Re: Digest Number 53

January 21, 1999

I take exception to the author's comment in this article that " we cannot

ethically expose humans to dangerous materials, " which, by implication, is

saying that we CAN expose animals to dangerous materials. It is not

acceptable to allow animals to be tested in toxicology studies, or any other

studies, for that matter. Now, I am not a member of PETA, but I am deeply

disturbed by the research industry's unquestioning acceptance of the use of

animals for research. It is a case where many feel that the ends justify

the means--and obviously the ends are noble: the betterment of the human

race. But can we really say we are bettering the human race when we use

defenseless animals in our pursuit of knowledge?

Just a thought.

Mark Farrell

>Message: 4

> Date: Thu, 21 Jan 1999 06:01:35 -0500

> From: " Barbara Herskovitz " <bherk@...>

>Subject: Causality in Illnesses Thought to Result from Toxic Exposures

Part

>I: Toxicology

>

>http://lectlaw.com/filesh/tabcaus.htm

>by J. Hutchinson, M.D., M.P.H. & Sanford S. Leffingwell, M.D.,

M.P.H.

>*

>

>Temporal characteristics refer to how long the exposure continued. Acute

>exposures are usually a single dose or a single period lasting from a

few

>seconds to as long as a day or so. In animal studies, the amount of

poison

>needed to kill half of the animals, called the LD50 for lethal

dose--50%, is

>the toxicologic datum most commonly available for a poison. It is

determined

>by exposing or dosing small groups of animals to different amounts of

>poison, noting the number in each group that die, and determining a dose

>that would kill half of them. Chronic exposures extend for a substantial

>fraction of the animals lifetime: the experiments can be designed so

that

>they are analogous to lifetime or 40-year working-life exposures in

humans.

>

>Nature of exposure refers to such questions as whether the chemical is

pure

>or in a mixture, the route by which the poison enters the body, and the

>physical and chemical state of the toxicant. Receptor characteristics

>include individual susceptibility based on age, gender, or genetic

make-up.

>Children, for example, may be more susceptible to lung irritants than

adults

> owing to their small, easily-obstructed airways.

>

>Different types of studies yield information on toxic responses. Animal

>studies provide most of our information because we cannot ethically

expose

>humans to dangerous materials. The studies fall into categories by the

>length of time involved, by the animal species used, and by the

illnesses or

>effects (end points) that the researchers looked for. Acute toxicity

>studies, yielding an LD50, are the most common. The LD50 is the bit of

>information most commonly available for substances. Acute toxicity

studies

>also are often useful in identifying target organs and in providing some

>information on the reversibility and duration of effects and mechanism

of

>action.

>

September 22, 1999

Hello, I am type O and am feeling much better since adapting to the " O "

diet. I was on Zoloft (for PMS symptoms) for 2+ years and gained a lot of

weight (on top of excess weight). I recently got off Zoloft and started

using a natural Progesterone cream 2 weeks out of the month, which helps.

In about 1 month's time, I have lost 9 lbs. It could be from not using

Zoloft and/or following the ER4YT food plan. I just started using the

bladderwrack, so I don't know how this will affect me. I use 5-HTP at night

for a wonderful sleep. I also take 10 mg. of DHEA, which has complimented

my increase in energy. An interesting note: I am really prone to sinus

infections and am sick of all of the different antibiotics I have taken.

Any cold I get inevitably leads to an infection. This past week I was

bedridden with a horrible cold and some flu symptoms. It lasted 3 days and

then I recovered rather well without any antibiotics. I feel sure that the

absence of dairy contributed to my quick recovery! Sorry I'm so long

winded.

Later,

Jean

Digest Number 53

>

> >

February 28, 2000

Joan:

that's great news! so glad you guys had a good day............

May 5, 2001

Hi Heike, Welcome to the group. Judy

December 17, 2001

, My son has Georgia medicaid throught the Beckett deeming waiver.

Now how do I go about finding a facility that will treat my son with HBOT

and bill it to medicaid? I called the local HBOT facility in Savannah

(located at Memorial Hospital) and they said they do not treat autism with

HBOT at their facility and that insurance will not cover it, although I know

for a fact that that hospital is a medicaid provider. Do I need to find a

local doctor who will recommend/prescribe HBOT before my son can become a

candidate for treatment? I feel like we have taken a step in the right

direction by getting the medicaid waiver but I don't really know how to

proceed from here. Thank you for all your hard work. Paige

December 17, 2001

Call Ken Locklear at the number I gave previously. He should be able to

refer you to a physician who will treat you. You're right. The Memorial

Hospital, who has a chamber, will not because they are part of UHMS. Bill

Duncan

----------

From: paigecouper@... [sMTP:paigecouper@...]

Sent: Monday, December 17, 2001 11:08 AM

medicaid

Subject: Re: [ ] Digest Number 53

, My son has Georgia medicaid throught the Beckett

deeming waiver.

Now how do I go about finding a facility that will treat my son

with HBOT

and bill it to medicaid? I called the local HBOT facility in

Savannah

(located at Memorial Hospital) and they said they do not treat

autism with

HBOT at their facility and that insurance will not cover it,

although I know

for a fact that that hospital is a medicaid provider. Do I need to

find a

local doctor who will recommend/prescribe HBOT before my son can

become a

candidate for treatment? I feel like we have taken a step in the

right

direction by getting the medicaid waiver but I don't really know how

to

proceed from here. Thank you for all your hard work. Paige

December 17, 2001

Dear Mr. Duncan:

I am not sure it is fair to the physicians at Memorial Hospital to write

that they will not treat a patient because " ...they are part of UHMS. " ,

unless you have specific personal knowledge of them.

I know most of the full time hyperbaricists in the US, and have been a UHMS

member since it was the UMS. Despite that 20+ yr. membership, I, like most

hyperbaric physicians, first make treatment recommendations based my

personal belief system as to the usefulness of any therapeutic modality upon

the disease processes of that patient, next the estimated risk/benefit of a

treatment for the patient, and only occasionally what any professional

society approves (whether UHMS or ACHM) a distant third.

In the case of hospital-based units, the chamber facility owner is often the

hospital, and the decision on what to treat is based upon the

recommendations of the hyperbaric oversight committee (or equivalent). If

that decision results in an approved list of indications, then that is all

that will be treated in their chamber. You might find that many of those

physicians would treat a wider variety of conditions if they could.

Hill

Re: [ ] Digest Number 53

, My son has Georgia medicaid throught the Beckett

deeming waiver.

Now how do I go about finding a facility that will treat my son

with HBOT

and bill it to medicaid? I called the local HBOT facility in

Savannah

(located at Memorial Hospital) and they said they do not treat

autism with

HBOT at their facility and that insurance will not cover it,

although I know

for a fact that that hospital is a medicaid provider. Do I need to

find a

local doctor who will recommend/prescribe HBOT before my son can

become a

candidate for treatment? I feel like we have taken a step in the

right

direction by getting the medicaid waiver but I don't really know how

to

proceed from here. Thank you for all your hard work. Paige

December 17, 2001

Paige.............If you find out please let me know!

Best Regards,

Marguerite

December 18, 2001

, I think Dr. Duncan was pretty accurate in his assumption. Since

most committees base their decisions on the 13 indications which is

acceptable to the FDA and these conditions came from the UHMS, what else

could it be. As a hyperbaricist and a member of the UHMS do you approve of

treating CP children and brain injury with HBOT? If you do, maybe you can

help out. If not, I think Dr. Duncans point is right on target.

Hartsoe

Re: [ ] Digest Number 53

>

> , My son has Georgia medicaid throught the Beckett

> deeming waiver.

> Now how do I go about finding a facility that will treat my son

> with HBOT

> and bill it to medicaid? I called the local HBOT facility in

> Savannah

> (located at Memorial Hospital) and they said they do not treat

> autism with

> HBOT at their facility and that insurance will not cover it,

> although I know

> for a fact that that hospital is a medicaid provider. Do I need

to

> find a

> local doctor who will recommend/prescribe HBOT before my son can

> become a

> candidate for treatment? I feel like we have taken a step in the

> right

> direction by getting the medicaid waiver but I don't really know

how

> to

> proceed from here. Thank you for all your hard work. Paige

>

December 18, 2001

I think I should have added one big question. Are you aware of the fact

that the UHMS is losing its credibility to those in the medical profession

outside of its membership? Are you aware that the FDA is now looking at

the IHMA as the organization that provides info and stats on HBOT instead of

the UHMS as in the past?

Hartsoe

Re: [ ] Digest Number 53

> >

> > , My son has Georgia medicaid throught the Beckett

> > deeming waiver.

> > Now how do I go about finding a facility that will treat my son

> > with HBOT

> > and bill it to medicaid? I called the local HBOT facility in

> > Savannah

> > (located at Memorial Hospital) and they said they do not treat

> > autism with

> > HBOT at their facility and that insurance will not cover it,

> > although I know

> > for a fact that that hospital is a medicaid provider. Do I need

> to

> > find a

> > local doctor who will recommend/prescribe HBOT before my son can

> > become a

> > candidate for treatment? I feel like we have taken a step in

the

> > right

> > direction by getting the medicaid waiver but I don't really know

> how

> > to

> > proceed from here. Thank you for all your hard work. Paige

> >

December 18, 2001

Dear :

1. Yes, but your assumes UHMS had much credibility outside hyperbarics.

Having participated in AMA Annual and Interim meetings as the delegate for

ACHM (which is accredited by AMA), I can tell you that hyperbarics is

generally a non-entity to organized medicine.

2. Yes, I have heard that from IHMA. I have not heard it from an independent

source. Unless FDA has changed dramatically, it is rare for them to limit

comment to a single group.

PS: You actually asked 2 questions.

Re: [ ] Digest Number 53

I think I should have added one big question. Are you aware of the fact

that the UHMS is losing its credibility to those in the medical profession

outside of its membership? Are you aware that the FDA is now looking at

the IHMA as the organization that provides info and stats on HBOT instead of

the UHMS as in the past?

Hartsoe

Re: [ ] Digest Number 53

> >

> > , My son has Georgia medicaid throught the Beckett

> > deeming waiver.

> > Now how do I go about finding a facility that will treat my son

> > with HBOT

> > and bill it to medicaid? I called the local HBOT facility in

> > Savannah

> > (located at Memorial Hospital) and they said they do not treat

> > autism with

> > HBOT at their facility and that insurance will not cover it,

> > although I know

> > for a fact that that hospital is a medicaid provider. Do I need

> to

> > find a

> > local doctor who will recommend/prescribe HBOT before my son can

> > become a

> > candidate for treatment? I feel like we have taken a step in

the

> > right

> > direction by getting the medicaid waiver but I don't really know

> how

> > to

> > proceed from here. Thank you for all your hard work. Paige

> >

December 18, 2001

Dear :

Have you been involved in hospital oversight committees on hyperbarics?

I've been personally involved in several, and involved in reviews for

hospitals, and various organizations from State Boards of Medical Examiners,

Medicare, and Depts. of Health and Human Services. Most hyperbaric steering

committees are initially completely unaware of any FDA approvals (but are

quite aware that off-label use of any approved drug is legal-lidocaine was

FDA approved for local anesthesia, but every ER used for cardiac arrhythmias

long before it was approved for hearts), and have never heard of UHMS.

Overall, unless there is a full time, formally trained medical director,

hospitals tend to approve whatever the vendor of the chamber or chambers

recommend, much to their later regrets.

I wonder why you attack UHMS, which really has little power beyond

expulsion of a member, and no power with non-members. As a former president

of a competing medical society, ACHM, I am not an obvious defender of UHMS,

but what you say is wrong. I think you focus on an easy target instead of a

useful one.

Why not take on someone with real power: Medicare? You want to see

neurological uses approved, then fix this one. It is a national program,

supports the most people, and is used a base of approval by virtually all

3rd party payers. Additionally, most of the non-storefront units in the US

live or die on Medicare. Physician reimbursement, which pays my 30

employees, has dropped by over 1/3rd in 5 years, and is dropping by 12-15%

(depending upon the state) for next year. Out-patient reimbursement under

APCs will drop almost 50%. What will that do to availability of services

even if you do get Medicaid coverage?

While you focus on children, have you thought that federal law prohibits a

physician from participating in the Medicare program, and billing a patient

for services specifically not approved by Medicare? [The only way to do it

is to formally exit the Medicare program, with a long delay to re-entry,

which is why pioneers like Dick Neubauer are not in the Medicare program.]

The data on the use of HBOT in stroke is much better than in CP, and this is

a MAJOR problem for rapid expansion into neurological use.

How about quitting attacking a strawman and going for the real problem: CMS?

Re: [ ] Digest Number 53

, I think Dr. Duncan was pretty accurate in his assumption. Since

most committees base their decisions on the 13 indications which is

acceptable to the FDA and these conditions came from the UHMS, what else

could it be. As a hyperbaricist and a member of the UHMS do you approve of

treating CP children and brain injury with HBOT? If you do, maybe you can

help out. If not, I think Dr. Duncans point is right on target.

Hartsoe

Re: [ ] Digest Number 53

>

> , My son has Georgia medicaid throught the Beckett

> deeming waiver.

> Now how do I go about finding a facility that will treat my son

> with HBOT

> and bill it to medicaid? I called the local HBOT facility in

> Savannah

> (located at Memorial Hospital) and they said they do not treat

> autism with

> HBOT at their facility and that insurance will not cover it,

> although I know

> for a fact that that hospital is a medicaid provider. Do I need

to

> find a

> local doctor who will recommend/prescribe HBOT before my son can

> become a

> candidate for treatment? I feel like we have taken a step in the

> right

> direction by getting the medicaid waiver but I don't really know

how

> to

> proceed from here. Thank you for all your hard work. Paige

>

December 18, 2001

, my point quite simply is, if the UHMS would approve CP and Stroke as

an indication treatable by HBOT, then it could be treated in the Medical

centers such as Duke. The UHMS has made it very clear to me that will not

happen without double-blind studies, yet only 4 of the 13 approved

conditions had such studies. A very hypocritical attitude, to say the

least. I understand the problems of treating off-label conditions as a

Medicare provider, however that will not happen without the UHMS. This was

told directly to me by the FDA many months ago. If you like, I will try to

find my notes and give you the individuals name. The point being, once

again, the UHMS could vote and approve neurological damage as an indication

treatable by HBOT and solve a lot of our problems. This would also force

insurance companies to pay.

One more thing, when I have tried to communicate with UHMS members including

Caroline Fife, I have seen arrogance and rudeness towards myself and others

as parents and independant freestanding HBOT centers. Yourself excluded, of

course. At least you have taken the time to address the issue which I

appreciate and feel is a step in the right direction.

They would like for me to simply go away, I will not. They would like to

see disappear, he will not. They would like to see all centers

treating non UHMS indications close down, they will not. We are here to

stay.

I am bothered by the animosity that I often see between professionals and

non professionals but I can also understand the reason for it. Human

nature is to fight vigorously for what you think is right. This can often

cause frustration which turns to anger. I apologize if I had that tone.

You have good legitimate points. So do I and " We " .

The one thing I understand about MD's is the need to not become personally

involved with patients when they see death and suffering on a daily basis

and they must be able to keep their emotions and sanity in order to do a

good job. That is true to a point. However, when they have the opportunity

to actually witness before and after videos, medical records, etc. of

children walking and talking for the first time, TBI's coming out of comas,

and the list goes on, to use the excuse that it is only anectdotal evidence

and therefore does not count is morally wrong and puts them in a category of

denying a patients rights to proper treatment. There is no justification

for this.

Hartsoe

Re: [ ] Digest Number 53

> >

> > , My son has Georgia medicaid throught the Beckett

> > deeming waiver.

> > Now how do I go about finding a facility that will treat my son

> > with HBOT

> > and bill it to medicaid? I called the local HBOT facility in

> > Savannah

> > (located at Memorial Hospital) and they said they do not treat

> > autism with

> > HBOT at their facility and that insurance will not cover it,

> > although I know

> > for a fact that that hospital is a medicaid provider. Do I need

> to

> > find a

> > local doctor who will recommend/prescribe HBOT before my son can

> > become a

> > candidate for treatment? I feel like we have taken a step in

the

> > right

> > direction by getting the medicaid waiver but I don't really know

> how

> > to

> > proceed from here. Thank you for all your hard work. Paige

> >

December 18, 2001

, I just wanted to say O. What wonderful and things to behold. I

think this is great. Keep up the good hard work.

Well for those of you who care...

I just finished my testimonial on HBOT experience, and PHEW, it equaled 4

pages!!! All that that was from just 41 treatments over a year ago with my

son. If anyone would care to read it, let me know and I can forward it.

Hugs

Tammy & Nate

December 18, 2001

Dear :

I understand your point about UHMS and Duke, but the fact is: if Duke

wanted to treat CP they could do it tomorrow. They could do a randomized

cross-over study which would insure that every participant got O2. For that

matter, odds are that if the hyperbaric med staff at Duke told their

administration that they believed this to be a safe and effective treatment

for CP , they would be allowed to treat. The problem is that they wouldn't

get paid for the treatments, and sooner or later, someone in administration

would notice that there chambers were busy, but they were losing money.

While your statement, " The UHMS has made it very clear to me that will not

happen without double-blind studies, yet only 4 of the 13 approved

conditions had such studies " is doubtlessly true, I think you missed the

point. Back when the initial FDA presentation was made, double blind studies

were not the standard of evidence, but they now are what is usually

required. Times and requirements change-that's not hypocrisy, it is

progress in decision making by FDA. UHMS has chosen a strict standard, but

one that is widely used today. To back-off from that strict standard would

expose all of us to severe scientific criticism. In that light, UHMS

requiring strict evidence is simply not repeating prior errors in approving

without such studies.

I am sorry that any physician was less than compassionate and polite to any

patient or family member. One thing to remember is that Caroline, who is a

very kind and smart lady, had no obligation to you if you were not

physically present for consultation as there would be no doctor-patient

relationship. If this was just a phone call, you may have caught her at a

bad time. As a thought experiment, what would have happened had you called

Fulbright and Jaworski, and asked to speak with one of them on the phone?

How much time would they have spent with you, someone with whom they had no

relationship?

One should certainly fight for what is right. The trick is to know what

that is. I find it all too often " right " to be a shifting target.

Re clinical detachment: I believe good doctors should become close to their

patients-they deserve personal care and compassion, not just the best

information and treatment. If you read JAMA you would find a wealth of

stories from physicians about such encounters.