Brain, Vision, Memory : Tales in the History of NeuroscienceA Monthly Summary of News and Events
Vol. 1 No. 6 - June 1998
This newsletter is sponsored by EEG Spectrum International, Inc.,
a leader in providing clinical service and training professionals.
Past issues are available at www.eegspectrum.com/newsletter/
Information on how to subscribe or cancel a subscription appear at the end.
The opinions related in this newsletter reflect those of the author only.
Copyright (C) 1998 by David Alan Kaiser. All rights reserved.
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Brief Therapy: Doing Therapy Quickly and Effectively Thirty Years Ago - Chapter 1 (so far)
George von Hilsheimer
From The Ghost in the Box To Successful Biofeedback Training - Entire book
Robert Shellenberger and Judith Green
Bob Reynolds, Ph.D. Psych. Assessment & Rehab Services 770 Saybrook Road, Building B Middletown, CT 06457 (860) 346-1235 Ed Kravitz, Ph.D. 51 Hawley Ave Milford, CA 06460 (203) 876-8829 Ruth A. Bolton, R.N., Ph.D. Medical Psychology Group, Inc. Kiewit Prof. Building, Suite 302 39000 Bob Hope Drive Rancho Mirage, CA 92270-3202 (760) 341-2900 Phyllis Dillon 2310 Ocean Drive Vero Beach, FL 32963 (847) 234-8021 Stephen J. Johnson, Ph.D. 1276 McConnell Drive, Suite C Decatur, GA 30033-3506 (404) 321-1441 Email: CCR1276@aol.com Gail Tverberg 206 Wellesley Court Woodstock, GA 30188-6713 (770) 591-5737 Rosita Butler 3425 Ithaca Rd. Olympia Fields, IL 60461 (708) 748-6000 William A. Schnell, M.A.; Jane Schnell 2517 Niles Avenue St. Joseph, MI 49085 (616) 982-0046 Email: billandjanes@prodigy.net |
Clare Chisholm, M.A., LPC 244 Spokane Ave, Suite 3 Whitefish, MT 59937-2600 (406) 862-0337 Sue Ford 1217 Lynn Road Tryon, NC 28782 828-859-5576 828-859-2068 (new location) Carol Kershaw, Ed.D. 2012 Bissonnet St. Houston, TX 77005-1647 (713) 529-4588 William Gumm, Ph.D. 669 Airport Freeway, Suite 300 Hurst, TX 76053-3963 (817) 589-1419 Lloyd Sparks, M.D. 19723 Hwy 99 Suite E-213 Lynwood, WA 98036 (888) 670-1110 Patricia Wilson Learning Opportunity Ctr P.O. Box 2020 Dangar, NSW 2309 AUSTRALIA 049-61-3077 Rod Punnett, BCIAC, NRNP 1073 Newport Ave Victoria, BC, CANADA V85 582 250-370-0221 |
Or does it?
Henry K. Beecher's influential 1955 paper "The Powerful Placebo," published in the Journal of the American Medical Association, was the first study to attempt to quantify the magnitude of the placebo effect. This paper is the source for the ubiquitous citation of 35% improvement associated with placebos. Beecher claimed that 35% of 1082 patients were "satisfactorily relieved" by a placebo alone. This value was never meant to be carved in stone. It was a mathematical mean from only 15 clinical trials which involved a variety of diseases, with an range of improvement from 21 to 58 percent. From the beginning the reliability of this number (35%) should have been questioned.
Forty years later, it was. In the Journal of Clinical Epidemiology, Kienle and Kiene (1997) determined, after examining all of the initial studies, that "no evidence was found of any placebo effect in any of the studies cited by (Beecher)." One hundred percent off the mark! Setting a record in scientific endeavors that cannot never be broken, only tied. Instead of a placebo effect, Kienle and Kiene (1997) concluded that the improvements reported in the 15 studies could be accounted for by the following: spontaneous improvement or recovery, symptom fluctuation, regression to the mean, concomitant treatments, scaling bias, obliging reports by patients, irrelevant response variables, experimental subordination, conditioned answers, psychosomatic phenomena, and other factors including an "active placebo" also known as an (active) treatment. And not one factor listed by these authors had anything to do with the spooky unconscious (that is, psychological anticipation).
In a related paper the same authors wonder whether the placebo effect was perhaps largely illusory. In fact they muse that it may not even exist at all and be another vestige of Freudian thought still clinging to post-modern thought. (These were not their words, however). Some authors concurred. For instance, Gotzsche (1995) argued that the concept of placebo should be discarded altogether. But others disagreed and continued to argue that psychological mechanisms underlay nonspecific effects (Kirsch, 1997). [In other words, Freud would not die.]
As any physicist can tell you, studying a phenomenon, even when it does NOT exist, can be very interesting and fruitful. For a placebo effect to exist, what neurobiological mechanisms must control it, what neuroanatomical or functional systems must be involved? What are the duration and dosage curves like and why? Levine volunteered endorphins to answer some of these questions. Others have gone so far to say that the placebo effect may occasionally be toxic! (cf. Shapiro & Shapiro, 1997; Freud kills). While important questions have yet to be addressed, some researchers in the mental health field began to sling the term around like mud at anything they did not have patent rights to. Perhaps with hindsight, Kienle and Kiene (1997) warned that "the placebo topic seems to invite sloppy methodological thinking." And sloppy thinking is the hurdle facing any treatment modality which competes effectively with the current standard.
In 1992, Russell Barkley argued that neurofeedback must be compared to the placebo condition before he would take any claim seriously. He went so far as to suggest using bogus feedback in his report (CHADDer Box). Human protection committees and researchers such as Michael Linden (1996) recognized how the "option" of false feedback was probably unethical; and others have understood how it is also impractical. False feedback "breaks the blind" of the patient. Subjects, particularly children, are quick to detect when information on the monitor is not associated with their own EEG. This fact itself points to darker workings in the mind.
Those who would recommend placebo controls as a necessary hurdle to acceptance are probably unaware of the Nuremberg Code which was formulated shortly after World War II in response to Nazi atrocities. This code limits the extent of future human experimentation and was the precursor to the Declaration of Helsinki accepted by the World Health Organization in 1964, a declaration to which our governmental and regulatory bodies are expected to prescribe. The Declaration of Helsinki elevates concern for the health and rights of individual subjects over concern for society, for future patients, or for science.. "In any medical study," it asserts "every patient -- including those of a control group, if any -- should be assured of the best proven diagnostic and therapeutic method." Re-read that statement. It ends the use of placebo controls when a proven therapeutic method exists. A study that violates this provision should not be accepted for publication and any application to a regulatory body for a treatment which unnecessarily involved placebo -controlled trials ought be rejected.
Ought to be.
The Code of Federal Regulations under which the FDA operates includes mention of the use of placebo controls, thus deeming them acceptable for US biomedical research. Some researchers complain (in letter to BMJ, etc.) that without a placebo control, their grant proposals will never be funded. Even when alternative treatments are available, a placebo control is an implicit requirement in competitive funding situations. This de facto requirement includes disorders of moderate severity and pain, clearly in violation of the Declaration of Helsinki.
Ignoring the ethics of requiring placebo controls, or even the phenomenological argument of whether placebo effects exist at all, I realize that one can define an active treatment by a set of criteria that placebos cannot meet. (Please excuse the terms if better ones already exist. I am writing this at 3 am in the morning).:
Neurofeedback meets each of the above criteria for ADHD/ADD, epilepsy , and other conditions. Unfortunately, this is an unsubstantiated claim at the moment as most of this information is in the clinical record only and currently unpublished. Perhaps if some agreement can be reach on active treatment criteria, studies can be designed to address each issue, one at a time.
Here's a thought: If a treatment only meets four or less of the five criteria above, should we say this is an active treatment, a placebo, or something in-between? For instance, what is to be made of the fact that the long duration criteria is not met by stimulant therapy for ADHD (e.g., when most individuals stop taking stimulant meds, the symptoms return). And on a similar lines of thinking, if a treatment meets and exceeds all five criteria for a condition, do we call it a cure?
DK
Healy suggests that antidepressants treat a range of nonspecific symptoms that lie along a continuum. He traces the history of antidepressants, which, along with the antibiotics and antihypertensives, created a therapeutic revolution shortly after World War II. Concepts of illness and disease are discussed, from Hippocrates to the creation of the FDA. An interesting point: In 1804, 90 patent medicines were listed; by 1857, the list had grown to 1500, doubling in number approximately every 13 years. (Had the rate stayed the same, by the end of 1999 we would have more than three million pharmaceuticals.)
For the NEJM review, see [http://www.nejm.org/public/1998/0338/0020/1475/1.htm]
Brain, Vision, Memory : Tales in the History of NeuroscienceDescribes the growth of knowledge about theain from the early Egyptians and Greeks to Leonardo Da Vinci to Emanuel Swedenborg (the first and last theoretical biologist?) to the present time, focusing on vision.
For more information, see [mitpress.mit.edu/book-home.tcl?isbn=026207186X]
Amanda Armstrong, Ph.D. published an article on neurofeedback in the recent "Proceedings of the Straub Foundation". Congrats, Amanda!
Brain Child is a listserver which lets parents talk to other parents about their children's condition and ongoing treatment. Parents are encouraged to speak out, share experiences, ask questions, make comments, seek advice, and in the process learn more from each other than you might learn on your own. Brain Child includes parents of children at every stage of neurofeedback training, from start to end. The Brain Child (Client's listserver) archive: http://www.problemchild.org/archive/
Siegfried Othmer, Ph.D., of EEG Spectrum International gave the opening address at this year's Australian AAPB (May 22-24).
Follow the threads yourself at http://search.dejanews.com/dnquery.xp?QRY=neurofeedback
A number of those recent additions were Neurofeedback clinicians webpages; and most of these were hosted by or associated with EEG Spectrum International. These include:
The training also includes the all-important practicum section which focuses on actual operation and use of instrumentation. Additionally, opportunity is provided outside the formal curriculum for practitioners to experience training on themselves as well as discussing professional issues, marketing, and the particulars of establishing a financially successful practice based on this modality.
Faculty: Siegfried Othmer, Ph.D., BCIAC; Susan Othmer, BCIAC; M. Barry Sterman, Ph.D.; Nancy White, Ph.D. ; Julian Isaacs, Ph.D.; Pat Fields, Psy.D.; David Kaiser, Ph.D.; Martin Wuttke, BCIAC; William Scott, BSW, CCDP
| LOCATION | DATES |
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| Encino, CA | Jun 4- 8, 1998
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| Toronto, ONT | Jun 18-22, 1998
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| Encino, CA | (Adv. Practicum) Jul 11, 1998
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| Encino, CA | Jul 16-20, 1998
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| Seattle, WA | (Adv. Practicum) Aug 5, 1998
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| Seattle, WA | Aug 6-10, 1998
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| Encino, CA | Aug 20-24, 1998
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| Boston, MA | (Adv. Practicum) Sep 9, 1998
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| Boston, MA | Sep 10-14, 1998 |
| TOPICS COVERED |
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| EEG Biofeedback Theory: Neurophysiological Basis; Research History |
| Clinical Applications: Assessment, Protocol Selection, Practicum & Case Review |
| Specialty Applications: For Behavior Modification & Performance Enhancement |
| COST (5-Day Course): $895.00
Additional Attendees from Same Facility: 30% discount Reattendees: $200.00 |
denniscampbell@eegspectrum.com
To enroll, contact Dennis Campbell
or call EEG Spectrum International at 800-789-3456 or (818) 788-2083.
Please include your name and phone number in all email messages.
Conferences for Neurofeedback Clinicians & Researchers | ||
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| CONFERENCE | LOCATION | DATES |
| Amer Psychological Assoc. (APA) | San Francisco, CA | August 14-18
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| Soc for the Study of Neuronal Regulation (see below) | Austin, TX | September 10 - 13
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| FutureHealth 1999 (see below) | Palm Springs, CA | February 5-9, 1999 |
"CALL FOR PAPERS": The Society for the Study of Neuronal Regulation (SSNR) is seeking original research papers for presentation at the 1998 SSNR Conference in Austin Texas, September 10 - 13. Entries need to be submitted by via e-mail, fax, or regular mail to David Trudeau, M.D., SSNR Program Chair as soon as possible (deadline by 1 August 1998).
David L. Trudeau, MD SSNR Program Chair #4402 168 E. 6th St. St. Paul, MN 55101 Fax 612.725.2292 Voice 612.298.9773 trude003@maroon.tc.umn.edu
Workshops galore
For more information, see [www.ssnr.com/98-info.htm]
For additional information and updates: bio@Futurehealth.org
Scientists must be able to speak freely about what they know -- we all agree on this point. But scientists must also speak responsibly about the work of others. This is one of the rules of science. Science is just a set of rules to keep us from lying to one another -- nothing more and nothing less. Science is a set of rules, a set of procedures. It's a system where truth does not require a consensus but can stand alone against 100 signatures. When one dons the robes of "scientist", one is presumed to be telling the truth, the whole truth, and nothing but the truth, to the best of one's ability.
But what is to be done with the following hypothetical situation: Say one is wearing the mantle and s/he denounces another scientist's work as having "no scientific credibility". Now this is asserted despite the fact that the work has been published in peer-reviewed journals. What should happen to such a claimant? Has the scientist who did the honest and competent work slandered? Have the journals' editors been slandered? Or is it like the floor of the House where no libel laws apply? Ignoring the legal mumbo-jumbo, what should be done? Science can allow incompetence to survive under its mantle (which might account for EITHER the statements OR the acceptance of the work into print), but dishonesty and irresponsibility have to be pushed out.
In a recent newspaper article, a neurologist was questioned about EEG biofeedback for managing epilepsy. Although he stated how he was not familiar with neurofeedback research and its effect on epilepsy, he claimed that "there was no way such a system could work." His premising statement made all the difference. With this knowledge, we the listeners could interpret whatever comments followed as honest (though uninformed) opinion, partly outside the mantle of science. Although I would not make a statement about a field that I had no knowledge about, I guess this person was simply being human in responding to the reporter's questions. Isn't it human nature to take our limited (or not-so-limited) knowledge and make complete world models out of them? That's how I get across the street in the morning. But then again why did the reporter seek out a neurologist for a response any one on a streetcorner could give?
Now someone could (and should) turn this tattered argument around and question the claims of neurofeedback practitioners. Are they responsible? Are they scientific? Are they quantifiable? you should ask. And most importantly, are they honest? And as long as you're asking, stick around and listen to what they have to say.
David Kaiser, Ph.D.
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