Adderall as a motivational enhancer

Prescription stimulant use is on the rise at college campuses, especially at elite schools where the pressure and demands can be overwhelming. Students have a variety of methods to handle the stresses of their studies, but the consumption of prescription stimulants, such as Adderall or Ritalin, has become more popular among healthy individuals. While this trend raises multiple important ethical issues, the interesting idea that prescription stimulants may be masking authentic versions of ourselves was the topic of the most recent Neuroethics in the News discussion. Facilitated by AJOB Neuroscience editorial intern Ryan Purcell and AJOB Neuroscience Editor John Banja, the discussion centered around a recently published article by Torben Kjaersgaard entitled “Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement^."1

                                                                from Smart Drug Smarts

The cognitive enhancement debate is not new; scholars have been considering the ethical dilemmas, such as equal access, safety, coercion, and cheating, of healthy individuals seeking enhancement via prescription drugs for almost a decade.^2,3 There is also a debate surrounding whether or not current stimulants are even cognitive enhancers at all, which would render the discussion irrelevant.^4,5 Kjaesrgaard doesn’t focus on any of these issues though, and instead presents the ethical dilemmas associated with motivational enhancement of drugs such as Adderall and modafinil. He argues that these stimulants are not eliciting performance enhancement, but instead performance maintenance and sometimes increased motivation for a task, and this can often be ethically problematic. While the future may hold cognitive enhancers that have the ability to increase a person’s capability to solve a task or make an individual “smarter,” current stimulants promote wakefulness, arousal, and stimulation. The invocation of these emotions is related to motivation, and Kjaersgaard argues that motivation enhancement is an important but “neglected subitem in the bioethical debate on cognitive enhancement.”¹

 

 Motivation in this article is defined as a “broad set of affective states that influence whether a person will voluntarily use their cognitive ability in the performance of a task,” which comes from a paper by IIieva and Farah.³ Very few papers have reported on the reasons for consumption of prescription stimulants by healthy individuals, but the article alludes to a recent qualitative study published by Scott Vreko⁶ to show that students who take these stimulants are typically seeking to enhance their motivation and interest during an “Adderall” day spent studying in the library. Vrecko reported four experiential “feelings” that students experience when taking Adderall including feeling up, drivenness, interestedness, and enjoyment; feelings all related to motivation. Many of the students were unable to study unless taking the drug or felt they were more effective and interested when under the influence. It is possible that these students could be self-medicating depression or ADHD, and as problematic as that may be, what if these students are just lazy? (Kjaersgaard does note that many of the students only attribute their inability to study to factors related to school, suggesting depression is not an underlying factor). Is there really anything wrong with trying to become a more productive, studious person? If a boost in motivation is needed to study for a midterm or prepare a presentation at work, is there anything ethically fraught about seeking an external stimulant? Or, is intrinsic motivation somehow more meaningful than motivation induced by prescription stimulants? The answer, according to Kjaersgaard, is sometimes. 

Lack of motivation could be part of a much larger problem connected to the meaning, structure, and purpose in a person’s life. The constant use of prescription stimulants to get through four years of college or every task at work could signal feelings of alienation, and treating these feelings with pharmaceuticals is unethical.  A student who enjoys learning and finds it self-fulfilling, but needs to take Adderall to get through one class unrelated to his major is not participating in an unethical act because the one-time use does not change the course of his life or who he is. Most importantly, this student isn’t trying to escape from reality. However, Adderall is not helping the student that is trying to get through college as a biology major because his parents want him to go to medical school. In this instance, the student is on a path of becoming his least authentic self, a complex issue that should not be controlled with prescription stimulants. Continually using stimulants to overcome a lack of willpower means that “we risk losing touch with ourselves in some sense.”¹ When we start to regard lack of motivation as a physiological problem, instead of a vice, we are losing an essential part of the human condition and we are perhaps only masking the most authentic version of ourselves. 

                                                               from DistanceAdvising

 This twist on the cognitive enhancement debate is interesting because for the first time we live in a society where the quest to become what you may consider your most authentic self is actually possible.  Serfs in the Middle Ages were not questioning whether or not serfdom was their actual calling, and classes were still starkly divided as late as the 19^th century. Some have made the claim that we should take cognitive enhancers because we have an obligation to society to be the best, smartest, most productive versions of ourselves. But, do we instead have an individual obligation to become the most authentic, true version of ourselves? Is it even possible to find your most authentic self? And, as Dr. Banja pointed out with this Monty Python sketch, what if your true self is boring and dull? In this case the use of prescription stimulants may not be holding you back in the slightest.  

While it may be true that the fate of college students does not drastically depend on prescription stimulant use, perhaps rampant Adderall consumption is a chance to have a conversation regarding the collegiate atmosphere. In college and in life, we move at a faster pace than before and ubiquitous technology means that something or someone is constantly demanding attention. This can often make life seem overwhelming and challenging, but by accepting the occasional Adderall usage, are we ignoring other fundamental problems with our social structure? Maybe prescription stimulants are a solution for the vast majority of people that are unsatisfied with their jobs, especially if income is a priority over authenticity. But, does society suffer at all if every person is trying to be productive, but is sacrificing essential pieces of what makes us human to get there? 

References: 

(1)          Kjærsgaard, T. Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement. AJOB Neurosci. 2015, 6 (1), 4–10.

(2)          Chatterjee, A. Cosmetic Neurology: The Controversy over Enhancing Movement, Mentation, and Mood. Neurology 2004, 63 (6), 968–974.

(3)          Ilieva, I. P.; Farah, M. J. Enhancement Stimulants: Perceived Motivational and Cognitive Advantages. Front. Neurosci. 2013, 7.

(4)          Lucke, J. C.; Bell, S.; Partridge, B.; Hall, W. D. Deflating the Neuroenhancement Bubble. AJOB Neurosci. 2011, 2 (4), 38–43.

(5)          Smith, M. E.; Farah, M. J. Are Prescription Stimulants “Smart Pills”? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals. Psychol. Bull. 2011, 137 (5), 717–741.

(6)          Vrecko, S. Just How Cognitive Is “Cognitive Enhancement”? On the Significance of Emotions in University Students’ Experiences with Study Drugs. AJOB Neurosci. 2013, 4 (1), 4–12.

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Strong, K. (2015). Adderall as a Motivational Enhancer. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/04/adderall-as-motivational-enhancer.html

The Newly Released 6.1 Issue of AJOB Neuroscience

The 6.1 Issue of the American Journal of Bioethics Neuroscience (AJOB Neuroscience) is now hot off the presses with two target articles highlighting ethical issues behind the use of two very different therapeutic interventions: first-in-human trials to treat Parkinson’s disease using stem-cell based therapies and prescription stimulants to enhance motivation.

The Target Article “Ethical Criteria for Human Trials of Stem-Cell Derived Dopaminergic Neurons in Parkinson’s Disease”¹ by Samia A. Hurst et al. discusses three specific considerations of a phase I(safety)-II (efficacy) clinical trial designed to test an experimental neurorestorative stem cell therapy for Parkinson’s disease. Parkinson’s disease is a result of the loss of dopamine-producing neurons in the substantia nigra, and significant depletion of dopamine leads to the tremors, rigidity, and difficulty initiating or halting movement that is often seen as the disease progresses. To compensate for the diminishing levels of the neurotransmitter, standard treatment relies on the drug levodopa, which is converted to dopamine in the body. Levodopa is not curative though, and for that reason, researchers are beginning to study the neurorestoration technique of dopamine-producing stem cells transplants². As promising and groundbreaking as stem-cell therapy is, protecting human subjects will be of utmost importance as the therapies enter clinical trials.



Parkinson’s disease is progressive, meaning that patients could exhibit a wide spectrum of mild to debilitating symptomology. After considering the risk-to-benefit ratio of enrolling patients who have either just been diagnosed or are at an advanced state of the disease, the authors suggest that only patients with approximately less than 15 years to live with “moderately advanced” Parkinson’s disease should be enrolled. Moderately advanced Parkinson’s is defined as a time when patients have been diagnosed and are responding to levodopa therapy. These patients should have minimal motor impairments and no impairment of cognitive function. Since neurosurgery is not without risks and stem-cell therapy benefit may not be obvious for a long time period, a clear informed consent process is critical. The patients must understand that the study’s purpose is not to alleviate Parkinson’s symptomatology immediately, but to instead increase understanding for the disease and the experimental, high risk nature of the procedure.



The authors conclude that a sham surgery, which involves inserting a needle into the brain, but not injecting stem cells, cannot be justified in a phase I-II clinical trial. Sham surgery is fraught with its own ethical concerns related to the powerful placebo effect, especially when research has suggested that Parkinson’s disease patients are especially susceptible to the placebo effect^3,4. While a 2005 investigation of sham surgeries in Parkinson’s disease research suggested that the majority of clinicians support sham surgeries over unblinded controls⁵, finding interventions better than placebo or sham is challenging if sham is the ultimate threshold over which novel therapy should pass⁶. The authors ultimately recommend an open-label clinical trial design or a trial that compares stem-cell therapy to alternative medicines other than highly invasive surgery. The authors also remark that even if Parkinson’s disease patients are more likely to improve based on a placebo, Parkinson’s is degenerative and the placebo effect would most likely not survive declining motor function over the long-term of this study.



In the second Target Article, “Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement,”⁷ author Torben Kjaersgaard raises questions about the nature and value of human effort. The enhancement debate has been ongoing for over a decade⁸, and revolves around the value of “hard work” and integrity to complete a goal. For some, the idea of enhancing cognitive function is a shortcut that creates an unfair playing field where certain individuals have surpassed their natural talents. Others argue that there is nothing wrong with a world full of only the smartest and motivated people. The discussion is made more complicated by research suggesting that current stimulants do not enhance performance^9,10.



While this debate is not new, Kjaersgaard adds a fresh perspective by arguing that prescription stimulants, such as Adderall and Ritalin, impact motivation (rather than the task performance itself), raising distinct ethical concerns from those related to simply enhancing cognitive function. A lack of motivation or a tendency to become distracted could be signs of moderate depression or ADHD, or as the article notes, feelings of worthlessness and escape. If stimulants are needed to get through most days, then is the user trying to escape from reality and avoiding tackling a more significant problem? Medically enhancing motivation turns a lack of drive or inspiration into a fixable, physiological problem, which is convenient, but Kjaersgaard argues that this undermines important aspects of the human condition.

from Institute for Ethics and Emerging Technology

The editorial written by Karen S. Rommelfanger and L. Syd M Johnson discusses the first Gray Matters Report from the President’s Commission for the Study of Bioethical Issues and what lies ahead for research, funding, and education for future neuroscientists in light of the lauded and equally contested Human Brain Project and the BRAIN Initiatives. The authors note that these articles are examples of the types of pertinent discussions that result from infusing neuroscience research and medical advances with ethical questions. In moving forward with the UK and US Brain Projects, it is absolutely necessary that ethicists work alongside researchers to ensure these types of dialogues continue.



The Emory Neuroethics Program offers forums for discussion on these pertinent issues and cutting edge topics in neuroscience. The upcoming Neuroethics and Neuroscience in the News event will be held on March 18^th, 2015. AJOB Neuroscience Editor John Banja and AJOB Neuroscience Editorial Intern Ryan Purcell will facilitate a discussion on the science, ethics, and media portrayals of neuroenhancement including the recent Kjaersgaard article.

References

(1)  Hurst, S. A.; Mauron, A.; Momjian, S.; Burkhard, P. R. Ethical Criteria for Human Trials of Stem-Cell-Derived Dopaminergic Neurons in Parkinson’s Disease. AJOB Neurosci. 2015, 6, 52–60.

(2)  Grealish, S.; Diguet, E.; Kirkeby, A.; Mattsson, B.; Heuer, A.; Bramoulle, Y.; Van Camp, N.; Perrier, A. L.; Hantraye, P.; Björklund, A.; Parmar, M. Human ESC-Derived Dopamine Neurons Show Similar Preclinical Efficacy and Potency to Fetal Neurons When Grafted in a Rat Model of Parkinson’s Disease. Cell Stem Cell 2014, 15, 653–665.

(3)  Goetz, C. G.; Wuu, J.; McDermott, M. P.; Adler, C. H.; Fahn, S.; Freed, C. R.; Hauser, R. A.; Olanow, W. C.; Shoulson, I.; Tandon, P. K.; Parkinson Study Group; Leurgans, S. Placebo Response in Parkinson’s Disease: Comparisons among 11 Trials Covering Medical and Surgical Interventions. Mov. Disord. Off. J. Mov. Disord. Soc. 2008, 23, 690–699.

(4)  McRae, C.; Cherin, E.; Yamazaki, T. G.; Diem, G.; Vo, A. H.; Russell, D.; Ellgring, J. H.; Fahn, S.; Greene, P.; Dillon, S.; Winfield, H.; Bjugstad, K. B.; Freed, C. R. Effects of Perceived Treatment on Quality of Life and Medical Outcomes in a Double-Blind Placebo Surgery Trial. Arch. Gen. Psychiatry 2004, 61, 412–420.

(5)  Kim, S. Y. H.; Frank, S.; Holloway, R.; Zimmerman, C.; Wilson, R.; Kieburtz, K. Science and Ethics of Sham Surgery: A Survey of Parkinson Disease Clinical Researchers. Arch. Neurol. 2005, 62, 1357–1360.

(6)  Freed, C. R.; Greene, P. E.; Breeze, R. E.; Tsai, W.-Y.; DuMouchel, W.; Kao, R.; Dillon, S.; Winfield, H.; Culver, S.; Trojanowski, J. Q.; Eidelberg, D.; Fahn, S. Transplantation of Embryonic Dopamine Neurons for Severe Parkinson’s Disease. N. Engl. J. Med. 2001, 344, 710–719.

(7)  Kjærsgaard, T. Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement. AJOB Neurosci. 2015, 6, 4–10.

(8)  Farah, M. J.; Illes, J.; Cook-Deegan, R.; Gardner, H.; Kandel, E.; King, P.; Parens, E.; Sahakian, B.; Wolpe, P. R. Neurocognitive Enhancement: What Can We Do and What Should We Do? Nat. Rev. Neurosci. 2004, 5, 421–425.

(9)  Lucke, J. C.; Bell, S.; Partridge, B.; Hall, W. D. Deflating the Neuroenhancement Bubble. AJOB Neurosci. 2011, 2, 38–43.

(10)  Smith, M. E.; Farah, M. J. Are Prescription Stimulants “Smart Pills”? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals. Psychol. Bull. 2011, 137, 717–741.

Want to cite this post?



Strong, Katie. (2015). The Newly Released 6.1 Issue of AJOB Neuroscience. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/03/the-newly-released-61-issue-of-ajob.html

Can free will be modulated through electrical stimulation?

The will to persevere when many of life’s challenges are thrown at us is an ability that comes more naturally for some than for others. Additionally, even the most determined among us have days and times when moving forward through a challenging task just proves too difficult. The subjective nature of this experience can make it difficult to study, but recently researchers from Stanford University published a case study where electrical brain stimulation (EBS) to the anterior midcingulate cortex (aMCC) left two patients with the feeling that a challenge was approaching, but also that they could overcome it [1]. For the most recent journal club of the semester, Neuroscience graduate student and AJOB Neuroscience editorial intern Ryan Purcell led a discussion on the experimental procedure to stimulate what is referred to as the “the will to persevere” and the effect this technology may have if it were to become more mainstream in society.

"The location of the electrodes in P1 and P2 overlaid onto the standard emotional salience network derived from a group of normal human subjects." Parvizi et al.

It has long been known that the anterior cingulate cortex (ACC) and its midcingulate region (aMCC) are involved in emotions that rely on cognitive control, and recent research has shown that this brain network is possibly involved in complex emotions such as motivation and endurance [2,3]. In the case study discussed during journal club though, researchers went beyond an animal study and recorded a first-hand account of two patients becoming determined and motivated to overcome what they perceived as an oncoming challenge during EBS to the aMCC. The aMCC, located deep within the brain, is not typically implanted with electrodes for clinical reasons, but researchers were attempting to discover the origin of seizure activity in two patients with epilepsy by implanting intracranial electrodes in four different deep brain regions. Electrical currents at each of these regions were delivered and then based on patient feedback and physiological reports, researchers could localize the epileptic activity. It was determined that the patients were suffering from medial temporal epilepsy, but when electrical stimulation occurred at the aMCC, while no signs of seizures were observed, both patients did report similar and unique emotional states, along with specific physical symptoms. Patients physically experienced what was described as “shakiness,” hot flashes, and an increase in heart rate, but interestingly also psychologically felt a sense of foreboding regarding a challenge and the confidence that the challenge could be overcome. As seen in this supplemental video, patient 1 describes the experience as driving “towards a storm that’s on the other side, maybe a couple of miles away, and you've got to get across that hill.” Although this seems like a situation that would cause worry and anxiety, the same patient reported that the feeling was not really negative, but instead “it was more of a positive thing like…push harder, push harder, push harder to try and get through this.” These patient accounts suggest that researchers had tapped into the part of the brain responsible for motivation, endurance, and the will to persevere, and in doing so were able to elicit these feelings on command - far removed from any situation similar to stressful driving.



Researchers also realized that by stimulating the aMCC, the behavioral and emotional changes caused by EBS could potentially be due to functional changes that take place within a vast neuronal network connected to the aMCC. Using fMRI and functional connectivity analysis, researchers observed that EBS in the aMCC region of interest led to the activation of a network previously characterized as the emotional salience or cingulo-opercular network [4]. This suggests that the motivation, endurance, or the lack of these two emotions are most likely not alone regulated by a single brain region, the aMCC, but instead a complex, distributed network.



This paper presents the exciting and interesting idea that we could regulate motivation with stimulation to the brain, but really this is just a small case study with two patients. These findings may have been an unexpected result from trying to find the source of epilepsy, and may only occur in this experimental setting, perhaps even only in patients who have a history of epilepsy. The paper reads as if the researcher asking the questions of the patients was the same researcher conducting the stimulation trials, and as a result many of the questions are very biased and leading. After patient 1 has vividly compared his experience to driving in a storm, the researcher attempts to ask patient 2 about driving as well. To which patient 2 responds with laughter “I don’t get to drive.”



This is an interesting observation, but would need to be replicated on a larger scale with blind research practices put into place. However, since the aMCC is located deep within the brain and typically electrodes are not inserted for clinical reasons, it may prove difficult to conduct invasive procedures without a clinical agenda. In this case study, these patients were already unique in that they may have been very determined individuals even without external stimulation since they were undergoing invasive brain surgery for epilepsy most likely as a last resort. Having the power to increase motivation and/or determination could be used in a clinical setting for depression or chronic pain, and while it is only speculation regarding the personality traits of these two patients, a study that is open to participants without any diagnosed neurological disorders could provide more baseline activity for modulating the aMCC and its neuronal network. For this large study to take place though and to find interested participants, most likely the technology would need to advance with a noninvasive procedure.



While this type of technology would have obvious clinical benefits for treating depression and perhaps one day the ability to self-regulate our motivations at home, having the power to externally regulate free will begs certain questions. Should anyone be denied the chance to become a more productive, motivated version of themselves? Or, if this type of technology were considered acceptable, should anyone be forced to become a more determined, motivated citizen who does not experience weakness of will? If advances in neuroscience continue to address the questions of whether free will even exists at all, and then if we ever have the power to impose a standard of willpower that everyone should meet, this would have important implications for our legal and justice system. Two common theories for justifying punishment include the utilitarianism and the retributivism theory [5]. Simply put, utilitarianism is based on the idea that punishment is justified because it produces a situation in which the balance of good and evil (or happiness and unhappiness) is maximized [6]. Punishment helps to reduce crimes, which promotes a society where good prevails over evil. For example, punishment in the form of imprisonment can lead to the reduction of crime because the idea of prison can deter criminals and criminals are removed from society. The retributivism theory relies more on the idea of a social consensus on what is deemed a moral wrongdoing and criminals who commit crimes deserve to be punished [7]. If we had the power to control weakness of will and modulate willpower, this could be very powerful when applied to crimes that are associated with a weakness of will, perhaps those that involve illicit drugs, alcohol, or even the more heinous pedophilia, as specifically discussed in this previous blog post. However, then the justification of additional punishment according to the utilitarian viewpoint would be less valid, since the stimulation alone would potentially reduce crime. In this situation, a criminal would be giving up some level of free will in the name of societal benefits, so one could argue that electrical stimulation could be considered similar to jail time, a punishment that removes freedom and the ability to make many choices from perpetrators’ lifestyles. In this sense, additional punishment according to the retributivism theory would also be less valid since the electrical stimulation would be punishment enough. Finally, there is an additional possibility that is being explored by neuroscientists like David Eagleman who believe that our retributivist justice system (resulting in an overcrowded prison system) should be revised to one focused on rehabilitation, or rather neuro-rehabilitation [8, 9, 10]. Even in the name of rehabilitation though, does such a crime exist that justifies the punishment of nonconsensual direct manipulation of neuronal networks? Having the strength and the will to persevere is most likely a characteristic that we all want all the time, but is choosing not to persevere still a choice that we are always entitled to make, regardless of the context of the choice?





References:



1) Parvizi, J. et al. (2013). The Will to Persevere Induced by Electrical Stimulation of the Human Cingulate Gyrus. Neuron 80, 1359.

2) Rudebeck, P.E. et al. (2006). Separate neural pathways process different decision costs. Nat. Neurosci. 9, 1161.

3) Shackman, A.J. et al. (2011). The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat. Rev. Neurosci. 12, 154.

4) Seeley, W.W. et al. (2007). Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. 27, 2349.

5) Greene, J.; Cohen, J. (2004). For the law, neuroscience changes nothing and everything. Phil. Trans. R. Soc. Lond. B 359, 1775.

6) Bernstein, R.F. (1979). Legal Utilitarianism. Ethics 89, 127.

7) Scheid, D.E. (1983). Kant's Retributivism. Ethics 93, 262.

8) Eagleman, D.The Brain on Trial. (2011). The Atlantic. Retrieved on April 7, 2014 from http://www.theatlantic.com/magazine/archive/2011/07/the-brain-on-trial/308520/.

9) A novel addiction therapy: The real-time fMRI. Initiative on Neuroscience and Law. Retrieved on April 7, 2014 from http://www.neulaw.org/research/real-time-fmri. 

10) Rommelfanger, K. (2011). Neuro-rehabilitation: A vision for a new justice system. The Neuroethics Blog. Retrieved on April 7, 2014, fromhttp://www.theneuroethicsblog.com/2011/10/neuro-rehabilitation-vision-for-new.html



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Strong, K. (2014). Can free will be modulated through electrical stimulation? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/04/can-free-will-be-modulated-through_8.html

Uncovering the Neurocognitive Systems for 'Help This Child'

In their article, “Socioeconomic status and the brain: mechanistic insights from human and animal research,” Daniel A. Hackman, Martha J. Farah, and Michael J. Meaney explore how low socioeconomic status (SES) affects underlying cognitive and affective neural systems. They identify and focus on two sets of factors that determine the relationship between SES and cognitive development: (1) the environmental factors or ‘mechanisms’ that demonstrably mediate SES and brain development; and (2) those neurocognitive systems that are most strongly affected by low SES, including language processing and executive function.  They argue that “these findings provide a unique opportunity for understanding how environmental factors can lead to individual differences in brain development, and for improving the programmes and policies that are designed to alleviate SES-related disparities in mental health and academic achievement” [1].

Neuroscience can tell us how SES may affect her brain.

Can it move us to do something about it?

Theoretically, I have no doubt that neuroscience can make a powerful contribution to early childhood development by determining whether and which neurocognitive systems appear to be more extensively affected by low socioeconomic status.

This is, as the authors themselves point out, important work, because understanding which systems are affected can help educators and policy-makers develop programs to target them more directly and successfully. For example, the work of D’Anguilli et. al. demonstrates that low-SES children pay more attention to unattended  stimuli, and are thereby more susceptible to becoming distracted and having a harder time focusing on a given task. [2] A corresponding, corrective strategy would consist in introducing games, lessons and computer-based strategies which explicitly target executive functions – and indeed, just such a set of measures is being used by the Tools of the Mind curriculum, which as of this year is being implemented in 18,000 pre-kindergarten and kindergarten classrooms, in Head Start programs, public schools, and childcare centers across the nation.

Fig. 1: The yellow 'brain development' box represents those neurocognitive systems that are most affected by low SES, and could include 'language processing' and 'executive function'

So far, so good. So what am I worried about?



What do you think? 



I’m not ‘worried’ so much as left wondering about one issue in Hackman et. al.’s review that I would now like to explore, and that I would welcome further discussion about.



My concern relates to the broader relationship between scientific knowledge and our individual and collective moral motivation to do something about an ongoing injustice. Allow me illustrate what I mean using two diagrams adapted from the Hackman et. al. article. The first represents the state of our knowledge regarding the relationship between SES and development, without any concrete neuroscientific understanding of the neurocognitive systems that mediate between them:

Fig. 2: We know that SES affects developmental outcomes,

even if we don't understand the neurocognitive systems that mediate the relationship

The second represents the state of our knowledge regarding the relationship between SES and development, now including our emerging neuroscientific understanding of the neurocognitive systems that mediate between them, outlined in the paper:

Fig. 3: Neuroscience is beginning to elucidate which neurocognitive systems are

most strongly affected by SES, and thereby influence children's developmental outcomes

My question is this: if sociologists and psychologists have already firmly established the relationship between SES, specific environmental mediators, and resulting developmental outcomes, as in Figure 1, (and they have, as the evidence cited by Hackman’s et. al. attests to), then can the addition of a scientific understanding of the intermediary mechanisms in any way enhance or strengthen our practical commitment to improving children’s SES and the corresponding environmental mediators that affect their development?  In other words, if I already know that SES, and specifically prenatal influences, directly affect elements of children’s cognitive and emotional development, do I need to know anything before doing something about it? And will knowing more about it, including understanding the causal sequence mediating the relationship, prompt me to do anything more about it than I was doing before?



Again, as mentioned, I fully recognize and appreciate the potential of neuroscientists and their collaborators to “design of more specific and powerful interventions to prevent and remediate the effects of low childhood SES.” [1] A second, equally essential neuroscientific question to explore is whether certain brain propensities increase the likelihood of individuals' living in low-SES circumstances. Could we say that certain brain propensities correspond to developmental diseases, or to a kind of physical handicap - one that traps people in poverty and decreases their likelihood of attaining a better quality of life?  If so, would this oblige us to take action? These are fundamental questions that need to be explored further. For my part, I'm not sure I agree with the statement that neuroscience can “highlight the importance of policies that shape the broader environments to which families are exposed” with any more clarity or motivational force than our existing knowledge already does. [1]



I am a neurophile, but…

Here’s why I’m slightly skeptical.  To borrow an example from the philosopher Peter Singer, imagine that you’re driving down the street and see a person bleeding profusely from his leg. [3] You could rush in and help this man, but you’re wearing your brand new, $375 J.Crew Ludlow suit jacket, so you think to yourself, ‘Ok, do I leave him there? I mean, it’s terrible, but I guess so, because I don’t want to get blood all over my beautiful jacket.’ If you responded to the situation in this way, we would probably call you a moral monster.

One of these is not like the other. Or...?

Now consider a different case. Imagine that you’re watching your favorite episode of the Walking Dead when a commercial from Care comes on and reminds you that for $375, you could pay for and facilitate 8 healthy births, and thereby help save the lives of several mothers and their babies. Now you think to yourself "Well, I guess it would be good to save those people, but I really just want that jacket." In this case, our general consensus would be that while you're no Mother Theresa, we probably wouldn't want to condemn for being a moral monster. (After all, that jacket is made from 'world class wool'!) So what gives? As Singer pointed out in a series of influential articles, our rational obligation towards the mothers and their newborns should be the same as towards the bleeding man. [3] So how and why do our intuitions differ?

In his article, “From neural ‘is’ to moral ‘ought’: what are the moral implications of neuroscientific moral psychology?,” the philosopher Joshua Greene suggests that an evolutionary perspective may help explain the differences in our responses. He proposes, “consider that our ancestors did not evolve in an environment in which total strangers on opposite sides of the world could save each others’ lives by making relatively modest material sacrifices. Consider also that our ancestors did evolve in an environment in which individuals standing face-to-face could save each others’ lives, sometimes only through considerable personal sacrifice. Given all of this, it makes sense that we would have evolved altruistic instincts that direct us to help others in dire need, but mostly when the ones in need are presented in an ‘up-close-and-personal’ way.” [4] According to Greene, this makes a sense of why human beings can be extraordinarily altruistic in their immediate, interpersonal interactions, but still gobsmackingly selfish in their transnational relations.



Unfortunately, our relationship to children in lower-SES environments is closer to the distant pregnant mothers in Singer's analogy than it is to the bleeding stranger right in front us. Few of us interact with low-SES children on a daily basis, and so many of us worry about how they get on in more abstract, theoretical terms. But if this is right, then more information, or even more scientific understanding, will not be enough to move us toward addressing their developmental issues. Rather, we will need to use other kinds of knowledge, such as our emerging understanding of biased moral motivation, to reflectively increase the probability of translating our moral principles into actions. That is, examples like Singer's bleeding stranger tell us something about how our moral motivation works, and we need to use this type of knowledge to try and make low-SES children seem more like the man with the leg wound in our moral imaginations. This would increase the likelihood of our doing something to improve low-SES children's circumstances. One way of achieving this would be to ensure that we interact with low-SES parents and their children on a more regular basis, e.g., by doing something as simple as taking public transportation. This would make us more likely to put our hard-won neuroscience research to use.

____



[1] Hackman, D. A., Farah, M.J., Meaney, M. J., 2010, 'Socioeconomic status and the brain: mechanistic insights from human and animal research,' in Nature 11, Available at https://mail-attachment.googleusercontent.com/attachment/u/0/?ui=2&ik=bb31177d51&view=att&th=13ad223ce6979971&attid=0.4&disp=inline&safe=1&zw&saduie=AG9B_P9-g3MEKF3MHUpOaKNL2td1&sadet=1355272405884&sads=-iGOQ0R2Qyb4_aHrUapR1YuvG1g



[2] D’Angiulli A, Herdman A, Stapells D, Hertzman C. 2002, 'Children’s event-related potentials of auditory selective attention vary with their socioeconomic status.' Neuropsychology 22:293–300.



[3] Singer, P., 1972. 'Famine, affluence, and morality.' Philosophy and Public Affairs 1, 229–243.



[4] Greene, J. 2003. ''From neural 'is' to moral 'ought': what are the moral implications of neuroscientific moral psychology?' Nature. Available at: http://www.overcominghateportal.org/uploads/5/4/1/5/5415260/from_neural_is_to_moral_ought.pdf







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Haas, J. Uncovering the Neurocognitive Systems for 'Help This Child'. The Neuroethics Blog. Retrieved on
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