Multiple Sclerosis

MS is a disease in which manifestations wax and wane, and which is not immediately fatal (and sometimes not at all), and proving or disproving the therapeutic worth of an intervention can be frustratingly difficult. The response of multiple sclerosis (MS) to hyperbaric oxygen (HBO2) therapy falls into this category. The letter of James and Perrins [see page 236] takes the pro- HBO2 point of view in direct opposition to a recent editorial by Dr. Jacoby in the Journal (1). The dispute has unaccountably become both polarized and emotional, reminiscent of other medical debates, which were finally resolved by carefully designed outcome studies. If, on the basis of current evidence, HBO2 therapy for MS can be neither accepted nor dismissed out of hand, there are two time-tested ways of approaching the truth. One is to perform comprehensive reviews of all available data, which has been done by Bennett and Heard (2). Although the authors failed to find an effect of HBO2, they left open the possibility that HBO2 might be effective for some subsets of patients, perhaps using prolonged treatment.