LETTER TO THE EDITOR

The Dream of a Future World

To the Editor:There are presently two major limitations to the use of neuro-

modulative procedures for the treatment of many pain and move-ment disorder syndromes. The first is the lack of knowledge of thesetherapeutic opportunities both of general practitioners and special-ists and of patients. The second limitation can be ascribed to theeconomic restrictions that, even in the western countries, are ham-pering the necessary diffusion of these therapies.

Moreover, more than half of the population on our beloved planetis in no economic condition to receive any of the neuromodulationtreatments we currently address to patients affected by chronic pain,movement disorders, spasticity, or other syndromes that nowadayscan satisfactorily be treated by means of these devices.

One of the reasons why the devices we use are expensive isclaimed to be due to the costs of research and development from theproducers. In some cases, this aspect sounds particularly strange as,for example, the technology used in the development and produc-tion of the stimulators we use for spinal stimulation, subcutaneousstimulation, and deep brain stimulation is based on the technologyused for the cardiac pacemakers that are currently produced in thou-sands of places all over the world and by many companies.

When attending a congress we usually see all the booths of thesponsoring companies in the exhibition areas showing productsthat sometimes do minimally differ in their characteristics, but theydo only differ in the brand, color, or way of using a remote control toprogram the device.

Let us think about what happened in the car industry. In the past,every brand was developing and using their own products and cars

really completely differed for the materials used and the conceptsapplied. This attitude lately disappeared and now we can seeengines produced by one company powering cars from differentcompanies. This brought to the limitation of costs.

The same could be applied to the medical field of industries pro-ducing both stimulators and infusion pumps. This could even bringto the use of a common hardware to control these devices by meansof differently branded software. This could even bring to the limita-tion of costs of both production and distribution and to a betterpostmarket assistance of these devices by only moving electronsonline and not technical experts around the world.

Moreover, some industries could produce the common hardwareand some other companies could produce the software and, in theend, this could bring the world industrial medical world to movefrom competition to cooperation and the lower costs of this couldbring to the wider spread of these therapies to the rest of the world.The dream to have a worldwide use of stimulators, pumps, and,generally, neuromodulation would only bring to a better knowl-edge of these therapies and to the extension of these treatmentseven to patients from “non-triple A” countries, and the world wouldbenefit from that.

Thus, I would invite all the companies to meet and find a way tofuture cooperation.

Ivano Dones, MDDepartment of Neurosurgery,

Fondazione Istituto Neurologico “C.Besta”,Milano, Italy

Neuromodulation: Technology at the Neural Interface

(onlinelibrary.wiley.com) DOI: 10.1111/ner.12042

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www.neuromodulationjournal.com Neuromodulation 2013; 16: 178© 2013 International Neuromodulation Society