15 March 2019

South Africa: Quack Claims About Oxygen Treatment Are Dangerous

If you go scuba-diving and come up to the surface too fast, you might need Hyperbaric Oxygen Therapy. But, experts warn, it can't treat cancer, stroke, Alzheimer's disease, autism, or arthritis, as some quack outfits are claiming.

Hyperbaric Oxygen Therapy (HBOT) is generally known as the treatment to cure "the bends" (decompression sickness) in underwater divers.

The therapy uses high concentrations of oxygen at high pressure, and has been approved for use in 14 conditions including decompression sickness, gas gangrene (caused by a bacterial infection and accompanied by an odorous gas), necrotising soft tissue wounds (as with diabetic foot wounds caused by severe bacterial infection) and thermal burns amongst others.

But practitioners of so-called mild hyperbaric oxygen therapy (mHBOT) are fraudulently cashing in on the science that supports medically-approved HBOT.

Dr Cecilia Roberts, President of the Southern African Underwater and Hyperbaric Medical Association (SAUHMA), says the association is "very concerned with the false hope, claims and marketing of mHBOT as well as the threat to the scientific field of Hyperbaric Medicine."

Treatment is administered in a special chamber where patients inhale 100% percent medical oxygen at high pressure - twice the average atmospheric pressure exerted at sea level. This increases the amount of oxygen in the blood, which "has direct and indirect therapeutic medical effects which promote the healing process," says Roberts. But this applies only to the conditions for which it is indicated.

Dr Jack Meintjes, Programme Coordinator for Underwater and Hyperbaric Medicine programmes at Stellenbosch University, says misinformation is being fed to the public by mHBOT opportunists: "If you administer low pressure HBOT, it is like moving someone from Johannesburg down to Cape Town and then claiming you are treating them. We know this is not true. You have to have a certain level of the medicine, so to speak, to have an effect and that will only be possible if the pressure is high enough to dissolve more oxygen in the plasma. But the quacks quote the evidence for proven HBOT for their mHBOT saying, 'Look, here is the evidence for HBOT, come to us and we will treat you.'"

mHBOT is usually administered in an inflatable soft chamber with air or air mixed with added oxygen.

These chambers - prohibited by the American Food and Drug Administration for use other than in acute mountain sickness - often do not comply with South African safety regulations.

Fabric chambers are not designed to be used with 100% oxygen. Oxygen in high concentrations increases the risk of fire. Cosmetics such as deodorant, hairspray and makeup could easily combust under high oxygen content. "Our team specifically investigates all these things, and we know exactly what the safety rules and regulations are according to international standards. Some mHBOT practitioners and marketers do not even have a fire extinguisher on site, so how can they advise on the correct fire extinguishing systems when they sell these chambers to the public as home devices?" says Meintjes.

The increased atmospheric pressure in the hyperbaric chamber is another safety concern and a serious risk. If the soft chamber inadvertently deflates, as in the event of an unexpected power shortage, this could cause serious injury to a patient's eardrums or lungs.

But in spite of warnings and recommendations from HBOT experts and bodies such as SAUHMA, the use of mHBOT devices is on the rise.

The South African company O2xygenate claims mHBOT can be used for a string of indications including cancer, stroke, Parkinson's disease, Alzheimer's disease, autism, arthritis, multiple sclerosis and cerebral palsy amongst others - none of which is approved for treatment with HBOT or mHBOT. O2xygenate also advertises its services for diabetic ulcers and burns - conditions indicated as treatable with HBOT only. Treatment costs range from R500 an hour to R8,000 for 20 treatments. The company also sells soft hyperbaric chambers for home use.

The company SpecialKids advertises mild hyperbaric treatment through O2xygenate for off-label conditions in children. Its website provides a direct link to the O2xygenate website.

Former chiropractor Malcolm Hooper, who owned the hyperbaric treatment clinic Oxymed Australia, is to stand trial for unsafe practice following the death of a former client who was undergoing treatment for multiple sclerosis at Hooper's facility.

"The problem is," says Dr Meintjes, "Our colleagues associate us with all this quackery and they won't refer patients to us here at the Tygerberg HBOT Department. Instead, despite the evidence for the successful treatment of soft tissue and bone damage following radiation, or certain diabetic foot wounds with HBOT, two or three amputations are done each day at Tygerberg Hospital; we do not get a single referral. And it costs the state patients nothing to be treated here."

Pretoria-based vascular surgeon and former president of SAUHMA, Dr Gregory Weir, says, "Modern hyperbaric oxygen therapy is part of mainstream evidence based medicine. The hyperbaric physician and his team is an under-utilised resource."

Weir has lodged a complaint with the South African Health Products Regulatory Authority (SAHPRA) about the misuse of mHBOT. The matter has been referred to the Deputy Director of Medical Devices at SAHPRA, Andrea Julsing. "SAHPRA should be made aware of the false claims made by the charlatans who exploit patients for financial gain," says Weir.

Useful organisations

Southern African Underwater and Hyperbaric Medical Association: www.sauhma.org

South Pacific Underwater Medicine Society: www.spums.org.au

European Underwater and Baromedical Society: www.eubs.org

Undersea and Hyperbaric Medical Society: www.uhms.org

Canadian Undersea and Hyperbaric Medical Association: www.cuhma.org

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