Translator: Michele Gianella Reviewer: Ivana Korom
There are 22 million cocaine users around the world,
9 million of them in the Americas and 5 million in Europe.
What makes cocaine consumption,
which seems to be spreading relentlessly,
so appealing to people all around the world?
The answer is quite simple.
Because it produces a great pleasure.
A pleasure that closely resembles that of the first love,
a pleasure we all remember and long to experience again,
just the way we felt it for the first time.
But were it just for this reason,
cocaine wouldn't be that big a deal.
The problem, as you can see on this slide,
comes from the fact
that cocaine, aside of producing pleasure,
damages functionally - namely, decreases the efficiency
of a very important part of the brain,
called prefrontal cortex.
This cortex is called prefrontal because it's behind the forehead
and accounts for about a third of the brain.
It's responsible for a number of key functions in all mammals.
Good functioning of this part of the brain
is critical for any mammal's survival, men and women included.
The moment cocaine decreases this functioning,
our consciousness,
our ability to make decisions,
our ability to control impulses,
is progressively and inexorably reduced.
And this is the reason why, indeed,
cocaine addiction is considered today,
by world’s cutting-edge neuroscientists,
a full-fledged brain disease,
a mental disorder.
How did society deal insofar with cocaine consumption?
First of all, none of what has been done has passed any test of effectiveness.
Past strategies could be grouped into three major families:
drugs, to cope with the desire and the intensity of pleasure;
psychotherapy, which tries to shed a light on past conflicts,
or any underlying problem
that may have lead to cocaine use;
and rehabilitation facilities,
in order to fix behavior patterns
that have been disrupted by cocaine.
But none of these three, either separately or together,
ever really worked.
In the fourth canto of Divine Comedy's Inferno,
the philosopher Democritus,
"che 'l mondo a caso pone"
believes that the world and the universe
came out of the encounter between Chance and Need.
Dante sent him to "Inferno", the Hell
and made a great judicial mistake, as he did not deserve it at all.
Since the beginning of time,
the world and the whole universe develop and expand
precisely because Chance and Need meet.
And the story I am about to tell you
comes from a piece of newspaper.
It was a crumbled piece of "Il Resto del Carlino",
of Friday, April 5, 2013,
The father of a patient -
a 32-year-old cocaine-addicted physician,
who had already been treated for a couple of years,
and still continued to practice as a physician,
thus putting the health of his patients at risk -
actually gave it to me.
What was written in it?
"The light ray that will defeat cocaine,"
the headline said.
It described an experiment made in the United States
by a guy, I had never heard of, called Antonello Bonci,
an Italian who went to the US 15 years before
to lead the National Institute on Drug Abuse (NIDA),
which was, and still is today,
the most important center worldwide for drug addiction research.
What did this article say?
In the interview, the neuroscientist explained
that a number of laboratory rats that were made addicted to cocaine --
just imagine, cocaine-addicted rats
would press their lever up to 2000 times per hour,
for a small dose of cocaine.
However, after undergoing
a new surgical technique
called optogenetics,
lost interest in cocaine.
How could this happen?
You know -- or I tell you now -- that in the rat's brain
there is a pleasure system,
which is hundreds of times smaller than its human equivalent
but works in more or less the same way.
It is called the limbic system.
This part of the brain, which can be called "the brain's guts",
generates all of our passions;
love, hatred, sex drive, hunger, thirst and so on.
What does optogenetics do?
Optogenetics is a revolutionary scientific method
discovered in Stanford by a psychiatrist
named Karl Deisseroth,
who inserted in a particular way
small channels
into the rats' brain cells
and made these cells sensitive to light.
All that was needed, was to put an optic fiber into the rat's brain,
the size of a hair,
turn on the light
and the limbic cells --
because this system is genetically determined,
it can activate with extreme precision
any given part of the brain,
and we chose the limbic system --
it input --
once the sensitized part was illuminated,
the rats stopped looking for cocaine.
Clearly, a ray of light from the American laboratories
must have also hit my prefrontal cortex
because from that moment on the sky was my limit.
I undertook --
and so many people asked me how I did, it but I really don’t know --
the endeavor of translating the rat method to humans,
trying to obtain on men, similar results to those obtained with rats.
However, we couldn't use optogenetics, an invasive and unauthorized technique.
I figured out I could do it
through magnetic stimulations and impulses.
You see that there is a coil
with an internal electrical current,
a coil that emits magnetic stimulations
which can reach the limbic system,
just like rat's brains
were reached out by the optogenetic system.
We had all reason to think we would get results in humans
similar to those obtained in rats by Bonci with his experiment.
And here is the rTMS room.
In almost no time, out of the blue,
I had to find a way to get this medical device,
and here it is.
It's made of a comfortable, dentist-like armchair
the patient can lie down comfortably on.
While he is lying down,
a so-called neuronavigator identifies with great precision
an area, the size of a 2-euro coin,
under the left temple.
This area is treated
with 12 minutes of magnetic waves
that produce a similar effect to what was observed in rats.
We called the first patient treated with rTMS Beatrice.
A 38-year-old woman
who had been using cocaine non-stop since the age of 14.
She sat in this chair,
and after 12 minutes of treatment got up, opened her eyes,
smiled at us and said,
"Something extraordinary has happened.
I no longer crave for cocaine.
I no longer think about cocaine.
If I think about cocaine, I don't want to get it anymore.
That never happened to me."
Imagine how we felt
when we heard something like this!
We had definitely broken through a barrier:
we ported the results of rats directly to humans,
as it has been recognized internationally.
But we couldn't take it for granted.
We immediately started to work.
We wrote a first paper
based on a small pilot sample
of 16 patients treated with rTMS,
compared with 16 control patients under conventional drugs.
And we noticed even there
that those treated with rTMS
showed a much better outcome than the other control patients.
And since then,
more and more patients began to respond much like Beatrice did.
They were tens, in the beginning, and then became hundreds.
Now we have almost exceeded 500 patients.
But I'd lie if I told you that everything went smoothly.
As someone said before me, those who exceed the limits pay a pledge.
We have also paid our pledge.
The first one being,
about a fifth of the treated patients
didn't manage to stop using cocaine.
With all our technological innovations,
we had no way of helping them quit.
That's why we invited several psychoanalysts
to help us study the situation and look after the patients.
They took care of these patients
and many of them,
thanks to the combined treatment of TMS, that's applied to all patients
plus this stubborn 20%, who received a focused additional help
with psychotherapy and psychoanalysis,
finally responded
and most of them also stopped using cocaine.
This news spread worldwide
and we were contacted by many high-profile magazines
such as Science and National Geographic.
They wanted to know us, and we worked with them for months.
It was a very nice experience
to be interviewed and have our patients interviewed.
In September of last year, these two newspapers published our work.
The National Geographic decided to give us the cover,
and distributed our article in 23 languages ​​around the world.
From that moment on, our fame -
with great satisfaction but also great fear from our side,
started to increase.
Why fear?
(Applause)
Thank you.
Why fear?
Because although we were sure that our method works fine,
science can't be based on observations alone.
Scientific data are also needed.
We had worked for years
collecting data very precisely,
delivering them to the US,
where independent experts
studied them, evaluated them, elaborated on them.
And a few weeks ago, we received their results.
Our data proved
that on a sample of about 200 patients, which is a very large sample,
followed up for 24 months, two years, which is a very long period,
the overwhelming majority of patients
had completely stopped using cocaine.
We were then acutely aware
of having found a fourth way of treatment.
A fourth way that has all the rights to pretend
that it could be the right way
to defeat cocaine once and for all.
It is a fourth way that doesn't replace the previous three,
but can be used together
to further increase the efficacy of rTMS.
From that moment on, our team of three, four people at most
grew up to dozens of people: doctors, psychiatrists, neurologists,
psychoanalysts, psychologists, laboratory technicians,
statisticians, administrators, etc.,
And all these team members,
including also our American collaborators,
decided to combine their efforts
to have this treatment method
spread worldwide as much as possible,
in order to replicate our results.
But we have explained, and we are explaining,
to all those who ask us to be able to work like us,
that humans aren't only made of brains.
Humans are made of brain and mind, body and soul.
And we must consider people in all their complexity,
if we want them
to find the strength to completely give up cocaine.
And not only the patients, their families are also considered,
and the environment
where cocaine found its way to spread.
This is poised to bring about the necessary cultural change
that will allow many people to save their lives
and many other people to definitely improve theirs.
Thank you.
(Applause)
Alessandro Cecchi Paone: Congrats, professor. Truly fascinating.
It's one of the perks of attending TED, to be among the first to know
that such an important discovery, as you said, was made
for both individual and collective health and wellbeing.
I guess the audience will agree with me that, should this knowledge spread,
you'll soon need a bodyguard service too.
LG: Check.
ACP: Oh, it happened already?
LG: I already have them.
ACP: I'd volunteer, otherwise. I do it all the time, as a bodyguard.
Thank you, see you soon.
LG: Anyway, some give others pain, some give them joy.
I think I'm among those who gave others more joy than pain.
ACP: And you only tell me now? I run away with you, immediately!
Go find another presenter!
Thank you, professor.
(Applause)