The Register-Herald, Beckley, West Virginia

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August 9, 2012

For people with depression, magnetic pulses can give relief


Skeptics question the price tag in light of uncertain benefits.

"The majority of studies that evaluated rTMS failed to find evidence of an enduring treatment effect after the initial response . . . and some . . . failed to find any significant treatment effect," concluded Health Plan of Nevada, a UnitedHealthcare insurer, which rejected coverage in March.

With the nation's health-care spending expected to top $2.7 trillion this year, the battle over paying for rTMS demonstrates why it is so difficult to rein in health-care costs. New technology is generally allowed into the market after studies show it is reasonably safe and more effective than placebos. But that's not the same as showing it works better than current approaches.

Experts differ over whether it's smart to cover new techniques if they haven't proved superior to established methods. And they can also disagree over the medical research itself: Was a study done well? Were there enough patients enrolled? Did it ask the right questions? Insurers often call for more research, while doctors and patients — many desperate for help — warn against delay. And costs are rarely discussed publicly.

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In December, when Curtis first had a magnetic coil placed on her scalp while a $70,000 machine sent pulses into part of her brain, she had already spent a decade trying seven different prescription medications in her battle with depression.

Getting no relief but gaining weight and feeling sluggish and "out of it" because of the drugs' side effects, she eagerly agreed to the month-long series of five-day-a-week treatments. Most patients have between four and six weeks of near daily sessions.

Curtis' psychiatrist, Niku Singh, who is also the medical director at TMS NeuroHealth, suggested that she try the procedure. "I was all for it," said Curtis, whose insurance did not cover the treatment. "It's a matter of nothing else had worked, so what did I have to lose?"

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