Tue 01-September-2020

“Biological psychiatry” is a journal I’m not very likely to cross paths with (I’m more of “expert systems with applications” kind of guy). The only reason I came across the article and the incredible work it describes is because my PhD supervisor, the esteemed Prof. Barbara Sahakian, was one of the contributors and co-authors.

Even if somebody pointed me directly to the article, I wouldn’t be able to appreciate the entirety of the underlying work. First and foremost due to lack of any medical/neuroscientific subject matter expertise, but also because this incredible work is described so modestly and matter-of-factly that one may easily miss its significance, which is quite enormous. A team of world-class (and I mean: WORLD-CLASS) scientists planted electrodes in the brains of six patients suffering from severe (and I mean: SEVERE; debilitating) obsessive-compulsive disorder (OCD). The results were nothing short of astonishing…

The experiment examined the impact of direct brain stimulation (DBS) on patients with treatment-resistant cases of OCD. I have mild OCD myself, but it’s really mild – it’s just being slightly over the top with to do lists and turning off the stove (the latter not being much of a concern given that I leave my place roughly once a fortnight these days). I tend to think that it’s less of an issue and more of an integral part of my personality. It did bother me more when I was in my early 20’s and I briefly took some medication to alleviate it. The meds took care of my OCD, and of everything else as well. I became a carefree vegetable (not to mention some deeply unwelcome side-effects unique to the male kind). Soon afterwards I concluded my OCD is not so bad considering. However mild my own OCD is, I can empathise with people experiencing it in much more severe forms, and the six patients who participated in the study have been experiencing debilitating, super-severe (and, frankly, heartbreaking) cases of treatment-resistant OCD.

DBS was a new term to me, but conceptually it sounded vaguely similar to BCI (brain / computer interface) and even more similar to TDCS (trans-cranial direct current stimulation). Wikipedia explains that DBS is “is a neurosurgical procedure involving the placement of a medical device called a neurostimulator (sometimes referred to as a “brain pacemaker”), which sends electrical impulses, through implanted electrodes, to specific targets in the brain (brain nuclei) for the treatment of movement disorders, including Parkinson’s disease, essential tremor, and dystonia. While its underlying principles and mechanisms are not fully understood, DBS directly changes brain activity in a controlled manner”. That sounds pretty amazing as it is, though the researchers in this particular instance were using DBS for a non-movement disorder (definition from the world-famous Mayo clinic is broader and does mention DBS being used for treatment of OCD).

Some (many) of the medical technicalities of the experiment were above my intellectual paygrade, but I understood just enough to appreciate its significance. Six patients underwent general anaesthesia surgery (in simple terms: they had holes burred in their skulls), during which electrodes were implanted into 2 target areas in order to verify how each of them will respond to stimulation in a double-blind setting. What mattered to me was whether *either* stimulations would lead to improvement – and they did; boy, did they improve…! The Y-BOCS scores (which are used to measure and define clinical severity of OCD in adults) plummeted like restaurants’ income during COVID-19 lockdown: in the optimum stimulation settings + Cognitive Behavioural Therapy (CBT) combo, the average reduction in y-COBS was an astonishing 73.8%; one person’s score went down by 95%, another one’s by 100%. The technical and modest language of the article doesn’t include a comment allegedly made by one of the patients post-surgery: “it was like a flip of a switch” – but that’s what the results are saying for those two patients (the remaining four ranged between 38% and 82% reduction).

There is something to be said about the article itself. First of all, this epic, multi-researcher, multi-patient, exceptionally complex and sensitive study is captured in full on 8 pages. I can barely say “hello” in under 10 pages… The modest and somewhat anticlimactic language of the article is understandable (this is how formulaic, rigidly structured academic writing works whether I like it or not [I don’t!]), but at the same time is not giving sufficient credit to the significance of the results. Quite often I’d come across something in an academic (or even borderline popular science) journal that should be headline news on BBC or Sky News, and yet it isn’t (sidebar: there was one time, literally one time in my adult life that I can recall a science story being front-page news – it was the discovery of the Higgs Boson around 2012). Professor Steve Fuller really triggered me with his presentation at TransVision 2019 festival (“trans” as in “transhumanism”, not gender) when he mentioned that everyone in academia is busy writing articles and hardly anyone is actually reading them. I wonder how many people who should know of the Tyagi study (fellow researchers, grant approvers, donors, pharma and life sciences corporations, medical authorities, OCD patients etc.) actually do. I also wonder how many connections between seemingly-unrelated research are waiting to be uncovered and how many brilliant theories and discoveries have been published once in some obscure journal (or even not published at all) and have basically faded into scientific oblivion. I’m not saying this is the fate of this particular article (“Biological Psychiatry” is a highly-esteemed journal with impact factor placing it around top 10 of psychiatry and neuroscience publications, and it’s been around since late-1950’s), but still, this research gives hope to so many OCD sufferers (and potentially also depression sufferers and addicts, as per the Mayo clinic, so literally millions of people) that it should have been headline news on the BBC – but it wasn’t…