Tuesday, May 24, 2016

Survival Needs and Growth Attenuation Therapy: Do They Signal a Need for a “Dependency Ethics”?

By John Banja, PhD

In 2006, the world learned about a child born with profound and life-long cognitive and physical disabilities who had undergone growth attenuation therapy (GAT) four years previously [1]. Called “Ashley” in media reports, she not only received the GAT—which consisted of administering high doses of estrogen over the span of a few years so as to staunch her physical growth—but she additionally had a hysterectomy, removal of her breast buds and an appendectomy. In response to international outrage that the child suffered these “mutilations” because she was disabled, her parents argued that these interventions would enable them to take better care of her, especially as she aged.

Image courtesy of Pixabay
GAT is back in the news with a New York Times magazine article [2] appearing March 22nd and an empirical study on parental perspectives recently published in the Cambridge Quarterly of Healthcare Ethics [3]. Children who receive GAT have an intellectual capacity that will likely never exceed that of a 1 year old, and they require 24 hour a day care throughout their lives. GAT typically consists in their receiving daily doses of estrogen between ages 3 and 6. The estrogen stimulates the premature closing of the growth plates or cartilaginous structures occurring at the ends of the long bones in their legs and arms, resulting in some reduction in height. About 75 percent of parents who choose GAT for their children do so because they are the child’s primary caregivers, and they justify their treatment decision in light of its facilitating both their and their child’s quality of life [2]. One parent was quoted as saying, “My daughter is trapped in a wheelchair all her life, and she’s more comfortable…We brought her out of her chair and into our laps…She needs to be in our laps for our whole life” [2]. Alternatively, disability rights advocates repudiate GAT as a violation of the child’s bodily inviolability. They insist that these children have an inherent right to grow and thrive into adulthood, and they vigorously condemn GAT as a victimizing and infantilizing intervention [4].

Tuesday, May 17, 2016

Cognitive Enrichment on Cognitive Enhancement at the Michigan Undergraduate Philosophy Conference

By Shweta Sahu

Photo Credit: Anne Trelfa
On February 19, the Michigan Undergraduate Philosophy Conference assembled for the 4th annual meeting at the Insight Institute of Neurosurgery and Neuroscience in Flint, Michigan. The program is jointly hosted by the Center for Cognition and Neuroethics and the University of Michigan-Flint Philosophy Department. I had the pleasure of attending and presenting at this incredible event through the generous support of the American Journal of Bioethics Neuroscience and the Neuroethics Program at Emory. The goals of the Center for Cognition and Neuroethics are to promote “the exploration of conceptual foundations of neuroscience” and to “study the implications of their advances for society in the legal, political, and ethical realms.” The conference, organized by Cody Hatfield-Myers, a senior at the University of Michigan- Flint, brought together students from multiple states in the US and even a few students from Canada.

The event, directed at undergraduate students, aimed to foster the sharing of students’ diverse papers, all linked by the common themes of cognition and neuroethics. Central topics of discussion included: philosophy of mind, cognitive science, neuroscience, philosophy of action and free will, identity, medical ethics and memory, learning, belief, and knowledge. Common questions that seemed to resurface included: What is self-identity? Can you freely alter your own self-identity? Are there aspects of one’s personal identity that it would be wrong to alter, eliminate or hide? If so, why? What is the proper role of medicine—to eliminate illness or to enhance people (physically, morally, psychologically) to make them “better than well”? What are the limits of parental control over the health and well-being of the body and mind of their child (as was the case with my talk)? Do children have the right to determine whether or not they are subjected to medical or psychological treatments? How are health, life and death, medicine, physical and mental illness portrayed in art, music, and in literature?

Tuesday, May 10, 2016

Notes from the field: Critical Juncture at Emory

by Lindsey Grubbs

Early in April, Emory University hosted the third iteration of Critical Juncture. This annual(ish) graduate-student-led conference focuses on intersectionality, examining interconnecting dynamics of systems of oppression including racism, sexism, ableism, and classism. This year’s conference, while maintaining a broader focus on the complexities of identity and oppression, took as its theme “representations of the body”: which bodies are, and perhaps more importantly which are not, represented in science, politics, the arts, and the academy, and what forms do these representations take?

From its beginning, the conference has links to neuroethics at Emory. One of the co-founders of the conference, Jennifer Sarrett, was a past Neuroethics Scholars Program Fellow. This year, I—one-time managing editor of this blog and current intrepid neuroethics blogger—served as one of the co-organizers.

Tuesday, May 3, 2016

Oxytocin: The Hormone of Hype, Hope, and Healing

By Shweta Sahu

Due to his work interrogating the role of certain chemicals in vole behavior at Yerkes National Primate Research Center, Dr. Larry Young has come across the problem of his results being portrayed hyperbolically, as the science sometimes goes to fictional lengths. Yet this work has important implications for mental health. To demonstrate this exaggeration as well as its potential, I am going to address: 1. the buildup of the oxytocin hype, 2. the translation of the research and 3. the ethical implications in humans.

Prairie voles, image courtesy of Flickr user theNerdPatrol
Oxytocin and pair bonding
Dr. Young researches oxytocin (OT), a neuropeptide known to be involved in birthing and associated with maternal bonding, and his lab utilizes voles as an experimental model. Their research was founded upon on the idea that prairie voles are highly social, bi-parental, and monogamous by nature while meadow voles are less social, uniparental, and promiscuous. They investigated differences in oxytocin receptor distribution in the brains of prairie voles and meadow voles and found that in the monogamous prairie voles, there are more oxytocin receptors in the reward system of the brain. Young and colleagues then injected oxytocin antagonists into the nucleus accumbens (NAcc), an area implicated in bonding and reward. They found that prairie voles, whose oxytocin receptors were blocked, would not bond when they mated.

Tuesday, April 26, 2016

Should Presidential Candidates Be Required to Undergo Preclinical Alzheimer’s Disease Testing?

By Kaitlyn B. Lee

Kaitlyn “Kai” Lee is a Project Coordinator in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She helps to investigate the ethical, legal, and social issues of integrating whole genome sequencing into clinical care as part of MedSeq, a project funded by the NIH’s Clinical Sequencing Exploratory Research (CSER) program. Kai earned her BA in Neuroscience from Middlebury College and hopes to continue her education through a joint JD/MPH program.

In her op-ed published in the Houston Chronicle, “Presidential candidates should be tested for Alzheimer’s,” radio and television personality turned author and keynote speaker Dayna Steele advocates testing presidential candidates for Alzheimer’s disease and releasing their results to the voting public. Steele believes voters have a right to know their future president’s Alzheimer’s test results, as she maintains, “I want to know that the candidate I choose not only supports my priorities but is also of sound mind – a mind that will last through four or eight years” (Steele, 2016). Drawing upon her own personal experience with her mother’s Alzheimer’s disease, Steele describes the progression of her mother’s disease from simply forgetting things, to driving while lost, to total mental and physical incapacitation. Steele cites her mother’s rapid 3-year decline to assert that an affected person in a position with as much power as the President would be devastating for the country, arguing that we can avoid such a “catastrophe” by insisting candidates be tested for Alzheimer’s disease and disclose those results to the public.

Tuesday, April 19, 2016

A Review of Gut Feminism

By Katie Givens Kime

Katie Givens Kime is a doctoral student at Emory University in the Graduate Division of Religion, as well as the Center for Mind, Brain and Culture, and the Psychoanalytic Studies Program. Her dissertation investigates the role of religious conceptions in addiction recovery methods.

As neuroscience has expanded in capacity, resources, and public attention, many in the social sciences and humanities have been loudly critical: “Reductionism! Neurobiological chauvinism!” The essence of such critique is that the objectivity championed by the sciences masks all sorts of hidden biases, unconscious agendas, political motivations and economic purposes. Many historians and philosophers of science have argued that even choosing the object of scientific study and communicating observations inevitably involves language, point-of-view, and value prioritization. This means the nature of scientific knowledge, to an important degree, is unavoidably sociocultural [1].

Feminist theory has leaned more heavily upon this critique than other social sciences, for reasons at the roots of feminist movements. Essentialist claims about the “biology” and “nature” of women’s bodies have historically justified all manner of public policy, cultural conventions, and medical care models that violate and oppress women and other historically vulnerable populations, from the right to vote to equal pay. Thus, when it comes to the engagement of neurobiological data of most any sort, feminist theory is a realm of scholarship where deep suspicion has reigned. Projects revealing the sexism, racism, and classism embedded in the structures of supposedly objective scientific inquiry have been crucial for the success of various waves and stages of feminist liberation movements.

Tuesday, April 12, 2016

Neuroethics and the BRAIN Initiative

By Henry T. Greely

Hank Greely is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He specializes in ethical, legal, and social issues arising from advances in the biosciences, particularly from genetics, neuroscience, and human stem cell research. He directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience in Society; chairs the California Advisory Committee on Human Stem Cell Research; and serves on the Neuroscience Forum of the Institute of Medicine, the Advisory Council for the National Institute for General Medical Sciences of NIH, the Committee on Science, Technology, and Law of the National Academy of Sciences, and the NIH Multi-Council Working Group on the BRAIN Initiative. He was elected a fellow of the American Association for the Advancement of Science in 2007. His book, THE END OF SEX AND THE FUTURE OF HUMAN REPRODUCTION, was published in May 2016.

Professor Greely graduated from Stanford in 1974 and from Yale Law School in 1977. He served as a law clerk for Judge John Minor Wisdom on the United States Court of Appeals for the Fifth Circuit and for Justice Potter Stewart of the United States Supreme Court. After working during the Carter Administration in the Departments of Defense and Energy, he entered private practice in Los Angeles in 1981 as a litigator with the law firm of Tuttle & Taylor, Inc. He joined the Stanford faculty in 1985.

On April 2, 2013, President Obama launched the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative®. (Neuroscience has yet to reveal why an initiative about the brain had to have an acronym that spelled BRAIN; * legal issues explain the trademark notation.) Built on the report, BRAIN 2025: A SCIENTIFIC VISION, of a committee created to advise Francis Collins, the NIH Director, and chaired by neuroscientists Cori Bargmann of Rockefeller University and Bill Newsome of Stanford, the Initiative, in spite of political deadlock and budgetary woes, has survived and, in some respects, even thrived.

Tuesday, April 5, 2016

Erasing Memories

By Walter Glannon, PhD

Walter Glannon, PhD, is Professor of Philosophy at the University of Calgary. He is the author of Bioethics and the Brain (Oxford, 2007) and Brain, Body and Mind: Neuroethics with a Human Face (Oxford, 2011) and editor of Free Will and the Brain: Neuroscientific, Philosophical and Legal Perspectives (Cambridge, 2015).

Neuroscientists can measure changes in the brain associated with different types of memory. Recent experiments on rodents have shown that memories can be manipulated. In one experiment, researchers implanted a false fear memory in a mouse brain, causing it to elicit a fear response to a stimulus to which it was not actually exposed [1]. In a different experiment, researchers electrically stimulated place cells in a mouse hippocampus as well as cells in the reward system during sleep. This induced learned behavior where mice linked a specific location to a reward [2].  This type of manipulation may eventually serve a therapeutic purpose in humans.  Psychiatric disorders including subtypes of major depression, generalized anxiety, phobia, panic and especially post-traumatic stress disorder (PTSD) can be conceptualized as disorders of memory content. In such a model, the neural representation of the emotional component of the memory, or emotional trace, of a traumatic experience persists beyond any adaptive purpose. This causes dysregulation in the fear memory system, resulting in pathology associated with impaired cognitive, affective and volitional functions [3, 4]. I’d also like to propose that unlike disorders of memory capacity, such as anterograde or retrograde amnesia, where one cannot form or retain memories, the problem in disorders of memory content, like PTSD, is the inability to get rid of or “extinguish” them. 

Tuesday, March 29, 2016

AlphaGo and Google DeepMind: (Un)Settling the Score between Human and Artificial Intelligence

By Katie L. Strong, PhD 

In a quiet room in a London office building, artificial intelligence history was made last October as reigning European Champion Fan Hui played Go, a strategy-based game he had played countless times before. This particular match was different from the others though – not only was Fan Hui losing, but he was losing against a machine.

The machine was a novel artificial intelligence system named AlphaGo developed by Google DeepMind. DeepMind, which was acquired by Google in 2014 for an alleged $617 million (their largest European acquisition to date), is a company focused on developing machines that are capable of learning new tasks for themselves. DeepMind is more interested in artificial “general” intelligence, or AI machines that are adaptive to the task at hand and can accomplish new goals with little or no preprogramming. DeepMind programs essentially have a kind of short-term working memory that allows them to manipulate and adapt information to make decisions. This is in contrast to AI that may be very adept at a specific job, but cannot translate these skills to a different task without human intervention. For the researchers at DeepMind, the perfect platform to test these types of sophisticated AI: computer and board games. 

Tuesday, March 22, 2016

When it comes to issues of identity and authenticity in DBS, let patients have a voice

By Ryan Purcell

Reconstruction of DBS electrode placement, image courtesy
of Wikipedia
Deep brain stimulation (DBS) is an extraordinarily popular topic in neuroethics. In fact, you could fill a book with all of the articles written on the subject just in AJOB Neuroscience alone (and the editors have considered doing this!). A special issue on the topic in AJOBN can be found here. Among the most widely discussed neuroethical issues in the DBS arena are concerns over the effects on patient identity and authenticity. But perhaps one perspective that has not been fully represented in the academic literature is that of the patients for whom this is actually their last hope to find a way out of a profound, debilitating and often years-long episode of depression. At February’s Neuroethics and Neuroscience in the News journal club, Dr. Helen Mayberg spoke passionately about the approach that led her team to attempt DBS for major depressive disorder (MDD), the ensuing media response, and how that has affected her ongoing work to improve the technique, better understand the etiology of MDD, and allow patients to get back to their lives.