The Business and Ethics of the Brain Fitness Boom — Part 2: The Ethics
Posted Jan 06 2012 9:02am
The terminology “fundamental attribution error” describes the tendency to overvalue personality-based explanations for observed human behaviors, while undervaluing situational explanations for those behaviors. I believe that a primary reason behind many perceived and real ethical challenges in the brain fitness field is due not so much to certain stakeholders’ lack of personal or professional ethics, but derives from the flawed societal construct that underpins current, relevant innovations. To improve the ethics of the brain fitness business and its application (and empower consumers’ informed decision making), there must first be agreement about a meaningful, appropriate way to analyze and guide innovation. This is the crux of the problem. The current medical model is not up to the task at hand, since it is heavily skewed toward invasive drugs and devices driven by disease-based models, and fails to leverage cognitive reserve findings and the protective role of physical exercise, cognitive engagement, and cognitive training (Valenzuela, 2009; AHRQ, 2010).
Surely there are other methods better suited to the opportunity at hand other than the purely entertainment-driven “brain age” invention. The following quote from a recent paper in Global Policy invites all stakeholders to shift perceptions of aging from burden to human capital: “We contend that early and repeated preventive care ‘interventions’ (especially in health behaviors and geriatric medicine) and ‘preventive’ measures (such as social integration, design of cities and lifelong learning so that workers can upgrade skills) will delay the onset of late-life difficulties” (Olshansky et al., 2011).
If we are to transform the conversation that currently focuses on the medical model of diagnosis and treatment of a collection of disorders toward dialogue that centers upon a cost-benefits scalable model of life-course investments in brain health and fitness, what strategies could inform this new conversation?
Building mental capital and well-being
The Foresight Project on Mental Capital and Well-being (The Government Office for Science, 2008), a major research and policy initiative launched in 2008 by the government of the United Kingdom, was intended to “promote optimal mental capital trajectories through life for the general population [by] influencing individuals’ mental development and wellbeing from conception until death, analyzing possible interventions to address challenges, drawing upon considerations such as scientific efficacy, economics, governance and ethics.”
A growing portion of the 78 million baby boomers in the United States is investing time and effort into retaining their mental sharpness.
The Project, a massive endeavor marshaling hundreds of neuroscientists, resulted in dozens of detailed reports and put forward a new framework to guide public policy, with focus on the following two key concepts:
Mental capital. “This encompasses a person’s cognitive and emotional resources. It includes their cognitive ability, how flexible and efficient they are at learning, and their ‘emotional intelligence,’ such as their social skills and resilience in the face of stress. It therefore conditions how well an individual is able to contribute effectively to society, and also to experience a high personal quality of life. The idea of ‘capital’ naturally sparks association with ideas of financial capital and it is both challenging and natural to think of the mind in this way.”
Mental well-being. “This is a dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community. It is enhanced when an individual is able to fulfill their personal and social goals and achieve a sense of purpose in society.”
The Project issued a number of life-course recommendations, including the need to address the “massive under-utilization of the mental capital of older adults” and to “act decisively to establish protective lifestyles for those in middle age in areas where the situation is set to worsen, such as the growing number of older people at risk of dementia.”
Ultimately, the primary recommendation culled from all the reports was to promote optimal mental capital trajectories through life for the general population since “…achieving a small change in the average level of well-being across the population would produce a large decrease in the percentage with mental disorder, and also in the percentage who have sub-clinical disorder.”
Translating this to practice, the U.K.’s National Health Service has started to adopt a care model that relies heavily on self-care and automated service models early on in the care continuum. Computerized Cognitive Behavioral Therapy (CBT) has become the first standard of care for patients presenting with mild or moderate depression, rather than immediately opting for antidepressant medication. Given the mismatch between the number of available, trained therapists and people who would benefit from this form of brain training, computer-assisted CBT can make a significant difference as a complement or alternative to therapist-delivered CBT.
To Be Continued…
Next Monday, January 9th: Part 3 — The Real Need