Washington Post story on hyperbaric therapy for head injuries notes uncertain benefit–but not potential harms

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

It’s made clear that for at least some of the research, no benefit was found–that it didn’t work. For the studies that are mentioned that did see a positive benefit to hyperbaric therapy, the results are not quantified.

Also, there were some details that had the potential to confuse readers about the potential benefits. First, the story uses two anecdotes of dramatic improvement with the therapy, and this runs the risk of misleading readers. It’s not until the very end that we find out that “such anecdotes are not the same as rigorous scientific research.”

One of these anecdotes involved a woman recovering from brain tumor removal. The mechanisms of injury are very different from a mild traumatic brain injury and post-concussion syndrome.

Lastly, this quote was problematic:

Efrati said the brain is no different from any other part of the body. Pressurized oxygen has the power to repair many kinds of tissue damage. “A non-healing wound in the leg and a non-healing wound in the brain,” he said, “they are the same basic thing.”

The statement that a wounded brain and a wounded leg are basically the same thing isn’t quite accurate: One is typified by damage to brain cells, which are notoriously slower growing than soft tissue cells in the legs.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The  risks and complications of hyperbaric treatment are not mentioned.

According to Johns Hopkins Health Library these risks include (but are not limited to) lung damage, middle ear trauma, visual changes, and seizures. Many of these are dose-related, which means that the risks increase with duration of therapy and degrees of pressurization.

Furthermore, there are certain groups of people (like those with chronic lung, middle ear, sinus, or seizure disorders) who may not be good candidates.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story mentions a mixed bag of studies, but doesn’t give us a sense of how authoritative the studies were. For example: Were they randomized and controlled? Or observational? Etc.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

It should have been made more clear that the research supporting positive outcomes — as well as the two glowing anecdotes — came from physicians who run hyperbaric therapy clinics.

Having said that, we appreciated the inclusion of Dr. Cifu’s skepticism, as well as the cautionary last paragraph regarding anecdotes, and that more research is clearly needed in this area.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Availability of hyperbaric chambers, or rooms, is not discussed.

According to the Undersea & Hyperbaric Medicine Society, there are over 200 accredited facilities in the United States.

One thing we wanted to note: The statement from a researcher that there’s no way to patent (and thus, make money from) hyperbaric oxygen therapy as an explanation for why the evidence base is so fragmentary seemed to ring false in the setting of these private clinics that can create frequent return visits for long periods of time.