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From: Seán <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, 17 June, 2010 10:54:07
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