Misconceptions about oxygen by alternative medicine practitioners

An article called “Simple ‘4-7-8? breathing trick can induce sleep in 60 seconds” claims that this trick can get you to go to sleep within 60 seconds. All you have to do is the following:

? Exhale completely through your mouth, making a whoosh sound.
? Close your mouth and inhale quietly through your nose to a mental count of four.
? Hold your breath for a count of seven.
? Exhale completely through your mouth, making a whoosh sound to a count of eight.
? This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths

An integrative medicine expert, Dr. Andrew Weil, said it works because it allows the lungs to become fully charged with air, allowing more oxygen into the body, which promotes a state of calm.

“Promotes a state of calm” is nonsense. Let’s concentrate on the science. Does it allow more oxygen into the body? Ich dont think so.

The air we breathe contains about 21% oxygen. Nearly all oxygen in the blood is carried by hemoglobin. No matter how many deep breaths you take, you cannot get the oxygen saturation of hemoglobin (normally > 92%, closer to 98% in healthy people) above 100%. This is explained in more detail in a previous post of mine about why athletes don’t benefit from breathing pure oxygen after exertion.

This simple trick would be hard to remember but might work through the power of suggestion. It doesn’t cost anything, and unless you hyperventilate and pass out (but youll be in bed anyway), it is harmless.

The next misconception about oxygen is neither inexpensive nor harmless.

Two naturopathic “doctors” have been accused of injecting a woman with oxygen or perhaps purified water that had been taken from an Octozone machine. The oxygen was supposed to destroy any pathogens in the woman’s blood. In the process of trying to kill the pathogens, the injection killed the patient who paid $500 for the treatment.

The naturopathic duo left town and were at large for several months before eventually being caught and charged with homicide.

An autopsy found her death was due to an air embolism.

According to a recent review of the subject, “Traditionally, it has been estimated that more than 5 mL/kg of air displaced into the intravenous space is required for significant injury (shock or cardiac arrest) to occur. However, complications have been reported with as little as 20 mL of air (the length of an unprimed IV infusion tubing) that was injected intravenously.”

Pure water should never be injected IV either because it causes blood cells to die from hemolysis.

How about we just take our oxygen the old-fashioned way—normal breaths and never intravenously?

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Appendicitis and shared decision making

Staying with the current theme of appendicitis on my blog, here is a summary of recent developments. A JAMA Surgery Viewpoint suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics.

The paper acknowledged my criticisms of the Finnish study which found that simple appendicitis could be treated successfully with antibiotics in almost 75% of patients.

I respect the authors of the JAMA Surgery article and am happy they referenced the blog post noting my concerns about that Finnish trial: the trial compared antibiotics to open appendectomy—an operation with more complications than the more commonly performed laparoscopic appendectomy; the antibiotic used in the Finnish trial is not a first line choice in the United States; patients were followed for only one year.

The JAMA surgery paper answered three questions I posed in a previous post. One, the Viewpoint authors consider antibiotic therapy for appendicitis mainstream. Two, surgeons must assume that patients might opt for antibiotics despite at least a 25-30% chance of suffering a recurrence of appendicitis. Three, an informed consent discussion now should include a mention of antibiotics as an option.

I disagree with the Viewpoint authors’ assertion that antibiotics are as safe and effective as surgery for treating appendicitis. Based on one flawed study, antibiotic therapy cannot yet compare to the many years of excellent results of laparoscopic appendectomy.

Here are some other problems.

Let’s talk about shared decision-making. After hearing all the options, some patients will want to guide their own care. However, most patients would rather not. A 2011 Journal of Medical Ethics study of over 8000 patients found that 97% “of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor.”

What about the medicolegal implications of antibiotic therapy for appendicitis? Right now, the “standard of care” for appendicitis is appendectomy. Suppose a surgeon, in the interest of shared decision-making, explains the Finnish study to a patient and neglects to mention that it only involved patients with simple appendicitis. Or suppose that patient’s CT scan is read as simple appendicitis but is not accurate, and the patient actually had complicated appendicitis that went on to perforate despite antibiotic therapy.

If that patient becomes septic and requires a laparotomy and suffers a subsequent wound infection and massive hernia or dies, who is going to be held responsible for not recommending an appendectomy? Certainly not the patient.

In the era of shared decision-making and patient autonomy, maybe patients should be required to carry malpractice insurance so they can sue themselves if the decisions they make turn out badly.

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