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

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.

–> To Learn More:

• Invest in Brain Health to Dri­ve Inno­va­tion and Prosperity
•  2012 Sharp­Brains Vir­tual Sum­mit: Opti­miz­ing Health through Neu­ro­plas­tic­ity, Inno­va­tion and Data (June 7 — 14th, 2012)