Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News

Icon

Technology as the missing link to enable a brain-based model of brain care: interview with Dr. John Docherty

Dr. John Docher­ty is an Adjunct Pro­fes­sor of Psy­chi­a­try at the Weill Med­ical Col­lege, Cor­nell Uni­ver­si­ty, Direc­tor of Post Grad­u­ate Edu­ca­tion there, and Chief Med­ical Offi­cer of Brain Resource. Trained as a clin­i­cal research fel­low in neu­ropsy­chophar­ma­col­o­gy at NIMH, he lat­er returned as Chief of the Psy­choso­cial Treat­ments Research Branch, respon­si­ble for all fed­er­al­ly sup­port­ed psy­choso­cial treat­ment research in men­tal health nation­wide. He over­saw the land­mark Nation­al Col­lab­o­ra­tive Study of the Treat­ment of Depres­sion and served as a mem­ber and Chair­man for over 10 years on the NIMH and then NIDA Treat­ment Research IRGs. Dr. Docher­ty has wide expe­ri­ence in suc­cess­ful­ly imple­ment­ing inno­va­tion in both clin­i­cal oper­a­tions and man­aged health care. He found­ed North­east Psy­chi­atric Asso­ciates in 1985. As Nation­al Med­ical Direc­tor for Nation­al Med­ical Enter­pris­es, he over­saw med­ical con­trol and qual­i­ty improve­ment in 74 hos­pi­tals in 34 states. He was the Exec­u­tive Vice-Pres­i­dent and Chief Med­ical Offi­cer for Mer­it Behav­ioral Care, which then cov­ered 30 mil­lion peo­ple. In 1998, he found­ed Com­pre­hen­sive Neu­ro­Science (CNS). Its Care Man­age­ment Tech­nolo­gies are cur­rent­ly imple­ment­ed in 17 state Med­ic­aid plans. Dr Docher­ty has received numer­ous hon­ors and awards and has authored over 100 sci­en­tif­ic pub­li­ca­tions.

(Editor’s note: this inter­view with Dr. John Docher­ty was orig­i­nal­ly pub­lished in Sharp­Brains’ mar­ket report Trans­form­ing Brain Health with Dig­i­tal Tools to Assess, Enhance and Treat Cog­ni­tion across the Lifes­pan, pub­lished in July 2010)

Alvaro Fer­nan­dez: Dr. Docher­ty, it is a plea­sure to be with you today to dis­cuss the main theme of Sharp­Brains’ 2010 mar­ket report – how the con­ver­gence of sci­en­tif­ic find­ings and tech­nol­o­gy plat­forms and tools is reshap­ing how as a soci­ety and as indi­vid­u­als we will take care of cog­ni­tion and men­tal well­ness along the life­course, giv­ing birth to the emerg­ing dig­i­tal brain health and fit­ness mar­ket. Can you first briefly dis­cuss your career tra­jec­to­ry and your cur­rent role at Brain Resource?

Dr. John Docher­ty: Sure. The main theme of my work since the 1960s has remained the same, “How do we put knowl­edge into effec­tive use to improve men­tal health?” Over the last cen­tu­ry, med­i­cine made tremen­dous progress in gen­er­at­ing sci­en­tif­ic and clin­i­cal knowl­edge. Basic research dis­cov­ery sci­ence and clin­i­cal treat­ment devel­op­ment sci­ence have made great progress. With­in Psy­chi­a­try there was stan­dard set­ting advance in the 1960’s through the NIMH-VA coop­er­a­tive stud­ies to the method­ol­o­gy of assess­ing the effi­ca­cy of psy­chophar­ma­co­log­i­cal drugs. This work estab­lished prin­ci­ples adopt­ed for the study of med­ica­tions in the oth­er areas of med­i­cine. The study of psy­chother­a­py, how­ev­er, lagged in devel­op­ment. In my role of Chief of the Psy­choso­cial Treat­ments Branch of the NIMH , I helped con­tribute to the advance of that work by sup­port­ing the efforts of an extra­or­di­nary group of indi­vid­u­als led by Irene Waskow who car­ried out the TDCRP. This study estab­lished the method­olo­gies that made pos­si­ble the effec­tive sci­en­tif­ic study of the effi­ca­cy of psy­chother­a­pies. The evi­dence base and of such treat­ments as CBT, DBT, Moti­va­tion­al Enhance­ment Treat­ment and oth­er evi­dence-based psy­chother­a­pies derives direct­ly from this study and its sem­i­nal influ­ence. This was a con­tri­bu­tion to the sci­ence of Clin­i­cal Treat­ment Devel­op­ment research.

I would say that my major inter­est, how­ev­er, has been in the next step, the sci­ence of knowl­edge trans­fer. There has been and remains a long and cost­ly (in terms par­tic­u­lar­ly of unnec­es­sary suf­fer­ing) lag between the devel­op­ment of new knowl­edge and its com­mon and effec­tive use in prac­tice.

In order the help the field moved for­ward, I have worked for the last 20 years in the devel­op­ment and imple­men­ta­tion of meth­ods to effec­tive­ly trans­fer knowl­edge into prac­tice. Since 1994, I and my col­leagues have pub­lished 22 Expert Con­sen­sus Guide­lines using an inno­va­tion method of quan­ti­fy­ing expert opin­ion. Our goal was to put the com­bined voice of the nation’s experts in each Doctor’s office to help mak­ing all those day-to-day deci­sions that ben­e­fit from a thor­ough knowl­edge of cur­rent evi­dence and thought­ful infer­ences from that knowl­edge. Right now I am work­ing on a plan to pro­vide per­son­al­ized per­for­mance-based sup­port for men­tal health pro­fes­sion­als to pro­gres­sive­ly expand their range of com­pe­ten­cies and to stay cur­rent in those areas of estab­lished com­pe­tence. As Chief Med­ical Offi­cer of Brain Resource, my role is to ensure the integri­ty of the clin­i­cal data in our plat­forms and sys­tems.

Based on those expe­ri­ences, and also the com­pa­nies you have been involved with, what are your reflec­tions on how to put knowl­edge to good use?

I may sug­gest the fol­low­ing. One, that putting good evi­dence to work in prac­tice requires more than pub­lish­ing good research. I’d say that sci­en­tif­ic evi­dence is direct­ly rel­e­vant to per­haps 15% of clin­i­cal deci­sions,. The remain­ing 85%, demands some degree of infer­ence where we need oth­er trans­la­tion­al tools such as well-done quan­ti­ta­tive stud­ies of expert opin­ion.

Sec­ond, we require tech­nolo­gies that trans­late emer­gent knowl­edge into prac­tice. Con­tin­u­ous­ly updat­ed Expert Deci­sion Sup­port sys­tems embed­ded in EHR’s are absolute­ly nec­es­sary to close the gap between the devel­op­ment of new knowl­edge and its effec­tive use.
In Psy­chi­a­try, anoth­er spe­cif­ic tech­nol­o­gy that is required is one that pro­vides a reli­able and valid assess­ment of brain health at an afford­able price. Psy­chi­a­try has unfor­tu­nate­ly bad­ly lagged oth­er area of med­i­cine in eval­u­at­ing and diag­nos­ing the health of the major organ that it treats. We diag­nose only on the basis of man­i­fest symp­toms that reflect some degree of decom­pen­sa­tion of the brain’s func­tion­al capac­i­ty. Yet, our under­ly­ing clin­i­cal sci­ence has advanced to the point that, like car­di­ol­o­gists who can diag­nose under­ly­ing dis­or­ders in the heart ( ath­er­o­scle­ro­sis, myocar­diopa­thy, arrhyth­mias, etc.) before and sep­a­rate from symp­toms of car­diac decom­pen­sa­tion, we can also diag­nose the under­ly­ing prob­lems in brain health. These prob­lems in brain health are reflect­ed in neu­rocog­ni­tive dys­func­tion. In my opin­ion an assess­ment of basic neu­rocog­ni­tive func­tion should be an essen­tial part of any psy­chi­atric eval­u­a­tion. To do this, how­ev­er, requires a tech­nol­o­gy that makes such an assess­ment con­ve­nient and afford­able. For­tu­nate­ly, we now have some tech­nolo­gies such as the Brain Resource Web­Neu­ro pro­gram, among some oth­ers, that makes this pos­si­ble.

Once we have rec­og­nized the fun­da­men­tal impor­tance of under­ly­ing brain func­tion to men­tal health, the need for tech­nolo­gies, drugs and oth­er lifestyle inter­ven­tions and con­sid­er­a­tions to pro­tect and improve brain health gains salien­cy and urgency. Cog­ni­tive enhance­ment and reme­di­a­tion tech­nolo­gies are now emerg­ing. This is a nascent area of inno­va­tion and indus­try – and a wel­come one. We are in the phase now where the offer­ings are mul­ti­ply­ing rapid­ly, but are enter­ing the next phase of field mat­u­ra­tion that will require com­pa­nies to demon­strate the effi­ca­cy and effec­tive­ness of their offer­ings. That next will lead to the ben­e­fi­cial con­sol­i­da­tion and nar­row­ing of the field to the com­pa­nies which are able to empir­i­cal­ly val­i­date the pos­i­tive impact of their prod­ucts.

Final­ly, in order to tru­ly encour­age con­tin­u­ous inno­va­tion and improve­ment, we need to pre­serve both cre­ativ­i­ty and integri­ty. We need soft touch­es to guide the field in the right direc­tion –as in fact I believe Sharp­Brains is doing very well –, more than strict reg­u­la­tions that may be pre­ma­ture at this point.

I appre­ci­ate those words, thank you. We see the oppor­tu­ni­ty to improve brain care through the life course by upgrad­ing the very basic frame­work for care, mov­ing from the pre­ven­tion and treat­ment of a col­lec­tion of symp­tom-based diag­noses towards the enhance­ment and main­te­nance of under­ly­ing brain-based cog­ni­tive and self-reg­u­la­tion func­tions. Do you see any progress in that direc­tion?

First, let me say that I ful­ly share that point of view. As I not­ed, today’s diag­nos­tic frame­work is out­dat­ed in its lim­i­ta­tion to symp­tom based diag­no­sis. All the organs in the body have a func­tion, and the brain is no excep­tion. Let’s think of this anal­o­gy: the main func­tion of the heart is pump­ing blood — and when that func­tion starts to fail a vari­ety of symp­toms appear, and may end in heart fail­ure. Car­dio­vas­cu­lar health has seen major improve­ments over the last 50 years pre­cise­ly because of its under­stand­ing of the heart as a sys­tem with a func­tion. The brain’s main func­tion is infor­ma­tion pro­cess­ing, yet, psy­chi­a­try basi­cal­ly ignores it. It doesn’t take into account that so-called dis­or­ders, which are diag­nosed and treat­ed as if they were each sep­a­rate and bina­ry (you have them or you don’t) ill­ness­es, are pri­mar­i­ly signs of decom­pen­sa­tion, By that I mean, when the brain gets over­whelmed and can’t per­form its func­tion well.

What we have learned from neu­ro­science over the last decade is that we can, to a sig­nif­i­cant extent, start to iden­ti­fy the brain-based cog­ni­tive and self-reg­u­la­tion dys­func­tions that often pre­cede dis­or­ders. So, we should be ask­ing, what are the brain-based risk fac­tors, the main rea­sons under­ly­ing the appear­ance of men­tal health prob­lems? at what point of dys­func­tion do prob­lems -and which ones- appear?

In short, the men­tal health field should adopt a brain-based mod­el for diag­no­sis and treat­ment.

You seem to be say­ing that there is a grow­ing gap between neu­ro­science and psy­chi­atric prac­tice, between what we know about the brain and how to maintain/ enhance its func­tion­al­i­ty and how its “dis­or­ders” are diag­nosed and treat­ed. Do you see a way to bridge this gap?

I do, which is pre­cise­ly why I am now involved with Brain Resource. Today we have brain-based mod­els for most men­tal ill­ness­es, both those tra­di­tion­al­ly stud­ied by psy­chi­a­try and neu­rode­gen­er­a­tive ones, like Alzheimer’s Dis­ease, stud­ied by neu­rol­o­gy. What we need, to put that knowl­edge into prac­tice, are use­ful tools that help us pro­vide best care at the indi­vid­ual lev­el, select­ing from the broad types of inter­ven­tions avail­able and sys­tem­at­i­cal­ly and quan­ti­ta­tive­ly mon­i­tor­ing their impact. Hereto­fore, a doc­tor who want­ed to eval­u­ate neu­rocog­ni­tive func­tion had to refer his or her patient to a neu­ropsy­chol­o­gist which is very expen­sive. It can cost $4,000, and insur­ance cov­er­age is high­ly vari­able. Web­Neu­ro, the clin­i­cal deci­sion sup­port sys­tem by Brain Resource, helps auto­mate an infor­ma­tive basic form of that eval­u­a­tion. Since it is cheap­er to admin­is­ter and eas­i­er to obtain than a full eval­u­a­tion by a neu­ropsy­chol­o­gist , it opens a whole new realm of pos­si­bil­i­ties. For exam­ple, you could mea­sure and track the brain health of a whole pop­u­la­tion. A doc­tor or health­care sys­tem could eas­i­ly mon­i­tor the brain health of sev­er­al hun­dred patients, iden­ti­fy who is expe­ri­enc­ing dys­func­tions and would ben­e­fit from spe­cif­ic inter­ven­tions, track progress over time, and refine his or her own clin­i­cal prac­tice based on data.

I believe that, the more doc­tors we have using prac­ti­cal tools like this, the more obvi­ous it will become that we need to change our exist­ing diag­nos­tic mod­el and adopt a brain-based mod­el of psy­chi­atric diag­no­sis and treat­ment.

We often call this new mod­el a “brain fit­ness” one to empha­size 2 things: first, every­thing we can do before diag­nos­able dis­or­ders appear. As you said ear­li­er, men­tal health dis­or­ders are real­ly dys­func­tions, so the more func­tion we have to start with, the less like­ly the dys­func­tion will result in a diag­nos­able dis­or­der. This is the val­ue of the Cog­ni­tive Reserve is help­ing reduce the prob­a­bil­i­ty of devel­op­ing Alzheimer’s Dis­ease symp­toms, even when pathol­o­gy is present. Sec­ond, we need to adopt a new frame­work, based on func­tion­al­i­ty, on men­tal mus­cles if you will, but that will require a new lan­guage and new cul­ture. Are health pro­fes­sion­als ready? for exam­ple, how many doc­tors today could cor­rect­ly define work­ing mem­o­ry?

I’d say prob­a­bly no more than 5%. And you are right, that is pre­cise­ly the new type of cul­ture and frame­works we need to start pro­mot­ing cou­pled, in my opin­ion, with care­ful sci­en­tif­ic val­i­da­tion of the effec­tive­ness of any pro­posed inter­ven­tions.

Now, doc­tors real­ly learn by doing, but they don’t have much time to learn inter­est­ing things that are not direct­ly rel­e­vant to their work. In this regard, I believe Web­Neu­ro can become a knowl­edge trans­la­tion tool. Once doc­tors, prob­a­bly spe­cial­ists first and pri­ma­ry care physi­cians lat­er, see how they can objec­tive­ly and con­ve­nient­ly mea­sure key aspects of the brain’s func­tion.

Dear John, thank you very much for a very stim­u­lat­ing con­ver­sa­tion.

My plea­sure.

To learn more: you can read the Exec­u­tive Sum­ma­ry of Sharp­Brains’ mar­ket report Trans­form­ing Brain Health with Dig­i­tal Tools to Assess, Enhance and Treat Cog­ni­tion across the Lifes­pan, pub­lished in July 2010.

Leave a Reply...

Loading Facebook Comments ...

6 Responses

  1. Dason says:

    I’m sor­ry to say this but the med­ical hoo-ha used in the arti­cle bored me to where I couldn’t even fin­ish it… What’s the point of an inter­view if only peo­ple with a Master’s degree can under­stand it?

  2. Hel­lo Dason — I am sure you will find oth­er arti­cles you’ll enjoy more, more rel­e­vant to your inter­ests and needs. Sim­ply look at the Top 30 arti­cles list. The point of SharpBrains.com is to make us all think and engage — some have Master’s degrees, some don’t. We all have brains.

  3. Margaret Kim says:

    I know of John Docherty–what a won­der­ful man. Glad you’re shar­ing his knowl­edge with all.

  4. Laura Fay says:

    Dr. Docherty’s com­ments are very appro­pri­ate. It will be very inter­est­ing to see the devel­op­ments in the com­ing years in the area of cog­ni­tion and psy­chi­a­try. There are a num­ber of clin­i­cal stud­ies involv­ing cog­ni­tive reme­di­a­tion in schiz­o­phre­nia and major depres­sion that are expect­ed for pub­li­ca­tion in the com­ing months that will undoubt­ed­ly cast an impor­tant light on how clin­i­cians can help their patients deal with the cog­ni­tive impair­ments that so fre­quent­ly accom­pa­ny diag­nosed men­tal health con­di­tions.

  5. Hel­lo Mar­garet and Lau­ra — yes, it will be very inter­est­ing to see how the field evolves, espe­cial­ly giv­en health reform/electronic health records and men­tal par­i­ty law in the US.

  6. Madhu says:

    Hi,

    I just want­ed to let you know that I’ve includ­ed this post in the lat­est Sci­en­tia Pro Pub­li­ca now up over on my blog. Do drop by when you have a moment.

    thanks,

    Mad­hu

Leave a Reply

Categories: Cognitive Neuroscience, Health & Wellness, Professional Development, Technology

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Watch All Recordings Now (40+ Speakers, 12+ Hours)

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters and more, SharpBrains is an independent market research firm tracking health and performance applications of brain science.

Follow us and Engage via…

twitter_logo_header
RSS Feed

Search for anything brain-related in our article archives