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February 21, 2017

Getting inside the Brain

Reuel S. Amdur

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It is at least in part a question of philosophy and physiology, as well as psychology and medicine. Where is the location of thought, and then of disturbed thought and mood? For Zul Merali, President and CEO of the Royal Institute of Mental Health Research, the answer is the brain.

On November 1, in a presentation at the Royal Ottawa Hospital, Merali held forth on efforts to unlock the secrets of the brain through imaging technology.  Back in March, the hospital obtained a machine that combines the PET and the fMRI.  PET stands for positron emission tomography.  A PET machine can detect changes in blood flow in the brain due to brain activity.  It involves use of a radioactive isotope.  fMRI, functional magnetic imaging, also focuses on blood flow.  The magnet serves to align protons in a part of the brain.  While an MRI requires a subject to remain still, such is not the case with a PET.

Imaging techniques are needed to get at the inner workings of the brain because the brain is not accessible as other organs are.  The researcher can use such techniques to see what is happening, to see what is going on and, in case of dysfunctioning, to learn what is going wrong.  At least that is the hope. 

Merali pointed to the difference in progress being made in physical illness as compared to that in mental illness.  Thus, from 1965 to 1995, great strides were made in treatment of cancer and diabetes.  Suicide rates remained virtually unchanged.  (His argument founders somewhat if we consider developments in psychopharmacology.)  He turned then to a discussion of depression.

A major problem with depression is that it presents contradictory diagnostic indicators: too much sleep or not enough, too great an appetite or too little, for example.  His hope is that imaging technology may be able to give greater precision and open the door for more exact treatments. 

Imaging may be able to help pinpoint what works and what does not, on what area of the brain and with what treatment.  We are not there yet, and after the diagnostic refinement we then come to the need to move the technology from a research function to a treatment one.  He did not mention the extremely high cost of his PET-fMRI machine--$13.5 million.  Not the kind of money that every treatment centre call pull out of petty cash. 

The treatment angle may involve where in the brain stimulation is needed.  Already, psychosurgery is used to insert electrons in brains to produce stimulation to counter depression.  (He noted that this technique is not available at the Royal.)

Is it possible to drive down the cost so that the machine is widely available to make Merali’s dream a reality?

Then there is the broader question.  Is mental illness located in the brain or not?  If not, or if not solely, then there are limits to the prospects for progress through imaging.

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