What's New in Neurofeedback

• 
  On The Track with Neurofeedback - Newsweek article

• Schools push Ritalin, panel told - http://www.dispatch.com:80/news/newsfea00/may00/282385.html

• Class action lawsuit against manufacturers of Ritalin, APA, and CHADD - http://www.ritalinfraud.com/

• CBS News: Reading, Writing, and Ritalin - http://cbsnews.cbs.com/now/story/0,1597,193590-412,00.shtml

• AAAS: EEG Biofeedback Aids Impulse Control - http://www.eegspectrum.com/articles/aaas00.htm

• Neurofeedback Gains Attention for ADD Kids - http://webmd.lycos.com/content/article/2789.180

In a 1998 editorial in the Los Angeles Times, "Health Alternate to Health Care" (see for related article, Andrew Weil opens with the following insight: "attacking alternative medicine in general and herbal remedies in particular [in a recent New England Journal of Medicine editorial] did little to restore confidence in practitioners of conventional medicine." Seventy percent of all patients have undergone one or more alternative therapies; and since 1990 visits to alternative therapy providers has outnumbered visits to primary care physicians in the U.S. Why is our confidence in conventional medicine lagging at the very midst of the biomedical revolution? What is driving this renewed and vigorous interest in alternative medicine?

First, Weil would like to retire the term "alternative medicine" altogether. He would prefer the term "integrative medicine," an accurate label, as practitioners integrate standard and novel methods of treating a patient. Besides any negative connotations associated with anything "alternative", as a majority of patients seek out these forms of treatments, can we rightly call this treatments "alternative" anymore? Was Clinton, the major vote-getter, the "alternative" candidate in 1996?

What apparently spurred Weil into writing his editorial was the series of misrepresentations the authors of an NEJM editorial foisted on their learned audience. First, the authors argued about the "risks of alternative medicine". To support their claim, they cite three separate and isolated incidents. These rare reports of toxicity are obviously "anecdotal evidence", the same kind of evidence they denounced when it does not serve their purpose. They also neglected to make the obvious comparison: how much risk is associated with integrative treatments compared to the risk associated with standard practices. The risk of using prescription drugs involves as many as 100,000 deaths and 1.5 million hospitalizations yearly, according to Weil. The risk associated with warfare is often less lethal.

The NEJM authors believe that the increased interest in integrative treatments, beside being regressive and "irrational", may be due in part to the "harsh treatments that may be necessary for life-threatening diseases." Perhaps this is where the 100,000 yearly deaths factor into their argument. They also surmise that people resort to integrative medicine practitioners because they are disillusioned with the "often hurried and impersonal care delivered by conventional physicians." Possibly true for a handful of people, but I suspect that the manner of clinicians runs the spectrum from Mengele to Schweitzer in both camps. Perhaps the reductionism of conventional medicine, the reliance for treating the symptom and not the disease, which has made conventional so successful in so many diseases, does not always suit an individual's condition or state of mind. The increasingly tight relationship between organized medicine and the pharmaceutical industry may also contribute to a loss of confidence in the ivyed halls of medicine.

Integrative medicine "has not been scientifically tested and its advocates largely deny the need for such testing." Obviously they are not members of the PsyPhy listserver -- where members constantly assert the need for more evidence, more rigorous testing, more scientific publications. This misrepresentation irritates Weil the most. As he states, "Give those of us who support such methods the money and means to conduct research, and we will do it." National Institutes of Health opened the Office of Alternative Medicine in 1992 and since then only a single study in neurofeedback has been funded, to the paltry sum of $30,000 (i.e., rounding error in multi-site pharmaceutical studies).

The NEJM authors claim that what distinguishes integrative treatments from standard medicine is "an ideology that largely ignores biologic mechanisms, often disparages modern science, and relies on what are purported to be ancient practices and natural remedies". Operant conditioning is ancient? (B.F. Skinner attended Plato's Academy, didn't he?) When did the thalamocortical circuitry enter the "non-biologic" realm? That neurofeedback is either excluded from their characterization or unknown to the authors reveals the limits of their research into this topic.

The NEJM authors conclude that "Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments." One of the most interesting features of this editorial is that just a few pages away, another author (Avrum Bluming, M.D.) arrives at the exact same conclusion -- but with greater objectivity. "We must continue to insist on the painstaking accumulation of evidence in the scientific testing of each new breakthrough." The same turf is explored with reason and clarity. Patients want an increasing role in the decision-making process. Bluming argues that as patients sort through all the therapeutic options, responsible clinicians must be equipped to assist them. Patients are consumers -- conventional medicine has ignored this fact for 400 years. Consumers require inclusion in the selection and decision process. But ironically, at the one time when patients request more control over his or her healthcare, other developments (HMOs) have added another voice to the process, one infinitely removed from the patient.

- David Kaiser

FURTHER READING (updated 06/00)

Health Alternate to Health Care by Andrew Weil - No longer available online

Hope or Hype? http://www.latimes.com/news/timespoll/stories/19980830/t000078986.html

Alternative Medicine -- The Risks of Untested and Unregulated Remedies by Marcia Angell, M.D. & Jerome P. Kassirer, M.D., NEJM, Sep 17, 1998, Vol 339 (12), www.nejm.org/content/1998/0339/0012/0839.asp

Alternative Medicine -- The Case of Herbal Remedies www.nejm.org/content/1999/0340/0007/0564.asp

NEJM reviews of Alternative Medicine books www.nejm.org/content/1998/0339/0012/0855.asp www.nejm.org/content/1999/0340/0023/1845a.asp

The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies By Barrie R. Cassileth. www.amazon.com/exec/obidos/ASIN/0393045668/

Alternative Medicine and Ethics. Edited by James M. Humber and Robert F. Almeder. www.amazon.com/exec/obidos/ASIN/0896034402/

NEW BOOKS

Taming the Troublesome Child: American Families, Child Guidance, and the Limits of Psychiatric Authority

History of the American child guidance movement: evolution of care and concern for delinquent children in America starting from the early years of the 20th century.

Building Basic Therapeutic Skills : A Practical Guide for Current Mental Health Practice
by Jeanne Albronda Heaton, Heaton Jeanne

A psychoanalytic clinician explains fundamental therapy skills such as as becoming a good observer, establishing rapport, and managing emergencies.

The Biology of Violence
by Debra Niehoff

Argues for an interaction model of violence: the biology of behavior is mediated by environmental experiences.

Assessment of Neuropsychological Functions in Psychiatric Disorders
by Avraham Calev

Describes latest research on neuropsychology of schizophrenia, mood disorders, childhood mental disorders, and drug abuse. Includes the clinical assessment of neurocognitive deficits in these conditions and various treatments.

Mild Traumatic Brain Injury : A Therapy and Resource Manual
by Betsy S. Green, Kristin M. Stevens, Tracey D. W. Wolfe

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