In the March 14, 2017 issue of Chiropractic Economics [Laser Therapy is Better Than Dangerous Drugs], Dr. Silverman, who frequently lectures on behalf of Erchonia, presents the advantages of using low-level lasers in chiropractic therapies. While I can subscribe to most of the text, it contains a stunning statement.
Dr. Silverman claims that the light of these lasers can pass through clothes, so patients do not have to undress. This is some kind of “flat earth” statement, since it is only too well known that red laser light will lose more than 90 percent of its photons even after having penetrated a thin white shirt. Then another some 90 percent is lost before the photons have passed through the skin barrier.
Red laser light is excellent for superficial conditions such as open wounds and mucosa. For average chiropractic conditions, infrared light (800–1,000 nanometers) of fairly high power (in contact) is needed to achieve a reasonable penetration. A 635 nm red laser through clothes is clearly only a placebo treatment.
— Jan Tunér, DDS, is the editor of LaserAnnals and LaserLessons. He can be reached at firstname.lastname@example.org.
Robert Silverman, DC, responds:
As a self-professed expert in the field of low level laser therapy who performs no research, Jan Tunér should read his own books. On page 73 of his Laser Therapy Handbook (2004): “Biostimulation has been reported in the literature as low as 0.001 J/cm2.” Erchonia research (2000) demonstrated that the Erchonia laser emits 20 billion photons per second; yet, Tunér’s claim that a white T-shirt would block about 90 percent of these photons per second would still leave billions of photons per second to create photo- chemistry (biostimulation). Tunér goes on to state in the Laser Therapy Handbook on page 349: “In theory, 1 single photon can actually start a chain reaction.”
He refers to the same quote in his New Laser Therapy Handbook (2010); and on page 708 of his Laser Phototherapy (2014), he goes on to state: “A fully adapted human eye can see about 10 lux. This corresponds to about 1.5 x 10 watts of visible power or about 30 photons per second of energy through the pupil of the eye. This little energy flow can create a minute nerve sign.” What happens if 2 billion photons per second are going through clothes?
His lack of knowledge is further proven by his statement that “90 percent is lost before the photons pass through the skin barrier.” The first law of photochemistry states that “light must be absorbed for a photochemical reaction to take place.” If, in this case, visible light is not absorbed, what good is it? Power and depth of pene- tration are marketing terms. Visible low level lasers work on pain through photochemistry or biostimulation and reduce Cox 1 and 2 along with many other photochemical pathways—this is the same biochemical effect NSAIDS produce for pain reduction.
Depth of penetration does not matter in photochemistry (visible lasers) or biochemistry (drugs). Has anyone ever asked their doctor how deep their NSAIDs penetrate?
Both biochemistry and photochemistry work by stimulating biological pathways; both have to be absorbed to create systemic effects. With photo- chemistry, you can go to the site of pain and still get systemic effects without side effects.
Tunér’s lack of knowledge on photochemistry with visible lasers is further quantified by his statement: “For the average chiropractic condi- tions, infrared light (800–1,000 nm) of fairly high power, and in contact, is needed to achieve a reasonable penetration.” As Tuner has stated in his books that infrared lasers do not create photochemical effects but visible lasers do, he is comparing apples to oranges.
His statement that “a 635 nm red laser through clothes is a placebo treatment” is self-serving and has been proven false in a paper published in a 2016 issue of the Journal of the International Association of Functional Neurology and Rehabilitation. In this blinded and placebo-controlled clinical trial on chronic neck and shoulder pain, patients were not required to disrobe and positive results were achieved.
It should also be noted that Erchonia red lasers have obtained FDA clearances through blinded and controlled clinical trials on plantar fasciitis; post-surgical pain following liposuction and breast augmenta- tion; and fat reduction of the waist, hips, thighs, and arms. If his theory that infrared laser is needed for penetration is correct, then how did Erchonia prove fat emulsification in a 2000 study (published in the AACS journal)? He was sent a copy of it but declined to comment.
— Robert G. Silverman, DC, CNS, CCN, CSCS, CKTP, CES, CIISN, DACBN, DCBCN, HKC, SASTM, can be reached at email@example.com.
[The letters above were edited for brevity and clarity, and printed with permission. We encourage the open exchange of ideas. — eds.]