HBOT: Under Pressure
November 16th, 2007
If you’re just now tuning in, we were discussing the newest fad treatment for autism: hyperbaric oxygen therapy (HBOT). In the last post, I showed how the increase in blood oxygen content was minimal and could easily (and cheaply) be reproduced by simply giving a bit of oxygen by mask.
So, if there is something to this “therapy” (and that’s a question not yet answered by its proponents), then it has to be the pressure, right? After all, what other difference is there between the mild (some might say homeopathic) HBOT used for autism and simply giving the children a little extra oxygen by mask (apart from the thousands of dollars difference in cost)?
Before we go any further, I think that a little review is in order:
What is HBOT?
Real HBOT (where the H stands for “hyperbaric”) involves placing the patient in a hard chamber (usually made of steel) and raising the pressure to 2 atmospheres (atm) or more. An atmosphere is - as the name might suggest - a pressure equivalent to the atmospheric pressure at sea level (on Earth). It is equivalent to 14.7 psi or about 101.3 KPa.
HBOT is a recognized treatment for conditions where the hemoglobin in the blood is unable to carry enough oxygen to meet the needs of the body. Carbon monoxide poisoning - where the hemoglobin is bound by carbon monoxide - severe anemia and a few other conditions respond nicely to HBOT.
Other conditions that have been treated - with limited success - by HBOT (real HBOT) are those where a part of the body (near the surface) is not receiving adequate blood flow due to an infection (e.g. diabetic ulcers, gas gangrene). In those cases, pure oxygen under extra pressure can sometimes get enough oxygen to the blood-starved tissues to allow healing and - it is hoped - a restoration of normal blood flow.
For all of these conditions, the pressure is brought up to the point where, with supplemental oxygen, enough oxygen is dissolved in the blood plasma to support life (see figure 1).
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As figure 1 shows, the pressures needed to accomplish real HBOT are usually well above 4 atm and may be as high as 6 atm (the limit for most “hard chambers”). This sort of pressure is dangerous, as is administering oxygen at those pressures. It is not for the average physician and certainly not appropriate for home use.
HBOT, as promoted for autism, involves placing the child in an inflatable “soft chamber” and raising the internal pressure 0.3 atmospheres (4 psi) above the ambient (room) pressure. In some “protocols”, the child is also given additional oxygen; Dr. Rossignol’s published works suggest that he administers 24% oxygen during his HBOT “treatments”.
So, what does this additional oxygen (24% vs 21% in room air) at slightly elevated pressure work out to? It’s the equivalent - in terms of oxygen delivery - of administering 31% oxygen at room pressure.
You can buy a medical oxygen cylinder and face mask to deliver that amount of oxygen for the price of a single week of HBOT treatment, so why bother….unless there is something special about the pressure.
Why did the FDA approve the “soft chambers” if they aren’t any better than supplemental oxygen?:
This a question that comes up a lot: If HBOT for autism is unproven, then why are there so many companies making the “soft chambers”? And why can they claim that they are FDA-approved?
Well, it turns out that the FDA has approved these “soft chambers”… for treating altitude sickness. The FDA has also cautioned that “soft chambers” are not to be used with supplemental oxygen - most likely because of the fire hazard.
So, why is it that these “soft chambers” work for altitude sickness when they can’t significantly change the blood oxygen content at sea level? Let’s take a look at the charts from last post in a bit more detail.
If you look at the chart below (figure 2), you’ll see that blood oxygen content takes a fairly sharp drop at altitudes above about 3000 meters (10,000 feet). This happens because the atmospheric pressure drops to 0.67 atmospheres (9.7 psi or 695 millibars).
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Figure 2.
At altitudes above 3000 meters (10,000 feet), an additional 0.3 atmospheres (atm) pressure can make a big difference in the amount of oxygen in the blood. People who have been to these altitudes know how important that little difference can be.
An additional 0.3 atm can make the difference between being breathless in Leadville, Colorado (3094 meters, 10,152 feet) and breathing easily at the beach (sea level). An additional 0.3 atm can make the difference between being in the “dead zone” at the top of Mt. Everest (8848 meters, 29,029 feet) and being merely winded on the slopes of Pike’s Peak.
Of course, you could get the same amount of oxygen by breathing concentrated oxygen (which is what pilots in unpressurized aircraft do), but it is easier to carry an inflatable “soft chamber” to the basecamp and take turns working the foot pump than it is to lug enough oxygen cylinders.
This is what these “soft chambers” are approved for - not treating autism, cerebral palsy or strokes.
But, back to the issue of pressure.
Pressure effects on the brain:
What do we know about the effects of pressure on the human nervous system? As is turns out, we know quite a bit. People have been subjecting themselves to elevated pressures almost since we were able to produce compressed air. In caissons, diving bells, hard-helmet dive suits and - more recently - SCUBA diving. There are over one hundred years of data on the subject.
We know that, at elevated pressures, the nitrogen in air becomes a mild general anesthetic, causing nitrogen narcosis (”rapture of the deep”). This happens at pressures above about 4 atm (3 atm above sea level pressure), and so isn’t likely to affect people in the “soft chambers”.
As pressures go up, the partial pressure of oxygen also goes up. Oxygen is essential to human life, but it also has its Dark Side. In fact, many of the “alternative” practitioners have made quite a big deal about how autism is either caused by or causes oxidative stress. The amount of “oxidative stress” increases as the partial pressure of oxygen increases, so HBOT can (and does) increase oxidative stress and , potentially, oxidative damage.
On an organismal level, the toxicity of oxygen manifests itself as lung damage - which can occur in a matter of days and at lower oxygen concentrations than is usually thought - as low as 50% - and as acute central nervous system (CNS) toxicity.
The general “rule of thumb” is that acute CNS oxygen toxicity doesn’t occur at less than 1.6 atm partial pressure of oxygen, so the “soft chambers” cannot reach this level, even breathing 100% oxygen. However, it has been reported at lower pressures with longer exposures and these have mostly been in healthy adults without pre-existing seizure disorders.
[Note: Just "published" today (16 Nov 2007) is a study by DA Rossignol et al in which they "treated" six (6) autistic children with 100% oxygen at 1.5 atm. This was done for 45 minutes and repeated forty (40) times. This comes perilously close to the maximum recommended exposure for healthy adults. I will leave it to my readers to decide if this is a wise course of action.]
Finally, at even higher pressures - which can only be attained using special breathing gas mixtures, people experience high pressure nervous syndrome. This has only been seen at pressures approaching 20 atm, which is far higher than even “hard” hyperbaric chambers can reach.
Fortunately, all of the bad effects of high pressure are seen only at pressure far above those that a “soft chamber” can reach. Even breathing 24% oxygen in these chambers is unlikely to cause anything more than a transient increase in superoxide dismutase and other enzymes in response to the increase in reactive oxygen species.
[Note: Adminstering any additional oxygen in a "soft chamber" goes against the FDA certification of these devices. A very recent study which used 100% oxygen in a "soft chamber" is alarming and raises the possibility of catastrophic outcomes.]
Unfortunately, there is no data to suggest that any of the good effects of hyperbaric treatment are likely to occur at the low pressures seen in “soft chambers”. In fact, it seems decidedly unlikely that any of the effects seen at real HBOT pressures are going to be clinically significant at “mild” (homeopathic?) HBOT pressures.
A question of compressibility:
The pressure issue really boils down to compressibility: what effect does pressure have on the cells, the tissue and the organism? The only effect pressure can have - apart from its effect on the partial pressures of gases - is to squeeze the cells.
Fluids, especially water, is often thought to be incompressible; this is not precisely true. Water is much less compressible than gases, but it does change volume under pressure (just not as much as gas). There are a few gas-filled cavities in the human body, but they are all (usually) connected to the outside, so that they can equilibrate with the external pressure. We are generally only aware of these cavities when they fail to equilibrate, such as when we’re flying in an airliner with a cold.
The bulk of our body is fluid (or solid - such as bone) and is much less compressible than gas. But not incompressible. So, there is some change in volume with changes in pressure.
Fortunately, the compressibility of cellular components has been studied, so we can get a “ballpark” estimate of at least the magnitude of the effects at different pressures, if not the specific effects themselves. However, given what is known about the effects of high pressure on the human nervous system (see above), the effects of pressure are not likely to be positive.
To determine compression, we first need to know the bulk modulus of the material. Water, which makes up the majority of our bodies, has a bulk modulus of 2.2 Gigapascals (GPa). This means that going from sea level pressure (1 atm) to 20 atm (~0.002 GPa) would cause a 0.09% change (decrease) in the volume of water.
Now, the place where the real action takes place in nerve cells (and many other cell types) is the cell membrane. The bulk modulus of the lipid bilayer membrane has been determined to be about 0.165 Gpa, so a change from sea level pressure to 20 atm would cause about a 1.2% change in membrane volume.
What about the “soft chambers”?
A 0.3 atm (~0.00003 GPa) change in pressure (typical for “soft chambers”) would cause a 0.02% change in the membrane volume. This is almost certainly below the threshold of perception, even in sensitive nerve cells. Any changes detected would more likely be due to the increase in oxygen partial pressure (which increases about 30%).
So, is there a chance that hyperbaric therapy might help autism? Perhaps, but not at the pressures attainable in the “soft chambers” used by most “alternative” autism practitioners.
If they really wanted to see the effects of pressure alone, the HBOT “researchers” could dilute the air in the “soft chamber” with an inert gas such as helium so that the partial pressures of nitrogen and oxygen remain the same as they are at sea level (or whatever the ambient pressure is). This would require (at sea level) a mix of 23% helium and 77% air. It would be a simple test (and safe - even breathing the mix at sea level pressure would not be dangerous, as it still contains 16% oxygen) and would finally put to rest any question about the need for (mildly) elevated pressure.
Unfortunately, the risks of using real hyperbaric therapy (not to mention the costs) outweigh the potential benefits (which are largely hypothetical and unproven), so a trial of real HBOT for autism is probably not in our future.
Conclusion:
Lacking a plausible mechanism by which “mild” HBOT (sometimes called mHBOT by its proponents) can help autism and lacking any controlled data, this therapy has little to recommend it apart from offering some vague hope of “treatment” or “cure”. It is important to also note that HBOT has failed to deliver in other disorders, from stroke to cerebral palsy, and there is little reason to think that autism will be any different.
Prometheus
Filed under: Autism Science, Autism Treatments, Critical Thinking
November 16th, 2007 at 1:22 pm
Soft HBOT isn’t homeopathic. If it were, we would have underpressure. (Or normal pressure.)
November 16th, 2007 at 2:02 pm
Very timely post, in that I just for the first time saw this from Rossignol, James, et al :
http://www.biomedcentral.com/content/pdf/1471-2431-7-36.pdf
Is anyone surprised that they used “parental feedback” as a measurement for changes in behavior pre- and post-HBOT?
November 16th, 2007 at 2:24 pm
Vjatcheslav,
Good point. I assumed that the “H” in HBOT is for “hyper”, meaning “greater than normal”, so that an infinitesimally small increase in pressure over the ambient would qualify as “homeopathic”.
It’s not 40C or anything like it, but it could be at least 1X.
What do you think?
Prometheus
November 16th, 2007 at 2:51 pm
I’ve been reading the HBOT posts with great interest. This was one of the IT treatments floating around cyberspace nearly 8 years ago when my son was born with agenesis of the corpus callosum. We felt then much as we do now, and never really grasped for straws or this treatment. I always assumed the treatment had something to do with pressure (since the lateral ventricles are ‘bigger’ in the ACC brain and the fluid fills up where the corpus callosum should be), but I never looked any further into it. Interesting post.
November 16th, 2007 at 3:01 pm
Steve D,
I was actually disappointed that they didn’t use more objective measures of autism severity, since they are readily available and not that hard to use.
Figure 3 combines the subscales from the ABC-C, ATEC and SRS. I haven’t “run the numbers” yet, but only 10 out of 28 subscales (they’re listed twice - for 1.3 and 1.5 atm) showed significant difference. In addition, it’s not always the same scales that show a significant difference between the two “treatment arms”.
It would have been easy to have put some “control” kids in the mix (simply inflate the chamber enough to fill it), but it would have been fraudulent to charge for the “sham” treatment, which is, I suspect, why there were no controls.
I also wonder about the ethics of charging people to participate in an experimental treatment, but that’s not my call.
All that they have shown, as a result, is that the “treatment” didn’t inflict any harm on the 18 subjects. Of course, their measures for “harm” were also rather limited (oxidized glutathione and C-reactive protein. How about superoxide-dismutase? That would have been a more sensitive measure of oxidative stress.
Prometheus
November 16th, 2007 at 3:51 pm
I would question the value of any autism treatment study that doesn’t have any controls. Even if you are not going to randomize or have blinded assessments, having a control group should be a requirement. In autism, if we were to test water or prayer as a treatment, of course improvement will be observed. This is expected. Improvements as part of the natural course of autism are well documented. This without even considering evaluator bias.
Such autism studies without control groups, just like anecdotes, are worse than worthless, because they mislead about causation and treatment, plus they are a source of false hope.
November 17th, 2007 at 4:28 pm
[...] “soft chamber” hyperbaric oxygen therapy (HBOT) units—which are not, as Photon in the Darkness points out, are not “real” HBOT—-which involves placing a patient in a hard, [...]
November 20th, 2007 at 10:53 am
Hi Promotheus -
As I understand it, the double blind, placebo study is already underway and improvements have been noted by observers that aren’t the parents (i.e., improvements in cars/abills/whatever). I’m told the placebo was by going to either 1.3 pressure, or 1.03. Dunno about measuring more sensitive markers for oxidative stress. Also, are you sure the participants were charged for the study?
I’ve also seen some rather spectactular pre and post SPECT scans of children that show a significant increase in brain activity. Not sure if this will also be included in the DBPC study or not. (?)
Anyways, take care!
- pD
November 20th, 2007 at 3:11 pm
pD,
I’m curious - how do you know if “improvements have been noted” in the middle of a double-blind, placebo-controlled study?
If you mean that some of the kids have gotten better, but they don’t know yet if they’re in the treatment or placebo group, that’s a whole lotta nothin’. The reason people do double-blind, placebo-controlled studies is because some of the subjects in the placebo arm (of every study) show improvement.
As far as charging, that I’m not sure if the Rossignol et al study charged the patients in their study. The “non-random” assignment and lack of control group suggest that they were “regular” patients rather than “study” patients, but I have no way of knowing for certain whether or not they were charged for the treatments.
It is a common practice in “alternative autism research” to do “open label” studies (such as this one) on “paying customers”. As I commented above, I have serious ethical reservations about this practice, whether done in “alternative” or “mainstream” medicine.
Finally, the reported SPECT scans. I’ll just say this, one person’s “correction of hypoperfusion” is another person’s “reactive hyperemia”. ‘Nuff said?
Prometheus
November 21st, 2007 at 7:14 pm
“As I understand it, the double blind, placebo study is already underway and improvements have been noted by observers that aren’t the parents”
Dear Prometheus:
Since ASD is developmental “delay” and not developmental stoppage, wouldn’t also some control group of ASD children who are neither receiving “treatment” nor a placebo also be needed? You expect progress, albeit delayed, in all events. So, the outside control would be needed to account for progress attributable to things like self-fulfilling prophesy, additional involvement with the children by their parents, etc., even among the placebo group.
All I’m seeing is a “study” with such obvious design problems so that any conclusions drawn from it are far too questionable for it to be of any value.
November 21st, 2007 at 7:51 pm
WFJAG,
Actually, the placebo group is needed to control for the factors of expectation of improvement, self-fulfilling prophesy and increased parental involvement, not to mention sensory stimulation and a host of other factors.
The idea of using a placebo group that gets minimal pressure and no increased oxygen (i.e. just enough air pressure to inflate the “soft chamber”) is good. It puts the children in essentially the same environment, receiving the same exposures except for increased pressure and oxygen, the two things under study.
My only concern is that the parents and observers will be able to tell which kids are getting the “real” (homeopathic) HBOT by the way the “soft chamber” looks (e.g. wrinkles, resilience, etc.).
It would be important for them to do a survey before they “broke the code” to see if the parents and the observers can “guess” which children are in the placebo group. I’ve seen this done in a lot of studies as a way to validate or confirm the blinding.
If the study is done well (a big if, in my book), it could be very valuable. Of course, if it’s done well, it will probably not show any effect, for the reasons I’ve otlined above and in my previous posting.
Of course, I’m always open to new data.
Prometheus
November 23rd, 2007 at 2:08 pm
Dear Prometheus:
I may not have been as clear as I should have been. I recognize that a placebo group is supposed to serve as a control to see if the “treatment” has statistically measurable benefits. I was suggesting that, in light of what the study’s authors assert, an additional control is needed — children who received neither the “treatment” nor the placebo.
I noted that since ASD is a clinical diagnosis of “delay”, some progress is expected in all events. Another reason for a control of the control (placebo group) is the study doesn’t provide much info on how or by whom the ASD diagnoses were provided in the first place. Dr. Thomas Sowell, Ph.D., Econ., recently did a couple of articles on the problems of false positive ASD diagnoses. See Crusades Versus Caution, Nov. 13, 2007, http://www.townhall.com/columnists/ThomasSowell/2007/11/13/crusades_versus_caution, and Crusades Versus Caution: Part II, Nov. 14, 2007, http://www.townhall.com/columnists/ThomasSowell/2007/11/14/crusades_versus_caution_part_ii
I’m not holding him up as an expert in ASD or its diagnosis. But, as an economist, he does understand the use and mis-use of statistics, and design bias. As you and others commenting in this blog have noted, there are significant problems in determining whether the numbers underlying the alleged ASD “epidemic” are real. Dr. Sowell is asserting that the methodology used for pre-school aged children is fundamentally flawed, which problem is made worse by “diagnoses” made by people, many of whom are unqualified to do the screenings beyond recording answers to a checklist, who make the diagnoses based on checklists. Dr. Sowell argues that the checklists used in such screenings are deeply flawed, to include as factors supporting an ASD diagnosis, factors that are also consistent with concluding that the pre-school age child has a very high intelligence, or is speech delayed (which can be associated with a lot of other diagnoses, or, not infrequently is simply something that the child out grows - a different type of developmental delay, but not one that should be of major concern if correctly diagnosed). However, once the ASD diagnosis is given, it sticks and is seldom challenged or changed.
For reasons such as these, it appears that any study on the effectiveness of a treatment for ASD, not only is a placebo control group needed, but also an outside control group that receives neither the “treatment” nor the placebo, and probably, there should also be a verification of the ASD diagnosis by well educated/trained professional with solid clinical experience, to ensure that the subjects of the study should have an ASD diagnosis (since including in the “treatment” or placebo groups even a few subjects who were misdiagnosed as ASD could really skew the results).
You say “If the study is done well”. I don’t think it was — for quite a few reasons. Rather, the HBOT study appears to have been done by persons who believed in HBOT’s effectiveness, and then failed to establish rigorous criteria and controls to test that hypothesis. That the “treatment” may have been charged for (at least, the study doesn’t clearly say that there wasn’t a charge for the “treatment”) just adds to concerns. It is awkward, to say the least, to charge parents for a “treatment” of their children, and then say “Oops. Never mind!”
November 24th, 2007 at 2:40 pm
WFJAG,
I’m sorry that I missed the intent of your proposal; I was caught up on my own rather narrow research mind-set.
If I understand your point, it would be a useful validation of the study to compare their placebo group to a group of autistic children who had received <em>no</em> intervention at all.
While this “no treatment” group couldn’t be used to evaluate the efficacy of the treatment, it <em>could</em> be used to determine if there was something about the parents who elected to enroll in the study that affected the eventual outcome of the participants.
I have often wondered that very thing: is there something about the parents (and possibly their children) that makes the children’s outcomes different from the “general” autism population?
I also agree that not enough attention has been paid to the validity of the autism diagnoses of children in this (and other) treatment studies. Even saying that the diagnosis was made according to DSM IV(TR) criteria is no good, as the criteria are largely subjective.
Although there are many people who disagree with me on this point, I also argue that “validated” tests of autism (<em>e.g.</em> the ADOS and others) are both subjective <em>and</em> circular (<em>i.e.</em> their validity is tested by comparing their results to the diagnosis of autism by “experts”, who must use subjective findings to make the diagnosis).
As I have said before, the emphasis on treatment studies before the diagnosis of autism is placed on firmer ground is a mistake. At best, potentially useful treatments will be obscured by the number of non-responders who have been diagnosed incorrectly.
At worst, we have the situation that confronts us today, where any and all “treatments” - real, experimental and fanciful - are accorded equal validity (at least by the general population) because <em>nothing</em> seems to work well for all people who carry the “diagnosis” of autism.
Again, thank you for bringing up a thought-provoking issue.
Prometheus
July 3rd, 2008 at 1:22 pm
Please understand what is really happening in this field. Insurance groups around the world have and/or approved HBOt treatment for 13 approved indications. They are paying 100% reimbursement on this treatment because it works in these wound care environments. People are preventing limbs from being amputated, wounds are being healed in half the time it was normally taking and Radiation patients suffering from the treatment are being treated in HBO chambers and getting back to a normal quality of life. This is real, it is not something drumed up to sell equipment. For more information on the subject matter go to the Undersea Hyperbaric Medical Society and closely review their findings. I agree with some fo the material called out in this blog regarding the zip up chambers, unless your climbing mountains at high altitudes you should not have one. IN HBO Pressure is the key, period and the Acrylic Tube chambers and MP chambers out there are doing incredible work. Read the UHMS site and learn what approved indications are versus research indications are then form your opinion.
July 3rd, 2008 at 4:12 pm
DDV,
I always suggest that people read the post before trying to comment. If you had read what I wrote, you would have seen the following:
and
and
I don’t claim to have given an exhaustive list of the conditions that are legitimately treated by HBOT, but they all fall into the two categories I listed: impaired hemoglobin function and/or poor perfusion.
I note that the UHMS does not list “autism” (or “cerebral palsy” or stroke or…) as an indication, so it would seem that I am in agreement with that organization.
Again, if you read the post, you can avoid embarrassment in the future.
Prometheus
September 10th, 2008 at 12:04 am
do you have an autistic child? The medical community doesn’t recognize that they are sick with infections and a host of other afflictions. I’ve seen improvement from unapproved methods and if you wait 50 years for controlled studies where are you at? where did you gat the info. that 40 treatments is near toxic for adults? I want to look it up. thanks
September 10th, 2008 at 12:20 pm
RM asks:
That’s not really relevant to the discussion. The questions being addressed are: does HBOT “work” for autism and is it safe?
If you mean that the “medical community” as a whole often misses the fact that autistic people can have other illnesses and medical conditions in addition to autism, I agree. I suspect that much of this is due to the difficulty communicating with some autistic people, but there is also a tendency to attribute any unusual behavior or activity to “the autism”.
If, on the other hand, you mean that all autistic people have “infections and a host of other afflictions”, I’d like to see your data. There is some data supporting the claim that bowel problems are more common in autism, but it is not clear if this is greater than the increased incidence seen in other developmental disorders.
I’ve seen improvement from placebo and also “tincture of time”. In general, autistic children - and even young adults - continue to make developmental gains. If they don’t, then they probably don’t have autism.
The controlled studies keep us from wasting our time, effort and money on treatments that don’t work. They also might keep us from needlessly exposing our children to risk.
My sentence was a bit unclear - what I meant was that a single treatment using 100% oxygen at 1.5 atmospheres pressure (1.5 atm partial pressure of oxygen) is “perilously close” to the 1.6 atm partial pressure where healthy adults are at risk of developing acute oxygen toxicity.
Since healthy adults have had seizures (an early sign of acute oxygen toxicity) at partial pressures of 1.4 atm, and autistic people are known to have a higher than normal incidence of seizure disorders, I think that this is an unwarranted risk.
If you want to look it up - just to make sure that I’m not feeding you a bunch of baloney - look for references on “acute oxygen toxicity”.
Prometheus
September 10th, 2008 at 7:59 pm
no need to get defensive… I’m just looking for information and my initial question “do you have an autistic child?” totally relevant to the discussion because there’s a difference between talkin the talk and walkin the walk. I’ll presume you do not by your indirect answer, at least not a sick one. controlled studies are very important but time is of the essence re: early treatment. Ever give your child one of those fda approved psychotropic drugs? many children, families, and communities need the help now. It affects us all or you wouldn’t be here and what about all the gains reported for cerebral paulsy-are they all false? it is feasible to consider hbot may help the “sick” children with autism, also. I’m not about proving things with data. I’m a careful mother trying to collect it, consider the resuorce and make the best possible choice for my sick baby. Parents “in the same boat” are some of the best resources.what’s the dangerous atm 1.4 or 1.6 or both? not sure from your response.
September 11th, 2008 at 12:31 pm
RM,
I’m not defensive - I just don’t see that whether or not I have an autistic child changes whether HBOT is either safe or effective.
I’ve noticed that a lot of parents try to play the “You don’t know what I’m going through, so shut up!” card as a way to push back any doubt or skepticism. Let’s assume for a moment that I didn’t have a disabled child - wouldn’t being a disinterested third party with no “dog in the fight” actually make me more able to give an objective view of the situation?
Parents are - sad to say - the least able to give an objective appraisal of their children. Think of all the times friends have had to sit through the torment of the damned as a “child prodigy” (in the parents’ assessment) gives a violin recital. This is no less true for parents of disabled children.
As for the “gains” reported in cerebral palsy patients using HBOT, I refer you to an multi-centre study done in 2001:
Collet et al. Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. Lancet 2001 Feb 24. 357(9256):582-6
http://www.thelancet.com/journals/lancet/article/PIIS014067360004054X/abstract
They studied 111 children with CP, ages 3 - 12 years old. 57 got HBOT and 54 got placed in the chamber at only slight pressure. The HBOT group showed 2.9% improvement, the placebo group showed 3.0% improvement.
You are absolutely correct that autistic children and their families need help right now. That’s why it is important to know when useless and potentially dangerous treatments are being promoted - the families don’t have the time, energy or resources to waste on nonsense therapies.
You say, “I’m not about proving things with data.” That’s perfectly fine - there are lots of other people (like myself) who are willing to do it for you. We will be happy to collect real data - not just stories told in the Internet - and give you and the other parents the information you need to make the best choices for your child.
As for the “dangerous” pressure - it’s not a sharp line. Decades of information about normal, healthy adults exposed to elevated pressure show that the staying below 1.6 atm partial pressure is “safe”…for normal, healthy adults.
However, safe is as safe does. There are reports of normal, healthy adults having acute oxygen toxicity at partial pressures as low as 1.4 atm. In addition, people with a tendency to have seizures may be at risk at lower partial pressures. On the other hand, the study I referenced above used 1.75 atm partial pressure on children with CP and the only complications reported were ear blockages from the pressure.
There are several safety issues with the use of HBOT in autism in addition to the issue of oxygen toxicity. One of the biggest is the risk of fire. The low-pressure “soft chambers” (and some of the “hard chambers” used) are not approved for use with suuplemental oxygen. This is not just the FDA flexing its muscles to suppress “alternative” medicine - it is a very real concern about fire danger. Think Apollo 1.
Prometheus
September 11th, 2008 at 4:32 pm
Please don’t put me in the “you don’t know what I’m going through” category. Parents can be objective of thier children, maybe you cannot. You make blanket statements and are presumptuous. This will make people doubt you. I am collecting my own data, not you for me AND I’m having a hard time finding information that this therapy has harmed or injured a child. I do, however, appreciate your references and am reading them. It seems as though negative side effects are at much higher ata than 1.5 and for and timeframes over 60 minutes. They also don’t seem permenant but that doesn’t mean they aren’t.Also, it seems from the “research” aspect that many have made tremendous gains. I also wonder why a healthy adult would benefit from the extra oxygen being healthy and not having indications of oxygen deprivation or any other condition that may potentially benefit from pressurized oxygen. I can’t believe these researchers are allowed all these years to continue these treatments if there haven’t been any real outcomes of positve gains in patients. I do think people must proceed cautiously and really know from conventional medical testing and lab study, if their child may benefit. I don’t ever like to undermind parents and I do believe, in the case of “sick” autistic children, if it can’t hurt them then it’s worth trying.Regards
September 11th, 2008 at 5:27 pm
RM,
Let’s just say that your statements are a bit ambiguous - you tell me that I shouldn’t “talk the talk” if I don’t “walk the walk” (even though you apparently know nothing about my situation). If that wasn’t an attempt to claim that I can’t comment on autism therapies if I don’t have an autistic child, perhaps you could be more clear.
You then say that you’re “not about proving things with data”, which seems to contradict your claim to be collecting your own data. If it’s not to “prove” something - if only to yourself - why collect the data?
As far as HBOT harming a child, I doubt that it has done any obvious harm to an autistic child…yet. My concerns are about the effectiveness of HBOT - which appears to be nil - as well as its safety. I suspect that the first time HBOT harms a child, it will be from a fire in a “soft-shell” chamber.
You state that “..many have made tremendous gains.” Do you have a reference for that? The only published study on HBOT for autism (Rossignol et al 2007 http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18005455) was a pilot study of 18 children, had no control group and the only assessment of “gains” was based on pre- and post-treatment assessments by the parents. While you seem to think that parents can be objective about their children, I can point you to several studies showing that they (we) are not.
Finally, your assertion that “if it can’t hurt them then it’s worth trying” is not entirely true. None of these treatments is without a cost - costs of time, effort and energy, as well as money - and nothing is without risk. Since you can never say that a treatment is without risk, the question comes down to risk vs benefit.
If the risk is real - as it is with HBOT, which has killed people in the past - and the benefit is unknown (but likely to be either very small or non-existent), then it’s not worth trying.
Oh, to answer your question - “I also wonder why a healthy adult would benefit from the extra oxygen being healthy and not having indications of oxygen deprivation or any other condition that may potentially benefit from pressurized oxygen.”
The data we have on acute oxygen toxicity comes largely from deep diving - Navy divers, research divers and commercial divers have had episodes of acute oxygen toxicity and the information gathered has given us a good idea of what the safe limits of oxygen exposure are. This data has been collected for nearly 100 years. The research on human oxygen toxicity dates as far back as 1912.
There is no benefit for healthy adults (or children) to breathe oxygen at elevated partial pressure. In fact, there is a vast amount of data showing that breathing partial pressures over 0.5 atm for as little as 16 hours can cause pulmonary inflammation.
Prometheus
September 11th, 2008 at 10:46 pm
you can comment on whatever you want, I’m not sure you fully understand the rational of a parent with a very unhealthy child exhibiting autistic characteristics- I simply said there is a difference of being in the circumstance. Data- I’m not trying to prove anything to you with data(you asked me for mine) and I’m not here to present an argument. People being killed is the kind of information I’m looking for but haven’t found. One of our doctors cautions about toxicity as it has caused infants to go blind in the hospital from too much. reference from gains comes from parent account of two autistic children and parent of a child with cerebral palsy. also a study in hawaii , no control group but documented pre and post testing protocol from psychologist/neuropsychologist. It was no to you question re: healthy adult/child to do hbot - that’s the point I was making! but what about a sick one? All your data seems to be the damage it can do to a healthy person- that data exists. The potential good it can do for brain injured, co2 poisoning, stroke, coma, wound healing, cerebral palsy, autism… you see where I’m going? this is the grey area but, this therapy does heal some things and is approved by insurance for some things- it is a valid treatment for some things. I find the info. 0.5 & 16 hours causing pulmonary inflamation useful- is that a permanent side effect? I’ll be looking into it! remember “hope”!
September 27th, 2008 at 9:11 pm
m: in your “boat” … would try about anything. I’ve heard good things about low-pressure therapy.
Prometheus: I’m glad to read your analysis - puts me ‘on notice’ that I meed to be skeptical and weigh the risks. how would/could a fire start in a low-pressure chamber if a ‘concentrator’ is being used … is this inherently dangerous?
SM
September 29th, 2008 at 11:37 am
SM,
The “soft chambers” are made out of a synthetic fabric, which is flammable. At normal (i.e. atmospheric) concentrations of oxygen, this isn’t a problem, even at the (slightly) higher pressures inside.
However, if you use an oxygen concentrator - even if child is wearing a mask (which is also flammable, unless they’re using a special - and much more expensive - type), the elevated oxygen concentration makes the material of the chamber, the child’s clothing, the mask, etc. more prone to combustion.
All that’s missing is an ignition source. A spark of static electricity could be enough. If you need more information, just research medical oxygen fires.
My local fire department has a file of serious injuries and deaths caused by home oxygen that fills several filing cabinets. And these were mostly people using oxygen through a mask or nasal prongs, not inside a flammable fabric “chamber”.
So far, nobody has experienced a fire while treating an autistic child with “hyperbaric” oxygen, but as more people use this treatment, it is inevitable.
You’ll note that the manufacturers of these “soft chambers” (and the FDA) are very clear that they are NOT to be used with supplemental oxygen. This isn’t some ploy by “the government” or “Big Pharma” or “mainstream medicine” to keep parents from getting treatment for their children; these warnings are there because there is a significant danger of fire if supplemental oxygen is used.
Given the biological implausibility of HBOT in the treatment of autism, the risk of injury or death - even if it is very small - appears greater than the potential benefits.
I understand (Oh, boy! Do I understand!) the desperation of parents looking for something to help their child, but never forget that there is ALWAYS the potential to make your child WORSE.
Imagine an autistic child with extensive burns.
Prometheus
October 8th, 2008 at 2:19 pm
My daughter is half way through hbot at a liscensed facility - definitely noticing some positive changes and she seems to be doing well without singular(for chronic non-specific hives). Some reports of signs of improvements from hbot seem to coincide with what I’m currently seeing in my daughter (from a behavioral aspect). I thought it was best to use a facility with doctors on site. Definitely not seeing worse.I will continue to post and be objective- We’ve tried our fair share of things that didn’t work, some because they weren’t right for her and one that I believe was just a bunch of bs. I believe hbot has and can help some children (not discounting any potential risk). I am scared every day throughout this process. Hope you’re a person of faith and you can say a prayer for my girl! Thanks! RM
November 25th, 2008 at 7:00 am
More and more people are seeing the benefits of oxygen therapy and it really seems to be working
November 25th, 2008 at 3:05 pm
Ms. Oxygen,
People “see the benefits” of homeopathy, which is - by definition - a placebo. People claim to have “cured” diabetes through “spinal adjustment”, acupuncture and prayer.
That said, “oxygen therapy” has well-documented efficacy in a number of disorders. HBOT for autism is not one of them.
Thank you for your comment.
Prometheus
May 26th, 2010 at 1:04 pm
Here you can find some articles on HBOT and autism: [advertisement removed] if it helps? you may find opinions that YES and NO… In my opionion: if you believe it will help… it will… if you don’t believe it will help.. it will not.
Editor: the statement, “if you believe it will help, it will; if you don’t believe it will help, it will not” is a good definition of how a placebo “works”. REAL medical therapies, on the other hand, work whether you “believe” in them or not.