Atlanta Hyperbaric & Wound Care Clinic's weblog

I’ve read many research papers that end with the conclusion, “More research is needed to determine X,” X being whatever the researcher was trying to prove in the first place.  In fact, the more-research-is-needed theme has almost become a de rigeur badge of humility that an author must display in order to get his report published.

In my opinion, the question as applied to treatment with hyperbaric oxygen is more complicated than simply saying that more research is needed to establish proof of effectiveness.  Unfortunately, I have seen this approach taken all too often.

A respected neurologist at Mayo Clinic was asked, “Can hyperbaric oxygen therapy improve recovery from a stroke?” He responded that more research was needed to answer the question.  But is the question correctly framed and is his answer misleading?  After all, it is easy for a reader to conclude from this neurologist’s remarks that if hyperbaric oxygen needs more proof, why use it at all?

The most important question to be answered by a doctor before prescribing any treatment should be whether the potential benefits of the treatment outweigh the risks–not whether there is proof beyond a reasonable doubt that the treatment is effective.  Risk-benefit analysis is supposed to underlie all prescriptions, so why is hyperbaric oxygen treated differently?  Hyperbaric oxygen has been in common clinical use for decades so that any serious side effect should be known by now.  How many internists wring their hands in anguish before prescribing a daily aspirin tablet to prevent heart attacks?  Yet, I can without hesitation say that a treatment course of hyperbaric oxygen is safer than taking a daily aspirin tablet for the same length of time.  What side effects we actually ever see with hyperbaric oxygen treatment are both minor and reversible.

On the other hand, what are the potential benefits of hyperbaric oxygen therapy to stroke patients?  There have been few controlled studies and conclusive scientific proof does not exist.  But, ask virtually any patient or his close relatives about whether he benefited from hyperbaric oxygen following a stroke and the answer will almost always be in the affirmative.   Patients and their families will tell you that their gait, their speech and even their thinking ability improved.  So, if the risks are small and the benefits are potentially large, what is the reason for being skeptical?

Complaints abound about the cost of hyperbaric oxygen treatment, and I believe that financial considerations are the real reason for most of the more-research-is-needed mantra.  People also complain about “big pharma,”  after all.   I have always believed, however, that a patient has to make  cost decisions strictly on his own.  Only the patient knows his financial health and whether he can afford treatment.  The patient must decide whether the chance for the  benefits are worth the cost, not someone whose real concern is health care finance but who wants to dress up his issues in scientific garb.

Glenn L. Goodhart, M.D., J.D.

This entry was posted on Wednesday, June 17th, 2009 at 4:01 pm and is filed under Hyperbaric Medicine, stroke. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.