As an ML engineer, I improve models through trial and error. Sometimes a change improves my metrics, and other times it makes them worse, and I just revert it and try something else.
It's scary to think about neurological surgery making progress in a similar way. We may not have a good theoretical understanding of why a procedure works, but we observe positive outcomes in a small number of patients and then start looking into expanding its use.
It reminds me of procedures where doctors sever connections between the two hemispheres of the brain to reduce seizures. I've heard they can reduce symptoms, but disrupting connections in the brain can also have unexpected consequences. I hope we can do better than essentially throwing spaghetti at the wall.
This article soars from hope to hype to skepticism. I guess that's a consequence of reporting on the fringes of science.
In particular, I wish there was more detail on the 100-cohort study where patients experienced "modest improvements" and how that's calculated. Is that average increase of X points on an MMSE, etc.
In my experience in my family, dementia is not a linear slide. My 85yo mother with Alzheimer's will sometimes present very well and you have to really get into conversational details to notice the dementia. On other days, she'll pick up a paperback and try to use it as a phone. Some days she's steady on her feet, some days coordinating all of those muscles is just too much.
Over the course of a couple years, you can track the decline, but it's not a straight line. "Modest improvements" makes me concerned that they measured a valley to a peak. It's only 6 months since the 100-cohort study.
The problem with this stuff is (as the article mentions) is that it’s going to take a while to figure out whether any benefit is just temporary.
I would guess that there are a lot of variables to eliminate too - eg is it possible that just having a surgery and recovering from anaesthesia can yield some of these benefits in some circumstances? Given that we don’t really understand how most inhaled anaesthetics fully work
I've witnessed dementia patients take a fall, and then be dramatically more confused the next couple days. I've also seen them get some kind of social exposure, sunshine, exercise, etc. and present better for several days afterwards. Measuring "how well is the mind working" isn't like reading a digital meter.
Firstly it’s not curing anything, it’s yielding some improvement. But secondly: what surgeries are performed on people with Alzheimer’s disease, let alone ones where cognitive improvement is even going to be monitored or noticed afterwards? (and even if it were noticed: periods of lucidity are not rare. It would probably be ignored)
It seems like you're arguing with this guy for the sake of argument. If anesthetics "yielded some improvement" in Alzheimer's temporarily then any surgery would get the same effect and we would already know about it. And what is the second point you are trying to make here - that zero surgeries are ever performed annually on Alzheimer's patients for any reason? And of the ones that are, the family wouldn't notice the dramatic cognitive improvement shown in this article, but they noticed it here?
If you have the money for the surgery, an extra year of cognition is huge. Short-term quality of life improvements are totally worth it if you can afford it.
(Disclaimer: the non-paywalled part of the article did not mention side-effects or complications of the treatment so I don’t know what they are.)
Even if it is temporary, so what? Can't you just repeat it? And wouldn't clearing these drainage channels be harmless (modulo risks of any surgery) even if the theory didn't pan out? If I had early-stage Alzheimer's I'd go to the ends of the Earth and do everything I could to slow it down.
Repeat it? It's not removing a tumor. It's adding a path between lymph nodes and blood vessels. You can't just repeat that. After the surgery that path exists. It's a permanent functional change.
It would be great if it works out, but I believe this treatment has been suspended in China as there are mixed results (ie people have ended up worse).
Being from Scotland I'd trust an NHS evaluation more than random news reports.
But that would suggest that this cures some form of Alzheimer's but not all forms.
If your Alzheimer's is caused by poor drainage due to a one off blockage this would solve it completely, but if its due to something else this would probably just be temporary as the article notes.
Alzheimer's is tricky. The person who is consenting to the procedure may not be the person in the OR. And both parties are vulnerable to scams and snake oil. This procedure needs studies, so there's a clear rate of success we can understand and communicate.
Even if you are right, you are using the tone of a conspiracist. You are this close to posting, "They don't want you to know!"
Maybe dial it back a bit? You can be firm in your opinions and have more success in convincing others if you avoid vaguely worded accusations and the like.
FTA: "anecdotally at least, several clinicians say they’ve heard from colleagues in China that the majority of individuals backslide within a year of surgery, echoing broader concerns that any gains might not last."
Seems like this treatment is widely reported on and there's interest in running controlled trials to evaluate its actual success rate. It's shown up on HN a lot.
And honestly, caution is valuable here. People with Alzheimer's are extremely vulnerable. As are their loved ones. Ensuring it's got rigorous data so caregivers can understand the tradeoffs seems important. Surgery at an advanced age is risky, no matter what.
It seems China is repeating similar mistakes the western world did in the 20th century (e.g. psychosurgery, very weak regulations). It's like watching a car seconds before crash and you can't do anything to stop it.
> The rapid adoption, in the absence of hard evidence, prompted Chinese regulators to intervene. Last year, they restricted the procedure to more-formalized clinical research settings, rather than the ad hoc use that had proliferated previously. And Xie, the pioneer of the technique, has been in detention since September for undisclosed reasons.
There is probably also some benefit to being willing to let some harm come to patients in order to quickly determine if treatments are viable or not. Western medicine puts a premium on human life but development of treatments is certainly slowed by that ethos .
It puts a "premium" on life only because all those regulations were written with blood from those who can't defend themselves anymore as those same arguments were used back then as they are today.
In particular, I wish there was more detail on the 100-cohort study where patients experienced "modest improvements" and how that's calculated. Is that average increase of X points on an MMSE, etc.
In my experience in my family, dementia is not a linear slide. My 85yo mother with Alzheimer's will sometimes present very well and you have to really get into conversational details to notice the dementia. On other days, she'll pick up a paperback and try to use it as a phone. Some days she's steady on her feet, some days coordinating all of those muscles is just too much.
Over the course of a couple years, you can track the decline, but it's not a straight line. "Modest improvements" makes me concerned that they measured a valley to a peak. It's only 6 months since the 100-cohort study.
I would guess that there are a lot of variables to eliminate too - eg is it possible that just having a surgery and recovering from anaesthesia can yield some of these benefits in some circumstances? Given that we don’t really understand how most inhaled anaesthetics fully work
I've witnessed dementia patients take a fall, and then be dramatically more confused the next couple days. I've also seen them get some kind of social exposure, sunshine, exercise, etc. and present better for several days afterwards. Measuring "how well is the mind working" isn't like reading a digital meter.
It did cure some people, it yielded some improvements on average but it did yield extreme improvements in some people. That part isn't controversial.
> (and even if it were noticed: periods of lucidity are not rare. It would probably be ignored)
A year of being able to walk and talk normally when a patient could barely function at all would be noticed for sure.
Cure has a very specific definition. I don't think it applies here.
(Disclaimer: the non-paywalled part of the article did not mention side-effects or complications of the treatment so I don’t know what they are.)
I wouldn't assume you could. I guess that's why people study these things.
Being from Scotland I'd trust an NHS evaluation more than random news reports.
If your Alzheimer's is caused by poor drainage due to a one off blockage this would solve it completely, but if its due to something else this would probably just be temporary as the article notes.
The government shouldn't be in the business of telling people what they can do, or have done, to their own bodies.
And the surgeon is in prison according to the article.
Huh. You completely made that up. Where in the article does it say that? Here's the truth from the article:
> Last year, they restricted the procedure to more-formalized clinical research settings,
It is the hallmark of a lowlife to suppress research.
You need to think more.
We are not naive. We know when there is a conflict of interest. The intent to suppress is obvious.
Some conspiracies are real.
Maybe dial it back a bit? You can be firm in your opinions and have more success in convincing others if you avoid vaguely worded accusations and the like.
I favor trials, of course, but the ones suppressing it would rather just bury it.
And honestly, caution is valuable here. People with Alzheimer's are extremely vulnerable. As are their loved ones. Ensuring it's got rigorous data so caregivers can understand the tradeoffs seems important. Surgery at an advanced age is risky, no matter what.
> The rapid adoption, in the absence of hard evidence, prompted Chinese regulators to intervene. Last year, they restricted the procedure to more-formalized clinical research settings, rather than the ad hoc use that had proliferated previously. And Xie, the pioneer of the technique, has been in detention since September for undisclosed reasons.
Seems you missed out on 10-15 years of development. Regulation strictness these days rival western.