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.
I think that this technique may be one for the "best laid plans..." file. Getting into an fMRI is hard enough for people in dire medical need; i'm not sure that hospitals or those clinics for the super-rich are going to allow people to line up to learn how to suppress their backaches...
Michael Merzenich: 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.
I've heard about Posit Science before, and it's something I might generally be interested in. But evidently they've adopted the pharmaceutical industry's pricing model and not the software industry's. If he would slash his prices he'd get a lot more sales (and ultimately, more profit).
I agree with Kurt, having just checked out their website, I was pretty shocked by the pricing. Viewing the Demo and taking the brain speed test had me sold, I was ready to shell out $30-$50 to pickup the software, not out of necessity but out of interest. A $400 price tag is a little absurd, unless your pricing to have HMOs and the federal government pickup the tab, with the headaches that that brings up, they are just exacerbating the problem.
Teaching the brain - it's what I do with my daughter every day. My daughter's birth mother drank during her pregnancy and my daughter is left with permanent brain damage, mostly centered in the pre-frontal cortex (which is how I found your website.)
Fetal Alcohol Spectrum Disorders aren't researched all that much - I'll skip the rant about why that may be true, think socio-economics and you'll probably get there on your own. But the one thing we are learning from what we read on neuroscience is that the brain is remarkably plastic.
Our daughter can be taught to do the things that she isn't supposed to be able to do. It takes more patience than I ever imagined having but the brain is powerful and the idea that it can be trained to control itself (reduce pain in your example) is motivating. I don't have any superduper software or pills to help but when we identify places where she is "deficient" or "damaged" and we push in those areas, breaking down the process, handing her each step, the more self sufficient she becomes. Turning "can't" into babysteps of progress is the name of the game.
Someday when she is grown and gone, living on her own, completely self sufficient, some mastermind will publish a study that clarifies it all. Until then I'll keep chipping away, finding the parts of her brain that can replace the broken places.
Thanks for the site, interesting reading, I was hoping for something on executive function but I guess that will be on someone else's frontal cortex website.
" A $400 price tag is a little absurd, unless your pricing to have HMOs and the federal government pickup the tab, with the headaches that that brings up, they are just exacerbating the problem."
It's not *that* bad. Millions of families manage to scrounge up $400 for an XBox and $40 per game. Four THOUSAND dollars would be ridiculous.
At least you only have to pay that once. Think of it as a $10/month prescription taken for 40 months.
They do offer an installment plan, and if it works it would be good if there were assistance for low-income people.
It´s really impressive to know the power we have upon our body. Sure it will take much more to rise it to the effects of drugs, but with better feedback instruments, I´m sure that we´ll come to astonishing unthought possibilities. Although I knew the effects of humor in immunology, I thought we were far from comprehension of how to manipulate ourselves in such a way. Maybe can we dream man will come to be some kind of jedi even in a distant future ? LOL.
Thanks for the site, interesting reading, I was hoping for something on executive function but I guess that will be on someone else's frontal cortex website