Teaching Intersex, Teaching Interdisciplinarity: Interview with Sara Freeman

Sara Freeman

Graduate Student

Department of Neuroscience

Emory University

In this post, I would like to highlight the work of another
Emory graduate student, Sara Freeman. Just when Cyd Cipolla and I (in the
Department of Women’s, Gender, and Sexuality Studies) were coming up with our
plan to teach an interdisciplinary course bringing together gender studies and
neuroscience, we found out that Sara (in the Neuroscience Graduate Program) was
developing her own interdisciplinary course bringing together developmental
biology and the sociology of gender.

Sara’s course, which she is teaching this semester, is
called “Intersex: Biology & Gender,” and is cross-listed in the departments
of Biology, Sociology, and Women’s, Gender, and Sexuality Studies. “Intersex”
is a general term used for a variety of conditions in which a person is born with
physical reproductive or sexual characteristics that cannot be easily
classified as male or female (for more information, visit the Intersex Society of North America or the
American Psychological Association’s page on intersex). FYI: October 26th was Intersex Awareness Day! In Sara’s course, she is teaching about both the developmental biology of
intersex in humans and the social, political, legal and ethical issues related
to intersex.

I wanted to interview Sara about her course because I see
her work as highly relevant to the field of Neuroethics. First, Neuroethics
benefits from interdisciplinary collaboration between scientists (especially
neuroscientists) and researchers in the social sciences and the humanities, and
by including material from the sciences, social sciences, and humanities, and
by bringing together students from all of these fields, Sara’s course is
fostering exactly the kind of interdisciplinary collaboration that Neuroethics
needs. Second, Sara’s course is encouraging her students to grapple with
important neuroethical and bioethical questions, including ethical issues
related to the medical treatment of intersex individuals (see Dreger for a
review) and ethical issues related to the use of intersex individuals as
research subjects in scientific studies on sex/gender development. Read on to
find out more about Sara’s course!

Question: What inspired you to teach the course?

Image from "One in 2,000" (used with permission)

Almost a year and a half ago, a friend of mine showed me a
short documentary called “One in 2,000” which is about intersex in humans [for
info about the film, visit this link]. I was surprised
to learn how prevalent intersex is, and as a graduate student in the biomedical
sciences, I was even more surprised to learn that the most common “treatments”
for these conditions include surgical intervention to “normalize” ambiguous
genitalia (often performed on newborns), gonad removal, and lifetimes of
hormone therapy. I was even more outraged to learn that in the past, these
procedures were oftentimes performed without full disclosure of medical
information to the parents or to the patients themselves. Later in the video, as
I watched dozens of names of intersex conditions drift across the screen, my
outrage began to shift to embarrassment, because I only recognized four of
them! Because my undergraduate and graduate training has been in reproductive
biology, sexual behavior, and neuroscience, I expected that I would be fairly
knowledgeable about the hormones, receptors, and developmental pathways that
lead from an embryo through stages of sexual differentiation during
development, and finally into a reproductively-capable and arousable adult man
or woman. At that moment in time, my apparent intellectual ignorance of this
topic, my outrage at the ethics of medical authority, and my growing interest
in gender studies started to work together as a motivating force. I started
doing some research and quickly learned that although many of the biological
causes for intersex are well described, there remains a considerable lack of
social awareness and understanding of intersexuality. With this in mind, I
decided to draft a syllabus for an interdisciplinary undergraduate course about
intersex in humans.

Question: When you originally designed the course, what did
you want your students to learn from it? How did you plan to make the material
accessible to students from the sciences, social sciences, and humanities?

I designed this class as a cross-disciplinary introduction
to both the developmental biology and the sociology of intersex. It examines
how biologically an intersexed body might develop and what the existence of
these bodies means for the binary concept of gender in our society. I wanted to
pose the question to my students, “What is a male and what is a female?” and to
draw answers from a variety of disciplines. Thus, the course includes topics
from the biomedical sciences, like chromosomal biology, embryology,
endocrinology, and anatomy, as well as topics from sociology and the humanities,
such as gender theory, the role of gender in our society, relevant legal,
medical, and ethical issues, and what the study of intersexuality can glean
from historical movements such as feminism.

It was very important to me that the course be cross-listed
in departments from different areas of academia, and to my great delight, it
was listed in the Biology department, the Sociology department, and the
department of Women’s, Gender, and Sexuality Studies. I hoped that by studying
medical ethics, the biology of human sexual development, and gender theory and
sexuality, students from any academic background would appreciate the natural
individual sexual variation in both human bodies and behaviors. Gaining these
new perspectives relies on the unique level of discussion and engagement that
results from a classroom of students from diverse disciplines who would
otherwise not interact academically. For example, pre-med students from the Biology
department would learn about the gender-related issues in the practice of
medicine, which is a discipline that tends to uphold the binary approach to sex
and gender. These pre-med students will undoubtedly have to make important
decisions regarding sex and gender later in their careers as physicians, and it
is critical for them to start discussing these concepts with students outside
of their discipline. Similarly, non-biology majors from the Sociology or
Women’s Studies departments would learn the specifics of the genetic, hormonal,
and developmental basis of the human sexual variation that their disciplines
have been studying and celebrating for decades.

At that point, as your question reflects, the challenge for
me was to make sure that the material was accessible to the students. I hoped
to accomplish this in a few different ways. First, I established an online,
collaborative glossary and encouraged the students to keep track of each word
in the course material that they’ve never seen before and to add those words to
the collective glossary, along with a brief definition. I hoped that this
exercise would attack the common and often reflexive feeling of stupidity that
accompanies being exposed to a term or idea of which one was previously
ignorant. In this way, as the students completed the reading assignments each
week, they could celebrate and share the new words they learned. Right now, we
have over 140 entries in the glossary, and almost all of my students are participating!



Second, I acknowledged that I cannot be an expert in every
topic, and I invited several guest instructors from various departments to help
teach the course. These incredible individuals include: Kara Kittelberger
(Neuroscience), Jordan Kohn (Neuroscience), Kevin Watkins (Neuroscience), Katy
Renfro (Psychology), Anson Koch-Rein (Institute of the Liberal Arts), Aimi
Hamraie (Women’s, Gender, and Sexuality Studies), Dr. Kim Wallen (professor in Psychology),
Dr. Briana Patterson (pediatric endocrinologist from Emory Hospital), Dr. Pat
Marstellar (director, Center for Science Education), and Dani Harris, an
intersex person and advocate from the Atlanta community (Atlanta Police
Department). During the planning and conceptualizing phases of my class, I also
met with several other generous graduate students (Kristina Gupta, Cyd Cipolla,
Mairead Sullivan, Pii Dominick), instructors (Dr. Kevin Cryderman, Dr. Sara
McClintock, Dr. Deboleena Roy, Dr. Irene Browne, Dr. Tracy Scott), and staff
members (Sasha Smith, Danielle Steele). Without these people, my class would
not exist.

Lastly, in order to make two of the more challenging
biological concepts accessible for all students, I collaborated with Matt
Gilbert (web developer, graphic designer, instructor, and the friend who first
showed me the “One in 2,000” documentary mentioned above!), to create two online,
interactive “games”. The first is a meiosis game that allows students to
interact with the X and Y chromosomes as they replicate and divide during the
creation of eggs and sperm. Students can directly observe how variation in this
process can result in an embryo with a set of sex chromosomes other than the
expected XX or XY. The second online tool is a steroidogenesis game that
outlines the complex enzymatic pathways that synthesize steroid hormones, such
as testosterone and estrogen. Students can visualize how a body’s enzymes build
these hormones and can interact with that process to test their knowledge. By
making difficult biological pathways interactive, we improved the accessibility
of these core biological concepts for all students.

The "meiosis game" Sara and Matt Gilbert created for the course

HHMI Howard Hughes Medical Institute Grant No. 52005873

The "steroidogenesis game" Sara and Matt Gilbert created for the course

HHMI Howard Hughes Medical Institute Grant No. 52005873

Question: How has the course been going so far? Have you
been surprised by anything that has happened?

The course has been going wonderfully so far, in my opinion.
The guest lecturers have been engaging, the students have been open and
inquisitive during class discussion, and there has been tremendous support from
the Emory community. As far as surprises, I think my own biggest personal
surprise was that I haven’t really felt nervous. I was expecting to have to
deal with some nerves each day before class, but I find myself comfortable in
front of a classroom, which was definitely a pleasant surprise! I have also
been pleasantly surprised at the great level of maturity that the students have
exhibited in class. I imagined that because our discussion topics were often
going involve details about the genitals and sexuality, it might be challenging
for students to feel comfortable saying some of these words out loud. But they
have been very mature and confident and have handled the course material better
than I ever expected!

Question: Do you have any advice for other instructors who want to
teach interdisciplinary courses?

Collaborate. Don’t be afraid to reach out to a distant
department. Speak freely about your ideas. There are no dumb questions.
Acknowledging the intellectual areas in which you feel weakest will likely
result in a plethora of knowledge and support, which will overwhelm any potential
inadequacies that may accompany that acknowledgement. It’s ok not to know the
answer. Spend time following tangents. Be prepared to have the foundations of
your knowledge shaken. Welcome alternative viewpoints. Learn to speak using
unencumbered and discipline-free language, and if you find a situation where
that is too difficult, be prepared to explain your word choice and its
foundations to others.

Question: Has teaching this course influenced your current research in
any way or your plans for future research? Has it influenced how you think
about neuroscience research on sex and gender?

Yes, this course has definitely changed the way I think
about neuroscience research about sex and gender. I’m much more critical of the
field in general, and I’m also more aware of the misuse of the word “gender” to
describe animals in a research study. Also, after learning so much about intersex
subjectivity and medical ethics, I considered shifting my career track
entirely! I felt compelled by the idea of studying the issues surrounding why
many intersex individuals are lost to follow-up in the medical community, and I
thought about applying for a post-doctoral position at the Kinsey Institute at
Indiana University. Instead, I decided to accept a post-doc offer to continue
neuroscience research on peptide hormones and primate social behavior at UC-Davis
next summer. While my research aims for the immediate future don’t include any
specific plans to study intersex or gender, I definitely plan on teaching my
intersex course in the future as often as I am able to.

Want to Cite This Post?

Gupta, K. (2012). Teaching Intersex, Teaching Interdisciplinarity: Interview with Sara Freeman. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/10/teaching-intersex-teaching.html

Who is to blame when no one is to be praised?

Let’s imagine for a moment that I am extraordinarily brilliant, but my brilliance is not due to my own hard work nor is it due to the wonderful instruction I have received; rather my brilliance is due to the fact that I was born with gene X. Let’s further imagine that the effects of gene X are robust. That is, the effects of gene X (my extraordinary brilliance!) are largely insensitive to environmental variation and developmental course. As long as some minimal conditions of life are met, having gene X guarantees that I will be exactly as brilliant as I in fact turned out to be.



Question: Who is to be praised for my brilliance?

The glasses pair well with the genes.






If your intuition is similar to mine, your answer is probably something along the lines of: “No one, really. Your genius appears to have been innately determined in a way that your genius didn’t really depend on the actions or efforts of you or other people. Neither you nor anyone really deserves praise for that.”



As you can tell from my answer, I think that this ‘no praise’ intuition is driven, at least in part, by me classifying the development of the characteristic as being innately determined in such a way that the development of the characteristic is largely insensitive to environmental variation.



But here is the kicker: According to a new and provocative paper by Joshua Knobe and Richard Samuels, people are significantly less willing to classify an attribute as innate when the attribute is negative than when the attribute is positive. This is true even when the scenario that leads to the negative attribute is described as being the result of a gene that is largely insensitive to environmental conditions.



Even more surprising is that this effect held true even for scientists who were actively working as researchers in fields that regularly used the concept of innateness (e.g., biology, psychology)!



But, of course, the badness or goodness of the characteristic is irrelevant for whether a given characteristic is innate.



But the problem may be even worse. If praise/blame attributions are moderated, at least in part, by innateness judgments, then our praise/blame judgments would be asymmetrical for reasons that are unjustifiable.



But not all news is bad news.



When people viewed both the “bad” and the “good” version of each vignette prior to making the innateness classification, people were able to recognize that the goodness and badness of the characteristic was irrelevant, and, on average, the asymmetry in innateness classifications disappeared.



What does this all mean?



Well, these findings suggest another potential strike against the idea of the “objective juror” (see related posts by Cyd Cipolla here and here). If (certain degrees of) innateness should mitigate responsibility, and if we are biased toward not seeing negative characteristics as innate, we will be biased away from mitigating responsibility in criminal cases even in cases when we should.



This research also suggests a way to guard against potential biases. If a lawyer or judge is worried that a particular piece of information might bias jurors, the lawyer or judge may only need to provide the appropriate contrast case in order to get jurors to recognize that a particular piece of evidence may be irrelevant.



Want to cite this post?

Shepard, J. (2012). Who is to blame when no one is to be praised? The Neuroethics Blog. Retrieved on
from http://www.theneuroethicsblog.com/2012/10/who-is-to-blame-when-no-one-is-to-be.html

Zombies and Zombethics! Symposium

Zombies and Zombethics! Walking with the Dead: An Ethics Symposium for the Living on Halloween 2012.

This symposium will feature a Zombie Braains Inspired Panel (among many other exciting panels, see Zombethics Tab for more info) inspired by The Walking Dead Clip Below. This discussion will include a stellar group of virtual and local speakers followed by a moderated discussion.



If you already RSVP'd, lucky you! If you didn't RSVP, see how to get on the waiting list below.  The Zombie Walk at 1130am is open and does not require registration. Contact Alison Kear (akear@emory.edu) for details.



The Walking Dead: Season 1 Episode 6: Test Subject-19 Brain Scan of Transformation









GUEST PANELISTS

• Steve Schlozman, MD. Dr. Schlozman
  
  is a psychiatrist and Professor at Harvard as well as author of The Zombie Autopsies.

Also joining us will be our local friends of the Neuroethics Program:

• Eddy Nahmias PhD. Neurophilosopher and Associate Professor of Philosophy at Georgia State University. Dr. Nahmias will discuss the relationship between the brain and free will.

• Bob McCauley, PhD. Director of Emory's Center for Mind, Brain, and Culture and Professor of Philosophy. Dr. McCauley will discuss the relationship between the brain and mind.

• Darryl Neill, PhD. Professor of Psychology at Emory.  Darryl Neill will discuss the psychological underpinnings of zombiehood.

The session will be moderated by Emory's Neuroethics Program Director, Dr. Karen Rommelfanger.





This event is hosted by the Center for Ethics and organized by the Neuroethics Program and the Religion and Public Health Ethics Program.

The event is free, but seating is limited and attendance will be by RSVP only! Seating is now by waiting list only. Contact Alison Kear (akear@emory.edu) to be added to the waiting list.

 For full day's events, please click the Zombethics Tab.

The Military and Dual Use Neuroscience, Part II

In a previous post, I discussed several promising neuroscience technologies
currently under investigation by the military. Simply knowing that such
technology exists, however, does not in itself dictate a way forward for
neuroscientists and others who are concerned about the possible consequences of
military neuroscience research. In part, the complexity of the situation
derives from the diversity of possible viewpoints involved: an individual’s
beliefs about military neuroscience technology likely stem as much from beliefs
about the military in general, or technological advancement in general, as from
beliefs about the specific applications of the neuroscientific technologies in
question.

Star Trek's Commander Spock was generally ethical in his personal use of directed energy weapons, but not all of us are blessed with a Vulcan’s keen sense of right and wrong (Image).  

With that in mind, I think there are at
least three distinct angles from which an individual might find him or herself
concerned with respect to military neuroscience research. First, there are
those who are opposed to neuroscientific advancement in general due to its
potential implications on identity, moral responsibility, and human nature. Second,
there are those who may be amenable to scientific advancement in general, but
who distrust the military and are therefore suspicious of any technology that may
improve its combat capability. Finally, there are those who have no a priori problem with either the
military or technological advancement, but who have concerns about the ways
that particular technologies may be deployed within a military context.

Technological
Skeptics

Perhaps the most well-known skeptic of biotechnological
advancement is political scientist Francis Fukuyama, known largely for his 1989 prediction that the fall of the
Soviet Union would usher in the “end of history.” While Fukuyama does not oppose all biotechnological
advancement, his 2002 book Our Posthuman
Future: Consequences of the Biotechnology Revolution raises concerns about a number of particularly revolutionary
biotechnologies. For Fukuyama, belief in human equality depends upon a consensus
that there are certain essential qualities that unite all human beings. Modern
liberal societies, he argues, are notable in that they attribute essential
humanness to a range of persons – women, for instance, and racial minorities –
to whom such respect has historically been denied. Fukuyama’s fear is that
novel biotechnologies may undermine our collective belief in essential
humanness, and consequently the philosophical basis for political equality. One
area of particular concern for Fukuyama is neuropharmacology, where he predicts
the development of “sophisticated psychotropic drugs with more powerful and
targeted effects” with the capacity “to enhance intelligence, memory, emotional
sensitivity, and sexuality.” Many of Fukuyama’s arguments involve potential
inequalities generated through genetic engineering, but it is not difficult to
extend his logic to many neurotechnologies – for instance, brain-controlled prosthetic limbs,
or transcranial magnetic stimulation – currently under investigation by the military.

Francis Fukuyama, author of Our Posthuman Future 

Fukuyama, and others who hold similar belief
systems, tend to oppose a wide range of military and civilian biotechnologies
rather than military neuroscience per se.
 Such viewpoints, however, hold particular implications for military research if only because DARPA tends to be very, very good at what it does. Historically,
the military has played key roles in the development of microchips, cell
phones, GPS, and the Internet.
This is no coincidence: compared to other research programs, DARPA researchers
enjoy a number of unique advantages.  In Mind Wars, bioethicist Jonathan Moreno points out
that “in the DARPA framework decades of development are acceptable” and that,
according to the DARPA strategic plan, “its only
charter is radical innovation.” That DARPA’s innovation is of this radical kind should constitute a point
of concern for those who believe that neuroscientific research is already
progressing too quickly. While private pharmaceutical firms might develop drugs
targeted to specific symptoms or diseases, DARPA has a particular incentive to
invent drugs that produce what might reasonably be called “superhumans”: drugs
that make humans more intelligent, that increase human endurance and stamina,
or that substantially enhance human physical performance.

Constraining The
Military

Other concerns
stem from the nature of the military itself: as an institution that uses force
to achieve political ends, it is worth asking whether military neuroscience
should be avoided insofar as it renders the military better capable of
achieving these ends.

One area of
concern relates to privacy, where several new technologies suggest a fundamental shift in the nature of state surveillance. In
my first post on military neuroscience, I discussed the Veritas TruthWave EEG
helmet and fMRI lie detection as two especially notable surveillance technologies. While both technologies have significant drawbacks – accuracy in the
case of the EEG helmet, and usability in the case of fMRI – such advances may
nevertheless have worrisome implications. An article on TruthWave raises one relevant concern regarding false positives: “When
a person’s life or freedom is at stake, what is an acceptable margin of error?”
In at least some cases – drone strikes on suspected terrorists, for instance, in
which “all military-age males in a strike zone” are assumed to be enemy combatants – the military has demonstrated a tendency to set the “acceptable margin of error” higher than it might be in, say, a court of law. The present generation of mind-reading technologies occupy a grey area in the sense that they’re likely accurate enough to be more reliable than intuition, but not so accurate as to reliably avoid false positives. In conjunction with high-stress combat situations or high-priority military objectives, this grey area may become particularly difficult to negotiate. 



Further, it is possible that some innovations in military neuroscience may lower the cost of warfare, increasing the likelihood of intervention and violent conflict. In a 2005 article, Arizona State engineering and ethics professor Brad Allenby suggests that “military prowess, embodied in incredibly potent technological capabilities, acts like a drug, leading to dysfunctionally oversimplistic policy choices,” citing the Iraq war as a prominent example. Innovations in remote-operated robotic weapons – commonly known as UAVs, or “drones” – have already increased the U.S. military’s propensity to engage in combat operations. As one Washington Post editorialist puts it: “The detachment with which the United States can inflict death upon our enemies is surely one reason why U.S. military involvement around the world has expanded over the past two decades.”[1] Military neurotechnology seems poised to reinforce and accelerate this trend. Neurologically-controlled robots, for instance, may drastically improve the effectiveness and flexibility of current UAVs. More broadly, it seems likely that a war we are more likely to win is also a war that we are more likely to fight: in that sense, cognitively-enhanced soldiers, innovative prosthetics, and improved surveillance may all foreshadow a similar future involving a more powerful, more active U.S. military.   

UAVs, or “drones,” have likely decreased the U.S. military's threshold for global interventions (Image) 

Legality And
Other Issues

Many problematic aspects of new military
neuroscience technologies derive simply from the fact that they are new. Consequently,
many current international legal frameworks designed to constrain warfare may
not apply to new neuroscience technologies.

Concerns of this sort are discussed at
length in the U.K. Royal Society report. For instance, newly-developed pharmaceuticals may have uses
in the interrogation of suspected terrorists or prisoners of war. Coercion of
POWs is outlawed by the Geneva Convention, as are medical procedures contrary
to “the rules of medical ethics.” The extent to which the Geneva Convention
applies to terrorists, however, has been a matter of dispute.
Given recent reports of coercive pharmaceutical use at Guantanamo Bay,
concerns of this nature are particularly salient.

As is often the case, key questions of ethics and policy hinge on exactly how similar our universe is to “24” (Image). 

The deployment of novel chemical
incapacitants in combat raises complex legal questions as well. The Chemical Weapons Convention (CWC), an
international agreement ratified by the U.S. in 1997, bans the use of chemical
weapons in conflict. At times, however, the CWC can be ambiguous: according to a U.K.
Royal Society report on neuroscience and conflict, parts of the CWC may be interpreted to allow “the use
of toxic chemicals to enforce domestic law extra-jurisdictionally or to enforce
international law.” Insofar as international law and extra-judicial enforcement
of domestic law are themselves open to interpretation, the CWC may leave the door open to some offensive uses of
chemical weapons.

Finally, the use of cognitive-enhancing drugs to aid friendly soldiers is complicated by a provision of the
Uniform Code of Military Justice requiring servicemembers “to accept medical
interventions that make them fit for duty.” On one hand, novel enhancement drugs might provide safer alternatives to
currently-employed stimulants such as amphetamines,
thereby lowering the health risks to military personnel. Alternatively,
however, safer drugs could lower the costs associated with coercive drug employment,
resulting in a lower threshold for coercion of military servicemembers.

It’s Not All Bad

Depending on your perspective, of
course, what I have called “concerns” may in fact be substantial benefits. I'm certain that leading transhumanist Nick Bostrom sincerely looks forward to to brain-computer interfaces, and that pro-military foreign policy analyst Robert Kagan wholeheartedly supports technologies that sustain U.S.
military dominance. More generally, neurologically-enabled prosthetics have obvious
benefits for disabled persons,
and civilian spin-offs of many military neurotechnologies hold considerable
medical and commercial promise.  

A DARPA-produced prosthetic arm (Image) 

Nevertheless,
there is a large enough breadth of military neuroscience research, and an
similarly diverse set of ideological positions from which to criticize it, that any
given individual is likely to find something
in DARPA that they consider worthy of concern. Coming to such a conclusion,
however, is only a first step, and the second step: “what to do about it?” – does
not have a simple answer. To a large extent, those who publish on the
implications of dual-use neuroscience technology have made similar suggestions.
The Bulletin of Atomic Scientists, for instance, recommends greater interdisciplinary
discussion on dual-use technology, and a 2003 Nature editorial suggests that “researchers should perhaps spend more time pondering the
intentions of the people who fund their work.” While these publications are
certainly correct in identifying a need for additional discussion on dual use
technology, I’ve personally found myself frustrated at the lack of specific,
practical suggestions in much of the literature. 

It is Jonathan Moreno who, to my knowledge, has offered the most concrete suggestions for coping with the implications of military neuroscience. In Mind Wars, Moreno warns neuroscientists against rejecting all military funding, arguing that such a position would only push DARPA research into greater secrecy. If military neuroscience research is inevitable, he reasons, it is better for it to be done transparently (and therefore in some sense democratically) than for it to be done underground, where it cannot be criticized simply because it is not known about. Instead, he recommends that neuroscientists attempt to influence public discussion on military neuroscience in a similar fashion to scientists who opposed nuclear weapons use during the Cold War. From a regulatory perspective, Moreno further recommends the creation of a “neurosecurity equivalent to the National Security Advisory Board for Biosecurity,” a committee that would include scientific input from a range of disciplines, including neuroethics. Moreno is also optimistic that at least some in the defense industry might take ethical issues seriously, citing one defense contractor who has “had ethics advice from the very beginning [of a brain-machine interface project].” 

I don't agree with all of Moreno's suggestions - I think, for instance, that there's something to be said for the symbolic value of refusing to work on a project that you disagree with - but I admire his attempt to provide concrete solutions to an issue that defies simple analysis. In a 2012 article in PLoS Biology, Moreno and Michael Tennison suggest that “discussions in themselves will not ensure that the translation of basic science into deployed product will proceed ethically... These considerations must be embedded and explored at various levels in society: upstream in the minds and goals of scientists, downstream in the creation of advisory bodies, and broadly in the public at large.” Whether and how the ethics of military neuroscience are “embedded and explored” have yet to be determined, but the answer to these questions will have significant implications for the control and ultimate consequences military neuroscience research.

[1] Though it’s worth noting that the author, John Pike of Globalsecurity.org, considers this to be basically a good thing, writing that “the large-scale organized killing that has characterized six millenniums of human history could be ended by the fiat of the American Peace.”





Want to cite this post?

Gordon , R. (2012). The Military and Dual Use Neuroscience, Part II. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/10/the-military-and-dual-use-neuroscience.html

Neurolaw: Brains in the Courtroom

Regular readers of this blog know we often touch on issues
about law and neuroscience: whether 
it’s about crime, the lie detection seminar Emory hosted last spring, or
work on ethics and free will. (Also, spoiler alert, neurolaw is to be the focus
of our next journal club meeting- please come!) The field of neurolaw, which
is exactly what it sounds like- neuroscience and law, has been growing rapidly
over the past decade. Most of the discussions in neurolaw focus on how, and if,
new discoveries in neuroscience will affect legal definitions of responsibility
and culpability by changing the way we understand how the decision to commit a
crime is made. However- in the past year there have been several studies
looking at another side of brains the courtroom: that is, the neuroscience of
judgment itself. These studies are exploring how people consider evidence and how they balance moral and ethical decisions against empathic and sympathetic reactions. This new work opens up new avenues for interventions from neurolaw and neuroethics around the construction and use of institutions like the judge and the jury.

Science says: Lock 'em up.

(image courtesy of Special Collections, University of Houston Libraries)

Although I want to focus here on what I think is a new area of neurolaw, I’ll begin with a recent study that exemplifies the sort of work that is traditionally considered in the field. In August of 2012, Science published an article by Lisa G. Aspinwall, Teneille R. Brown and James
Tabery of the University of Utah titled “The
Double-Edged Sword: Does Biomechanism Increase or Decrease Judges' Sentencing
of Psychopaths?” This study focuses on the sentencing portion of a criminal
trial, where judges decide how to punish a person who has already been convicted.
They weigh aggravating factors (basically evidence that the person should get a
longer sentence) against mitigating factors (basically, evidence that the
person should get a shorter sentence.) In this study, researchers gave 181
trial judges a hypothetical case (based on a real case, Mobley v.
State)[1]
where the convicted person had been diagnosed with psychopathy. All judges
received the same psychiatric testimony of diagnosis, but some were also given
additional proof of psychopathy in the form of  “expert testimony from a neurobiologist who presented an
explanation of the biomechanism contributing to the development of psychopathy
(here, low MAOA activity, atypical amygdala function, and other
neurodevelopmental factors).” (846) Judges who received the version with the
additional biomedical information were more likely to list mental illness or
psychopathy as a mitigating factor. One judge, quoted in the article, said that
the biomedical evidence “makes possible an argument t that psychopaths are, in
a sense, mo- rally 'disabled' just as other people are physically disabled.”
(847) Judges who received the additional information gave sentences that were,
on average, a little over a year shorter.

This study touches on a concept I talked about last
month- namely that there is a distinction between innate and acquired mental disorders when it comes to sympathy and empathy. However, unlike what I talked about in that post, this
study shows that perhaps it is not the origin of a behavior which is significant, but how tangible the evidence for that behavior is. It is telling that the
anonymous judge quoted in the article described psychopathy as a moral disability rather than a moral disorder, seeing morality as a capacity that can be limited with a physical disruption to the limb. Although the results don’t seem that
significant- remember that this study wasn’t about deciding guilt – it is
important to note, as the authors themselves do, that the crime they discuss
was a particularly violent one and the assailant was presented, in all versions
of the case, as entirely lacking in empathy or remorse. Taking that into
consideration, the one-year difference in sentencing is a bit more significant,
and it is possible that there would be even larger discrepancies in cases that
are less violent or less reprehensible. I am interested to see if further
work is done.

Where Aspinwall et al. focused on the impact of
different types of evidence on judgment, the other two studies I want to
highlight looked at the neuroscience of judging itself. In February of 2012, Social
Cognitive and Affective Neuroscience
published an
article from a team at George Mason University about the role of oxytocin
in the perception of crime. A group of male subjects were given oxytocin (or
placebo) and then asked to read a series of descriptions of crimes.[2]
They were then asked, as unaffiliated third-parties, to rate the crimes in
terms of the degree of harm caused to the victim and then rate how much the
offenders deserved to be punished. 
The researchers that those administered oxytocin were more likely to see
increased harm to the victims but that this did not significantly impact how
much they thought the assailants should be punished.[3]The
authors of the study emphasized that it was important that the subjects saw
themselves as an uninvolved third-party – first, because this removed the
confounding factor of personal relationship to either victim or perpetrator,
and second, because it more closely mimicked the circumstances of a jury trial.

Clarence Darrow, lawyer most likely to

make all sorts of borderline prejudicial remarks

(image in the Public Domain)

In a similar study, published in the March 2012 of Nature
Communications, a team of researchers in
Japan used fMRI
machines to measure neural activity in people while they were making
decisions about punishing a convicted murderer. The study was designed to
examine how arguments designed to elicit sympathy mapped onto brain regions
and, in turn, how those were utilized in the decision making process. The
researchers found that, in fact, brain activity was consistent with regions
previously associated with sympathy and that the sympathetic response was
correlated with shorter sentences. This left the research team with the
following question: Although judges often instruct jury members to disregard
certain prejudicial remarks while making their decisions, such as pleas for
sympathy or comments not admitted to the record, is it reasonable to ask people
to do such a thing?

These studies open a possibility within neurolaw for an
examination of the institution of the jury trial, raising important ethical
questions about how we, as citizens, make moral judgments, and the level of
conscious control we can have over our sympathetic reactions. The jury trial is
a sacred institution within United States law, and for good reason.  Yet so far, the nacent field of
neurolaw has focused almost exclusively on the impact neuroscientific evidence
will have on the courtroom in terms of how it reframes criminal actions. Neuroscience, and most importantly neuroethics, is giving us more information
about morality in general. What will happen to the jury trial if it is found
that people cannot lay aside urges for sympathy, no matter how they are instructed? Or what if it turns out we are able to judge situations in which we are an
uninvolved third-party with more reason than we do situations where we have
personal involvement, regardless of the level of empathy we may feel for the
persons involved? How will this work change the rules of evidence and criminal
procedure, if at all? And should they?

Want to cite this post?


Cipolla , C. (2012). Neurolaw: Brains in the Courtroom. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/10/neurolaw-brains-in-courtroom.html

---

[1] In 1995,
Stephen Anthony Mobley was found guilty of the murder of John C. Collins. The
case was one of the first to introduce the concept of a dysfunctional MAO-A
gene as a factor in the courtroom. Mobley was sentenced to death and executed
in 2005. The hypothetical case used some of the same descriptive details,
(e.g., the assailant attacked his victim during a restaurant robbery) but,
importantly, was not a murder conviction, and thus, not a capital crime.

[2] They chose men because previous
investigations have shown that men frequently score lower on standard tests of
empathy than women.

[3] One final
point about this study that was interesting to me- although it seems, on the
surface, to be more relevant to a study of how potential jurors make decisions,
one of the recommendations based on the findings is for potential treatment of
psychopaths.

The Army's on Ecstasy: Marching toward an ethical drug policy

Post-traumatic stress disorder (PTSD) among American soldiers returning from Iraq and Afghanistan has reached epidemic proportions, affecting between 75,000 to 225,000 veterans. In fact, suicide is now the leading cause of death in the army, with more soldiers dying by suicide than in combat. Frustratingly, existing treatments for PTSD are limited and ineffective for between 25-50% of patients. Last year a clinical trial using MDMA (i.e. Ecstasy) in conjunction with psychotherapy was shown to ameliorate PTSD symptoms far more effectively than any other known treatment. Despite these promising results, it could be ten years or more before MDMA is approved for use in treating PTSD, and even then clinicians will face additional hurdles until our nation’s drug policy is seriously overhauled. Given the public health imperative for effective PTSD treatment, it’s high time to rethink our stance toward illegal drugs and create an ethical drug policy that paves the way for expedient psychedelics research while providing honest education, harm reduction measures, and on-demand treatment for drug addiction.



PTSD is a chronic, debilitating mental illness. People with PTSD are hyperaroused, repeatedly re-experience their trauma in the form of nightmares, panic attacks, and flashbacks, and often suffer from comorbid depression and drug abuse. The army's own research illustrates that trauma is widespread and long-lasting: around 25% of Vietnam veterans remain symptomatic, even decades after the end of their service. The army is fully aware of this growing issue, and has taken many steps over the years to address it, including the formation of the National Center for PTSD within the US Department of Veterans Affairs, which has emerged as the world’s leading research and educational center on PTSD. The Obama administration has also increased funding for mental health services at the VA by 39% since 2009. Despite these and other efforts, the statistics are alarming: about 18 veterans take their lives each day.



PTSD treatment typically involves pharmacotherapy, psychotherapy, or some combination of both. To date, the selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine are the only two FDA-approved drugs to treat PTSD, although others are prescribed off-label. Meta-analyses, which pool data from dozens of randomized clinical trials (RCTs) to try to assess drug efficacy, have found SSRIs to be slightly more effective than placebo, with about 50% of RCTs finding medication to be more effective than placebo in reducing PTSD symptoms. However, SSRIs take several weeks to begin working, often have undesirable side-effects, and many patients fail to respond at all. Psychotherapeutic approaches for PTSD include cognitive behavioral therapy (CBT) and psychodynamic psychotherapy, which are often effective, although attrition rates are high and many never respond. Clinicians and researchers alike recognize the need for more treatments, and the army is scrambling to find them, even exploring mindfulness-based therapies, such as loving-kindness meditation.

MDMA-assisted psychotherapy offers hope for those suffering from PTSD, but the US' fear-based approach to drug policy and education has delayed its development into an approved medicine. (credit: www.maps.org/)

The trick to successful PTSD psychotherapy is to hit the “window of tolerance,” wherein the patient is neither over- nor under-aroused while revisiting his past trauma. Within this sweet spot, the patient can work through difficult emotions without overwhelming anxiety (hyperarousal) or numbing detachment (underarousal). Finding this zone is tricky, requiring the establishment of a trusting patient-therapist relationship, a degree of introspective awareness by the patient, and massive amounts of courage. This may sound simple, but many veterans have spent months, years, or even decades in silence, repressing and suffering through their traumatic memories and emotions. Additionally, therapy within the optimal arousal zone must be ongoing; it’s not a one-shot deal. If therapists or scientists could devise a means by which patients with PTSD could widen, maintain, and more quickly establish this openness, therapy sessions could deliver results more quickly and effectively. And this is exactly where MDMA comes in.

MDMA, known by its street name, Ecstasy, is a psychoactive drug that produces feelings of euphoria, a sense of intimacy with others, and diminished anxiety. It belongs to a class of drugs known as “empathogens,” or “entactogens,” implying that its effects (typically 4-6 hours in duration) increase one’s ability to empathize or feel. MDMA was first synthesized a hundred years ago, but was popularized by the organic chemist, Alexander Shulgin, in the 1970’s. Shulgin himself experimented with the drug and shared it with colleagues and friends, some of whom began using it in psychotherapy sessions. Among underground psychotherapists, MDMA developed a reputation for enhancing communication during clinical sessions, reducing patients’ psychological defenses, and increasing capacity for therapeutic introspection. By the early 1980’s, an estimated 500,000 doses of underground MDMA had been consumed under the code name "Adam," with the media and drug enforcement agencies taking no notice of that use, as sessions were conducted in private settings and didn't produce problems (see Rosenbaum & Doblin for an historical account).



But this soon changed, as MDMA spilled out into the club scene and the US Drug Enforcement Agency (DEA) took notice. In response to impending drug legislation, the medical community presented their research findings to DEA Administrative Judge Francis L. Young, who recommended that MDMA be placed under Schedule III, meaning it had medicinal value but may lead to dependency or abuse (by comparison, Ritalin is a Schedule II substance due to its medicinal value but higher potential for abuse). But in the mid-80’s, Ronald Reagan’s “War on Drugs” was raging, and the DEA placed MDMA under Schedule I, the most restrictive status for a controlled substance. From then until today, federal law states that MDMA has “no currently accepted medical use in treatment” and “a lack of accepted safety for use…under medical supervision.”



This ruling proved devastating for research into the potential therapeutic benefit of MDMA. In spite of the legislation, researchers persisted in their attempts to study the drug’s cognitive and behavioral effects and to prove that it was safe for responsible use by the medical community. But roadblocks to the timely progress of their research were insurmountable. Researchers around the world were pressing for more studies on the potential therapeutic benefits of MDMA in treating psychiatric disorders, such as pain, anxiety, depression, and most importantly, PTSD. Between 1986 and 1988, five different applications for permission to conduct double-blind, controlled studies with MDMA in human subjects were submitted to the US Food and Drug Administration (FDA). All were summarily rejected. Scientists quickly became hip to the fact that securing government approval, obtaining drug licenses, and gaining institutional review board (IRB) support for human studies were both untimely and cost-prohibitive, and so human MDMA research ground to a standstill. Psychiatrists, with their careers and licenses at stake, abandoned their clinical use of the drug. And with that, the hope that MDMA could some day ameliorate the suffering of the many PTSD-afflicted men and women returning home from armed combat disappeared.



Fast-forward to 2001. After sixteen years of sustained effort, Dr. Rick Doblin, founder and director of the Multidisciplinary Association for Psychedelics Research (MAPS), a non-profit research and educational organization that supports scientific research into therapeutic uses for psychedelics, finally obtained FDA approval for an MDMA-assisted psychotherapy study. Nevertheless, it took Dr. Doblin and other investigators three more years of battling with the DEA and Independent Review Boards (IRBs) before the first experimental session with MDMA-assisted psychotherapy was carried out in a PTSD patient (for a brief history, see Check 2004). The study was finally completed in 2008 and its overwhelmingly promising results published in 2010 (see below). That’s a full nine years from FDA approval to results and publication. (Comprehensive information about MDMA-assisted psychotherapy research can be found here.)

The first Phase II clinical trial using MDMA-assisted psychotherapy to treat PTSD finds that 83% of subjects receiving MDMA no longer met PTSD-criteria after two months, compared to only 25% in the placebo group. (Mithoefer et al., 2011. J Psychopharmacol. 25(4):439-52)

 I had the opportunity to speak with Dr. Doblin about why MDMA/PTSD research over the years has been so painfully slow. According to Dr. Doblin, there remains “a delay that takes place with MDMA research because of drug policy.” Doblin explained that as a Schedule I controlled substance, MDMA could take another 10 years before it’s rolled out for use to treat PTSD. He believes that this is largely due to the unscientific, fear-based approach that the National Institute on Drug Abuse (NIDA), DEA, and the Office of National Drug Control Policy (ONDCP) have taken in their drug education and policymaking, and the reticence of scientific researchers to advocate on behalf of a sensible, empirically-driven approach toward drug policy. The government, especially the DEA and NIDA, continues to balk at research that poses, as Doblin puts it, “a threat to NIDA’s educational campaign.”



Doblin believes that this educational campaign is based on the notion that “drug use goes up when the perception of risk goes down.” Consequently, drug education programs exaggerate the risk of any and all illicit drugs, even when the science clearly dictates otherwise. Cannabis is an obvious example. Despite its medicinal applications for patients with cancer, chronic pain, and insomnia, the government has opted to “sacrifice those patients and those benefits because [they] want to tell a story to people” that cannabis is exceedingly dangerous. And the same sacrifice is now being made with MDMA for PTSD. The government’s basic argument is that they “can’t have unfettered scientific explanations because if it proves that some of these drugs are beneficial in some way, that will send the ‘wrong’ message to people. Therefore, they have to block science because there may be some inconvenient findings. Drug abuse prevention should instead be based on honest information. If you can start with that, everything is different, and you’re not scared of research that may show potential benefits.”



The government’s current scheme raises a number of ethical concerns. Obstructing scientific progress or misrepresenting scientific evidence to fit a political agenda harms scientists, patients, and society at large. The mission of mental health scientists in the US, as stated by the National Institute of Mental Health (NIMH) is to “transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.” However, in the case of developing novel therapies using recreational drugs like MDMA, drug policy prevents scientists from paving that road. This is simply unethical. As Doblin clearly stated, “when scientists see that politics is blocking their research, they have an obligation to point that out.” Scientists should challenge such practices by speaking out in public forums, participating in educational programs that promulgate evidence-based information, and supporting political organizations that advocate drug policy reform, such as the Drug Policy Alliance. Patients, in this case trauma survivors, must also make their voices heard by massively mobilizing against bureaucratic maneuvering that impedes their fair, timely access to effective treatments. For veterans with PTSD, their lives literally depend on it. Those who don’t suffer from PTSD or conduct research using controlled substances must examine the value they place on scientific inquiry, even when it challenges their preconceived social, political, or religious notions. At play here is also the broader issue of cognitive liberty, whether an individual is free to alter the state of his or her consciousness using any method available. This includes stimulants like Ritalin for cognitive enhancement in healthy adults, psychedelics like MDMA for informal psychotherapy, and LSD and psilocybin for spiritual visionaries. Do we really want to live in a society where the limits of human curiosity, creativity, and well-being are restricted? Hopefully, conversations about how best to expand and protect these freedoms while minimizing harm will permeate public dialogue.



In summary, this country is slowly emerging from a dark age in drug policy. Government regulators are just beginning to take a more reasoned approach toward research into stigmatized illegal drugs like MDMA, but a long road lies ahead. Even though the present administration has eschewed the term, the “War on Drugs,” and stated that “drug policies must be rooted in science,” its Director of the Office of National Drug Control Policy, Gil Kerlikowske, still believes that cannabis is “a dangerous drug,” and that the “Just Say No” campaign is one of the “major successes” of drug education. Progress is slow, indeed, and will require a grassroots, coordinated effort to effect significant change. As our service men and women continue to suffer, and the low-hanging fruit of MDMA-assisted psychotherapy remains out of their reach for at least a decade more, it is now our duty to serve them and advocate for a science-based drug policy that clears the path for psychedelics in treating mental illness.





Want to cite this post?

Kohn, J. (2012). The Army’s on Ecstasy: Marching Toward an Ethical Drug Policy. The Neuroethics Blog. Retrieved on
, from
http://www.theneuroethicsblog.com/2012/10/the-armys-on-ecstasy-marching-toward_3.html

Intrepid Grrrl Reporter: A Dispatch from the NeuroGenderings II Conference

Two weeks ago, I had the pleasure of attending the NeuroCultures - NeuroGenderings II Conference at the University of Vienna.
The conference brought together an international group of scholars to discuss brain
research on sex and gender from a feminist perspective. The conference was a
treat for me, as I was able to meet a number of leading scholars in the field,
including some of the people I have mentioned in previous blogs. I presented a poster on the course, "Feminism, Sexuality, and Neuroethics," which Cyd Cipolla and I co-taught last spring, and also presented a paper reviewing contemporary neuroscience research on transsexuality.

Although it is difficult to summarize two days' worth of
keynote speeches, panels, and poster presentations, I would say that two main
themes emerged within the conference: the first was a critique of neurosexism
both within scientific research on sex, gender, and brain and in how this
research is communicated to the public through the media. The second was an
attempt to explore whether it would be possible to conduct feminist neuroscience research on sex and gender and, if so, what
such research would look like.

Critiques of Neurosexism

My Poster Presentation

A number of the presenters at the conference carefully
analyzed how sexist assumptions inform a great deal of contemporary neuroscience
research on sex and gender. For example, in her keynote talk, Cordelia Fine analyzed
a representative sample of recent neuroimaging studies on language
lateralization. According to Fine, the studies reflected sexist assumptions in
three ways: 1) by exaggerating the extent of male-female differences; 2) by exaggerating
the functional importance of M-F differences (many of the researchers made
post-hoc speculations about the significance of M-F differences, i.e. greater
activation in X area in males compared to females may explain why men like
football more than women); and, 3) exaggerating the fixedness of these
differences by not investigating how differences might vary over time (plasticity)
or based on context.

Other scholars examined how neuroscientific research on sex
and gender is conveyed to the public by popular science writers. For example,
in her presentation, Odile Fillod analyzed the ways in which the theory that
oxytocin promotes maternal bonding in humans has been popularized in France.
According to Fillod, the theory has been used in some cases to support a
conservative agenda, specifically the idea that women are natural care-givers
whereas men are not.

Imagining a Feminist Neuroscience

Daphna Joel

A number of the presenters grappled with the question of whether
it would be possible to conduct feminist neuroscience research on sex and
gender and, if so, what such research would look like. Presenters came at this
question in very different ways. Keynote speaker Daphna Joel,
a practicing researcher in psychology and neuroscience, described how her
thinking was revolutionized after she found that 15 minutes of stress could
change a particular structure in a rat’s brain from the “male form” to the “female
form” (and vice versa). I highly recommend reading her article, “Male or female? Brains are intersex” in Frontiers
in Integrative Neuroscience in which she argues that there is no such thing as a “male brain” or a “female
brain.” At the conference, Joel suggested that a feminist neuroscience research
program would be attentive to the fact that the brain is a complex structure
with the ability to change over time, while investigating the ways in which sex
interacts with a variety of other factors to influence different brain
structures in complicated ways.

Isabelle Dussauge

Coming at the question from a very different perspective, Isabelle Dussauge led the audience through a thought experiment. Assuming the role of a historian
from the year 2090, she described what had happened in the 2020s and 2030s
after queer feminists created their own organization to fund queer/feminist neuroscience
research. She described an influential experiment funded by the organization, which
compared the neural mechanisms of desire between those from sexual or gender
minority groups and those from sexual or gender majority groups in order to
understand the effects of power differentials on neural mechanisms of desire.
Notable aspects of the experiment included the following: participants brought
in objects that they found arousing and non-arousing and were scanned while
interacting with those objects; in addition to scanning, extensive qualitative
interviews were conducted with participants; and, scanning and qualitative
interviews were repeated regularly over the span of two years. At the end of her talk, Dussauge expressed both doubt and hope that such an experiment would ever be conducted.

At the end of the conference, I don’t think we had resolved
the question of whether a feminist neuroscience research program on sex and
gender is possible or, if it is possible, what it would look like, but the
conference certainly got me thinking in all sorts of new ways. What do you
think? Is there such a thing as a feminist neuroscience research program on sex and
gender?





Want to cite this post?

Gupta, K. (2012). Intrepid Grrrl Reporter: A Dispatch from the NeuroGenderings II Conference. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/10/intrepid-grrrl-reporter-dispatch-from.html