Treating Our Addiction
Since it first arrived on the scene as a new form of neuromodulation, deep brain stimulation has been subject to its fair share of ethical scrutiny. As we have stated in this space in the past [NBR Jan17 p2, NBR Sep17 p2], it is important to recognize issues of privacy and informed consent whenever we are dealing with implanted brain devices
The latest DBS ethics issue involves clinical trials of DBS for treating addiction, particularly trials conducted in China. The online journal BioEdge recently raised skepticism about the ethical rigor of clinical trials in China, particularly as it relates to informed consent. The article also claimed that scientists don’t fully understand how DBS works. Another article from the Associated Press pointed out China’s “long, troubled history” of brain surgery for drug addiction and suggested that the country’s punitive drug laws may encourage patients to seek DBS therapy.
In part because of these published reports, we chose to attend a session on DBS for addiction at the recent INS 2019 meeting in Sydney, Australia [see conference report, p7]. The presenter was ChenCheng Zhang, a neurosurgeon from RuiJin Hospital in Shanghai, which was singled out in the BioEdge piece. We were impressed by the presenter’s knowledge of the space and his citations of previous work in this area in Europe and North America. In an interview with NBR, Zhang stressed that the research is preliminary and that the clinicians’ primary concern is the safety and well being of the participants. As it turns out, the FDA recently approved a clinical trial of DBS for severe opioid use disorder at West Virginia University.
We’re certainly no fan of the draconian drug laws in China and we should indeed be vigilant of a Clockwork Orange scenario where drug users are forced into therapies they would not otherwise choose. But let’s not forget that drug laws in the U.S. are nothing to be proud of, as evidenced by the racial inequities experienced by thousands of drug users sitting in America’s prisons. And let’s not lose sight of the fact that drug overdoses—including from legal drugs—have claimed the lives of hundreds of thousands of Americans in recent years. We would like to see the bioethics community as concerned with the dangers of prescription drugs as they are with the risks from implanted brain devices. And we’d like regulators to eliminate once and for all the notion that pharmaceuticals are inherently “safer” than device interventions.
As has been the case with other neurological disorders, individuals with addiction disorders who choose to participate in a clinical trial of DBS therapy are making a profound contribution to our understanding of the biological mechanisms underlying their disorder. It’s in everyone’s interest to make sure that they have all the relevant information they need to make that decision.
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