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Does Brain Fitness Require Medicalization? Insights @ 2012 SharpBrains Virtual Summit

Posted Aug 30 2012 5:11pm

In June of this year, SharpBrains hosted its third annual online “virtual summit” on our evolving understanding of how the human brain works, and how it can be made to work better. As readers of this blog know, SharpBrains is a US-based market research firm and think tank dedicated to studying the scientific, social, and business trends associated with brain health and performance. As always, the summit featured a range of contributions from scientists and business leaders whose common interest is in gathering, compiling and applying knowledge about the brain.

The foundational conviction of the summit organizers and attendees is that we’re entering an era when knowledge about the brain will have a massive social and economic impact, giving us unprecedented capacity to address human problems such as mental illness, stress and dementia, as well as enhancing general health and human performance. In fact, what’s been clear to me from my attendance at all three of these summits is that we’ve already entered this era, as science-fiction as that may seem. We’re currently living in an age when brain functioning can be measured inexpensively and reliably using web-based technology, cognitive capacities of people young and old can be increased using non-drug methods, and large-scale integrations of scientific knowledge are producing insights that eluded the scientists of just a few years ago. It’s a time of rapid change and huge opportunity.

Is Having a Brain a Medical Condition?

One of the summit’s emergent themes was the extent to which applied knowledge of the brain is, and is not, going to be medical. Discussion returned several times to the issue of the extent to which applied neuroscience should, or should not be, tied to the traditional disciplines and delivery models of healthcare. One aspect of this question is the increasing rejection of the often arbitrary categorical distinction between illness and wellness, a product of medicine’s historic focus on categorical diagnosis. This issue is playing out in many different ways, for both scientific and practical reasons. Within the scientific community it’s increasingly agreed that although diagnostic categories can be a useful tool, they can also distort our understandings in ways that do a disservice to those we serve. Neurologist and summit speaker Peter Whitehouse highlighted this issue in his critique of the diagnostic entity called Alzheimer’s Disease, an “illness” without a distinct pathophysiology or a reliable diagnostic test. Psychiatry, too, is being compelled to consider new alternatives to its outworn diagnostic system, ways of understanding dysfunction and selecting interventions on the basis of individuals’ brain physiology and cognitive performance rather than on a checklist of observed symptoms. Summit speakers Robert Bilder and Evian Gordon discussed how “Big Data” is creating new, synthetic understandings of the connections among behavioral syndromes and results from neuroimaging, cognitive neuroscience, cell biology, and genetics. Dr. Gordon also highlighted the potential of large international databases, crossing multiple levels of analysis, for realizing the ideal of a truly personalized medicine.

Brain fitness as a consumer-led movement

The new popular term “brain fitness” is itself telling, because its focus is on wellness and peak functioning rather than dysfunction. “Fitness” is indeed an apt metaphor in many ways, given that our brains get better at things they practice doing, and that targeted practice of cognitive functions—even in the form of playing shoot-’em-up video games—can lead to meaningful real-life changes in mental ability. “Brain fitness” is a growing consumer-led movement, and as such, it’s not going to wait around for medical or scientific imprimaturs. As discussed throughout the Summit , it’s already hit the consumer world, with inexpensive, wearable EEG monitoring devices, a chain of brain-themed US retail stores, and websites where millions of users try to improve their cognitive functioning by playing games for a few minutes every day.

Growth brings challenges too, and the field was encouraged to think about the costs and the benefits of a wide-open, consumer-oriented approach to brain fitness, as opposed to an approach that relies on the traditional gatekeepers of health, namely, physicians and other health professionals.

Pros and Cons of Medicalization

Professionalization has two chief benefits: it reduces risk in cases where the application of knowledge carries with it the possibility of harm, and it serves as a means of guaranteeing quality by holding interventions to some sort of evidentiary standard with respect to their efficacy. In the case of brain fitness it seems relatively easy to dismiss the former benefit as irrelevant. There certainly seem to be few side effects to effective brain-training products that are currently available. Indeed, one of the most salutary aspects of technologies based on neuroplasticity is that they work through the brain’s own naturally regulated change mechanisms, unlike medical and surgical interventions whose potential for harm is typically linked to the fact that they override these same mechanisms. But plasticity-based interventions have shown themselves in some cases to be remarkably powerful, so some caution is warranted before declaring them entirely risk-free. The second point may be more important. Whenever some consumer trend takes hold, the marketplace becomes crowded with sellers making ever-bolder claims, and in the case of brain fitness it’s bound to be difficult for consumers to sort the evidence-based wheat from the unproven chaff. The long-term result may be that the public will become disaffected with brain fitness due to a preponderance of wild claims and ineffective solutions, unless high-quality resources such as The SharpBrains Guide to Brain Fitness gain traction in helping consumers and allied professionals to navigate lifestyle and product options.

There are additional benefits of delivering brain assessment and training through some sort of professional framework. First, there will need to be some means to identify those in need of professional attention and introduce them into the medical system. Second—and this is an issue that is beginning to get some attention—there will be an increasing need for discussion of the ethics of neuroactive technologies, and such a discussion is most likely to be given proper attention in scientific and professional circles. Third, professionals are well positioned to monitor and improve brain functioning across long spans of time, and it’s becoming clear that monitoring longitudinal change across years is going to be important, especially during later adulthood.

However, the costs of medicalization are high, because it increases expense, imposes often stifling regulatory constraints, slows down a field’s responsiveness to newly developed technology, places massive decision-making power into the hands of insurers, and sets the stage for unhelpful inter-disciplinary turf wars. The tendency of all of these factors is to limit innovation’s reach, and to discourage self-motivated consumers. Again, think of the “fitness” metaphor.

Shaping the Future

In the Internet age the likelihood is that more an more consumers will take charge of their own brain health and fitness, and if the professional world is slow to adapt, it may well be bypassed in a growing number of situations. Moreover, with an aging population, the demand for brain products will vastly outstrip the capacity of professionals to provide them. What is urgently needed is some way to mitigate the risks of a consumer-driven phenomenon by establishing quality standards, addressing the safety question, improving public education, incorporating universal, longitudinal brain-health monitoring into primary care, and initiating a serious neuro-ethics conversation.  Perhaps a good start to shape the agenda for the 2013 SharpBrains Virtual Summit?

– Dr. Philip Toman is a clinical psychologist and the founder of Choratech, a company whose mission is to bring applications of neuroscientific research to ordinary people. He has participated in all three SharpBrains Virtual Summits so far.

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