Well, Bernard has Had Enough of the medical establishment dismissing the possibility of neurofeedback as a legitimate alternative to drugs, surgery, and implanted devices.
And in January this year, he wrote a wonderfully well-researched letter to Dr. Christine Phelps, Deputy Executive Director (Center for Education and Science) for the American Academy of Neurology/AAN Foundation.
In it, he addresses the kind of things that drive me personally crazy.
Chief among these is the double standard pulled out when evaluating neurofeedback against medical or surgical interventions.So while his letter was more focused on asking the right questions of the AAN and demanding some answers, I'm going to take this opportunity for just a wee rant. Bear with me please...
Invariably, neurofeedback (and other non-conventional interventions) is somehow required to show research evidence using large numbers of participants, double-blind trials (meaning neither the clinician nor the client know which intervention is being delivered) and to be able to explain its "mechanism of action" (i.e., how it works, exactly).
But most medical and surgical interventions commonly used don't meet these requirements.
- Medications are frequently used "off-label" (i.e., not for what they were designed to do and without studies to show whether they work for the new purpose)
- Medications are combined every day in ways that have never been investigated for safety or effectiveness. Here is one example of medications combined to "treat" the symptoms of ADD -- note the off-label use of one of the medications plus the combining of drugs. In other examples, the combining is less intentional (e.g., a medication for pain combined with a medication for depression), but there is still no research to indicate whether these are safely and effectively combined. I have often seen people given medications to combat the side-effects of another medication -- without evidence of whether changing the side-effect pattern also means you are (or are not) changing the ability of the first medication to do it job.
- The mechanisms of action for most psychoactive drugs (ones affecting the brain) are not known. Talk about "chemical imbalances" is based on theories not yet proven to relate to any particular problem or to medication's effect on any particular problem -- notice in the ADD link above how the medication "was believed to...". That is pretty common phrasing for medications -- suggesting that we know the drug has a specific effect and we think that might be the reason it's helpful. (Has a physician ever measured your neurotransmitters to get the "right dose"?)
- Devices are put in people's bodies (and in their brains!) or surgeries done without the benefit of the kinds of studies they insist on for other "alternative" interventions.
There are some wonderful examples of this in a book about the U.S. medical system called Overtreated. Some common descriptions given there are knee surgeries and bone marrow transplants for breast cancer.
Worse, physicians seem quite comfortable pronouncing on the usefulness of neurofeedback when they aren't even trained in that area. A bit like me, as a psychologist, telling a cardiologist what works and what doesn't -- or telling a client of mine whether they should follow the recommendations of a cardiologist. There are some wonderful examples of this in a book about the U.S. medical system called Overtreated. Some common descriptions given there are knee surgeries and bone marrow transplants for breast cancer.
A neurologist told one of my migraine clients that while he "knew about" HEG and its use for migraines, I really should have been doing finger-warming with her. Unfortunately, he didn't seem aware of the differences in effectiveness between the two (not least of which is related to no home practice required with HEG for no headaches vs 20 minutes per day with finger-warming + use for each headache, since it doesn't prevent them). His lack of knowledge didn't stop him from sharing his opinion, though.
And it's not just physicians -- it seems to be an issue for any profession trained in the medical model generally. Just yesterday, someone asking about neurofeedback told me she had asked her psychologist about it and her psychologist told her neurofeedback was useless -- "you might as well just learn to relax". Somehow, I suspect that psychologist had not done any professional continuing education about neurofeedback, yet was comfortable giving an opinion and advice about it.
So, I encourage you to go and read Bernard's thought-provoking letter. And, although it took me a while to find his post, do click on the AAN link he gives you there to let them know people are reading, interested, and wondering.
Perhaps I am going the other way from Bernard, though. Rather than trying to be accepted by the medical/disease-focused community, I find that people are looking for alternatives and complementary approaches, doing their own research (thanks Web!), and finding me without the medical world's involvement.
More and more of my clients are looking for an way to allow their brain to better self-regulate and manage itself instead of looking for the intrusive "quick fixes" of the medical model.
Since this is my own personal preference as well, I'm always delighted with we find each other ;-).
