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Who Owns Self-Regulation?

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futurehealth.org Headlined to H3 6/19/10

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Some years ago, the Economist Magazine covered the nascent neurotechnologies and came up somewhat alarmed about our potential futures. If people were concerned about such issues as genetically modified foods, stem cell research, genetic screening, etc., they should really be worried about what the future has in store with regard to the alteration of brain function. That future looked really scary for its loosening of the moorings on who we are and who might have the power to shape our individual futures.

Now it is several years later, and the Economist sounds a very different tone in discussing the potential of brain-altering drugs that may enhance memory, concentration, and learning. Our future with "cognition enhancers" seems almost entirely positive. We are having our first relevant experience even now as existing drugs are being used "off-label" by populations that carry no diagnosis. "Provigil and Ritalin really do enhance cognition in healthy people," urges the Economist. Provigil can add about a digit to one's digit span and both Provigil and Ritalin can enhance executive function.

The Journal Nature recently queried its subscribers in an informal survey and found that some 20% of respondents had used Provigil, Ritalin, or beta blockers for "non-medical purposes." (If members of orchestra ensembles were queried, the use of beta blockers would be found much higher than 20%.) New drugs are coming along that are either glutamatergic, cholinergic, or nicotinic and may as an adjunct to their medical role also enhance normal levels of functioning. Surveying this scene, the authors at the Economist pronounce that "(m)ind expansion may soon, therefore, become big business."

In an accompanying editorial, the Economist peers into this future with some relish. "Unapproved drug use is at best worrying".and at worst dangerous and immoral". Such thinking leads to strict controls and even prohibition".Yet strict controls would be both futile and wrong." "Is it 'natural' to prop up the aging body with a nip and a tuck, but to restrict help for the aging mind to brain-training on the Nintendo?"

In just this one sentence, the Economist has embodied a number of assumptions that are relevant to our discussion. It is taken as a given that brain-training on the Nintendo is not something that will ever be subject to regulation. Implicitly it also trivializes such cognitive challenges vis-Ã-vis the "substantive" intervention of real drugs" Would the discovery that brain-training can be as effective as drugs in cognitive enhancement alter their judgment that brain-training ought to be free of regulatory control? Obviously not, because they are making the same case with regard to drugs. Here, more even than in the case of drugs, "strict controls would be both futile and wrong."

Regulation is just not doable when drugs can be purchased over the Internet, and when all the devices necessary for cognitive enhancement and brain-training are available over the counter. We are moving into an age where people are taking responsibility for their own well-being, and that by now includes the domain of most psychopharmacological agents. It will most certainly also include the self-regulation technologies.

This future is not to be feared. Home training has been a mainstay of biofeedback therapy since forever, and the principal complaint in that regard is that compliance with home training regimens tends to be poor. Improvement on that score is only to be welcomed. Who among the clinicians reading this is doing as much neurofeedback on themselves as they should?

The clinician is needed in the early phases of biofeedback or neurofeedback / eeg biofeedback in order to set a course toward self-regulation, initiate the client into the process, and bring progress measures to bear. Success, however, means that the clinician gradually works himself out of a job with respect to most clients. They graduate with the competence now in hand, or else they continue on a home-training basis with as much autonomy as they can manage. We used to send people home with temperature trainers and GSR-2 devices. Now the ads for the EmWave are everywhere, and people can monitor their breath with Resperate. Anybody can use the ROSHI, and most people can benefit from the most basic protocol-based neurofeedback training. The natural owner of self-regulation is the guy who owns the brain. We should present no barriers to the diffusion of knowledge with respect to self-regulation.

It follows that if the training procedures themselves are not so hazardous that they must be kept out of the hands of the public, then the public can similarly consult anyone they wish, and are even at liberty to pay them for the advice. And those who have special competences in this area should be free to market their competences. Ours is not a society that feels the need to preserve everyone from risk. We allow people to drink alcohol, to smoke cigarettes, to ride motorcycles, and to reduce their life expectancy radically with mountain-climbing. The people's liberty should not be lightly encumbered.

 

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www.drothmer.com
Siegfried Othmer has been active in neurofeedback for more than twenty years, through instrumentation development, clinical research, and the conduct of professional training courses.

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