HBOT autism and the NHS

The National Health Service [NHS] in the UK prides itself on delivering healthcare that is free at the point of delivery but paid for out of general taxation. Despite occasional lapses into the land of woo, as with  homeopathy on the NHS , it generally fulfils its duty to provide value for money for the taxpayer and cost-effective treatment for the patient. 

Judith Duffy writing in today’s Sunday Herald, reports that the NHS is to investigate the effectiveness of Hyperbaric Oxygen Therapy.  [HBOT] According to the Herald:

Hyperbaric oxygen treatment involves administering pure oxygen under increased atmospheric pressure while the patient is enclosed in an airtight chamber. This results in higher levels of oxygen getting into the blood stream, which can assist the healing process of damaged tissues.

The Herald again:

Hyperbaric oxygen therapy was initially developed to treat cases of divers suffering from decompression sickness, but has since been used for other conditions such as multiple sclerosis and cerebral palsy. However medical opinion is divided over its effectiveness.

Now a new study by NHS Quality Improvement Scotland (QIS) will assess how successful and cost-efficient the therapy is for a range of illnesses and publish a set of guidelines to be used by doctors in the UK and internationally.

The full protocol for the study is available on line as a PDF file. Interestingly, it limits itself to the use of HBOT in adult subjects [16+] as did this review by the US Dept. of Human Health and Services. [HHS] And  a recent report from the 7th EUROPEAN CONSENSUS CONFERENCE ON HYPERBARIC MEDICINE (2004) did not contain any recommendations for use with specifically pediatric complaints. In fact it specifically recommended against the use of HBOT for cerebral palsy.

It also recommended that

The hyperbaric therapeutic facilities enter one of the following categories:

  •  hospital based or hospital connected.
  • stand-alone.

Stand-alone facilities can treat patients not critically ill, but must be capable of providing care in case of clinical complications.

This is important. Many parents of autistic children are buying HBOT chambers. One advocate for the Defeat Autism Now! campaign has even installed one in a school. 

I doubt that any of these installations are “capable of providing care in case of clinical complications.” I also wonder at the health and safety implications. Oxygen is a highly combustible material. My mother has to observe strict guidelines on the use of oxygen cylinders for her chronic pulmonary disorder.

Health and Safety notwithstanding, is HBOT any good for autism? Probably not, if the claims made by its proponents are anything to go by. Autism Street recently blogged on some of the more absurd claims of the autism HBOTters.

Meanwhile, I am looking forward to next February when NHS QIS publishes its recommendations. Unlike many purported interventions for autism HBOT is not quackery. It has a respectable track record in treating specific traumatic injuries. But it is being hyped as a miracle cure for conditions as diverse as multiple sclerosis and retinitis pigmentosa.

I wonder how the “autism is treatable” crowd will react to its findings. Their most common complaint is that the medical establishment does not take them seriously and will not investigate the efficacy of the treatments they espouse. Well on this occasion it does and it has. How seriously will they take its judgement?

I suggest that their response will provide an indication of how seriously we should take them. And I will add a prediction. Anything less than a glowing endorsement will be taken as proof positive of a government/big pharma conspiracy to hide the truth and sacrifice a generation of children on the altar of corporate greed.

The socialist in me would love the chance to beat the evil capitalist drug companies with any stick that came to hand. I just need to know that it’s a proper stick and not one that will break in my hands.

According to the Herald most people are holding a watching brief.

Dr John Ross, honorary consultant at NHS Grampian, said:

“There are a number of conditions that hyperbaric oxygen is thrown at, which are commonly incurable, but with really very little indication currently that hyperbaric oxygen does anything,” he added.

That view was backed by Capability Scotland, which said that it would not recommend the treatment for cerebral palsy, as there was only “poor quality” or anecdotal evidence for its effectiveness.

Mark Hazelwood, director of MS Society Scotland, said that some people who used hyperbaric oxygen therapy for treatment of multiple sclerosis reported an improvement in their condition.

But he added: “The clinical evidence supporting the efficacy of treatment for people with MS is certainly limited, so we welcome this review and hope that it will help to clarify its effectiveness.”

As is their wont, newspapers always try to find or manufacture an opposing point of view. They claim to do this in the interests of balance but often seem  to relish the controversy that results.

So I have no idea whether  Philip James, professor of hyperbaric medicine at Ninewells Hospital, Dundee is presenting a balancing viewpoint or being used to stir up an argument when he is quoted thus.

“We are dealing with a primary failure of medical education – I call it a black-hole’ in medicine.”

I will wait and see what he has to say in February.

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5 thoughts on “HBOT autism and the NHS

  1. It is quackery as it relates to autism. Chelation is also an effective treatment of heavy metal poisoning. The context makes the quackery.

    If it’s proven effective and safe, then it ceases to be quackery and “alternative medicine”. The promotion of it as a treatment based solely on testimonials at best, before it has been tested and proven, is what makes it quackery.

    I understand there was a trial of HBOT for autism presented at a recent conference. What I’d like to know about that one is whether there was randomization and blinding. Anyone know? These are essential requirements of any treatment test for autism in my view.

  2. Interesting.

    HBOT as practiced in “alternative” autism medicine is likely to be pretty safe. The “hyperbaric chambers” they are using can only hold 1.3 atmospheres (total), or a little over 30 kPa (about 4 psi) above ambient atmospheric pressure. Even breathing pure oxygen at that pressure should be safe for several hours.

    These “soft chambers” were developed to treat “altitude sickness” high in the mountains, where the slight increase in pressure leads to a significant elevation in oxygen delivery.

    I’ve read what Rossignol (the leading “scientist” in HBOT fro autism) has said about the matter, but it’s all just smoke and mirrors – lots of handwaving but no substance.

    [1] Oxygen delivery – even breathing 100% oxygen in these “soft chambers” will increase oxygen delivery only about 12% over breathing room air at sea level. And it is only 3% more than breathing 100% oxygen at sea level.

    If the inhaled oxygen concentration during HBOT is less than 100% (and it will be), the increase in oxygen delivery will be even more trivial.

    These small increases in oxygen delivery – especially for only a few hours a week – will have no significant effect on any organ system.

    [2] Pressure effects – Rossignol, recognizing that the oxygen delivery increase is negligible, has speculated that it might be the pressure that causes the “improvements” he has noted.

    While there are air-filled cavities in the human body (lungs, intestines, middle ear), most of the body is water. Water is not absolutely incompressible, but 30 kPa of pressure (the amount of overpressure the “soft chambers” can generate) will cause only a 0.001% change in the volume of the body water.

    Neurological effects have been seen at higher pressures, but only above about 15 atmospheres (1520 kPa or 220 psi). Few hard chambers can reach this pressure – the “soft chambers” would explode long before this pressure was reached.

    Using “soft chamber” HBOT at or near sea level is about the closest thing to a placebo treatment I can imagine.

    Prometheus

  3. Joseph,

    My son does not have time for double-blind longitudinal studies. His best shot at improvement is now, when he is young. It will be far too late by the time the studies you want could be completed. As a purely scientific proposition, you are not wrong; in the real world, you are.

    In the meantime, it is helpful to get whatever information we can — and anecdotal evidence can be pretty darn convincing once it amasses. Look at the gluten free/casein free diet. As far as I know, there are no long term double blind studies proving its effectiveness. But many kids have seen substantial improvement — even some that I know.

    Don’t begrudge me the opportunity to help my son.

    Robert

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