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Rewiring the brain

Rating

2 Star

Rewiring the brain

Our Review Summary

This was an engaging story about deep brain stimulation (DBS) and its potential to help people in a minimally conscious state. The story also projected that the technology may be used for a variety of problems involving a neural component in the brain.  It tempered the enthusiasm for the technology by indicating that the benefits patients might derive were likely limited and for degenerative conditions, were temporary.

It could have done a better job at informing the reader about the nature of the evidence available about the described treatment. It should have emphasized that a case report is among the weakest classes of evidence in medical research. 

The article mentions many conditions, so what starts out as a focused article on minimally conscious trauma vicitms morphs into a survey of many diseases, for example Parkinsonism, obsessive-compulsive disorder, adddiction and depression.  But the story is unclear about whether or how widely the technology is available for all or for any of these disorders. 

Costs were not mentioned.  Harms were not described.  The potential for benefit was not quantified. 

Overall, while this was an intelligent and insightful discussion of the new technology, the story’s tone may be overly optimistic across a broad range of conditions.  

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No estimates of the cost of this treatment were provided.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story provided some insight into possible regain of function (i.e. eating and hair brushing).  From this, the reader could infer that while the treatment might provide some benefit, it did not hold out promise of complete recovery.  However – the reader is not provided with any guidance about what percentage respond to this treatment.  It is not possible for the reader to derive a sense about the probability of success or failure.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

There was no mention of harms associated with deep brain stimulation.  There are some minor or temporary problems that may occur as well as risk of brain hemorrhage. There is no mention of complications of foreign material in the brain, of stimulators  housed in the chest, "mild anesthesia" and of the insertion of wires into the brain. 

However – in its description of the benefit for Parkinson’s disease, the story mentioned that it was not beneficial for end-stage symptoms and indicated that the benefits of treatment were temporary for this degenerative condition.  This provides an important perspective about limits of benefits.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story described the results of one patient who is part of a clinical trial investigating the benefits of deep-brain stimulation for appropriate candidates in a miminally conscious state.  While providing a great deal of detail about the single patient reported on, the story characterized the information available as something ‘announced’ by scientists in early August.  Rather than an announcement, the case report was actually a published letter in the journal Nature.  Inclusion of this information is useful background for readers weighing the credibility of the treatment claims.

The compelling and dramatic descriptions of benefit have the effect of persuading the reader that the procedure is indeed effective when it has not been proven to be.  It also should have emphasized that a case report is among the weakest classes of evidence in medicine.

Does the story commit disease-mongering?

Satisfactory

The story does not engage in overt disease mongering.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story quotes three of the authors of a published study; in addition it contains interview material from a person being treated that had Parkinson’s disease as well as another clinician who did not appear to contribute to this publication.

However – there was no one with an expertise in the miminally concious state not connected with this particular technology in some way who appears to have been interviewed for this story. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story stated that "Twenty percent of miminally conscious patients recover well enough to return to the community and resume their lives" and that those suffering from traumatic brain injury have few options.  However – it did not provide any insight as to what the treatment options are. 

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story indicates that the highlighted treatment, deep-brain stimulation (DBS) , is a technology used to treat the tremors of Parkinson’s disease, and provides a list of other conditions for which it’s use is being investigated. 

It would have been best to be absolutely clear that its use for patients with minimally conscious state is investigational.  In the publication describing this case study, the authors state "…the generalizability of the results is unknown, and expectations raised by this report should be tempered." (Nature (2007)448:600-604.

The article mentions many conditions for which there does not appear to be FDA approval for the use of this technology. 

Does the story establish the true novelty of the approach?

Satisfactory

The story provided an engaging look at the potential benefit for deep brain stimulation to improve the condition of people in a minimally conscious state.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a published press release.

Total Score: 3 of 10 Satisfactory

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