Is Neuromarketing Influencing Pathological Shopping Behavior?

By Elena Lopez

Elena Lopez is currently pursuing her BBA at Goizueta Business School and is also pursuing a degree in Neuroscience at Emory College of Arts & Sciences. She is involved in volunteer-related organizations that help those with limited resources and offer free consulting services, such as Volunteer Medical Interpretation Services and Emory Venture Strategic Partners. Elena developed a curiosity for neuroethics after attending the NBB Paris study abroad program and the 3rd international Neuroethics Network conference. She hopes to combine her passion for science and business in her future career goals.

Just over a month has passed since the biggest holiday shopping season of the year, and many Americans are already planning how they will financially recover from their overspending and failed budgeting plans. Financial sites like Forbes and the CNBC personal finance page have already come out with articles titled "Oops, you overspent on the holidays" and "Holiday spending hangover? Get your finances back on track" in an attempt to help consumers recover from financial losses. Months before the frenzy began, NBC reported that the National Retail Federation forecasted sales for November and December 2016 would increase 3.6% from last year to reach a whopping $800 billion dollars- with 90% of those sales consisting of online purchases (Weisbaum, 2016). With the growing presence of the digital component in sales and advertising, interactions between consumers and retailers can be tailored to the individual and offer greater shopping experiences. In the same NBC report, Deloitte stated that digital interactions likely influence two-thirds of every dollar spent (Weisbaum, 2016).

According to the 2016 Holiday Purchase Intentions Survey conducted by the National Purchase Diary (NPD) group, a market research company that specializes in consumer shopping trends, more than 20% of consumers went over their planned budgets in 2015 (Weisbaum, 2016). Another finding also indicated that a year later, 22% of people were still paying off last year’s holiday purchases (Weisbaum, 2016).

While it is not uncommon for some people to get euphoric during the holiday season and overspend, there could be a significant risk for those who are particularly vulnerable to over-spending. In today’s consumer world, both the myriad of options to choose from and the abundance of discounts tagged throughout stores and in online promotions are likely tapping into shoppers’ impulse control (or lack thereof). In short, advertisements and product placements could be contributing to overspending, especially in particularly vulnerable consumers.

What is compulsive buying?

Image courtesy of Flickr.

A small number of consumers have an especially hard time controlling their shopping urges. Compulsive buying (CB) is a term that describes an individual’s impulsive and irresistible urge to purchase an item. This urge only fades once a purchase has been made and results in a ‘high’ for the consumer (Weinstein et al., 2016). Compared to other ‘addictive’ behaviors like sexual, Internet, and gambling addictions, CB is associated with those who have higher incidences of personality traits that involve novelty seeking, harm avoidance, and reward dependence (Granero et al., 2016). Based on a nationwide telephone survey conducted in 2004 that assessed the prevalence of compulsive buying in the U.S. adult population, researchers estimated that 5.8% of the 2,513 respondents could be classified as compulsive buyers (Black, 2007). In a more recent meta-analysis conducted using three different databases (Medline, Web of Science, & PscyhInfo) in hopes of identifying all articles mentioning CB, researchers found the prevalence of CB to be around 4.9%, and higher in certain subgroups: 8.3% for university students and 16.2% in shopping-specific examples (Maraz et al., 2016). In a Norwegian study investigating the development of a new set of tools to aid in determining shopping addiction, researchers developed a new scale that incorporated psychometric properties that would capture core addiction criteria for the diagnosis of CB, which had been previously ignored (Andreassen et al., 2015). The scale developed was called the Bergen Shopping Addiction Scale (BSAS) and included elements of addiction to ensure its validity in an addiction framework (Andreassen et al., 2015). The study demonstrated that the BSAS could prove valuable in epidemiological studies and treatment settings because the scale had reliable psychometrics, structure, convergent and discriminative validity, and effective content, after relationships from various statistical methods were considered (Andreassen et al, 2015). While substantial debate exists around the efficacy of such scales, 18 million Americans could be affected if these studies prove to be generalizable to the whole country.

Due to the pervasiveness of people displaying addictive-like symptoms while shopping, (including: cravings, loss of control, psychological & physical withdrawal symptoms, development of tolerance, and more; Alavi et al., 2012), CB was proposed for inclusion in the DSM-5 as a behavioral addiction along with other pathological behaviors like gambling (Grant & Chamberlain, 2016). However, unlike other addictive behaviors like drinking or doing drugs, shopping is often normalized by society. CB suffers from the same conceptual tension as many behavioral addictions in that it seems to be less legitimized than substance-related addictions. After significant debate, CB was ultimately rejected for inclusion in the DSM-5 (Grant & Chamberlain, 2016); even so, the repetitive and debilitating behavior affiliated with CB results in a multitude of issues ranging from substantial debts to damaged relationships (Black, 2007).

Image courtesy of Wikimedia Commons.

Currently, the biology of CB and treatment strategies for CB remains unresolved. Recent findings have concluded that behavioral addictions have similar neurochemical effects as substance addiction, inducing the involvement of specific reward systems (e.g., dopaminergic system) (Alavi et al., 2012). Although the validity and reliability for the diagnostic criteria for CB is still under question, and no formal criteria has been accepted into the DSM, CB diagnoses involve face-to-face interviews assessing a person’s buying behavior and attitudes, the person’s associated feelings, and how often the idea of buying and shopping runs rampant in their mind. This method has been widely accepted by the research community (Granero et al., 2016).

Though treatment options for CB are still being explored and there has been an increase in patients seeking treatment for CB (Granero et al., 2016), no gold-standard exists. Researchers have investigated the current status of treatments and have directed future potential research plans for CB, spanning across both psychotherapy and pharmacotherapy (Hague et al., 2016). Other recent experimental evidence suggests a core component of treating CB lies in the training of impulse control (Hague et al., 2016). In pharmacotherapy treatments, selective serotonin reuptake inhibitors (SSRIs) did not show significant efficacy in regards to treating CB when compared to a placebo (Hague et al., 2016). Nonetheless, a lack of clarity clearly remains in both these treatment options and further longitudinal studies should be implemented to fill the gaps current research provides.

The influence of neuromarketing

Image courtesy of Wikimedia Commons.

In the past decade, the focus on neuromarketing has proliferated as top brands, like Coca-Cola, Google, and Disney, have started using neuroimaging techniques to improve their marketing strategies (Hartston, 2012). Neuromarketing involves using a plethora of scientific measures, including fMRI brain imaging, EEG, heart rate, breathing patterns, and eye movement to gather data with the hope of increasing the efficacy of ad placements and product promotions (Hartston, 2012). Neuromarketing services, by design, tend to assist in creating advertisements and product layouts that bypass a consumer’s ‘rational’ decision-making to instead influence the consumer’s unconscious buying motivations. According to one study, advertisements that maximize emotional and brand attachment and activate various reward pathways (like the mesolimbic dopaminergic pathway) in participants’ brains generated the greatest response in “willingness to pay” (Hartston, 2012). This could not only affect the general population, but may also elicit more powerful effects for those who suffer from CB.

In an fMRI study, researchers scanned brains of participants who were identified as being compulsive or non-compulsive buyers during purchase decisions using strict criteria, such as currently undergoing psychotherapeutic treatment due to their CB behavior (Raab et al., 2011). Raab and colleagues found that being presented with a product and its price resulted in higher striatal activation in compulsive buyers compared to non-compulsive buyers. These data suggest that hyperactivation of dopaminergic regions is associated with compulsive shopping behavior (Raab et al., 2011). For those who suffer from CB, having hyperstimulated reward areas may undermine the individual’s conscious decision to avoid making such purchases and may instead promote impulse decisions to reoccur unconsciously, similar to a drug addict being unable to resist a craving against better judgment (Hartston, 2012).

The difference between traditional marketing and neuromarketing research is in the method of data collection and what those results reveal. Both methods of marketing research work towards the same goal of improving advertisement strategies and brand management for the product and/or company; yet, because neuromarketing discloses ‘hidden information’ that normal focus groups would not, certain results derived from neuromarketing research could manipulate behavior beyond what traditional marketing methods notice. For example, in a World Advertising Research Center conference, Jon Harper, the global head of brand and communications for Synovate, presented his findings of consumer responses on a controversial Lebron James ad, using both traditional and neuromarketing techniques. He found that the ad performed poorly using a traditional marketing survey, but surprisingly scored well on SRI’s “Neuroengagement score" that tracks EEG and eye-movements (Dill, 2011). The participants rated being upset by the ad—with overall negative feelings— but the neuromarketing research revealed that the viewers were extremely engaged and held a high level of attention throughout the ad (Dill, 2011). As this instance indicates, companies can use neuromarketing methods to augment traditional marketing methods to construct the most convincing marketing strategy for their product. Market specialists can also directly determine the specific content in ads that activate reward sensitive areas and grab the consumers’ attention, with the hope of challenging impulse control.

Image courtesy of Flickr. 

As with most impulses, time usually acts as a protective barrier and reduces the urge to act (Hartson, 2012). However, online shopping allows consumers to have non-stop access to buy almost anything at anytime, placing compulsive buyers at an all-time risk. In a study investigating online CB as a specific form of Internet addiction, researchers found that individuals with a high sensitivity for shopping excitability, characterized by their compulsive buying scale ranking and a craving assessment, were at a higher risk of using online shopping sites excessively and developing online CB because they were more prone to the gratification of their online purchases, as compared to those with no CB tendencies (Trotzke et al., 2015). Companies like Amazon, through a careful cultivation of algorithms, promote a considerable number of products that the consumer may not have even wanted to buy in the first place and enable the consumer to peruse merchandise at their leisure. A study investigating consumers’ attention in shopping situations used eye tracking to evaluate the attentional processes that comprise CB (Buttner et al., 2012). The results demonstrated that compulsive buyers were more likely than non-compulsive buyers to get distracted by products unrelated to their goal, suggesting there is an attentional bias present in compulsive buyers (Buttner et al., 2012).

The need for more directed research to understand the potential danger of neuromarketing on CB

Products and services that are known to be harmful to consumers, like tobacco and indoor tanning, already have warning labels attached to them. What if an ad could influence a consumer to exhibit pathological behavior and continue to spend in the face of negative consequences like extreme debt or dangerous hoarding? Should these ads also then carry warning labels? What prevalence of CB is necessary in the population before officials step in and enforce regulations to protect vulnerable populations?

Neuromarketing has been seen to augment (instead of compete with) traditional marketing methods. Traditional market research is already subject to principles of ethical marketing that seek to promote fairness, transparency, and responsibility in advertising. While neuromarketing research could unveil data that determines which advertisements activate the striatum, it is still uncertain whether these findings could actually promote impulsive-compulsive behavior more than traditional marketing campaigns (Javor et al., 2013). That is why it is even more important to start thinking about guidelines that would hinder predation on vulnerable groups if newer studies reveal the true detrimental impact of neuromarketing on those with impulsive-compulsive buying behavior. Already, a group of neurologists agree that some individuals, including children, minorities, and those with psychiatric disorders, need special protection against specifically targeted neuromarketing practices (Javor et al., 2013).

Furthermore, since only a small percentage of the population exhibits CB and neuromarketing is still relatively new, studies have not yet investigated the prolonged effects of the use of neuromarketing on the potential increase in CB prevalence, the development of a more severe compulsion, or its impact on other pathological behaviors.

Image courtesy of Wikimedia Commons.

Many companies are now viewing neuromarketing as a way to gain insight into (what they purport are) previously unattainable customer preferences, like emotional and unconscious responses to various advertisements. The scientific validity, integrity, and unregulated aspects of neuromarketing are still being debated in this new conglomerate field, making neuromarketing a critical subject for neuroethicists to explore (Diallo, 2016). In a previous post on this blog, Dr. Rebecca Von Der Heide, a director of neuroscience for Nielsen Consumer Neuroscience, has shed some light on how she reduces the ethical skepticism associated with the notions of mind-reading while using neuroimaging methodologies for marketing (Diallo, 2016). Her company uses procedures that protect the rights of all research participants and agree to conform with the Neuromarketing Science and Business Association’s code of ethics (Diallo, 2016)

Finally, as neuromarketing has become more mainstream, neuroethicists have an important role in mediating how such brain research is interpreted and applied to advertisements (Ulman et al., 2015). More specifically, the application of neuroimaging techniques raises key ethical questions related to personal privacy. With the potentially revealing and personal data that neuromarketing research can uncover, what safeguards can be put in place to protect study participants in the consumer arena? And who will ultimately own these data, the participant? Or will the data exist as a company asset to be bought and sold? Three groups of experts should be consulted in the formation of these guidelines: those who can acquire the necessary data and analyze it correctly, those who can advice on the value conflicts of stakeholders in the neuromarketing enterprise, and those who can provide patient stakeholder perspectives. Moving forward, new guidelines incorporating the knowledge and insight of neuroscientists as well as the input of neuroethics experts and the professionals from groups such as Debtors Anonymous could be extremely valuable.

References



Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., Setare, M. (2012). Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. International Journal of Preventative Medicine, 3(4), 290-294. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354400/



Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6(1), 14–18. Retrieved from: http://www.psychiatry malaysia.org/file_dir/128534499346199d718a7b6.pdf#page=16



Buttner, O.B., Paul M., Florack, A., Leder, H., Schulz, A. M. (2012). Compulsive buyers show an attentional bias in shopping situations. Advances in Consumer Research, 40, 1121-1121. Retrieved from: http://www.acrwebsite.org/volumes/1012225/volumes/v40/NA-40



Diallo, I. E. (2016) Consumer neuroscience vs. skepticism: an inside look at the challenges of a novel field. The Neuroethics Blog. http://www.theneuroethicsblog.com/2016/01/consumer-neuroscience-vs-skepticism.html



Dill, F. (2011). Company Neuromarketing and Traditional Market Research. The Eponymous Pickle. Retrieved from http://eponymouspickle.blogspot.com/2011/09/comparing-neuromarketing-and.html



Granero, R., Fernandez-Aranda, F., Mestre-Bach, G., Steward, T., Baño, M., Pino-Gutierrez, A…. Jimenez-Murcia, S. (2016). Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions. Frontiers in Psychology, 7(914), 1-12. Retrieved from https://doi.org/10.3389/fpsyg.2016.00914



Grant, J. E., Chamberlain, S. R. (2016). Expanding the definition of addiction: DSM-5 vs. ICD-11. CNS Spectrums, 21, 300-303. doi:10.1017/S1092852916000183



Hague, B., Hall, J., Kellett, S. (2016). Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence. Journal of Behavioral Addictions, 5(3), 379-394. DOI: 10.1556/2006.5.2016.064



Hartston, H. (2012). The case for compulsive shopping as an addiction. Journal of Psychoactive Drugs, 44(1), 64-67. DOI: 10.1080/02791072.2012.660110



Javor, A., Koller, M., Lee, N., Chamberlain, L., Ransmayr, G. (2013). Neuromarketing and consumer neuroscience: contributions to neurology. BMC Neurology, 13, 13. doi:10.1186/1471-2377-13-13



Maraz., A., Griffiths, M. D., Demetrovics, Z. (2016). The prevalence of compulsive buying: a meta-analysis. Addiction, 111(3), 408-419. Retrieved from doi: 10.1111/add.13223.



Raab, G., Elger, C. E., Neuner, M., Weber, B. (2011). A neurological study of compulsive buying behavior. Journal of Consumer Policy, 29(1), 3-14. DOI 10.1007/s10603-011-9168-3



Trotzke, P., Starcke, K., Müller, A., & Brand, M. (2015). Pathological Buying Online as a Specific Form of Internet Addiction: A Model-Based Experimental Investigation. PLoS ONE, 10(10), e0140296. http://doi.org/10.1371/journal.pone.0140296



Ulman, Y. I., Cakar, T., Yildiz, G. (2015). Ethical issues in neuromarketing: “I consumer, therefore I am!” Science and Engineering Ethics 21(5), 1271-1284. doi: 10.1007/s11948-014-9581-5



Weinstein, A., Maraz, A., Griffiths, M.D., Lejoyeux, M., Demetrovics, Z. (2016). Compulsive Buying– Features and Characteristics of Addiction. Neuropathology of Drug Addictions and Substance Misuse, (3), 993-1007. http://dx.doi.org/10.1016/B978-0-12-800634-4.00098-6



Weisbaum, H. (2016). Consumers Will Spend Almost $800 Billion on Holiday Shopping. NBC News. Retrieved from http://www.nbcnews.com/business/consumer/consumers-will-spend-almost-800-billion-holiday-shopping-n667646





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Lopez, E. (2017). Is Neuromarketing Influencing Pathological Shopping Behavior? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/01/is-neuromarketing-influencing_28.html

Neuroethics and the Third Offset Strategy

By Jonathan D. Moreno

Jonathan D. Moreno is the David and Lyn Silfen University Professor at the University of Pennsylvania where he is a Penn Integrates Knowledge (PIK) professor. At Penn he is also Professor of Medical Ethics and Health Policy, of History and Sociology of Science, and of Philosophy. Moreno is an elected member of the National Academy of Medicine and is the U.S. member of the UNESCO International Bioethics Committee. A Senior Fellow at the Center for American Progress in Washington, D.C., Moreno has served as an adviser to many governmental and non-governmental organizations, including three presidential commissions, the Department of Defense, the Department of Homeland Security, the Department of Health and Human Services, the Centers for Disease Control, the Federal Bureau of Investigation, the Howard Hughes Medical Institute, and the Bill and Melinda Gates Foundation. Moreno has written several books, including Impromptu Man: J.L. Moreno and the Origins of Psychodrama, Encounter Culture, and the Social Network (2014), The Body Politic, Mind Wars (2012), and Undue Risk (2000). He has also published hundreds of papers, articles, reviews and op-eds, and frequently contributes to such publications as The New York Times, The Wall Street Journal, The Huffington Post, Psychology Today, and Nature. In 2008-09 he served as a member of President Barack Obama’s transition team. His work has also been cited by Al Gore and was used in the development of the screenplay for “The Bourne Legacy.”

A new U.S. strategic doctrine called the third offset poses an important challenge for the field of neuroethics. The neuroethical issues related to national security were not among those discussed at the Dana Foundation’s landmark “Mapping the Field” conference in 2002. But only a year after the Dana conference, Nature published a tough editorial called “The Silence of the Neuroengineers.” The editors accused Pentagon-funded investigators of failing to respond to, or even consider, questions about the potential uses of technologies like brain-machine interfaces. An indignant letter from the chief scientist at the Defense Advanced Research Projects Agency (DARPA) suggested that the Nature editors harbored a prejudicial attitude, failing to take into account the medical advances that could eventuate from DARPA-funded neuroscience (1). Since then the possible military and intelligence applications of modern neurotechnologies has stimulated a modest literature (2). Nonetheless, the field is still underperforming in its attention to the national security environment.

The Pentagon, image courtesy Wikimedia.

The arguments for intensifying a focus on what might be called neurosecurity are many, including a steady pattern of substantial funding in the tens of millions for neuroscience projects by various national security agencies. Though DARPA has received the most attention among those who have followed these developments, both the Intelligence Advanced Research Projects Agency (IARPA) and the Office of Naval Research (ONR) have substantial programs in fields like electro-magnetic neurostimulation and computational neuroscience. As well, the dual use argument that reverberated in the exchange about the Nature editorial points up the momentum behind federal funding for neuroscience. Even those who worry about “militarized” science are put in the awkward position of threading a moral needle when, for example, new prosthetics for severely incapacitated persons are in the offing and when new therapies for dementia and trauma are so desperately needed. Such is the case in the U.S. Brain Initiative in which DARPA plays a key role.

In my own work I have tried to locate national security neuroscience in both the history of science and the history of national security doctrine, especially in the U.S. Seen through those lenses there are important overlapping cases that illustrate the fact that, though the relevant technologies are vastly improved, neurosecurity is not a new concern for defense planners. Since the ancient world commanders have striven to achieve psychological advantages over adversaries, advantages that ranged from propaganda to narcotics. The two world wars saw the introduction of intelligence tests and personality inventories. Cold war intelligence and military officials worried about whether a new compound called LSD-25 could be used as a “truth serum” or a way to demoralize fighters. As strange as these concerns might seem to us now, still more bizarre were serious explorations of ESP like “remote viewing” and telekinesis.

One important lesson of American warfighting capacity during World War II was that although U.S. industrial might out produced all the other protagonists in terms of sheer quantity, the quality of war materials often lagged behind that of Nazi Germany and Imperial Japan. Therefore since the Truman administration a consistent premise of U.S. policy has been that of technological superiority over all actual and potential adversaries. This posture has virtually assured that even implausible “technologies” that might confer an advantage will be considered. It has also resonated well with a country that has been transformed into a post-World War II national security state in which essentially all sectors play a role in the defense of the nation and all societal purposes and resources may be subordinate to national security goals.

U.S. Army "CyberCenter of Excellence," courtesy of Wikimedia

The appreciation of the importance of a technological edge has been characterized among U.S. defense planners as an “offset strategy.” For that community nuclear weapons comprised the first offset in the face of a Soviet enemy with significant numerical advantages in conventional weapons. For all its MAD quality (the doctrine was called “Mutual Assured Destruction”), the strategy enabled a balance of power during the cold war and was subject to a more or less successful nonproliferation regime. The second offset included precision-guided munitions like laser-guided “smart bombs” and computerized command-and-control systems, proving themselves in the Gulf War of 1990-91. These technologies were clearly cutting edge in their day, but new possibilities have emerged that require new ways of thinking about defense research and development. As well, national security strategists face a multi-polar world that also includes non-state actors capable of terror attacks that pose mainly a psychological rather than an existential threat.

The result is a moving target in several senses of the term, one that requires exploring novel technological approaches. For several years these new technologies have been collected under the heading of the third offset, described by Real Clear Defense as “an attempt to offset shrinking U.S. military force structure and declining technological superiority in an era of great power competition—a challenge that military leaders have not grappled with in at least a generation (3).”

The precise outlines of third-offset technologies aren’t as clear as in the first two offsets, so observers have waited for Pentagon budgets in order to learn of their R&D commitments, though of course there are classified or “black” projects that are not publicly available. Nonetheless, some budget specifics are of particular interest for neuroethics. These include:

Autonomous "deep learning" machines and systems for early warning based on crunching big data; 

Human-machine collaboration to help human operators make decisions; 

Assisted-human operations so that humans can operate more efficiently with the help of machines like exoskeletons;  

Advanced human-machine teaming in which a human works with an unmanned system;  

Semi-autonomous weapons “hardened” for cyber warfare (4).

Because the third offset technologies are not clearly definable one needs to be alert to other projects that fit within the scope of the new doctrine, complement some of its goals, and fill out the neuroethical issues. Naturally, many of these projects are dual use. An example is DARPA’s SUBNETS (Systems-Based Neurotechnology for Emerging Therapies) program. In cooperation with other federal agencies and private industry, DARPA aims to develop improved electronic microarray chips for deep-brain stimulation for neuropsychiatric disorders and for prosthetics (5). Implantable chips that go well beyond the standard 96-elecrode array might not only be advantageous for new therapies but also for enhanced performance on a variety of tasks. An open question is whether material might be developed to create biocompatible microarrays of thousands or even tens of thousands of electrodes. DARPA’s Neuroengineering Systems Design project “aims to develop an implantable neural interface able to provide unprecedented signal resolution and data-transfer bandwidth between the brain and electronics….The goal is to achieve this communications link in a biocompatible device no larger than one cubic centimeter in size, roughly the volume of two nickels stacked back to back (6).”

A reliable human-machine interface would be a critical component of the third offset. But some DARPA planners wonder if such a device could turn out to be still more powerful, enabling direct human-to-human communication over distances. The controversial Nature editorial in 2003 anticipated these efforts in its indictment of passive neuroscientists who were failing to address the underlying ethical questions: “The agency wants to create systems that could relay messages, such as images and sounds, between human brains and machines, or even from human to human (7).”

Military and intelligence applications of neurotechnologies are a critical driving force behind all the developments that are of interest to neuroethicists. Yet reporting and analysis of these developments have been left mainly to political scientists and technology journalists. As the third offset strategy and its components make it clear, It is no longer plausible for neuroethicists to fail to take into account the national security environment. To do so is to commit a form of scholarly malpractice.

References 

1. Jonathan D. Moreno, Mind Wars: Brain Science and the Military in the 21st Century (Bellevue Literary Press, 2012). 

2. James Giordano, Ed., Neurotechnology in National Security and Defense: Practical Considerations, Neuroethical Concerns (Taylor and Francis, 2015). 

3. Mackenzie Eaglin, “What Is the Third Offset Strategy?” Defense News, February 16, 2016.   

4. Aaron Mehta, “Work Outlines Key Steps in Third Offset Tech Development,” Defense News, December 14, 2015. 

5. Lawrence-Livermore National Laboratory, “Lawrence Livermore Lab awarded $5.6 million to develop next generation neural devices,” June 11, 2014.   

6. Defense Advanced Research Projects Agency, “Bridging the Bio-Electronic Divide.” 

7. Editorial, “Silence of the Neuroengineers.” Nature 423, 787 (19 June 2003) 

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Moreno, J.D. (2017). Neuroethics and the Third Offset Strategy. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/01/neuroethics-and-third-offset-strategy.html

The Medicalization of Mental Illness in Gun Violence

By Carolyn C. Meltzer, MD

Dr. Meltzer serves as the William P. Timmie Professor and Chair of the Department of Radiology and Imaging Sciences and as the Associate Dean for Research at the Emory University School of Medicine. Her work focuses on applying novel advanced imaging strategies to better understand brain structure-function relationships in normal aging, late-life depression, and Alzheimer’s disease. She is also involved in oncologic imaging research and, while at the University of Pittsburgh, oversaw the clinical evaluation of the world’s first combined PET/CT scanner. She established the Emory Center for Systems Imaging to broadly support the advance of imaging technologies in basic and translational research, including beta testing of the first human combined MRI/PET scanner. Dr. Meltzer has also served as the Chair of the Neuroradiology Commission and Chair of the Research Commission on the American College of Radiology’s Board of Chancellors, President of the Academy of Radiology Research, Trustee of the Radiological Society of North America Foundation, and President of the American Society of Neuroradiology.

On January 6, 2017, a young man pulled a semiautomatic handgun from his checked baggage and shot and killed several passengers in the Fort Lauderdale airport. In the days following the incident, information about erratic behavior and his prior involvement in incidents of domestic abuse emerged.

Image courtesy of Wikimedia Commons

The US has the highest rates of both gun-related deaths and mass-shooting incidents. In the latest available statistics from the Center for Disease Control and Prevention (CDC), 33,304 people were killed by firearms in 2014. Over the past decade (2007-2016), there have been 16 mass shootings in the US (Mother Jones’ Investigation: US Mass Shootings 1982-2016), including several -- at Virginia Tech, an Aurora theatre, the Sandy Hook Elementary School, Charleston’s Emanuel African Methodist Episcopal Church, and the Pulse nightclub in Orlando – that drew substantial national attention.

Particularly since Sandy Hook in 2012, public and political attention has focused heavily on mental health reporting. Despite stark disagreements on the gun control, public acceptance of restricting gun access to those with mental health conditions is strong and has resulted in registering people with known psychiatric illness in the national background check system (Kangas and Calver 2014). Initial efforts focused on those involuntarily committed and/or ruled mentally incompetent by the courts, yet several states have pushed to include people voluntarily seeking mental health treatment. Unintended consequences of mental health background checks may include discouraging individuals from seeking psychiatric treatment based on fear of breach of confidentiality or restriction of rights.

Image courtesy of Flikr

While sensible on the surface and potentially comforting to a jittery public, attempts to medicalize gun violence may be fraught with peril. A psychiatric disorder is a poor and non-specific predictor of violent behavior and evidence on whether mental illness increases the risk of violence is mixed (Norko and Baronosky 2005; Glied and Frank 2014). While public officials may be quick to denounce as “deranged” or “mentally ill” a shooter who appears to hold an extreme ideology or perpetrates a hate crime or seemingly senseless mass shooting, such features are not necessarily indicative of a psychiatric diagnosis. Despite epidemiological evidence to the contrary, the majority of Americans believe people with schizophrenia are likely to act violently toward another person (Harvard Mental Health Letter 2011). The assumed causality between mental illness and mass shootings can easily become generalized to be the driving force in all gun-related deaths (Metzl and MacLeish 2015). Gun laws focusing broadly on mental illness may further perpetuate this misconception and amplify the public stigma associated with psychiatric conditions.

A greater understanding of the roles and interplay of such factors as mental health, substance abuse, past displays of violence, social stress, and availability of a firearm could be useful in developing evidence-based gun safety policies. Yet federal research into the many variables associated with gun-related injuries is limited by a 1996 Congressional action barring the CDC and NIH from promoting gun control and slashing funds for the CDC firearm injury prevention program. Restricting resources to an important public health matter is both ethically problematic and may discourage young scientists from focusing on an area of study for which no significant funding exists.

References

Follman M, Aronsen G, Pan D. US Mass Shootings, 1982-2016: Data from Mother Jones’ Investigation. Sept. 24, 2016 found here (accessed January 8, 2017).

Kangas JL, Calvert JD. Ethical Issues in Mental Health Background Checks for Firearm Ownership. Professional Psychology: Research and Practice 2014;45(1):76-83.

Mental Illness and Violence. Harvard Mental Health Letter. Volume 27, no. 27, January 2011.

Wintemute GJ, Betz ME, Ranney ML. Yes, You Can: Physicians, Patients and Firearms. Annals of Internal Medicine. 2016 165(3): 205-213.

Glied S, Frank RG.  Mental Illness and Violence: Lessons From the Evidence. American Journal of Public Health 2014, Vol. 104, No. 2, pp. e5-e6.

Metzl JM, MacLeish KT. Mental Illness, Mass Shootings, and the Politics of American Firearms. American Journal of Public Health 2015;105(2): 240-249

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Meltzer, C. (2017). The Medicalization of Mental Illness in Gun Violence. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/01/the-medicalization-of-mental-illness-in_13.html

A CRISPR View of Life

By Shweta Sahu

Image courtesy of Wikimedia Commons

We now live in a society where many are trying to get a leg up where they can, whether it be through pharmacological neuroenhancement (like Ritalin and Adderall) or other neurotechnologies (like transcranial direct current simulation). Technology also allows us to exert an even earlier influence on neurodevelopmental disorders through prenatal genetic testing for fetuses. Such technologies include amniocentesis and chorionic villus sampling, that screen for Down’s, Edwards’ and Patau’s syndromes, and give parents the chance to decide whether they would like to terminate or continue with their pregnancy. One article even claims 53% of all pregnancies were aborted following prenatal diagnoses of Down’s Syndrome, though there is still much dispute over the exact numbers.

More recently, research has turned to looking into how to intervene at even earlier stages with gene editing of embryos. CRISPR (clustered regularly interspaced short palindromic repeats) is a naturally occurring bacterial defense mechanism, that when combined with certain enzymes, like “Cas” (CRISPR associated proteins), enable scientists to manipulate the gene sequence of an organism. CRISPR technology brings to life the idea that we can edit genes by either inserting or cutting out specific DNA sequences. Among the vast, exciting biomedical applications of this CRISPR/ Cas system are some promising leads, such as developing CRISPR based disease models. Diseases like schizophrenia and autism involve many genes and using CRISPR, one lab has been able to recreate the genetic mutations and investigate the “faulty” neurons that play a role in these conditions in animal models more efficiently. Whereas this previously took a couple years (requiring the time consuming method of trial-and-error to find the specific sites of mutation) projects like this take only a couple months with the help of CRISPR due to its ability to target sequences in an efficient, site-specific manner. 

Moreover, using genome engineering technologies like CRISPR has the potential to increase our ever-growing knowledge of disease processes and subsequent treatments. More specifically, this ability allows us to treat diseases involving muscle differentiation, cancer, inflammation, fetal hemoglobin, and Epstein Barr in animal models and some hope to potentially be used to eliminate gene mutations from the human population. One example of this includes a special birth case. This year, a 3-parent baby was born via a technique called “spindle nuclear transfer”, where mitochondrial genes from a donor woman were added to the mother’s own egg, and consequently fertilized by the father’s sperm. This reproductive technology was prompted by the desire to avoid Leigh syndrome, a fatal neurologic condition affecting one in 40,000 newborns. The mother had previously given birth to 2 babies with this condition, and thus looked to the 3-parent embryo technique as the answer. Because the Food and Drug administration (FDA) banned such a technique in the US, the procedure was performed in Mexico, where no such FDA exists.

Further yet, this CRISPR/ Cas technology may be the first stepping stone to applying these as therapies for neurological diseases. Many genetic disorders of the nervous system are caused by trinucleotide repeats, and recently, the CRISPR/ Cas system has been used in editing the mutations that cause conditions such as Huntington’s Disease (HD) and Fragile X Syndrome (FXS) in cell models. The CRISPR/ Cas system, in conjunction with single guide RNA (sgRNA) targets a specific sequence of DNA and induces a site-specific double stranded DNA break that can subsequently be either altered—resulting in a silenced gene—or deleted—resulting in a null allele. These small cuts in the DNA lead to larger changes in the gene, which affects function of subsequent proteins. When this procedure is applied to mutated genes throughout the genome of an organism, it can restore proper gene/ protein function. In this way, gene editing has the potential to provide the basis for successful therapy for neurodevelopmental disorders.

However, today's debate concerns not so much the research itself, but rather its ethical implications and the clinical applications that result in permanent changes to the human gene pool. For example, one article cites the example of a seven-time Olympic medalist in cross-country skiing whose genetics, the author claims, enabled the medalist to excel in his chosen sport. Might it be possible some athletic-oriented parents wanted the same for their child and genetically edited their child’s genome so as to introduce the overactive erythropoietin gene that confers high oxygen-carrying?

Genetically modifying genes opens doors to another major ethical concern: designing babies that carry permanent allele alterations implies heritable changes to the human germline DNA. Traits that society deems “unfit” would be eliminated from the population by selecting for the “better” alleles of the “fit” population; in turn, these “fit” alleles would be fixed into the population with gene editing technologies. The “unfit” alleles would eventually be lost from the population because genetic modification would prevent them from ever being passed on. Is it possible that one day in the near future clinicians and physicians will use CRISPR to decide which beneficial alleles get passed on? This would allow us to bypass natural selection in totality. 

Image courtesy of Prezi

Among similar lines, one study done at Yerkes in the Dias and Ressler lab opens yet another door to the realm of epigenetics and how ancestral sensitivity to certain stimuli can be transferred to subsequent generations. One notable example of this transgenerational information transfer includes the “Dutch Hunger Winter” in 1944, during which the F0 generation experienced the famine conditions and the F1 generation, in utero at that time, later developed astonishing rates of diabetes and obesity, as did their offspring (F2 generation). Similarly, another study found that a nutrition-linked mechanism through the male line seems to have influenced the risk for cardiovascular diseases and diabetes mellitus mortality. Taken further, maybe one day we can use CRISPR to edit our genes so that such unfavorable traits are not passed along in this way.

Might this be uniquely ethically complicated as we discuss editing genes related to brain function? One lab in China has genetically engineered more than 12 monkeys with a version of autism, in hopes of testing treatment for autism in humans. The reasoning for using monkeys in this study is that we share a more developed prefrontal cortex (a brain area where many psychiatric disorders seem to be impacted) and this should enable more generalizable results and translatable treatments.

Françoise Baylis, Canadian bioethicist and philosopher, posed the following questions. If you have a patient with Huntington’s, why treat just their symptoms, “allow them to reproduce and have children with Huntington’s, and we just have to do this over and over and over again? Why not fix it once and for all?!” This question of hers addresses the issues with the balance of “to do” or “not to do.”

Kevin Esvelt, an assistant professor at Harvard delves more into the delicate balance between the benefits and costs of using such technology and expands on the future directions for neurodiversity. He states, “if you give parents the option of zero autism risk in exchange for a certain loss of creativity or unusual talents, I expect almost all of them would take it — to the detriment of humanity.”

Image courtesy of the Genetic Literacy Project

That brings me to my next question, that of responsibility. Whose decision is it? Who decides what a “beneficial gene” is and who all should receive such modifications? A recent poll conducted by Harvard T.H Chan School of Public Health, researchers asked about “changing the genes of unborn babies: who should decide?” The results indicated that 53% of responders said “scientists, physicians, and technological experts” while 9% said “government officials and policy makers” (31% answered neither, presumably the potential parents). Some argue that parents should have complete authority when it comes to gene editing, a process they likened to that of autonomy in choosing sperm donors. However, a contrasting view argues that “parental autonomy must be weighed against the interests of future generations who cannot consent to the genetic modifications their flesh will be heir to.”

Does this mean that the social injustice will deepen and the gap between the classes will widen or perhaps we’ll have an even more rampant view of “normalizing” and less appreciation of neurodiversity? According to one source, in Israel, their national health system provides its citizens with preimplantation genetic diagnoses, such that “any Israeli citizen can now fertilize multiple embryos with in vitro fertilization (IVF) and then choose to implant the one that seems to have the best genetic health.” But it’s unclear if everyone would agree what “best genetic health” would mean and how that would be interpreted by neurodiversity advocates.

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 Sahu, S. (2017). A CRIPSR View of Life. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/01/a-crispr-view-of-life.html

Future (Brain) Identities, Lost in Translation

On December 6-7, 2016, the 92nd Street Y and the Future Today Institute successfully convened leading "research scientists, technologists, ethicists, policy makers, authors, elected officials, academics and artists to take stock of where we are—and where we are going." 

On Dec 7, Emory's own Neuroethics Program Director, Dr. Karen Rommelfanger gave the closing keynote for the Future. Today Summit at the 92Y in New York. The topic of her talk was Future (Brain) Identities, Lost in Translation.

A preview of her talk can be found below.

In the full talk Dr. Rommelfanger discusses how neuronal signals are translated into actions of machines or even other brains.

She concludes that many things have not changed with these technologies. Talking on the phone is probably still a better way to communicate than a brain to brain interface and frankly as far as powerful prosthetics go the most powerful brain prosthetic for memory continues to be the written word.

Image credit: Future Today Summit

However, these technologies move, some faster than others, from the bench and hospital to general consumers. It’s worth asking if these innovations are creating new relationships and how they are serving as social mirrors reflecting our societies deepest values and desires.

Image credit: Future Today Summit

We continue to renegotiate these relationships with technology in realms of law, privacy, and will continued to be challenged with how to interact with these devices and technologies.

Want to cite this post?



Rommelfanger, K. (2017). Future (Brain) Identities, Lost in Translation. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/01/future-brain-identities-lost-in.html