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Trying brain pacemakers to zap psychiatric disease

Rating

4 Star

Categories

Trying brain pacemakers to zap psychiatric disease

Our Review Summary

We especially appreciate the lack of hype in this story.  The reporter clearly worked hard to stick to the evidence – not merely to promote the potential.

 

Why This Matters

About 65-70 percent of patients with major depressive disorder improve substantially with 1 to 2 course of standard treatment (medication, psychotherapy or combinations). Subsequent treatment options have progressively lower rates of treatment response. Therefore, a significant number of people need other treatment options. Deep brain stimulation is an invasive treatment, but one that has shown promise in a small number of patients.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

We give the story credit for at least citing a $30,000 cost for the “surgeries” but wish it had explained what that included and what it might not.  Surgery to change the battery every two years certainly adds to cost.  Undoubtedly patients require more intensive expensive followup and perhaps specialized checks to ensure the device is working.

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

Satisfactory

With broad strokes across discussion of three different uses for three different conditions, the story did an adequate job quantifiying benefits. As stated in the “Evidence” criterion above, this is where a control group and reporting response rates for treated versus control groups would be very informative.  Instead, we only get a qualitative description of benefits which is useful but which might leave careful readers asking for more.

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

Not Satisfactory

This is one area where the story could have been improved.  There was no detailed discussion of what can go wrong with deep brain stimulation.  There was a brief mention of “if” the electrodes cause neurological side effects.  But how often does that happen?  And the story noted that the surgery does “sometimes” cause dangerous brain bleeding or infections.  How often is “sometimes”?

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

Not Satisfactory

At a very high, overview level, the story explained the current state of the evidence. But more information would have been better. Current evidence for depression/OCD is based on case series. These studies don’t have a control group, making the results more subject to bias.

Does the story commit disease-mongering?

Satisfactory

No disease mongering of any of the conditions discussed. The story was repeatedly clear about deep brain stimulation being used when standard medications or behavior therapy had not worked. But it would be helpful to give estimates of the proportion of patients with depression or OCD who aren’t helped by available treatments.

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

Satisfactory

Several sources were cited.  Dr. Mayberg’s connection to St. Jude Medical was mentioned.  The story could have mentioned that Dr. Okun’s center and Dr. Greenberg have received funding from Medtronic. Greenberg’s current funding from the National Institute of Mental Health was noted.  We think the sourcing and disclosure was adequate.

Does the story compare the new approach with existing alternatives?

Satisfactory

A strong point of the story was that it repeatedly provided the context for the use of deep brain stimulation — “when standard medications fail…worst-case patients…doesn’t mean patients can abandon traditional therapy…people with intractable (problems)…(people who) failed behavior therapy.”

This story already attempted to accomplish a lot, but to be complete, it could have offered explicit description of currently approved options: antidepressant medications (multiple classes); psychotherapy (multiple options); combinations of medications or medications and therapy; transcranial magnetic stimulation (limited availabilty), vagal nerve stimulation, ECT – and estimate of the proportion of patients who fail these treatments.

Nonethless, we feel it met the criteria for a satisfactory score.

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

Satisfactory

The story states that 70,000 have had deep brian stimulation for Parkinson’s or other movement disorders, and that studies are underway on at least 60 people with intractable obsessive-compulsive disorder and 100 with severe depression.  The experimental nature of these approaches is clear from the story.

A nice touch would be to give a link to clinicaltrials.gov to allow readers the option of looking up more information on the studies in progress and finding out if recruitment is open and how to access the study.

Does the story establish the true novelty of the approach?

Satisfactory

The story did a good job putting the new uses of deep brain stimulation into the context of other research and other therapeutic approaches.

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

Satisfactory

It’s clear that the story did not rely on a news release.

Total Score: 8 of 10 Satisfactory

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