Redefining the X and Y-Axes of Cognitive Enhancement

By Somnath Das

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

I am a Senior at Emory University and am currently pursuing a double major in Neuroscience and Chemistry. Currently, I am applying to medical school. My interest in healthcare lies primarily in understanding the behavioral motivations of patients as they navigate through various healthcare systems. I also wish to study how to effectively translate innovations powered by biomedical research into accurate health information for patients and optimized healthcare delivery. Neuroethics allows me to focus these interests onto patient dignity and rights when considering the role of novel therapeutics and interventions in treatment. Studying this fascinating field has given me a perspective on the role that deontological considerations play in both neuroscience and medicine as a whole. It is with this perspective that I hope to approach my patients with a balanced worldview, taking into account both individual rights as well as stakeholders and developers participating in a rapidly changing field.

Hearing from leading scholars at the Neuroethics Network was a once in a lifetime moment for me. Participating in a wide-ranging, multi-faceted discussion about frontiers in the field proved to be really engaging and fostered my development as a student. Each seminar challenged my understanding of various topics both within and beyond the field of neuroscience, and each speaker gradually enhanced my appreciation of what is a growing field.

One session that I particularly enjoyed focused on Science Fiction and Neuroethics. During the session, we viewed the movie Limitless. In the movie, Bradley Cooper takes NZT, which allows him almost unlimited cognitive abilities. He gains fame, fortune, and myriad positive and negative consequences. The movie asks us to consider both the benefits and drawbacks of cognitive enhancement; Cooper’s character eventually realizes that the drug not only enhances cognition, but this enhancement is to the detriment of his physical health. Compounded with the drug’s side effects are looming parties attempting to get their own fix, which put Cooper’s life in significant danger throughout the movie. In the end, the movie aims to balance out its own plot by blessing Cooper’s character with this drug followed by having him discover and contend with his own Achilles heel.

After the movie, the panel delved deeply into discussion about the movie’s themes, particularly what we can learn from science fiction when understanding science. The movie shows a young white male winning victories through the Western lens of success – i.e. an individualist and capitalist society’s perspective on what it means to truly win. Eventually, a member of the audience noted that the current debate on cognitive enhancement is Western-oriented, and thus provoked an intense discussion on how the movie and different societies perceive enhancement and success. One of the panelists noted that if a person from a collectivist society were to be offered cognitive enhancement, they would be concerned about whether their own social networks have access to enhancement as well. The fact that the drawbacks of NZT affected Cooper only physically could also be taken into consideration as a uniquely Western portrayal of enhancement. A movie from a collectivist society could have easily defined the drug’s side effects to include hampered ability to connect emotionally with others (or to be excluded from a group) and thus affect their ability to actively participate in society despite their newfound intelligence. Therefore, Limitless is a uniquely Western (perhaps even uniquely American) portrayal of the benefits of drugs that enhance our cognitive abilities. Yet, cognitive enhancement has the potential to affect all societies, not just our own.

Image courtesy of Flikr. 

Another fascinating idea that repeatedly came up during the panel focused on how cognitively enhancing drugs would shift or flatten a society’s own bell curve. Ethical considerations ranging from universal access to drugs to how these enhancers may change our definition of disability were brought up. However, throughout the discussion I gradually realized that before we begin discussing the bell curve’s distribution, we must also consider what exactly is on the y-axis; the panelists had a discussion about what exactly these drugs are helping, and one noted that cognitive enhancers strengthen already established neuronal networks that enable the user to be better at what they already knew was beneficial towards their self-gain. The movie, for example, did not discuss Cooper’s ability to predict and understand what others were thinking; yet a user’s theory of mind is part of their cognitive ability, too. Cooper’s sensory abilities and emotional intelligence were also not profoundly enhanced, but these abilities, too, are cognitive in nature. I went up and spoke to the panelist about this thought, and he told me that he felt that “cognitive” enhancement is a misnomer. These drugs do not enhance all cognition, but rather they strengthen already existing cortical networks to perform tasks that were previously learned such as typing on the computer, learning a new language, or computing a math problem. They are not creating a new person per se, they are rather bettering the old one.

Ethical considerations such as drug access for all and drug safety were repeatedly brought up during our Neuroethics debates in class as well as during the conference. However, there is a critical need to reassess our own perspective on how this debate really should be structured. Cognitive enhancement’s effects have already made deep inroads into our society [1], so a debate representing its efficacy across multiple parameters is necessary in order to safely control the regulation of this neurotechnology. Increasing globalization also means that cognitive enhancement is likely to affect societies other than our own, and thus there is a need to reframe the debate to have a global lens as well. As I learned from the Neuroethics Network, if we reframe the debate to reflect the reality of cognitive enhancement’s potential and limitations of the current technology and the multiple stakeholders affected by these neuroscientific developments, we will be more able to propose more fruitful uses of such neurotechnologies.

References



1. Mehlman, Maxwell J. "Cognition-Enhancing Drugs." The Milbank Quarterly 82, no. 3 (2004): 483-506.



Want to cite this post?

Das, Somnath. (2016). Redefining the X and Y-Axes of Cognitive Enhancement. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/redefining-x-and-y-axes-of-cognitive.html

Cognitive Enhancement in the Movie Limitless Through a Lens of Structural Racism

By Nadia Irfan

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

The Western society familiar to most of us attending the Neuroethics Network conference in Paris is certainly one that values and glorifies financial gain and socio-economic upward mobility. We are obsessed with the notion of the “optimal” self: an idealized image of a self that never tires, never ages, and is always running at its top performance. The Neuroethics Network Cinéma du Cerveau movie Limitless raises an interesting perspective about who represents this image, who achieves and maintains this lifestyle, and whether this optimal version only has value in a competitive context.

I think when representing cognitive enhancement, it is important to note the lens it is viewed through. Eddie Morra, the main character in the film, is played by Bradley Cooper, “a young, able-bodied, white, cis-gendered heterosexual male,” as noted by Dr. Karen Rommelfanger at the conference. This white male image, when paired with idealized cognitive enhancement, appeals to young and old demographics, with the young wrapped up in the sexiness of the drug, and the old fascinated by anti-aging.

An indirect display of inaccessibility to the drug is the social power to maintain possession once receiving it. Studies show that there is an implicit tendency for white participants to associate white faces with pleasantness and black faces with unpleasantness [1]. Taking this a step further, studies even show that race bias engages the same neural circuitry as a conditioned fear response [2]. This is already clearly reflected in society when you look at marijuana-related arrest disparities between African American and Caucasian citizens. Despite similar reported rates of use, African Americans are on average three times more likely to be arrested for carrying illegal substances than their white counterparts. All this is to shape how we contextualize the question: who gets this drug? Given the innate biases that already dictate how we criminalize certain groups, a cognitive enhancer such as the one depicted in Limitless may only further exacerbate issues of race and class inequalities and the audience is not forced to understand how with Eddie Morra as our lens. This is exemplified in Morra’s rise to political power by the end of the film. If financial access is dominated by the white majority of large-scale business owners and cognitive enhancement moves them to places of political power, the drug is reinforcing a social dynamic that is already in place. Further, Morra receives the drug through familial connection. Trickle down effect of obtaining the drug through connections like this would be nearly impossible since distribution would be kept to those deemed trustworthy. Cultural perception of trustworthiness is subject to earlier mentioned racial bias perpetuated by media such as the movie we are discussing now. And for those not in the know, at $800 a pop the price is a direct display of inaccessibility. Its use carries tones of Wall Street cocaine abuse, a designer drug.

Image courtesy of Flickr user, Claire.

At the end of Limitless, we are meant to celebrate Eddie Morra’s rise to the top. We are given no indication that he will necessarily do good with his superhuman ability, and yet the tone is very clearly to root for him. Would we still share this opinion if the main character wasn’t the epitome of where western ideology dictates power should be distributed? The drug here appeals to a world in which productivity overshadows moral values, but the audience’s discussion of who is “responsible” enough to gain access to this productivity changes when our lens does [4]. Inherent racial bias prevents an image other than a white male from possessing the fortitude and social responsibility to utilize the drug.

A second question sparked by this film was that of accountability. Are you the optimal self and if so, are you then accountable for all the actions performed under the drug? The subplot I have in mind for this question is Morra’s possible murder of a prostitute. The panel raised the issue of whether or not his lapse in memory warranted the disassociation between Morra and the murder. I think immediately of the case of Domenico Mattiello who manifested sexually abusive tendencies after developing a brain tumor. The same issues are raised in this subplot of what our limit is for holding someone accountable for the consequences of their actions when they may not have been coherent when making them. The difference in this case is there is now the added layer of responsibility of choosing to take an unapproved drug. The movie uses the mystery of the drug to take responsibility away from Morra and the audience celebrates as he gracefully slips out of the accusation. Again, we have to wonder if an audience would be so accepting of this if our lens were not through the character played by Bradley Cooper. Prejudice towards minority groups predict stereotypes of untrustworthiness that would not allow the potential murder to be swept under the rug so completely [1].

At the end of the movie Eddie Morra comes out singularly on top, creating a way to maintain enhancement without depending on a faulty substance. By doing this he beats out his competitor, Carl Van Loon. It is interesting that we do not root for Van Loon, as he embodies the struggle it takes to climb to the top. Similar to the discussion of race disparity, Van Loon has attributes that make him less appealing to root for. He’s older, he’s not as flirtatious or attractive, he didn’t do it first, and he’s a step behind. Our values change to support competitive edge [3]. Morra is ultimately the most appealing when he is at the very top, and this competitiveness discourages cooperation and solidarity [3]. The other component of this argument, made by Dr. John Harris at the conference, is that enhancement such as this is simply the next step of evolution, and that striving for progress is what benefits society the most. However, again I say this argument is largely due to the lens we’re given. Morra’s competitors were another wealthy businessman and an unintelligent Russian loan shark. Nothing is lost in this competitive scenario because the characters losing are not worth rooting for. We do not see the drug presented to a more collectivist-based culture, where the benefit of one is the benefit of all. Progress above all else is again reflected in Western contexts, and it would be interesting to see this drug’s value and whether it is still considered a gateway to the optimal self in a context where competition was not so favored.

Overall, I can honestly say I enjoyed the movie, but was even more captivated by the neuroethical implications found within it. How drugs such as these are presented to the public is an ethical concern in and of itself as it shapes the way we understand moral issues of the drug. In the movie and in the real world of cognitive enhancement, is it important to take into account the progression of Western socio-economic gain and how it is fostered by unequal distribution, how this competition feeds back into power structure dynamics and the political and justice system, how these structures relate to inequalities due to inherent structural racism as well as varied cultural values and how might they inform notions of fair or useful competition in society.

References

1. Amodio, David M., and Patricia G. Devine. "Stereotyping and evaluation in implicit race bias: evidence for independent constructs and unique effects on behavior." Journal of personality and social psychology 91, no. 4 (2006): 652.

2. Olsson, Andreas, Jeffrey P. Ebert, Mahzarin R. Banaji, and Elizabeth A. Phelps. "The role of social groups in the persistence of learned fear." Science 309, no. 5735 (2005): 785-787.

3. Cabrera, Laura Y. "How does enhancing cognition affect human values? How does this translate into social responsibility?." In Ethical Issues in Behavioral Neuroscience, pp. 223-241. Springer Berlin Heidelberg, 2014.

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Irfan, Nadia. (2016). Cognitive Enhancement in the Movie Limitless Through a Lens of Structural Racism. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/cognitive-enhancement-in-movie.html

Reflections on the Neuroethics Network Conference in Paris

By Thomasine Kushner 



*Editor's Note: Tomi Kushner is co-chair with Yves Agid for the Annual Neuroethics Network Conference in France. She had these reflections to offer.  The remainder of the posts this week will feature student reflections on various sessions in the conference. Enjoy!

The 3rd Neuroethics Network conference took place, June 29-July 1, 2016 hosted by ICM (Institut du Cerveau et de la Moelle épinière), Paris’ renowned Brain and Spine Institute. This annual conference brings together researchers, scholars and clinicians in neuroscience, neurology, psychiatry, and law to foster dialogue and interdisciplinary collaboration with regard to the ethical issues generated by advances in brain science.

A theme of the Neuroethics Network is that in order for neuroethics to be effective on an increasingly broader, more pluralized world stage, the field needs to “go global.” Contributing to a more international vision this year were delegates from: Argentina, Australia, Canada, France, Germany, Ireland, New Zealand, Serbia, Switzerland, The Netherlands, United Kingdom, and USA.

Echoing the diversity of the geographical representation was the wide variety of topics addressed, including: “Is the Brain Anything More than a 20-Watt Supercomputer?” (Yves Agid, ICM ,France), “Mosaics in Neuroethics: Piecing Together the Capacity Puzzle” (Joseph Fins, Weill Cornell Medical College, USA ) “How Smart Do We Want Machines to Be?” (John Harris, University of Manchester, United Kingdom) “Nonreductive Approaches to Human Neuroscience and the Care of Severe Brain Injury” (Grant Gillett, Otago Bioethics Centre, New Zealand).

A highlight of the meeting was the traditional “Cinema du Cerveau,” which shows a commercial film, followed by a panel commenting on the neuroethics dilemmas raised. This year the film was “Limitless,” in which “smart drugs” offer enhanced mental acuity but, as the plot unfolds, produce unforeseen consequences.

Emory University played a prominent role in the film session with Karen Rommelfanger, of the Neuroethics Program in the Center for Ethics, on
the panel and 21 Emory University students participating in the audience
discussion. Many of the students also continued their questions
throughout the next day and took advantage of the opportunities to speak
with our esteemed colleagues during the breaks.

The entire program and the roster of excellent talks can be seen here.

Introduced for the first time at a bioethics meeting were Electronic Posters, displayed on TV monitors throughout the meeting and to be posted on the Neuroethics Network website (under construction) for the coming year. Plans are already underway for next year’s Neuroethics Network meeting, June 19, 20, 21 2017, and E-Poster submissions are warmly welcomed.

The Neuroethics Network also heralded the establishment of “Clinical Neuroethics,” a new annual issue of “CQ the Cambridge Quarterly of Healthcare Ethics.” The first issue will make its debut in October 2016. Recognizing that the aim of brain science is to improve patient care, CN will serve as a forum for discussing how findings in the lab should best be applied to the real world of patient care. Thomasine Kushner serves as Editor and James Giordano as Associate Editor.

For information on the Neuroethics Network meeting in Paris, 2017, and Clinical Neuroethics, contact kushertk@gmail.com

Mental Alchemy

By Adina Roskies

Adina Roskies is Professor of Philosophy and chair of the Cognitive Science Program at Dartmouth College. She received a Ph.D from the University of California, San Diego in Neuroscience and Cognitive Science in 1995, a Ph.D. from MIT in Philosophy in 2004, and an M.S.L. from Yale Law School in 2014. Dr. Roskies’ philosophical research interests lie at the intersection of philosophy and neuroscience, and include philosophy of mind, philosophy of science, and ethics. Her recent work focuses on free will and responsibility. Dr. Roskies is also a member of the AJOB Neuroscience editorial board.

In the last several months I’ve attended a few workshops on the topic of “cognitive ontology.” One workshop, held at the Rotman Institute at the University of Western Ontario was entitled “Rethinking the taxonomy of psychology”; the other, at Macquarie University was called “Reshaping the mind: New work on cognitive ontology”. The basic question raised by these workshops is whether the concepts we use to investigate cognition and refer to its constructs and processes are the “right” ones, or the ones we ought to use. The way in which this question has been elaborated by the speakers at these meetings varies: the topic has very broad scope. In what follows, I’ll sketch a few of the ways it has been discussed. As you will see, although the topic is more centrally one of interest to philosophy of neuroscience and psychology, it also has potential ramifications for neuroethics.

The way in which I have been thinking of cognitive ontology is prompted by my interest in neuroimaging. Functional neuroimaging studies measure changes in blood flow that correlate with changes in neural activity. Cognitive neuroimaging attempts to relate the changes in neural activity to cognitive processes involved in the performance of various tasks. In order to do this, scientists typically attempt to analyze a complex task into its component processes, and then to identify brain regions or networks that implement these components. By careful task design and comparison between different conditions, neuroimagers attempt to understand the functional role of various brain regions or networks. This methodology raises a number of pressing scientific and philosophical questions. First, the way in which we analyze or functionally decompose cognitive tasks is largely based on intuition: it may seem relatively clear what steps one would execute in order to do a task if, for example, one wanted to program a computer to so it, but there is no guarantee that the brain uses the intuitive solution. And in other cases it may not at all be clear what steps one would employ. But what if the brain does not carve up tasks in the way that we do? Because of the nature of neuroimaging, we will always get patterns of brain activations that we can associate with our task decompositions. However, these may not correspond to the functions the brain actually employs. The fact that meta-analyses of neuroimaging studies by and large suggest that there is a many to many mapping of brain regions to functions may reflect that our intuitive taxonomy is incorrect, and that we are not carving the mind/brain at its joints (alternatively, it may just reflect that there is a many-many mapping). Moreover, one might wonder whether our methods will necessarily ratify the inaccuracies of our intuition, mistaken as they may be, or whether and how we can bootstrap ourselves to a better ontology.

Image courtesy of Wikimedia Commons

Scientists should be worried about this and many are. New methods are being developed that use brain data rather than intuitions about psychology to try to develop revised taxonomies of function. Whether such methods are necessary and whether they are preferable will depend in part on answers to general questions about structure-function mappings in the brain that are themselves matters of great debate. I expect we will hear much more about methodological developments and philosophical debates about these topics in the near future.

A very different area in which the question of cognitive ontology comes up is with regards to the question of the status of folk psychology, otherwise called belief-desire psychology. Here contemporary questions about brain organization and function intersect with classic debates in the philosophy of mind regarding the nature of intentional states. It is interesting to ponder whether today’s neuroscience bears on the issue of whether mental states such as beliefs and desires are real, whether they are good ways of talking about the mind, or whether they are so off-base that they should be abandoned and replaced with a better cognitive ontology. While some cognitive constructs have been argued not to exist on the basis of failure to find reliable activations, it is yet unclear whether this “New Wave Eliminativism” as Tim Bayne has called it, has philosophical roots in classical eliminativist positions. If the current eliminativism is just the tip of an iceberg, neuroethicists may have a big job to do: our social, moral and legal worlds are anchored in folk psychology.

Perhaps the clearest way in which we are already rethinking our cognitive ontology is in the realm of psychiatry. The new DSM-V is not the only game in town: the NIH has instituted a more brain-focused scheme called RDoC, which requires psychiatric diseases and research programs to identify plausible neural mechanisms. Moving psychiatry from a symptom-based to brain-centered discipline will have effects on diagnosis, on research funding, on societal reaction, and even perhaps on clinical outcome, all of which should be of concern to neuroethicists.

The question of cognitive ontology is really many questions, and they are difficult ones to parse and to answer. It is unclear to me whether the questions are largely academic and we are really not badly off, or whether we are instead in the neuroscientific dark ages, not unlike the position of alchemists prior to the development of modern chemistry. The fact that I can’t tell makes the topic doubly interesting.

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Roskies, Adina. (2016). Mental Alchemy. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/mental-alchemy.html

Should Getting High be a Possible Treatment for Depression?

By Maria Paula Martinez

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Maria Paula Martinez is a student of a joint degree program majoring in Neuroscience and Behavioral Biology at Emory University and Biomedical Engineering at Georgia Institute of Technology. She is 20 years old and originally from Bogota, Colombia.

What if instead of the traditional and usually ineffective serotonin-reuptake inhibitors (SSRIs) used to treat depression, we could provide patients with a drug that directly mimics the effects of serotonin, the “happiness neurotransmitter”? Not only have such compounds been around for over a millennium, but they are the active ingredients in psychedelic drugs such as magic mushrooms. A scientific paper released in The Lancet Psychiatry this past May opened the possibility for compounds like psilocybin, the active ingredient of “shrooms”, to potentially treat depression. A group of researchers in the Imperial College of London were able to give psilocybin to 12 patients with depression who had unsuccessfully tried at least two different treatment types and had suffered from depression for an average of 17.8 years. The results of this preliminary study were astonishing. Not only did all patients show significant improvements after a single week of treatment, but the remission rate was double that of patients given SSRIs in a three-month treatment period (Cormier, 2016). Even though these are only preliminary results, it seems there is little control over how the media decides to portray these results, and what is likely to happen when these news articles reach the hands of patients with depression is not promising. “Magic-mushroom drug lifts depression in first human trial” and “How Magic Mushrooms Could Treat Depression” are only two of the titles of the news articles about this study. Both in prestigious journals, Nature News and Time, respectively, they portray an erroneous view of how this hallucinogen can be used as a treatment for depression and make the line between illicit drug and therapy a blur.

Psilocybin is a psychedelic drug of abuse that causes hallucinations and reduces inhibition (Park, 2016). Even though psilocybin itself does not cause physical dependence, the tolerance level of the drug can increase rapidly and withdrawal symptoms are observed when its use is stopped. According to the US Department of Justice, psilocybin is illegal because of the potential for negative physical and psychological effects under its use. Aside from producing hallucinations and impairing the ability to discern reality from fantasy, panic reactions and psychosis may also result from its consumption (Baumeister et al. 2014). The most common side effects include anxiety, paranoia, depersonalization and “bad trips,” but these vary based on personal predispositions (Tyl et al. 2014).

Psilocybe mexicana, image courtesy of Wikipedia.

In the Lancet study, researchers used a very controlled environment to ensure the safety of the patients. All of the subjects received two doses of psilocybin, 7 days apart from each other, in a dark room with psychological support present. Support was also provided before and after each session and patients were assessed periodically up to 3 months after the treatment to ensure that no psychotic symptoms developed (Carhart-Harris et al., 2016). The authors of the study claim that there is much to consider before psilocybin becomes a viable treatment option, but the results do suggest that psilocybin could be a possible treatment in the future (Cormier, 2016). However, if you had a condition that compromised your quality of life dramatically—to the point that you consider ending your own life— wouldn’t you take the risk of self-medicating with psilocybin, even if it is illegal?

The problem with research on such controversial topics is that it will reach most of its audience through a media that tends to misinform people and give them a false sense of hope. People suffering from depression who, based on studies like this, decide to use “shrooms” for the purpose of getting better could be at risk. One could argue, like the authors of the study do, that serotonin receptor agonists like psilocybin do not have the negative psychological effects that were previously thought. After all, recent studies have shown that this compound helps stabilize hyperactivity in the medial frontal cortex, which is directly associated with depression (Carhart-Harris et al., 2012); reduces anxiety (Gasser et al., 2014); lessens depressive and obsessive compulsive symptoms (Ballenger et al., 2008); and reduces addictive behaviors in tobacco users (Johnson et al., 2014). All of this evidence suggests that the label, rather than the effects, is what makes this drug illegal, but such conclusions were drawn from studies like the recently published Lancet study that were conducted in safe and controlled environments. This would not be the case if a patient with depression decided to self-administer psilocybin as treatment to improve her mood. Due to the perceptual alterations and heightening of emotions associated with the drug, dangerous behaviors could occur when not taken in a safe and controlled environment (Johnson, Richards and Griffiths, 2008). However, this is not what people have access to through the media displays of the results. With results portrayed as so promising, what prevents the rest of the population from starting to self-medicate to treatment their depression or perhaps to enhance their mood?

Psilocybin experience session. Image courtesy of Wikipedia. 

In the USA, psilocybin is classified as a Class I drug, along with MDMA and heroin, due to the potential for its abuse and the fact that it has no current acceptable medical use (Nutt, King and Nichols, 2013). The risks associated with the use of psilocybin are especially threatening for patients with depression who might have less predictable responses to psilocybin (Tyl et al. 2014). For a healthy individual, the worse that is likely to happen if they are found possessing psilocybin is imprisonment, but in the case of patients with depression who have an increased susceptibility for “bad trips,” the lack of control with which they could potentially ingest this drug could lead to worsening of their conditions and even self-inflicted harm (Amsterdam, Opperhuizen and Brink, 2011). The use of psilocybin and other hallucinogenic compounds might have a bright future as a treatment for depression, but the time period between the release of the preliminary results and the actual development of a viable treatment that is accompanied by suitable regulations will likely be long.

In the meantime, as psilocybin is promoted through the media as a therapeutic approach for depression, it may become more socially acceptable to use this drug, thus obscuring the reasons why it was made illicit to begin with. These reasons include, but are not limited to, the safety concerns around psilocybin’s use. Marijuana’s transition into becoming a legal drug started with its medical use and the stigma surrounding the drug decreased to the point where not only did people not see it as “bad”, but its use is becoming more and more legal for recreational purposes and its consumption is increasing (Cerdá et al. 2012). The question becomes: do we want psilocybin to follow in this path when we do not fully understand the long-term consequences the hallucinogen will have for both patients with depression and for healthy individuals?

As humans, we have a tendency of bending scientific results to align with our existing beliefs and biases. Carhart-Harris, the primary author of the Lancet study, told Time that the experience under the effects of psilocybin is a faster psychotherapeutic approach “that changes the way you feel and think so you feel differently about yourself” (Park, 2016). This is the perfect example of how, through media, the use of psilocybin seems like an experience that we should all have; we might not all suffer from depression, but we surely do have personal issues that might benefit from one or multiple of these “sessions”. The main problem with this study is not the research itself, but the fact that its overly positive portrayal might persuade people to use hallucinogens for its possible antidepressant effects regardless of whether one is diagnosed with clinical depression or warranting a prescription for antidepressant drugs.

Psilocybin may not be as harmful of a drug as others in the same controlled substance category, but this does not mean that there are no risks associated with its use. We must think carefully about how to discuss, research, and translate the use of psilocybin from the bench to the real world.

References

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doi:10.1016/j.euroneuro.2013.12.006

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Martinez, Maria Paula. (2016). Should Getting High be a Possible Treatment for Depression? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/should-getting-high-be-possible.html

Dopamine Stimulating Headphones and How They Can Change Our Definition of Being High

By Laura Morales

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Laura Morales is 21 years old and originally from Panama. She is currently a senior pursuing a double major in Neuroscience and Behavioral Biology and Psychology in Emory University in Atlanta, GA.

If you have ever heard a song that sends chills down your spine, relaxes your entire body and gives you a general feeling of being close to ecstasy, you have experienced the “high-like sensation” the makers of Nervana wish to tap into. The company Nervana has designed a set of headphones that, while playing music, transcutaneously send electrical signals into the left ear to stimulate the vagus nerve to match the frequency of the beat of the music. The vagus nerve is involved with activation of the parasympathetic nervous system, which is normally activated when the body is at rest. This nerve stimulation results in the release of neurotransmitters like dopamine, serotonin and endorphins—these are transmitters thought to be related to that “feel-good” sensation (Ashby & Isen, 1999). Vagus nerve stimulation has been used to treat epilepsy (Schachter & Saper, 1998), although the mechanism through which it works is not well understood. While reducing seizures, there have also been reports that vagus nerve stimulation has improved the overall mood in people with epilepsy (Terry Jr, 2014). Transcutaneous vagus nerve stimulation has also been shown to have equivalent anticonvulsive effects as the more invasive method (Ellrich, 2011). Similar to this therapeutic approach, Nervana advertises their headphones as promoting wellness and recommends the headphones be used twice a day for 45 minutes to improve mood and increase general health.

According to the World Health Organization (WHO), a psychoactive drug is a substance that “when taken in or administered into one’s system, [affects] mental processes.” Many drugs of abuse like methamphetamine and cocaine work by modifying levels of neurotransmitters, especially dopamine (Di Chiara & Imperato, 1988). If Nervana use alters neurotransmitter levels, what makes the headphones different from consuming a drug that results in the equivalent kind and degree of neurotransmitter change?

What makes it socially acceptable (or socially insignificant) that these headphones stimulate the release of neurotransmitters, yet lack any additional regulations over the average pair of headphones? On their website, the company Nervana claims that they have found no evidence of dependence to the use of their headphones in the hundreds of humans in which they have tested the product. They also say that, because the stimulation can make the person feel more relaxed, it should not be used while operating heavy machinery—not dissimilar from warnings that come along with something like cough syrup. Even though the company has not found any signs of dependency, measuring the changes in neurotransmitter sensitivity caused by constant stimulation would require a more extensive, longitudinal study. After decades of research into the use of cannabis, only recently has it been shown that consistent use blunts the brain’s response to dopamine (Volkow et al, 2014). If constant exposure to neurotransmitter stimulation can blunt the brain’s response and increase the threshold for the neurotransmitter to have an effect, one wonders if a similar effect or desensitization would accompany long-term use of Nervana. More extensive research on the use of these headphones and how the headphones can alter brain function must be done, and if they have been done by the company, the data should be released for consumers to know that the product is safe.

Image Courtesy of Flikr user Naveen Jamal.

Neuroscientists still do not fully understand the brain’s plasticity—its way of making chemical and structural changes throughout life (Dagranski et al, 2004). Neurotransmitters seemingly are sensitive to whatever we expose ourselves to, but for some reason a pair of headphones that alter their activity seem more harmless than a chemical substance that is actively ingested but also alters neurotransmitter function.

The more we understand about neuroplasticity, the more ways we will find to push the limits, to change normal functioning and to alter the way we feel through external stimulation. Does this mean we would eventually have to revisit our meaning of what it is to be under the influence? Even though there are no imaging studies provided, there are likely to be some similarities between the dopaminergic pathways being activated by the vagus nerve stimulation of the headphones and other drugs that alter dopamine activity. Even though vagus nerve stimulation is used to treat epilepsy, there is a difference in what might be safe in a therapeutic approach versus a recreational approach and how we might weigh risks versus harms when one is sick versus healthy. While it may sound absurd to create a dependency to listening to music using a specific set of headphones, it is imperative to note that we do not understand the pathway through which they may be altering the brain.



It is difficult to see a pair of headphones as potentially presenting a risk, but if it is altering the brain’s chemical composition, even by stimulating endogenous change in the brain, it could potentially have the same effects as drug use. Of course, everything will stimulate an endogenous change in the brain (Draganski et al, 2004), whether it is via a drug or everyday learning, from the coffee you may have had this morning to reading this now. The more we learn about the brain, the more ways we will find to technologically alter it. The main issue is not that there might be a change in the brain that produces an alteration in mood, because we also rely on activities such as yoga and drinking tea to change our mood, but rather that these headphones have the potential to produce changes in ways that are unclear and therefore in ways that challenge one’s ability to mediate an endogenous change. Hence, such technologies require more cautious use and research on long-term effects and potential dependency. We must be wary about the potential risk of using neurotechnologies that might seem harmless, such as headphones, as well as the allure to experiment with novel technologies, especially when the impact of those technologies on our brains is not well understood.

References

Schachter, S. C., & Saper, C. B. (1998). Vagus nerve stimulation. Epilepsia,39(7), 677-686.

Terry Jr, R. S. (2014). Vagus nerve stimulation therapy for epilepsy. Epilepsy Topics. InTech, 139-160.

Volkow, N. D., Wang, G. J., Telang, F., Fowler, J. S., Alexoff, D., Logan, J., ... & Tomasi, D. (2014). Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity. Proceedings of the National Academy of Sciences, 111(30), E3149-E3156.

Patel D., (2016), Nervana Dopamine-Stimulating Headphones Crowdfunds Nearly $600,000. The Huffington Post. Retrieved from http://www.huffingtonpost.com/deep-patel/nervana-dopamine-stimulat_b_9810332.html

Psychoactive substances (n.d.) In World Health Organization: Terminology & classification. Retrieved from http://www.who.int/substance_abuse/terminology/psychoactive_substances/en/

Di Chiara, G., & Imperato, A. (1988). Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Proceedings of the National Academy of Sciences,85(14), 5274-5278.

Ashby, F. G., & Isen, A. M. (1999). A neuropsychological theory of positive affect and its influence on cognition. Psychological review, 106(3), 529.

Draganski, B., Gaser, C., Busch, V., Schuierer, G., Bogdahn, U., & May, A. (2004). Neuroplasticity: changes in grey matter induced by training. Nature,427(6972), 311-312.

Ellrich, J. (2011). Transcutaneous vagus nerve stimulation. Eur Neurol Rev,6(4), 254-6.

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Morales, Laura. (2016). Dopamine Stimulating Headphones and How They Can Change Our Definition of Being High. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/dopamine-stimulating-headphones-and-how.html

The Ethical Implications of Harvesting Human Organs from Pigs

By Anayelly Medina

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Anayelly is a rising Senior at Emory University majoring in Neuroscience and Behavioral Biology.

The Chimera is a Greek mythological fire-breathing monstrosity composed of multiple animal parts with the head of a lion, the body of a goat, and the tail of a snake. Not surprisingly, in the realm of science, chimera is also the name given to an organism or embryo containing a mixture of cells from two species. Recently, the world has learned of the current research efforts being made towards growing human organs in other animals, specifically pigs [2,3,4,5]. From these efforts, the human-pig chimera has been developed and so have ethical questions concerning the process and outcomes of this research.

According to the United Network for Organ Sharing, in the United States, about 22 people die each day while waiting for an organ transplant. This shortage of organ transplants has played a role in fueling researchers’ interests in developing alternative methods to solve this problem. One proposed method [5], by Pablo Ross, involves creating a human-pig chimera embryo, inserting it into the uterus of a pig, allowing it to develop, and having an end result of the growth of a human organ as the chimera develops. The process of creating the chimera, in this case one that will potentially develop a human pancreas, first involves removing the DNA in a pig embryo that would allow it to grow a pig pancreas. This removal process is conducted through a gene editing technique known as CRISPR. The CRISPR process involves utilizing a protein molecule such as CAS9 to cut out the targeted DNA section from a DNA strand. The CAS9 enzyme includes a guide RNA (gRNA) that matches up to the target DNA section and removes it. The removal of the pig’s DNA section creates what is called a “niche” (void) in the DNA strand; human induced pluripotent stem cells, or iPS, are then injected into the embryo when it’s just a few cells in a petri dish [2]. Researchers then hope that these injected human stem cells will take advantage of the void in the DNA and result in the development of a pig fetus growing a human pancreas. This human organ would then be compatible with a human patient from whom the iPS cells are derived, reducing the risk of organ rejection by the body. The potential ability to grow human organs inside of other animals in order to solve the organ donor/transplant shortage seems like a proposal without faults. Nevertheless, the future of this technology could lead to the purposeful growth of a human brain in a different species. Purposefully growing a human brain in a different species would raise a multitude of questions regarding their placement/personhood on the human/ animal scale. Furthermore, there are questions surrounding the ethics of such a procedure that must be addressed.

The mythical chimera, courtesy of Flickr user Eric Parker

One of the concerns that arises when dealing with interspecies embryos is determining their value. These embryos contain both pig and human DNA; as such, at what point do we determine whether such an organism “counts more” as an animal or a human? As professor Stuart Newman states, “you’re getting into unsettling ground that I think is damaging to our sense of humanity” [4]; furthermore, bioethicist Jason Robert states that “one of the concerns that a lot of people have is that there's something sacrosanct about what it means to be human expressed in our DNA” [4]. For individuals who believe that human nature and our humanity lies in the sequencing of our genes, the idea of having animals containing human DNA may result in them questioning their “personhood”. Are they less of a person or are the animals now more like a person? As stated by Regalado, “the worry is that the animals might turn out to be a little too human for comfort” [3].

Another main concern of this research involves the process of inserting human genes into the pig embryo but then having some of these genes migrate into the developing pig’s brain. The concern is that this migration of human stem cells into the brain of the animal could result in chimeras acquiring a cognitive state [2] and make them more human [3]. Once again, the deontological issue of determining what side of the human/nonhuman side these animals are on arises. As stated by Imam, “mental condition is an intrinsically human experience” [2]; if these chimeras were to develop a cognitive state, what would occur in terms of continuing with the procedure? Would these chimeras now hold autonomy? Researchers, such as Lowe, offer a solution, stating that “with every organ we will look at what's happening in the brain and if we find that it's too human like, then we won't let those fetuses be born" [5]. Lowe’s proposed solution has its own issues. At what point in the developmental stage are these chimeras considered to hold a cognitive state (if a human brain were to show signs of development). Ultimately, the old question of what “counts” as life arises once again. Furthermore, when considering humans, according to Farah, we wouldn’t sacrifice one healthy human for five life-saving organs [1]; if these chimeras were to develop a cognitive state, would such a notion hold true for them as well?

The concern surrounding these ethical issues, especially that of altering cognitive function, is evident through the National Institute of Health’s (NIH) refusal to fund this research in the United States [1] [Ed. note: this may be changing]. In other locations, such as the UK, guidelines for research involving animals containing human genetic material have already been established. Finally, what must also be considered in this research are the rights of the animals since the procedure requires surgical techniques and alterations of their genetic code that are yet to be fully understood. In addition, if such a technique were to function, then the development of organ farms would also be concerning to both humans and animals. The possible development of “organ farms” would raise further questions regarding the ethics of creating a new market for human organs.

References

1. Farah, M. 2015. An Ethics Toolbox for Neurotechnology. 86: 34-37.

2. Imam, J. 2016. Human organs grown in pigs may help transplant patients, scientists say. Cable News Network (CNN). June 9. Available at: http://edition.cnn.com/2016/06/09/health/human-organs-chimera-irpt/index.html (accessed June 11, 2016).

3. Regalado, A. 2016. Human-animal chimeras are gestating on U.S. Research Farms. MIT Technology Review. January 6. Available at: https://www.technologyreview.com/s/545106/human-animal-chimeras-are-gestating-on-us-research-farms/ (accessed June 11, 2016).

4. Stein, R. 2016. In Search For Cures, Scientists Create Embryos That Are Both Animal And Human. NPR. May 18. Available at: http://www.npr.org/sections/health-shots/2016/05/18/478212837/in-search-for-cures-scientists-create-embryos-that-are-both-animal-and-human (accessed June 12, 2016).

5. Walsh, F. 2016. US bid to grow human organs for transplant inside pigs. BBC News. June 6. Available at: http://www.bbc.com/news/health-36437428 (accessed June 12, 2016).

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Medina, Anayelly. (2016). The Ethical Implications of Harvesting Human Organs from Pigs. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/the-ethical-implications-of-harvesting.html

A Battle of Nerves

By Sol Lee

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Sol Lee studies Neuroscience and Behavioral Biology at Emory University. As a pre-med student, he is enthusiastic about primary care and global health concerns. Sol is currently doing research on glutamate receptors in Parkinson’s Disease in the Smith Lab.

Absolutely preposterous. This was the response of British doctors in 1916 as they declared heresy to Frederick Mott’s proposal: that post-traumatic stress disorder (PTSD) coincides with an abnormal physical alteration of the brain. PTSD is caused by traumatic events or extreme stressors such as war, personal assaults, and car accidents. Symptoms include negative changes in feelings or beliefs, constantly feeling jittery or alert, having difficulty sleeping or concentrating, and experiencing flashbacks. Physicians and scientists at that time, and until recently, believed that PTSD simply meant emotional trauma. After one hundred years, however, new research suggests that Mott may have been right.

In a New York Times article [1], Robert Worth expands on current PTSD research and details its close ties with explosive blasts experienced during war. For years, explosive blasts were thought to have similar effects as concussions, and blast-related injuries were treated as such. Neuropathologist Daniel Perl, however, realized that blast-injured brains and brains of PTSD patients display tangible patterns of dust-like scarring, which are quite different from the tau buildup in concussed brains.

For some, this news generates a sigh of relief. It may ease one’s mind to realize that symptoms of PTSD are associated with a neurological wound, as opposed to a purely psychological one. It may also help to ameliorate the stigma against PTSD, as some veterans may not want to admit to an invisible psychological disorder. For others, such as the military, this news means that more time, energy, and money must be invested into exploring biological correlates of PTSD. In the past, military authorities refused to treat PTSD because they believed PTSD to be a retreat from war. In more than a few morbid instances, blast-injured and rattled soldiers who fled from battle were sentenced to death by firing squad. PTSD is now regarded more seriously and psychological treatments have been pursued, but redefining PTSD and the toll of war on the brain and body in a biological context means looking at this age-old disorder with a fresh perspective.

Ethical gray areas emerge with any kind of new research, and this issue is no different. For example, if a person with PTSD commits a crime, how will this research affect the legal outcome against the defendant? Will neuroimaging scans demonstrating neurological abnormalities in patients with PTSD be accepted as evidence in court? Because juries are prone to be biased towards scientific evidence, the legislative system should be careful in implementing biological evidence of PTSD until further research is done. At this point in time, scientists do not know whether neurological scarring in PTSD is only caused by PTSD and to what degree the biological correlates of PTSD accurately reflect the state of the illness in a patient. This evidence may be more likely to convince juries to mitigate sentences even more so than the fact that a person is a veteran, but the issue of implementing this kind of evidence lies not only with people’s interpretation of the science, but also with the accuracy of the currently underdeveloped science behind PTSD. Because the logistical, social, and legal ramifications of PTSD have been shaped around beliefs that PTSD is a mostly psychological disorder, new research that suggests otherwise will challenge existing standards and regulations for treating PTSD.

Soldier from the US Army, image courtesy of Wikipedia

Such data has already impacted the way we think about and treat PTSD. PTSD is being treated more seriously as an illness, and the military has given credence to ongoing research on neurological injuries by requiring soldiers to wear gauges that register possible concussions and brain injuries that could contribute to PTSD and also register other brain injury related sequelae, like memory loss and mood changes. This implementation, however, imposes a series of questions. What about soldiers who want to continue fighting despite potential brain injury? Is it ethical to pull soldiers out of a crucial operation? Against their will? Currently, a team has developed a checklist to identify concussed soldiers, but six versions of the checklist had to be created because so many soldiers were memorizing the correct answers in order to stay on the battlefield [1].

For soldiers who do need it, however, medical help should be available. Studies have shown that health care reforms of the 1990s have greatly improved the quality of treatment and efficiency of the Veterans Health Administration [2], but care must be taken to ensure that new policies and treatments are properly implemented into the existing system. This is important to note as trauma not only affects soldiers, but also victims of sexual abuse and auto accidents. Perl’s research focused on PTSD caused by blasts, but developmental, physical, and experiential trauma can be innately unique and demand distinct treatment methods. Trauma is also known to affect adolescents with developing brains differently than adults with mature brains. Perl’s research does not prove anything conclusive on its own, but highlights the fact that our current understanding of PTSD is still in its infancy.

More research must be done to confirm and add to the knowledge that we have on PTSD. Moving forward, we must not forget that PTSD does have a psychological component, and that there is no denying the success of psychotherapy for PTSD [3]. This is crucial to note because just as some may find solace in the physical aspect of PTSD, others may feel even more helpless and doomed by a seemingly irreversible biological disorder. These victims must not forget, however, that there is a silver lining: neuroplasticity is real, and experiences change the brain. Neural pathways are continuously changing and can and improve with new experiences [4]. Research on biological correlates of PTSD should continue and should complement, not compete with, existing treatment methods.

Change can be difficult, especially when there are boundless implications and ramifications to this issue of PTSD. However, this is exactly why we must continue seeking progress on this issue. Researchers estimate that over 24 million people have PTSD at any given moment. They also estimate that the real number may be much higher, as soldiers may be too proud to report a wound that they don’t consider to be ‘real.’ In order to properly set the tone for the future of PTSD, one of the most crucial steps is to be personally aware and to educate others about the importance of PTSD research and the need to reduce stigma against mental disorders. As the public becomes more aware of the comprehensive effects of PTSD, more research and better treatment methods will be pursued and developed. Better helmets and expanded veteran care are a good start, but they should just be the beginning of a nationwide reexamination of trauma. As we study the brain and discover more and more fuzzy lines between physical and emotional injuries, we must carefully consider the naivety with which we once viewed PTSD and retain a humility about the limits (and future horizons) of our current understanding of mental illness.

References

1. Worth, R. F. (2016). What if PTSD is More Physical than Psychological? The New York Times, June 10. Available at: http://www.nytimes.com/2016/06/12/magazine/what-if-ptsd-is-more-physical-than-psychological.html

2. Oliver, A. (2007). The Veterans Health Administration: An American Success Story? The Milbank Quarterly 2007;85(1):5-35. doi:10.1111/j.1468-0009.2007.00475.x.

3. Tran, K., K. Moulton, N. Santesso, and D. Rabb. 2016. Cognitive Processing Therapy for Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis [Internet]. CADTH Health Technology Assessments.

4. Bryck, R. L., & Fisher, P. A. (2012). Training the Brain: Practical Applications of Neural Plasticity From the Intersection of Cognitive Neuroscience, Developmental Psychology, and Prevention Science. The American Psychologist, 67(2), 87–100. http://doi.org/10.1037/a0024657

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Lee, Sol. (2016). A Battle of Nerves. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/a-battle-of-nerves.html