Archive for Sunday, August 10, 2003

Hyperbaric oxygen therapy: medical hope or hot air?

August 10, 2003

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Some parents of children with cerebral palsy and other forms of brain damage say a treatment long used by doctors for other conditions has brought what seem like near-miraculous advances in kids who hadn't been able to talk, walk or feed themselves.

The treatment -- hyperbaric oxygen therapy (HBOT) -- delivers pure oxygen at higher-than-normal pressures to patients sitting or lying in a chamber.

Although there's no proof, advocates believe that in brain damage cases the extra oxygen can prompt dormant or damaged neurons to become reinvigorated.

Hyperbaric oxygen therapy has long been used in mainstream medicine to treat a dozen very specific problems, such as stubborn wounds, but its use in neurological conditions is highly controversial.

In the past few years, parent activism has spawned a nationwide movement to get research and recognition for the use of the therapy for their disabled children. And the mainstream medical community -- though skeptical -- is starting to funnel some money and effort into the question.

"As of now, there is no scientific evidence in support of the use of hyperbaric oxygen therapy for cerebral palsy, but on the other hand, there are still enough questions here that we are reluctant to say this is just foolishness," said Dr. Murray Goldstein, medical director of the United Cerebral Palsy Research and Education Foundation.

At the same time, hyperbaric oxygen therapy also has a long history of being championed by quacks who promise it will do everything from restore hair color to cure cancer, and some worry that desperate parents are spending money and time on a fruitless search for a miracle.

Proven effectiveness

Parents frustrated by the lack of interest by traditional medicine have formed the International Hyperbaric Medical Assn., which has sponsored two symposiums on the therapy and brain injury in children. They believe that the many reports of benefit prove it works.

Cheryl Bryant Bruce and her 9-year-old son, Gregory, settle in for
a hyperbaric oxygen therapy treatment. Gregory has brain damage and
is undergoing the treatments, in which patients breathe increased
levels of oxygen inside a special oxygen chamber with a mild
increase in atmospheric pressure.

Cheryl Bryant Bruce and her 9-year-old son, Gregory, settle in for a hyperbaric oxygen therapy treatment. Gregory has brain damage and is undergoing the treatments, in which patients breathe increased levels of oxygen inside a special oxygen chamber with a mild increase in atmospheric pressure.

At the same time, a growing number of stand-alone hyperbaric centers have sprung up nationwide to meet the demand, which has created some concern in the mainstream hyperbaric medical community. The therapy is generally considered safe, but pure oxygen can pose a hazard, including the rare risk of seizure.

One reason so many centers are cropping up -- more than 500 nationwide -- is that many mainstream hyperbaric doctors turn away patients with brain injuries.

"We get calls from people who have cancer, people who have HIV, arthritis -- all kinds of things," said Dr. Neil Hampson, director of the hyperbaric medicine program at Virginia Mason Medical Center in Seattle and president of the Undersea and Hyperbaric Medical Society. "And we don't treat those patients either without published, scientific evidence" that it works.

Hyperbaric oxygen therapy has been around for many years. In the 1930s, doctors learned it could treat decompression sickness in divers ("the bends"), and since then the recognized applications have expanded to the treatment of many types of nonhealing wounds, carbon monoxide poisoning and intercranial abscesses. As of April 1, Medicare covers the therapy for stubborn sores that often afflict diabetics' feet.

Legacy of hype

But hyperbaric oxygen therapy also has a long history of being oversold. The legacy of hype remains one of its biggest obstacles. Even today, many of the most vocal proponents easily slide into sweeping statements about the therapy that are far from proven.

Reports of benefit remain largely anecdotal, and experts in hyperbaric medicine say they're still waiting for proof.

Getting money to undertake rigorous clinical studies is difficult because hyperbaric oxygen therapy cannot be patented, like a new drug.

Goldstein of the cerebral palsy foundation said that what's known about brain injury doesn't support the notion that hyperbaric oxygen therapy could be helpful, and that has made it difficult to find respected scientists willing to do the research. Still, the foundation is committed to trying to get more answers.

At the same time, the federal Agency for Healthcare Research and Quality has commissioned a report surveying the state of the evidence about hyperbaric oxygen therapy and brain injury, which is expected to be released this year.

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