The Frontal Cortex

Ten years ago, neuroscientists were bullish about pharmaceuticals. It sometimes seemed as if every tenured professor was starting his own drug company or consulting for someone else's drug company. But virtually none of those drugs have come to market, at least not yet. The brain is an exquisitely complicated machine, and every beneficial effect seems to inspire numerous side-effects. (Our neurons also have a labyrinth of redundant pathways, which makes it treat any particular bit of errant cellular activity.) It's a little depressing how many of our most effective drugs owe nothing to the billions we've spent on basic research in the last few decades. Prozac and other SSRI's, for example, were invented by accident fifty years ago, and they remain the most effective treatment for depression. (For severe cases of depression, we're back to using electro-shock therapy, which seems to stimulate BDNF and neurogenesis. What would Ken Kesey say?) Hopefully, some of these futuristic drugs will eventually come to market, but it's clear that the going is much tougher than anyone ever expected.

But there's hope. I'm excited by the latest trend in neuroscience medicine, which doesn't depend on pharmaceuticals at all. Instead, it uses the brain's own innate plasticity as a form of healing. Most often, this takes the form of rigorous cognitive enhancement software programs, like Posit Science or Lumosity, both of which were developed by eminent neuroscientists. These programs have already generated some impressive results, and demonstrated that exercising the cortex can help prevent and alleviate the sort of mild cognitive impairment that comes with aging. (The data from Posit Science is particularly well-validated.) As Michael Merzenich, the scientist behind Posit Science, recently told me: "If we got these same improvements with a pill, we'd be counting the money already. We'd have billions in sales. But this isn't a pill--it's much better than that."

And then there's the latest treatment for pain, which uses real time fMRI imaging to teach patients how to use their brain activity to ameliorate the hurt.

A patient slides into the coffin-like scanner and watches a computer-generated flame projected on the screen of virtual-reality goggles; the flame's intensity reflects the neural activity of regions of the brain involved in the perception of pain. Using a variety of mental techniques -- for instance, imagining that a painful area is being flooded with soothing chemicals -- most people can, with a little concentration, make the flame wax or wane. As the flame wanes, the patient feels better. Superficially similar to an older technology, electroencephalogram biofeedback, which measures electrical feedback across multiple areas of the brain, fMRI feedback measures the blood flow in precise areas of the brain.

"We believe that people will use real-time fMRI feedback to hone cognitive strategies that will increase activation of brain regions," Dr. deCharms said. With practice and repetition, he said, this could lead to "long-term changes in the brain."

This approach to treating back pain is largely based on the work of Dr. deCharms and Dr. Sean Mackey. In a 2005 study, the doctors showed that every single chronic pain patient undergoing the fMRI "brain training" reported a decrease in pain intensity, with an average decrease of 64 percent. The patients had stopped being the helpless victims of a structural abnormality in the body, and could now focus on dealing with the pain in their mind. Simply knowing that they could control the pain somehow made the pain less terrible.

Given the checkered histories of recent pharmaceutical painkillers, I certainly hope treatments like this fMRI imaging gain wider currency. It may turn out that the brain is it's own best medicine.