Marketing gimmicks

By Jan Tunér

We all know that marketing is a biased business and take it for what it is worth. At least that is what we like to believe. But should marketing really not influence our behavior, it wouldn’t be there in the first place, so let us not fool ourselves.

Marketing, at least within the EU, is not allowed to lie, but it is sometimes close to. Cosmetics are not permitted to be marketed as having a biological effects. Should it have, it must be registered as a pharmaceutical. Typically, flowery words such as unique, revolutionary, ground breaking, extra, and ultimate are used. And if any clinical effect is claimed, the performed study is “on file” – meaning kept in a closed drawer and performed by the people of the company itself.

So how is marketing on the PMB market? This is medicine, isn’t it? Advertising needs to be unbiased and based upon some scientific evidence. Just as with pharmaceuticals. Well, not a good comparison, sorry. Read the new book by the Danish doctor Peter Gotzsche – Deadly medicines and organized crime and you will lose most of your illusions.

Then, how is the quality of PBM marketing? In my experience, we can see anything from serious and honest marketing to sheer quackery. Companies claiming weak red lasers being able to penetrate clothes, private gimmicks such as solitons and scalar waves, you name it! And then the in-between guys, laying on fat and stacking the cards.

As an example, I have studied a marketing pamphlet from Multi Radiance Medical in the US, claimed to be a “Technology Anchored in Science”. Such a claim calls for a call of the cards. Let us take the claims as they appear in the pdf:

The challenge to practitioners has been to exceed the limitations of low powered therapeutic lasers, and effectively deliver photons, or pain-reducing and healing power, to specific treatment areas and depths without harm to the patient. Multi Radiance Medical meets this challenge.

Which are the limitations referred to? The obvious content could be written by any ambitious laser manufacturer.

Multi Radiance Medical uses three clinically proven wavelengths: 660 nm, 875 nm and 905 nm to cover the entire therapeutic spectrum for optimal tissue saturation.

What does “proven” mean? 660 and 905 nm are indeed well documented, but the 875 nm (being an LED!) is not. Combining several wavelengths may be advantageous in some situations and unwanted in other. But there is no research supporting the simultaneous use.

And what about the 660 nm? In a study by Antonialli (2014), this is actually listed as both a 670 nm LED and a 640 nm LED. So much for “laser therapy”, and which wavelength is correct?

905 nm Super Pulsed Laser Therapy penetrates the deepest into tissue. Multi Radiance Medical uses three clinically proven wavelengths: 660 nm, 875 nm and 905 nm to cover the entire therapeutic spectrum for optimal tissue saturation. Sophisticated software algorithm synergizes multiple wavelengths, creating a cascading effect: 660 nm absorbed by superficial tissue clears the way for infrared 875 nm to penetrate deeper and eliminate cellular interference which allows infrared 905 nm super pulsed laser to go even deeper: Multi Radiance Medical’s proprietary multi-source technology successfully manipulates the interaction between light, laser and magnetic energy fields to achieve the desired penetration in the target tissue area.

The sentence in bold, alone, should raise a flag!! But then there’s this…

4-5 inches of penetration – 13 cm! This is absolutely not true if a therapeutic number of photons at that depth of 13 cm is to be reached. “Depth of penetration” can be defined in several ways, but unless a sufficient number of photons have reached the target, the description of penetration is meaningless. Penetration can be increased by firm pressure, moving the probe closer to the target and creating an ischemic area, improving penetration. But in slight contact with skin – no way! There is no evidence for the claim that prior 660 and 875 improves the penetration of 905, nor that a magnetic field could make them do so. But indeed, GaAs lasers have deeper penetration than GaAlAs lasers.

And the magnet itself? The beneficial effect of a static magnet on nerves remains to be documented.

…enables clinicians and assistants to quickly identify areas to treat and uses proprietary technology to automatically dose these areas with the proper amount of laser energy, without over-treating.

Obviously this magic machine can identify the pathological area and automatically supply the ideal dosage. Nobel Prize!

Only FDA cleared device combining neurological electrical stimulation and laser in single probe. Because of “one of a kind” combination therapy design, can allow for third party insurance reimbursement.

PBM is rarely reimbursed, but electrotherapy is sometimes. So the addition of electrical stimulation to MultiRadiance devices is apparently, by their own admission, just there to allow for insurance reimbursement.

Patented technology changes frequencies (number of laser pulses emitted per second) to “scan” target tissue from superficial to deep, preventing bodily adaptation to laser energy and thus resilience to its therapeutic effects. Treatment presets are based on clinical experience and research.

Changing the pulse repetition rate does not affect penetration and the biological effect is unknown. This is pure speculation and not based upon research. On the contrary, according to Hamblin et al.. Further, the changing of pulse repetition rates in this machine also significantly varies the output.

Allows delegation of treatment to staff without potential of thermal hazard.

True, but what is the point? Suggesting that other Class 3B lasers cause thermal damage?

Superpulsed GaAs lasers give deep penetration without the unwelcome effects of Continuous Wave (lasers) such as thermal damage, as well as allowing for shorter treatment times.“
-Michael R. Hamblin PhD, Harvard University “The Effects of Pulsing in Low-Level Light Therapy.

Continuous Class 3B lasers do not cause thermal damage in Caucasian skin, unless a very thin probe is used. GaAs lasers are weaker than most 808 nm lasers, which also contributes to the non-thermal effects. So this is a misinterpretation of the article referred to. Ironically, the same paper negates the claim above about pulsing! And how powerful is the GaAs diode? The MR4 is listed as 25 W peak pulse power, with another applicator listed as 50,000 mW (4x 12,500 mW). Despite the large numbers, an educated eye views this a very low powered diode, less than a few mW average power. The use of the peak pulse power is a way to fool the uneducated customer. There are no 25,000 or 50,000 mW going out from the probe, and with an area of 4 cm2, the power density is extremely low. So how much is actually coming out?

According to the study of Antonialli (2014), in which the claimed ’50,000 mW’ device was used, the total power coming from the three light sources is as follows: 905 nm x 4 diodes of 0.3 mW each (!!), 875 nm 4 LED diodes of 17.5 mW each and LED 670 nm 4 diodes of 15 mW each. In total 131.2 mW of laser and LEDs. Hardly 50,000 mW!

And, further, although the device is only ever referred to as a ‘super-pulsed laser’, the actual average output power of each GaAs laser is, at its highest level (i.e., when pulsed at the highest rate of 3000 Hz), just 3.75 mW! In this study the pulse rate was 250 Hz, producing an average output power of 0.3125 mW for each of the four laser diodes, a total of 1.25 mW.

Said study found an effect in clinical performance and recovery after exercise. This shows that the 131.2 mW dispersed over a large area of 4 cm² (33 mW/cm²) can be effective in certain conditions. But this is not my point.

Finally, let me show you another promotional paper from the same company. This is another way of stacking the cards. Of course very strong lasers can be inhibitive and even less effective than placebo. But it all depends on the type of tissue and the condition. A study showing the contrary can easily be performed. And the “super pulsed laser” is rather a flea-powered one, with the addition of two arrays of LEDs providing the majority of the optical output.

J Athl Train is indexed on PubMed, but there is no paper with the title referenced under the picture in the ad, nor any authored by De Marchi T et al. This is just the first hint of disinginuity…

There is an article, “Phototherapy in skeletal muscle performance and recovery after exercise: effect of combination of super-pulsed laser and light-emitting diodes”, with De Marchi as a co-author, published in Lasers in Medical Science in 2014. However, in that study they used only the MultiRadiance device and no Class IV laser.

The doses used in the study are reported as 10, 30 and 50 Joules per site (60, 180 and 300 Joules total per muscle), however these are the combined totals of all the LEDs and the laser emitter; the laser emitter itself delivered only 0.024, 0.071, and 0.119 Joules per site! Treatment times were 76, 228 and 381 seconds per site (totals per muscle group were 456, 1368 and 2286 secs, respectively).

CK activity was reduced most at 30 J, and the curves from the chart in this paper show no resemblance whatsoever to those shown in the ad.

I am sure that the promoted laser is effective in certain therapies but the marketing contains features that have no scientific backing, many arguments used in this promotion pdf are lacking credibility and some are downright wrong.

PBM is a wonderful method, the truth is good enough!