Hyperbaric Oxygen has not been proven to be successful in the treatement of diabetic foot infections. The preceding was a statement of fact. Now I know there are podiatrists, patients and other practioners that would disagree with that statement since they have “seen” it work. What you saw or experienced was a patient healing, that very well might have occured without hyperbaric oxygen. I have prescribed Hyperbaric oxygen for patients, and had patients heal and not heal with hyperbaric therapy. My conclusion then was that it did not work, but was a money maker for wound care centers/hospitals.
So, why the booming populatiry for an ineffective treatment modality? The answer is, as in everything, is money. The fees for one treatment range anywhere from $150-$2,000 an hour. Hyperbaric Oxygen is covered by Medicare and Medicaid as well as most private insurers in most states. There are usually documentary issues with the diabetic wound one most eclipse in order to be approved for the Hyperbaric Oxygen therapy. Not one of which is: do you think this Diabetic wound might actually heal or not heal without Hyperbaric Oxygen? Their is a supervising physcian present, if he is reimbursed by insurance between 200-400$ for having to become exhausted from just sitting there for an hour. Now realize these are generally two hour treatments and according to guidelines you need 20 treatments (many patients go for much more because you know if something is not working just try it more). So clearly there is financial reward to those centers/hospitals that can obtain the most hyperbaric patients that are eligible (so we know no one is cheating the guidelines).
One of the reasons hyperbaric oxygen is so expensive here is quite frankly insurance. People can get paid exorbitant amounts. There are private companies that only charge 60-100/ hour for out of pocket treatment. These companies mostly cater to athletes as well as those with neurological such conditions that will never be covered by insurance. So when the companies and physicans say it is about the patient, their actions contradict their words.
Now to proving it doesn’t work, well I will leave it to someone not named me. Please read this article published in 2006 in Clinical Infections Disease (a reputible journal compared to most of the publications the hyperbaric industry publishes there junk in):
http://cid.oxfordjournals.org/content/43/2/193.full
Essentially he did a literature review and found not one single study that provided any evidence that hyperbaric oxygen worked for diabetic feet. Coincidentally this is the same time Hyperbaric oxygen therapy blew up on soceity. Now centers are opening all over the United States.
I have included his Results and Conclusion section:
Results. Although recognized for reimbursement by Medicare and major insurers, the evidence base for hyperbaric oxygen therapy for diabetic foot care remains weak. A systematic review for the Cochrane Collaboration concluded that hyperbaric oxygen therapy may have value in treating diabetic wounds, but the studies reviewed all had methodological weaknesses, and the positive effect of treatment was not seen in the single reviewed randomized trial to include a sham treatment arm. Hyperbaric oxygen therapy consumes very substantial resources—and has the potential to consume far more—that could be better spent on other aspects of management or prevention of diabetic foot ulceration.
Conclusions. Hyperbaric oxygen therapy should not be offered for diabetic foot wounds until large-scale, adequately blinded, controlled, and powered randomized studies have clearly demonstrated efficacy and cost effectiveness in the healing of ulcers and the prevention of major amputation.
So naturally none of that was done and we as soceity just started ordering more.
Here is another article
If you read this article its funny because it is a literature review it points out that the only randomized control study of hyperbaric oxygen proved it did not work but still comes to the conclusion it works for diabetic wounds despite evidence to the contrary.
I bet shockwave is better than this, and so it is
http://www.medicalnewstoday.com/releases/219444.php
To be honest that study is as much garbage as most of the hyperbaric studies.
If only there was an independant arbitrator like the national institute of health:
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102274409.html
Oh wait there is, so after reading this, please, when you see the patient tell them I want to be paid 350 dollars for two hours and my company wants to make 2,000 for few hours while you lie down in a chamber that peddles false hope.
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