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Hyperbaric Medicine Officially Enters the Prohibition Era

Physicians' Forum Counterpoint
from Volume 1 Issue 1
Research in Hyperbaric Medicine

By Paul G. Harch, M.D.

The Physicians' Forum article in the inaugural issue is a comprehensive discourse with many good points on the legality of off-label HBOT, research funding, a registry, recommendations for patients seeking off-label treatment, and standardized testing/documentation. However, these points are nearly lost in an extremely confusing, obfuscating tangle of terms, definitions, and concepts that is partly based on a double standard. Despite the confusion, the message and threat to the entire hyperbaric medicine community was transmitted so loud and clear in the final paragraph that I was moved to declare this the "Prohibition Era Of Hyperbaric Medicine." It appears that the purpose of the article is to alter the historical method of the practice of medicine and hyperbaric medicine by jeopardizing a physician's membership in a medical society should they dare to use HBOT for an off-label indication.

Stephen D. Reimers, PE - Mr. Reimers was introduced to hyperbarics as a young Naval officer in 1969

Stephen D. Reimers, PE

Mr. Reimers was introduced to hyperbarics as a young Naval officer in 1969 and has been designing and building hyperbaric facilities ever since. He is a long-time member of the committees that manage the two codes that most affect clinical hyperbarics; ASME PVHO-1 Safety Code on Pressure Vessels for Human Occupancy and Chapter 19 ÒHyperbaric FacilitiesÓ of NFPA 99 Health Care Facilities. Presently he runs two companies, Reimers Systems, Inc. (RSI) and Hyperbaric Clearinghouse, Inc. (HCI). RSI is a major installer of monoplace chambers. They have developed liquid cylinder based oxygen supply systems and air ventilation equipment that make it possible to establish a monoplace center nearly anywhere.

A statement from Edward Teller, Ph.D. Director Emeritus, Lawrence Livermore National Laboratory

 "It would seem plausible that if in our hospitals severe surgery would be followed by the use of Hyperbaric Oxygen, healing would be accelerated by 30%. This alone would result in the saving of billions of dollars, not to even mention the reduction in human suffering."

Flow Dynamics of Patient Hoods. S. D. Reimers, MS, PE.


What flow rate to use with a patient hood is a question with many implications. Hood flow rate primarily affects patient inspired CO2 levels, humidity level, hood noise level and oxygen consumption. It can also have substantial effects on breathing pressures and patient comfort. For many years, "standard practice" for management of patient hoods had been to supply them with a steady flow of about 28 to 30 actual liters per minute (alpm, actual volumetric liters at chamber conditions) regardless of the size of the patient. However, the scientific basis for that practice is obscure. This paper presents an analysis of the flow dynamics of patient hoods and the associated implications regarding hood flow rate selection.

Testimony - The Impact of Hyperbaric Medicine on Government Health Care, Disability & Education Expenditures


"The Impact of Hyperbaric Medicine on Government Health Care, Disability and Education Expenditures"

International Hyperbaric Medical Association Foundation

The International Hyperbaric Medical Association

Paul Harch, M.D.
Former President

Labor, Health and Human Services and Education Subcommittee
Of the Committee on Appropriations

United States House of Representatives

May 2, 2002
Chairman Regula, Mr. Obey, and distinguished members of this committee, I am Dr. Paul Harch, President of the International Hyperbaric Medical Association, and a resident of Louisiana. Bob Livingston was my Congressman. Two years ago, Mr. Istook of Oklahoma started the Hyperbaric Oxygen Initiative at the National Institutes of Health. Many of his constituents have become my patients, one of whom I will present today for the first time in a public setting.

We were all taught that brain cells don’t regenerate. Four years ago, NIH announced to this panel that medicine had been in error all of these years and challenged the medical community to begin searching for a way to do so. Hyperbaric Medicine has been repairing brain injuries right here in America for 30 years, but no one would look at it because everyone "knew" that it was not possible.

Whole Brain Radiation and Solitary Brain Metastasi

The initial approach to using radiation postoperatively to treat brain metastases, used to be whole brain radiation, but this was abandoned because of the substantial neurological deficits that resulted, sometimes appearing a considerable time after treatment. Whole brain radiation was routinely administered to patients after craniotomy for excision of a cerebral metastasis in an attempt to destroy any residual cancer cells at the surgical site. However, the deleterious effects of whole brain radiation, such as dementia and other irreversible neurotoxicities, became evident.

Argument for Medicare/Medicaid - Coverage of Hbot - Treatment of Diabetic Foot Wounds

Hyperbaric Oxygen Treatment of Diabetic Foot Wounds

Argument for Medicare/Medicaid

By Paul G Harch MD

Hyperbaric oxygen therapy (HBOT) was first defined as a drug in 1977 by Gottlieb (1). Unfortunately, this critical definition has been long forgotten and substitute definitions have mis-characterized HBOT as a therapy for "certain recalcitrant, expensive, or otherwise hopeless medical problems."(2) This mischaracterization has resulted in a confusing collectionHyperbaric Oxygen Chambers of different lists e.g., CMS, UHMS Accepted Indications, and international lists(3), of seemingly unrelated reimbursable diagnoses (chronic refractory osteomyelitis, air embolism, cyanide poisoning, compromised flaps and grafts, carbon monoxide poisoning, acute stroke, etc) supported by widely varying amounts of basic science and clinical evidence. In 1999 the drug definition of HBOT was refined and restated as the use of greater than atmospheric pressure oxygen as a drug to treat basic pathophysiologic processes and their diseases (4). With that definition the above lists could now be understood as cohesive sets of diagnoses connected by HBOT effects on the acute and/or chronic underlying pathophysiology common to the diseases. Furthermore, the definition suggested and argued for the application of HBOT to additional diseases that shared this pathophysiology. The 1999 drug definition of HBOT will be used in this paper to argue for HBOT effectiveness in the treatment of infected diabetic foot wounds, and hence, CMS reimbursement for the same. The argument will be constructed by identifying the underlying pathophysiology in diabetic foot wounds, presenting the evidence for the beneficial effects of HBOT on this pathophysiology, demonstrating a similar benefit in patients with diabetic foot wounds, and then showing the risk/benefit and cost/effectiveness evidence for HBOT in diabetic foot wounds. This argument will lead to the conclusion that CMS coverage of HBOT should be extended to diabetic foot wounds.

Effect of HBOT Tailing Treatment on Neurological Residual & PSCT Brain Images in Type II (Cerebral) DCI/CAGE

PG Harch, KW Van Meter, SF Gottlieb, P Staab. JoEllen Smith Hyperbaric Medicine Unit, New Orleans, LA 70131.

Background: No guidelines exist for HBOT tailing treatment of residual neurological injury and no studies document their effect on SPECT brain images and neurological condition in Type II/CAGE DCI as we report herein.

Cognitive & Cerebral Blood Flow Improvement in Chronic Stable Traumatic Brain Injury Induced by 1.5 ATA Hyperbaric Oxygen

Kevin Barrett, Paul Harch, Brent Masel, James Patterson, Kevan Corson, Jon Mader. The Transitional Learning Community at Galveston, 1528 Postoffice St., Galveston, TX 77550; and UTMB, Division Hyperbaric Medicine Galveston, TX

Following severe traumatic brain injury, cognitive improvement is most dramatic the first six months following injury and largely static after 18 months. Anecdotal reports exist that attest to the efficacy of HBOT to improve posttraumatic neurologic deficits by increasing blood flow in the ischemic penumbra despite protocol differences, CBF, speech, neurological and cognitive testing have not been studied serially in patients undergoing HBOT for chronic stable TBI.

HBOT Induces Cerebrovascular Changes & Improves Cognitive Function in a Traumatic Brain Injured Rat

Low pressure hyperbaric oxygen therapy ( LPHBOT ) Induces cerebrovascular changes and improves cognitive function in a rat traumatic brain injury (TBI) model.

Paul G. Harch, CL Kriedt, MP Weisend, KW Van Meter, R.I Sutherland, Baromedical Research Institute & LSU School of Medicine, New Orleans, LA 70114, and University of New Mexico Depts. of Psychology and Physiology, Albuquerque, NM 87131

: In 1996 pilot data were reported on this project [UHM, 1996, 23: (Suppl); 48]. The present study ia a replication of the cognitive improvements and blood vessel changes in that experiment using a larger number of rats.

METHODS: 42 adult male Long-Evans hooded rats were subjected to the unilateral weight-drop focal cortical impact model of TBI. 49 days following TBI, the ram underwent LPHBOT in 2 groups: (1) 80 bid 13 ATA/90 HBOTs (n=l 9); (2) 80 bid sham air treatments (n=23). Motor function and spatial memory tasks were assessed before and after HBOT. Animals were sacrificed, brains sectioned, stained with T,T-diaminobenzidine, and vessel density analyzed via computer assisted densitometry.


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