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  (Source: JayForce)
Procedure involves drilling into patient's skull, destroying parts of their pleasure center

The Chinese medical community is testing a bleeding edge brain surgery procedure that is equal parts controversial and intriguing.  While the procedure -- designed to treat drug addiction -- draws some comparisons to archaic therapies, it leverages modern neuroscience to carefully target the neural circuits involved in addiction and destroy them.

I. Drilling Into the Human Brain -- Treatment or Travesty?

The procedure itself sounds like something from a horror film.  The procedure begins with drilling a series of small holes into the patient's skull.  The patient is awake during the entire surgery.  That is crucial, as it allows the patient to report any abnormal sensations, which would occur if the surgery team affected the wrong location.

Electrodes are then inserted into the nucleus accumbens, a region full of dopagenic neurons.  The region is often referred to as one of the brain's "reward centers".  And while rewards can be associated with healthy activities -- sex, exercise, art, music, and more -- they also are commonly activated by all manner of addictions.

So the controversial neurosurgery involves literally cooking this pleasure center, killing the neurons.  The result is that the addict no longer receives any "reward" in the form of dopamine from using their substance of choice.

Drilling
The surgery involves drilling into the human skull and killing part of the brain.
[Image Source: HomeZooka]

The surgery is primarily used on cocaine and heroine addicts, but could apply to serious addicts of other kinds, including internet addicts and overeaters.

The surgery is officially banned by the Chinese Ministry of Health, which outlawed it in 2004 on the grounds of insufficient evidence of its safety.  However, a report by TIME claims that the surgery has been performed 1,000 times since.  Even government hospitals appear to be involved; the military Tangdu Hospital in Xi’an published a study on the procedure's effectiveness in the peer-reviewed Journal of Stereotactic and Functional Neurosurgery.

Nucleus Accumbens
Ablation typically targets the nucleus accumbens, a reward center. [Image Source: CUNY]

The procedure is general referred to as "ablative surgery" -- destroying part of the brain to try to cure it from some form of mental illness, such addiction.

According to the study, from a pure statistical perspective the surgery works better than any alternative.  Traditional treatment for opiate addicts only achieves a 30 to 40 percent "cure" rate at best -- 60 to 70 percent of addicts relapse.  But with the surgery 47 percent of addicts (out of 60 patients who received the treatment) remained drug free five years later, while only 53 percent relapsed.

But the cure comes at a cost, the authors admit.  Of the patients receiving the treatment, 60 percent experienced some side effects.  Most common was a change in personality.  Roughly 53 percent of the patients experienced such a change, with most becoming more "mildness oriented".  Memory loss was also experienced by 21 percent of patients, and motivation loss by 18 percent.

II. U.S. Experts are Mortified

Experts are not convinced the cost is worth the slightly higher cure rates.  David Linden, professor of neuroscience at Johns Hopkins University and author of “The Compass of Pleasure” called the procedure "horribly misguided", commenting to TIME, "This treatment will almost certainly render the subjects unable to feel pleasure from a wide range of experiences, not just drugs alone."

In China, where thousands of drug traffickers are executed a year, kicking the habit could be life-saving.  But the procedure is not free -- it costs around $8,400 USD, or about the amount an average Chinese citizen makes in an entire year [source: CIA Factbook].

And more alarmingly, similar electroshock procedures are being applied to patients with other conditions like depression, with much lower success rates.  Dr. Wang Yifang No. 454 Hospital of the People’s Liberation Army in Nanjing admitted in a recent Wall Street Journal interview to performing ablative surgery 1,000 times.  Most of his patients suffered from schizophrenia, but also patients suffering from depression and epilepsy.

Surgeons
Chinese surgeons are performing the procedure at a rate critics call "alarming".
[Image Source: Xinhua]

Dr. Wang defends his procedure saying that he is performing a service to society.  He states, "In many of the mental disease hospitals 30 to 50 percent of patients cannot be treated by medicine. And these patients have caused a great burden to their families and society."

Dr. Michael Shulder, a top neurosurgeon at Newark University Hospital in New Jersey, indicates that very rarely such procedures are warranted, but he said that the sheer number of patients Dr. Wang performed the surgery on was astonishing.  He said that to do ablative surgery on over 1,000 patients was "completely off the charts” and that even 10 would be considered “highly controversial."

III. Ablative Surgery Debate Echoes Lobotomy Debate of Decades Past

Decades ago the world grappled with the risk versus reward blunt dissection lobotomies -- surgeries to remove part of the frontal cortex.  For showing the therapeutic effects of lobotomizing the mentally ill António Egas Moniz won the Nobel Prize for Physiology or Medicine in 1949.  In decades following almost 20,000 lobotomies were performed.  But by the 1970s, the U.S. banned the procedure after evidence of the severe side effects it caused emerged.

Nobel Prize
In just three decades lobotomies went from being worthy of a Nobel Prize to being shunned by the U.S. medical community. [Image Source: IBN Live]

By contrast, ablative surgery is far more targeted -- but it still is killing a part of the body's most delicate piece of machinery.  The real problem is that in the U.S. and UK only about two dozen ablative surgeries are performed a year (typically on people with certain kinds of severe depression; never on drug addicts).  And there are differences between those surgeries and the new addiction therapy surgeries being performed in China.  Thus the population size may be too small and specific to draw thorough conclusions about the procedure's success rates and side effects.

About the only nation that appears to be in a position to, for better or worse, give a thorough analysis is China.  But some allege that such information may be impossible to attain, as they accuse the Chinese medical community of pervasive academic misconduct.

Shi-Min Fang -- a biochemist-turned-freelance writer who formally held positions at the University of Rochester in New York and the Salk Institute for Biological Studies in La Jolla, Calif. -- tells The New York Times, "The results of clinical research in China are very often fabricated. I suspect that the approvals by Ethics Committee mentioned in these papers were made up to meet the publication requirement. I also doubt if the patients were really informed in detail about the nature of the study."

In other words, even if Chinese doctors say ablative surgery is working great, the truth could be a different animal altogether.

Sources: Journal of Stereotactic and Functional Neurosurgery, TIME, WSJ



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RE: Only 47% success rate?
By Jedi2155 on 1/1/2013 9:23:44 PM , Rating: 2
There is a case of a hospital here where a doctor practicing there has had multiple lawsuits where he forgets his tools inside the patients before patching them back up. As to why he still is practicing is another issue, but just saying... basic human error can easily decrease any value below 99%.


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