Good question, as HBOT has been around for over 100 years! So, the question is: why do so few people know about it? A quick Google AI request gives us some insight: "...this is due to a combination of factors, including limited FDA-approved indications, a lack of large-scale clinical trials for many potential uses, high costs, and a general perception as a "fringe" or controversial treatment within some parts of the medical community."

We believe that this AI assessment is true, so let's have a closer look at these factors:

Limited FDA-approved indications

Back in around 2000, the FDA (the US Food and Drug Administration) approved the use of HBOT for the following list of ailments:

• Air and gas bubbles in blood vessels.
• Anaemia (severe anaemia when blood transfusions cannot be used).
• Burns (severe and large burns treated at a specialized burn centre).
• Carbon monoxide poisoning.
• Crush injury.
• Decompression sickness (diving risk).
• Gas gangrene.
• Hearing loss (complete hearing loss that occurs suddenly and without any known cause).
• Infection of the skin and bone (severe).
• Radiation injury.
• Skin graft flap at risk of tissue death.
• Vision loss (when sudden and painless in one eye due to blockage of blood flow).
• Wounds (non-healing, diabetic foot ulcers).

The European Committee for Hyperbaric Medicine (ECHM) went further adding:

• Compartment syndrome (excess pressure build up in muscles).
• Acute peripheral ischemia (sudden blockage of blood flow to a limb).
• Replantation of extremities (reattachment of a completely severed body part).
• Chronic refractory osteomyelitis (persistent bone infection).
• Exceptional blood loss anaemia.
• Pneumatosis cystoides intestinalis (gas-filled cysts in the intestinal wall).
• Refractory interstitial cystitis (chronic cystitis).

The UK Government has yet to follow suit, authorising HBOT on the NHS for only gas embolism and decompression illness.

Other than in the UK, this is a great start, but there are many, particularly chronic, conditions for which their suffers can also benefit from HBOT. So why, even outside of the UK, stop at this list...

A lack of large-scale clinical trials

Large scale clinical trials (double blind tests with sufficient participants) need to be funded, and the funding necessary can be enormous. So, who funds these trials? Resorting again to Google AI: "Clinical trials are funded by a variety of sources, including pharmaceutical companies, government agencies (like the NHS and the National Institutes of Health in the US), government-funded research bodies (such as the Medical Research Council), and non-profit research charities (like the British Heart Foundation and Cancer Research UK)."

Let's remove the rich pharmaceutical companies as anyone willing to fund such trials as they only stand to lose when those that use HBOT reduce their reliance on drugs.

Let's remove the cash-strapped NHS as anyone willing to fund such trials as they are always crying poverty.

Let's remove non-profit research charities as anyone willing to fund such trials as the charities would not exist if the problem they support is solved.

This realistically leaves PhD or post doctorate students, or maverick university groups in the fray; neither of which are ever realistically going to be able to raise the necessary funds as they are often funded themselves by pharmaceutical companies or government agencies.

The high costs

The cost of providing HBOT on the NHS will be huge; not because the equipment is prohibitively expensive, but it would be the cost of staffing and training as the provision of HBOT is so very labour-intensive (when you consider the very low patient throughput that can be achieved compared to say an X-ray machine or ultrasound/CT/MRI scanner) with ongoing treatment plans needed for each patient.

The general perception as a "fringe"

Almost by definition, all new treatments start out as fringe e.g. smallpox vaccination and penicillin.

So, the above covers the reasons why the UK Government probably won't be authorising the use of HBOT on the NHS any time soon.

Now we deal with the question of why aren't doctors prescribing or even recommending it?

In the UK, NICE (the National Institute for Health and Care Excellence) determines whether a treatment will be routinely funded by the NHS and provides processes and procedures for the treatment's prescription. Doctors can prescribe or recommend treatments that are not authorised by NICE (termed 'off-label'), but, and here's the rub, the doctor takes professional responsibility and potential liability for the decision. Presented with this, why would any doctor risk their livelihood and reputation when all they need to do to protect themselves is to strictly adhere to the NICE guidelines in every case?

This, most unfortunately, often leaves the patient themselves to research alternative approaches for their treatments with their doctors often recommending against any such alternatives and distancing themselves from any deviations from the NICE guidelines.

If you agree, or you know otherwise, please let me know.

Nick
nick.crawford@ardenforestwellness.co.uk

Disclaimer: The views above are solely that of the author and do not represent any position taken by Arden Forest Wellness nor any other entity. The author, upon notification to nick.crawford@ardenforestwellness.co.uk, will, without unnecessary delay, correct any factual inaccuracies or remove any copyright material. The author takes no responsibility for the use or misuse of the information presented here which is provided as-is with no guarantee or warranty, either expressed or implied, or liability for damages, consequential or otherwise.