When the ancestors of modern reptiles emerged from the water and committed to air breathing, they triggered an approximate .300-million-year evolutionary journey that led us to the wonderfully complex network of tubes, membranes, and muscles we presently call the human respiratory system (West, Watson, and Fu 2007). Its primary purpose: the movement of oxygen (O2) from the air we breathe into our blood and then carbon dioxide (CO2) in the opposite direction. Under normal conditions, human respiratory machinery is considered “overbuilt” for the demands typically placed upon it (Dempsey, La Gerche, and Hull 2020).
Nevertheless, there are scenarios that preclude the efficient transfer of O2 from the lungs to the blood. For example, patients with emphysema—a type of chronic obstructive pulmonary disease (COPD)—present with damaged and inflamed lungs that are less capable of transferring O2 into the circulation. Lung damage is also a characteristic of COVID-19 that may also cause pneumonia and pulmonary oedema (fluid accumulation in the lungs) that further reduces O2 transfer capacity. By contrast, a patient with heart failure may have a perfectly intact respiratory system, but their weakened heart muscles are less able to pump blood (and O2) around the body. At the other extreme, a fit and healthy mountaineer arriving at Everest base camp (5,364 meters or 17,598 feet) must contend with a thinner atmosphere characterized by less O2 availability. All such scenarios result in a common outcome: less O2 in the blood. Supplemental oxygen is a widespread therapy comprising a nasal tube or face mask that delivers O2 at higher concentrations and/or flow rates than occur under normal conditions. Since the late 1800s, there has been a growing body of literature on the crucial role of supplemental oxygen in acute respiratory care (Heffner 2013).
The wealth of evidence on the use of supplemental O2 in the clinical setting has provided the commercial world a foundation on which to base a series of products aimed at the general population. In part 2 of this series, in which I explore how legitimate medical treatments have been misappropriated in the hyper-commercial health and wellness industry, I discuss the monetization of oxygen in three such products, and the marketing hyperbole, false promises, and exaggerated claims that result.
Hot Air
The most obvious commercial misrepresentation of medically certified supplemental oxygen is so-called “canned oxygen.” Canned oxygen, as the name suggests, comprises a spray-can containing (somewhat incongruously) “95% pure oxygen.” It is claimed that several inhalations via the accompanying mask or inhaler cap, repeated periodically throughout the day, can “improve breathing and reaction time.” Moreover, by using the product immediately before physical activity and/or exercise, canned oxygen can supposedly augment sports performance by delaying the onset of fatigue. Some brands integrate eucalyptus and other essential oils into the gas mixture which, it is claimed, can “relax the nervous system, relax the muscles, and relieve stress.” If manufacturers cite any scientific data on their websites, it rarely has any relevance to the listed device, mostly linking to studies on hyperbaric oxygen therapy in patients or prolonged inhalation of medically certified gas mixtures. Hence, vendors of canned oxygen are gripping tightly to the coattails of the supplemental O2 clinical data. Not only is there a lack of research to support the use of commercial canned oxygen, for any outcome, but the mechanism is inherently implausible. This is because the effects disappear quickly, even in hospitalized patients breathing supplemental O2 for thirty minutes (Gruber et al. 1995). Thus, it is extremely unlikely that several breaths of high-concentration O2 will meaningfully influence the physiology of a healthy individual. Indeed, there may be a lack of research on the device precisely because the basic physiology is well understood. One merchant of canned oxygen, to feign scientific legitimacy, published an online press release mocked up with the appearance of a peer-reviewed journal article, complete with split-page columns, scientific-looking graphs, and a bibliography with four references. People familiar with science publishing will easily spot the ruse, but this flimsy attempt at coercion may well succeed on a layperson.
What could possibly be “purer” than oxygen?
Oxygen as a “product” is marketable because it is “pure,” ubiquitous, and essential to life; thus, commercialization of oxygen comes very close to exploiting the ingrained bias for natural produce (i.e., the appeal to nature fallacy). Nevertheless, if there is one product that could be considered purer, more wholesome, and more ubiquitous to life than oxygen, it is waterthat has been infused with oxygen. Oxygenated water is a liquid food supplement, purchased in its bottled form or as a powder that is dissolved in … water. A given “dose” typically contains 30–120 mg of oxygen per liter of fluid and is usually sold as “stabilized oxygen,” sometimes mixed with flavorings, acids, preservatives, vitamin C, caffeine, and/or electrolytes. Commercial claims are vast: faster recovery due to potential effects on “lactate elimination”; overcoming sensations of fatigue, headache, migraine, and dehydration; improved overall health; improved aerobic endurance; improved vitality; improved liver function; and “detoxification.” Interestingly, animal models (Forth and Adam 2001) and one human study (Vatnehol et al. 2020) show that it is theoretically possible to increase O2 absorption through the gastrointestinal tract. However, as an aid to health, oxygenated water has been strongly criticized by the medical community owing to the miniscule quantities of O2 potentially absorbed via this method. Contrary to the commercial claims, the data on oxygenated water and exercise capacity or fitness are unconvincing. Several studies show no effects of oxygenated water on exercise O2 uptake (Leibetseder et al. 2006), exercise performance, or muscle O2 content (Fleming, Vaughan, and Feeback 2017). A narrative review published in the British Journal of Sports Medicine concluded that performance-enhancing claims for oxygenated water “cannot be taken seriously” (Piantadosi 2006).
Under Pressure
Hyperbaric (literally “high pressure”) oxygen therapyis a more theatrical (and expensive) form of supplemental oxygen, gaining prominence due to endorsements from athletes and celebrities including Cristiano Ronaldo, Michael Phelps, LeBron James, Mohamed Salah, and Justin Bieber. During a typical exposure, an individual lies for one to four hours in a large horizontal tube in which the air has been pressured to increase the “drive” for O2 to enter the blood. In some respects, hyperbaric O2 therapy can be considered the antithesis of high-altitude exposure. Some of the first hyperbaric chambers were constructed in the early 1900s to treat decompression illness resulting from diving accidents but have since been incorporated as standard medical treatments for various indications including carbon monoxide poisoning, decompression illness, gas embolism, severe anaemia, and to facilitate healing of chronic wounds that result from circulatory problems and a lack of O2 in the injured tissues (e.g., in type 2 diabetics) (Hajhosseini et al. 2020). The robust clinical data coupled with celebrity endorsements has inspired naturopathic clinics and health spas around the United States to invest in hyperbaric O2 chambers for their clients. These facilities make unsupported claims to improved health and vitality. One vendor suggests, without evidence, that their chambers can result in “more energy, better brain function, improved immune function, [and] decreased inflammation” while others propose the therapy as a treatment for cancer, Lyme disease, autism, and Alzheimer’s disease. Even the FDA, which is typically slow to address baseless claims in health and wellness, warn that: “If you are considering the use of a hyperbaric oxygen therapy … be aware that some claims of what it can do are unproven” (FDA 2021). Hyperbaric O2 therapy is not without risk, with reports of damage to the middle ear (e.g., tympanic membrane rupture), retinal damage, sinus pain, potentially fatal oxygen toxicity, and even pulmonary oedema in patients with undiagnosed heart problems (Heyboer et al. 2017). The FDA even warn that “Explosions and fires have occurred in HBOT chambers that have not been reviewed by the FDA and are located at unaccredited facilities” (FDA 2021). Most medical procedures carry risks that are carefully considered by the physician in a “risk-to-benefit” analysis. However, in otherwise healthy individuals, without anemia, circulatory problems, or decompression illness, the risks of hyperbaric O2 therapy are impossible to justify.
Conclusions
In terms of unproven commercial health and wellness interventions, lax federal regulations leave us with almost too many to count. By and large, they are marketed on logical fallacies, the exploitation of ingrained human biases, extraordinary claims and unextraordinary evidence. Even so, monetizing oxygen appears particularly unscrupulous, and products such as those aforementioned should be the biggest incentive yet for us to help the public distinguish legitimate clinical practices from illegitimate commercial ones. At best, commercial O2 “therapies” are ineffective, often costly procedures, tenuously supported by the clinical data; at worst, they are gross misappropriations of medical treatments that pose unjustified risks to otherwise healthy people.
References
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