Dr Shock MD PhD

Because Vagus Nerve Stimulation (VNS) is still considered investigational the Centers for Medicare and Medicaid Services in the US will not cover costs for VNS treatment. In spite of approval by the FDA.


When Dr Shock returned home from Germany this evening he found the newest Journal of ECT on his doormat.Because of his recent articles on his blog about VNS he read the editorial of this journal with great interest and amazement.

Pros for VNS as a reimbursable treatment
Patients have been implanted the device, some with good effect but continuation of this treatment is uncertain. Some patients won't be able to replace their devices when the battery dies. Some patients can afford replacement with their own money.
The most important question still remains: can we predict which patients might benefit from VNS. Another point to the matter is that with clear definition of treatment resistant depression and all other options failing wouldn't VNS be an option. Treatments that work for a minority of patients are readily excepted in other field of medicine such as oncology.



Cons with VNS
The company that manufactures the VNS device has enlisted the help of psychiatrists. A letter-writing campaign was started. Where is the line between advocacy for patients versus advocacy for industry?
Results from trials are disappointing. Recent trials were used collecting safety data and effectiveness. Their quality varies, efficacy at least for the short term disappointing.

For Dr Shock this all is hard to apprehend. The Netherlands until now has a very different health care system than the US although differences are getting smaller.
If a treatment is approved it should at least have a the opportunity to prove it self. Continuation for those who clearly benefit from the treatment should be guaranteed.

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