Heartless Vol. 2: The tale of the oxygen

This entry is the second part of a series aiming to provide current and correct information about therapies for cerebral palsy. Read Heartless Vol. 1 http://conductiveupbringing.blogspot.com/2010/04/heartless-vol-1.html.

Oxygen is a huge business these days. It is easy to sell ‘oxygenated’ products–soft drinks, face creams and such—because generally people believe that oxygen is good for them and it’s the fountain of health and youth. Or…do they? There’s also a parallel, equally popular, equally woo-based group of products warning us of dangerous oxidative compounds, trying to sell us the latest anti-oxidants ("this week’s magic berry").

Now, is oxygen a friend that apart form breathing in, we also have to drink and rub into our skin, or is it a foe that starts oxidative processes in our body killing us with free radicals? It looks like the quacks can’t decide if more oxygen is better or less oxygen is better. They just market whatever sells, relying on the public not looking into their ludicrous claims.

It’s really not as simple as they make it sound. The air contains just as much oxygen as we need at just about the right pressure. Our body has astonishingly clever ways to make sure the oxygen we breathe in gets everywhere we need it in the right amount we need it. “Super oxygenated water” is quackery of the silliest kind, and is totally unable to “carry nutrients to your cells” or “flush toxins out of your body”. We can’t extract oxygen from water because we don’t have gills, and our digestive system is not designed to absorb oxygen—the oxygen from such water will never make it to our bloodstream. If you want more oxygen, take a deep breath, and your lungs will do the job for you, as that’s what they’re designed for. (1) Alternatively, go out to the fresh air and do something fun, like India on this photo! 


The free radicals that are indeed oxidative compounds in our body, are not all bad because our immune system uses them to kill invaders, so all the "free radicals are bad for you—drink this anti-oxidant rich tea or juice" is an ignorance-based theory used to sell the teas and juices. The juices are (luckily) not able to destroy the free radicals in our body. (2)


What about Hyperbaric Oxygen Therapy (HBOT) for cerebral palsy?

HBOT is administration of pure oxygen in a high-pressure chamber. It is a legitimate treatment for certain conditions, 13 of them altogether. These include carbon monoxide poisoning (under pressure, enough dissolved oxygen is delivered to the tissues for the person to survive and the pressure also helps oxygen to displace CO from the hemoglobin); decompression sickness (HBOT allows the nitrogen dissolved in blood come out of solution slowly, without causing damage); anaerobic bacterial infections (the increased oxygen tension kills the bacteria), and a few more. (3, 4, 5)

Note that the contents in the brackets are plausible, accurate descriptions of how the treatment works: no guesswork, assumptions or imaginary processes are involved. That’s why HBOT is approved for these conditions. The reason it is not approved for cerebral palsy, autism, multiple sclerosis, spinal cord injury and the sort is that there’s nothing a lot of pressurized oxygen can do for these people.

Cerebral palsy is caused by parts of the brain being dead. The death of nerve cells in the brain is final, and no amount of oxygen forced into anywhere is going to cause a recovery from that, or improve the situation in any way. It is true that the parts of the brain died due to lack of oxygen; and if there was a way to deliver oxygen to the brain at the time when the damage happened, the cerebral palsy could have been prevented. But any time later is too late and will not reverse the irreversible.

However, when you google “Hyperbaric Oxygen Therapy” and “cerebral palsy”, the above information is clearly not what you find. You’ll encounter pages, pages and pages of woo: web sites advertising or selling HBO sessions or chambers, ready to convince you what an advanced science it is to ‘oxygenate’ brains in order to recover them.

Here is an example of ‘information’ these websites provide:

“Hyperbaric Oxygen Therapy (HBO) is a medical treatment that uses pure oxygen administered under pressure to alleviate hypoxia at the cellular level. The concept behind HBO for the treatment of anoxic brain insults is that of increasing oxygen delivery, and therefore, metabolic activity of inacative brain cells. After an injury or infarct, brain matter dies and is replaced by glial cells. The area around the gliosis, the peri-infarctional zone, appears as gliosis on scans, but may in fact be viable for years following the initial insult. HBO delivers high doses of oxygen to these peri-infarctional zone cells surrounding the dead neurons, and may be causing these cells to become metabolically active).”

This isn’t true. This is equivalent to saying that feeding chocolate cake to your dead grandma at her funeral may increase her metabolic activity and therefore bring her back to life, because despite your grandma being dead, she may be viable for years after she passed away.  

Unfortunately, dead brain cells are not viable. Dead brain cells remain forever dead, this is how the world is put together. If there will ever be a cure for cerebral palsy, it will more likely be replacing damaged cells with new cells than awakening dead cells. (Miraculous stories of people coming back from death are always stories of miracle, not miracle supported by hyperbaric oxygen. If a miracle is bound to happen, it will happen anyway without the assistance of HBOT.)

Apart from such ‘scientific’ description of what HBOT does to the brain of brain injured people, some sites also link studies that are supposed to prove that this treatment causes a significant progress in various developmental areas. These carefully cherry-picked studies—without an exception—are designed in a way so that they allow result changing flaws. The various MDs who give their names to support the studies might just have financial interests in fabricating the ‘proofs’ since they’re selling the treatments themselves.  One of the most ridiculous single-case studies describes the improved motor functions of an 18-month old child after a 3-month period of HBO treatments, measuring various skills before and after the treatment period.  The problem with this is that ANY child, however disabled, will make improvements in the period between 15 months of age and 18 months of age.  There’s no way to tell if any therapy accelerated the development or no without controls, and that is precisely why real studies always use controls.  If controls are not used, one can ‘prove’ anything in the world: you can make a child wear pink socks every day for a 3-months period and measure their development before and after.  There will be progress, so you can say that it was caused by the pink socks.  That’s why most of the fabricated studies don’t use controls.  When they do, the control group is just a group of children who doesn’t get any treatment, and they measure the outcomes using parent questionnaires.  The parents who know their child got the treatment report more favorably of their child’s progress than the parents whose children didn’t get treatment.  The researchers know very well that this bias will happen and is enough to create statistically significant results in favor of the treatment group.

The ‘science’ behind HBOT curing or improving symptoms of cerebral palsy is nonsense. However, the hype was (and still is) growing and growing.  Despite the non-plausible theory, could there be any benefit to sitting in the chamber?  There is a way to decide that; one just needs to conduct a real research study which is designed to rule out all biases and show us what really HBOT can do.  This 2001 study included 111 children who were randomly assigned either into the test (HBO) group or to the control group that got placebo: they got to sit in the chamber, too but it contained slightly pressured room air only.  Both groups got 40 treatments, and the parents didn’t know which group their child was assigned to.  The children were measured before and after for gross motor function, attention, memory, daily living skills and speech.  Both groups improved during the course of the study for all of the outcomes, but both groups improved the same without any difference between the treatments; slightly pressured room air did exactly the same that hyperbaric oxygen did. (Nothing, that is.) (6—abstract, 7—full pdf study)

The reason both groups made progress in all measured areas is that it's not the entire brain that is damaged in brain injured children, it's always only parts.  The undamaged parts are perfectly capable to do what everyone else’s brain does: learn.  Children always learn.  If we want them to learn better we just need to teach them better.

Please accept your children for whoever they are. Your children are beautiful, they are sweet and they’re perfect.  If you feel you would do anything for your children, then make them feel secure, loved, accepted, and teach them the best way you can.  There is no hope in hyperbaric oxygen, but there is hope in the fact that every living human being can learn.  The difference appropriate teaching methods make to the disabled child's life are much more wonderful than anything the quacks ever dared to offer.  The miracle is the ability of all human beings to overcome everything that’s been thrown at them through love and the hard work of their teachers and themselves.  That way they will be more likely to make the best of what they have and what they’ve learnt and live a full and happy life.

1.http://scienceblogs.com/insolence/2006/09/your_friday_dose_of_woo_if_our_intestine_1.php

2.http://www.sciencebasedmedicine.org/?p=294

3.http://scienceblogs.com/denialism/2008/10/breathing_102.php

4.http://www.sciencebasedmedicine.org/?p=249

5.http://www.nytimes.com/2009/03/10/health/10brody.html?_r=1

6.http://www.ncbi.nlm.nih.gov/pubmed/11558483

7.http://www.mild-hyperbaric-oxygen-therapy.com/articles/Hyperbaric%20Oxygen%20for%20Children%20with%20Cerbral%20Palsy-a%20Randomized%20Multicentre%20Trial.pdf