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Comment by dumbneurologist | Hacker News Reader

Disclaimer: I am a neurologist

The enthusiastic replies on this thread are understandable, but disappointing to see: we all need to be less credulous regarding the lay science press, and especially the lay medical press.

I would love nothing more than to have this kind of therapy be a reality for my patients. However, I am deeply skeptical of this report.

Why? Because

- hyperbaric oxygen therapy has a big industry of quackery behind it[1][2]

- oxygen is a standard part of medical care and can just as easily be harmful as helpful

- because there is just no way in hell that oxygen is going to reverse cell death.

- this is in newsweek, and not a peer-reviewed journal.

And if there was no cell death, then the recovery is almost inevitable.

Some posters are skeptical because 15 minutes is impossible.

On the contrary: the key point is the temperature. The article says the water was 4 degrees C. That is cold enough that you can recover fully. In fact, the most amazing recovery is also one of the best-documented: with a 66-minute submersion in Utah that was followed by complete recovery[3] (this is a far more interesting article than the original post - it was in 1988, and utilized extracorporeal rewarming). This observation was used to pursue hypothermia in other causes of anoxic injury, which is clinically used today. I'm sure the 66-minute case also got oxygen during the recovery, but to say that it was due to oxygen (which is standard of care) rather than the temperature is silly.

Sorry to be a wet blanket, but this article is just clickbait junk.

1. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.h...

2. https://www.quackwatch.org/01QuackeryRelatedTopics/HBOT/hm01...

3. http://www.nytimes.com/1988/07/26/science/the-doctor-s-world...

View on HN

I am a neurosurgeon, and am also skeptical. Here are some thoughts after looking at the actual paper in Med Gas Research.

First, after looking at the MRI, I see more evidence of cerebral edema than of infarction. The MRI sequence that would show the actual infarction, DWI is presented, but as a 3d volume(which I have never seen done before with DWI) and does not show the thalami where most of the FLAIR hyperintensity is.

Second, Unlike what the article would have you think, there is not massive cortical infarction. In fact the cortex looks not too bad. The main lesions appear to be bilateral thalamic edema. Note that thalamic dysfunction can present with severe neurological deficits often mimicking massive cortical dysfunction.

Third, measuring volumes in an MRI that is not taken at 1mm slices can be problematic. Thus where the authors talk about volume differences may just be slice variations between scans.

Fourth, I would have expected something this groundbreaking to be in NEJM, JAMA, BMJ, Lancet, Stroke, or Neurology. Medical Gas Research is a very obscure journal.

Fifth, Paul Harch is way outside the medical mainstream. During the Terry Schiavo case in Florida he was one of the people arguing that she was not in a permanent persistent vegetative state. It seems like he pushes hyperbaric oxygen to treat a host of brain disorders such as cerebral palsy, autism, stroke, traumatic brain injury. There is very little actual scientific studies backing up these assertions.

So overall, I am very skeptical about this article. In addition, usually when groundbreaking science is presented by the press, you often have an expert in the field who was not involved with the study, talk about methodology, background, and implications. This article did not do so, making it all the more suspect. I think, ultimately this is another Newsweek poorly researched click bait article.

Thank you both for taking the time to create accounts and respond. Both of these responses are amazing, and it's lurkers/posters like you that make this site great.

One question: some of your responses attack only the credibility of the speaker (OP's 1st, 4th and your 4th, 5th points). Is this typical in scientific discourse? They seem to detract from your analysis to me.

Contrary to popular belief (and internet logical fallacy experts), attacking the credibility of the speaker is a perfectly fine thing to do. The quality of the speaker is often times a pretty good indicator of the quality of the message.

Indeed. Just because a conclusion is based on logically fallacious arguments doesn't mean it's untrue, or that the arguments should have no persuasive power whatsoever. (Taken to its logical extreme, even a stopped clock is right twice a day.)

Attacking the arguer's credibility isn't fallacious if their argument depends in any way on their credibility, as it clearly does in this Newsweek story.

I'm not familiar with that exception in logical thinking. What argument is logically dependent on someone's credibility?

For instance, this Newsweek article and the claims made by the doctor in it depend on the doctor's own reports of their interpretations of MRI scans. Observing that the doctor making those interpretations is disreputable is an important and logically meaningful point.

Really what you're observing is that the argument in Newsweek sidesteps logic and appeals implicitly to the authority of that doctor. Presented with the argument that the subject of the article is credible enough to be believed on their own terms, we're left with a debate about that subject's credibility.

The weird idea embedded in this meta-debate is that alone among all the innumerable topics we can address with logical argument, from rankings of Led Zeppelin songs to the proper distribution of ownership of the means of production between capital and labor, the credibility of a human being on any particular subject is exempt from scrutiny, lest we fall into the trap of "ad hominem".

It's not necessary to drag one's assessment of their credibility into this at all, though. Points 1-3 of the original post are all that need to be argued.

https://news.ycombinator.com/threads?id=throwaway7890

Credibility is not "exempt" from scrutiny, it simply doesn't change the truth value of any factual statements about whether the treatment works. If it somehow could change the truth of whether this approach worked or not, then if this guy presented the opposite conclusion, somehow this treatment could either start or stop working based only on the person's opinion and reputation.

There's obviously no causal mechanism for that to happen and believing it would require magical thinking. So arguing over it is irrelevant and inserting it into the argument is pointless. We instead can properly say that he hasn't answered a lot of good questions about his approach or presented sufficient evidence to believe in it, which is the rational approach.

In pure logic, credentials don't matter. However we're discussing something that is not pure logic (i.e. we are relying on the author's expertise and insight, and the publication to accurately represent that), so credibility is certainly relevant.

Argument from authority. A said X, A is an authority on X, Therefore, X is true.

This is a valid inductive argument. It is valid when A is an actual authority, when they are speaking truthfully, etc. It doesn't guarantee the truth of the conclusion but it is a fine argument. How do you know Booth shot Lincoln? You read it in a textbook, the textbook is written by someone who is an authority on history or that part f history, etc. It isn't deductive (like a proof in geometry or logic) but it is a good argument. Many logic books call argument from authority invalid and what they mean is that it isn't deductively valid but it is an inductively valid argument form (If it were always invalid, we would be quite mired in ignorance).

Other people have made good replies, but this is also a pet peeve of mine, so I'm going to jump in as well.

Another way to think about it is as witness testimony.

When you do a logical, mathematical proof, you are building on a well-defined and well-known set of axioms, using well-defined steps of logical inference. With a few well-known exceptions, we don't argue over mathematical proofs. Either the logic flows from the axioms or it doesn't.

Once you step away from pure mathematics, you no longer have a small number of well-defined axioms or clear inference. Instead you have a lot of what amounts to witness testimony. Sometimes, you recount an observation. "X drowned and was dead for 15 minutes." "X had brain damage." "X fully recovered." It is reasonable to dispute these statements based on the credibility of the person making them.

Some of these statements may be the product of inference, which is also less clear than logical inference. For instance, "X has brain damage." might have been inferred from "An MRI of X looked like Y." and "Y indicates severe brain damage." Now you have a host of ways where the statement could be wrong, based on the reliability of the person making the observation and the inference. Did the person actually take an MRI, or were they lying about it, or did they misread it, or did they actually rely on a third-party who did one or the other? Is the inference method "Y indicates severe brain damage" valid? Did the person in question correctly apply it?

People don't like to attack the credibility of others; it seems mean and it can easily slip into elitism. But examining the credibility of someone presenting evidence is absolutely critical to truth-finding. Personal integrity is an absolute necessity, in science, medicine, and law.

Pointing out that someone is a quack is a really effective refutation of their arguments. If you were arguing about WWII history with someone, might it not affect your trust in their credibility if you found out they were a Holocaust denier? Or if you're arguing geography with someone and it's pointed out that they're a flat Earther?

Pointing out someone is a quack is also a great way to keep differing opinions out of a discussion and thus make sure that rational discourse is avoided on issues that are useful to the person pointing.

It's always useful to think of these situation in circumstances where you don't have any emotional involvement because otherwise you mind can play tricks on you.

For example imagine you are a European Scientist who really wants to fit every animal onto tree structure with mammals over here and squid here and all the animals fall into some easy to understand structure that makes total sense to you.

And some weird guy comes back from Australia with natures most awesome animal the platypus. A furry creature that lays eggs with poison feet. Your simple identification chart is totally jacked. It way easier to say he is a quack that evaluate the evidence you don't like. Heck it's totally inconvenient that your life's work is wrong, it's going to cost you money and esteem.

tldr; pointing out a quack is a great excuse for avoiding evaluating their arguments but refutes none of them. Everyone's time is valueable and figuring out what adventures to spend it on is important. Confusing that reasonable justification of where to spend your time with their argument being false is a dangerous habit to get into. You end up always thinking you are right and avoiding things that challenge your beliefs.

It's an Internet myth that the credibility of an argument's source is out of bounds in a debate. If and only if the arguer's credibility has no logical connection to their argument, then attacking the arguer is fallacious. Otherwise, as is very much the case here, it is not.

Good point. I think people may confuse logic with believability.

I could propose in this comment a cure for cancer based on a perfectly sound a logical argument and my (lack of medical) credibility would have zero affect on the cogency of what I was saying.

But it does mean, you should probably not be convinced, or at least not send me all of your money to invest in my cancer research startup.

Also for some reason it's very easy to judge something as reasonable when we actually don't have any domain expertise. Not sure why, it seems built into most of us to feel natural.

I'm not going to give an inch on this. This isn't an issue of logic versus persuasion. It is logically valid to attack the credibility of an argument that depends in any way, implicitly or overtly, on the credibility or authority of its bearer.

The "ad hominem fallacy" is misused on the Internet probably more than it is applied correctly.

I don't think you have to give an inch. I'm agreeing it's legit to judge someone's argument based on credibility.

The reason is imperfect information. If I described here an actual, real, cure for all cancer, people shouldn't believe it because credibility is shit, it hasn't been clinically proven, and it might take 10 years to do so.

If I write in a solid proof for a millennium prize problem, you're probably going to be safe not worrying about my credibility at all because the truth will be known in pretty short order.

Usually the more uncertainty the more credibility has to be weighted.

> If and only if the arguer's credibility has no logical connection to their argument, then attacking the arguer is fallacious.

The arguer's credibility does not affect the truth value of any statements, so it's always more useful to argue over why someone is wrong. You cannot guarantee that any segment of the population agrees with your credibility assessments. And these assessments should be established via appeals to factual evidence to begin with, anyhow, if we're to believe they should carry any weight at all. Otherwise, we're arguing over feelings instead of facts.

For people with wild, unsupported claims, it's better to simply take the tact that we have not yet seen evidence that establishes those claims and that what's on offer presently does not meet the necessary burden. In that argument, it really doesn't matter who is making the claim, only that the claim itself is not supported.

> The arguer's credibility does not affect the truth value of any statements

It is evidence which you should weigh in deciding how much credence to give their statements.

> so it's always more useful to argue over why someone is wrong.

It's a tradeoff, so there's no obvious bright line with which everyone will agree. But certainly there are some people for which some arguments or claims can be reasonably dismissed out of hand, relative to the preferences of the person making this decision.

If it's evidence, then it must have an effect on the truth or falsity of the statements. So if X says "the sky is blue" then X's credibility must be causally related to whether or not the sky is blue. As there's no such mechanism, this is pointless.

You essentially point out that it's an easy shortcut. And it is, but there's no good reason to take it. One's feelings of credibility do not change the truth value of any statements and so arguments over it are not useful. You will end up arguing over whose feelings are superior and not over observable facts.

When presented with a statement, what matters is the probability that the statement is true. The credibility of a source is strong evidence in this regard and can be used to sway the probability mightily. You're right, of course, that arguing over the credibility is pointless, but an appeal to authority is not fallacious if you and I both agree on the authority.

(Though an appeal to authority is a perfect setup for a motte-and-bailey, so it's important to be wary. Also, it is not, nor ever can be, proof, since that should hold irrespective of authority.)

Yes, I can understand using a mental shortcut by evaluating something simpler that's well-correlated with the truth value. However, this generally runs afoul of Goodhart's law at some point and we invest entirely too much work into something that's meant to be a shortcut.

Moreover, when it's an argument, you want others to agree with you. If you have to take shortcuts and infer the truth of something by proxy because you are either too lazy or not capable of evaluating the matter directly, you probably have no business arguing over it in the first place when you could instead apply your expertise to show how wrong it is.

Worse, your own correlations work against you, as you can now correlate that someone who cannot or will not do that work in making an argument, dragging irrelevant (if sometimes correlated) things into the argument becomes a signal for someone using non-factual means to persuade, which necessarily correlates quite strongly with making false claims.

In short, yes, it can be simpler and it can lead you to being right, if for the wrong reasons. But nobody else has good cause to trust it, it's vulnerable to manipulation, and it's simply better in all cases to be less lazy and fully explain why something is wrong using facts instead of opinions of someone's credibility.

The arguer's credibility has no bearing on the truth value of purely logical arguments that can be fully evaluated within the four corners of the argument. Very few scientific assertions fit that rubric. In the ordinary case where a conclusion is at some pointed predicated on an unknown fact, then the credibility of the speaker absolutely matters.

Saying that a person's credibility decides the truth value of the statement requires a causal relationship. To say otherwise is to posit a mechanism via which one's opinions somehow shape reality itself. So it seems to me that our notions of 'fact' might not be aligned?

I understand evaluating someone's credibility as a proxy when I have no means of investigating something. I do not understand it when we are talking about scientific assertions, which must be falsifiable in order to be scientific in the first place.

If you aren't the one attempting falsifying it, then you still have to trust somebody based on their credentials.

If you aren't the one attempting to falsify it, then you have no reason to argue over it to begin with, in which case you won't be making any ad hominem arguments to start with.

If that were the case, most people in this thread shouldn't be posting (arguing) but personally running their own medical trials. Any other source would in some way require trust in that source's credentials.

That's of course a bit black/white to say, most arguments don't hold if you push them to their extremes like that. I said it because I believe (your) arguments like "saying that a person's credibility decides the truth value of the statement requires a causal relationship" are similarly black/white.

So yes, in a way the disagreement hinges on a very strict interpretation of the word "fact" versus a less strict interpretation.

It's also to save time in evaluating claims like these. If you've spent any amount of time arguing about pseudoscientific topics (or considered pseudoscience by some), you must have found that yes you can in theory evaluate all[0] (dubious or not) claims in logical, scientific, falsifiable manner. But at some point, especially in pseudoscientific-ish topics, there will be such a great number of claims[1] that you'll find yourself spending most of the time refuting spurious claims rather than actually getting any further.

At that point, you'll never get to the strict definition of the word "fact" (at least, about the particular claim that is the topic of interest), because the claims just keep piling on faster than you can evaluate them. Allowing for a bit less strict definition, allows you to prune the evaluations greatly, and at least allows you to get somewhere.

Now, that struggle doesn't seem to take place in this thread on HN, but according to user "dumbneurologist" it has taken place before elsewhere. And you're still taking that person's word on a matter of (merely claimed) reputation as well.

So yes, there is something to say for taking someone's reputation into account. But it's a pragmatic reason. If you had all the time in the world to dig into everything as deep as you want, you wouldn't strictly need to. But since we do not live in this perfect world, we can and probably should shortcut to the more interesting points of debate by including reputation.

That's the best I can argue this, I think :) It's still a choice, however. You can still choose to only accept strict facts (including "I don't know" when more specific strict facts are unavailable).

[0] ok, not all of them

[1] part of the definition of pseudoscience, where you keep adjusting or special-casing gaps in your hypothesis when it doesn't fit the data, almost necessitates this

> If that were the case, most people in this thread shouldn't be posting (arguing) but personally running their own medical trials. Any other source would in some way require trust in that source's credentials.

We're not discussing the study but logic, so that's really not germane.

> It's also to save time in evaluating claims like these.

You can save far more time by ignoring them.

Reality is stochastic. Scientific debates are grounded in probability, not formal logic. If someone has published 38 papers which were complete junk, that gives us a very strong prior about their 39th paper.

Poor researchers are very common. Conspiracies to smear people are very rare. If an academic has a bad reputation, the odds are good that their reputation is deserved.

None of this is conclusive - mavericks do occasionally produce brilliant-but-unconventional research - but it's hugely relevant. There aren't enough hours in the day to give every paper the benefit of the doubt. We have to use Bayesian shortcuts and crude heuristics to filter things for credibility, otherwise we'd be drowning in a sea of junk. The occasional false-positive is a price worth paying.

It's fine to use that to say what is and isn't worth attention. It's not fine to use that as an argument to convince others. You have much better arguments: poor methods, insufficient evidence, lack of controls, etc. and none of those rely on personality.

Yes, when appropriate. Think of it as a Bayesian prior...

Exactly. There's good reason to think that most of human reasoning and the way we attain "knowledge" is not strict deductive logic from firm premises. Rather it's a mixture of Bayesian inference, abductive reasoning "to the best explanation", etc.

Haha. This is an incredibly polite reply, sharpened to a very fine point.

I'm grateful I have something to contribute to a site that I've gotten an incredible amount out of. And it's a powerful reminder that very very smart people can have a hard time critically appraising medical claims. As powerful as the internet is, medicine is really complicated, and it's easy for doctors to forget that.

I'll let the surgeon speak for him/herself, but for my part: I am raising the issue of industry size and quackery to give other readers context. It doesn't make the article wrong necessarily, but I would want to have that context as a non-expert reader trying to understand how it fits into the larger body of scientific understanding. And I would say yes, that does happen (and is appropriate to have happen) in scientific discourse.

On a related note: one amazing site that isn't well known is the OpenPayments[1], maintained by the US government. If you live in the US and have doctor, you can see how much compensation they received from industrial sources. Some of the numbers are shocking. Put your own doctor in, and see where they are. There is no need to resort to conspiracy claims when you can audit them, to some degree, yourself.

The physician mentioned in the article, Dr. Paul Harch, has received $74.48. So way to go Dr. Harch! we can worry much less about getting a skewed opinion based on a industry payments.

But weighing against that is his CV, which lists publications with "D Amen", who I suspect is Daniel Amen - an overly-credulous hyperbaric oxygen physician who has his own page on quackwatch[2], and subscribes to medical theories that are even less credible than the ones in newsweek. When Mehmet Oz[3] is an endorsement on your web site (Amen; not Harch), the public is justified in putting you in the same category. Farther down the CV is "Department of Defense trials for hyperbaric oxygen and TBI: issues of study design and questionable conclusions", wherein I'm predicting he single-handedly dismantles a large federal study of whether HBO is useful for traumatic brain injury. Feel free to find the original article and independently appraise it, if you think it's worth your time... I can barely find 10 minutes to pay back a favor to a good-natured community that has taught me a lot about computers and programming.

Finally: let's not lose sight of the incredibly good thing that happened for this child. Regardless of how or what or why, this is an exceptional outcome, and it's fantastic for this child. I only wish it wouldn't create false-hope for families who are less fortunate, but have thousands (or tens of thousands) of dollars to blow on questionable treatments and false reason for hope.

1. https://openpaymentsdata.cms.gov/

2. https://www.quackwatch.org/06ResearchProjects/amen.html

3. https://www.youtube.com/watch?v=WA0wKeokWUU

I personally prefer propublica's Dollars For Docs data visualization and search features of the open payments dataset, it seems more fluid. However, it does not have the recent update for 2017 that open payments has.

As a medical student I appreciate you all commenting here, it also helps those of us with a general understanding put things into perspective.

https://projects.propublica.org/docdollars/

Pretty amazing! I wish there was Dollars for Docs in Europe (and the rest of the world)! Apparently, "the disclosures were required under the Physician Payments Sunshine Act, a part of the 2010 Affordable Care Act" [1], I hope this doesn't get reverted in the new non-affordable act.

[1]: https://www.propublica.org/article/about-the-dollars-for-doc...

Words I didn't know, in case it saves others a couple minutes...

Infarction - Tissue death due to inadequate blood supply

Edema - Abnormal build up up fluid within the body

Cortex - Wrinkly, outermost layer of the brain.

Thalamus - Part of the brain relating to sensory and motor signals.

DWI - Form of MRI. Measures Brownian motion of water molecules. Does not necessarily involve driving while intoxicated

Cortical, in this context, refers to the cortex of the brain (the wrinkly, outermost layer).

Thank you, updated.

Thank you, dumbneurologist for the reality check, and thank you HN commenters for being the most down-to-earth no-bullshit community I've ever found. The breadth of expertise of commenters checking bait articles at the door makes HN an extremely refreshing and clear-headed place to consume news.

Everyone has their faults and I'm not saying that HN never gets caught up in hype sometimes, but this is the best place to be for a level-headed thoughtful takes on things, and you usually do it while retaining a general optimistic attitude.

So thank you.

I second that. HN is good for that reason and also the lack of half page ads on another popular website SD.

Sorry, SD? The acronym is not clicking, would like to make sure I'm not missing a site with benefits similar to HN, even if it requires viewing a few half page ads. Thanks,

Slashdot.com - haven't checked it in years but was a similar tech focused site with above average comments, its heyday was late 90s-early 2000s iirc

Maybe it is Slashdot?

Sorry - yes Slashdot. It is awful nowadays, but I started there. Somebody should tell them.

Agreed. Slashdot has become unusable.

- do not apologize for spreading more information

- this is hacker news I hope people are in it for some sort of rigor, not just for wow effect

I forgot the 66min case, but that brings me to something I heard recently. Some paramedics said they managed to sustain some kid under cardiac arrest for 18 minutes (he had a nice if not full recovery). The average rule is that if heart has not restarted after 6 minutes, brain damage is irreversible. So where does that leave us ? Should we try (say we have many people capable of doing CPM) to pump as long as possible ?

- should we try to lower body temperature as much as possible to slow metabolyc processes ?

I can't speak intelligently to your questions, because I have no relevant first-hand experience or knowledge of CPR literature.

My only point regarding

> The average rule is that if heart has not restarted after 6 minutes, brain damage is irreversible

is that it doesn't mean it's worthless to continue CPR. Different people have different preferences about how grievous an injury they would want to survive. Whether to continue comes down to that preference. Have an advanced directive, and make sure your loved ones know what you want to have happen if you are every in an emergency!

I just don't know the physics of CPR blood flow, I hoped that with enough man power you have to sustain CPR as long as possible because it means oxygenation. Although I remember MD on reddit saying the amount of oxygenation is so low it's rarely worth it..

A friend of mine had her heart restarted at age 40 after 20 minutes of resus by the excellent London Ambulance Service. Intensive Care then applied a cooling apparatus to drop brain temperature.

My friend was in a coma for 6 weeks and had brain damage because of the lack of oxygen.

On one hand, this was distressing because she lost mathematical ability. This prevented her working in her previous field as a chemistry researcher.

On the other hand, she switched to psychology via a one year Masters degree and is now working on a fascinating project on hacking the mind's compassion responses to activate the parasympathetic nervous system and damp down anxiety (sympathetic nervous system) triggered by cardiac damage.

Just saying that although brain damage sounds terrifying, people can and do cope with it.

Yep.

I had a teacher in grade school and one day she didn't come back to class, she had had a gigantic stroke. 6 months later she rolled into class in a wheelchair, a changed person, she could not speak or do basic tasks for herself.

Over the next two years she relearned most of her abilities, walking, talking, thinking, speaking, teaching and was back to "normal" again. Then she had another stroke.

She did not give up, and did it all over again.

She was always a cruel teacher in my eyes (I was very young) but seeing her persist throughout what I would assume would permanently put you out to pasture was an amazing experience and I always had enormous respect for her.

She continued teaching and retired ~20 years later.

We had a teacher in early high school, lovely lady, who dropped dead over the holidays from an aneurysm. It was a real shock for everyone, and the source of my first proper existential crisis.

What's her opinion on the whole cost of survival question ? worth it ?

I'm reluctant to say this...

But future generations will probably laugh at us. Our rule of thumb about deprivation of oxygen and brain damage is based on the idea that brain damage occurs on the "down" side when the brain is deprived. Actually, the damage occurs on the "up" side when a patient is revived under non-ideal circumstances for brain operation. It turns out the brain if you wake it "up" properly can stay "down" as long as other organs. Think kidneys frozen for 24 hours before being successly transplanted. And a proper wake up involves slow extracorporeal rewarming as mentioned in one of the top comments.

If we can accept this down/up inversion as true, then it means that rushing to revive a patient is what does the damage. It means applying CPR in the field as soon as possible does the damage.

If true, it means 20 minutes, or even 2 hours, of not breathing is nothing as long as the cold body is rewarmed slowly.

If true, it means it is better to keep the brain "down", body "frozen", everything cold as possible (but above the temp of ice crystals riping apart blood cells causing permanent limb loss) until --and this is the key part-- a proper wake "up" can be performed.

If true it means the current limits observed with oxygen deprivation exist only because we are still concerned with reviving as soon as possible. Leave that child passed out! (But keep 'em cold.)

If all this is true, it means that saving a loved one is best done buy applying ice over applying CPR.

Future generations will shake their heads in disbelief, at how many people we have needlessly injured and killed with the barbaric practice of rushing to revive. I look forward to the improvement in how we save/restore lives. I look forward to the improvement from the slow but steady diffusion through our collective awareness of of the idea:

Down-and-cold-is-okay/ Prematurely-revived-is-bad.

I'm no medical professional, but this matches the last thing I read on the topic. A sudden inrush of oxygen to an oxygen-starved brain triggers apoptosis, and that there'd been a bunch of recent (albeit cautious) success stories from gradual resuscitation rather than rapidly warming the victim while flooding their lungs with oxygen.

God, that's possible this would just be an oxyde overdose u_u;;; that would be so lame.

What book was this ?

*This observation was used to pursue hypothermia in other causes of anoxic injury, which is clinically used today.

With pretty astounding results, honestly. My son was born having been without oxygen for at least 6-9 minutes. He was immediately put on a "cold blanket" with his temperature maintained at 92 (F) for 72 hours to prevent brain damage... He has since made a complete recovery with no physical neurological issues present.

This article might be complete bunk, but the hypothermia treatment protocols definitely are NOT.

I'm very glad for the outcome your son and family experienced, but can hardly imagine the horror that you went through in that 72 hours and subsequent time until you became assured of the outcome.

I've read a little about the "Dobkin Technique" where a cold compress is held over the eyes and face of a patient in cardiac arrest to simulate the 'mammalian diving reflex' and delay brain death like shown in these cases. Is there any truth to this or is it pseudoscience? Why wouldn't this be a more known treatment if it works?

I have no idea about the treatment you describe, but the mammalian dive reflex is very real, and is a useful way to induce bradycardia. For example, splashing cold water on your face can legitimately help with a panic attack

the diving reflex is real, and is used clinically to treat supraventricular tachycardia (where a re-entrant electrical feedback loop in the heart can be broken by slowing down the choke-point through which it passes). It slows down the heart and lessens its contractile power consumption. That could conceivably work (in my mind) after a cardiac arrest, but it isn't really related to brain death (which is an issue in the days and weeks following, in the ICU where oxygenation and glucose usually plentiful).

Remember: the "theory" behind any medical idea is almost irrelevant if you have data regarding the outcome. If you have outcome data, it supercedes the theory, and is all-important. The theory simply helps us prioritize which treatments to assess first - the better the fundamentals, the more worthy it is of scarce research resources.

That's one of my biggest criticisms of the lay press: they emphasize the scientific narrative and don't focus enough on the outcomes. The most meaningful outcomes in scientific terms always mean the same thing: a meaningful improvement by blinded observer in something we care about.

"meaningful improvement" - this means that improving survival by a tenth of one percent might not be worth the trouble of implementation

"blinded observer" - because it cancels out the placebo effect and expectations

"something we care about" - such as returning to school. But if you do a SPECT scan and the SPECT scan "looks better" to the doctor? That's not important. We sometimes use things that are well-documented to reflect important things even though they are not important in their own right... we call these biomarkers.

"The enthusiastic replies on this thread are understandable, but disappointing to see: we all need to be less credulous regarding the lay science press, and especially the lay medical press."

So fucking what? I suffered a moderate (GCS 8) TBI 6 years ago and it has been the most impactful thing to ever happen in my life, more so than even the births of my children. This article is a small glimmer of hope in an otherwise depressing and difficult subject.

I am beyond glad people such as yourself exist in this world, are skeptical, and do the hard work of helping people and making lives better. But please remember that us lay people need these bits of hope and glimmers of light. I don't particularly care about the science, as a parent and TBI patient I'm simply glad she's ok. This article made me tear up.

We have to separate the points here.

"Hope" is a real, tangible thing, crucial in our lives, and provably effective.

The question is do we need to accept quackery to have it? Is that sometimes the only way? I suspect the answer is, rarely.

There is so much legit and exciting work being done w.r.t. TBIs that it seems we should not have to rely on it in this area. But that's a guess. Until you've walked in someone's shoes...

Sorry to hear of your suffering.

Well, this is the basis for religion.

I am an atheist, scientist (physics) and I used to actively discourage people from religion (which is pure quackery).

This until I realized that religion helps people who do not want to otherwise think about the world around them. One of the people I managed to move away from religion and change his beliefs ended up deeply depressive. Another one was deeply unhappy with the change. I lost these two friends.

So, while I profoundly belive that people who do science must be atheists (otherwise they have some mental disorders, trying to combine fire and ice), I do not think anymore that everyone is a good candidate for enlightenment. The hope you get from religion vs. the hope you do not have in science (in the religious sense) must be carefully weighted.

I am not religious but I believe that some form of religion has been fundamental to the human species historically. Humans wouldn't have become humans without it. So it is a hard thing to give up.

I think that there is an inherent need in people to explain a way or another what they experience.

Some time ago religion was the only way to go, now science has taken over. Science also gave people the right to say "I do not know".

    I profoundly belive that people who do science must be atheists

That is simply false. Just look at the history of science - just a few examples being Francis Bacon, Robert Boyle, Newton, Kepler, Leibniz, Euler, Faraday, Maxwell, etc. who were all Christian. A far greater proportion of scientists are religious than one might think (see http://www.pewforum.org/2009/11/05/scientists-and-belief/).

A contemporary scientist (hard science, say physics) who belives in god is a fraud. One cannot from 9 to 5 think scientifically and then in the afternoon just push this aside and state that god is behind everything anyway. This is pure hypocrisy, fraud and betrayal of science.

What was "god" yesterday is science today.

Science and religion have exactly zero common points, they function in fundamentally different ways. One way is to invent our of the blue some kind of superior entity (because why not), the other is to take the risk to say "this is how it works, and this is how you can prove it does not".

I have a PhD in physics and attended a fair share of "discussions between physicists and priests" - complete loss of time. Our world works on science, if someone does not agree I purpose to move back to middle age comfort, propelled by religion and not science. This until winter comes, when suddenly electricity is no longer the effect of the wrath of Zeus but something explained by science.

Hey, I don't mind - you can believe what ever you want. I'm just pointing out that the surveys showing a decent proportion of contemporary scientists (including physicists) have deistic or theistic beliefs renders much of what you are saying empirically incorrect.

You mentioned people who lived in times she religion was the basis of the society. I am talking about contemporary physicists (or other hard science scientists).

And this is not a matter of belief : if someone states that he is a scientist, it is not possible to be religious. Simply because these two postures are not compatible. You can be one of the other but not both.

I am really sorry to hear that you've had such a terrible thing happen to you. I think the scientific community is moving in the right direction in recognizing the insidious nature but ultimate impact that these injuries can have. But by skepticism helps us protect the already-scarce resources we have to study what treatments actually work. Let's not repeat the mistakes of the autism community that spent millions and decades on trying to blame vaccines. The science will eventually come out, but we can literally spend as much money as we want to to reach the same conclusions.

You deserve to have hope, but for me personally, hope comes from the fact that science works. This article is not real progress (even though the child had a good outcome, and that's awesome), but there are a dozen places where real progress is occurring, even if it's less visible.

All I really needed to know this article was shit was this sentence:

"She was immobile and constantly squirmed and shook her head."

Uhhh... That's a pretty fast and loose use of "immobile".

Yeah, generally speaking, when it comes to scientific reporting, if it sounds too good to be true, it probably is. The fact that the top commenter (as of this writing) sees this as "Star Trek levels of medicine" should clue everyone in.

> The fact that the top commenter (as of this writing) sees this as "Star Trek levels of medicine" should clue everyone in.

Clue in on what exactly? That the current top commenter, and others - including myself - got baited? Hard to blame them, IMO. That's the effect when popular press is literally lying to people. :/.

(Also that's why I usually read HN comments even before the original article - in case there's an expert who debunks the story, which happens pretty often.)

>>Clue in on what exactly?

On the fact that it does sound too good to be true.

I mentioned Star Trek precisely because it stretched the limits of believability. Usually I'm pretty skeptical but, yknow what? Sometimes I want to be amazed. I feel a little silly that I took this article for granted, but I sure wish I lived in a world where I could take most articles for granted.

Thank you for providing a honest answer. Well intentioned mistakes combined with self reflective and vulnerable answers do not seem to require much criticism.

Yeah, when I saw the 4˚ bit, all of my surprise vanished. There's nothing new here, except the degree of coverage the story is getting.

> - this is in newsweek, and not a peer-reviewed journal.

Newsweek... that rings a bell. Didn't they also do the Satoshi Nakamoto fake?

> because there is just no way in hell that oxygen is going to reverse cell death.

Does oxygen have the ability to promote neurogenesis?

https://www.google.com/search?q=oxygen+therapy+neurogenesis

As a layman I was struck by the claim of it being a "low-risk medical treatment". This started alarm bells ringing.

Thanks for a second opinion and the links.

OR:

Dr. Harch is published and well respected. He also has many documented cases of saving divers lives - including working with the US Navy. Could this be just a case of the medical community not accepting a new technique? In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine [1]. He has a legit cv: http://www.hbot.com/about. Some of this publications:

1. Harch PG, et al. SPECT brain imaging in the diagnosis and treatment of type II decompression sickness. Undersea and Hyperbaric Medicine, 1992;19(Suppl):42.

2. Harch PG, et al. The effect of HBOT tailing treatment on neurological residual and SPECT brain images in type II (cerebral) DCI/CAGE. Undersea and Hyperbaric Medicine, 1994;21(Suppl):22-23.

3. Harch PG, et al. HMPAO SPECT brain imaging and low pressure HBOT in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Medicine, 1994;21(Suppl):30.

From the article [1] you mentioned: "In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine as a subspecialty of both emergency medicine and preventive medicine."

Now that they mention it, it's pretty obvious that cell death didn't occur. If it did, how did oxygen counteract it?

That seems like the most persuasive argument to address, and I'm not sure those references do.

Could be a cell sleeping state that shutdown when there was a lack of oxygen and woke up when oxygen was plenty fold.

If you want to nitpick about it - his publication record is here:

https://www.ncbi.nlm.nih.gov/pubmed/?term=harch+pg%5Bau%5D

As far as I can tell, he only really has editorials and reviews for the most part (which you can pump out to low quality journals any day). He was involved in a small scale rat experiment, a few case reports, and 40-patient non-controlled case series. Basically, at the level of a junior medical resident or fellow.

Furthermore, any references to his publications on his site are buried. The best I can find is here:

http://www.hbot.com/blog/edward-lucarini/hbot-tbi-references

Which are mostly book chapters (grunt work often farmed out to suffering medical students) and case reports (considered "interesting" but scientifically worthless). When judged by academic accomplishments, i.e. peer reviewed papers in high-impact journals, he is essentially not on the map.

> Could this be just a case of the medical community not accepting a new technique

That the medical community wants evidence to substantiate an extreme claim is not a valid criticism of the medical community: it's literally the scientific process.

There are just too many extreme claims based on "unconventional" medical ideas to possibly draw conclusions that any one of them deserves closer attention.

It's great that some doctors at LSU think these ones are deserving - I really want them to succeed, because it means my patients benefit. But the mechanistic reasoning behind /why/ we think it /should/ help is so dubious that there are a thousand better places for me to spend my own time.

Bottom line: 99% of doctors want to see new, revolutionary ideas succeed. If they don't think things are work, it's because they haven't personally seen it being revolutionary. And the harder it is to see a revolutionary effect... the less revolutionary it is, by definition

Paul Harch wrote a book claiming HBOT can help treat:

• Stroke

• Autism and other learning disabilities

• Cerebral palsy and other birth injuries

• Alzheimer's, Parkinson's, multiple sclerosis, and other degenerative neurological diseases

https://www.amazon.com/Oxygen-Revolution-Hyperbaric-Groundbr...

Wikipedia is saying there is zero scientific evidence to back up any of this. I'd say Dr Harch crossed the line into quackery by making these grand claims, despite his otherwise reputable background.

Which is sad because his books all have plenty of 5/5 star ratings by people who are desperate for answers and are being oversold an unproven science.

I highly doubt there has been a conspiracy in the "medical community" to not take oxygen therapy seriously. It's not exactly a new treatment, as the OP's comment points out, it's been tested since at least 2000 (17 years ago) by mainstream medical groups.

>Could this be just a case of the medical community not accepting a new technique

You honestly think neurologists enjoy going to parents of toddlers and telling them their child may never lead a normal life again? If this were a legitimate treatment most neurologists would jump on it.

The fact is there is -zero- chance that oxygen therapy months after the accident had any effect. Oxygen doesn't magically make neurons regenerate. Neurons are energy hungry and die within hours under the absolute best of circumstances.

This story is nothing new. The pool was very cold, that's why the kid made a "miraculous" recovery. Cooling the brain massively reduces neuron losses. This has been known for decades now and contrary to your supposition the medical community has adopted it where the evidence proves it is helpful - in some cases of suspected brain damage due to oxygen deprivation they will force the person's body temperature down and slowly re-warm while introducing oxygen. This has to be done carefully because re-introducing oxygen too quickly after a certain amount of time can induce apoptosis and make the damage worse.

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