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Daifailluh al-Bugami was just a year old when his parents noticed that his lips turned blue as he slept at night. It was his weight, doctors said, putting pressure on his delicate airways.

Now Daifailluh is 3, and at 61 pounds he is nearly double the typical weight of a child his age. So the Bugamis are planning the once unthinkable: To have their toddler undergo bariatric surgery to permanently remove part of his stomach in hopes of reducing his appetite and staving off a lifetime of health problems.

That such a young child would be considered for weight-loss surgery—something U.S. surgeons generally won’t do—underscores the growing health crisis here and elsewhere in the Middle East. Widespread access to unhealthy foods, coupled with sedentary behavior brought on by wealth and the absence of a dieting and exercise culture, have caused obesity levels in Saudi Arabia and many other Gulf states to approach or even exceed those in Western countries.

While solid national data are hard to come by, some experts say that obesity has turned into a serious health problem for Saudi children, with an estimated 9.3% of school-age youths meeting the World Health Organization’s body-mass-index criteria for obesity, according to research published in 2013 in the Saudi Journal of Obesity. About 18% of school-age children in the U.S. were considered obese in 2010, according to the Centers for Disease Control and Prevention.

Daifailluh’s doctor, Aayed Alqahtani, is a leading advocate of a radical approach to the problem. Patients travel to him from across the country and the Gulf region. Over the past seven years, he has performed bariatric surgery on nearly 100 children under the age of 14, which experts on the procedure believe is the largest number performed by one doctor on young children.

Dr. Alqahtani’s work is being watched amid a global debate about the appropriate age for bariatric surgery. In the U.S., the minimum is generally considered 14. The World Health Organization, in a 2012 report on pediatric bariatric surgery, concluded that there is a dearth of data available on the long-term outcomes of the procedure in children and that a “conservative approach” is necessary until long-term studies are conducted.

Bariatric surgery has been embraced as an effective and relatively safe procedure for morbidly obese adults. The concern with children revolves mostly around nonsurgical risks, such as how the abrupt change in nutrition could affect long-term brain development and sexual maturation.

Dr. Alqahtani says the decision to operate on Daifailluh is a difficult one because of his age. But after nearly two years of consultation with the clinic, Daifailluh’s obesity-related medical problems haven’t gotten any better. “We should not deprive our patients from bariatric surgery based on their age alone,” the surgeon says. “If they have [medical] conditions that threaten their lives, then we should not deny the bariatric surgery.”

The worsening obesity problem here also is manifesting itself in other ways. Some 20% of the Saudi adult population has Type 2 diabetes, a condition linked to obesity, according to the International Diabetes Federation, compared with 8.3% in the U.S., according to the CDC. The cost of diabetes treatment in Saudi Arabia is expected to rise to $2.4 billion in 2015, more than triple that spent in 2010, according to a recent study in the Journal of Family and Community Medicine.

Obesity, particularly among women, has become rampant across much of the Middle East, particularly in oil-rich Gulf nations. In Kuwait, almost half of adult women are considered obese, while 44% of Saudi women and 45% of Qatari women meet the criteria, according to the International Association of the Study of Obesity. Experts says Saudis, in particular, are more likely to carry certain genes linked to obesity.

Saudi lifestyle and parenting practices may exacerbate the problem, according to doctors at weight-loss clinics. Nannies or cooks are often employed, so parents may not know what their children are eating. Saudis often are coaxed to eat large quantities of food when visiting relatives and friends.

In Riyadh, physical activity is limited, particularly for girls, and high temperatures and few green spaces make walking difficult. School gym classes generally take place just once a week. Western-style fast food is abundant, particularly at the air-conditioned malls frequented by children and families.

Bariatric surgery has become an accepted treatment among obese Saudi adults and is paid for by the government. An estimated 11,000 bariatric surgeries were performed on Saudis in 2012, according to Dr. Alqahtani.

The surgery, of which there are several types, generally reduces the size of the stomach and, with some techniques, rearranges the digestive path to bypass much of the intestines. Some types are reversible but generally considered less effective. After the surgery, patients must eat very small meals—ideally for the rest of their lives. Many studies have shown that adults, on average, lose over 50% of their body weight after surgery.

Increasingly, youngsters are heading to the operating room here, where parents see no other options. These days, Dr. Alqahtani performs surgery on three to four youths a week.

“I have seen in my clinic patients who cannot sleep lying down—they sleep sitting—because of sleep apnea, and their age is 10 years, sometimes 5 years,” says Dr. Alqahtani, a professor in the college of medicine and an obesity specialist at King Saud University.

Pediatric surgeons in the U.S. say they also are facing demands from families to operate on younger patients. Thomas Inge, surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital, says he will be operating on a 12-year-old later this month. He says that as younger and younger children are referred for consideration of surgery, care teams will need to carefully weigh the pros and cons.

Evan Nadler, a pediatric surgeon at Children’s National Medical Center in Washington, D.C., is considering doing the operation on two young children. He and the family of a 7-year-old D.C. boy have agreed that surgery likely is the best option, he says. The family of an 8-year-old from the Middle East has decided to wait until their daughter is older and can better understand the surgery, he says.

Many doctors say they aren’t ready to follow Dr. Alqahtani yet. Kirk Reichard, chairman of the pediatric-surgery committee for the American Society for Metabolic and Bariatric Surgery, notes that there are no data to show that surgery doesn’t affect young children’s long-term sexual maturation or cognitive functioning. The brain, particularly in growing children, is sensitive to nutrition and needs enough energy to mature properly. Nutrition also has the potential to affect hormones linked to sexual maturation.

Dr. Alqahtani says he has seen evidence of normal growth following the procedure in his under-14 patients, many of whom are now four years postsurgery.

“We will certainly use his experience to inform us in some ways, but [Dr. Alqahtani’s work] won’t take the place of trials,” says Dr. Reichard.

One of the main criticisms from some weight-loss experts about performing the surgery on those under 14 is that changes in diet and exercise can prevent further weight gain. In addition, says Dr. Reichard, “there are a lot of other therapies short of surgery that can be helpful in managing” related medical conditions.

Saudi Arabia’s Dr. Alqahtani says he requires his child patients to enroll in a weight-loss program for at least six months because patients able to lose even a bit tend to have better outcomes after surgery. But he says that by the time families come to him, their children have such substantial health problems it is generally too late for diet and exercise alone.

Dr. Alqahtani was trained as a surgeon at McGill University in Montreal and at a minimally invasive surgery center in Denver. When he returned home to Riyadh in 2002, he says, he was inundated with pediatric patients so obese they were suffering from advanced stages fatty liver disease, diabetes and sleep apnea, a disorder in which patients repeatedly stop breathing for short periods during sleep—all diseases typically not seen until middle age.

Om Abdullah Asiri says she tried to help her 11-year-old son lose weight by restricting his eating at home. But he would eat fast food while out with his friends and plays videogames for hours on end, she says. “I can’t control him outside the home,” she says.

He grew to 250 pounds. His body-mass index—a calculation that uses weight and height to estimate percentage of body fat—was 61. A BMI of 40 or above is the most severe obesity category, according to the World Health Organization.

Ms. Asiri traveled with her son, Abdullah, from their home in Abha, more than 600 miles south of Riyadh, to see Dr. Alqahtani for the operation. Lying on a hospital bed the day before his surgery, Abdullah said he is “happy and ready” for the surgery.

His mother says surgery is the best solution for Abdullah, who has high blood pressure, fatty liver, hip pain and severe sleep apnea. Afterward, he won’t have a choice but to eat better, she says. “The surgery will make him change.” She says he dreams of playing soccer with his friends.

The procedure Dr. Alqahtani performs is called the gastric sleeve, which slices off a portion of the stomach but leaves the rest of the digestive tract intact. It is gaining in popularity because of its good weight-loss results and minimal side effects. The operation, conducted through tiny incisions in the abdomen, takes him just 30 minutes.

One recent morning, he operated on a 20-year-old, two 17-year-olds, a 12-year-old, then Abdullah, who was then 10.

Complications can include bleeding in about 10% of cases, and leaking and blood clots in 1% to 2%. Dr. Alqahtani says he has had only two leaks in 1,700 cases, neither in children.

Dr. Alqahtani says each of his pediatric patients has lost at least some weight, and nearly three-quarters have lost more than 50% of their initial body weight. Abdullah has lost close to 50 pounds since his surgery about two months ago, according to his 29-year-old brother, Ahmad.

Dr. Alqahtani says about 90% of his patients have seen medical conditions such as diabetes and hypertension clear up, according to a paper scheduled for publication in the journal Surgery for Obesity and Related Diseases. He published outcomes on 108 children in the peer-reviewed Annals of Surgery journal in 2012.

Recovery involves a six-week transition diet starting with clear liquids and puréed food. Patients eventually can resume solid foods at much-reduced quantities. At first, patients feel full after just 1 to 2 spoonfuls of food, though they gradually can eat more as their stomachs stretch.

Some bariatric-surgery experts have raised questions about whether children are capable of maintaining the restrictive lifetime diet after surgery or whether they will sabotage the procedure when they become teenagers and have a greater autonomy to eat what they want. Some experts question whether parents should make such a drastic and permanent decision for a child.

The decision has been excruciating for the family of Daifailluh, the toddler from Ta’if. Daifailluh was referred to Dr. Alqahtani’s clinic about two years ago after difficulty breathing sent him to the intensive-care unit at a hospital in his hometown. Doctors there determined the toddler was seriously overweight. His mother, Hessa Salem al-Bugami, says she tried to improve his diet but didn’t have good guidance until she came to Dr. Alqahtani’s clinic, a trip of nearly 500 miles from Ta’if. “I feel like I failed,” she says.

At first, the family wanted Daifailluh to lose weight without the operation. Ms. Bugami says her son has always had an “open appetite” and never refuses food. She says she feeds him brown bread and boiled chicken and rice, and limits his portions, hiding the rest of the food. But his obesity hasn’t improved, she says.

Daifailluh will cry and sometimes throw temper tantrums when he wants food, she says. She has tried distracting him with toys, locking the two of them in a room to play for so long she ended up missing her own meal.

“When he starts crying, it’s hard not to give him any of the food, to make the crying stop,” she says. “I feel like I work really hard, but it’s just too much on me.”

Daifailluh, who was hospitalized again for pulmonary problems, is waiting for a surgery date, which will come if he gets final medical clearance from Dr. Alqahtani.

The entire family is worried about the surgery, particularly the effects of anesthesia and whether the surgery will reduce his appetite too much. Ms. Bugami also worries that her son will regain the weight when he leaves the house eventually and is no longer under her watch.

But that is a concern for another day. “Right now is the most scary situation,” she says.

Write to Shirley S. Wang at shirley.wang@wsj.com

http://online.wsj.com/news/articles/SB10001424052702304851104579360992538215578?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702304851104579360992538215578.html

Thanks to Pete Cuomo for bringing this to the attention of the It’s Interesting community.

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A Guardian article about Japanese young people no longer being interested in sex and relationships has generated a lot of blogosphere criticism recently, primarily about Western media exoticising “weird” Japanese culture. Those criticisms duly noted, there have also been some recent Japanese innovations that seem to not only support the premise of the article – that technology is taking over the space once occupied by sex and dating – but take it further. Several recent inventions in Japan seem not only likely to disrupt traditional relationships in the way that social media or text messaging has, but to physically replace companionship and affection. A report this week of the physiological benefits of using the Hugvie, a soft doll that simulates a human heartbeat so that the user can “cuddle” with the person on the other end of their phone, is one such case.

Here are some Japanese inventions, like the Hugvie, that may be the most solid proof that Japan is indeed throwing out the idea of relationships and becoming a dystopian future of human loneliness.

The Hugvie is a soft body-fitting pillow with a slot in the head for a smart phone. Users can cuddle with the pillow while talking on the phone, and the pillow’s internal vibrators generate a simulated heartbeat of the caller based on the voice’s tone and volume. In other words, the soft, “blobular” doll transforms a standard phone conversation into a “cuddling” experience with your phone companion. The gizmo was invented by an Osaka University professor who built off of an earlier remote-controlled doll.

A video from the product’s launch last year shows users talking into the phone end and cradling their pillows, and new evidence suggests that the pillow might be as satisfying and soul-warming as the video portrays: a joint study from the University of Sussex and Osaka University that levels of the stress hormone cortisol were reduced in people after using the pillow.

Wine for cats
Earlier this month, a Japanese company took the age-old stereotype of the lonely cat woman and made it a little less lonely with the invention of Nyan Nyan Nouveau, a non-alcoholic feline wine. Masahito Tsurimi, the chief executive of the company behind the wine, told the Wall Street Journal that it was invented in response to requests from cat-owners – despite the fact that only one in 10 cats were willing to taste it.

Tsurimi said he saw a bright future in the “specialty pet-drink business” six years ago when he was worried about where future beverage sales would come from with a shrinking, ageing Japanese population. It was probably just a nice bonus when he read about the country’s sexual aversion and social awkwardness on top of that.

The girlfriend coat
In April of this year, RocketNews 24 reported that a group of engineering students at Tsukuba University created a coat that could hug its wearer and whisper phrases into its ear. Meant to simulate a girlfriend, motors in the coat operate the “arms” that squeeze the wearer when he puts it on. In a pair of headphones he slips on with the coat, he also hears one of a number of programmed phrases: “I’m sorry, were you waiting?” and “Guess who?”

The university students named it the Riajyuu Coat. According to gaming site Kotaku, riajyuu is a mash-up Japanese word that means someone who is pleased with his non-virtual life. Unlike some of the other replacements for human contact, this one appears to have just been a joke between friends, and the inventors have no real plans to release it commercially.

Video game relationships
Japan has cultivated a global reputation for their romantic simulation video games, and for good reason: while some of the games are just bizarre, like a game in which both the player and his mate are pigeons, others mimic relationships down to eerily small details. LovePlus, for instance, a dating simulation game released in Japan in 2009, invites players to choose one girl that they prefer out of three types – a “goodie-goodie”, “sassy”, or “big-sister” type – and then earn “boyfriend power” points by going to the gym or doing homework to become smarter. The girl can get mad at their boyfriends, too: in a 2010 article, LovePlus gamer Shunsuke Kato told the Wall Street Journal he was on the outs with his LovePlus “girlfriend” for being busy at work and only playing the game for 10 minutes a day.

The game has blurred the line between real and virtual to such an extent that a Japanese resort town once known for honeymooning, Atami, launched a promotional campaign in 2010 that relied on recreating the virtual trip to Atami from the game. At Atami’s (real) Hotel Ohnoya, the staff was trained to check in single men as couples, and restaurants created Love Plus-inspired menus for the gaming guests.

If there’s some silver lining to be found in all of this, it’s that a business opportunity will be there to pad the landing when humans do something self-destructive. As Japan has demonstrated, the risk of a plummeting birth rate and the social instability inherent in becoming a society where unmarried people exist in large numbers at least opens up the possibility for bizarre romance-gamer tourism, wine for cats and pillows you can cuddle with.

http://m.smh.com.au/digital-life/digital-life-news/bizarre-japanese-inventions-signal-the-future-of-human-loneliness-20131104-2ww7d.html

Thanks to Kebmodee for bringing this to the attention of the It’s Interesting community.

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white america

By NEIL SHAH

More white Americans are dying than being born for the first time in modern history—suggesting minorities and newcomers will play an important role in fueling the population growth America’s recovering economy needs to thrive.

The number of non-Hispanic white Americans who died in the year ended June 2012 exceeded the number who were born during that period by about 12,400, the first “natural decrease” for this group. That’s according to a U.S. Census Bureau report released Thursday and an analysis of separate data from the National Center for Health Statistics by demographer Kenneth Johnson at the University of New Hampshire. The white population edged up in absolute terms last year thanks to immigration, Census figures show.

The Census data show that as the non-Hispanic white population grows at a slower pace, the share of young Americans who are minorities is increasing, said demographer William Frey of the Brookings Institution, a left-leaning think tank in Washington. While most American children under 5 years old are still white—50.1%—that proportion is expected to fall because the majority of births have been minority children for two years in a row, a trend driven mostly by Hispanic and Asian births.

The growth rate of America’s white population has been slowing for years, but demographers had expected white births to continue exceeding deaths for some time. Census researchers had projected the “natural decrease,” or white Americans’ deaths exceeding births, would begin around 2020 and the overall white population would start falling outright several years later.

“Even during the great influenza epidemic of 1919, there was no white ‘natural decrease,’ ” said Mr. Johnson, calling the new numbers “stunning.” The epidemic of 1918-19 killed more than 600,000 Americans. The big driver of the recent numbers, Mr. Johnson said, was a drop in white births, which fell about 13% last year from 2007 levels.

The findings illustrate how rapidly the U.S. is becoming more diverse and how much of the nation’s population growth is likely to be driven by minorities and new immigrants in the years ahead.

The recent trends are partly due to the nation’s weak economic recovery, which has encouraged many young women to delay having children—a trend that demographers say could now reverse. Fertility rates dropped to low levels during the Great Depression and the 1970s malaise before rising again, according to Mark Mather of the Population Reference Bureau.

But the Census numbers underscore a more powerful, long-term demographic shift. As the nation’s white population ages, there are fewer white women of childbearing age—a trend unlikely to change—and that results in fewer white children. At the same time, young adults, whether white, black or Hispanic, are having fewer children. America’s replacement level—how many children it takes to keep population constant as people die—is about 2.1 births per woman. The fertility rate of U.S. women is about 1.9 births.

That means U.S. population growth will depend significantly on immigration. There are now 14 states where the majority of children under 5 are nonwhite, Mr. Frey said; in 2000, only five states, including the District of Columbia, had “minority majority” toddler populations.

The U.S. population is “browning from the bottom up,” Mr. Frey said.

Thanks to Mr. Cuomo for bringing this to the attention of the It’s Interesting community.

http://online.wsj.com/article/SB10001424127887324049504578541712247829092.html?mod=rss_business

Woman listening on cell phone Fingers to temple. Image shot 2008. Exact date unknown.

One moment, please. … Your call is important to us. …. A representative will be with you shortly.

Annoyed yet?

That’s just a fraction of the 43 days the average person will spend on hold with automated customer service in one lifetime, according to a survey conducted by data collection provider ResearchNow and commissioned by TalkTo, the developer behind the business-centric texting app of the same name.

After polling 500 consumers, ResearchNow determined that 58 percent get ticked off at waiting, and 48 percent believe calling a business is useless. Overall, 86 percent said they had been put on hold when calling a business.

“This research shows how poorly the phone performs as a customer-service channel,” TalkTo CEO Stuart Levinson said in a release.

Granted, Levinson is using this data to hawk TalkTo’s texting app. Nevertheless, anyone who has waited to be connected to, say, an airline’s customer service department, knows he has a point.

“Being put on hold is a fact of life when you call a customer-service department,” ConsumerWorld.org founder Edgar Dworksy told the Wall Street Journal’s MarketWatch blog.

Being on hold nearly became a lifestyle for an Australian man who called Qantas airline to confirm a flight, back in July 2012. Andrew Kahn claimed he waited 15 hours, 40 minutes and 1 second before he hung up. “I had had enough,” Kahn told the Telegraph last August.

Callers who ring up Continental Airlines can feel a bit of Kahn’s pain, according to a report. In 2011, FastCustomer, a customer service tech provider, found the carrier put customers on hold for an average of 13 minutes, the longest in its study. Time didn’t exactly fly with four other airlines that also made the top 10 of FastCustomer’s longest-wait list: Air Canada, Delta, Southwest and JetBlue.

So the next time you have to place a call to a customer service department, make sure you have a good book handy. You’re going to be on the phone a while.

http://www.huffingtonpost.com/2013/01/24/43-days-on-hold-in-your-lifetime_n_2536240.html

 

How far should doctors go in attempting to cure addiction? In China, some physicians are taking the most extreme measures. By destroying parts of the brain’s “pleasure centers” in heroin addicts and alcoholics, these neurosurgeons hope to stop drug cravings. But damaging the brain region involved in addictive desires risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy.

In 2004, the Ministry of Health in China banned this procedure due to lack of data on long term outcomes and growing outrage in Western media over ethical issues about whether the patients were fully aware of the risks.

However, some doctors were allowed to continue to perform it for research purposes—and recently, a Western medical journal even published a new study of the results. In 2007, The Wall Street Journal detailed the practice of a physician who claimed he performed 1000 such procedures to treat mental illnesses such as depression, schizophrenia and epilepsy, after the ban in 2004; the surgery for addiction has also since been done on at least that many people.

The November publication has generated a passionate debate in the scientific community over whether such research should be published or kept outside the pages of reputable scientific journals, where it may find undeserved legitimacy and only encourage further questionable science to flourish.

The latest study is the third published since 2003 in Stereotactic and Functional Neurosurgery, which isn’t the only journal chronicling results from the procedure, which is known as ablation of the nucleus accumbens. In October, the journal World Neurosurgery also published results from the same researchers, who are based at Tangdu Hospital in Xi’an.

The authors, led by Guodong Gao, claim that the surgery is “a feasible method for alleviating psychological dependence on opiate drugs.” At the same time, they report that more than half of the 60 patients had lasting side effects, including memory problems and loss of motivation. Within five years, 53% had relapsed and were addicted again to opiates, leaving 47% drug free.

(MORE: Addicted: Why We Get Hooked)

Conventional treatment only results in significant recovery in about 30-40% of cases, so the procedure apparently improves on that, but experts do not believe that such a small increase in benefit is worth the tremendous risk the surgery poses.  Even the most successful brain surgeries carry risk of infection, disability and death since opening the skull and cutting brain tissue for any reason is both dangerous and unpredictable. And the Chinese researchers report that 21% of the patients they studied experienced memory deficits after the surgery and 18% had “weakened motivation,” including at least one report of lack of sexual desire. The authors claim, however, that “all of these patients reported that their [adverse results] were tolerable.” In addition, 53% of patients had a change in personality, but the authors describe the majority of these changes as “mildness oriented,” presumably meaning that they became more compliant. Around 7%, however, became more impulsive.

The surgery is actually performed while patients are awake in order to minimize the chances of destroying regions necessary for sensation, consciousness or movement.  Surgeons use heat to kill cells in small sections of both sides of the brain’s nucleus accumbens.  That region is saturated with neurons containing dopamine and endogenous opioids, which are involved in pleasure and desire related both to drugs and to ordinary experiences like eating, love and sex.

(MORE: A Drug to End Drug Addiction)

In the U.S. and the U.K., reports the Wall Street Journal, around two dozen stereotactic ablations are performed each year, but only in the most intractable cases of depression and obsessive-compulsive disorder and after extensive review by institutional review boards and intensive discussions with the patient, who must acknowledge the risks. Often, a different brain region is targeted, not the nucleus accumbens. Given the unpredictable and potentially harmful consequences of the procedure, experts are united in their condemnation of using the technique to treat addictions. “To lesion this region that is thought to be involved in all types of motivation and pleasure risks crippling a human being,” says Dr. Charles O’Brien, head of the Center for Studies of Addiction at the University of Pennsylvania.

David Linden, professor of neuroscience at Johns Hopkins and author of a recent book about the brain’s pleasure systems calls the surgery “horribly misguided.”  He says “This treatment will almost certainly render the subjects unable to feel pleasure from a wide range of experiences, not just drugs of abuse.”

But some neurosurgeons see it differently. Dr. John Adler, professor emeritus of neurosurgery at Stanford University, collaborated with the Chinese researchers on the publication and is listed as a co-author.  While he does not advocate the surgery and did not perform it, he believes it can provide valuable information about how the nucleus accumbens works, and how best to attempt to manipulate it. “I do think it’s worth learning from,” he says. ” As far as I’m concerned, ablation of the nucleus accumbens makes no sense for anyone.  There’s a very high complication rate. [But] reporting it doesn’t mean endorsing it. While we should have legitimate ethical concerns about anything like this, it is a bigger travesty to put our heads in the sand and not be willing to publish it,” he says.

(MORE: Anesthesia Study Opens Window Into Consciousness)

Dr. Casey Halpern, a neurosurgery resident at the University of Pennsylvania makes a similar case. He notes that German surgeons have performed experimental surgery involving placing electrodes in the same region to treat the extreme lack of pleasure and motivation associated with otherwise intractable depression.  “That had a 60% success rate, much better than [drugs like Prozac],” he says. Along with colleagues from the University of Magdeburg in Germany, Halpern has just published a paper in the Proceedings of the New York Academy of Sciences calling for careful experimental use of DBS in the nucleus accumbens to treat addictions, which have failed repeatedly to respond to other approaches. The paper cites the Chinese surgery data and notes that addiction itself carries a high mortality risk.

DBS, however, is quite different from ablation.  Although it involves the risk of any brain surgery, the stimulation itself can be turned off if there are negative side effects, while surgical destruction of brain tissue is irreversible. That permanence—along with several other major concerns — has ethicists and addiction researchers calling for a stop to the ablation surgeries, and for journals to refuse to publish related studies.

Harriet Washington, author of Medical Apartheid:  The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, argues that by publishing the results of unethical studies, scientists are condoning the questionable conditions under which the trials are conducted. “When medical journals publish research that violates the profession’sethical guidelines, this serves not only to sanction such abuses, but to encourage them,” she says. “In doing so, this practice encourages a relaxing of moral standards that threatens all patients and subjects, but especially  the medically vulnerable.”

(MORE: Real-Time Video: First Look at a Brain Losing Consciousness Under Anesthesia)

Shi-Min Fang, a Chinese biochemist who became a freelance journalist and recently won the journal Nature‘s Maddox prize for his exposes of widespread fraud in Chinese research, has revealed some of the subpar scientific practices behind research conducted in China, facing death threats and, as the New York Times reported, a beating with a hammer. He agrees that publishing such research only perpetuates the unethical practices. Asked by TIME to comment on the addiction surgery studies, Fang writes that publishing the research, particularly in western journals, “would encourage further unethical research, particularly in China where rewards for publication in international journals are high.”

While he doesn’t have the expertise to comment specifically on the ablation data, he says “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 publication requirement. I also doubt if the patients were really informed in detail about the nature of the study.” Fang also notes that two of the co-authors of the paper are advertising on the internet in Chinese, offering the surgery at a cost of 35,000 renminbi, about $5,600.  That’s more than the average annual income in China, which is about $5,000.

Given the available evidence, in fact, it’s hard to find a scientific justification for even studying the technique in people at all. Carl Hart, associate professor of psychology at Columbia University and author of the leading college textbook on psychoactive drugs, says animal studies suggest the approach may ultimately fail as an effective treatment for addiction; a 1984 experiment, for example, showed that destroying the nucleus accumbens in rats does not permanently stop them from taking opioids like heroin and later research found that it similarly doesn’t work for curbing cocaine cravings. Those results alone should discourage further work in humans. “These data are clear,” he says, “If you are going to take this drastic step, you damn well better know all of the animal literature.” [Disclosure:  Hart and I have worked on a book project together].

(MORE: Top 10 Medical Breakthroughs of 2012)

Moreover, in China, where addiction is so demonized that execution has been seen as an appropriate punishment and where the most effective known treatment for heroin addiction— methadone or buprenorphine maintenance— is illegal, it’s highly unlikely that addicted people could give genuinely informed consent for any brain surgery, let alone one that risks losing the ability to feel pleasure. And even if all of the relevant research suggested that ablating the nucleus accumbens prevented animals from seeking drugs, it would be hard to tell from rats or even primates whether the change was due to an overall reduction in motivation and pleasure or to a beneficial reduction in desiring just the drug itself.

There is no question that addiction can be difficult to treat, and in the most severe cases, where patients have suffered decades of relapses and failed all available treatments multiple times, it may make sense to consider treatments that carry significant risks, just as such dangers are accepted in fighting suicidal depression or cancer.  But in the ablation surgery studies, some of the participants were reportedly as young as 19 years old and had only been addicted for three years.  Addiction research strongly suggests that such patients are likely to recover even without treatment, making the risk-benefit ratio clearly unacceptable.

The controversy highlights the tension between the push for innovation and the reality of risk. Rules on informed consent didn’t arise from fears about theoretical abuses:  they were a response to the real scientific horrors of the Holocaust. And ethical considerations become especially important when treating a condition like addiction, which is still seen by many not as an illness but as a moral problem to be solved by punishment.  Scientific innovation is the goal, but at what price?
Read more: http://healthland.time.com/2012/12/13/controversial-surgery-for-addiction-burns-away-brains-pleasure-center/#ixzz2ExzobWQq

Thanks to Dr. Lutter for bringing this to the attention of the It’s Interesting community.