Well said Sean and glad to hear you are still following this group. I know Ash was not intending any slur against all HBO practitioners. We run a fine line between the the lunatic fringe of HBO on the one hand and those from 'traditional medicine' who 'know' it is all rubbish on the other.
It appears my original mail in reply to Ash's message did not get transmitted, so here it is again..
Mike Bennett
Thanks Ash! I think you are suggesting my primary area of interest is snake oil?
The thread title certainly fits to the more 'alternative' end of the spectrum of users (think CP, autism, MS) and some of the more experimental uses (ischaemia-reperfusion injury, idiopathic sudden hearing loss) - but my reviews are a modest attempt to bring together and identify some of the more evidence-based indications (any SCUBA-divers on the list?). In general the use of HBOT is pretty well controlled by those who pay the bills in our various countries (with notable exceptions).
Most of my colleagues would not describe those controls in the kind of words one can use in this forum, but my approach is gaining some small traction. I am growing old while waiting for the field to assume a more EB position, but am grateful for small victories ....
Mike B
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Seán
Sent: Thursday, 17 June 2010 19:54
To: [log in to unmask]
Subject: Evidence and HBOT
Subject: Re: Popular but ineffective treatments?
Following on from Ozone, how about including Hyperbaric Oxygen Therapy
(HBOT) Paul?
It's supposed to cure everything from A to Z, including spider bites, and on the basis of what evidence, dare I ask?
Michael Bennett who has done monumental work on systematic reviews for HBOT, and who is a member of this Group will support my statement, I'm sure. I'm copying Mike into this email as well, in case he misses this group posting.
Regards,
Ash
Dr Ash Paul
As an ex/occasional-diving and hyperbaric doc, I'm sure it's possible to work as an HBOT physician and be a practitioner of EBM. I think you'll find that's Mike Bennett's position too - hope he won't mind me saying so. I don't think you'll find any reputable person in the field believing "It's supposed to cure everything from A to Z" - I'm sure you didn't mean to characterise them as such. There are well-publicised lists of approved indications, some with more evidence to support them than others. Like all practitioners of EBM, one works on the understanding that evidence will accrue that may result in continued use of the treatment, or its abandonment. Such is life.
So, for the record, HBOT is the gold-standard treatment of choice for decompression illness, and not referring for treatment would probably be seen as negligent.
As in much of medicine, there is little high quality evidence, and it is difficult to attract funding for the necessary large RCTs. Therein lie the problem: while HBOT remains a specialty practiced on the fringes of the NHS it will continue to struggle to attract such funding, and without better evidence it will find it difficult to position itself in the mainstream.
As you rightly say there are a number of Cochrane reviews of HBOT evidence, and most have Mike Bennett's name on them somewhere. These
demonstrate:
Some evidence of benefit in soft tissue radiation damage, tumour sensitization to radiotherapy, traumatic brain injury, idiopathic sudden onset sensorineural hearing loss and tinnitus, chronic wounds in diabetics or secondary to venous disease, and acute coronary syndrome!
Possible benefit in thermal burns, acute migraine, and stroke.
No benefit in fracture healing, dental implants, carbon monoxide poisoning (although debate continues in the field about this..), malignant otitis externa, delayed onset muscle soreness, and multiple sclerosis.
There are at least a couple more reviews in production AFAIK.
And it's only the Loxosceles reclusa (Brown Recluse) spider!
Seán Hopson
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