Why Behavior Change Is (Still) Better Medicine Than Drugs

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While attending the Institute for the Future's Health Horizons Fall Conference on Monday, one thing became eminently clear. The 21st century will be the era of brain, the last great scientific frontier. Due to societal shifts, environmental changes, and the fact that we are just living longer, we are poised to see a sharp rise in cases of diseases such as Alzheimer's, Parkinson's, autism, and post-traumatic stress disorder. The only thing worse than the increasing prevalence of brain disease is the sobering fact that few viable treatments currently exist.

For years, we've heard the mantra of behavior change and health. Exercise more and you'll cut your risk for heart disease and stroke. Eat more fruits and vegetables and you can decrease your risk for colon cancer (or possibly prostate cancer, as discussed in a previous Decision Tree post, "Why Behavior Change is Better Medicine than Drugs"). Could behavior change serve our brain health as well as it did other organs of the body?

On Monday, the neurotechnology community drew a definitive line in the sand with regard to treating the brain.  On one side were panelists that believed that society is not being medicated enough for mental disorders, including ADHD in children. On the other side, proponents of behavioral training argued that brain plasticity, the innate ability of the brain to rewire itself continuously throughout life, is our best bet to combat brain disease.

Consider the use of ADHD drugs in children, or cognitive-enhancing drugs, such as modafinil, by professionals (including a large group of scientists) in the workplace. Proponents of medication say that the cognitive enhancers are not doing anything unnatural. Rather, they are taking someone who's a mediocre performer in terms of concentration, and simply moving them to the upper 90th percentile. Then, according to the same logic, I guess these panelists would also support legalizing steroids in major league baseball. After all, the steroids are not making the athletes super-human. Rather, they're taking the middle-of-the-road performers and nudging them to the upper echelon of the sport. Hmmm....

My former postdoc advisor, Dr. Michael Merzenich of the University of California San Francisco, led the charge for behavioral training as a better alternative to drugs for diseases of the brain. Mike's lifelong work focused on the neuroscience of learning, and how brain plasticity occurs at various stages of development. He believes that many ailments of the brain, including ADHD, occur because we are using our brains "incorrectly", but specific behavioral training can reverse and improve these deficits.

The wonders of behavioral training and brain plasticity are not limited to sparse findings in a dark lab. In fact, Mike's most promising research has been translated into several commercial computer software applications, which have enhanced the reading capabilities of dyslexic children, as well as improved the speech processing and memory of senior citizens.

Whether you are sold on behavioral training as a feasible alternative to drug therapy in brain illness or not, one point remains solid: the cost of conducting clinical trials for behavioral training regiments is a mere fraction of the cost of drug trials. Given that it's terribly expensive to run drug trials, and that only a small fraction of drugs in a pharma company's pipeline succeeds in the clinic, we clearly can't afford to ignore behavioral training as a new way to treat the brain.