Fwd: Psychosurgery Promoted by the NYT_ Here We Go Again...

[Guest guest]

Companion piece, regarding medical research as fraud:http://snipurl.com/tfxfu [Rappoport]FRAUD ACROSS THE BOARDThis is another backgrounder for my upcoming telephone seminar, THE BIG MEDICAL CON GAME, on December 7. To sign up, just above.NOVEMBER 25, 2009. People want to believe in medical science for many reasons. Well, medical science, according to the legend, is based on pristine studies, reviewed by experts, and published in reputable journals.But let’s look at a couple of revelations along this line.29 Percent Of Cancer Studies Report Conflict Of Interest============ALLIANCE FOR HUMAN RESEARCH PROTECTION A Catalyst for Public Debate: Promoting Openness, Full Disclosure, andAccountability http://www.ahrp.org FYITrue to an ignoble tradition of lending its "authoritative" front page topromote psychiatry's most radical experimental approaches to dealing withpatients disabled by mental illness, today's front and center article in TheNew York Times, "Surgery for Mental Ills Offers Both Hope and Risk," byBenedict Carey, sends an optimistic positive spin on psychiatry's currentspade of experimental brain surgeries. A large photograph--rather thancompelling evidence--attempts to lend the story significance.http://www.nytimes.com/2009/11/27/health/research/27brain.html The article acknowledges that the new surgeries are not backed by newscientific evidence of their benefit to justify the serious risks involved: "The great promise of neuroscience at the end of the last century was thatit would revolutionize the treatment of psychiatric problems. But the firstreal application of advanced brain science is not novel at all. It is aprecise, sophisticated version of an old and controversial approach:psychosurgery, in which doctors operate directly on the brain."Indeed, Paul Root Wolpe, a medical ethicist at Emory University,acknowledges the high risk experimental procedures that patients are beingput through: “We have this idea — it’s almost a fetish — that progress is its ownjustification, that if something is promising, then how can we not rush torelieve suffering?” But, Dr. Wolpe reminds readers, "It was not so long ago, he noted, thatdoctors considered the frontal lobotomy a major advance — only to learn thatthe operation left thousands of patients with irreversible brain damage.Many promising medical ideas have run aground, and that’s why we have tomove very cautiously.”Despite "large gaps" in the neurosurgeons' understanding of the braincircuits they are operating on, several surgeries are currently beingpromoted: cingulotomy, capsulotomy, brain stimulation (DBS), and radiation(gamma knife surgery)--all pose high risk for patients with littledemonstrable evidence of success.In cingulotomy, doctors drill into the skull and thread wires into an areaof the brain called the anterior cingulate. "There they pinpoint and destroypinches of tissue that lie along a circuit in each hemisphere that connectsdeeper, emotional centers of the brain to areas of the frontal cortex, whereconscious planning is centered.""This circuit appears to be hyperactive in people with severe O.C.D., andimaging studies suggest that the surgery quiets that activity."The evidence to justify the risks does not exist: neurosurgeons proceed onwhat "appears" and imaging studies that "suggest" but do not demonstrate.In capsulotomy, "surgeons go deeper, into an area called the internalcapsule, and burn out spots in a circuit also thought to be overactive."Surgeons who perform DBS, sink wires into the brain but leave them in place."A pacemaker-like device sends a current to the electrodes, apparentlyinterfering with circuits thought to be hyperactive in people withobsessive-compulsive disorder (and also those with severe depression). Thecurrent can be turned up, down or off, so deep brain stimulation isadjustable and, to some extent, reversible."The technique described in the Times article is called gamma knife surgery."Doctors place the patient in an M.R.I.-like machine that sends beams ofradiation into the skull. The beams pass through the brain without causingdamage, except at the point where they converge. There they burn out spotsof brain tissue..."Underscoring the danger these latest neurosurgical procedures pose, Dr.Darin D. Dougherty, director of the division of neurotherapeutics atMassachusetts General Hospital and an associate professor of psychiatry atHarvard, put it more bluntly." Given the history of failed techniques, likefrontal lobotomy, if this effort somehow goes wrong, it’ll shut down thisapproach for another hundred years.” The evidence, from a small long-term follow-up study, reported by therespected Swedish Karolinska Institute in the Archives of GeneralPsychiatry, [1] found that 50% of 25 patients treated with any of thecommonly used surgeries for OCD, showed that response rates did not differsignificantly between surgical methods. "Only 3 patients were in remission without adverse effects at long-termfollow-up.One of the 9 patients undergoing radiosurgery (patient 20) developed aright-sided radiation necrosis with subsequent apathy, memory problems, andexecutive dysfunction. Another (patient 10) developed a brain edema thatreached its peak size 1 year after surgery; the patient was hospitalizedwith symptoms of apathy, incontinence, and seizures. At long-term follow-up,urinary incontinence, apathy, and executive problems persisted. In bothcases, complications may have been caused by too high a radiation dose.Another patient who underwent multiple thermocapsulotomies (patient 8) hadpersistent urinary incontinence at long-term follow-up. Symptoms of apathyand poor self-control for years afterward." "A mean weight gain of 6 kg was reported in the first postoperative year.Ten patients were considered to have significant problems with executivefunctioning, apathy, or disinhibition. Six of these 10 patients had receivedhigh doses of radiation or had undergone multiple surgical procedures."Conclusions: "Capsulotomy is effective in reducing OCD symptoms. There is asubstantial risk of adverse effects, and the risk may vary between surgicalmethods. Our findings suggest that smaller lesions are safer and that highradiation doses and multiple procedures should be avoided."The invariably positive claims made by proponents of neurosurgery are likelyexplained by the inherent bias of these stakeholders.As Dr. Christian Ruck, the lead author of the Swedish paper, published inthe Archives of General Psychiatry correctly notes:"An inherent problem in most research is that innovation is driven by groupsthat believe in their method, thus introducing bias that is almostimpossible to avoid." So why, did the New York Times once again, see fit to publicize admittedlyhigh risk, radical surgical procedures that demonstrably cause at least halfof the patients serious long-term debilitating adverse effects thatundermine their quality of life? [2] References:1. Christian Rück, MD, PhD; Andreas Karlsson, MS; J. Douglas Steele, MD,PhD, MRCPsych; Gunnar Edman, PhD; Björn A. Meyerson, MD, PhD; Kaj Ericson,MD, PhD; Håkan Nyman, PhD; Marie Åsberg, MD, PhD; Pär Svanborg, MD, PhDCapsulotomy for Obsessive-Compulsive Disorder: Long-term Follow-up of 25PatientsArch Gen Psychiatry. 2008;65(8):914-921.http://archpsyc.ama-assn.org/cgi/content/full/65/8/9142. See NYT Archive on psychosurgery:http://www.psychosurgery.org/news-opinion/archives-of-the-new-york-times/ For example, in 1948, the Times reported: "A revolutionary discovery aboutmental illness, which has already resulted in surgical cures with noapparent ill effects for a group of asylum inmates who had been consideredhopelessly insane, was revealed to a specially called meeting at the NewYork Society of Neuro-surgery yesterday." SURGERY RESTORES ‘INCURABLY’INSANE: Revolutionary Brain Operation Called Topectomy Removes Tissues inCertain Areas Mar 19, 1948. Contact: Vera Hassner Sharavveracare212-595-8974 =====In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.