Category Archives: Rants

It is a popular sport in the LLLT industry to sneer at Big Pharma for their side effects and marketing practices, but the LLLT industry is far from criticism itself. Whilst LLLT side effects are hard to find, marketing overstatement and misdirection are common place.

In this months literature watch is a paper titled “The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis”. This small study showed that 10 Watt Class IV laser (mixed 8W 970nm, 2W 810) was successful in reducing pain and improving function in an RCT with 15 patients, and that there was good statistical significance at 6 months following a course of 6 treatments.

The claim by class IV laser manufacturers is that class IV lasers are better (faster, deeper and more effective) than Class 3b and LED systems. Conversely the 3B laser and LED manufacturers argue that less power density is more effective because delivering energy too quickly can overdose tissues and class IV lasers might burn the skin.

Throughout this paper there are marketing messages claiming the advantages  of shorter treatment times than low power LLLT systems and of course the title  shouts “10 Watt Class IV laser” just in case the reader is in any doubt that more power is what you need.

Regular readers of this column know my obsession with irradiation parameters, particularly dose rate effects (W/cm2) and will not be surprised to learn that I deconstruced the irradiation parameters used in this trial . Surprise, surprise they were the same low irradiance levels typically used by 3B lasers and LED systems, if not less and the treatment time was longer too.

Yes, it was a 10 Watt laser and yes, 3,000 joules was delivered, however it had a very large beam area and treatment was delivered over a very large area (45cm2) in a “painting fashion”. The fluence (dose) was 6.6 Joules/cm2 and the power density was a tiny 22mW/cm2, consequently  treatment time was a hefty 5 mins.

The average irradiance was not disclosed in the paper and the reader is directed to think that more power is quicker. Perhaps LLLT companies are no better than the pharma industry when it comes to disseminating specious information.

P.S.  research trials with 3B lasers are typically 30 seconds to 3 mins and our recommended treatment is 1 min with a large LED cluster to the lateral epicondyle and 30 seconds for any related trigger points.

Attend a THORLaser One Day Training Course to see the research and get all the information in making an informed decision: https://www.thorlaser.com/courses/

In the BMJ Last Saturday Anita Jain wrote “Gold jewellery, cars or an exotic foreign holiday, these are among the luxury gifts listed in a parliamentary committee report as being used by pharmaceutical companies to coax doctors into prescribing their drugs”. She goes on to describe the “3C strategy” employed by drug companies. “convince if possible, confuse if necessary, and corrupt if nothing else works”. Many (she says) will say an emphatic no to luxury gifts, but what about discounts, conference fees, hotels and flights?

Since we have been working with more doctors these days (rather than therapists) I am being approached with requests for hotel and flight costs and I confess I have conceded.

Why does this happen?
a) Because this is the world they live in (i.e. it is normal to have industry pay)
b) Academic and educational budgets are tight and industry has more money than it knows what to do with (they think).

So what should I do ?

I have conceded and paid out a few times, but not with any enthusiasm as we are not yet making $ billions in profits, but my conscience wrestles with it. I do not want to be guilty of behaving like bad pharma but then again I want our product to be accepted by mainstream medicine, so what should I do?

Comment below

At first glance this cellulite paper looks like a well designed study, but if you are familiar with LLLT parameters then you may notice something odd about them:
6 treatments (3 x week for 2 weeks) this is probably a good treatment interval
8 x 10 inches (516 cm2) that is a very large area
5 x 17mW Green 532nm this is a poor penetrating wavelength
Combined power of 102mW that is a tiny amount of power for such a large area
Irradiance 0.2mW/cm2 that is less than sunshine on a clear day
15 mins twice (two side of the body) that is a long treatment time
Fluence (dose) 0.18J/cm2 per side that is not enough to do anything

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Blue Cross and Blue Shield Kansas (BCBS) have updated their assessment of LLLT and it is still considered “experimental” despite referencing the “strong evidence” conclusions in systematic reviews published by the British Medical Journal (BMJ) and International Society for the Study of Pain (IASP). Then there is The Lancet Systematic Review on Neck pain and the MASCC “recommendation” statements, also brushed aside by BCBS.

How can this be when: (more…)

A letter by Bjordal et al was published addressing the tendinopathy study published Tumilty et al. Entitled “Lack of adherence to the laser dosage recommendations from the world association for laser therapy in achilles study”, full text below.

Tumilty et al reported delivering 0.21J per point however the WALT recommended energy per point in Achilles’ tendinopathy is 2.7 to 4.0J, so the authors did not adhere to recommended parameters from WALT.

Tumilty et al disagree but provide and inadequate argument as to why they claim adherence. Yes the the power density good and the treatment time was good but the beam size was too small and consequently the energy was wrong.

This matter was acknowledged in their published paper but was buried in discussion section rather than being acknowledged in the abstract or materials and methods where they claimed adherence to the WALT guidelines.

Future systematic reviewers of LLLT for tendinopathies must be made aware that the claim that their trial adhered to WALT guidelines is false.

This paper will weaken the effect size of future systematic reviews so I am using my blog to help highlight the Bjordal letter for reviewers to find on the future. See below.

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The BMJ reported that the US Centers for Disease Control and Prevention had declared there was a national epidemic of prescription drug overdoses which LED to 14,800 deaths in 2008. This is more than cocaine and heroin combined for the same period. If you think this an exaggeration click here to see the full government report.

They highlight the following key points :

• Death from opioid pain relievers (OPR) is an epidemic in the United States.
• Sales of OPR quadrupled between 1999 and 2010.
• Enough OPRs were prescribed last year to medicate every American adult for a month
• Abuse of OPRs costs health insurers approximately $72.5 billion annually in health-care costs.

And just in case you were not astonished already, I will remind those of you that have not heard me say it before that NSAIDs were the 15th biggest cause of death in the USA according to the New England Journal of Medicine 1999. Unfortunately there is no abstract so I am going to show you a little snip from the full paper

If only there was an alternative ;-)

Send me your comments below

I went to the Healthy Nation conference in London last Wednesday where the Rt Hon Stephen Dorrell MP, Chair of the House of Commons Health Select Committee was interviewed by Victoria Macdonald, Health and Social Care correspondent, Channel 4 News

He said that demands on the UK NHS have been rising at a rate of 4% a year since 1965 but the budget for health had increased at a rate of only 3% a year over the same period and it can’t be raised any more. To make the challenge even harder, our Chancellor of the Exchequer (George Osborne) has announced plans to save £20 billion in the NHS by 2014

I have done some sums and worked out the following:

At the time of the invention of our NHS, the average school leaving age was 15, people worked until 65 and died shortly after. So they were productive and paying taxes for about 50 years. On the flip side they were non-productive and somewhat of a burden to the state (in education or healthcare or state pension) for just 15 years.

Now with half the kids these days being encouraged to attend university, the average school leaving age is around about 19 years old; if they work until 65, they will have put in just 46 years work, but not die until nearer 80. So they will be non-productive and somewhat of a burden to the state (in education or healthcare or state pension) for 34 years!

This lifespan to workspan ratio is unsustainable

And that is not all

The demographic time bomb means that we have less and less working people to pay taxes for more and more creaky and confused (dementia / Alzheimer’s) old folk.

What the NHS needs is a non-recurring, low cost, home treatment that reduces pain & cognitive disability and increases productive lifespan

Can you think of anything that might do that ?

Home use LLLT is a fixed one-off cost therapy that should last for at least a decade per device. Produced in high volumes these could cost just hundreds of dollars each. They are significantly more effective than NSAIDs, less toxic and costs less money.

What would it take for a government somewhere in the world to insist that LLLT is used as a routine therapy in medicine?

Much more on the demographic time bomb topic written here