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WE live in an age of self-improvement.
Women can have their breasts enhanced. Men can get a silicon six-pack implanted under the skin of their abdomen. (Be warned: this does not look good on a slightly tubby gentleman. I’ve seen pictures.)
Anybody with enough space on their credit card can acquire disconcertingly white teeth.
But heaven forbid we might actually have to do the hard work required to get a real six-pack.
And why get off the couch or decline the extra fries if you can get rid of a few excess kilos with liposuction?
It’s not just physical improvement we crave.
I’ve written about neuroenhancement before: the various pharmacological and other methods people may employ in an attempt to boost cognitive performance.
Forget reading Anna Karenina or taking an evening class in astronomy. Who has time for that when you can buy better brain power on the internet?
Actually, it may not even cost you very much because, as I discovered last week, it’s easy and cheap to build your own transcranial direct current stimulation (tDCS) device at home.
According to an article in the Journal of Medical Ethics, “the do-it-youself (DIY) community has become galvanised by reports that tDCS can be used as an all-purpose cognitive enhancer”.
Now that’s a whole new use for the backyard shed.
Apparently, all you need is a 9-volt battery, around $50 worth of standard electronic bits and pieces and some basic instructions (and, happily, YouTube is there to help on that front).
It’s hard to know how many people are actually doing this, though there’s a lot of discussion in online forums, with people seeking advice on settings and placement of the electrodes.
I guess you could argue that anybody prepared to deliver an electrical current into their brain using a device they’ve cobbled together from things they picked up at the hardware shop is in need of some degree of cognitive enhancement.
That’s not to say tCDS is without value. According to the Journal of Medical Ethics paper, the technique is being trialled as a treatment for stroke, pain and depression and there is evidence it may enhance cognitive performance in healthy people, including working memory and numerical competence.
In fact, the authors write, tCDS “seems poised to radically change our ability to manipulate brain activity”, much as functional magnetic resonance imaging has revolutionised the measurement of that activity.
Both techniques offer versatility without a high degree of resolution, prompting the Canadian neuroethicist authors to describe them as “the Swiss Army knives of human neuroscience”.
So is taking a Swiss Army knife to your brain a good idea?
Well, clearly not outside a controlled clinical environment.
The paper identifies some of the risks associated with self-administration of what is, in the right hands, a relatively safe technique: incorrect placement of electrodes, possible interactions with psychoactive medication or recreational drugs, and the possibility of unintended effects, including long-term changes to an individual’s neurobiology.
To give just one example: if a left-handed person follows instructions designed for the right-handed majority, they could end up stimulating an entirely different part of the brain from the one they’d targeted.
Ultimately, though, there’s not much anyone can do to protect people from themselves.
It’s not as though we could put 9-volt batteries on the restricted list.
Jane McCredie is a Sydney-based science and medicine writer.
Sandy says “Whatever works for any patient with problems is ok by me” – but is it ethical to use deception? Yet again, the community judges the medical profession to a different standard to other health care ”providers”. In the past, doctors used placebos like saline injections – often to good effect, and safely. It is now condsidered both paternalistic and unethical to do this – if you are a medical practitioner. The CAM providers now provide the placebos with impunity. I don’t think the comments say too much about the author’s motivation or feelings – but much more about the commenters themselves.
Very judgmental article which has come from your own distorted emotions and fears.
I like my “disconcertingly” white teeth thanks and liposuction should only be used when people have failed to lose weight through exercise and diet.
It would be extremely unwise for cognitively healthy people to use tCDS and they should try cardio,healthy diets instead.Though, they are not “stupid”.
However,people with cognitive decline need information how to deliver this safely for themselves at home,or with a doctor,to not cause damage.
You need to offer another solution if you want to criticise.
Patients with cognitive decline due to Dementia,Stroke,Schizophrenia etc often receive no help from doctors,so start thinking about their quality of life and how you can improve it rather then your own feelings.
Deal with your own issues and emotions first,then you’ll be able to help others more effectively because you will think clearer and more objectively.
Whateever works for any patient with problems is ok by me, but I am sorry to see you are getting such a hard time from very forthright correspondents Jane. You were trying to sound caution, I thought, not pontificating.
I’ve had that from family, with whom it is difficult to discuss attitudes at times because we have dissimilar knowledge backgrounds, so I see both sides, especially because some relatively small proportion of doctors are at times arrogant. I do not feel a powerful person and have copped similar flack.
This delightful story goes to the heart of a problem not properly addressed in most discourse on evidence based medicine. Many medical conditions are a heterogeneous collection of differing aetiology. Think chronic pain, or headache. Treatments that may be very effective for a minority of patients, but on average of no benefit to the whole group will never show a positive result in an RCT.
For chronic symptomatic conditions it is the safety of treatments that should be established by rigorous trials, and efficacy can be left to individuals to sort out what works for them.
Dr Ben Ewald
Is there a Journal of Journalism Ethics? I hope there is.
Such expressions of paternalism and contempt for people are unacceptable, whether they be uttered by a journalist or a doctor. Your patronizing tone is of great concern to me. Unfortunately in my experience it is not uncommon for doctors to have such disdainful attitudes. You are probably reflecting common medical opinion , but please don’t think that just because they issue from the ivory tower that they are helpful productive or justified. In addition, there is often a difference between the evidence base behind certain interventions and medical conditions and the standard medical opinion of them. I would suggest you write in a suitably robust and evidence based manner without the ridicule and spin.
In fact,similar devices have been around for some time.
The more scholarly amongst us, Jane, may be interested to look at this book:
http://www.amazon.com/books/dp/1438446144
which details the use of similar devices for the management of alcoholism.
There has also been considerable interest in the use of microcurrent stimulation in the management of fibromyalgia.
There is, however, a problem, or two. The evidence for these approaches is not documented in journals popular with the medical profession,and these treatments are cheap and not patentable.
As far as alcoholism goes, a thorough reading of the link supplied above will demonstrate that there has been FDA approval for such devices in the USA (though none of us hear about them).
In the meantime, what is the pubic to think? Are we to think that the medical profession cares only for treatments that we can control, or for treatments that supply large profits to our collaborators in the pharmaceutical industry?
Other commentators have already pointed out the clearly observable fact that the interventions proposed must, by definition, be of exceedingly low risk, and that the minimal risk involved should be clear even to individuals with a sketchy education in either physics or neuroscience.
Certainly the interventions suggested are far safer than second generation antipsychotics, except that they are not controllable by our profession.
So, do we act as apologists for the power hierarchy within our profession, or simply stop trying to control proposed treatments that at the least are almost certainly harmless?
“I think your protestations are directly reflecting your attitude that physicians are omniscient and should be treated like Gods….” I can not agree more with Calochilus. It’s sad but true whether you physicians accept it or not- this is the community think about you. A patient advocate group-may be a solution?
9 Volt batteries and a few wires even if shorted is unlikely to produce enough current to do any damage, or to produce enough current to get into the brain. Most likely it acts like a TENS on the scalp. If it doesnt produce a burn whats the harm? Anything that gets people off narcotics is great in my view, evidence based or not. We have so many patient on excessive doses of narcotics for “chronic pain” that any means of reducing this is welcome. Unfortunately, unlike the experience of the commentator above, nearly all those I have seen on narcotics for chronic pain have minimal result from “alternative therapies”, including acupuncture/pressure/moxibustion, cupping, herbs and spices and bags of minerals and vitamins. Massage has helped a few back pains, Topamax has been brilliant for migraine, and now lyrica looks excellent for nerve pain, especialy painful diabetic neuropathy and post stroke pain.
Protecting people from themselves is not nearly a difficult as protecting them from the Luddite medical profession. I spent years enduring severe pain before I could even get a referral to a specialist pain clinic. When I did get a referral I waited 15 months to actually get an appointment. When I had my appointment, I spent almost 2 hours with 2 specialist physicians. The result? “We’ll let you know”. That was 3 years ago and I’ve had no further contact.
The crunch came, I was forced to abandon COX2 inhibitors because of adverse reactions, I can’t use NSAIDS, opiates nor aspirin or paracetamol. What choices do I have, Methadone?not on your nellie. Luckily, OTC tDCS devices are available cheaply, with good reliability and simple to use. after only 3 treatments, my pain has been brought under control.
I think your protestations are directly reflecting your attitude that physicians are omniscient and should be treated like Gods, that you are attempting to protect hallowed ground from invasion by the great unwashed. What rubbish. A great many medical practitioners are already rendered nearly obsolete by the unfettered distribution of real information , not just the grossly inadequate peer reviewed drug trials but the whole gamut of biassed rubbish, published in the attempt to feather the nests of the profession.
If you are concerned about tDCS, talk to a few people who have insight and maybe a little experience before you castigate those left by orthodoxy, with no real alternatives .