RUSSIAN ADDICTS CURED BY SURGERY

Tom Whitehouse reports from St. Petersburg

The surgeon wanted to make sure that Svetlana, a 19-year-old heroin addict,
was still alert, as he gently burrowed a narrow probe into her brain. So he
asked her to tell him how she makes bortsch, Russia's beloved beetroot soup.

'First,' Svetlana explained, 'you prepare the meat stock, then fry some
carrots, onions and garlic. Then add the beetroot.'

'Good,' he replied, confident that the revolutionary three-hour operation to
free Svetlana from heroin addiction was not interfering with her ability to
listen, speak and think.

His concern is not surprising, given the radical nature of the treatment -
involving the removal of 1.5 cubic millimetres of brain tissue.

'It's a painless and effective method,' said Dr Sviatoslav Medvedev,
director of St Petersburg's Institute of the Human Brain, which has overseen
more than 100 such operations during the last two years. 'Eighty per cent of
our operations have been successful and I don't know of any other method
that cures addiction so successfully.

'We give only a local anaesthetic, so that during the operation we can talk
to the patient and be sure we're not disturbing any vital functions.' Five
weeks later, Svetlana is preparing to return to university to study
engineering. The scars on her temples are fading as her hair grows back, and
she says she has kicked a three-year heroin habit.

'The day I had this operation, I was born again,' she said. 'I'd recommend
anyone addicted to heroin to have it. Otherwise, I would have died.'

Medvedev and his patient are making bold claims. The surgical 'cure' for
heroin addiction is less painful than removing wisdom teeth and only
slightly more expensive. Potentially, the world has a devastating new weapon
in the fight against drugs. But foreign brain specialists will be able to
judge the St Petersburg team's research and results only after their
publication 'some time this year'. In the meantime, Medvedev is ready for
Western scepticism.

Beneath his office window lies a statue of 'Pavlov's Dog', the Russian husky
conditioned to salivate at the sound of ringing bells rather than at the
sight of the food they usually preceded. Ivan Pavlov won a Nobel Prize in
1904 for his pioneering analysis of conditional reflexes. 'I think the West
is too cautious about neurosurgery because of the obsession with human
rights and its association with the use of electric shock treatment,' he
said. 'It is a pity because it cuts off a lot of possibilities.'

A big demand for surgery is not expected immediately from Western heroin
addicts. 'You know the economic and political situation in Russia. Can you
imagine someone in the West wanting to come to Russia to have two holes
drilled in his head?' says Medvedev. His surgeons realised the potential of
brain surgery on addicts after routine operations on patients with 'pains'
in amputated limbs.

'This started 30 years ago with the treatment of phantom pains. Many of our
patients were also drug addicts because they had used morphine regularly to
kill the pain. Then we noticed that after brain surgery, they were no longer
addicted.'

Successful brain surgery on severe depressives and obsessives, which is
conducted in many Western countries as a treatment of last resort,
encouraged the St Petersburg scientists to believe it would work for heroin
addicts.

'Addiction is a kind of obsession,' said Medvedev. 'There's a kind of circle
in the brain which has to be cut. That's our task.

'We take out a cubic millimetre from one hemisphere and another cubic
millimetre from the other hemisphere and that stops the addiction.' The real
innovation, the team claims, is designing cheap and simple equipment to
locate the part of the brain that governs addiction and to execute the
surgery. Like their Western counterparts, the Russians employ magnetic
resonance imaging, MRI - a type of 3-D colour X-ray - to 'map' the brain.

Then, using a specially designed steel headframe - which resembles a
medieval torture device - they plan the surgery. Instead of using MRI during
the operation, which is painful and would require a general anaesthetic,
Russian brain surgeons 'go in blind' using their calculations. This is much
cheaper and gives them the crucial ability to monitor the patients'
alertness while they are under local anaesthetic.

Since there are no nerve endings in the brain, the most painful part of the
operation is cutting the skin covering the skull. The surgery is painless.
While Western brain surgeons use a highly expensive 'gamma-knife' or a probe
cooled by liquid nitrogen to cut brain tissue, the St Petersburg team's
physicist, Vladimir Nizkovolos, has designed his own 'knife' cooled by
liquid carbon dioxide - the cheap 'dry ice' used by Seventies rock bands for
special effects.

'I've got no idea how much it costs, because I made it myself,' said
Nizkovolos. 'We use our intellect. The West is spoilt by its wealth.'

Instead of using a compressor to control the carbon dioxide flow and
regulate the temperature of the 'knife', Nizkovolos has customised an old
pump for car tyres. 'I can't afford to buy a compressor, but even if I could
it would be no more sensitive than my foot.'

Nizkovolos admits with resigned embarrassment that he earns about UKP25 a
month. Poverty takes its toll. Some members of the medical team look paler
and sicker than the heroin addicts they are about to operate on. Their
determination to sustain Russia's brilliant scientific tradition keeps them
going. The addicts pay UKP1,400 for their operation - a fortune in Russian
terms. This covers only the costs. The scientists hope that by patenting
their inventions they may make money. But there is a catch. 'It costs
UKP60,500 to get an international license for a new invention,' said
Nizkovolos.

And Svetlana? 'I've seen the people I used to take heroin with, but I have
no desire to join them. I'll have new friends at university.'