In June of this year, Sharp?Brains hosted its third annual online ?vir?tual sum?mit? on our evolv?ing under?stand?ing of how the human brain works, and how it can be made to work bet?ter. As read?ers of this blog know, Sharp?Brains is a US-based mar?ket research firm and think tank ded?i?cated to study?ing the sci?en?tific, social, and busi?ness trends asso?ci?ated with brain health and per?for?mance. As always, the sum?mit fea?tured a range of con?tri?bu?tions from sci?en?tists and busi?ness lead?ers whose com?mon inter?est is in gath?er?ing, com?pil?ing and apply?ing knowl?edge about the?brain.
The foun?da?tional con?vic?tion of the sum?mit orga?niz?ers and atten?dees is that we?re enter?ing an era when knowl?edge about the brain will have a mas?sive social and eco?nomic impact, giv?ing us unprece?dented capac?ity to address human prob?lems such as men?tal ill?ness, stress and demen?tia, as well as enhanc?ing gen?eral health and human per?for?mance. In fact, what?s been clear to me from my atten?dance at all three of these sum?mits is that we?ve already entered this era, as science-fiction as that may seem. We?re cur?rently liv?ing in an age when brain func?tion?ing can be mea?sured inex?pen?sively and reli?ably using web-based tech?nol?ogy, cog?ni?tive capac?i?ties of peo?ple young and old can be increased using non-drug meth?ods, and large-scale inte?gra?tions of sci?en?tific knowl?edge are pro?duc?ing insights that eluded the sci?en?tists of just a few years ago. It?s a time of rapid change and huge opportunity.
Is Hav?ing a Brain a Med?ical Condition?
One of the summit?s emer?gent themes was the extent to which applied knowl?edge of the brain is, and is not, going to be med?ical. Dis?cus?sion returned sev?eral times to the issue of the extent to which applied neu?ro?science should, or should not be, tied to the tra?di?tional dis?ci?plines and deliv?ery mod?els of health?care. One aspect of this ques?tion is the increas?ing rejec?tion of the often arbi?trary cat?e?gor?i?cal dis?tinc?tion between ill?ness and well?ness, a prod?uct of medicine?s his?toric focus on cat?e?gor?i?cal diag?no?sis. This issue is play?ing out in many dif?fer?ent ways, for both sci?en?tific and prac?ti?cal rea?sons. Within the sci?en?tific com?mu?nity it?s increas?ingly agreed that although diag?nos?tic cat?e?gories can be a use?ful tool, they can also dis?tort our under?stand?ings in ways that do a dis?ser?vice to those we serve. Neu?rol?o?gist and sum?mit speaker Peter White?house high?lighted this issue in his cri?tique of the diag?nos?tic entity called Alzheimer?s Dis?ease, an ?ill?ness? with?out a dis?tinct patho?phys?i?ol?ogy or a reli?able diag?nos?tic test. Psy?chi?a?try, too, is being com?pelled to con?sider new alter?na?tives to its out?worn diag?nos?tic sys?tem, ways of under?stand?ing dys?func?tion and select?ing inter?ven?tions on the basis of indi?vid?u?als? brain phys?i?ol?ogy and cog?ni?tive per?for?mance rather than on a check?list of observed symp?toms. Sum?mit speak?ers Robert Bilder and Evian Gor?don dis?cussed how ?Big Data? is cre?at?ing new, syn?thetic under?stand?ings of the con?nec?tions among behav?ioral syn?dromes and results from neu?roimag?ing, cog?ni?tive neu?ro?science, cell biol?ogy, and genet?ics. Dr. Gor?don also high?lighted the poten?tial of large inter?na?tional data?bases, cross?ing mul?ti?ple lev?els of analy?sis, for real?iz?ing the ideal of a truly per?son?al?ized medicine.
Brain fit?ness as a consumer-led movement
The new pop?u?lar term ?brain fit?ness? is itself telling, because its focus is on well?ness and peak func?tion?ing rather than dys?func?tion. ?Fit?ness? is indeed an apt metaphor in many ways, given that our brains get bet?ter at things they prac?tice doing, and that tar?geted prac?tice of cog?ni?tive functions?even in the form of play?ing shoot-?em-up video games?can lead to mean?ing?ful real-life changes in men?tal abil?ity. ?Brain fit?ness? is a grow?ing consumer-led move?ment, and as such, it?s not going to wait around for med?ical or sci?en?tific impri?maturs. As dis?cussed through?out the Sum?mit, it?s already hit the con?sumer world, with inex?pen?sive, wear?able EEG mon?i?tor?ing devices, a chain of brain-themed US retail stores, and web?sites where mil?lions of users try to improve their cog?ni?tive func?tion?ing by play?ing games for a few min?utes every?day.
Growth brings chal?lenges too, and the field was encour?aged to think about the costs and the ben?e?fits of a wide-open, consumer-oriented approach to brain fit?ness, as opposed to an approach that relies on the tra?di?tional gate?keep?ers of health, namely, physi?cians and other health professionals.
Pros and Cons of Medicalization
Pro?fes?sion?al?iza?tion has two chief ben?e?fits: it reduces risk in cases where the appli?ca?tion of knowl?edge car?ries with it the pos?si?bil?ity of harm, and it serves as a means of guar?an?tee?ing qual?ity by hold?ing inter?ven?tions to some sort of evi?den?tiary stan?dard with respect to their effi?cacy. In the case of brain fit?ness it seems rel?a?tively easy to dis?miss the for?mer ben?e?fit as irrel?e?vant. There cer?tainly seem to be few side effects to effec?tive brain-training prod?ucts that are cur?rently avail?able. Indeed, one of the most salu?tary aspects of tech?nolo?gies based on neu?ro?plas?tic?ity is that they work through the brain?s own nat?u?rally reg?u?lated change mech?a?nisms, unlike med?ical and sur?gi?cal inter?ven?tions whose poten?tial for harm is typ?i?cally linked to the fact that they over?ride these same mech?a?nisms. But plasticity-based inter?ven?tions have shown them?selves in some cases to be remark?ably pow?er?ful, so some cau?tion is war?ranted before declar?ing them entirely risk-free. The sec?ond point may be more impor?tant. When?ever some con?sumer trend takes hold, the mar?ket?place becomes crowded with sell?ers mak?ing ever-bolder claims, and in the case of brain fit?ness it?s bound to be dif?fi?cult for con?sumers to sort the evidence-based wheat from the unproven chaff. The long-term result may be that the pub?lic will become dis?af?fected with brain fit?ness due to a pre?pon?der?ance of wild claims and inef?fec?tive solu?tions, unless high-quality resources such as The Sharp?Brains Guide to Brain Fit?ness gain trac?tion in help?ing con?sumers and allied pro?fes?sion?als to nav?i?gate lifestyle and prod?uct options.
There are addi?tional ben?e?fits of deliv?er?ing brain assess?ment and train?ing through some sort of pro?fes?sional frame?work. First, there will need to be some means to iden?tify those in need of pro?fes?sional atten?tion and intro?duce them into the med?ical sys?tem. Second?and this is an issue that is begin?ning to get some attention?there will be an increas?ing need for dis?cus?sion of the ethics of neu?roac?tive tech?nolo?gies, and such a dis?cus?sion is most likely to be given proper atten?tion in sci?en?tific and pro?fes?sional cir?cles. Third, pro?fes?sion?als are well posi?tioned to mon?i?tor and improve brain func?tion?ing across long spans of time, and it?s becom?ing clear that mon?i?tor?ing lon?gi?tu?di?nal change across years is going to be impor?tant, espe?cially dur?ing later adulthood.
How?ever, the costs of med?ical?iza?tion are high, because it increases expense, imposes often sti?fling reg?u?la?tory con?straints, slows down a field?s respon?sive?ness to newly devel?oped tech?nol?ogy, places mas?sive decision-making power into the hands of insur?ers, and sets the stage for unhelp?ful inter-disciplinary turf wars. The ten?dency of all of these fac?tors is to limit innovation?s reach, and to dis?cour?age self-motivated con?sumers. Again, think of the ?fit?ness? metaphor.
Shap?ing the Future
In the Inter?net age the like?li?hood is that more an more con?sumers will take charge of their own brain health and fit?ness, and if the pro?fes?sional world is slow to adapt, it may well be bypassed in a grow?ing num?ber of sit?u?a?tions. More?over, with an aging pop?u?la?tion, the demand for brain prod?ucts will vastly out?strip the capac?ity of pro?fes?sion?als to pro?vide them. What is urgently needed is some way to mit?i?gate the risks of a consumer-driven phe?nom?e?non by estab?lish?ing qual?ity stan?dards, address?ing the safety ques?tion, improv?ing pub?lic edu?ca?tion, incor?po?rat?ing uni?ver?sal, lon?gi?tu?di?nal brain-health mon?i?tor?ing into pri?mary care, and ini?ti?at?ing a seri?ous neuro-ethics con?ver?sa?tion. ?Per?haps a good start to shape the agenda for the 2013 Sharp?Brains Vir?tual Summit?
? Dr. Philip Toman is a clin?i?cal psy?chol?o?gist and the founder of Chor?at?ech, a com?pany whose mis?sion is to bring appli?ca?tions of neu?ro?sci?en?tific research to ordi?nary peo?ple. He has par?tic?i?pated in all three Sharp?Brains Vir?tual Sum?mits so?far.
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The U.S. military forces are among the bravest and most selfless people in our country. They dedicate and risk their lives to protect our citizens and rights. While serving in the military, it?s common to be transferred to varying locations both within the U.S. as well as internationally. Moving is stressful and uprooting your entire life over and over again is difficult. To make matters worse, pet rules vary from one location to the next, limiting how many pets are allowed and prohibiting select breeds and types of dogs. Risking life and comfort for our country is part of military service. For all that our service men and women do for our country, to deny them the familiarity and love of their own pets is not acceptable. Pets are family and should be able to provide comfort and affection to their loving owners no matter where life and military service may take them. 
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