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Promises, promises: the perpetually “promising” state of ozone therapy

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Ozone is a pale blue toxic gas, a variant of oxygen, its molecules each made of three oxygen atoms: “trioxygen,” rather than the dioxygen we need to survive. Ozone has a distinctive “fresh” smell and is widely used as a disinfectant — because it murders cells — plus many other industrial applications related to oxidation.

Ozone therapy has many supposedly promising therapeutic applications that are controversial at best. Much like laser therapy, ozone therapy is kept alive by lots of enthusiastic and jargon-riddled speculation about how it might work, rather than by good clinical tests of whether or not it actually works — a classic example of “mechanism masturbation.”

For decades consumers could buy ozone generators for self-treatment, like this bizarre vintage medical device of unknown provenance. It still “works”: it produces a strong ozone odour & the paddle causes the sensation of little sparks when applied to the skin. Photo by neon collector Jenny Beatty, used with permission. See several more high-res photos.

It’s also a good example of “pseudo-quackery,” a quackery that seems much more legit than it is, because it continues — after more than a century — to masquerade as an advanced and technological medicine, not quite mainstream but almost (if you squint). That veneer of sophistication is greatly enhanced by a “growing body of literature” devoted to ozone therapy, of course — as there is for literally anything, thanks to a scientific publishing industry that vomits up unprecedented numbers of junky papers every year. Every paper is either about a low quality trial with an off-the-charts risk of bias, or a pointless garbage-in-garbage-out review of such trials passed with some overheated editorializing.

So what does ozone therapy supposedly have the “potential” to treat? Everything from COVID-19 and diabetes. And in the pain domain? Back pain, osteoarthritis, and fibromyalgia. In papers like these, the conclusion is always “promising,” with the inevitable token disclaimer that “higher quality studies are needed.” Studies that never get done.

There is no compelling clinical evidence for ozone therapy, and it remains well out in medical left field … where it largely belongs, and where it will probably remain indefinitely.

Nevertheless, I will review what there is to review. As a science journalist (and a curious human who genuinely wants to know what works), I cannot really justify ignoring the available evidence, such as it is — even if it’s so terrible that it’s actually worse than nothing. That is the dilemma that the geyser of modern junk science has created: I can’t extract much value from it … but I can’t ignore it either!

Meme of Inogo Montoya with caption: “Promising. You keep using that word. I do not think it means what you think it means.”

The “science” of ozone therapy for fibromyalgia

What self-respecting snake oil wouldn’t be touted as a fibromyalgia cure? They almost literally all are, and of course ozone therapy isn’t going to be left out.

There aren’t any actual clinical trials for this usage of ozone therapy… not even one. Not even a bad one!

There is a common citation, however, widely exploited by naturopathic clinic websites: Tirelli et al describe their clinical impressions of treating sixty-five cases of fibromyalgia with ozone therapy, claiming “a significative [sic] improvement (>50% of symptoms) in 45 patients.” They declare it to be an “effective” therapy in their title, as if they have proven something. But this was not any kind of clinical trial; it’s just a low quality collection of anecdotal reports, put together by a group of clinicians who are clearly diehard fans of ozone therapy.

The only other example I’m aware of was an “open label pilot study” by Hidalgo-Tallón et al — more of the same, utterly worthless. This stuff barely even qualifies as junk science — it’s on a lower level than that.

The only thing these citations are good for is selling ozone therapy. Ka-ching.

This post is an excerpt from my full review of ozone therapy. The full article continues with detailed discussions of ozone for arthritis, and (paywalled) ozone for back pain. There's no good news, but it is interesting.

I can never just share an excerpt, though! I cannot just conveniently exploit the hard work of my past self, and transplant my own original words into a new blog/newsletter post. That would be much too easy. As a writer, it is literally impossible for me to look at anything I have ever written without seeing eleventy ways to improve it (three to five of which seem urgent). So it’s never “just” an excerpt: it’s always a new, improved version of what was there before, to some degree. Every. Single. Time.