Future Directions and the Path Forward

<strong>20.1 Disappointment at Current Lack of Progress</strong> Despite the impressive accomplishments that have steadily accumulated since the 1960s that now consist of the publication of thousands of peer-reviewed papers [that can be retrieved by a PubMed search using the MeSH term “LLLT” and a new MeSH term “photobiomodulation therapy” (PBM)] and hundreds of clinical trials, many of which have been high-quality, randomized, and well-controlled, LLLT has still not reached the stage of acceptance by mainstream medicine. There remains considerable skepticism (and sometimes frank disbelief) amongst biomedical scientists, the medical profession, and the public at large. The reasons for this skepticism and disbelief are many and various, and they differ depending on the source. Biomedical scientists often refer to a lack of mechanism and the absence of agreement on dosimetry and parameters. Physicians often claim there is a lack of large clinical trials and not enough systematic reviews. Hospital and insurance administrators cannot agree on coverage and reimbursement. Finally (and regrettably), there has been marketing hype, over-promising, and frank misinformation from some of the companies that make devices (lasers, LED arrays, mixed clusters) that are used in the LLLT industry.