The need for collaborative definitions in neurodegenerative disease research

As the population ages, public concern regarding neurodegenerative diseases is rapidly accelerating. Alzheimer’s Disease (AD) is estimated to effect 5.3 million individuals in the United States alone [1], and treatment options for these patients remain limited. The cause of pathogenesis in AD has remained elusive, severely limiting therapeutic developments. 

http://www.sfn.org/index.aspx?pagename=brainBriefings_10_unravelingalzheimers

Alzheimer’s Disease, like many neurodegenerative diseases, is associated with accumulated clumps of protein in the brain, termed “inclusions” or “aggregates”. As a general rule, healthy individuals do not exhibit these inclusions. The protein inclusions associated with Alzheimer brains include amyloid β (Aβ) plaques and tau neurofibrillary tangles; however the extent to which these aggregated proteins contribute to disease, if any, is unknown. Due to the dearth of evidence linking aggregation to disease progression, it has been suggested that aggregates and plaques may actually exist as a protective mechanism to sequester away ‘toxic,’ soluble proteins rather than being toxic themselves [2]. In this theory, soluble protein in the cell somehow acquires a toxic function. In order to minimize interactions with that toxic protein, it is collected and sequestered away within protective ‘aggregates.’ 

Webinar o abeta alzforum shared slides 101311 sl

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However, identifying toxic, soluble precursors of aggregates in the laboratory has proven extraordinarily difficult. Part of the problem stems from a lack of standard methodology between laboratories – there are essentially as many definitions of ‘soluble’ and ‘aggregated’ protein as there are labs investigating protein solubility. This is further complicated by the variety of models used to re-create and identify these proteins (either from actual post-mortem AD patient brains, animal models, or from cells in a dish) and by attempts to identify the subspecies of proteins within these two solubility pools: as singular, individual (monomeric) proteins congregate, separate protein classes identified as oligomers, proto-fibrils, and fibrils are formed from accumulated protein. These protein classes are loosely defined both by their size and biochemical structure. Recent evidence has implicated the amorphously defined oligomers as being the culpable, ‘toxic’ protein species; however, there is no clear consensus on what exactly oligomers are or how to best isolate them in the laboratory. Indeed, this was the focus of a recent Alzheimer’s Research Forum Webinar in which neuroscientists “met” to discuss the issues surrounding a lack of common terminology and protocols in the field of Aβ oligomer research.

Walsh alzforum webinar_oct 13_2011_final

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In order to effectively treat neurodegenerative diseases such as Alzheimer’s, it is imperative to identify the cause of degeneration. Until recently, aggregated protein was generally accepted as the toxic species and thus, therapeutic research focused largely on decreasing aggregation. However, if aggregation is actually a protective, compensatory response to toxic oligomers, then preventing the formation of (or breaking up) aggregates might actually be harmful! Instead, it may be more beneficial to the patient to stimulate aggregate formation, thereby decreasing the presence of noxious oligomers. The amorphous definitions applied to different aggregation states necessarily make it difficult for different labs to investigate this issue and build on each other’s findings. Evidence in the Alzheimer’s and larger neurodegenerative disease fields have increasingly implicated oligomeric protein as being toxic to the cell; however, until a clear consensus on how to isolate this protein in a physiologically relevant manner is reached, it will be difficult to empirically assess what role, if any, oligomers play in cell death within the brain. As scientists, we have an enormous obligation to the patient, and to future generations of researchers, to make our terminology and techniques as uniform and transparent as possible. Replicability, the basis of scientific progress, demands nothing less.




--
Terrell Brotherton

Neuroscience Graduate Student (Glass Laboratory)




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Brotherton, T. (2011). The need for collaborative definitions in neurodegenerative disease research. The Neuroethics Blog. Retrieved on
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Recommended Reading



1. Barnes, D.E. and K. Yaffe, The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol, 2011. 10(9): p. 819-28.


2. McLean, C.A., et al., Soluble pool of Abeta amyloid as a determinant of severity of neurodegeneration in Alzheimer's disease. Annals of Neurology, 1999. 46(6): p. 860-6.

Neuroethics journal club: Right-brained, wrongly reasoned

Who’d believe there’s a liberal professor (he freely acknowledges he belongs to this group) that’s willing to admit that conservatives might be right about something? Don't get too excited; he also thinks the reasoning that many conservatives use to decide what’s right is all wrong. What’s more, he thinks that neuroscience proves the way that many conservatives reason is wrong. The professor, Dr. John Banja, led a discussion of one of his articles last Wednesday at the second meeting of the Neuroethics Journal Club hosted by the Neuroethics Program at the Emory Center for Ethics.



I had this great idea to summarize Dr. Banja's message with music videos. It turned out to be harder than I thought (but I'm still peppering this post with pop)--there is not one song that has the words "virtue essentialism" in the title, although those words are in the title of Dr. Banja’s article: “Virtue Essentialism, Prototypes, and the Moral Conservative Opposition to Enhancement Technologies: A Neuroethical Critique”. Banja describes virtue essentialism as a type of argument often employed by scholars like Leon Kass, Gilbert Meilander, and Michael Sandel. According to Banja, there are three characteristics of “virtue essentialist” arguments: (1) they invoke concepts like “dignity” as if those concepts have an essence--i.e., definition--that everyone agrees upon, (2) they adopt absolutist positions, because their positions supposedly are based on clearly-defined concepts and, (3) they attack anything that smacks of moral relativism.



You might wonder why you should be worried about this virtue essentialism that Dr. Banja describes. Consider this: virtue essentialist arguments make up the backbone of many of the publications authored by President George W. Bush's President's Council on Bioethics (PCB). W announced he was creating the PCB back in 2001, during the same speech in which he announced he would only allow embryonic stem cell research to be carried out on cell lines already in existence. Bush promised that the council would "consider all of the medical and ethical ramifications of biomedical innovation," and appointed Leon Kass to be the head of the council.



You might still be wondering why this is relevant in today’s political atmosphere. We talked about that at the journal club, too. First I’ll explain how we got there. Banja is not alone in his concern about the arguments made by Kass and others. Ruth Macklin, writing in 2006, dissected just the sort of reasoning--or lack thereof--that Banja wants to attack, all neuroethics style. According to Macklin, issues in bioethics were not black nor white before these self-styled "conservatives" came along; she explicitly links their appearance to the polarized political climate of the Bush regime during which you were either one of us or one of them. Macklin also observes that Kass and others who call themselves "conservatives" in bioethics are characterized largely by being against anything "artificial: artifical reproduction, artificial life extension, artificial intelligence and artificial life, and, in general, making ourselves 'artificially better'."



Didn't I promise there would be rock? Here's David Byrne on "making ourselves 'artifically better'":

Byrne continues the tradition of rockers confounding us all by writing from a perspective that seems a little--gulp--conservative (cf., Graham Parker's You Can't Be Too Strong.)



What's wrong with virtue essentialism and why do we need neuroscience to figure it out? Banja began by discussing "essentialism," which as you might guess is the view that everything has an essence. There is something about Lady Gaga that is essentially Lady Gaga. You might say she was "born this way" (bad joke, sorry). Essentialism, explained Dr. Banja, has been around at least since the time of Plato, who captured it essence (again, sorry) in the Socratic dialogue with Euthyphro, in which Socrates asks what the essence of “holiness” or “piety” is. Socrates runs into Euthyphro down at the courthouse and, thinking that it might help him defend himself in his upcoming court case, asks Euthyphro for a definition of “piety”. As Dr. Banja emphasized, the best Euthyphro can do is come up with some examples. He fails to define it in a way that Socrates can’t deconstruct. Here’s the moral of the story: if it were true that concepts like "holy" had some essence, then we could somehow discern that essence and know when our actions were holy (or "fair" or "just", etc.).



Then Wittgenstein came along and dared to suggest that we might not classify things based on their essence that our god-given reason is supposed to somehow have access to. Instead, he suggested we categorize things based on "family resemblances"--things that they have in common. Wittgenstein's insights spelled the beginning of the end for essentialism. He was implying that there might not be any source of morals outside of humanity. Maybe there's no right or wrong outside of what we say is right or wrong.



Song time again! Perhaps Stereolab can use their perfect pop powers to help us understand the source of the morals that form the backbone of a society.



The once-firm moral foundation that Wittgenstein started to undermine really crumbled once neuroscience and psychology came into the picture, said Dr. Banja. In the 70s, psychologists like Eleanor Rosch began to test how people categorize. These experiments gave rise to prototype theory, a theory that holds that we are able to classify things not because our reason has access to their essence, but because our brains build prototypes. Such prototypes are the “statistical central tendency of a body of concrete exemplars,” to recycle Dr. Banja’s quote from philosopher Andy Clark. In other words, we supposedly classify things by keeping a running average for every category and by measuring the distance of any item we are classifying from the average. I would show you an image from a study Dr. Banja described so that we could understand prototype theory, but in the spirit of this semi-musical post, I think I have to link to songs that neuroscience grad student Laura Mariani mentioned at the journal club. This music, composed by Komar & Molamid and David Soldier, is based on the results of an on-line survey. Click on the links to hear the “prototypes” of what people consider to be the "most wanted song" and "most unwanted song".



Prototype theory, concluded Dr.Banja, presents some problems for virtue essentialist arguments as defined above. It holds that there can be no completely objective definition of concepts like "dignity". Hence, anyone who argues against something like cognitive enhancement because they feel it degrades dignity will have to accept that their idea of what dignity means might not be agreed upon by everyone. This is a good result. It replaces the moral majority with a democratic process of ethics.


In closing, we discussed why virtue essentialism seems to work, even if it is flawed. Dr. Banja recalled the points he made at the end of his article: it works because it appeals to people. It plays their heartstrings. The excesses of the Bush administration showed that Republicans had learned how to hit the right notes to get all the votes, according to Dr. Banja. My labmate Lukas Hoffman countered that you could say the same thing about the Democrats. With the Tea Party on one hand and Occupy Wall Street on the other, it’s certain that people are feeling like something is wrong more and more, and believing that they know what that is. How can they be reminded that everything might not be what it seems? Education is key, offered MD/PhD student Orion Kiefer. And he's right. Anyone who has a sound grasp of science will understand that theories can sometimes be overturned, even theories about right and wrong, and that there’s always room for debate.



Next month's meeting of the journal club will take place November 16th from 1-2pm. You can RSVP by sending an e-mail to neuroethics@emory.edu. Dr. Paul Root Wolpe, director of Emory's Center for Ethics, will facilitate a discussion on emerging technologies and lie detection.



-- David Nicholson

Neuroscience Graduate Student (Sober Lab)



I leave you with one last tune to inculcate you against the siren song of anybody that would make appeals to your gut feelings about what’s right and what’s wrong.





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Nicholson, D. (2011). Neuroethics journal club: Right-brained, wrongly reasoned. The Neuroethics Blog. Retrieved on
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Neuroethics Recommended Awesome Reading (RAWR)!: Neuroethics, Gender and the Response to Difference

The Neuroethics Blog first installment of RAWR (Recommended AWesome Reading) features an article by Emory's own Dr. Deboleena Roy.

Deboleena Roy

Dr. Deboleena Roy is an Associate Professor of Women's Studies and Neuroscience & Behavioral Biology. Dr. Roy's academic interests and background are exquisitely interdisciplinary. Trained as a neuroendocrinologist and molecular biologist, Dr. Roy uses her perspective as a neuroscientist to explore dimensions of feminist theory and feminist ethics.



Her recent article published in the journal Neuroethics is titled, "Neuroethics, Gender and the Response to Difference." In this article, Dr. Roy invites readers to examine how neuroscience data, particularly data emerging from studies utilizing brain imaging, are informing larger conversations about sex and/or gender differences. Science often benefits from having the luxury of moral authority, but Dr. Roy's article reminds us that neuroscience and scientific research have often been fraught with a lack of thoroughly considered experimental design and this has lent itself to harmful and misleading interpretations. In her article, she highlights how even recently published neuroscience data suffer from lacking a more broadly conceived approach. The result of these being that experiments are often inherently constructed with assumptions that reinforce social stereotypes and interpreted in ways that can promote damaging societal power differentials with regard to race and gender.



A primary example of such work can be seen here in the popular media, and can be viewed in accompanying embedded video on that page. And also seen in the figure below, from a study published in Science last year describing how men are essentially "turned off" by a woman's tears. Note the reinforcement of gender roles and general assumptions in the study design of distinct heterosexual identities (i.e., gender binaries).

Gelstein et al., 2011 Science Vol. 331 no. 6014 pp. 226-230

The abstract to Dr. Roy's article is below. To read more, the article can be found here.



This paper examines how the new field of neuroethics is responding to the old problem of  difference, particularly to those ideas of biological difference emerging from neuroimaging research that purports to further delineate our understanding of sex and/or gender differences in the brain. As the field develops, it is important to ask what is new about neuroethics compared to bioethics in this regard, and whether the concept of difference is being problematized within broader contexts of power and representation. As a feminist science studies scholar trained in the neurosciences, it seems logical to me that, as a growing field, neuroethics should reach out to the rich bodies of scholarship on the history of medicine, feminist theory and feminist bioethics while attempting to approach discussions of sex, gender and sexuality differences in the brain. What is also clear to me is that feminist scholars need to learn how to engage with neuroimaging studies on sex, gender and sexuality not just to critique, but also to productively contribute to neuroscientific research. The field of neuroethics can potentially provide the appropriate forum for this interdisciplinary engagement and create opportunities for shared perplexity. I suggest three possible points of departure for creating this shared perplexity, namely (i) is difference being measured in the study for the purpose of understanding difference in and of itself, or for the purpose of division?; (ii) is there an appreciation for biological complexity?; and (iii) is it assumed that structural differences can be conveniently translated into functional differences? 



Stay tuned for our next installment of Neuroethics RAWR! showcasing local Neuroethics Scholarship.





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Rommelfanger, K. (2011). Neuroethics Recommended Awesome Reading (RAWR)!: Neuroethics, Gender and the Response to Difference. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2011/10/neuroethics-recommended-awesome-reading.html

The Prodrome: The Evaluation of Risk for Schizophrenia

How has research on schizophrenia recently changed?

In the past twenty years, schizophrenia research has turned its attention to the symptomatic period preceding a transition to the first episode of psychosis¹. In an attempt to prevent or at least dampen the cognitive, social, and psychological deterioration associated with the development of schizophrenia, research has identified a host of symptoms now described as “prodromal symptoms” to schizophrenia². The prodrome is the period of subclinical symptoms that develop prior to the onset of an illness, such as visual aura leading up to the onset of a migraine. With schizophrenia, these symptoms have a diverse range of manifestations from depression to grandiosity (an unrealistic sense of superiority), have no definite linear progression, and can only be retrospectively identified as prodromal schizophrenia once a transition has occurred. Until the patient develops full onset schizophrenia, symptoms can only be accurately described as putatively prodromal³. 

"Kaleidoscope Cats": Paintings of cats by artist Louis Wain reflecting the development of his schizophrenia over a period of time. Images from the Bethlem Royal Hospital Archive and Schizophrenia.org

Can clinicians predict a future onset of schizophrenia?

Putatively prodromal symptoms of schizophrenia are disturbing experiential changes that create a great deal of distress. Research on the schizophrenia prodrome aims to provide relief and care for symptomatic individuals and to identify high risk for a transition to psychosis⁴. By refining diagnostic criteria, researcher hope to quantify risk in order to predict a possibility of conversion; however, a diagnosis of prodromal schizophrenia is never possible, as the development of schizophrenia is not caused by any concrete factors. The manifestation of putatively prodromal symptoms is in no way an indication of an inevitable conversion to psychosis⁵.

What is the potential benefit or harm in evaluating risk for schizophrenia?

Due to the harmful psychological effect of putatively prodromal symptoms and the potential of delaying or preventing a transition to psychosis, research will continue to explore the possibilities of identifying and treating prepsychotic symptoms. However, clinicians must proceed with extreme caution as “diagnosing” a patient with prodromal schizophrenia, or even associating the symptoms with schizophrenia or psychosis, could exacerbate distress. For example, the stigma of schizophrenia could be detrimental to the putatively prodromal patient. I posit that a connection of current symptoms to schizophrenia, a psychotic illness with visual and auditory hallucinations, could damage the patient’s sense of reality. This association could provoke the already fragile patient, exacerbating symptoms and encouraging a progression towards psychosis. With this being said, the upcoming Diagnostic and Statistical Manual of Mental Disorder, DSM-V, will likely include criteria for “Attenuated Psychosis Syndrome” in order to facilitate patients’ access to medical coverage from insurance providers^6,7.

What about preventative treatment?

As for possible treatment for subthreshold symptoms, a viable pharmaceutical approach has yet to be thoroughly researched. Therapeutic treatment remains expensive and often difficult to acquire due to the complexity of insurance stipulations. Atypical antipsychotics are being tested and clinically prescribed for putatively prodromal symptoms, though their use for full onset schizophrenia is still relatively new⁸. Some studies suggest that the discontinuation of antipsychotic medications can encourage a transition to full onset psychosis⁹.

What are some ethical implications of risk evaluation and preventative care?

The early detection of psychosis presents a host of neuroethical dilemmas. How do you identify a risk of psychosis and does that identification consequently turn risk into a disorder? Is the prepsychotic period the last possible chance for patient consent and autonomy? Schizophrenia typically develops in late adolescence or early adulthood¹⁰. Does the approach to a risk of psychosis change if the patient is a minor or in the midst of a major life transition, such as entering college? Antipsychotics can have destructive effect but might be the key in preventing the development of schizophrenia. When is the right time to start medication, if the progression to psychosis is gradual and indeterminate? What therapeutic approaches should be the first line of treatment and how might this affect the patient’s progression? Finally, how should individual clinicians respond until there is a directive for symptom assessment and treatment, and how might this future directive in turn affect the medical industry and society as a whole?




--Sabrina Bernstein

Neuroethics Program Intern






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Bernstein, S. (2011). The Prodrome: The Evaluation of Risk for Schizophrenia. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2011/10/evaluation-of-risk-for-schizophrenia.html

Sources and Additional Reading

¹ Haroun, N., Dunn, L., Haroun, A., & Cadenhead, K. S. (2006). Risk and protection in prodromal schizophrenia: ethical implications for clinical practice and future research. Schizophr Bull, 32(1), 166-178.

² Bota, R. G., Sagduyu, K., Filin, E. E., Bota, D. A., & Munro, S. (2008). Toward a better identification and treatment of schizophrenia prodrome. Bulletin of the Menninger Clinic, 72(3), 210-227.

³ Häfner, H., & Mauer, K. (2006). Early detection of schizophrenia: current evidence and future perspectives. World Psychiatry, 5(3), 130-138.

⁴ Corcoran, C., Malaspina, D., & Hercher, L. (2005). Prodromal interventions for schizophrenia vulnerability: the risks of being "at risk". Schizophrenia Research, 73(2-3), 173-184.

^5,8 McGlashan, T. H., Addington, J., Cannon, T., Heinimaa, M., McGorry, P., O'Brien, M., et al. (2007). Recruitment and Treatment Practices for Help-Seeking “Prodromal” Patients. Schizophrenia Bulletin, 33(3), 715-726.

⁶ Addington J, Cadenhead KS, Cannon TD, Cornblatt B, McGlashan TH, Perkins DO, Seidman LJ, Tsuang M, Walker EF, Woods SW, Heinssen R; “The NAPLS group”. (2007). North American Prodrome Longitudinal Study: A Collaborative Multisite Approach to Prodromal Schizophrenia Research. Schizophrenia Bulletin. 33(3): 665-672.

⁷ American Psychiatric Association (2010). Attenuated Psychosis Syndrome. APA DSM-5 Proposed Revisions.

^{9, 10} Larson, M. K., Walker, E. F., & Compton, M. T. (2010). Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Review of Neurotherapeutics, 10(8), 1347-1359.

Oxytocin: Liquid Trust and Artificial Love

The website for the company Vero Labs sells a product called Liquid Trust. It is a hormone-based spray that, when applied like a cologne, is supposed to help win the trust of those around you. According to the website, the spray contains “pure human Oxytocin”, a hormone and neuropeptide that is involved in emotions such as trust, social bonding, and even love. The idea of a commercially available product that can secretly control the behavior of those nearby seems too far-fetched to be possible, and, in fact, it is. But surprisingly, the problem with Liquid Trust is not the ingredients but the dosing. In a 2005 Boston Globe Article neuroeconomist Paul Zak explained that the amount of oxytocin that would be inhaled by standing next to someone wearing Liquid Trust is not enough to have any behavioral effect and called the product “totally bogus”.

A bottle of Liquid Trust

So then, what can oxytocin do if taken in a high enough dose? Zak coauthored a study in the journal Nature that demonstrated the hormone’s trust-increasing effects. In an investment game, participants were more likely to give over money if they had inhaled an oxytocin nasal spray. Oxytocin also helps form emotional bonds in relationships between romantic partners and parents and their children.

An oxytocin molecule (Wikipedia)

Some researchers hope that oxytocin can be used to treat people with conditions such as social anxiety and autism who have trouble feeling comfortable and connected in social situations. But there is also the possibility that it could be abused. The Boston Globe and National Geographic articles mention the possibilities of oxytocin being used at political rallies (to gain the trust of the audience), by businesses (to make customers feel more comfortable spending money), or even as a date-rape drug. Increasing oxytocin levels could also have undesired side effects. For example, doses of oxytocin have been shown to increase ethnocentrism and xenophobia since the hormone seems to primarily increase trust towards those in a person’s “in-group”. While this research seems to suggest that a dose of oxytocin can instantly lead to feelings of trust, comfort, connection, and even love, it is not exactly that simple. Research conducted by Larry Young at Emory University showed that oxytocin and vasopressin (another hormone) can explain the differences in the mating behaviors of the monogamous, pair-bonding prairie voles and the promiscuous meadow voles.

Prairie voles (New York Times)

When the prairie voles mate, oxytocin and vasopressin are released in their brains, leading to lifelong bonding. Giving injections of these hormones to prairie voles that have not mated can still cause them to bond. But giving these hormones to the meadow voles does not affect their behavior since they also lack oxytocin and vasopressin receptors in the regions of the brain involved in reward processing. Genetic differences in the expression of the receptors also mean that even among prairie vole males, some are more likely to be monogamous than others. And there is evidence for the existence of similar genetic differences among humans, meaning that oxytocin will not affect everyone the same way. Still, this research has led to talk of using hormone (and even genetic) therapies to help people stay faithful to their partners and to keep marriages stable. And also to do the exact opposite: creating an “anti-love drug” to prevent people from becoming over-invested in their relationships. These methods of artificially regulating love bring up additional questions about the ethics of using medical technology to change “normal” behaviors and to chemically alter our emotions. While “love drugs” might, at first, seem like a form of mind control, how is taking medication to treat infidelity or infatuation different from taking them to treat depression or ADHD? And how would using oxytocin be different than attending therapy to resolve the same issues? Some of the reluctance towards the medication route might have to do with the negative connotations of psychiatric drugs, but there are deeper issues involved about freewill, our ability to choose, our sense of self, and our position in society. These questions are currently being asked about existing treatments, and as neuroscience and neurotechnology continue to advance, more such issues will arise.



--Jonah Queen


Neuroethics Program Intern





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Queen, J. (2011). Oxytocin: Liquid Trust and Artificial Love. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2011/10/oxytocin-liquid-trust-and-artificial.html

Neuro-rehabilitation: A vision for a new justice system

In the wake of Troy Davis’ execution, we’re reminded to revisit conversations about the efficacy of our current legal system and notions of justice. Often the arguments for or against capital punishment are weighted with broader moral conversations and convictions than conversations about more specific aspects of our legal system and mechanisms of social justice.

Others, like Will Campbell, say it more plainly, “Capital punishment. I just think it’s tacky.”

When we ask ourselves, “Do you believe in capital punishment?” Two simple answers might come to mind:

1. "No, killing people is wrong." and/or
   
   


2. "I believe in 'an eye for an eye'": a (mis)interpretation of the Abrahamic Tradition by individuals who want to justify vengeance.

Neither of these responses properly frames the real issues with capital punishment. Capital punishment is part of an antiquated and broken system that is heavily laden with issues of race, social resources and political strategy. These important issues were addressed at the recent Center for Ethics Panel discussion on Troy Davis that was reviewed here.

Some argue that capital punishment is the only way to hold truly depraved individuals accountable for the crimes they have committed. But our current justice system and its use of capital punishment, or even imprisonment, is not necessarily strictly retributive (punishment for what social crime was committed), but prospective (prevention for what social crime might ensue).

Capital punishment does not seem effective when we consider the fact that states with capital punishment do not have lower violent crime rates. In addition, the U.S. imprisons more individuals per population than any other developed country; imprisoning one-quarter of the world's prisoners. Not to mention, abysmal recidivism rates that range from 40-70%. Here is an opportunity to revisit what responsibility means and what purpose punishment should serve.

David Eagleman, Director and founder of the Initiative on Neuroscience and Law is testing what's called neuro-rehabilitation. Currently, his initial experiments involve smoking cessation via bio(neuro)-feedback methods for reducing cigarette cravings. He explains these experiments in this video (@ 23min).

His experiments center around the notion that not all people are created equal and, more specifically, not all brains are created equal. One thing to understand about equal rights is that these rights, liberties—or even the concept of freedom—presuppose having equal opportunities to access them. Consider this story:

In 2000, the man began collecting sex magazines and visiting pornographic web sites, focusing much of his attention on images of children and adolescents… When he started making subtle advances on his young stepdaughter, his wife called police. He was arrested for child molestation.

The day before he was to be sentenced to prison, the man walked into the emergency room with a headache. …An MRI revealed the tumor, and it was cut out days later.The man’s behavior began to improve...The man eventually moved back home with his wife and stepdaughter.

About a year later, the tumor partially grew back and the man started to collect pornography again. He had another operation last year, and his urges again subsided.”

This is not to compare this man with Troy Davis, but to point out another instance where our current criminal justice system is currently ill-equipped to handle such a case.

Studies have shown that 45-64% of prisoners have been diagnosed with mental illness. Given our high recidivism rates, we must wonder, if neuro-rehabilitation might be more just.

Who is to blame for this crime? Can the crime be blamed on his brain? Does this mean we don’t have free will? Whereas pedophilia might have been formerly explained as simply a moral failing and weak will, new neurotechnologies offer more to this explanation.

In retaliation to the “My brain made me do it,” a common response is, “Well, then everyone will start blaming some brain malady for their crimes. Someone has got to take responsibility.”

Realizing that brain mechanisms are at the heart of the body’s ability to execute a behavior does not change that the behavior was socially inappropriate or against the law. If you commit a crime, and engage in criminal activity, you are guilty. But, now what do we do with a convicted criminal? Does locking up the criminal change his/her brain or ensuing actions?

Here we must revisit ideas of “individual” responsibility. We say that people must be held accountable for their crimes; that they have a responsibility to society to follow the rules. What about being responsible for the communities around you? Most criminals don’t come from a high socioeconomic status, they don't come from a privileged class, and tend to not come from what we would call a healthy home. And the society into which we are born and which we defend is often predicated upon these inequalities. We are therefore each responsible for considering the conditions in our communities that facilitate criminal behavior. With such a spectrum of causes and dominant factors involved in individual life circumstances, doesn't it seem that executing or imprisoning convicted criminals is a primitive proxy for proper mental health care and social rehabilitation?

However, we must be cautious. We don’t want to use neuroscience as a new technique for justifying the disenfranchisement of those that are already marginalized (for example, by using brain imaging as a pre-screening tool for adults or even children). Current neuroimaging techniques can, at best, only describe the subject's brain at the moment of being scanned and cannot guarantee that an individual's brain activity patterns before or after the scan will behave in the same manner. By pre-screening children we run into a number of problems, but most significantly that a number of factors can shape brain development and activity. Recent data suggests that the brain continues to develop even after adolescence. In the long run, judicious application of neuro-rehabilitation may prove more productive and less cost-prohibitive than the process that leads to and includes execution or long-term incarceration.

We must also consider what kind of social norms we create when we legally enforce murder. What is the larger consequence to society when we enforce laws that equate death as the most extreme mode of punishment?

Capital punishment reinforces a notion that death is not a natural part of life; that death is something that happens to you when you do something wrong. In this way people become a vessel for delivering a cosmic justice, enforcing a higher power’s supposed infinite wisdom.

In a society where we have an anti-aging industry and one that promotes so-called transhumanism, a perspective said to see beyond the limits of the human body and in doing so creates the possibility for living forever, we have to ask how the demonization of a natural process of life can truly serve society? Death is something that the body is designed to do and something that can happen unexpectedly, and this is still natural. As Steve Jobs put it (Rest in Peace, Mr. Jobs), "Death is very likely the single best invention of life."

People should not feel punished by the procession of time and its consequent aging. Nor should they be compelled to question how they lost the favor of a higher power when they become terminally ill or when their loved ones die of cancer. The experience of death should not be abused by having it legally equated to a mode of punishment.

Nor should "medicine" be used to kill people, says Emory physician, Dr. Joel Zivot. In a recent interview, Dr. Zivot a physician and anesthesiologist at Emory questioned the role of physicians in advising or assisting to deliver the capital punishment. He is concerned that the State, by associating themselves with community-practicing physicians, attempts to make execution appear more well-regarded. Dr. Zivot goes on to claim that our justice system attempts to execute convicted criminals “humanely,” but reminds us that there is nothing humane about execution. He finds it difficult to reconcile the healing mission of medicine with the use of “medicine” for killing people. He states, “Medicine should not have any other use than medicine.” This misuse of medicine becomes even more difficult to justify in conditions where those who might benefit from these medicines actually can’t get access to those medicines due to drug shortages.

If our plan is to utilize the assistance of physicians and scientists in our justice system, and we should using every resource possible to ensure and expedite a just society, our current methods fail to do so. Perhaps, neurorehabilitation methods, used with scrupulous consideration, could be more on the mark in delivering justice.

--Karen S. Rommelfanger, PhD

Neuroethics Program, Center for Ethics

Want to cite this post?


Rommelfanger, K. (2011). Neuro-rehabilitation: A vision for a new justice system. The Neuroethics Blog. Retrieved on
, fromhttp://www.theneuroethicsblog.com/2011/10/neuro-rehabilitation-vision-for-new.html

Recommended reading:

A fantastic bibilography compiled by the MacArthur Foundation Research Network on Law and Neuroscience.