The Business and Ethics of the Brain Fitness Boom — Part 2: The Ethics

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
• Next Tues­day, Jan­u­ary 10th: Part 4 — The Future

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Note: This is an excerpt from the Gen­er­a­tions arti­cle  The Busi­ness and Ethics of the Brain Fit­ness Boom, by Alvaro Fer­nan­dez. Copy­right © 2011 Amer­i­can Soci­ety on Aging; all rights reserved. This arti­cle may not be dupli­cat­ed, reprint­ed or dis­trib­uted in any form with­out writ­ten per­mis­sion from the pub­lish­er: Amer­i­can Soci­ety on Aging, 71 Steven­son St., Suite 1450, San Francisco,CA 94105–2938; e‑mail: info@asaging.org.

Read Pre­vi­ous Series here:

• The Busi­ness and Ethics of the Brain Fit­ness Boom — Part 1: The Business