Friday, August 13, 2010

Brain Balance Centers: a critique

They've come to my attention now three times in one week, so I figured the goddesses were sending me a sign. Emily, they were saying, you must give a critical look at Brain Balance Centers and then blog your conclusions.

My first encounter with Brain Balance Centers (BraBaCens for our purposes) occurred as we drove through an affluent Colorado suburb. There it was. "What is that?" I naturally wondered to myself. A nearby billboard advertising their brilliance failed to clear up my confusion much.

My second encounter was right here on this blog when a commenter posted a comment in the guise of, well, commenting, but it really seemed more like a plug for BraBaCens.

The third exposure came to me via an email from a family member. They've just opened up a BraBaCen in our city, it seems. It's a franchise, you see. Having by this time looked into BraBaCens a bit, I expressed my skepticism in somewhat strong language--it was early, I'd just woken up--and then said that I'd bet the house they'd sited said franchise in an affluent part of town. Why, yes, as a matter of fact, in the most affluent part of our town one can find. Kinda close to Thoughtful House, actually. Damn. I really wanted to get out of that house.

So...without further adieu, goddesses of the universe, I hear ya. Here's the critique, in 10 easy steps. (NB: The gods of spacing and formatting have apparently gone on holiday. Sorry.)

Step 1. Let's start with this assertion from BraBaCens (all quotes are from this site, unless otherwise noted):
"We recognize that many childhood disorders are actually manifestations of a single underlying condition."
My critique: Well, the NIH sure as shit is wasting a lot of green on looking for the causes for these "many childhood disorders." Hey, NIH--it's over. You can stop funding now. If only cancer were the same way, then...oh, nevermind.

Step 2. They say: "Called 'functional disconnection'--an imbalance in the connections and function between and within the hemispheres (sides) of your child's brain--this condition is responsible for a host of behavioral, academic, and social difficulties."
My critique: Wouldn't any neurological difference/disorder by definition involve some kind of problem either between hemispheric communication or within the hemispheres? I mean, that pretty much covers the entire brain, so they're on pretty safe ground there. Note that they've come up with their own sciency-sounding name for this massive obviousness: Functional disconnection. Pseudoscience alert!

Step 3. According to BraBaCens, they "work with children who have ADD/ADHD, dyslexia, Tourette's, Asperger's, and autism spectrum disorders" (yes, they list those last two separately).
My critique: One of the cardinal signs of a pseudoscience is the promise to ameliorate unrelated problems with a single, curative method...that is proprietary.

Step 4. They "measure and improve your child's brain and body function on numerous dimensions."
My critique: They are messing with spacetime here, apparently.

Step 5. They say, "To gain a full understanding of your child's difficulties (sic) we first conduct a comprehensive assessment (whattaya think that costs?) of all areas of their brain and body function (because these, it seems, are two different things). Then, by integrating physical and cognitive exercises with dietary change (alert! alert!), we are able to correct the underlying imbalance, improve function, and reduce/eliminate negative behaviors."
My critique: They're basically promising to rewrite developmental and learning differences through exercise and diet. Sigh. Wouldn't it be great if it were just that straightforward? And wouldn't everyone already know about it if it were?

Step 6. I'll let you read their "Science" page for yourself, quoted below. Once again, they provide the most basic umbrella description that would encompass any brain difference and behave as though it were a specific, newly discovered mechanism that now solves all remaining questions regarding their laundry list of disorders and differences:
A properly functioning brain communicates between both hemispheres as well as within each hemisphere at lightning speed. Think of these communications like runners in a relay race: They connect, pass on information, and release, repeating this process millions of times a minute. In a poorly functioning brain, these runners are often out of sync, missing each other or passing on only partial information. This miscommunication is called Functional Disconnection and is at the root of all types of neurobehavioral and learning problems.
My critique: First, this is like saying that the underlying cause of books is words, put together in different ways, and sometimes, it doesn't make sense. Um, duh. Ulysses, anyone? And once again, has anyone let the NIH know that it's all over?

Step 7. They elaborate:
The Brain is Changeable
It was once thought that the brain was static, unable to grow or change. But extensive research and in depth study of epigenetics has shown that it’s remarkably adaptable, able to create new neural pathways in response to stimulus in the environment, a branch of science called neuroplasticity. Additionally, it is now understood the difficulties associated with a wide range of learning disorders and neurobehavioral disorders result primarily from environmental influences that affect genetic expression and are therefore often correctable. Because the brain can change, and because difficulties can be corrected, children suffering from Functional Disconnection can be greatly helped.
My critique: I don't remember how long ago it was "once thought that the brain was static," but the plasticity of the brain has long been recognized, especially young brains, although us aging folk catch a break here and there, too. I like the way they toss in "epigenetics" there, even though that doesn't have a hell of a lot to do with initial recognition of the brain's plasticity. And here's a newsflash: The brain/nervous system creates neural pathways in response to stimulus from the environment. Guess what? That applies even if you're a sea anemone.

Step 8. They say: "It is now understood that the difficulties associated with a wide range of learning disorders and neurobehavioral disorders result primarily from environmental influences that affect genetic expression and therefore are often correctable."
My critique: Aaargh. Any gene expression is under environmental influence. It doesn't just sit there and happen. But what they're really saying here is bad neuroscience. They're saying that these influences are exogenous and that the neuronal alterations they produce can somehow be reversed. That's not good neuroscience. The brain is notoriously recalcitrant to redirection of pathways once they've been laid down (brainworms, aaaagh!). But it helps BraBaCens to assert these things because then, they can offer the right "environment" (for the right amount of money) to "correct " them.

Step 9. They quote a professor of neuroscience from UCSF (or, in their lingo, U.C.S.F.):
“Research has shown that engaging the brain’s plasticity to drive beneficial changes requires exact stimuli delivered in the appropriate sequence with *precise timing*. The training must be intensive, repetitive, and progressively challenging. Individuals must be strongly engaged in the training, paying close attention. It’s all about the mind’s vitality–nurturing it, reclaiming it and giving it strength.”
- Michael Merzenich, Ph.D.
Professor of Neuroscience, U.C.S.F.

My critique: What they don't say is whether or not Dr. Merzenich is saying this about their approach or about the brain's neural plasticity in general. He's an emeritus at UCSF who's done a ton of work in neural plasticity, but what his association--if any--with BraBaCen is remains unclear. Possibly on purpose. I have emailed Dr. Merzenich to clarify whether or not he has an acknowledged association with BraBaCens or if they're co-opting his quote to enhance the scienciness of their Website.

Step 10. In the comment left on my blog, I was specifically invited to review the "The Truth" section of the BraBaCen Website. So, I did. I have my regrets. You can read it for yourself, but please don't stand near any irony meters while doing so.
My critique: They make several claims on this page and then provide a list of scientific publications that, presumably, are intended to support those claims. The list is below. They use this list to support the following claim:
As stated, clinical research indicates that these Neurobehavioral/ Developmental Disorders are related or have in common an underlying functional imbalance or under-connectivity of electrical (brain) activity within and between the right and left sides of the brain. As a result, the brain literally becomes desynchronized or “out of rhythm‟. So, just as an orchestra may be filled with gifted musicians, the music played will sound horrible if the musicians play out of rhythm. It is the same with the brain; it too must function in rhythm or synchronicity.

Yes, that is a enormous steaming pile of bullshit. So, let's look at the reference list.

The first is a book with no page citations. Evidently, the entire book supports the assertions. Interestingly enough, one of the book's authors, R. Mellilo, is the creator of...the Brain Balance(TM!) program. Ahem. He also is an "internationally known chiropractic neurologist." Woo. This "groundbreaking" book came out in 2004 and thus must rely on data preceding that publication year. So...this groundbreaking book by the guy who developed the Brain Balance (TM!) program who's also a chiropractic neurologist has stuff in it that's at least seven years old. Ahem, woo.

Leisman, G & Melillo, R. (2004). Neurobehavioral Disorders of Childhood; An Evolutionary Perspective, 1st Ed., Springer Science + Media,inc., New York.

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The second is just confusing. Clearly, they copied and pasted something from the FDA but didn't do it quite right. But it does bulk things out, doesn't it:

Terry Davis, FDA (just use web citation format as seen below)

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The third is...the DSM IV-TR. Which, I assume, contains information directly counter to what they're asserting on their "Science" page, as it does in fact divide these disorders into discrete categories.

American Psychiatric Association (2000). Quick Reference to the Diagnostic and Statistical Manual of Mental Disorders from DSM-IV-TR®, 4th Ed., Text Revision, Washington, DC, American Psychiatric Association.

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The fourth resides in the dead-link cemetery:

International Dyslexia Association, “IDA Fact Sheet On Dyslexia and Related Language-Based Learning Differences”, 2007. http://www.interdys.org/FactSheet.htm

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The fifth is simply hysterical, in addition to being 14 years old. Click on it. WTF?

Aspergers.com, “What is the epidemiology of Asperger’s Disorder?”, 1996. http://aspergers.com/aspepi.htm

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The sixth is also six-feet under in the dead-link cemetery. But given the title...I'm guessing it probably just discusses Rett Syndrome, which they do not even mention in their laundry list of things they're gonna correct. Of course, that's....clearly genetic, so it doesn't fit with their effort at a rationale, either...

National Dissemination Center for Children with Disabilities, “NICHCY Connections…to Rett syndrome”, April 2004. http://nichcy.org/resources/rett.asp

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The seventh? See "sixth," above.
National Dissemination Center for Children with Disabilities, “NICHCY Connections…to Childhood Disintegrative Disorder”, April 2004. http://nichcy.org/resources/disintegrative.asp

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In other words, of the seven "citations" they provide, only one has anything to do with what they're describing in The Truth, and it's a book written by the guy who developed the program.


My guess is, there's a certain expectation that the list alone is sufficiently convincing without parents having to do all that pesky footwork to check these references out.


Finally, in a tour-de-force of marketing, they promise to be "brain based, not drug based." This is a brilliant appeal to parents who are extremely uncomfortable turning to drug therapies--therapies that have proved to be enormously effective in many cases--for their children. It's gonna bring them in in droves. Them, and their presumably pretty deep pockets (read on).


So, what do we have here? Let's refer to our
pseudoscience checklist, shall we?

1. Is there a clear monetary reward? A quick overview of the ZIP codes in which BraBaCens are established and the offer of the good doctor's books on the site and the fact that the program, according to one report, costs at least $5000, gives this one a big ol' checkmark. It's a franchise, for God's sake. Some parents report having spent even more ...and some parents are not happy with their outcomes. I recommend reading all of the comments at this link.

2. Are there requirements for paying more as you go along? There are many mentions of tweaking and evaluating and ongoing this and that. And then there's that $5000 and growing (see #1, above). To quote one parent: "

There were promises by the director of music cds, books, software programs for post session. In the end, our family is out $5K. When the program completed, we were told, 'we'd love to continue to work with your child-but we will need another $3K to continue.'"

3. Is there a central personality rather than a core science supporting the therapy? Yes. The author of the book that serves as the sole existing cited support for their ideas. They also refer to their program as "proprietary." If you had something that really, truly ameliorated the "negative" behaviors of any one of these disorders, how would you choose to disseminate it?

4. Is there use of sciency-sounding but often nonsensical terms? "Functional disconnection," anyone? I can just hear parents in my neighborhood throwing that one around, nodding sagely. And that blather about how the brain is involved in brain differences...gee golly whiz.

5. Is there a promise to cure a number of unrelated disorders? Yes. While I can buy that there is some overlap among these disorders/differences (that'd be because there is science underlying that), the ideas posited here are shallow and unsupported, and the fact remains that even with overlaps and commonalities, these disorders that they're promising to cure wholesale on the basis of an asserted common mechanism are still distinct. Tourette's is not autism. ADHD is not dyslexia.

6. I'm adding in another one here: Do they rely on testimonial instead of science? Why, yes. Example:

We urge those of you who still have questions to visit our new blog for the Georgia Brain Balance Centers at BrainBalanceGABlog.com and take the time to read the information and decide for yourselves. There are some very powerful parent testimonials...

But no mention of powerful science or data or outcomes.


Conclusion of critique: I'd keep away from these folks and their expensive, proprietary promises.