Hyperbaric oxygen therapy: hope or hype?

November 28, 1993|By Holly Selby | Holly Selby,JEF DAUBER/STAFF GRAPHICStaff Writer

When E. J. Roberts seeks respite from the disabling fatigue caused by AIDS, he dons a green paper coverall, green paper shoes and a plastic hood that looks like a space helmet. He enters a steel chamber resembling a small submarine.

As oxygen is piped into his hood, the 24-year-old Essex resident says he sits back and passes the time by singing show tunes.

The chamber belongs to Life Force, a clinic set up three months ago in a former Mount Vernon art gallery. Mr. Roberts and others infected with the human immunodeficiency virus come here from as far away as North Carolina for treatment at $125 per session.

"I've tried AZT; it made me sick. I've tried ddI; it made me sick, too," Mr. Roberts says of two anti-viral drugs used to combat AIDS. "Why not try this?"

This is hyperbaric oxygen therapy. Best known as a way of treating the "bends" -- a deadly condition in which divers have nitrogen bubbles in the blood -- the therapy is also used at institutions such as the Maryland Shock Trauma Center to treat some types of wounds, burns and infections.

While in a chamber of highly compressed air, patients breathe pure oxygen. Some doctors say that saturating the blood with oxygen promotes healing by stimulating capillary growth in unhealthy tissues.

The owners of Life Force tout the therapy as a way to alleviate the fatigue often associated with the virus that causes AIDS.

Michelle R. Reillo, a nurse who is president of the clinic, contends that the therapy also halts progression of the virus, saying oxygen saturation "slows viral replication by interrupting biochemical reactions." She has made similar statements in letters to doctors.

But researchers have not established whether hyperbaric oxygen therapy helps people who are HIV- positive, let alone that it might impair the virus that leads to full-blown AIDS and eventual death, according to specialists in the field.

Still, people with AIDS who have received the treatment say it makes them feel better afterward. While acknowledging their testimony, some doctors say that the patients may be experiencing a placebo effect -- a phenomenon in which a treatment works because patients believe in it.

'We have to be very cautious'

"I think we have to be very cautious about application of a potentially very expensive technology that is unproven. We don't do it with medications and I don't think we should do it with technologies," says Dr. Joseph O'Neill, director of research at Chase Brexton, a Baltimore AIDS clinic that manages the cases of about 1,500 patients.

Chase Brexton doctors do not prescribe hyperbaric oxygen therapy. Nor do doctors at the Moore Clinic, a part of the Johns Hopkins Hospital that oversees care of nearly 3,000 patients who are HIV-positive.

"We don't refer patients because we feel there isn't very much data to support using [the therapy] with HIV," says Moore's director, Dr. Joel Gallant.

One Baltimore doctor says she cautions her patients that the therapy is unproven but does not prevent their using it.

"The way I approach patients with a terminal illness is that you don't want to deprive them of hope," says Dr. Janet Horn, an internist. "If a patient is in the end stages of AIDS, or even before, and has exhausted all the things that we know are of proven benefit, and if he wants to seek treatment elsewhere, that's up to him."

Fighting fatigue

Many who have tried the therapy say it helps them. Since September, when he began receiving hyperbaric oxygen therapy, Mr. Roberts says he sleeps eight hours a day instead of 18. Previously, he says he was unable to overcome his intense fatigue, which led him to quit his job as a convenience store manager.

Similarly, Domingo Vega, 37, also says hyperbaric oxygen therapy relieves his fatigue. "I used to come home and get into bed. Now I work, and then I come home, and I still do my normal activities."

In many ways, the discussion surrounding the Life Force clinic epitomizes a larger debate that began with the onset of the AIDS epidemic: whether people with HIV should -- or can -- wait for treatments to be proven effective or seek out any that seems promising.

On one side is Ms. Reillo. "I have a problem with withholding a noninvasive, basically low-risk treatment when clearly it seems to help," she says.

Before establishing Life Force, the nurse worked at Shock Trauma and collaborated on a study of the effect of hyperbaric oxygen therapy on people with AIDS. After becoming convinced the therapy works, she left Shock Trauma to open the clinic.

On the other side of the debate is the medical establishment, embodied by Dr. Roy A. M. Myers, a Shock Trauma surgeon who oversaw the study. "We have not proven anything," he says.

Beginning in December 1990, 25 people with AIDS who were experiencing fatigue received the therapy three times a week, some for as long as two years. All reported feeling better and suffering less fatigue, he says. Eight of the 25 have since died.

Blood tests abandoned

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