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Improving Brain Health Outcomes with Tech, Incentives and Comparative Effectiveness Research

Mal­prac­tice Method­ol­o­gy (New York Times OpEd by Peter Orszag)

Right now, health care is more evi­dence-free than you might think. And even where evi­dence-based clin­i­cal guide­lines exist, research sug­gests that doc­tors fol­low them only about half of the time. One esti­mate sug­gests that it takes 17 years on aver­age to incor­po­rate new research find­ings into wide­spread prac­tice. As a result, any clin­i­cal guide­lines that exist often have lim­it­ed impact. How might we encour­age doc­tors to adopt new evi­dence more quick­ly?

If this is the case with health care over­all, despite much progress over the last 30–40 years, imag­ine how worse it may be when we talk about brain health, when neu­ro­science and cog­ni­tive neu­ro­science are rel­a­tive­ly more recent dis­ci­plines.

This is a key insight to keep in mind as we debate the val­ue and lim­i­ta­tions of inno­v­a­tive brain health solu­tions, espe­cial­ly those that are non-inva­sive and have no neg­a­tive side effects:  what mat­ters most to actu­al human beings liv­ing today is how those tools and solu­tions seem to per­form, based on best evi­dence, com­pared to alter­na­tives avail­able today — not com­pared to Pla­ton­ic ideals about research and prac­tice which may exist in our minds but not in the real, empir­i­cal world. Of course we then need to guide research so that we have bet­ter evi­dence in the future, but progress must occur in par­al­lel and rein­force each oth­er: progress in prac­tice and in research.

The OpEd author then pro­ceeds to defend mal­prac­tice reform as the pri­ma­ry way to do so. This may well be so with health­care as a whole, but when we are talk­ing about brain care I believe his next 2 pro­pos­als are more direct­ly rel­e­vant: Read the rest of this entry »

The Future of Cognitive Enhancement and Mental Health: Meet the Experts

Since 2006, as part of the research sup­port­ing The Sharp­Brains Guide to Brain Fit­ness and Sharp­Brains’ mar­ket reports, we have inter­viewed dozens of lead­ing-edge sci­en­tists and experts. Below are some of our favorite quotes and inter­views — you can read the full inter­view notes by click­ing on the links:

Con­ver­sa­tions in 2010

“…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…we require tech­nolo­gies that trans­late emer­gent knowl­edge into prac­tice.” — Dr. John Docher­ty, Adjunct Pro­fes­sor of Psy­chi­a­try at Weill Med­ical Col­lege, and for­mer Branch Chief at NIMH.
Full Inter­view Notes.
“We should be think­ing about the brain through its whole life­time…We need to break the silos, to aggre­gate knowl­edge, to help advance our knowl­edge of the brain 50 years in 5 years.” — Patrick Dono­hue, founder of the Sarah Jane Brain Project.
Full Inter­view Notes.

Con­ver­sa­tions in 2009

My dream in all of this is to have stan­dard­ized and cred­i­ble tools to train the 5–6 main neu­rocog­ni­tive domains for cog­ni tive health and per­for­mance through life, cou­pled with the right assess­ments to iden­ti­fy one’s indi­vid ual needs and mea sure progress” — Dr. Michael Merzenich, Emer­i­tus Pro­fes­sor at UCSF, and pio­neer in brain plas­tic­i­ty research.
Full Inter­view Notes.
“We have an oppor­tu­ni­ty to make major progress in Brain Health in the XXI cen­tu­ry, sim­i­lar to what hap­pened with Car­diovascular Health in the XX, and tech­nol­o­gy will play a cru­cial role.” — Dr. William E. Reich­man, Pres­i­dent and CEO of Bay­crest.
Full Inter­view Notes.
Growth only real­ly comes at the point of resis­tance, but that is the moment that we tend to stop. Because it hurts…pushing our lim­its is a mus­cle that can be cul­ti­vat­ed like any other–incrementally” — Joshua Wait­zkin, chess cham­pi­on and author of The Art of Learn­ing.
Full Inter­view Notes.
“The cor­re­la­tion between iden­ti­cal twins reared apart gives an over­es­ti­mate of her­i­tabil­i­ty because the envi­ron­ments of iden tical twins reared apart are often high­ly sim­i­lar. But the main con­tra­dic­tion of her­i­tabil­i­ty esti­mates lies in the fact that adop­tion pro­duces a huge effect on IQ” ‑Dr. Richard Nis­bett, Pro­fes­sor at Uni­ver­si­ty of Michi­gan and author of Intel­li­gence and How to Get It: Why Schools and Cul­tures Count.
Full Inter­view Notes.

For more, please vis­it our Neu­ro­science Inter­view Series.

Update: Innovation to Upgrade Brain Care

Here you have the July107px-gray1197thumbnail edi­tion of our month­ly eNewslet ter cov­er­ing cog­ni­tive health and brain fit­ness top­ics. Please remem ber that you can sub­scribe to receive this free Brain Fit­ness eNewslet­ter by email, using the box in the right col­umn.

Tech­nol­o­gy to upgrade brain care: In this exten­sive inter­view, Dr. John Docher­ty helps con­nect the dots on why new frame­works and tools are a must to put recent brain research to good use. A must read for all pro­fes­sion­als in the field.

Research

Find­ings from NIH Expert Pan­el: The Amer­i­can Soci­ety on Aging asked Alvaro Fer­nan­dez to com­ment on the find­ings from a major cog­ni­tive health research review by the Nation­al Insti­tutes of Health. Lifestyle still mat­ters, and pro­tec­tive fac­tors against cog­ni­tive decline are led by cog­ni­tive train­ing, phys­i­cal activ­i­ty and cog­ni­tive engage­ment.

Sci­en­tif­ic cri­tique of BBC brain train­ing exper­i­ment: Dr. Eliz­a­beth Zelin­s­ki shares her con­cerns about the April 2010 BBC study, which includ­ed sub­stan­tial and unex­plained dropout rates, and ques­tion­able out­come mea­sure­ment and inter­pre­ta­tion.

The val­ue of being bilin­gual and build­ing a Cog­ni­tive Reserve to pre­serve learn­ing and mem­o­ry even in the face of brain dam­age are explored in recent stud­ies.

San Fran­cis­co Bay Area study seeks par­tic­i­pants: The Gaz­za­ley Lab at UCSF is look­ing for par­tic­i­pants aged 20–59 to explore the impact of dis­trac­tion and mul­ti­task­ing on per­for­mance across the lifes­pan.


Inno­va­tion

What impressed Inno­va­tion Awards Judg­ing Pan­el: Get some insight into what most impressed the Judg­ing Pan­el about each Win­ner and Final­ist of the 2010 Brain Fit­ness Inno­va­tion Awards.

New — Sharp­Brains’ 2010 Mar­ket Report:  Sharp­Brains’ flag­ship, 207-page, third annu­al mar­ket report finds con­tin­ued growth for dig­i­tal tech­nolo­gies to assess, enhance and treat cog­ni­tion.

To man­age brain fit­ness through life, we need to put puz­zle pieces togeth­er: inno­v­a­tive tools to help us bet­ter mon­i­tor our cog­ni­tive health and take informed action are bad­ly needed.…and already emerg­ing.

The inter­net will fry your brain. Sure: In his lat­est book, Nicholas Carr does a great job high­light­ing the impli­ca­tions of life­long neuro­plasticity, but picks the wrong ene­my.

Seri­ous Games”:  Can video games inspire peo­ple to per­form acts of altru­ism? Kyle Smith reports.

Teasers

Yahoo Opti­cal Illu­sions and teasers: Yahoo! has cre­at­ed an expand­ed sec­tion of illu­sions and teasers, and we were glad to con­tribute to it. Enjoy…and have a great sum­mer!

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. Read the rest of this entry »

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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