Friday, December 30, 2011

Ethics and Memory-Altering Drugs

In the last several years new research has come out that may indicate that our memories are not set in stone and may perhaps be erasable. In the article Give memory-altering drugs a chance, author Adam Kolber presents many ethical challenges facing research of memory altering drugs. Kolber writes that society is alarmed by the prospect of altering memories fearing a person’s sense of identity may be lost as well as the ability to lead a true and honorable life. However, this fear and excessive debate over the ethics of memory alteration is, at this point, extreme and could delay key research in therapies for people who are debilitated by their memories. I believe that the current research on memory modification is worth pursing and with proper regulations, like any intense therapy, can meet most ethical challenges.

Thursday, December 29, 2011

The Benefits of Memory-Altering Drugs

Pharmaceutical drugs that dampen memories and/or dissociate memories from physiological reactions have the potential to provide powerful benefits for society. There are widespread wars, natural disasters, and other traumatic events that cause people to suffer from their memories of these events, the most extreme manifestation being PTSD. Post-traumatic stress disorder has been notoriously difficult to treat with therapy alone and the addition of pharmaceutical drugs to the treatment regimen may speed the healing process and make it more complete. Propanolol, for example, has been shown to reduce physiological responses during mental imagery of a traumatic event (Brunet et al. 2007). In PTSD, strong physiological responses tag memories as important and increase the frequency with which the brain recalls the traumatic memory, thereby driving a positive feedback loop, which is difficult to disrupt. A drug like propanolol that decreases physiological responses associated with a traumatic memory may be a promising way to disrupt the positive feedback loop and pave the way towards a faster and more efficient healing process.

Wednesday, December 28, 2011

Memory-Altering Drugs, Do We Really Have the Right?

The debate surrounding the use of memory-altering drugs is an important one – mainly because the social implications and the ethical questions raised are huge and varied, and also because there’s a compelling argument to be made for both sides.

The case for the use of such technology – specifically, memory dampening drugs for the treatment of victims of trauma – is fairly straightforward. A number of individuals who have suffered a traumatic experience go on to develop post-traumatic stress disorder (PTSD), and have to deal with a host of long-term psychological and physiological symptoms that severely affect their day-to-day life. Many of them believe that making that traumatic memory disappear would provide them with much-needed relief, allowing them to live happier lives. If this is truly the case then surely, every effort should be made to restore to these people the quality of life they deserve, unfettered by any emotional scarring caused by a traumatic incident. But of course, we don’t know that it IS true yet, which is where the problems arise. 
 

Tuesday, December 27, 2011

Give Mind-Altering Drugs a Chance

Recent studies in posttraumatic stress disorder (PTSD) research have identified several pharmacological treatments that promise to lessen the emotional pain associated with memories of traumatic events. These recent advances have sparked early debates surrounding the ethics of pharmaceutically “dampening” memories, fears of unwanted memory manipulations, and misconceptions of full-blown memory erasing in the future. In a recent Nature article, Adam Kobler, a Professor of Law at Brooklyn Law School, and the editor of the Neuroethics and Law Blog, argues that these fears surrounding pharmaceutical memory manipulation are “overblown” and instead hinder important research that is needed to help individuals cope with and recover from emotionally distressing memories1.

Monday, December 26, 2011

Ethics of Memory-Altering Drugs

Disturbances in memory represent some of the most frightening aspects of several psychiatric and neurological diseases. It gets right to our sense of self as in many ways our memories shape our view of the world and are critical for our ability to function normally in it. We are often surprised, though, to find just how fallible our memories can be, especially for highly stimulating or traumatic events. Kubie took a particularly cynical view of the matter in a 1959 comment suggesting that humans have trouble telling the truth even when they try.[i]

Sunday, December 25, 2011

Fourth Installment: First Year Neuroscience Students at Emory Write about the Ethics of Memory-Altering Drugs

This year, Emory's First Year Neuroscience Graduate Students were asked to write a blog post for the Neuroethics portion of their Neuroscience and Communications Course.

These posts are delivered in 4 weekly installments, each week featuring a commentary on a different neuroethics piece. This is final installment!

This week, we feature blogs covering the following article:

Neuroethics: Give memory-altering drugs a chance Nature 476, 275–276 (2011)




Want to cite this post?
Rommelfanger, K. (2011). Fourth Installment: First Year Neuroscience Students at Emory Write about the Ethics of Memory-Altering Drugs. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2011/12/fourth-installment-first-year.html

Friday, December 23, 2011

Sham Surgery: All Options Should be on the Table

The issue of whether or not a sham brain surgery is necessary for the research of Parkinson’s disease is complicated. Following several decades, different treatments for Parkinson’s disease have been developed, such as cell implantation, fetal nerve-cell transplantation or gene therapy. There was some common point that the radical or significant effect on the improvements of motor disability or balance control was found during the phase I trial; however, during the phase II trial, the treatment effect did not precede that in the sham-surgery control group. In an ethical point of view, is it ethical to easily and immaturely shift studies failed in the phase II trial without regard to the potential values to patients? Besides, due to the shortage of funding resource, fewer and fewer research groups could afford the expensive sham-surgery which is also too risky to find enough subjects of the control group to compare with the experimental group. Therefore, increasing numbers of scientists started to argue about whether the sham-surgery is really necessary.

Thursday, December 22, 2011

In Support of Sham Surgery

A control group seems to be an undisputed cornerstone to a strong study. So what happens when people say the control group is muddling the conclusions? This is the opinion dividing researchers who develop surgical treatments for Parkinson’s disease. In the last decade, several interventions that appeared promising in Phase I trials failed to have a significant impact in Phase II (sham-controlled) trials and subsequently were abandoned [1,2,3,4]. Many patients who benefited from the early trials say that the sham controls are obscuring the efficacy of the much-needed treatments. Meanwhile, proponents of the sham controls claim that the controls are necessary to demonstrate the efficacy of a treatment, especially in light of the robust placebo effect in the Parkinson’s population. Katsnelson’s article “Why Fake It?: How ‘Sham’ Brain Surgery Could Be Killing Off Valuable Therapies for Parkinson’s Disease,” presents an interesting discussion of this issue [5]. The ethical concerns of the two groups are as follows:

Wednesday, December 21, 2011

Questioning Controls in Sham Surgery

The article Why Fake It? How ‘Sham’ brain surgery could be killing off valuable therapies for Parkinson’s disease brought up differing viewpoints on sham surgery. Proponents of sham surgery claim that they are critical about discovering whether new treatments actually work or if the positive outcomes are based solely on placebo. While opponents of sham surgery argue that the sham surgeries are unnecessary and detrimental to advancing therapies.

Tuesday, December 20, 2011

In Defense of Sham Treatment

There is an ethical dilemma in neurosurgical trials regarding the use of sham surgeries as placebo controls. There have been countless instances of treatments that showed promise during preliminary trials, but failed to move past phase II clinical trials when the treatments proved ineffective compared to sham controls (Freed et al., 2001 & Olanow et al., 2003). The article “Why Fake It? How ‘Sham’ brain surgery could be killing off valuable therapies for Parkinson’s disease” discusses the issues regarding using shams in neurosurgical studies particularly in Parkinson’s disease.

Monday, December 19, 2011

The Ethics of Sham Surgery: Thoughts from a graduate student of neuroscience

I am on my way to become a scientist. In this phase of my life I am finding out how to, as one of our ethics professors puts it, “tease apart the fabric of the universe!” It is an interesting journey! The pursuit of science has taught us much through the millennia: how to build great monuments to the sky, how to heal our sick, what lies beyond the stars, what lies within our minds, etc. Scientists before me have expanded the scope of that which is accomplishable today. More so, they have shifted the views of our selves, of each other, and of the space in which we live. With such an impactful pursuit, it is incumbent upon any who would practice science to perpetually consider the effects of each contribution. Likewise, the public must be mindful of their role in guiding the arm of research—through public opinion, financial support, and the law—and develop thoughtful stances on the topics of the day.

Third Installment: First Year Neuroscience Students at Emory Write about the Neuroethics of Sham Surgeries

This year, Emory's First Year Neuroscience Graduate Students were asked to write a blog post for the Neuroethics portion of their Neuroscience and Communications Course.

These posts will be delivered in 4 weekly installments, each week featuring a commentary on a different neuroethics piece. This is the third of four installments.

This week, we feature blogs covering the following article:

Experimental therapies for Parkinson's disease: Why fake it Nature 476, 142-144 (2011)

http://www.frontiersin.org/integrative_neuroscience/10.3389/fnint.2011.00069/full


Want to cite this post?
Rommelfanger, K. (2011). Third Installment: First Year Neuroscience Students at Emory Write about the Neuroethics of Sham Surgeries. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2011/12/third-installment-first-year.html

Friday, December 16, 2011

Conflicts with Pinker's Assumptions

Congratulations, citizen of the world! You’ll be pleased to know the world you live in has become remarkably less violent in the past 50-100 years AND on top of all that, it’s all thanks to YOU! You, and absolutely every other fellow human being currently living, are amazingly intelligent, exceedingly compassionate, and astonishingly advanced in your use of logic and reasoning. As a result of these impressive improvements beyond the traits of previous generations you’re responsible for making the world a safer, less violent place. Sound too good to be true? I think it’s a bit audacious myself, but according to a recent article and book by author Steven Pinker this is exactly what has been happening over the course of the past century. Pinker argues that contrary to popular notions, incidences of violence world-wide have been shockingly low compared to other periods in world history, and that this decline stems directly from our capacity for reason. As Pinker states, “the most important psychological contributor to the decline of violence over the long term may.. be reason.”1

Thursday, December 15, 2011

Pinker's Wishful Thinking

Steven Pinker’s particular brand of wishful thinking reeks of pandering at best, ivory tower blindness at worst. In citing a few convenient “statistics” (evoking the term liberally), sprinkled with a few self-serving platitudes, Pinker deftly paints a caricature of reality and history that converges to his thesis. To say that Pinker isn’t an entertaining artist would be disingenuous.

Wednesday, December 14, 2011

The Rise of Nonviolence

World War I. The Holocaust. The Partition of India. The Khmer Rouge. Rwanda. Darfur. Each is a twentieth century event in which at least 500,000 people were killed based on their race, ethnicity, ideology, or religion. Now what if someone told you that despite these recent atrocities, our world is becoming increasingly nonviolent? That the incidence of major war, homicide, rape, abuse, and intolerance have all precipitously declined since the Middle Ages, and especially within the past 50 years? You might meet that argument with some skepticism. In his latest book, The Better Angles of Our Nature1, Harvard psychologist Steven Pinker argues exactly that. Pinker illustrates that historical criminology data overwhelmingly indicate the modern world is far less violent than we conventionally realize. According to Pinker, this is a result of our “better angels” of self-control, empathy, morality, and reasoning, triumphing over our “inner demons,” for four reasons: 1) the Leviathan; 2) gentle commerce; 3) the expanding circle; and 4) the escalator of reason.

Tuesday, December 13, 2011

Pinker: A Correlation Between Ability to Reason and Levels of Violence?

Violence, as Pinker suggests in his article “Taming the devil within us,” is something that has percolated through the eons of mankind when one considers what it is to be human. But—what exactly is violence? When one takes a closer look at what it means to be violent, one will encounter varying definitions even within a given culture. For instance, while some people love to hunt and animal research is ubiquitous in scientific research, there are those that abhor such things and find them extremely violent. Moving between cultures exponentially confounds the issue, as in many cultures it is perfectly acceptable and common practice to beat your spouse—something which those of us in the United States would find quite alarming and violent.

Monday, December 12, 2011

Graduate Student Neuroethics Publishing Opportunity!

**Special Graduate Student Issue**
Call for Papers
For the
American Journal of Bioethics Neuroscience
Seeking short (~3000 words) submissions from graduate students in all disciplines on topics in Neuroethics including:
Addiction - agency - animal experimentation - attention - awareness - brain damage - culture - free will -computers - consciousness - decision making - deep brain stimulation - brain manipulation - distributed cognition - dualism - ecology - emotion - enhancement - evolution - explanation - extended mind - feelings- brain imaging - genetics - identity - intentionality - introspection - knowledge - language -l earning - memory - metaphysics - military applications - mind-body interaction - moral belief - moral intuition - moral judgment - moral knowledge - moral responsibility - moral theory construction - neural networks - neuroanatomy - neurobiology - neurophilosophy - perception - personhood - pharmacology - philosophy - reason - psychiatric disorders - psychosurgery - psychotherapy - representation - responsibility - self, theory - truth - unconscious mechanisms
Please submit your manuscripts to
By January 31st, 2012
for the summer 2012 issue of AJOB Neuroscience
All submissions will be peer reviewed

Second Installment: First Year, Neuroscience Students at Emory Write About Neuroethics of the Brain and Violence

This year, Emory's First Year Neuroscience Graduate Students were asked to write a blog post for the Neuroethics portion of their Neuroscience and Communications Course.

These posts will be delivered in 4 weekly installments, each week featuring a commentary on a different neuroethics piece. This is the second of four installments.

This week, we feature blogs covering the following article:

Decline of violence: Taming the devil within us by Steven Pinker Nature 478, 309-311 (2011)

SOURCE: M. EISNER CRIME JUSTICE30, 83–142 (2003)



Want to cite this post?
Rommelfanger, K. (2011). Second Installment: First Year, Neuroscience Students at Emory Write About Neuroethics of the Brain and Violence. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2011/12/second-installment-first-year.html

Flaws in Pinker's Argument

In his article “Taming the devil within us,” Steven Pinker argues that violence in modern society has decreased over time. He states that there are three main factors propelling this change, empathy, morality, and most importantly, reason.

Pinker begins this discussion by proposing “evidence” to support his claim that violence has decreased over time, especially in the recent years after World War II. He provides anecdotal evidence to support his claims, while never exploring actual statistical numbers or experimental evidence. For example, Pinker states that “If you added up all the homicides…the casualties of religious and revolutionary wars, the people executed for victimless crimes…and… genocides…they would surely outnumber the fatalities from amoral predation and conquest.” When considering the potential causes behind a behavioral phenomena, one must agree that the phenomena exists to begin with. I do not necessarily disagree with Pinker in his assumptions, but I do not see any substantial evidence to indicate that violence is actually decreasing in human society.

In order to investigate this theory, a systematic review of the history of violence would need to be conducted. This study would necessitate not only the number of times an act of violence occurred at a particular time in human history, but what precipitated the act (for example what the social pressures/circumstances were) in addition to the severity of pain inflicted. Moreover, Pinker never clarifies exactly what he means by the use of the term “violence”. In the general sense of the term, many incidences of “violence” could be included that have risen in the last 50 years, such as weapons being brought onto school campuses (1). Additionally, Pinker never clarifies whether he is referring to violence in adults, children, or even people with physical or psychiatric disorders. In order to examine why there has been a decline in human violence over the course of our existence, one must have to provide evidence to support that this phenomenon is actually occurring in the first place.

After this proposal, Pinker states that this decline has occurred because people are more actively inhibiting their violent tendencies. This inhibition comes about through the increase of empathy, morality, and also reason. To be honest I don’t even know where to begin when addressing the problems I have with these arguments! I am not saying that they have no validity whatsoever, but again, Pinker does not provide any conclusive evidence to support his ideas.

Pinker puts the most emphasis on the third explanation, reason, so that is where I will focus. Specifically, Pinker posits that reasoning people will abstain from violence in order to maintain their own well being. History has shown that people will also engage in violent behavior in order to maintain their own well being. Societies, including countries, will risk and sacrifice the lives of their soldiers in order to prevent “worse” violence and/or violence in their home countries, a prime example for which is the most recent Iraq war. “Reasoning” people will also partake in violent activities based on other motivating factors, including social pressure. A social experiment conducted in a high school in 1967 turned normal sophmore students into “aggressive zealots” in only about one week’s time (2). This experiment was conducted in order to better illustrate to students why and how German citizens sided with Nazis in the second World War. Another example of social pressure’s effect on “reasoning” people were the Milgram experiments which showed that individuals will inflict pain on others simply because an authority figure told them to do so (3).

Pinker provides a very simplistic approach, which needs to be subjected to much more scrutiny and detail than what is provided in this article in order for his argument to be taken more seriously.

--Jodi Godfrey
Neuroscience Graduate Program


Want to cite this post?
Godfrey, J. (2011). Flaws in Pinker's Argument. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2011/12/flaws-in-pinkers-argument.html


Citations
3.) Behavioral Study of obedience. Milgram, Stanley The Journal of Abnormal and Social Psychology, Vol 67(4), Oct 1963, 371-378. doi: 10.1037/h0040525

Friday, December 9, 2011

Response to “The Making of a Troubled Mind”

Prophylactic medicine is the new medicine. The primary ethical issue brought up by the paper revolves around the notion of diagnostic testing. Everyone wants to try and catch the disease early so that we can come up with treatment options and help them salvage whatever quality of life they have left. The problem arises because these tests are not perfect. They sometimes miss the targets, leading to false negatives. They also sometimes hit targets that aren’t actually targets, leading to false positives. In both cases, there could be catastrophic consequences. It’s usually one or the other though. So when the condition is more dangerous than the treatment, it’s important to minimize the false negatives, such as in the case of cancers. When the treatment is more dangerous than the condition, however, it’s important to minimize the false positives, such as for hypercoagulability. In the case of schizophrenia, it appears that the symptoms of the condition outweigh the commitment and side-effects of treatment.

Thursday, December 8, 2011

“The Making of a Troubled Mind”

David Dobbs describes new developments in schizophrenia research, prodromal schizophrenia, and potential new treatments for the disorder in “The Making of a Troubled Mind”. He cites several recent advancements in researchers’ understanding of the disease and indicates that targeting GABA receptors is a promising pharmacological therapy. Like many psychiatric and medical diseases, schizophrenia presents itself in various subtle ways before it may be clinically recognized and diagnosable. This is because the mechanisms behind the disease—dysfunctional pyramidal and chandelier cell structure and activity, at least in part—are present throughout a person’s life but only start causing significant, noticeable problems in adolescence. Pre-clinical signs of schizophrenia may include paranoia, cognitive impairments, hallucinations or “peculiar” thoughts.

Dobbs mentions a survey to assess a young person’s risk of developing schizophrenia—the Structured Interview for Prodromal Syndrome. It has shown up to an 80% accuracy rate for predicting which young people will go on to have a psychotic episode over the next two-and-a-half years. Diagnosing someone with prodromal schizophrenia could provide the opportunity for them to begin an antipsychotic regimen early, as well as “psychotherapy, cognitive training [and] family therapy”. It seems perfectly benign on the surface, but herein lays the question of ethics: how beneficial is it to administer this survey to adolescents?

Wednesday, December 7, 2011

“Dans le doute, mon cher… abstiens-toi”1?

If science has one defining tenet, it would be the pursuit of knowledge. By pushing boundaries and expanding the horizon of the possible, science itself seems antithetical to the old adage "Where ignorance is bliss, 'tis folly to be wise."2 But the philosophy of truth and the reality of its application are two very different things. As clinicians’ ability to diagnose conditions earlier and earlier improves, a complex ethical issue arises. Where exactly does one draw the line between the bliss of ignorance and the benefits of knowledge? Such a debate hinges on two questions: What are the inherent ramifications of that knowledge, and what benefits does it grant. The first question is the more complex, as it begs at the very ontology of disease, when knowledge is but an echo of future sorrow, whose ears wish for such a burden. Yet by knowing the future, you can prepare. Thus knowledge, in itself, of a future disease or disorder is a double edged blade. It cuts through the wilds of uncertainty, but not without drawing the blood of its wielder. The second question is less metaphysical. As the science of bio-markers improves and genetic screenings become commonplace, disease may become as predictable as the weather. If this prediction permits valuable treatment that could turn the tide of fate, then aren’t all the difficulties of knowing, suddenly so much less damning? Healthcare as we know it could be transformed. People will no longer get disorders, they will get antidotes. When knowledge offers a way out of doom, only the fool would cover his ears.

Tuesday, December 6, 2011

Ethical Implications of Diagnosing High-risk for Schizophrenia

In the last decade, there has been a push to develop and characterize a diagnosis for adolescents at high-risk for schizophrenia, called prodromal risk syndrome.1 The Personal Assessment and Crisis Evaluation (PACE) clinic in Melbourne, Australia, was first to develop a classification of prodromal syndromes.2 The disease of schizophrenia is most typically diagnosed in early adulthood, when most schizophrenics experience their first psychotic break, therefore, early intervention tactics are aimed at adolescents. This is one of the reasons that the PACE clinic is located in a shopping mall.3

On the other side of the globe, the North American Prodrome Longitudinal Study (NAPLS) has been developing and improving methods to reliably diagnose individuals in the prodrome stage. Once identified, they offer these individuals psychotherapy, family therapy, drugs, or cognitive training to hopefully lessen the progression of symptoms. Their method of assessment scores symptoms including family history of psychosis, unusual or fragmented thoughts, school or social troubles, as well as peculiar emotions, behaviors, and thinking, such as; paranoia. After following the individuals for two years, they developed an algorithm that successfully predicts progression to schizophrenia with an accuracy rate of 80%.1 While this is an impressive rate of accuracy, many ethical implications are raised by both the existence of false positives and true positives. 

Monday, December 5, 2011

The Risks of Schizophrenia: Is Early Intervention Always Beneficial?

John Forbes Nash Jr. was a brilliant mathematician at Massachusetts Institute of Technology when in 1959 he began to exhibit extreme paranoia and erratic behavior. Later that year, he would check into a mental hospital where he would be diagnosed with schizophrenia. Although over 50 years have passed since that time, schizophrenia has no cure, no well-defined cause, and no means of prevention.

Sunday, December 4, 2011

First Installment: First Year, Neuroscience Students at Emory Write About the Neuroethics of Schizophrenia and the Prodrome

This year, Emory's First Year Neuroscience Graduate Students were asked to write a blog post for the Neuroethics portion of their Neuroscience and Communications Course.

These posts will be delivered in 4 weekly installments, each week featuring a commentary on a different neuroethics piece.

This week, we feature blogs covering the following article:

Schizophrenia: The making of a troubled mind Nature 468, 154-156 (2010)




Want to cite this post?
Rommelfanger, K. (2011). First Installment: First Year, Neuroscience Students at Emory Write About the Neuroethics of Schizophrenia and the Prodrome. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2011/12/first-year-neuroscience-students-at.html