If HBOT is so Good, Why Is It Not More Widely Accepted?

Article published by Elmer M. Cranton, M.D.

Doctors are rarely taught about hyperbaric oxygen therapy (HBOT) in medical school and therefore most do not know about it. Only about 20 medical schools, less than 15 percent, have actual hyperbaric oxygen facilities, while perhaps another 20 have access to HBOT facilities. If physicians don’t know about a therapy, they obviously won’t prescribe it. If they don’t prescribe HBOT, there is no incentive for more hyperbaric treatment facilities to be established. Therefore, there exist very few hyperbaric chambers, compared with potential need and benefit that could otherwise be achieved—only about 400 chambers in the entire U.S.A. Many of those are dedicated to diving accidents (bends) and are not available for other medical conditions. And, many are located in hospitals that restrict HBOT to a small number of medical conditions reimbursed by Medicare.

Hyperbaric facilities are very expensive to establish and outfit. Because only a few of the many medical conditions that might be helped by HBOT are reimbursed by health care insurance, patients must commonly pay the cost out of their own pockets. Fees for HBOT can range from $150 per hour to almost $1,000 per hour. This denial of insurance reimbursement discourages the creation of new facilities and many patients cannot afford the cost of HBOT when refused medical insurance coverage. It is not uncommon to require 50 to 100 of the hour-long treatments for full benefit.

Advertisements and marketing claims for hyperbaric oxygen therapy is regulated like a drug by the government’s Food and Drug administration (FDA). It costs tens of millions of dollars to conduct medical research that meets FDA standards to allow claims for successful treatment of a specific illness. Medical insurance companies commonly take the position that if the FDA has not issued a formal approval, then the therapy is experimental and they refuse to pay. Because oxygen cannot be patented, profits on sales of oxygen are too small to pay for studies that meet FDA requirements.

Psychological defense mechanisms also come into play. If a doctor is not taught about HBOT in medical school (and most are not), and if a doctor therefore does not routinely use or prescribe HBOT for patients, then one of two things must be true in their minds: 1) either that doctor’s medical education was deficient and he or she is not providing the best of care for patients; or, 2) other doctors routinely using and prescribing HBOT for conditions that are not FDA-approved (off-label) must be “quacks” who exploit desperate patients. Which do you think their choice will be? It’s apparently difficult for many medical doctors to shed an attitude of God-like omniscience and admit that they simply do not know everything there is to know.

The medical profession is becoming polarized concerning HBOT. A large and powerful majority of medical doctors believe that HBOT should be restricted to treatment of those rare conditions with prior FDA approval. That majority now criticizes and even attacks the growing number of physicians who have become familiar with more than 30,000 published scientific papers the subject, and who advocate or use HBOT to treat patients with so-called off-label (non-FDA-approved) conditions. Opponents of such expanded utilization of HBOT should admit that they are remiss in their care of patients, they should open their minds, educate themselves further, and change their ways.

The medical community eagerly accepts scientific research buttressing a therapy it already approves. Somewhat more reluctantly, it examines and debates entirely novel approaches. But what it really hates is reappraising a treatment once rejected—getting the egg off their collective faces. Medicine, after all, is made up of people—people trailing MDs after their names—who, like the rest of us, do not enjoy admitting error.

Someday when HBOT therapy is an established part of standard medical care, historians of twentieth century medicine will wonder how so much supportive research on its benefits could have been published by skillful medical researchers and even more scrupulously ignored by the guardians of our health. By that time, most of the individuals who attempted to keep HBOT on the fringe will probably not be alive to blush, sparing them extensive embarrassment.

The amount of positive research is certainly formidable. And some studies that purport to demonstrate that HBOT doesn’t work actually show the opposite. For example, a recent Canadian study of cerebral palsy showed significant benefit. Under political pressure from parents, the study was reluctantly designed and conducted by Canadian physicians who were inexperienced in the use of HBOT. Both the treatment and placebo groups were pressurized and both groups benefited. The published conclusion in that study mistakenly stated that HBOT did nothing. It’s easy for opponents to design flawed studies and interpret the results to support their biased positions.

In a sense, we’re attempting to set the record straight and to tell people—especially physicians—to become familiar with the published scientific evidence . Mainstream medical journals engage in unconscionable editorial censorship. They refuse to publish positive research studies on alternative therapies, and are quick to print editorial criticism and anecdotal letters to the editor that are biased against such treatments. They have also been quick to uncritically print flawed studies that erroneously allege to disprove a controversial therapy.

Elmer M. Cranton, M.D. retired in 2007 after 40 years of busy medical practice. For many years he was associated in practice with his son, John A. Cranton, ARNP. Dr. Cranton and his son, John, stressed evidence based medical therapies to enhance each patients’ inherent ability to heal, including primary care, family medicine, internal medicine, preventive medicine, nutrition, and healthy life-style. Additional specialties included EDTA chelation therapy, hyperbaric oxygen therapy (HBOT), clinical nutrition, geriatrics, chronic fatigue syndrome, fibromyalgia, preventive medicine, and cardiovascular disease.