The story investigates whether hyperbaric oxygen therapy might prove useful in treating post-concussion syndrome — a lingering constellation of symptoms affecting a small minority of those who suffer mildly traumatic brain injuries.
Although the story makes it clear that research to date has been inconclusive, and the potential costs substantial, it could have been more clear about the risks associated with the therapy. Furthermore, some of the examples of anecdotal experience with the therapy weren’t related to post-concussion syndrome and may confuse readers.
Hyberbaric oxygen therapy has many more unproven uses than it does proven ones. It’s enough of an issue that the FDA has published this pamphlet to help guide consumers regarding which are which.
Sources with conflicts of interest may frame the research in a promotional way; making the therapy sound widely available, affordable, effective and risk-free. Which is not always the case. Reporters covering this topic need to be on guard for this and scrutinize the purported benefits, as well as the significant limitations, in this area of research.
The story mentions that “patients typically receive between 40 and 60 hour-long hyberbaric treatments spread over two to three months” and that a treatment “typically cost between $200 and $400 per session and is rarely covered by insurance.”
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.
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.
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.
There is no disease mongering in this story. Mild traumatic brain injury (mTBI) and post-concussion syndrome (PCS) are both widely accepted and researched medical conditions.
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.
It’s mentioned that post-concussion syndrome has proven difficult to treat, with existing therapies having varied success at targeting symptoms, but not addressing the cause.
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.
The story established this is an emerging and unproven therapy for post-concussion syndrome.
The story does not appear to rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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