Tuesday, November 25, 2014

Drug and Alcohol Abuse Among Physicians: How Concerned Should We Be?

By John Banja 

John Banja, PhD is a medical ethicist at Emory University’s Center for Ethics, a professor in the Department of Rehabilitation Medicine, and the editor of AJOB Neuroscience.

In next month’s (December, 2014) issue of the American Journal of Bioethics, I’ll have an article appear on drug and alcohol use among health professionals. My paper is a counter-argument to one that appeared in JAMA in 2013,1 which recommended that physicians who are involved in serious, harm-causing medical errors should be drug and alcohol tested on the spot. Now, I’ve studied the occurrence of medical errors for over a decade, and the more I thought about that proposal, the more I thought it was a bad idea. So I wrote the article, sent it to AJOB, and eventually it was accepted.2

The point of this blog post is to discuss something that stems from what I learned from the literature on drug and alcohol abusing physicians: most of them can go years, even decades, without the drug or alcohol abuse seriously affecting their work life or technical skills. Physicians who abuse alcohol—which is the most commonly abused substance—can go decades without anyone noticing performance deterioration.3 And when I asked an anesthesiologist recently about the second most popularly abused drugs, oxy- or hydrocodone based narcotics, and how long she thought a physician can be on them without anyone noticing, she pursed her lips and quietly said, “years” (although this doesn’t include intravenous injection of narcotics, where the impact on performance will probably become noticeable in months.)3-5

Tuesday, November 18, 2014

Can Neuroscience Validate the Excuse “Not Tonight, Dear, I have a Headache?"

Men and women experience fluctuations in sexual motivation over a lifetime. Whether sexual desire is enhanced or diminished at any particular time can depend on a number of factors and circumstances, but researchers from McGill University recently set out to determine specifically how pain impacts sexual behavior.1 Results from this study, published in The Journal of Neuroscience earlier this year, were the topic of the most recent “Neuroethics and Neuroscience in the News” discussion facilitated by Emory Women’s Gender and Sexuality graduate student Natalie Turrin and Neuroscience graduate student Mallory Bowers.

To study how pain impacts sexual motivation, researchers used a partitioned Plexiglas chamber where the partition contained small, semi-circular openings only large enough for the female mice to pass through (this study required that male mice be greater than 45 g and female mice smaller than 25 g). In this set-up, the females were free to either cross the partition and engage in sexual activity with the male mice or “escape” to the side where the males were unable to follow. Sexual motivation in this study was measured by how many total mounts occurred, and since mounting involves male participation, time spent on the male side of the chamber was also a measure of female sexual motivation. When researchers injected female mice with inflammatory agents in the vulva, hind paw, tail, or cheek to induce pain, female mice consistently participated in less mounting behavior and spent less time on the male side of the cage compared to no injections. Males, on the other hand, when injected with the same inflammatory agents in either the penis, hind paw, tail, or cheek, experienced unimpeded sexual activity (total number of mounts did not decrease compared to controls) in an open field paradigm where the males had unrestricted access to the females. Although it has been observed that female mice can have a higher sensitivity to pain than male mice,2 researchers observed that male and female mice exhibited the same level of sensitivity towards inflammation to the hind leg according to the mouse grimace scale (MGS), a visual observation of a mouse’s facial features to determine pain levels.

The final experiments to study sexual activity involved rescuing the lack of sexual motivation from female mice using either an antinflammatory agent or two different prosexual drugs. The analgesic pregabalin reversed the reduction of total mounts that resulted from inducing pain in females, and according to the MGS, also reduced the level of pain. “Prosexual” drugs, apomorphine (APO) and melanotan-II (MT-II), had the same rescuing effect, but based on the MGS, did not have the ability to relieve pain from the inflammatory injections. It should be noted though that APO increases locomotion3 in mice, which may partially account for the females moving towards the male side of the cage more often.

Tuesday, November 11, 2014

Neural Prosthetics, Behavior Control and Criminal Responsibility

By Walter Glannon, PhD

Walter Glannon is a professor of philosophy at the University of Calgary where he holds the Canada Research Chair in Biomedical Ethics and Ethical Theory. He is also a member of the AJOB Neuroscience editorial board.

Philosophers have argued that moral and criminal responsibility presuppose that actions cannot result from sequences that bypass agents’ control of their mental states as the causes of their actions (A. Mele, Autonomous Agents, 1995). Agents must act from their own mechanisms, which cannot be influenced by drugs, electrical stimulation of the brain, brainwashing or other interventions (J. M. Fischer and M. Ravizza, Responsibility and Control, 1998). Moral and criminal responsibility excludes all forms of brain manipulation.

Via thejuryexpert.com

With deep-brain stimulation (DBS) and brain-computer interfaces (BCIs), neuroscientists can alter the brain and the mental capacities it mediates. The first device modulates dysfunctional neural circuits causing neurological and psychiatric disorders through electrical stimulation of targeted sites in the brain. The second allows people with extensive paralysis to bypass the site of injury and translate intentions into actions by transmitting signals from the motor cortex to a computer. Because these devices and the practitioners who implant and activate them manipulate the brain and mind, the philosophical argument noted above suggests that they undermine the mental control necessary for criminal responsibility. Yet by modulating, bypassing or replacing damaged or dysfunctional regions of the brain, they can restore the mental capacities necessary to form and execute action plans. By enabling rather than disabling these capacities, neural prosthetics allow people to regain enough control of their thought and behavior to act autonomously and be responsible for their actions. Moral and criminal responsibility does not depend on brain function or dysfunction as such but on whether or to what extent the brain enables or impairs the mental capacities necessary for behavior control. In cases of brain injury or disease impairing these capacities, brain implants may restore some of this control. Theoretically, it does not matter whether mental states and events are generated and sustained by a natural or artificial system, provided that agents identify these states and events as their own and is what moves them to action. Artificial devices implanted to regulate thought and behavior are not necessarily alien to the agent but can be considered as a type of expanded embodiment. They can ensure that the agent is the source of her actions. Brain- and mind-altering devices should make us reconsider the meaning of ‘autonomy,’ ‘ownership’ and ‘control’ in discussions of moral and criminal responsibility.

Tuesday, November 4, 2014

Gearing up for the International Neuroethics Society Conference!

November 13 & 14 in Washington, D.C.

There is still time to register for the annual International Neuroethics Society Conference.

The schedule can be found here.

Learn the latest on the United States National Institutes of Health BRAIN Initiative and the European Commission Human Brain Project. Hear about international case studies of neuroscience in the courtroom, discuss human rights in the neuroethics dialogue AND engage in networking opportunities during breakfast, lunch and two receptions.

Speakers include NIH Directors, representatives from Congress, co-director of the Human Brain Project and a representative from the US Presidential Commission for the Study of Bioethical Issues.

Public Event on November 13: "Neuroscience Knowledge & the Robotic Mind."
We kick off our meeting with a thought-provoking public event on November 13 from 5 - 7 p.m.

All-day Annual Meeting on November 14: Speakers include

Check the website for updates www.neuroethicssociety.org 

Both events take place at the award-winning American Association for the Advancement of Science (AAAS) Building, 12th & H Streets, NW. Washington, D.C. Space is limited!

Tuesday, October 28, 2014

What is uniquely human? A report from The Social Brain Conference

Photo credit: Anders Gade
By James Burkett

James Burkett is a 2014 recipient of the Emory Center for Ethics Neuroethics Travel Award. He is a graduate student in Emory's Neuroscience program, conducting research on social attachment and empathy in Dr. Larry Young's lab.

This October 5th thru the 8th I had the pleasure of attending the Federation of European Neuroscience Societies’ (FENS) bi-annual Brain Conference, held in Copenhagen, Denmark. FENS represents the neuroscience societies of 42 different societies in 32 countries, and is the primary organization for neuroscience in Europe. The conference, titled “The Social Brain,” focused on how the brain produces and is affected by social behaviors in humans and in animals. Chaired by eminent scientists Sarah-Jayne Blakemore (Director of the University College London’s Institute of Cognitive Neuroscience), Frans de Waal (world-famous primatologist at Emory University), and Giacomo Rizzolatti (discoverer of mirror neurons at University of Parma, Italy), the conference brought together a wide array of human and animal researchers at the top of their fields. Throughout the conference, this bipolar grouping was frequently brought to the same question: what is it that makes humans different from animals? What is uniquely human? As with a sculpture, this conference seemed to answer this question by chipping away at the monolith of things commonly thought of as unique to the human species.

For a long time, humans were thought to be unique for their tool use [1,2]. However, many surprising examples of tool use have now been seen in animals. Chimpanzees are now known to fashion weapons for use in hunting, as well as using tools for nut cracking and termite retrieval; and will sometimes be seen carrying favorite tools for great distances [1]. Even this behavior is not unique to apes, however: Caledonian crows also craft and use tools for grub retrieval, and even have local tool-making traditions they pass on to the next generation [2]. There are now many internet videos showing crows solving extremely complex tasks with available tools.

Several speakers showed that the human species is not unique in its ability to cooperate and to understand cooperative relationships [1,3,4]. Chimpanzees, for instance, are perfectly capable of learning cooperative tasks without training, and even spontaneously develop individual styles, preferred partners, reputations, and feedback between partners on their choices [1]. They may do this through the use of specialized “mirror neurons,” which are present in motor planning and emotional areas of the brain and fire both when an action or emotion is being experienced, and when it is being observed in others [3,4]. These mirror neurons were first discovered in Rhesus macaques, but have since been found in humans and chimpanzees. Elephants readily learn cooperative tasks as well, even waiting for their partner to arrive when a task is presented that cannot successfully be performed alone [1]. Even more distant from humans was a striking example of inter-species cooperative hunting between groupers and moray eels, where groupers show signs of shared intentionality and referential gesturing in order to get moray eels to help them catch fish [5]. Tiny 5 gram cleaner wrasses, which have more than 2,000 inter-species social interactions a day while cleaning parasites off of other fish, show signs of cooperative strategies, individual recognition, social prestige, audience effects, tactical deception and reconciliation.

Tuesday, October 21, 2014

Burden of proof: does neuroscience have the upper hand?

As an undergraduate, I took several introductory level philosophy classes while majoring in neuroscience. Some of it I could appreciate and most of it went over my head, but a thought that kept nagging me was, “haven’t neuroscientists solved all of these issues by now?” It was only after I had worked in neuroscience laboratories for a few years that I began to realize just how qualified all of our statements had to be due to the plethora of limitations that go along with any result. I began to wince anytime I heard someone use the word “proof” (only salesmen use the term “clinically proven”, but don’t get me started on that…). It seems clear to me now that, for the most part, natural scientists, social scientists and humanities scholars are really all working toward the same goal just in different, albeit complimentary ways. At the first “Neuroscience, ethics and the news” journal club of the semester, Lindsey Grubbs, a PhD student in Emory University’s English Department, facilitated our discussion about a topic that she has previously written about for this site. The main focus was on what role neuroscience can and should play in answering questions that have long been in the realm of the humanities and how these results should be communicated to the general public.

From the Daily Mail Online

Tuesday, October 14, 2014

Ambivalence in the Cognitive Enhancement Debate

By Neil Levy, PhD

Neil Levy is the Deputy Director of the Oxford Centre for Neuroethics, Head of Neuroethics at Florey Neuroscience Institutes, University of Melbourne, and a member of the AJOB Neuroscience Editorial Board. His research examines moral responsibility and free will.

The most hotly debated topic in neuroethics surely concerns the ethics of cognitive enhancement. Is it permissible, or advisable, for human beings already functioning within the normal range to further enhance their capacities? Some people see in the prospect of enhancing ourselves the exciting prospect of becoming more than human; others see it as threatening our humanity so that we become something less than we were.

In an insightful article, Erik Parens (2005) has argued that truthfully we are all on both sides of this debate. We are at once attracted and repulsed by the prospect that we might become something more than we already are. Parens thinks both frameworks are deeply rooted in Western culture and history; perhaps they are universal themes. We are deeply attached to a gratitude framework and to a more Promeathean framework. Hence we find ourselves torn with regard to self-transformation.

When someone feels torn in this kind of way about how they should think about or respond to something, they are ambivalent. Parens thinks that ambivalence is in fact the right response to cognitive enhancement: we ought to recognize that we are torn in both directions and acknowledge and respect this fact. We should not seek to resolve the ambivalence; we ought to embrace it. While I think that Parens highlights something of great importance when he argues that we are torn, I think he is wrong that we ought to attempt to respect both frameworks.

Tuesday, October 7, 2014

Can neuroscience discuss religion?

In a previous post, Kim Lang presented the views of several prominent neuroscientists and neurologists on spirituality and religion. With the knowledge that atheism is prevalent in the scientific community, she wondered how is it that some neuroscientists are nevertheless able to integrate their religious and scientific beliefs. One of the neuroscientists whose standpoint she surveyed was Michael Graziano, a Professor of Neuroscience at the Princeton University Neuroscience Institute. Dr. Graziano believes that current research on the neurological basis of consciousness proves that spirituality is not only a natural tendency of humans, but also that its foundations are visible in the very structure of the brain [1].

Several questions arise from Dr. Graziano’s statement, and I will try to shed some light on each.

To start with, is neurotheology actually studying spirituality, religion, or both? What is the difference between the two? The conceptual separation between the two terms is definitely blurred. In this interview for Big Think, American Buddhist writer and academic Robert Thurman says that spirituality is “love and compassion”, is “going into a deeper area of your mind where you are asserting your free will”, where “you let go of your self-protective and defensive controls, and what you tap into is the nature of the universe, the flow of energy interconnecting things”. In contrast, Thurman believes religion is built upon spirituality, but has taken a secondary role as a tool of social and state organizations. Rituals and rules specific to each religion end up regulating the access to the spiritual, and become, in Thurman’s words, a control rather than a regulating mechanism. Neuroscientist and philosopher Sam Harris, who has recently authored a book called Waking Up: A Guide to Spirituality Without Religion, seems to have similar views on the issue. He explains:

"Although the claim seems to annoy believers and atheists equally, separating religion from spirituality is a perfectly reasonable thing to do. It is to assert two important truths simultaneously: Our world is dangerously riven by religious doctrines that all educated people should condemn, and yet there is more to understanding the human condition than science and secular culture generally admit."

Thursday, October 2, 2014

Neuroethics and the Emory Tibet Science Initiative

I recently interviewed fellow Neuroethics Blog contributors Dr. Julia Haas and Dr. Gillian Hue about courses they taught during the summer at Tibetan Buddhist monasteries in South India as part of the Emory-Tibet Science Initiative (ETSI). Julia (who is a Postdoctoral Research Fellow in the Philosophy-Neuroscience-Psychology Program at Washington University) taught philosophy of science at Drepung Loseling Monastery in Karnataka, and Gillian (who is the senior program coordinator for the Emory University Initiative to Maximize Student Development, program associate in the Emory Neuroethics Program, and the Managing Editor for AJOB Neuroscience) taught neuroscience at the Sera Jey Monastery in Bylakuppe.

A neuroscience class at Sera Jey Monastery (Photo credit: Gillian Hue)

The ETSI (part of the Emory-Tibet Partnership) works to introduce science programs into the education of Tibetan Buddhist monks and nuns. Julia explained that “for the past six years they had a pilot program in the north of India [in Dharamsala], and now it is gradually being rolled out as part of the curriculum for some of the higher monastic degrees.” Such degrees are offered at Drepung Loseling and Sera Jey, which function as monastic universities.

Tuesday, September 23, 2014

Neuroethics in Theory and in Practice: A First-hand Look into the Presidential Commission for the Study of Bioethical Issues

Anyone who turned on CNN this past summer probably remembers the most popular news stories ranging from Obama’s recent efforts to quell political violence in Iraq to Emory University’s admission of two Ebola patients. What was missing from several (if not all of these newscasts), however, was any mention of the continuation of President Obama’s BRAIN initiative right here at Emory University. Specifically, this past June, the Atlanta university welcomed the prestigious Presidential Commission for the Study of Bioethical Issues to confer over many pertinent issues surrounding various ethical and neuroscientific issues. I was lucky enough to be able to attend the session and catch a glimpse of the commission in action. Upon the commission’s completion, I found myself excited while simultaneously confused about the group’s overall mission and decided it would be worthwhile to investigate the Bioethics Commission further. Particularly, I hoped to understand why it is that Obama created a group to investigate several important issues discussed on this blog every week.

From Center for Genetics and Society