The freedom to become an addict: The ethical implications of addiction vaccines

by Tabitha Moses 

Tabitha Moses, M.S., is Administrative and Research Coordinator at Lehman College, CUNY, as well as a Research Affiliate at the National Core for Neuroethics at the University of British Columbia. Tabitha earned her BA in Cognitive Science and Philosophy and MS in Biotechnology from The Johns Hopkins University. She has conducted research in the areas of addiction, mental illness, and emerging neurotechnologies. She hopes to continue her education through a joint MD/PhD in Neuroscience while maintaining a focus on neuroethics.

The introduction of “addiction vaccines” has brought with it a belief that we have the potential to cure addicts before they have ever even tried a drug. Proponents of addiction vaccines hold that they will:

1. prevent children from becoming addicted to drugs in the future, 


2. allow addicts to easily and safely stop using drugs, and 


3. potentially lower the social and economic costs of addiction for society at large.

However, it is critical to be aware of the limitations and risks - both ethical and physical - of introducing these vaccines into mainstream medical care.

A child receives a vaccine in the 1930s

Before delving deeper into this discussion, we must understand that the term addiction vaccine is a misnomer. The vaccine itself is against a specific drug or substance, not against addiction in general. Currently these vaccines have been produced for nicotine, cocaine, and heroin. (See a previous blog post on cocaine vaccines here). While the different types of addiction vaccines have varying mechanisms, the end result is that an individual who has received the vaccine against a specific substance - cocaine, for instance - will no longer feel any of the effects of the substance that are typically associated with the high. As a result, the idea is that a person can never become addicted to a substance that does not have any physical or emotional feelings associated with it. It is also important to understand what is meant by addiction here. While there is still much controversy surrounding the underlying cause and neurological underpinnings of addiction, in general, addiction can be best described as “an inability to control use [or a substance or behavior], and that’s often best described as continued use despite potently negative consequences.” For more on the topic, see a previous post by Dr. Mike Kuhar on addiction here and an interview with Dr. Steve Hyman here.

It is, however, not an “addiction vaccine." The idea is that preventing an individual from feeling the highs associated with a certain substance will also prevent addiction to that substance. That said, if a nicotine-vaccinated individual tried a cigarette because she was craving a certain release and felt no sensation upon having one, there is nothing stopping her from finding a different high. As such, the vaccine does not stop all addictions per se.

When the news broke about these types of vaccines there were many parental groups espousing the potential positive impact the vaccines would have on their children. Some parents and even researchers suggested the idea of adding these vaccines to the regular pediatric vaccine schedule. However, while addiction indisputably has a negative impact on the individual and his or her family and friends, this vaccine is not in the same category as those in the regular vaccine regimen. Increasing evidence suggests that addiction is not just about the substance at hand, but about many other factors. The majority of addicts become addicted to substances as a result of deeper underlying mental health issues, and exposure to early life trauma and adversity. Removal of one substance will not remove the underlying problems or prevent addiction to other substances or behaviors. Frequently, without the appropriate care, an addict may stop using a specific drug only to replace it with another drug or behavior (substitution). Therefore, by vaccinating children against cocaine we are only stopping them from feeling effects of cocaine, not from becoming an addict.

Chart comparing past year psychiatric disorder between individuals with and without

alcohol and drug use disorder--created by the author from data drawn from Stinson et al.

Additionally, while the deadly viral and bacterial infections against which we usually vaccinate (such as polio, measles, and tetanus) have no known benefits, certain drugs do have potential benefits (for instance, nicotine, LSD, MDMA, and marijuana). If we permanently block the ability of the body to respond to these drugs, this could have future detrimental effects for the individual. For instance, if these drugs are developed for medical purposes the person who was vaccinated will not be able to receive the benefits of the drugs.

Furthermore, the question of autonomy falls heavily into play here. While it seems absurd to think that an individual might want the right to become addicted to a drug, it is less outrageous to believe that he or she might want the right to know firsthand what the effects of the drug are. Many people, particularly artists and others who work in creative fields, cite numerous professional benefits to using certain illicit drugs occasionally. And keep in mind, not everyone who tries a drug will become addicted to it. While others may not agree with these methods, and in particular with the legal implications, it would be difficult to argue that it is ethical to take this option away from a person before she is able to understand it.

If these vaccines are not to be given to children, the question that naturally follows is: when would it be appropriate to provide them to adults? For adults, the biggest concern with the vaccine is that of fully informed consent. To be able to make a fully informed decision, a person should be able to understand all implications. This is not possible unless she has experienced being under the influence of a certain drug. Unfortunately, this leads to its own set of ethical quandaries. Should we insist an individual sample a drug to know the “high” prior to receiving the vaccine? It seems completely unethical to insist that an individual, who is asking to not become addicted to a drug, try the very substance she actively wants to avoid. Although, it could also be unethical to remove the ability for a person to ever feel a certain way without that person’s full awareness of the substance’s effects. 

Image by Senior Airman Areca Wilson

However, we must ask what level of informed consent is necessary: We do not require a person to experience a disease prior to receiving a vaccination that prevents that disease. Do the effects of drugs such as cocaine and nicotine fall into this type of category? While there may be no perfect situation in which to provide the vaccine to people, there may be opportunities where it could be used as a therapeutic tool in concert with intensive therapy and treatment. In these cases the person receiving the vaccine should be sober and not in the severe stages of withdrawal when receiving the vaccine. There does not appear to be any situation in which it is appropriate to provide the vaccine non-consensually, be it to children or to individuals unable to consent.

The commonly overlooked question in much of this discussion is why individuals become addicted to certain substances. Addiction is not merely a result of a physiological addiction to a substance; for example, some individuals become addicted to substances as a result of deeper underlying mental health issues. Removal of one substance will not remove the underlying problems or prevent addiction to other substances or behaviors. Therefore, these addiction vaccines would likely not result in a reduction of addiction in general, but rather in the reduction of addiction to the substance for which the vaccine is crafted.

Addiction vaccines have the potential to mask the issue and lead to potentially larger problems. In their current form, they are by no means a cure, and in most circumstances they are unlikely to be appropriate. Nonetheless, these vaccines could play an important role in addiction treatment if administered with proper consent in appropriate situations. While these vaccines have the potential for good, the focus of addiction research should be on the underlying processes that lead to initiating and then continuing drug use as well as factors that lead to relapse.

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Moses, T. (2015). The freedom to become an addict: The ethical implications of addiction vaccines. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/12/the-freedom-to-become-addict-ethical.html

Combating neurohype

by Mo Costandi

Mo Costandi trained as a developmental neurobiologist and now works as a freelance writer based in London. His work has appeared in Nature, Science, and Scientific American, among other publications. He writes the Neurophilosophy blog, hosted by The Guardian, and is the author of 50 Human Brain Ideas You Really Need To Know, published by Quercus in 2013, and Neuroplasticity, forthcoming from MIT Press. Costandi also sits on the Board of Directors of the International Neuroethics Society.

In 2010, Judy Illes, president elect of the International Neuroethics Society, argued that neuroscientists need to communicate their research to the general public more effectively. Five years on, that message is still pertinent - and perhaps even more so.

Since then, public interest in neuroscience has continued to grow, but at the same time, coverage of brain research in the mass media is often inaccurate or sensationalist, and myths and misconceptions about the brain seem to be more prevalent than ever before, especially in areas such as business and education.

Why is this? And what can be done to remedy the situation? A handful of studies into how neuroscience is reported by the mass media and perceived by the public provide some answers – and reiterate the point made by Illes five years ago.

Several years ago, for example, researchers at University College London analysed nearly 3,000 articles about neuroscience research published in the three best-selling broadsheet and the three best-selling tabloid newspapers in the UK between 1st January 2000 and 31st December 2010.

They conclude that “research was being applied out of context to create dramatic headlines, push thinly disguised ideological arguments, or support particular policy agendas,” and that “neuroscientists should be sensitive to the social consequences neuroscientific information may have once it enters the public sphere.”

Photo courtesy of Pexels

More recently, researchers in the Netherlands examined the reporting on neuroscience in Dutch newspapers. They found that the quality of the coverage depends largely on the time a paper is released, its topic, and the type of newspaper, and that the accuracy of reporting tended to be low, with free and popular newspapers in particular tending to provide a minimal amount of detail.

Researchers sometimes criticize journalists for reporting on neuroscience inaccurately, and press officers at academic institutions and scientific journals can also be subjected to criticism about over-hyped press releases, which are often the source of bad reporting. In one recent case, a correlation between high-strength marijuana and white matter integrity was widely reported as a causal relationship (compare the paper, the press release, and the subsequent media reports). But as another recent study showed, researchers are not entirely faultless, as they sometimes contribute to these processes by providing their press office with exaggerated information about their findings.

Accordingly, there are a number of things that researchers can do to counteract misrepresentations and misunderstanding of neuroscience. Paramount among these is that they communicate their own work and that of others as accurately as possible, without overstating their interpretation of any findings, and also emphasizing any limitations and caveats the research might have.

This mostly refers to interactions with journalists who are reporting on new findings, but growing numbers of researchers are taking to social media – especially blogs and Twitter – as a way of both engaging with the general public, and with each other, directly.

By disseminating accurate information, researchers may help improve the quality of reporting about neuroscience, and help to stem the tide of misunderstanding about the brain. And it could be argued that they have a moral responsibility to do so.

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Costandi, Mo (2015). Combating neurohype. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/12/combating-neurohype.html

Getting aHead: ethical issues facing human head transplants

By Ryan Purcell

Gummy bear head transplant, courtesy of flickr user Ella Phillips

In a widely circulated Boston Globe editorial this summer, Steven Pinker told bioethicists to “get out of the way” of scientific progress. There is abundant human suffering in the world today, he said, and the last thing we need is a bunch of hand wringing to slow down efforts to attenuate or even eliminate it. The prospect of head transplantation, however, has the potential to make us all a bit more appreciative of our local bioethicists. Even if there were not any technical issues (of which, there are of course plenty), coming to terms with the muddier personal and societal issues inherent in a procedure such as this could take quite a while. Nevertheless, Dr. Sergio Canavero is not planning to wait around and wants to perform a human head transplantation by the end of 2017. Are we ready?

Dr. Jordan Amadio, an Emory neurosurgery resident and co-founder of Neurolaunch, led a discussion on the topic at the Emory Center for Ethics Neuroethics Program’s November “Neuroethics, Neuroscience, and the News” series. As a neurosurgeon he was able to shed light on the technical aspects of Dr. Canavero’s proposal to a full room of students and faculty members from across the humanities and sciences (the topic drew quite a bit of interest on campus). In short, Dr. Amadio was skeptical. Unlike peripheral nerves, spinal nerves do not readily regenerate (but see this ref). There has been an enormous effort in neuroscience and physiology to understand how to regenerate spinal nerves. If this problem could be solved, spinal cord injuries would be less likely to lead to debilitating paralysis. However, Canavero believes he is ready to move beyond this prodigious hurdle using ultra-sharp instruments to cleanly sever the spinal cord with minimal tissue damage (unlike the traumatic break due to a car accident, for example) and using “fusogens” like polyethylene glycol (also commonly used as a clinical laxative) to fuse the donor and recipient spinal cord segments. Dr. Amadio’s conclusion on the science was clear: there is no strong evidence that Canavero’s “Gemini spinal cord fusion” protocol will work (as an aside, the protocol was published as an editorial in Surgical Neurology International).

Undoubtedly, researchers will continue to explore how to regenerate spinal nerves. So if the procedure were technically feasible, should it be attempted? There are huge risks involved, even for a terminally ill prospective patient. As Dr. Hunt Batjer, the president of the American Academy of Neurological surgeons commented to CNN, “there are a lot of things worse than death.” Debilitating, unmanageable neuropathic pain, for example, is a real possibility. Who knows whether one individual’s brain and spinal cord could communicate effectively with another’s spinal cord and body? NYU medical ethicist Dr. Arthur Caplan notes that “The brain is not contained in a bucket—it integrates with the chemistry of the body and its nervous system.” He calls the idea of head transplantation “rotten scientifically and lousy ethically.” Researchers are only beginning to understand the ways in which peripheral organs such as the gut (our “second brain”) and the microbiome within it affect brain function and mood. While this remains an emerging area, it is becoming clear that – no matter how sharp the knife – one cannot cleanly separate the brain (or the mind) from the body.

Will head transplants waste potential organ donations?

There are also considerable concerns related to justice and fairness. The donor for such a procedure would have to be a young, healthy individual who likely died of a traumatic brain injury but whose body was in pristine condition for transplant. There is a considerable opportunity cost here for the thousands of patients waiting for organ donations. In fact, nearly two dozen people die in the US every day while waiting for an organ donation. This donor body could end up providing many critical organs, which would all be lost should Dr. Canavero’s procedure fail. At what probability for success would this opportunity cost be acceptable? At first glance, this seems like the opposite of the trolley problem – should you try to save one person while putting five or more at higher risk of death? I’d also add, who are you saving? The body or the head?

What would this surgery mean for personal identity? Apparently Dr. Canavero believes that the body is simply a vehicle for the brain and that we should not let deteriorating bodies limit our lifespans. This seems to be an extreme view that glosses over the role of the body (below the brainstem) in an individual’s sense of self. To quote Frederik Svenaeus from his 2012 article on organ transplantation and personal identity, “The self becomes attuned through its bodily being, and such attunement is necessary for all forms of human understanding (that we know about).” In other words, even if your brain was kept alive, you might not be. Granted, a patient with a severe degenerative disease (like Canavero’s first volunteer) may not be concerned about identity issues with a pressing need to extend his life, but this concept should give pause to those hoping that in the future they could simply trade in their bodies as they start to fail. Not to mention, the definition of self and identity may differ across cultures.

Head transplants: 1960's science fiction come to life

Dr. Canavero understands that the idea of head transplantation is on the cutting edge (so to speak) and that it will likely make many people uncomfortable. Perhaps this is why he has launched a personal PR campaign including a TEDx talk. Yet he does not seem to fully appreciate the ethical implications of his proposed procedure. He told The Guardian that in science, “what can be done, will be done” and, matter-of-factly that “Cloning will come into play,” presumably to get around those nasty whole-body tissue rejection issues. Somewhat unsurprisingly, Dr. Canavero has lost the support of his colleagues in Italy (where the surgery is now illegal) and will be moving to Harbin, China seeking a less constraining regulatory climate. Indeed, he claims in the same article that the choice to participate in the surgery should be up to the patient. The surgery will be expensive but Canavero claims there is great enthusiasm and fundraising potential from the ultra-rich, presumably stoked by his talk of life-extension.

For his part, Dr. Canavero does have some mainstream support. Dr. Michael Sarr, a retired Mayo Clinic surgeon and Editor-in-Chief of the academic journal Surgery was quoted in The Guardian as saying, “I’m confident that at least in theory the operation will work. The science is there.” Canavero, too, dismisses his critics, claiming that all scientific revolutionaries were dismissed early on. So, are we ready for this? It may not matter as ethicists, surgeons, and the world will just have to watch as Dr. Canavero continues to push forward, full speed “a-head.”

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Purcell, Ryan (2015). Getting aHead: ethical issues facing human head transplants. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/12/getting-ahead-ethical-issues-facing.html

Don’t miss our Special Issue of AJOB Neuroscience: The Social Brain

By Katie Strong, PhD

If you haven’t already, be sure to read the 6.3 Issue of AJOB Neuroscience, our special issue on The Social Brain guest edited by Dr. Jean Decety. The issue centers on the biological, neuroscientific, and clinical evidence for human social cognition, along with the philosophical and ethical arguments for modifying morality and social emotions and behaviors, such as empathy, trust, and cooperativity.

The first target article by Jean Decety and Jason M. Cowell entitled “Empathy, Justice, and Moral Behavior” argues that despite the importance of empathy for driving our social lives, forging necessary social bonds, and making complex decisions, empathy alone is not enough in regards to moral resolutions and judgements. While empathy underpins cooperativity and the formation of social bonds, empathy has evolved to promote bias and in-group social preferences. The target article provides evidence that empathy does not always lead to moral decisions, and empathy often favors in-group members over out-group members. Decision making can be biased to favor relatives or a single individual over many people and for that reason, reasoning must accompany empathy. “Empathy alone is powerless in the face of rationalization and denial. But reasoning and empathy can achieve great things,” state the authors at the conclusion of the paper.

The second target article that focuses heavily on moral judgment is called “How the Mind Matters for Morality”. Authors Alek Charkroff and Liane Young discuss how the intentions behind an action guide moral judgement. The authors of the paper report that when judging others, intent matters. For example, an accident that causes harm to another with innocent intentions is deemed more forgivable than malicious intentions that have no consequence. But does intent matter when it comes to actions that have no victims, such as purity violations (incest or ingesting taboo foods)? According to a study cited in the target article, we do not weigh the intentions of those who commit harmful acts and impure acts as identical; participants judged accidental harms less morally wrong than accidental incest and the intent to harm as more morally wrong than the intent to commit incest. The authors conclude that a variety of controversial topics in bioethics include what many consider purity violations, such as suicide, cloning, sexual reassignment, and human enhancement. While many condemn these acts because they are harmful to others, we may also be averse to these actions because we regard them as purity violations. Understanding how these contentious acts are judged could reshape certain aspects of many bioethical debates.



The three remaining target articles discuss “the social brain” with specific respect to psychopaths, children, and caretakers. In “A Neural Perspective of Immoral Behavior and Psychopathy,” Tasha Poppa and Antoine Bechara review the evidence in the literature that tie together emotional deficits and immoral behavior – traits of those diagnosed as psychopathic – with dysfunction in specific neural pathways. The authors speak to other contributing factors as to why individuals may participate in immoral behaviors aside from brain abnormalities, including genetic factors, child abuse, and certain environmental stressors. Although rehabilitative treatments for psychopaths has not proven successful, further studying the origin of these psychopathic behaviors may yield more personalized and more effective treatments towards modifying behaviors. “Social Support Can Buffer Against Stress and Shape Brain Activity” by Camelia E. Hostinar and Megan R. Gunnar focuses on the neural mechanisms behind social support for stress with an emphasis on how this impacts children. Children benefit immensely with regards to interpersonal skills and even brain development when raised in an environment that offers parental support. For that reason, the authors suggest a number of social support systems for parents and child-care workers that would encourage positive environments for children (with a positive impact on their brains) including longer paid maternity and paternity leave and home-visitation programs for at-risk families (advocating for these techniques over other neurointerventions such as oxytocin nasal spray).



The final target article, “Improving Empathy in the Care of Pain Patients” by  Philip L. Jackson, Fanny Eugene, and Marie-Pier B. Tremblay cite studies indicating that healthcare workers are not as perceptive or empathic as non-experts when it comes to the pain of patients and therefore risk underestimating levels of pain. Authors provide a number of reasons for this behavior, including gender and race bias, self-preservation against a decline in mental exhaustion, and desensitization following years of exposure. Despite this lapse of empathy, the authors are wary of interventions —such as transcranial direct-current stimulation (tDCS) or oxytocin nasal sprays—that would be designed to improve or enhance empathy of healthcare. Even noninvasive behavior medications such as training programs would need to be further studied to determine the impact on physicians’ mental wellbeing. Improving empathy by any means though is fraught with ethical concerns if “we are aiming for “suprahuman empathy” by labeling as a deficit what should be seen as a healthy empathic response given the situation,” the authors of the paper remind us. 

The 6.4 Issue of AJOB Neuroscience will be hot of the presses soon and will include two target articles: “An ethical evaluation of stereotactic neurosurgery for anorexia nervosa” by Sabine Müller et al. and “A threat to Autonomy? The Intrusion of Predictive Brain Implant” by Frederic Gilbert. Check back with The Neuroethics Blog for a press release and synopsis of the articles!

References



(1) Liane Young, R. S. When Ignorance Is No Excuse: Different Roles for Intent across Moral Domains. Cognition 2011, 120 (2), 202–214.



(2) Expertise Modulates the Perception of Pain in Others. Current Biology 2007, 17 (19), 1708-1713 (accessed Nov 17, 2015).



(3) Decety, J.; Yang, C.-Y.; Cheng, Y. Physicians down-Regulate Their Pain Empathy Response: An Event-Related Brain Potential Study. NeuroImage 2010, 50 (4), 1676–1682.



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Strong, K. (2015). Don’t miss our Special Issue of AJOB Neuroscience: The Social Brain. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/12/dont-miss-our-special-issue-of-ajob.html