The word “paradigm” is over misused and overused, diluting its utility. Thomas Kuhn coined the term in The Structure of Scientific Revolutions to refer to an overarching explanatory system in science. Scientists, according to Kuhn, work within a paradigm during periods of “normal science,” punctuated by occasional “paradigm shifts” when the old explanatory model no longer sufficed, and a radically new explanatory system was required. The term has since come into colloquial use to mean any scientific breakthrough, which marketers quickly overused to refer to just about any new product.
I am therefore cautious about using the term, but I think it is appropriate in this case. In medicine I would consider a new paradigm to be an entirely new approach to some forms of illness. Common treatment paradigms include nutrition, physical therapy, surgery, and pharmacology. A new paradigm is emerging in my field of neurology – directly affecting brain function through electromagnetic stimulation.
The brain is a chemical organ, with many receptors for specific neurotransmitters. This has allowed us to use a pharmacological approach in treating brain disorders – using drugs that are agonists (activators) or antagonists (blockers) of various neurotransmitter receptors, or that affect the production or inactivation of the neurotransmitters themselves. There are limits to this approach, however. First, neurotransmitters are not the only factor affecting brain function. The brain is also a biological organ like any other, and so all the normal physiological factors are in play. Further, there is only so much evolved specificity to the neurotransmitters and their receptors.
We spend a great deal of time in the pages of Science-Based Medicine taking down every form of pseudoscience in medicine. Of course, what we see as pseudoscience, proponents often see as emerging or cutting edge science. They are taking advantage of the fact that there is a great deal of legitimate emerging science, and they hope they can sneak past the gates by cloaking themselves in the trappings of real science (jargon, studies, their own journals, etc.). Emerging science, however, no matter how plausible and earnest, still has yet to prove itself (by definition), and has to go through the rigorous process of scientific evaluation to slowly gain acceptance. That process – sorting out what works from what doesn’t, the real from the fake – is where all the action is in SBM.
It is refreshing sometimes to talk about an emerging field that, while still experimental, is legitimate and has the potential to usher in a genuinely revolutionary treatment.
I have been following the research into brain-machine interfaces for some years, and reporting on many of the significant “baby steps” in the advance of this new technology. A recent study published in The Lancet represents another incremental and encouraging advance. Researchers at the University of Pittsburgh implanted two strips of 96 electrodes into the motor cortex of a 52 year-old woman with tetraplegia. The electrodes are capable of detecting the firing of neurons in the motor cortex and transmitting those signals to an external processor that in turn controls a fairly sophisticated robotic arm. The arm is described as having seven degrees of freedom – three dimensions of translation, three dimensions of orientation, and one dimension of grasping.
After two days the subject was able to move the robotic arm with her thoughts alone. Over the course of the 13 week study she progressively gained control of the arm and eventually was able to feed herself with the arm. While this is still very far from a “cure” for paralysis or a restoration of full function, for someone who is tetraplegic (all four limbs are paralyzed) having any independent function is a huge improvement in quality of life.
So where are we with this technology?
The primary reason that I and others favor science-based medicine, as opposed to the alternatives, is that science works. As Carl Sagan said, “Science delivers the good.” Science has other virtues – it is transparent and self-corrective also.
Recently two unrelated news items have provided an opportunity to compare a scientific vs a pseudoscientific approach to the same problem – that of communicating to patients who are locked-in.
Locked-in describes those who suffer from an injury or neurological disease that mostly paralyzes them, so that they cannot move or communicate. One scenario that leads to a locked-in state is a brainstem stroke, where patients are paralyzed below the eyes – they can only blink and move their eyes, but nothing else. Widespread trauma can lead to a similar situation. ALS, which leads to progressive loss of motor neurons, can also result in total or near total paralysis.