Category Archives: Rants

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

It must gall to have performed a controlled clinical trial for a year only to find at the end that your physics department had adjusted the active laser such that it did not perform as planned.

The trial by Tumilty et al (TITLE: Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial) set out to deliver twelve treatments of 100mW/cm2 of 810nm laser for 30 seconds to 6 points (3J per point) on the Achilles tendon over a 4 week period, but something went wrong and the treatment failed to have any significant effect over placebo.

What went wrong: The university physics dept had been asked to adjust the 810nm 100mW, 2.5W/cm2 power density to 100mW/cm2. They achieved the 100mW/cm2 by expanding the beam, but unfortunately they also decided to reduce the aperture to 0.07cm2. This had two unfortunate effects, the 100mW beam became reduced to 7mW and the beam did not adequately cover the pathology. So only 0.21J was delivered and only a tiny part of the pathology was treated.

WALT guidelines say 2-3 points should be treated with 8 Joules, the beam power density should not exceed 100mW/cm2 and irradiation should cover most of the pathological tissue. So this trial was a long way short of the recommended energy and it did not adequately cover the pathology.

Unfortunately these errors are hard to find in the paper. The “method’ reported states that the laser was 100mW, the power density was 100mW/cm2, treatment time was 30 seconds, giving a dose of 3J per point. It is only late in the “discussion” that the errors are presented.

Throughout the paper it is implied that the correct parameters were used and the WALT Guidelines were adhered to, but that is not true. It is not apparent in the paper that the tube had a cap at the end and that it had a 0.07cm2 hole drilled in it. Our initial presumption was that he tube was an empty tube, it was only after correspondence with the authors that we learned these extra facts.

What worries me is that this trial will be used in systematic reviews or as evidence against LLLT or the WALT guidelines

Don’t make these mistakes on your patients or in research, register for a THOR training course and learn about parameters, dose calculations and treatment methods, especially if you intend to run a clinical trial and maybe contact me to help get your trial parameters right,

click here for training

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