Are the BBC drug pushers ?

The BMJ “Editors Choice” headline this week was “Key opinion leaders, your time is up”. The editor Fiona Godlee asked “Why is it considered normal for medical leaders to accept personal payment for promoting a company’s drug or device?” She was referring to the BMJ article “Drug Marketing” which interviews former pharma sales representative Kimberly Elliott about  Key Opinion Leaders. “These people are paid a lot of money to say what they say,” she said. “I’m not saying the key opinion leaders are bad, but they are salespeople just like the sales representatives are.” “Influential doctors can earn up to $400 an hour”.

Perhaps a little more surprising is the BBC’s  lazy reporting on the use of anti-inflammatory creams for osteoarthritis “Treat knee pain  with creams call”. The BBC report says that “both tablets and creams containing the drugs had the same effect on knee pain, the study showed”. No comment on how short lived the effects are or how weight loss, exercise, acupuncture or laser might be more effective and have no side effects. Perhaps the BBC should have read their previous report on this matter “Arthritis drugs fail after weeks”. For the public the BBC is also a Key Opinion Leader, it is rightly proud of it’s journalistic independence, but this kind of laziness is same as being “bought”, it’s just that they do it for free !

I was chairing the musculoskeletal session at NAALT last weekend, during the Q&A at the end, one of the expert panel commented that LLLT / cold laser / photobiomodulation research should be published less in the medical laser journals and more in the relevant professional / pathological journals. This got a strong response from some of the conference delegates and the Chair (myself) citing the volume of good clinical work published across a wide range of medical journals and despairing at problem of eminence based practice rather than evidence based. Upon hearing that, Mary Dyson, (former Editor of Gray’s Anatomy) who, for 20 years has insisted on research and wide publication in credible medical journals,  suggested that, perhaps, now it is time to publish in that other  Key Opinion Leader bugle “The Readers Digest”. There was a roar of approval from the other delegates.

You can follow the links above or read the text here Continue reading Are the BBC drug pushers ?…

Elbow room for improvement

Here is another systematic review of from the Norwegian, Brazilian, British and Greek stable.

A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow) 

As  usual it finds that less power density is more effective (less power density, but more time) for reducing inflammation and improving tissue repair. It is a recurring theme on this blog and I hope you are making a note of it.

A pain in the …. Annals

The Annals of Internal Medicine published a review of the evidence of medications for acute and chronic low back pain. These are the clinical practice guidelines for the American Pain Society and American College of Physicians (available here via Pubmed). Laser did not get a recommendation because “no suitable reviews of LLLT were identified”.  It’s worth reading a letter to the editor that strongly criticizes the overview methodology and makes a case for LLLT. click here for the letter to the editor

Reuters Health

For decades the Cold Laser / LLLT pioneers have preached to each-other about their work and published in LLLT dedicated journals. It is nice to see more LLLT being reported in other medical journals and in the main stream press. In my bi-monthly Literature Review for PMLS 30 papers were published outside the Laser press

Today Reuters Health Interviewed Jan Bjordal about a paper he co-authored and published in the American Journal of Sports Medicine

http://www.reutershealth.com/archive/2008/05/14/eline/links/20080514elin001.html

Continue reading Reuters Health…

Top prize for laser paper

Not much I can add to this other than it is his second award this year from an orthopaedic conference for best paper.

Fra: Jan Magnus Bjordal
Sendt: lø 12.04.2008 11:37
Til: Roberta Chow; Rodrigo Alvaro B. Lopes Martins; M.Johnson
Emne: SV: SV: Your Submission to The Lancet

Dear all
Our neck pain review with laser therapy won the main award (!) of the joint national neck and back pain congress in Oslo (400 physicians, spinal surgeons, physios, manual terapists and chiropractors are attending there).

I went home to Bergen yesterday because I did not expect it. They have just annonouced it in Oslo. I tried to get a plane back to receive it but I could not find one.

Jan M

Cold Laser - whats in a name ?

At the NZ2008 laser meeting last week we debated the nomenclature surrounding the popularly named “Cold Laser Therapy” as it seems most often called in the USA. In the UK the most common phrase now is Laser Therapy though for a while it was Laser Biostimulation, US government employed scientists call it Photobiomodulation, it used to be called Laser Biostimulation by the American Society for Lasers in Surgery and Medicine, who last year adopted Photobiomodulation instead. Pubmed have chosen LLLT (stands for Low Level Laser Therapy) as the MeSH term (MeSH stands for Medical Subject Heading) however they lave used that label for almost every form of medical laser treatment (low level or otherwise). This was a term coined by Oshiro and Calderhead back on the 1980’s. For the record I am fan of calling it Photobiomodulation and I have managed to get that as the term adopted on Wikipedia a couple of years back (hooray for me).

This exercise was triggered by an article in the Independant newspaper today “Doctors warn of ‘cowboy clinics’ if laser therapy is deregulated“. It is an article about government deregulation of IPL for hair removal and is just one tiny example of how the distinctions around medical laser devices are not being made. I wonder if the journalist has any idea that at another end of the scale lasers improve tissue repair, reduce inflammation, reduce pain and some would argue even stimulate hair growth (Mester to name but one example).

Here are some words and phrases I have collected over the years:

Bioregulating Laser
Biostimulating Laser
Broad Band Radiation Therapy
Cold Laser Therapy
Diode Laser Therapy
He-Ne Laser therapy
helium-neon laser irradiation
Infrared laser light
Laser Acupuncture
Laser Biostimulation
Laser Irradiation
Laser Phototherapy
Laser Therapy
LED phototherapy
LED therapy
LELT (Low Energy Laser Therapy)
LEPT (Low Energy Photon Therapy)
Light Therapy
light-emitting diode phototherapy
LILT (Low Intensity Laser Therapy)
LLLT (Low level Laser Therapy)
low fluence diode laser irradiation
low level light treatment
Low Light Laser Therapy
Low Power Laser Irradiation
Low Power Laser Therapy
Low Reactive Level Laser Therapy
lower-level laser therapy
Mid Laser Therapy
Monochromatic Infra Red Energy
Monochromatic Infrared Photo Energy
Monochromatic Light Therapy
Monochromatic phototherapy
near-infrared light therapy
NIR laser therapy
nonablative laser therapy
PBM (Photobiomodulation)
Photo Irradiation
Photobioactivation
Photobiomodulation
Photobiostimulation
Photomedicine
Photon Therapy
Photoradiation
Photostimulation
Phototherapy
Physiotherapy Laser
Polarised Polychromatic Light
Polarised Radiation
Red light phototherapy
Soft Laser Therapy
Therapeutic Laser

P.S. it is also quite common for laser wavelength and / or lasing medium to be added to the title . common examples are 810nm laser diode therapy for xyz. In case you are not familiar with the common wavelengths and materials used they are: 660nm 810nm 830nm 904nm

Full list as follows: 632.8 650nm 635nm 660nm 670nm 680nm 750nm 780nm 705nm 908nm 810nm 820nm 830nm 850nm 870nm 880nm 890nm 904nm 905nm 950nm

Materials: GaAlAs, Gallium Aluminium Arsenide, GaAs, Gallium Arsenide, HeNe, Helium Neon, AlGaInP, Aluminium Gallium Indium Phosphide.

Phil Passy, Founder of MedX Health dies

I was shocked when I heard that Phil Passy died unexpectedly 22nd February 2008. Phil was Founder, President and CEO of MedX Health and a fellow industry pioneer. I first met Phil in the year 2000 in Athens, Greece at the World Association for Laser Therapy meeting when he boldly asserted that one day LLLT products would move from highly individual products competing on technical differences to a near commodity product as industry standards for the technology and treatments were agreed. It was a visionary statement that I thought was crazy but now I believe he will ultimately be proven right. Any new technology requires passionate and persistent personalities behind it striving for years to achieve widespread adoption and Phil was one of bravest and hardest working figures in the industry. He radiated passion and his dogged persistence has created a publicly listed company leaving an indelible mark on the history of LLLT. Medicine is an exceptionally tough field to create a radical breakthrough in and whilst many have resorted to snake oil sales methods, Phil always took the high road and created an ethical company making conservative / realistic claims for the products and services offered. Phil can rest in peace knowing that he was a good man, doing good work for the health of mankind and that he played an important role in establishing LLLT and moving industry forward. Thanks Phil.

Oh no, not another LLLT society

It’s not new, but it is clever. The American Society for Photobiology Kendric Smith makes the case for academics improving their knowledge of photobiological fundamentals.

Laser and LED Therapy is Phototherapy

All too frequently the people in the laser [and light emitting diode (LED)] phototherapy field are untrained in the basics of photobiology. This can lead to bad science and bad clinical trials, and can contribute to conflicting results concerning a given endpoint. Furthermore, it diminishes the stature of the field, and delays the admission of laser (and LED) phototherapy into the mainstream of science and medicine.Kendric C. Smith, Ph.D., Professor Emeritus of Radiation Oncology (Radiation Biology), Stanford University School of Medicine, Founder and First President of American Society for Photobiology.

Continue reading Oh no, not another LLLT society…

No news to report

There has been nothing monumental going on in the world of LLLT this last 7 days (my blog week starts on a Wednesday in case you are wondering). ASLMS and NZlaser2008 are both in April so I chose New Zealand. I subsequently received five separate requests to be in Florida in the last few days so maybe I will concede and see y’all at both.

LASER ACUPUNCTURE DOSE RANGE AND DOSE RATE EFFECTS

I am interested to get feedback on this. If we can suspend the debate about what acupuncture is and how effective it is for a minute …. it is my observation that a wide range of laser devices are used in acupuncture. Red* and near infrared*, 1mW to 500mW.

It is well documented that laser can inhibit as well as stimulate cellular function (read more here). Dose ranging studies and dose-rate (fluence rate) studies have been performed and we find that the thresholds for stimulation are quite low (at the target tissue level) and that they are in the range 5 - 30mW/cm2 (though this depends on what method of beam measurement was used by the original authors)(read more here)(and more here).

I would expect that the same wavelength, dose range and dose-rate issues will be true for acupuncture but do not recall seeing anything published. A quick glance at Pubmed finds 407 articles witeh the words Laser Acupuncture (click here to see) but zero return when the terms dose rate, dose range or fluence rate are added to the search.

We need dose rate studies and even more research with ineffective outcomes to help identify what actually works.

*(typically 632.8 and 660nm for red and 810nm - 830nm + 904nm)