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Brain Health: The Future of Cognitive Care

A final step toward improv­ing stan­dard med­ical prac­tice will be to bet­ter align finan­cial incen­tives for deliver­ing higher quality care.
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According to Peter Orszag's New York Times OpEd, Mal­prac­tice Method­ol­ogy:

Right now, health care is more evidence-free than you might think. And even where evidence-based clin­i­cal guide­lines exist, research sug­gests that doc­tors fol­low them only about half of the time. One esti­mate sug­gests that it takes 17 years on aver­age to incor­po­rate new research findings into wide­spread prac­tice. As a result, any clin­i­cal guide­lines that exist often have lim­ited impact. How might we encour­age doc­tors to adopt new evi­dence more quickly?

If this is the case with health care over­all, despite much progress over the last 30 to 40 years, imag­ine how worse it may be when we talk about brain health, when neu­ro­science and cog­ni­tive neu­ro­science are rel­a­tively more recent disciplines.

This is a key insight to keep in mind as we debate the value and lim­i­ta­tions of inno­v­a­tive brain health solu­tions, espe­cially those that are noninvasive and have no neg­a­tive side effects: What mat­ters most to human beings liv­ing today is how those tools and solu­tions seem to per­form, based on the best evi­dence, com­pared to alter­na­tives avail­able today -- not com­pared to pla­tonic ideals about research and prac­tice which may exist in our minds but not in the real, empir­i­cal world. Of course we then need to guide research so that we have bet­ter evi­dence in the future, but progress in practice and in research must occur in par­al­lel and rein­force each other.

The OpEd author then pro­ceeds to defend mal­prac­tice reform as the pri­mary way to do so. This may well be so with health­ care as a whole, but when we are talk­ing about brain care I believe his next two pro­pos­als are more directly relevant:

Bet­ter tech­nol­ogy would help, too. Your doctor's com­puter should be able to not only pull up your health records (after you have approved such access) but also quickly sug­gest best-practice meth­ods of treat­ment. The doc­tor should then be able to click through to read the sup­port­ing research. Sub­si­dies in the stim­u­lus act help doc­tors pay for this kind of technology.

A final step toward improv­ing stan­dard med­ical prac­tice will be to bet­ter align finan­cial incen­tives for deliv­er­ing higher quality care. Hos­pi­tals now lose Medicare dol­lars, for exam­ple, if they suc­ceed in reduc­ing read­mis­sions. Med­ical pro­fes­sion­als should be given incen­tives for bet­ter care rather than more care.

A cou­ple of recent inter­views in our expert series elab­o­rate on these points, show­cas­ing how innova­tion is already tak­ing place:

Enabling and accel­er­at­ing such inno­va­tion is of course why we are launch­ing the Sharp­Brains Coun­cil for Brain Fit­ness Inno­va­tion as the first global cross-sector com­mu­nity and plat­form designed to sup­port inno­va­tors com­mit­ted to the cog­ni­tive health and brain fit­ness of their constituents / clients / patients / employ­ees. Want to bet that brain health care in the future will look significantly different than today?

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