Neurofeedback has now existed for more than half a century, and it is flourishing in the clinical arena. Many academic researchers, meanwhile, are still stuck at first base worrying about the placebo as a complete explanation of neurofeedback efficacy–the proposition that neurofeedback is nothing but an expensive placebo. Looking at this collectively, it appears that the the placebo hypothesis is drawing much more interest among some academics than what is actually happening in the clinical realm. To those of us inhabiting the real world of clinical practice, this is such a ludicrous spectacle that it is difficult to take seriously. Researchers tend to orient to the published literature and thus listen only to each other. That misses most of the ferment, vitality, originality, and diversity of the field, which happens to reside almost exclusively in the world at large rather than in the formal environs of the research laboratory. Much of the resulting novelty and diversity has not found its way into the journals for the simple reason that clinicians by and large don’t publish their work. They network with other clinicians at conferences and through the Internet.
Continue reading “Fifty ways to leave your love… of the Placebo Model of Neurofeedback”
There is one field in which an extensive mutually beneficial relationship has existed between amateurs and professionals. It is in astronomy, and the phenomenon was recently taken up in Science Magazine by John Bohannon (Volume 318, 12 October 2007, pp 192-3). Significantly, this symbiosis is occurring in a science in which we have only limited ability to do experiments. Mostly the science is observational. Most of the scientific observations are specifically targeted and hypothesis-based. They are so numerous that time on the big observatories for each project is scarce and therefore precious. But there is another crucial aspect of astronomy that focuses on celestial events that are not predictable either in time or place. This is mostly where the amateurs come in. They represent a world-wide army of knowledgeable observers that is on watch every night around the globe. 
An article in a recent issue of the New England Journal of Medicine finds that anti-depressants don’t contribute significantly to the recovery of bipolar patients. It is estimated that some 70% of bipolars are also being prescribed one or another anti-depressant. Since these are not fast-acting medications, it is often difficult to tell which of the medications being prescribed are actually doing the work.The surprise in the paper, however, was something else. It turns out that the placebo group did better than the medication group! Not only did the addition of anti-depressants fail to improve outcome, but the outcome was actually somewhat worse overall than among those who did not have anti-depressants added to their regimen. The difference was not statistically significant, according to the researchers. Some 23.5% of the treatment arm made “durable recoveries,” whereas some 27.3% of the placebo group did so.