Neurofeedback gets political?

While I tend to keep my political views out of my professional work, I find myself tentatively venturing into the muck of some current politics with my clinician’s hat firmly on. A recent series of articles has examined a connection between Betsy DeVos, the (at this moment) nominee for education secretary and a company that provides neurofeedback and biofeedback services. Articles like What the heck is neurofeedback? from a site called Motherboard (update: the article seems to have disappeared) or DeVos-Backed Company Makes Questionable Claims on Autism, ADHD from the Education Week site don’t really bother me too much. And in fact these have been well rebutted by the International Society for Neurofeedback and Research.

However, once the New York Times got into the game I felt obliged to respond. The language of the article (actually all the articles I’ve read) is clearly designed to suggest there is something wrong with DeVos’ relationship with the company Neurocore. I am not here to comment on politics, DeVos’ qualifications, whether her relationship with Neurocore is problematic or whether Neurocore does good work.

Rather, I am here to discuss Neurofeedback. Because the New York Times article seems to be attempting to criticize DeVos’ relationship by delegitimizing neurofeedback as an effective treatment for numerous conditions. I would like to consider several points in the article.

From the beginning, neurofeedback is trivialized:

“The treatment offered by Neurocore, a business in which Ms. DeVos and her husband, Dick, are the chief investors, consists of showing movies to patients and interrupting them when the viewers become distracted, in an effort to retrain their brains.”

No, neurofeedback is not a treatment that consists of showing movies to patients. That’s like saying Adderall is a treatment that consists of ingesting a small object. It may be what a patient does, but it is not what the treatment is.

Describing neurofeedback in such an obviously trite manner sets the reader up to more easily believe it is little more than snake oil. The Times continues by setting up a series of claims that are more-or-less accurate but, to bastardize the Vin Scully quote, are used much like a drunk uses a lamppost: for support of a pre-existing belief, not illumination.

“Neurocore has not published its results in peer-reviewed medical literature.”

Has your health care provider published the results of his or her treatments? No? Does it mean they aren’t good at what they do? Or does it mean that they rely on the existing literature like the vast majority of professionals providing clinical service?

“Social workers, not doctors, perform assessments, and low-paid technicians with little training apply the methods to patients, including children with complex problems.”

This is clearly meant to delegitimize by creating a number of false associations between non-physicians and bad care (I assume by “doctor” the New York Times means physician, but maybe that’s just my issue). Why should a physician assess ADHD, depression, anxiety, or any condition that relies on behavioral observation? In fact, most “medical” assessments are performed by possibly low-paid technicians. Does your doctor draw your blood? Give you an EKG? Run you through the MRI? No. A technician does.

That’s not to say training isn’t important. To become certified in neurofeedback, you need at least:

  • 36 hours of didactic training
  • 25 hours of mentoring/consultation
  • 100 client sessions
  • 10 sessions of personal neurofeedback
  • 10 case conferences
  • a written exam

Furthermore, you need to be a licensed clinician or working under the supervision of a licensed clinician.

The Times then goes on to question the effectiveness of neurofeedback. The article quotes Sandra Loo and Eugene Arnold who argue that there is no solid evidence that neurofeedback is effective or that its effects last. It would help if the authors of the article actually bothered to examine the literature. They would quickly have found a number of studies (especially for attention deficit in children) that show strong effects that far outlast treatment (as another aside, stimulant effects for ADHD do not outlast treatment. Stop taking the meds and the effects fade). References are easily found at the article linked above, ISNR or AAPB, the major professional organizations overseeing biofeedback and neurofeedback.

While quoting numerous detractors, the Times provides supportive evidence only from the already-maligned Neurocore. This serves to further delegitimize both Neurocore and neurofeedback. Why didn’t the Times contact one of the professional organizations or perhaps the BCIA, which certifies individuals in biofeedback?

The article then throws even more weight onto the negative side of things by suggesting there is little oversight for neurofeedback:

“Federal oversight of the field is minimal. “When it comes to treatments like this, there’s no formal body,” said Scott O. Lilienfeld, a professor of psychology at Emory University. “This has been a big problem. We don’t have an F.D.A. for psychotherapies,” he said, referring to the Food and Drug Administration.”

Do I really need to point out that every kind of health care treatment is overseen at the state — not the federal — level? My practice is governed by state law and professional guidelines. There is, in fact, formal professional oversight — that’s why we have organizations like the American Medical Association, the American Psychological Association and professional neurofeedback and biofeedback organizations.

The Times then further builds its story about the poor quality of neurofeedback by connecting it with unrelated treatments:

“Over the past year, the Federal Trade Commission has begun to crack down on some companies promoting the successes of brain training programs for treating a variety of problems.

Last January, Lumos Labs, the creator of Lumosity games, agreed to pay a $2 million fine over advertising claims that said its educational-oriented games could help children perform better in school by targeting specific areas of the brain. A few months later, the F.T.C. imposed sanctions on the developers of the LearningRx “brain training” programs for advertisements that claimed its product could “permanently improve serious health conditions” like A.D.H.D., autism and dementia.”

This is such an apples and oranges argument that I don’t even know where to go with it. Except it’s like saying oranges must be terrible fruit because you can’t make good apple pie out of them.

I can’t comment on Neurocore. I don’t know anything about the company. What I do know about is good health care. I know that I must take some action when a legitimate, evidence-based treatment is inaccurately portrayed in order to make a point about supposed bad behavior. Those of us who work to provide the best possible care for our patients make careful, informed choices about the treatments we offer. We choose treatments that provide real benefits. We train hard in them. We invest time, money and all sorts of resources to get better at them. To give you, our clients, the best we can offer.

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14 comments on “Neurofeedback gets political?
  1. Well written and thoughtful. I do hope you have submitted this to the NY Times letters of the editors.

  2. Thanks for your pertinent observations. At one level, my reactions to the NYT treatment were similar to yours. But at another level, my reaction was that of resignation, that this misrepresentation of neurofeedback is just what is to be expected from the standard critics.

    It occurs to me that this is some ways the experience of the abused in a long-term pathological relationship. The abuse becomes normalized to a degree, and is eventually met with resignation. This may be the moment where we say: No More. Our work has been maligned long enough. We’re not going to take it any more. To that task, you have provided some nice ammunition.

  3. I hope you send this to the NYTimes.

  4. Dear Dr. Rosenthal:

    Thank you for your commentary. I am physician involved with neurofeedback, specifically the Cygnet ILF system. I have seen improvement in patients with developmental delay, migraine headaches, seizure and autism and head injury. I agree that there is good clinical evidence that it is highly effective and quite safe, the sine qua non of FDA approval. We hope to have our web page up soon. 4aMentalEdge.com.

    Sincerely,
    P Terrence Moore, MD

  5. Judith Lytel says:

    A very good response, Saul. Please direct it to the NYT as a corrective to the article.
    Thanks

  6. Stuart Black says:

    Hi Saul, excellent critique & deconstruction of the article. Can I use some of your arguments next time this sort of piece appears ?

  7. I have just enthusiastically endorsed this blog article on my own website.

  8. What a thorough and exquisite rebuttal. Thank you so much.

  9. Saul,

    Thank you for your efforts. I hope this or something like this gets published in the NYT, on the other hand, I would not be surprised that they will not publish it because it would be an admission of poor journalism. While it can get discouraging to see politics take a front row on this, I am a firm believer that progressively, the truth on these issues will be revealed, not by us as researchers and providers, but the growing ground swelling of patients who have benefited from these techniques and serve as living proof of the very evidence to those attempting to discredit its value.

  10. Thank you for your very reasoned response to the NYT article. It would also be nice if our professional groups would get behind this and respond in kind. It is too bad that the evidence we already have has been dismissed and/or trivialized by those who write about this field. Fact checking doesn’t appear to be their strong suit if it doesn’t fit their agenda.

  11. Steve Parent says:

    The NYT doesn’t like her. She likes NFB, so they don’t. Thank you for the thoughtful response.

  12. Thank you so much for your eloquent comments and rebuttal to the crap. It seems to be the season in which we are no longer afforded the luxury to sit on the sidelines quietly.

  13. Soy fonoaudióloga en su país le pueden decir patólogo del lenguaje, practico Neurofeedback desde el 2001 en mi País Colombia, y desde el 2009 tabajo con Cynet infra low de los Othmer, me parece muy eficaz y hago seguimientos a mis pacientes con excelentes resultados en habla, lenguaje en niños, autismo y muy muy eficaz en migrañas tengo en l actualidad tres pacientes con parkinson quienes no solo han mostrado que se freno el deterioro sino que han tenido mejoras en deglución, habla y marcha, doy fe del potencial enorme de Neurofeedback para condiciones difíciles como distonias. Son muchos testimonios a lo largo de esta practica clinica.

  14. Dear Saul Rosenthal,
    Thank you for your excellent letter on this important issue – I do have more information regarding one of your points.
    “I can’t comment on Neurocore. I don’t know anything about the company. What I do know about is good health care. I know that I must take some action when a legitimate, evidence-based treatment is inaccurately portrayed in order to make a point about supposed bad behavior.”
    Thought Technology has supplied ALL Neurocore’s instrumentation for over a Decade. With 43 years of manufacturing Medical Electronics, and sales in 85 Countries, and Distributors in over 50, we have had FDA Oversight in the USA, Canada, China, Korea, Japan, the European Union, etc. Neurocore started using the ProComp2 /BioGraph System, but switched to the ProComp/ Infiniti 5 / BioGraph 6.0 when they added HRV to their training. The are a serious organization, and avail themselves of our technical support to ensure their instrumentation is always up to date. We were also uplifted by their ability to get Blue Cross Coverage for their patients, as we know many providers struggle with this issue. We have not commented on this issue until now, but are heartened by the field standing up for Neurofeedback. When the story initially broke, I contacted a group I call CCG, the “Concerned Clinicians Group” – of all the illustrious Names in EEG, to see if I could mobilize what you have all succeeded in doing. Congratulations!

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