In 2001 the prestigious English medical journal, Lancet, published the only double-blind, randomized study of hyperbaric oxygen for the treatment of cerebral palsy ever performed. In the ensuing eight years, no one has attempted to extend or even replicate the study, and I doubt that any more clinical research will be done for the foreseeable future. What happened is a perfect example of, “My mind is made up, so don’t confuse me with facts.”
One of the coauthors of the Collet study, Dr. Pierre Marois, recently wrote a review article (http://www.jpands.org/vol12no4/marois.pdf ) on the subject of hyperbaric oxygen treatment of cerebral palsy that devoted a large segment to the controversy that still raises blood pressure at its very mention. On its surface, the Collet study was straight forward: It was an attempt to randomize children to hyperbaric oxygen treatment and compare them to children in a control group. The problem, and the controversy, turned out to be the control group.
Because Dr. Marois’ report is freely available and the Collet study is old news anyway, I won’t go into great detail. To make a valid comparison, both the researchers and patients in the Collet study could not know who was receiving hyperbaric oxygen. Consequently, both the oxygen and control groups had to be subjected to hyperbaric conditions–otherwise it would be easy for a patient to know if he were being treated simply by being able to feel the pressure or its absence. The treatment group received 100% oxygen at 1.75 atmospheres of pressure and the control group received room air at 1.3 atmospheres of pressure. In other words, the study compared treatment with hyperbaric oxygen to treatment with hyperbaric air, so it is inaccurate to call the hyperbaric air treatment a placebo. The results showed that both the children treated with hyperbaric oxygen and the children treated with hyperbaric air showed considerable objective improvement compared to children who received no hyperbaric treatment at all. But, there was no difference in outcome between the two hyperbaric treatment groups.
The coauthors began to squabble even before the study was published. According to Dr. Marois, Dr. Collet and the group that funded the study wanted everyone to believe that the patients treated with hyperbaric air were treated with a placebo, so that they could conclude that hyperbaric oxygen treatment for cerebral palsy was no more effective than a placebo. On the other hand, Dr. Marois pointed out that hyperbaric air is surely not a placebo, and in fact is in common use, with life-saving effect, for treatment of acute mountain sickness. Marois believes, as I do, that the Collet study plainly proves the efficacy of hyperbaric oxygen therapy for the treatment of cerebral palsy, although hyperbaric oxygen may not be more effective than hyperbaric air.
I’ve saved the best for last. The Collet study was done in Canada and Canada has socialized medicine. On the basis of the Collet study, the Canadian government does not pay for hyperbaric oxygen treatment of kids with cerebral palsy. The Canadian government does not pay for hyperbaric air for these children either, though based on the Collet study, it seems like it should. Does anyone think the proposed American socialized medicine scheme will pay for cerebral palsy kids to have hyperbaric oxygen or even hyperbaric air treatment?
Glenn L. Goodhart, M.D., J.D.