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 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.