This article describes some mouse and single-human-subject research at Stanford Medicine about an electrical brain stimulation device that is an offshoot of deep brain stimulation and that appears able to home in on and zap — in real time — the neuronal sudden urges and impulses that go rogue in a part of the brain called the nucleus accumbens.
The story did a good job discussing costs and laying out the study design for readers. Also, although the article starts out by spending a lot of time speculating about human benefits, it does eventually make it clear that this is preliminary rodent research. One big gap of the story was not acknowledging that should this idea ever make it to market, it will indeed carry serious risks, including infection, strokes and device failure. Those serious risks (and the steep price tag) may outweigh the benefits.
As one of the principal investigators puts it in the article, “clinical need” for safe, effective treatments of addictive and self-destructive behaviors is high. Readers and listeners will be instantly interested in any potential therapy that stops the behavior at its source inside the brain. That level of interest makes it necessary to be cautious and realistic about any application of animal research and a single case history, particularly, as the article notes, because mice and other non-human animals don’t exhibit such behaviors naturally.
Although the article might have been strengthened by including the costs of alternative therapies, it clearly notes the high cost of the implantable device.
The article offers a summary statement or two about how much better mice receiving responsive neurostimulation system (RNS) therapy did than control mice. But, it needed to make it more clear that regardless of what the researchers measured, mice studies should not be extrapolated to human benefits. It’s a risky endeavor. In this story, any caveats about the research were often followed up by statements that watered them down. For example:
“Whether this strategy could block harmful impulses in people remains unclear. For now the path seems promising.”
The article didn’t discuss harms. Bleeding in the brain, infection, and device failure are all known risks. This would have helped balance out the researcher’s unchallenged assertion that this procedure is “safe.” This is especially important to balance when talking about medical devices, which are not as regulated as drugs.
Although the article could have been stronger had it offered more detail about the protocol, it does a pretty good job of explaining what the research accomplished and why it may hold some potential.
No mongering here, though given the broad speculation about what this device might be used for, there does seem to be the potential for this intervention to be used in less than absolutely medically necessary ways.
The story doesn’t disclose that Casey Halpern, the lead researcher, has accepted payment from the maker of the RNS System device, Neuropace.
There are treatments for addictive or impulsive behaviors, although arguably they all have less than stellar records of success, and many that involve medications come with a host of side effects. Some mention of these should have been made, though.
The article makes clear that this is very early research and that the treatment is not clinically available for behavioral problems.
The “gee whiz” aspects of this research — particularly the researchers ability to map the troublesome neuronal activity pretty accurately — are well portrayed. The research is intriguing and the article brings that across.
The article did include one source not directly involved with the research.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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