The Two-Way Street

As it has in the past, the recent meeting of the North American Neuromodulation Society offered a host of scientific and clinical presentations that meshed nicely with commercial product offerings on the exhibit floor [see conference report, p7]. As we report in our article on page 1 of this issue, one such area of scientific advance that will likely have a tremendous impact on commercial product development is the role that glial cells play in the pain pathway.

Another significant area of clinical investigation presented at the meeting related to the mechanisms and effects of the placebo response. In an intriguing talk, Marta Ceko from the University of Colorado stressed that we can harness the placebo effect if we understand the mechanism. A patient’s prior beliefs guide how the brain—essentially a prediction machine—will respond to any therapeutic regimen, she said.

Nathaniel Katz, a clinical trialist from Tufts University, pointed out that clinical trials with a larger placebo response are much more likely to fail. He reported that patients with a high variability in pain reporting were more likely to be preferential placebo responders, which seems to suggest a ready means for clinical trial sponsors to filter enrollees. But he also pointed out techniques that could be used to modulate the placebo effect in these individuals.

Marta Pecina from Pitt pointed out similar phenomena in trials of antidepressant therapies. As we have opined previously in this space, the notion that we need to suppress placebo response in clinical trials is not just unfair to neuromodulation device therapies vis-à-vis drugs, it is antithetical to the fundamental goal of medical practice: to make the patient better. If a novel therapy for a disorder such as pain or depression can activate the placebo pathway to boost response, that should be welcomed and not punished.

Another key session at NANS was devoted to “Appropriate and Effective Collaboration with Industry.” Incoming president Peter Konrad presented a talk tracing the history of industry involvement in medicine, while Padma Gulur from Duke University spoke on managing conflicts of interest in clinical practice. While some have criticized the extent to which some academic researchers have collaborated with industry, if appropriate ethical guidelines are in place, this can be a two-way street that benefits industry, academia, and patients alike. In general, more transparency, such as requiring publication of failed trial results, is healthy for all parties.

As a society and as an event, NANS has played a critical role in the development of the neurotech industry and in the lives of patients with neurological disorders. We hope to see that continue in the years ahead.

James Cavuoto
Editor and Publisher


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