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erly clients, at pressures of 1.4 ATA or lower. While many “mild” cen- plicitous presentation to their potential clients and regulators. On
ters treat with compressed air only, some “mild” facilities attempt to one hand, they claim that their chambers need not adhere to the
increase the oxygen concentration for patients in their noncleared long-established standards for safe design and operation required for
chambers and compound safety issues by adding oxygen concentra- clinical hyperbaric installations because of the “mild” doses delivered
tors. The oxygen concentrators employed are themselves often im- at pressures just slightly elevated above sea level pressure. On the
ported without 510K clearance. Since both hyperbaric chambers and other hand, they attempt to convince their potential customers that
oxygen concentrators are classified as Class 2 medical devices, they these mild pressures will be as effective as the established higher pres-
have to be reviewed and cleared individually and in any joint usage. sures combined with essentially 100% oxygen offered by mainstream
In websites and promotional brochures, some of these facilities hyperbaric facilities. All too often, the current “mild hyperbaric” op-
have intentionally usurped the large body of published scientific ar- erators promote their therapy to vulnerable populations for unproven
ticles reporting the results of standard and properly dosed and deliv- indications. Until and unless, these “mild hyperbaric facilities” com-
ered hyperbaric oxygen. These include the 14 indications listed in ply with all appropriate safety regulations and select appropriate
Table 1. The mainstream hyperbaric community, as does the FDA, treatment pressures and protocols along with safely delivered and ap-
considers hyperbaric oxygen to be a “drug.” As such, it must be deliv- proved oxygen delivery systems to treat scientifically supported dis-
ered by prescription in adequate doses with proven protocols to be orders, they should be required to cease and desist treatments. The
effective. Ineffective treatments can delay the appropriate application delivery of hyperbaric medicine is the practice of medicine. Non-
of hyperbaric oxygen. Just recently, in Great Britain, a diver was physicians must not be permitted to deliver this very specialized med-
treated for decompression sickness (the bends) ineffectively in a ical treatment without the involvement, prescription and oversight
“mild” hyperbaric facility. The diver did not have resolution with the of properly trained and licensed physicians. Nurses and staff working
“mild” treatment and subsequently required retreatment at a standard under the direction of trained and preferably board-certified physi-
hyperbaric recompression/hyperbaric facility. Severe, improperly cians must be adequately trained to understand and respond to their
treated decompression sickness can result in death for the diver if patients’ unique hyperbaric environment and their patients’ reactions
treatment is inadequate or delayed. and special needs in this environment.
“Mild hyperbaric medicine” centers are targeting a vulnerable pop- Physicians of the UHMS would gladly welcome new colleagues to
ulation of patients with disorders for which there is no established our discipline if indeed they were committed to practice safe and effec-
role for hyperbaric oxygen at any pressure in any treatment protocol. tive hyperbaric oxygen treatments. As it now stands, we are a discipline
Desperate parents will pay large sums of money to these centers to which aims to police itself and seeks to support safe and effective treat-
treat children with cerebral palsy, autism or other unproven, often ments by professional and technical staff who are prepared and trained
neurologic indications. “Mild hyperbarics” is portrayed as an inno- to deal with the unique complications that can occur in the hyperbaric
vative new therapy. Another vulnerable group includes stroke patients realm and do so with greater frequency when the treatments are im-
who may be months or years post stroke. Although the treatment of properly delivered.
stroke patients with hyperbaric oxygen has been and continues to be
studied, this treatment is investigational and not reimbursed by References
health insurance carriers. Therefore, when treated in unsafe chambers 1.Leopardi LN, Metcalfe MS, Forde A, Maddern GJ. Ite Boerema--
and with ineffective doses, these patients accumulate a substantial surgeon and engineer with a double-Dutch legacy to medical tech-
debt with virtually no hope of improvement. nology. Surgery. 2004 Jan;135(1):99-103. doi: 10.1016/j.surg.2003
Both the American Medical Association (AMA) and the Bexar .08.022. PMID: 14694306.
County Medical Society have approved resolutions calling for a cessa- 2. Acott C. A brief history of diving and decompression illness. South
tion of “mild hyperbaric” treatments. As you may know, the Bexar Pacific Underwater Medicine Society Journal. 1999 29 (2).
County resolution was recently communicated to the Texas Medical ISSN 0813-1988.
Board (TMB). The TMB took prompt action to issue a cease-and-de- 3. Paquette IM, Vogel JD, Abbas MA, Feingold DL, Steele SR; Clinical
sist order to two “mild hyperbaric” activities in state. Each were oper- Practice Guidelines Committee of The American Society of Colon
ated by dentists. These operations were shutdown based on the and Rectal Surgeons. The American Society of Colon and Rectal
determination that these individuals were practicing medicine without Surgeons Clinical Practice Guidelines for the Treatment of Chronic
a medical license. Radiation Proctitis. Dis Colon Rectum. 2018 Oct;61(10):1135-
In summary, “mild hyperbaric” advocates and providers offer a du- 1140. doi: 10.1097/DCR.0000000000001209. PMID:

20 SAN ANTONIO MEDICINE • January 2023