Photobiomodulation Research: Why It Struggles While Drugs Get Billions

Introduction

Photobiomodulation (PBM), sometimes called “low-level laser therapy” is a safe and biologically active treatment that has shown benefits in pain management, wound healing, and neurological recovery. Yet despite decades of promising pilot studies, PBM remains on the margins of mainstream medicine.

Why? The answer lies in systemic barriers: lack of funding, challenges with study design, and an uneven playing field compared with pharmaceutical research.

Challenges in PBM Research

Funding Gaps

Large-scale randomized controlled trials (RCTs) cost millions of dollars. Pharmaceutical companies can afford this because patented drugs promise high returns. PBM devices, by contrast, are difficult to patent at the therapeutic principle level. Without exclusivity, there is little financial incentive to bankroll expensive trials. Most PBM research is conducted through small grants or academic pilot projects, resulting in small sample sizes.

Blinding Problems

In a drug trial, participants can take a sugar pill without knowing it’s a placebo. With PBM, however, patients can see the light or feel warmth. Creating a “sham” device that looks and feels identical but delivers no light is technically difficult. This makes blinding less reliable and gives critics grounds to question trial rigor.

Standardization Issues

PBM’s effects depend on wavelength, intensity, energy, and treatment time. Unfortunately, different studies use widely different parameters, making comparison difficult. This variability weakens meta-analyses and allows skeptics to dismiss results as “inconsistent.”

Publication & Regulation

Top medical journals often view PBM as “alternative” rather than mainstream. Regulators such as the FDA typically clear PBM devices for broad indications like “pain reduction,” not for specific diseases. This limits clinical adoption and reimbursement, discouraging further investment in research.

Underfunded PBM Trials

• Traumatic Brain Injury (TBI): Harvard/Mass General researchers have shown cognitive improvements in veterans with TBI using PBM. But without NIH or Department of Defense support, larger trials never materialized.

• Alzheimer’s Disease: Small studies suggest PBM improves mood, sleep, and cognition in dementia patients. Yet NIH reviewers reject PBM grants for “insufficient data”—a Catch-22 that keeps PBM stuck in the pilot stage.

• Wound Healing: PBM stimulates angiogenesis and fibroblast activity, key for diabetic ulcers. But device makers lack the capital for the large multicenter studies needed to establish PBM as standard care.

The Pharmaceutical Advantage

The story of aducanumab (Aduhelm) highlights the contrast.

• For decades, NIH funded basic amyloid-beta research in Alzheimer’s disease, costing taxpayers billions.

• Biogen built on this publicly funded work to develop aducanumab, winning FDA approval in 2021 despite inconclusive results and serious side effects.

• Biogen priced the drug at $56,000 per year, per patient, with Medicare expected to pay most of the cost.

Meanwhile, PBM—a low-cost, low-risk therapy showing promise in Alzheimer’s and other conditions—remains starved of funding and regulatory recognition.

A Skewed System

The system rewards profit potential, not patient benefit.

• Drugs: Backed by NIH funding, patent exclusivity, and lobbying power.

• PBM: Underfunded, difficult to patent, limited lobbying presence.

As a result, high-cost drugs with marginal benefit move quickly into practice, while low-cost therapies with strong safety records remain under-researched and under-utilized.

Conclusion

For chiropractors and other providers committed to safe, non-invasive care, PBM is an invaluable tool. But until funding and regulatory structures shift, PBM will remain disadvantaged compared with pharmaceuticals. The challenge for our profession is to continue advocating for this therapy, supporting high-quality clinical research, and educating patients about its benefits.

PBM may not yet have the financial clout of Big Pharma, but it has what matters most: the potential to improve lives safely, effectively, and affordably.