagnosed patients, ordered laboratory work, interpreted laboratory reports, implemented treatment plans, signed a physician's name to laboratory orders, and administered medications to patients under preexisting orders from physicians who no longer worked at the clinic. One doctor who had worked there complained that Bickle had pressured him to refer more patients for chelation treatments. Another concluded that Bickle had sought a physician as a figurehead for her clinic on order to protect herself against a charge of practicing medicine without a license. Several others described how she regularly made false entries in charts about patients having seen a doctor who actually was not present in the clinic and that many patients thought she was a medical doctor .
In 1999, the Oregon Attorney General secured a stipulated judgment similar to the one in Washington . During the following year, however, state investigators concluded that she had continued to illegally diagnose, prescribe for patients, and even administered intravenous treatment (chelation therapy) without a physician on the premises. In 2000, Bickle agreed to stop these practices, pay a $7,500 penalty, and refrain from owning or managing any facility at which persons engage in the practice of medicine . She appeared to stop seeing patients but gave similar advice through Internet broadcasts that promoted dietary supplements that she sold.
Chelation therapy is generic term for a series of intravenous infusions containing a chelating agent that can bind heavy metals and minerals and cause them to be excreted from the body. Several chelating agents are falsely claimed to be effective against cardiovascular disease, autism, and many other conditions . Many proponents falsely diagnose mercury toxicity caused by absorption of mercury from amalgam fillings. The most common chelating agent is Endrate, the disodium salt form of EDTA, but DMPS is sometimes used. Bickle's CV indicates that she was involved in several clinical trials involving DMPS and that she served on an institutional review board (IRB) that approved the trials. In 1998, the Cascade Health Group Web site advertised, "We are the IRB approved research facility in Portland for the diagnosis and treatment of MERCURY Poisoning and Detoxification." 
In 1997, Heyltex Corporation, which sponsored some of Bickle's work, terminated her as principal investigator in at least one of the DMPS studies. The reasons for this were spelled out by the study's Safety Monitor:
In the week I was there it seemed that everyone that came into the clinic was being recruited by Paula for the research project regardless of why they scheduled a visit. Several patients told me they felt they were being coerced into the study.
There appeared to be a pattern to Paula's evaluations regardless of the patient's complaint or reason they sought to visit Cascade Health Group. The reason was always mercury toxicity. . . .
My report to Heyltex on Paula's practices and her direct disregard of the protocol and patient safety led to her being dismissed as the Principal Investigator of this project. Throughout my association with the Bickles it became increasingly clear that they would take a little truth and wrap it around a lot of untruths while making everything sound believable. This became crystal clear to me during the week I spent in the clinic and questioned various practices and attempted to verify information that I had been previously given. I believe a large part of their motivation is financial in nature with little regard to true quality medical care for individuals or research .
Indeed, Bickle's "disregard of patient safety" figured prominently in the report issued by FDA following their inspection of her clinic in 1999. The violations included:
- Failure to document that adequate informed consent was obtained from any of the research subjects
- Failure to document IRB approval of the clinical trial
- Failure to promptly report the death of a subject to the IRB
- Failure to follow the research protocol:
- Failure to document that subjects had the required lab tests before and after the administration of the investigational drug (DMPS)
- Failure to document that subjects had the required physical examinations prior to administration of the DMPS
- Failure to conduct pre- and post-challenge urine tests
- Administration of DMPS before and after the period in which Bickle was the principal investigator
- Failure to maintain adequate records in the Case Report Forms
- Failure to account for the distribution of the DMPS
- Failure to document IRB approval of multiple amendments of the research protocol
- Representing in a promotional context that DMPS is safe and effective for the purposes for which it was under investigation
- Inadequate methods, facilities, and controls used for manufacturing, processing and packing of the DMPS to establish and maintain appropriate standards of identity, strength, quality, and purity as needed for subject safety .
The primary purpose of an IRB is to protect the rights and welfare of human subjects in research; it does so by reviewing, approving the initiation of, and monitoring the research study. The IRB on which Bickle served did not fit that description. It was operated by the Great Lakes College of Clinical Medicine (GLCCM), whose supporters apparently hoped that that by doing "research," they could continue to offer useless interventions to patients without being disciplined by state licensing authorities . But the GLCCM IRB did not operate properly. In March 2000, the FDA sent GLCCM a 14-page warning letter describing violations so serious that the FDA suspended GLCCM's authority to approve new research or enroll new subjects in ongoing trials with FDA-regulated products . In January 2001, after concluding that the deficiencies had not been corrected, the FDA terminated several studies and warned that the rest would be stopped unless the situation was remedied . In March 2001, the GLCCM board voted to cease operation .
In 1999, the California Medical Board placed Ronald Wempen, M.D., on five years probation in connection with his use of DMPS in one of the questionable GLCCM-approved research projects. The complaint charged that Wempen "entered the patient in an experimental study to chelate mercury from her system even though the patient had a low range of mercury and did not show mercury toxicity." 
For Additional Information about DMPS
- The Truth about DMPS: Reports of harm from DMPS use.
- Dubious Mercury Testing: Mentions bogus use of DMPS to boost reported urine levels of mercury.
- Dr. Paula Bickle. Dr. Paula Web site, accessed July 7, 2007.
- Paula R. Bickle, Ph.D. biography. Dr. Paula Web site, accessed July 7. 2007.
- Court orders Columbia Pacific University to cease operating illegally in California. Quackwatch, Nov 5, 2013
- Barrett S. Some notes on Lendon Smith. Quackwatch Web site, revised Dec 22, 2001.
- Pharmacy compounding. FDA compliance policy guide 460.200, Revised May 29, 2002.
- Stipulated findings of fact, conclusions of law, and agreed order. In the matter of certification to practice as a health care assistant of Paula Ruth Bickle, Certification No. HC00001404, respondent. State of Washington, Department of Health, Health Docket No 97-06-B-1024HC, signed Jan 28, 1998.
- Findings of fact, conclusions of law and final order. In the matter of the certificate to practice of Paula R. Bickle, Certificate No. HC00000207, Docket No. 00-11-B-1008HC, April 2, 1999.
- Motion and order to show cause and application for injunction for engaging in the unlicensed practice of medicine. State of Oregon v. Paula R. Bickle. In the Circuit Court of the State of Oregon, County of Multnomah, Case No. 9903-02683, filed March 12, 1999.
- Stipulated judgment and decree. State of Oregon v. Paula R. Bickle. In the Circuit Court of the State of Oregon, County of Multnomah, Case No. 9903-02683, filed April 29, 1999.
- Affidavits of Glen Campbell (4/28/00), Jennie Brown, RN (5/5/00), and Janina Kneeland, ND (6/5/00).
- Stipulated order and supplemental judgment and decree. State of Oregon v. Paula R. Bickle. In the Circuit Court of the State of Oregon, County of Multnomah, Case No. 9903-02683, filed July 5, 2000.
- Green S. Chelation therapy: Unproven claims and unsound theories. Quackwatch, revised Nov 9, 2013.
- Our clinic. Cascade Health Group, Archived Web site, 1998-1999.
- Floener P. Affidavit, Jan 19, 1999.
- Leja LS, Henry JC. FDA Form 483, Notice of inspectional observations. Issued to Paula Bickle, PhD, Cascade Consultants Research Foundation, Sept 8, 1999.
- Levin WM. What's new about the mercury controversy? Medmarket Web site, archived 1998.
- Masiello SA. Warning letter to L. Terry Chappell, M.D., Secretary, GLCCM IRB, March 9, 2000.
- Masiello SA. Letter to Barbara Gruenwald, executive director, GLCCM IRB, Jan 2, 2001.
- Chappell LT. Letter to Patricia Holobaugh, FDA Division of Inspections and Surveillance, July 17, 2001.
- Stipulated settlement and disciplinary order. In the matter of the accusation against Ronald Reiner Wempen, M.D., Sept 6, 1999.
This article was reviused on August 11, 2018.