Premature publication and the infra-red ‘cure’
Posted by apgaylard on July 17, 2008
Given my current near-obsession with LEDs and phototherapy, I was pleased that the nice people at Holford Watch pointed me to the Mail on Sunday. As I’m not a regular reader of this august journal of record; without this prompt, I would have totally missed this intriguing headline, “Dementia patient makes ‘amazing’ progress after using infra-red helmet“.
It sounds like science-fiction. The story reports that after wearing a ‘hat’ that allowed 700 LEDs to ‘bathe’ his brain with infra-red light Clem Fennell has experienced an amazing remission in his, “aggressive type of dementia“. Initially he was, “unable to answer the phone, order a meal or string more than a couple of words together”. After a series of treatments his deterioration has, reportedly, stopped; he responds more quickly to people when they talk to him; can order his own meals in restaurants; and can go to the bank or post-office on his own.
This is an amazing story and I hope that Mr Fennell’s remission continues. However, it opens up some interesting questions: how likely is it that the treatment is the cause of his remission? How likely is this to be very good news for many more sufferers and their families?
These are very difficult to answer. It is clearly very early-days for this device. The article tells us that it has, “yet to be proven in clinical trials” and, “It is too soon to say whether [it] could help other sufferers.”
It also adds, “The symptoms of Alzheimer’s disease and dementia can vary from day to day – and relapses are not unusual.” This raises the issue of whether the natural history of the disease could be the key factor here; would this remission have happened anyway? This is why a controlled trial is necessary, as the article points out.
So, how do the researchers think their device may work? The Mail comments that the infra-red radiation used is, “thought to be the right wavelength to stimulate the growth of brain cells, slowing down the decline in memory and brain function and reversing symptoms of dementia.”
To do this the radiation must penetrate the structures of the head and pass into the brain. Can the infra-red radiation do that?
It seems that near infra-red radiation (NIR) can, in fact, penetrate the structures of the head and pass into the brain. In fact, NIR spectroscopy (NIRS) can be used, “for non-invasive assessment of the brain function through an intact skull in human subjects by detecting changes in blood haemoglobin concentrations associated with neural activity.”
It also appears that transcutaneous reflectance-mode NIRS can be used to measure cerebral oxygenation. In this application an NIR source is placed on the skin, along with a detector a few centimetres away. The radiation passes through skin and bone, penetrating (to some degree) the brain; before being ‘reflected’ and completing the return journey back to the detector. Although there seems to be some contention about how much of the optical path is through the brain but, again, the idea that an external NIR source can illuminate the brain (at least to some extent) is reasonable.
(Though in 2006 a Nature News feature commented that in, “the near infrared spectrum, photons may penetrate several centimetres into the body.” That does make me wonder how substantial the irradiation of the brain might be)
The next question is, if it can ‘bathe’ the brain in infrared radiation, is that of any use?
The idea that it might be seems to have come from a treatment for cold sores. Virulite markets NIR therapy machines for the treatment of cold sores and wrinkles. (They claim that the cold sore treatment is now available on prescription from the NHS.)
It seems that some work has been done on an animal model – mice. The paper, published in the Journal of Neurobiology of Learning and Memory, concludes that exposure to NIR resulted in, “middle-aged mice being more considerate in their decision making, which results in an overall improved cognitive performance which is comparable to that of young … mice.”
This work used NIR with a wavelength of 1072 nm (9268 cm-1). This was selected, sensibly, to avoid the NIR absorbance band of water. From there it seems that an early prototype was tested. This was covered by both the Mail and BBC in January. The BBC report contains a brief reference to a small unpublished, trial, “In tests in people with dementia using infra-red lasers, eight out of nine people showed some improvement.”
Reassuringly, the Mail on Sunday article reported, “Dr Dougal stressed that a full, clinically controlled trial would be needed before his anti-dementia helmet could be licensed for public use. A trial of 100 patients is expected to start later this year.”
So there seems to be some sensible progression here, from mice to men; along with the promise of an apparently reasonable trial. Given that humans can’t see in the NIR part of the spectrum it doesn’t seem to hard to devise a good sham treatment. No Rudolph effect here!
Are there any reasons to be cautious? I’d say that there are. Aside form the obvious lack of a decent trial published in a peer-reviewed journal, there is a nagging question in my mind about the plausibility of a mechanism involving NIR, which could halt and turn back dementia.
There seems to be some uncertainty surrounding the cause of Alzheimer’s disease. If this is the case can we really be sure that stimulating the growth of brains cells will solve the problem? The claims that are made for this device often mention dementia; there are many kinds, with different causes – will a single therapy cure them all?
Perhaps that is why the coverage on the Nature blog, The Great Beyond, was quite cautious. Unlike the uncritical bulk of the media coverage ABC News carried a sceptical article in January. It included these quotes:
“I have not heard of anything along these lines before. Who knows what it is? But it sounds more hocus-pocus than anything,”
Dr. Ronald Peterson, director of the Alzheimer’s research centre at Mayo Clinic.
“I cannot conceive of any underlying biological mechanism by which that could work“
Zaven Khachaturian, editor-in-chief of Alzheimer’s & Dementia: Journal of the Alzheimer’s Association
Add to this that Dougal has a direct financial interest in the product and that some of the clinical evidence presented on Virulite’s website for their other products is less than convincing (the cold sore machine is, “medically proven” on the basis of a pilot study and the anti-wrinkle evidence is very thin): caution is in order.
Also the briefly reported small unpublished trial result of “some improvement” (in eight out of nine patients) seems to be a more modest claim than the ‘amazing’ result reported by the Mail on Sunday. This, again, gives pause for thought.
So, what can we make of this device? It would be truly marvellous if it turns out to work – but it’s just way too early to say. It’s certainly too early for raising hopes.
This is yet another example of science by press release. If a decent sized, well-designed trial published in a respectable peer-reviewed journal came out with a good result then that would be worth covering. As it is, this seems to be raising hopes prematurely. I hope that they don’t prove to be false hopes.
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