I bring up this issue because we supposedly have a free-market medical system and the Chinese–well, they’re communists.  Has the free market failed yet again?

Actually, I’m one of those true believers who thinks that markets never fail.  So, my a priori answer to this Sino-American conundrum is that we don’t have a free market in medicine and the Chinese probably don’t withhold cheap, harmless therapy that seems to work even though scientific evidence is less than certain.

I only recently came across this English-language review of the Chinese medical literature on the subject of hyperbaric oxygen for the treatment of cerebral palsy and my supposition about Chinese medical policy, at least, was born out.  This particular review confined itself to neonatal ischemic patients and the researchers, though from England, had an obvious command of the Chinese language. The authors found 20 Chinese-language reports of randomized, or what the authors called quasi-randomized, studies; quite a few other hyperbaric oxygen studies  for cerebral palsy did not meet the authors’ inclusion criteria and had to be excluded from the analysis.

Overall, the patients treated with hyperbaric oxygen fared better than the ones who did not receive hyperbaric oxygen.  Here are the authors’ conclusions in their own words:

“Treatment with hyperbaric oxygen possibly reduces mortality and neurological sequelae in term neonates with hypoxic-ischaemic encephalopathy. Because of the poor quality of reporting in all trials and the possibility of publication bias, an adequately powered, high quality randomised controlled trial is needed to investigate these findings. The Chinese medical literature may be a rich source of evidence to inform clinical practice and other systematic reviews.”

This conclusion is hard to quibble with: Maybe hyperbaric oxygen works and more study is needed to say for sure.  But I find it curious that the Chinese are willing to treat their brain-injured babies with hyperbaric oxygen whereas the American government–or at least Medicare and Medicaid, for the most part–refuses to pay for hyperbaric oxygen treatment of brain injury.

Physicians who treat children with cerebral palsy have to maintain a positive outlook.  I think that’s especially true for those of us who treat patients with hyperbaric oxygen.  We all agree that cerebral palsy cannot be cured.  See here, here or here.  The mainstay of therapy for most of these children is physical therapy, tailored to the individual, to improve strength and mobility.  Controlling seizures, muscle spasticity and other medical problems specific to individual children comprise much of the therapy these children receive.  Many kids with cerebral palsy are fortunate not to have substantial cognitive difficulties and can attend regular schools.  All of these treatments make life better for cerebral palsy patients and their families, but none of them help the underlying neurologic condtion.

Controversy  occurs only if someone claims a certain treatment option improves the underlying neurological condition of cerebral palsy.  Standard treatment, after all, is palliative.  It is awfully odd that hyperbaric oxygen therapy is so harshly opposed by its critics.    Because hyperbaric oxygen is the only option for cerebral palsy that claims to improve the underlying pathology,  it seems to me that such a treatment ought to be embraced.

I have spent a lot of time over the years trying to figure out why hyperbaric oxygen inflames passions the way it does and I know from experience that one of the reasons is economic.  Government and insurance companies have been encroaching on the doctor-patient relationship throughout my career and doctors don’t need much to put them in fear for their wallets.  Hyperbaric oxygen can represent economic competition for physicians who make their living operating or medicating and doctors are all too human when they see their own indispensability challenged.  I’ve found it especially sad, however, that some physicians go out of their way to discourage parents about hyperbaric oxygen for kids with cerebral palsy.  As tough as economic times may be, I like to think that most physicians still have a soft spot for children, especially children who face the problems that cerebral palsy kids do.

In any case, we at Atlanta Hyperbaric love treating cerebral palsy kids.  These kids will still have benefits from my treatment long after I’m gone and I can’t afford to waste any energy over those who are insecure.