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Comment by jrumbut | Hacker News Reader

This is a great comment. I've always been a little uncomfortable with the thought of this magnetic treatment in a way I couldn't put into words and this nails it.

I'm willing to trust, perhaps naively, that everyone is getting the same Prozac tablets. But how does the skill of the practitioner and maintenance of their magnetic treatment device affect outcomes? It's almost like a surgery, but I'm not sure who's actually been trained to perform it.

Which isn't to say someone shouldn't do it, just my own feelings based on limited understanding. Perhaps if I knew more I would have greater faith.

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The trial used fMRI data to find a cortical area that has functional connectivity with the DLPFC. That area is then targeted with a neuronavigation system (similar to AR), that helps the clinician place the TMS coil at the right spot and the right angle. This in addition to the magnitude of the pulses being based on the patient's threshold (e.g. minimum amount of stimulation that causes motor movement when used over the motor cortex) is what is meant by "personalized".

It's also of note that the treatment takes place over multiple days and there's multiple sessions in a day. During that time, patients are continuously evaluated. This trial was also only used on patients with treatment-resistant depression (i.e. have tried many different medications and forms of therapy, some included ECT) and were screened as such. From my understanding, the treatment was explored as a "last resort" for those that could find no other medical relief, but this obviously has further implications.

A whole lot of treatments end up refined with time.

The FDA approved treatment is "aim at the middle of the dorsolateral prefrontal cortex". Getting more activity and connectedness improves its regulation of overall emotional activity.

This research implies that aiming instead slightly differently and a different dosing regimen may be more effective.

This is no different from any other medical treatment, where we find refinements in how and where to apply basically the same treatment to get better results.

Yes. Treatments are simply implementations of science technology at a particular time.

To get some perspective on iterations of treatment, read this account of the work of August Bier.

He pioneered spinal anesthesia, something used all of the time today for epidurals during childbirth.

His experimental treatments he both performed and had performed on him by his assistant will, at the very least, raise your eyebrows.

https://en.wikipedia.org/wiki/August_Bier#Spinal_anesthesia

There are drug recalls: https://www.fda.gov/drugs/drug-safety-and-availability/drug-... which would invalidate your assumption about Prozac tablets.

Magnetic therapy makes me feel sick to my stomach for reasons that have for long been unknown to me. I'm more comfortable with the idea of undergoing electroconvulsive therapy than something that involves magnets. I'm not sure why it bothers me so much, but it does to an unusual degree.

Human emotional responses to wireless technology, even before the invention of said technology, are very interesting. Check out the wiki page for James Tilly Matthews.

Odd coincidence. The link to “pneumatic chemistry” in that article is purple because I was just reading about the history of bismuth.

Yikes, hope I'm not a hatter like this dude. Thanks for sharing, lead me to discover the Travels Through Time podcast and listened to this episode: https://www.youtube.com/watch?v=d7GdAHr7ZHU

It seems like a… blunt instrument.

That’s what gives me pause.

I concur with this, and the concern that you don't just get something for free. What is the actual mechanism at play here?

Do you have the same feelings about radiation therapy for cancer?

It's all a little freaky if you think about it: even in evidence-based medicine, a whole lot of it is people making qualitative determinations and squishy adjustments to treatment, and undoubtedly getting it wrong a whole lot.

Then again, the stuff shows benefits in trial, and presumably we get most practitioners trained up and doing the thing that's the standard of care well enough...

There might be the perfect amount of paracetamol to take to treat your light headache.

But in practice people just take two 500mg tablets and call it a day. Works well enough most of the time, even though it might be 'wrong' in some platonic sense of the word. (Eg you might have been helped enough with a slightly lower dose. Or perhaps 1250mg would have been better and suppressed slightly more of the pain. Who knows?)

No, it's a very different situation since radiation therapy has such a long history at this point.

I'm just not sure what the margin for error is, the failure modes for this magnetic therapy, or what makes a good magnetic therapist.

Not a reason to stop developing it though.

Magnetic treatment has a long history... we've given billions of MRIs, no one's grown a 3rd arm.

There are plenty of doctors that rather die than treat their cancer. There was even a "recent" HN story about it. The motivation is that for a nasty one, the treatment is often worse than the disease, and they rather spend their wealth and to easy their pain and enjoy their last months of living rather than going through a very hard process that might not work, might leave them in an not that good state.

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