Wednesday, April 05, 2006

Interesting UHMS Issues, from Don Chandler, Exec. Director, UHMS

Even though you might not be a member of the UHMS - most divers have an interest in the issues that Don Chandler discusses here.

To all--

In this email you will find information on the following issues:

1. Threats to Hyperbaric Medicine
2. UHMS Annual Meeting at Orlando
3. UHMS 40th Anniversary Meeting in Maui, Hawaii

1. Threats to Hyperbaric Medicine. I attended Dick Clarke's annual advanced symposium on hyperbaric medicine last week and attended the called meeting he organized for Friday evening to report on and discuss the threats to the practice of hyperbaric medicine. I thoroughly enjoyed listening to the papers during the regular sessions and then hung on every word as the speakers progressed through the called meeting sponsored by the Baromedical Research Foundation. Here is some of what I learned about the threats to hyperbaric medicine as viewed by Dick and some of our colleagues:
Payment determinations by third party purchasers of care.
Studies that fail to adapt standard hyperbaric protocols.
Government reimbursement policies; socialized medicine.
Academic, scientists and related position statements.
Evidenced-based medicine; databases and periodicals.
Perceptions regarding "approved" and non-approved uses.
Alternatives, biomedical advances in wound repair.
Safety concerns, adverse risk profiles.
The presenters at the called meeting were several and I pass to you some of the notes I took during the presentations:

Mike Bennett. Dr. Bennett informed the audience that Australia has problems with insurance providers similar to those experienced in the United States. He asked the rhetorical question, "Why are we in such a state?" Mike opined that it is because hyperbaric medicine is not taught in medical schools, some charlatans in the field are spoiling things for legitimate practioners, and disproof of high profile indications such as CP, MS, and others. Dr. Bennett went on to ask, "How can we turn things around?" Again he opined that we need to lobby, find some influential patients to give their life experiences with hyperbaric medicine, and accumulate good clinical evidence to present to whomever needs to see it. One of Mike's interesting points was that those who are practicing hyperbaric medicine are often beaten over the head by bean counters and that there have been some dispassionate reviews of the studies/successes in our field of medicine. He concluded his remarks by saying that we need more randomized trials but that funds are hard to find. We need these trials because we need to argue from a position of strength.

John Feldmeier. Dr. Feldmeier stated that the UHMS Hyperbaric Oxygen Therapy Committee report is our best and most influential publication. Good as it is some of the BC/BS leadership are challenging some of the conditions reported in the report. For example, he said that radiation injury was being challenged by "the blues" even though some were seeing as many as 60% of their patient load being treated for radiation injury...when John asked the audience for a show of hands as to how many were seeing as much as 50% radiation injury in their patient load, about half raised their hand; when he asked for at least 25%, the majority of the attendees raised their hand. Dr. Feldmeier suggested that it seems we are being held to a higher standard that other fields of medicine...he opined that it could be because hyperbaric medicine is not given in pill form nor in a hypodermic needle.

Wendy Buras. Dr. Buras presented some excellent ideas in response to her rhetorical questions, "Why have a basic science element?" "How can basic science complement clinical trials?" and "How can we determine beforehand which patients will respond to HBOT?" Dr. Buras suggested that if practitioners would take blood samples from each HBOT patient, and through good examination of those samples one could see the difference of HBOT responders vis-s-vis non-responders. She opined that such could potentially raise the efficacy of HBOT and lower costs. She went on to suggest that we need to pre-screen patients and develop molecular markers to identify responders.

Dick Clarke. Dick gave an overview of the Baromedical Research Foundation and mentioned the several clinical studies that are currently underway. He also stated that it costs about $25,000 to set up a clinical trial. He encouraged everyone to go the the foundation website at www.baromedicalresearch.org and pull up the clinical trials and other information that is there to become more familiar with what was going on already. Dick strongly encouraged anyone who had an interest in research to organize a clinical trial whether or not the baromedical research foundation was involved.

After taking several good questions from the floor, Dick concluded the called meeting with the following action plan:
Identify funding sources.
Identify participating institutions
Identify conditions for trials.
He encouraged each attendee to take about 30 days to think about what they had heard that evening and then respond with their ideas as to how we can move forward to challenge the threats to hyperbaric medicine, ideas for responding to the above plan, and to list the indications that need urgent attention.

To conclude this item, I hope I kept accurate notes as I would hate to misalign anyone who spoke that evening.

2. UHMS Annual Meeting at Orlando. Things are really shaping up for our annual meeting in Orlando. Soon you will receive a brochure that outlines the meeting. Remember, our blocked rooms are going fast, so please get your reservations made as soon as you can. Also remember that there are rooms at the Grosvenor, just across the street from our host hotel (Hilton) on Disney World. Lisa negotiated a room rate of $89 per day at the Grosvenor...and they are going to return $5 per room per day to the UHMS. How about that? We got about 130 abstracts (we had thought we had 180 until we discovered some were duplicates). Our Scientific Program Committee of Dr.'s Brett Hart and Laurie Gesell have again done an outstanding job...please make sure you tell them so when you see them in Orlando.

3. UHMS 40th Anniversary Meeting in Maui, Hawaii. Please keep in mind that you can register for our 2007 meeting on-site at our annual meeting in Orlando...and you will receive a discount for early registration. We will also be raffling one registration (including the banquet for two), a three-night stay at the Ritz, and reimbursement of a round-trip coach airfare from Los Angeles to Maui at the 2007 June rate. The science? It will be outstanding! How do I know this? Because we have outstanding members who develop outstanding papers that are helpful to all who are in the fields of Undersea Medicine and Hyperbaric Medicine. Also, if you are one who would like to take a Saturday to Saturday live-aboard dive expedition, the boat has only 14 bunk spaces...call Dick Smerz at (808) 587-3425 to reserve your spot.

That's all for now, folks, soon we should have an update on the BC/BS issue and as soon as I get the update I will be in touch.

Don