Some years ago the parent of an ADHD child we had trained told us, “I would have given my house for what you have done for my child.” Nowadays such sentiments are more likely to be expressed by parents of autistic children. Not every person who pays for our services feels this way, but clearly a lot of people recognize that the value of neurofeedback bears no relationship to its costs. There’s no way to put a dollar value on the recovery of function in traumatic brain injury, dementia, or psychological trauma, or in the case of developmental delay.
This presents no problem to the economist who sees the price of an item as giving us the best measure of what it is actually worth. But we do have a problem in the economic modeling of health care precisely because perceived value is so out of line with costs. This is true across the board, and most particularly when it comes to life-saving medical interventions, or procedures that extend our useful lives further into the future. There’s almost no limit to what most individuals would wish to have done in order to recover function, and to extend useful life expectancy. What would Howard Hughes, for example, have been willing to do for his obsessive-compulsive condition? (If only he had had neurofeedback!)
Can one put this in terms that an economist can work with? The mother at the beginning of this tale saw the value to her child as equal to the value of her house, which probably constitutes the bulk of her assets. All of our tangible assets taken together probably amount to some five to ten times our annual GNP, give or take a housing and stock market bubble. So even if most people would be willing to pony up only some ten percent of their assets to assure the desired outcome of a critical medical or rehabilitative procedure, the total value still comes to something comparable to our whole GNP. One could go on to construct a wholly different GNP based not on actual prices but rather on perceived value of what the economy actually produces. Let’s call this a virtual GNP, on the basis of which one could envision a virtual economy of the future in which such value judgments would have a greater policy impact. We can see how that might go in the case of health care:
Several disjoint pieces of information have been intruding on my consciousness for some while. At last year’s NBA finals, a courtside seat at Staples Center went for more than $27,000. That was for a single game. At about the same time, I noticed an ad informing readers that the 99cent store also had a bridal registry. These nuggets nicely encapsulate the two economic realms that coexist in our nation, particularly in our cities. The pattern is replicated abroad. In the world at large, there are enough cell phones for two-thirds of the world’s population, while the remaining one-third lives on less than $2 per day. When it comes to meeting basic survival needs, the amounts required are modest indeed, even in our society.
The inauguration of President Barack Obama was another one of those rare events that draws our individual nervous systems into collective patterns of activity all the way across the nation. David Kaiser did his dissertation on this general topic, monitoring a number of EEGs while a movie was being watched to determine the degree to which common and reproducible EEG activity was evoked as emotionally gripping scenes were on-screen. Ever since, I have on occasions like this imagined EEGs moving in a kind of unison across the country as we all watch the same emotionally evocative event at the same time.
Our infra-low frequency training is sending ripples through the field of neurofeedback because it appears to represent such a fundamental departure from prevailing models. It is at such a bifurcation point that a professional community is tested in its assumptions, in its procedures, in its processes for finding accommodation, and indeed in its humanity. Unfortunately, the field of neurofeedback already has a history of fragmentation behind it. Therefore history does not augur for a benign accommodation to our new findings. More than likely we will just be in for continuing Balkanization of our field.
Neurofeedback is reaching the threshold of mainstream acceptance, so we are going through a kind of ‘darkness before dawn’ phenomenon right now where critics are at their most strident. My inclination is increasingly to ignore these criticisms and attend to the business of growing the field, but inevitably the criticisms grate, and they evoke the urge to respond.
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.