Feb 06 2013
Snake oil often resides on the apparent cutting edge of medical advance. This is a marketing strategy – exploiting the media hype that often precedes actual scientific advances (even ones that don’t eventually pan out). The slogan of this approach could be, “Turning tomorrow’s possible cures into today’s pseudoscientific snake oil.”
The strategy works because, to the average person, the claims will sound plausible and scientific and will contain familiar scientific buzz words. There is therefore a proliferation of stem cell clinics, anti-oxidant supplements, and personalized genetic medicine.
We can add to the list of cutting edge pseudoscience, neural plasticity and brain training. Neuroscientists are discovering that even the adult brain has greater capacity for plasticity than was previously thought. Plasticity is the capacity of the brain to rewire itself, to acquire new abilities or compensate for damage. Mostly this is simply a technical description of a very common phenomenon – learning. Shoot a basketball 1000 times and (surprising to no one) you (meaning your brain) will get better at shooting baskets. Some of this is physical, such as developing the necessary strength in the involved muscles, but mostly this is the brain learning how to shoot baskets through plasticity.
One legitimate question that neuroscientists are researching is how generalizable (transferable) such training is. In other words, can learning to shoot baskets make you better at some other similar task, like throwing a baseball? Or – can doing one form of mental task make you smarter in general, or give you cognitive skills that apply outside of the task at hand? This question has not been fully resolved. There is mixed evidence, partly because of variable study techniques but also because there are numerous permutations of this question – which tasks transfer to which abilities. There are also different populations – young, adult, older adult and healthy vs cognitively impaired.
A 2012 review of brain training in general stated:
Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such brain training largely unsubstantiated.
I personally don’t like the term “brain training” as it suggests it is something other than simply learning. What we can conclude from the existing evidence is that performing and practicing mental tasks makes you better at those tasks. It is unclear how much they transfer to other skills or to basic mental ability (like memory or concentration) but the mixed evidence suggests significant limits on such transferability. One large study showed no transferability, even to similar tasks. Other studies do show some general memory enhancement in older adults.
Where there appears to be general agreement is the following – computer-based training programs work as well as traditional programs (pen and paper) and do not require computer savvy, video games may have some benefit (although maybe not as much as computer programs optimized for cognitive benefits), novelty seems to be an important feature, and overall being mentally active is good for mental ability. Open questions include the degree and manner in which cognitive skills transfer, and whether “plasticity-based” programs are better than other training programs.
There are now many companies and products exploiting this complexity, and the fact that this is a relatively new area of research with many open questions, to make specific claims for their products that are not justified by the evidence. One of the worst offenders is a product called Dynamic Neural Retraining (which results in an unfortunate acronym). The website for this product has all the red flags of snake oil. There is a page, for example, for testimonials but none for published research supporting their claims.
They also go way beyond the existing research, claiming that certain disorders (some legitimate, some dubious) are caused by limbic system dysfunction, and their program can change the limbic system through neural plasticity. Not a single link in this chain of claims is scientifically substantiated.
They target vulnerable populations, like those who believe they suffer from multiple chemical sensitivity. This is not a recognized disorder, and so people who believe they have this syndrome are likely responding to popular myths, are likely to be misdiagnosed (meaning they likely have a genuine underlying condition that is being neglected, which may be psychological or physical), and are also likely to respond to a placebo intervention (at least for a time).
Such products also benefit from the non-specific effects of the intervention. Just doing something, anything, to address a chronic problem is likely to make someone feel better. In the case of “brain training” interventions, there are real cognitive benefits to the increased mental activity. The problem is the layer of pseudoscience placed on top of this legitimate but limited intervention. The DNR “system” also employs other interventions, some of which are legitimate therapies, like cognitive behavior therapy. This is what I have called the “part of this complete breakfast” approach – give standard and proven therapy and then add the pseudoscience for marketing purposes.
“Brain training” remains a problematic area. Evidence-based recommendations include basic advice, such as – keep mentally active, keep physically active, and engage in novel activities. Video games and widely available brain training games (cheap or free) are likely as effective as expensive programs with expansive claims. Just do a Google search to see how much is available - here is one example (there, I just saved you $300).
Until there is rigorous research demonstrating specific and significant advantages for a particular “brain training” program, I would not believe the hype.
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