Wired magazine has a good piece on recent attempts to market neuroimaging services to individual consumers, Brain Scans as Mind Readers? Don’t Believe the Hype, by psychiatrist Daniel Carlat. Vaughan at Mind Hacks has a good discussion of the piece, Don’t believe the neurohype (thanks to Vaughan, also, for alerting me to the original piece). The Wired article, in addition to sharing Carlat’s adventures with the pay-per-scan industry, has a nice table of ‘neurologisms’ as well to help out the less-neurohip among us (myself included).
(I was a bit chastened by the line: ‘Add the prefix neuro to a discipline and you get a new field with instant cred. But the science can be less than compelling.’ uhhh… we at Neuroanthropology hope that our readers will judge us by our results; we plan to earn our ‘cred.’)
As Vaughan discusses, some people have a financial interest in over-interpreting brain scans and exaggerating what they can do:
Scientists and responsible clinicians will know about these shortcomings and make sure they don’t oversell their findings, but commercial companies are not selling you the data, they’re selling you a way of make you feel better about your insecurities, whether they be commercial concerns or health worries.
All I would add to this is ‘most‘ scientists know about these shortcoming and don’t paper over them when describing their research (and we’re happy to heap scorn on those who don’t have the proper humility).
Carlat visits a number of places where the claims about neuroimaging are running ahead of the actual capacity of these technologies, chief among them the Amen Institute where he undergoes a Spect scan while resting and while concentrating. He also discusses brain imaging with researchers at the Brain Research Laboratory, in New York University’s medical center, with a UCLA psychiatrist, and with people at Cephos, a company trying to create a neuroimaging ‘lie detector.’ Carlat’s visit to the Amen Institute is far and away the most disturbing.
Carlat undergoes two Spect scans at Amen, and Daniel Amen, who I presume is the driving force at the Amen Institute, starts jumping to all sorts of conclusions; because a scan shows an area of relatively less activity than other parts of the brain, Amen jumps to all sorts of conclusions: have you had a head injury (maybe your brain is broken)? How’s your temper? You have a brain ‘ding’… And the ‘patient,’ in the end, is given a prescription for lifestyle changes, supplements and medication; any bets on whether or not someone affiliated with the brain imagers sells these supplements or medication? As Carlat describes, some of the diagnosis is vague, other parts need no brain imaging data to be made, and some are just completely off the mark. As Carlat writes, Amen wonders if he might have a temper problem because of lower activity in the left temporal lobe, but Carlat’s wife actually finds his ‘calmness’ when she argues with her husband exasperating: ‘Do you even have a pulse?’ she has apparently asked him.
There seems to be a space for real abuse here as well as the promotion of a kind of neuro-hypochondria (because everything’s more compelling with ‘neuro-‘ added). As we know, brains are plastic, and they accomplish cognitive tasks in different ways, so any individual’s brain scan might not coincide with an ‘average’ taken across a test population. So the imager doesn’t really know that there’s any real ‘problem’ associated with an anomaly — even the same brain scans differently doing the same tasks in repetitions without any pathology. And we don’t know what any particular area is necessarily doing in relation to brain phenomenon, even if we have compelling imaging evidence that it is active during that phenomenon.
Perhaps the most sobering observation I found in the Carlat piece is the simple fact that brain scans are not yet diagnostically potent. That is, there is no psychiatric condition that can be diagnosed blindly from the brain imaging, even if there are correlates between certain patterns and conditions such as depression. As Prof. Robert Rubin of UCLA suggests,’ brain scan studies use data:
based on group averages. A typical study will image 10 people with depression and 10 people without depression. On average, you might find that the depressed group has lower frontal activity than the normal group. But there’s a lot of variability, meaning some depressed people have normal scans and some healthy people have abnormal scans.
Although this sort of data is fascinating to those of us who study and theorize about general brain processes, it’s pretty useless to a clinician trying to make a diagnosis (although it may help in some cases of Alzheimer’s and dementia to distinguish between conditions that present with similar symptoms.
Reading Carlat’s account of having his brain scanned at the Amen Institute didn’t help me to feel confident that the technology is being well used; I felt like I was reading an account of a palm-reading. After the patient admits to having depression earlier, ‘ah, yes,… here I see your depression line on your palm alongside your broken love line. Yes, you have a predisposition to depression and mixed luck with women…’ Put in the expression ‘this area of your brain’ and the phrase ‘lighting up,’ and you get pretty close. (Carlat brings up the same analogy, which occurred to me even before I got that far in the article.) Vague pronouncements, statements that could be true of everyone, repeating what the subject has already said, fishing for information, even turning 180 degrees if the patient resists an absolutely incorrect pronouncement — we’re in the territory of palmistry and astrology.
Carlat chalks up the fact that the Amen Institute brain scans might make people happier or help them to adopt healthier lifestyles to a kind of placebo effect. As we know, adding a bit of neuroscience language to even spurious explanations can make them seem more compelling (as we discussed in ‘Neuroscience’ persuasive, even when irrelevant and More on persuasive, irrelevant ‘neuroscience’). A bit of ‘neuro-speak’ might also make a psychiatry session more effective, but that’s more of a statement about our susceptibility than about the legitimacy of the explanations.
One of the most ‘promising’ areas to apply brain imaging technology is lie detection. Researchers are working hard to improve upon the standard polygraph, but it is hardly a huge advance on existing technology. As Carlat reports, in his case, the neural ‘lie detector’ failed to work, although Cephos and other proponents claim successful rates from 70 to 94 percent (I wonder what polygraph operators claim). What I found particularly disheartening was that the test for lying was so structured and contrived, with a 50 percent chance of success automatic (because of two possible courses of action), and multiple versions of the same questions asked over and over again. I can’t really imagine what sort of real-world application such a fragile, narrow assessment tool will have. Besides, I was reminded of my own experience being sent for a polygraph when I applied to work in a men’s wear store selling suits during college; the experience was so off-putting, with a slovenly, shady polygraph operator in an ugly office asking invasive questions just so I could sell suits, that I turned down the job. I didn’t want to associate with any company that thought this particular screening was a good idea.
I think neuro-imaging is a remarkable research tool, but the statistical modes of analyzing the data and the variability between individuals mean that it is going to be hard to use it diagnostically. Since we have a lot of variation in healthy brains (because they don’t all come with a uniform blueprint, nor are they ‘grown’ in the same way), it’s hard to know what your brain looks like healthy to be able to say if something is going wrong. In terms of basic research, those statistical tools and averaging among subjects are useful; in diagnostic terms, they’re fatal to the process.
As Carlat concludes, brain imaging isn’t really ready for widespread marketing as a consumer good:
Most neuromarketers are using these scans as a way of sprinkling glitter over their products, so that customers will be persuaded that the pictures are giving them a deeper understanding of their mind. In fact, imaging technologies are still in their infancy. And while overenthusiastic practitioners may try to leapfrog over the science, real progress, which will take decades, will be made by patient and methodical researchers, not by entrepreneurs looking to make a buck.
Don’t worry, that’s not what we’re doing at Neuroanthropology. We’re not just trying to sell you the same old anthropology with a bit of neuro-sparkle. And I’ll stop adding ‘neuro-‘ to the beginning of words now…