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Comment by paulsutter | Hacker News Reader

So there are 1.5 million brain injuries per year in the US[1], and they found one with a positive outcome.

Publication bias[2] is the most charitable explanation, but really it shows that even the New York Times is prone to sensationalism[3]

[1] https://www.braintrauma.org/tbi-faqs/tbi-statistics/

[2] http://en.wikipedia.org/wiki/Publication_bias

[3] http://en.wikipedia.org/wiki/Sensationalism

EDIT: No that does NOT make it interesting. It suggests that it would take order of 1.5 million more brain injuries to reproduce it. Hardly a medical advance.

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You have deeply missed the point of this case report.

We don't know what causes OCD (and we knew even less when this kid shot himself in 1983; the paper was not written until 5 years later).

When you get spontaneous remission due to an injury, that is a hint that the damaged region might be important in the disease process.

Unusual cases like these have the potential to rapidly accelerate our understanding of disease, which is why medical journals still publish case reports.

No one is proposing treating OCD with firearms.

Funny, you and I agree that we don't know what causes OCD, but the article states flat out that the damaged portion of his brain is responsible for OCD. That's the only medical-ish claim in the article, it's made with no references, and you still think this article is useful?

Yes, because the article states that the damaged portion of his brain was responsible for his OCD, which was a simple statement of fact, given that his OCD disappeared once the damage occurred.

But from this one case we can still extrapolate a very useful line of inquiry. It's almost like when you infer a single number in a Sudoku puzzle and the rest of the numbers become obvious after that, like a domino effect.

The article was just summarizing a case report which was published in a respected journal (which I read before commenting).

Wikipedia [1] provides a nice treatment of the rationale for the publication of unusual cases like this one.

In essence, case reports are meant to be a medium for the dissemination of new hypotheses, not a means of testing them.

They are acknowledged to be an extremely biased source of information, which is why they are not included in meta-analyses, and can not be used to support regulatory approval of new therapies. (And also why the lay person should probably ignore them when researching a medical condition.)

In exchange for this bias and unreliability, however, you get a very high sensitivity for rare, 'black swan' type events that may prove informative or thought-provoking, even though they would never amount to a blip in a controlled trial.

I don't know how or whether this particular case report informed research into OCD, but it's easy to imagine researchers following this up by doing lesion studies in animal models of OCD, perhaps leading to experimental deep brain stimulation treatments in humans targeting this region.

The fact that this freak injury would be hard to reproduce, and does not in itself represent a medical advance, is irrelevant (thus why I said you'd missed the point).

Did it need to go out on the AP news wire? No, but it's a compelling (or, OK, 'sensational') human interest story, so it's not too surprising it got picked up.

[1] http://en.wikipedia.org/wiki/Case_report

>So there are 1.5 million brain injuries per year in the US[1], and they found one with a positive outcome.

Which is what makes it interesting, duh!

Maybe you should think about our dear Phineas Gage and what an incredible coincidence means for a whole scientific branch, and for the human knowledge about some of the most complex (and ethically difficult) subjects to study, our own brains. http://en.wikipedia.org/wiki/Phineas_Gage

Did they claim the positive outcome indicated a medical advance of any sort? Perhaps I missed it.

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