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!