Should you read more because a neuroscientist said so?

By Lindsey Grubbs



Lindsey Grubbs is a PhD student in the English Department at Emory University, where she is also working on a certificate in bioethics. She holds a master’s degree in English and gender studies from the University of Wyoming. She is interested in the relationship between literature and science, and works with American literature from the nineteenth century until today to interrogate and complicate the boundaries between health and wellness, normalcy and aberrance, and physical and mental complaints.



As neuroscientists begin to approach topics usually falling under the purview of other specialties, how can they ethically incorporate various forms of knowledge rather than provide simplified metrics that will, in a data hungry society, be easier for most to latch onto?



In 2013, we saw the publication of at least two high profile studies claiming neuroscientific proof for the potential moral benefits of reading fiction. Greg Berns and his associates published “Short- and Long-Term Effects of a Novel on Connectivity in the Brain” in Brain Connectivity (Berns, Blaine, Prietula, & Pye, 2013), and David Comer Kidd and Emanuele Castano published “Reading Literary Fiction Improves Theory of Mind” in Science (Kidd & Castano, 2013). The Berns article makes a relatively modest claim: the day after an evening session reading a novel, test subjects had short-term increased brain connectivity in areas of the brain associated with taking perspectives and understanding narratives, and longer-term connectivity that lasted several days in the bilateral somatosensory cortex, which the authors suggest could help explain the mechanism of “embodied semantics,” the idea that there is somatosensory involvement in the processing of language, as when tactile metaphors like “I had a rough day” activate the somatosensory cortex (Lacey, Stilla, & Sathian, 2012). As suggested by its title, the Kidd and Castano piece makes a more dramatic claim: the authors conducted five experiments and write that reading award-winning literary fiction improves subjects’ theory of mind both alone and in comparison to nonfiction or popular bestselling fiction. The reaction to these studies in the press follows the trend of a mania for neuroscientific evidence and colorful images of the brain¹.  Why is it necessary, though, to grant scientific authority more weight as evidence than other forms of knowledge?

Via The Wire

Our society values information that seems objective over that which seems subjective—at times a value that makes sense, but one that is exaggerated in the case of something like responses to literature, which are inherently subjective. Writing for the New York Times, Alissa Quart writes, “The problem isn’t solely that self-appointed scientists often jump to faulty conclusions about neuroscience. It’s also that they are part of a larger cultural tendency, in which neuroscientific explanations eclipse historical, political, economic, literary and journalistic interpretations of experience” (Quart, 2012). The reading studies and the press reactions to them clarify the need for interdisciplinary work that truly engages with, rather than pays lip service to, multiple sources of knowledge—not just scientific protocol, but also generations of thoughtful work in the humanities.



Kidd and Castano’s study highlights the need for truly engaged interdisciplinary work, as it engages with literary topics without full consideration of the dynamics of reading—they perform what ought to be an interdisciplinary study without the necessary expertise, leading to a weaker study compounding the type of media “neurohype” this one received. While Kidd and Castano acknowledge literary theory by employing literary critic Roland Barthes’ differentiation between “readerly” texts, which encourage passive reading, and “writerly” texts, which engage the reader and require them to produce their own meanings (a move demonstrating that they’ve done some homework in literary theory), they use the terms imprecisely (Barthes likely would have classed all of the books in the study as “readerly”—none were “weird” enough to garner a “writerly” diagnosis, which describes text like James Joyce’s Finnegans Wake) and perhaps to the point of inaccuracy. Anyways, the terms originate over forty years ago, and hardly reflect more contemporary, nuanced understandings of how texts engage the reader.



More recent literary theory suggests that the value and substance of a text is not an inherent quality of a work; rather, the meaning of a text is created in the relationship between the reader and the page, both enmeshed in a complex context of race, class, gender, and other factors. By making the claim that “literary fiction” improves theory of mind while “popular fiction” does not—a messy distinction framed as though it were a straightforward one (it seems important to note that the results of Berns’ study—which used a “popular,” not “literary” novel—would suggest that this is wrong, and that reading need not be literary to improve empathy), Kidd and Castano’s study also risks propping up class-based distinctions. Supporting the bias that reading “high-culture” literature, which is undeniably bound up in classed, racialized, and gendered inequalities, is more morally salutary than reading other texts on the basis of one measure is irresponsible, and shows an inadequate engagement with the politics of reading. Despite a brief nod to the class-based distinctions between the two groups, the authors maintain that the notion of “literary value” has “ecological validity” because it can be detected by readers. But it is precisely this ecological validity that changes how the text will be read: we live in a culture that values certain types of writing from certain types of authors (most typically, dead white men), and this value is necessarily historically contingent—not “objective.” Today, we know when we pick up a mystery or sci-fi novel that we are supposed to read it easily, quickly, and probably with a bit of embarrassment. In contrast, when we pick up “serious” literature, we are supposed to engage and work at meaning—which we can easily imagine would impact the neural mechanisms at play.

Via stanford.edu

Incorporating an expert in literary study could have helped the experiment design avoid this problem. Consider the work of Natalie Phillips, an English professor working with neuroscientists and radiologists on a study of the neuroscience of reading and attention. Subjects read Jane Austen in an MRI and alternated between skimming casually and reading closely—revealing that the two types of reading produced very different patterns on the MRI. Her familiarity with literature allowed her to realize that there are not simply different types of texts, but also different types of reading—a key oversight in the Kidd and Castano study. Future research into the relationship between reading and the brain would be more thorough, convincing, and conceptually and ethically sound if it includes humanities scholars, who contribute a different kind of knowledge. Conversely, the growing body of work in the humanities that incorporates a cognitive approach must be vigilant about including science ethically, which is to say scientifically—not “pop-scientifically.”



As neuroscientists become more deeply engaged with social questions, as Berns and Kidd and Castano have done with these recent studies, we will need to begin sorting through a complex series of questions. Julianne Chiaet writes in Scientific American that Kidd and Castano’s study could influence educational programs, prison reform, and the treatment of autism. But how well supported does a scientific claim have to be before we use it to shape policy? Kidd and Castano acknowledge that the research is preliminary, focused on only one of a wide array of possible benefits of reading, and that much research remains—however, that doesn’t stop them from suggesting potential policy implications based on the limited knowledge they propose. They point to the new Common Core State Standards and argue that more fiction ought to be included in the curriculum (at the expense of other subjects of study). Alternatively, what are the implications of “prescribing” reading as a kind of social medication for those deemed pathologically asocial? Writing for Slate, Mark O’Connell expresses concern about looking at reading in a "morally instrumentalist" way. What are the dangers of suggesting that mandated reading programs could “fix” our criminals and children with autism at the expense of broader social reforms that would reduce the incentives to commit crimes or the stigma our culture aims at people with disabilities? Moving forward, tackling these types of questions will require the pooled expertise of those in the sciences and humanities.



¹ Berns uses neuroimaging, while Kidd and Castano use measures of theory of mind like “reading the mind in the eyes” tests.





Bibliography



Berns, G. S., Blaine, K., Prietula, M. J., & Pye, B. E. (2013). Short- and Long-Term Effects of a Novel on Connectivity in the Brain. Brain Connectivity, 3(6), 590–600. doi:10.1089/brain.2013.0166



Chiaet, J. (2013). Novel Finding: Reading Literary Fiction Improves Empathy. Scientific American. Retrieved June 16, 2014, from http://www.scientificamerican.com/article/novel-finding-reading-literary-fiction-improves-empathy/



Kidd, D. C., & Castano, E. (2013). Reading Literary Fiction Improves Theory of Mind. Science, 342(6156), 377–380. doi:10.1126/science.1239918



Lacey, S., Stilla, R., & Sathian, K. (2012). Metaphorically feeling: Comprehending textural metaphors activates somatosensory cortex. Brain and Language, 120(3), 416–421. doi:10.1016/j.bandl.2011.12.016



O’Connell, M. (2013, October 28). 10 Novels to a Better You. Slate. Retrieved from http://www.slate.com/articles/arts/culturebox/2013/10/does_reading_fiction_make_you_a_more_empathic_better_person.2.html



Quart, A. (2012, November 23). Neuroscience: Under Attack. The New York Times. Retrieved from http://www.nytimes.com/2012/11/25/opinion/sunday/neuroscience-under-attack.html



"This is your brain on Jane Austen, and Stanford researchers are taking notes." (2012, September 7). Stanford University. Retrieved June 11, 2014, from http://news.stanford.edu/news/2012/september/austen-reading-fmri-090712.html







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Grubbs, L. (2014). Should you read more because a neuroscientist said so? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/06/should-you-read-more-because.html

Predicting Alzheimer's Disease: Potential Ethical, Legal, and Social Consequences

By Henry T. Greely, J.D.





Henry T. (Hank) Greely is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He directs the Stanford Center for Law and the Biosciences and the new Stanford Program in Neuroscience and Society  SPINS). He is also a member of the AJOB Neuroscience Editorial Board.



Would you want to know the date and time of your death? Life-Line, the first published fiction by Robert A. Heinlein, one of the giants of 20^th century science fiction, explored that question. The story’s protagonist, Hugo Pinero, had invented a machine that could tell precisely when individuals would die, but, as Pinero found to his distress, he could not intervene to change their fates.



Would you want to know whether you would be diagnosed with Alzheimer disease (AD)? This question is rapidly leaving the realm of science fiction; indeed, it already has for some unlucky people. Our ability to predict who will suffer from this evil (and I chose that word carefully) condition is proceeding on several fronts and may already be coming into clinical use.



This post will briefly note the ways in which AD prediction is advancing and what some of the ethical, legal, and social implications of such an ability would be, before asking “should we care?”

Via the BBC

Science



Several different techniques are providing information about an individual’s risk of being diagnosed with AD, including genetics, biomarkers, and neuroimaging.



Genetics can predict AD with great confidence for about one person in a thousand. People who carry a mutated version of the PS1 gene (or, much more rarely, mutated versions of the PS2 or APP genes) are nearly certain to be diagnosed with AD, unless they die earlier from something else, and with an early onset version that typically strikes in one’s 40s or 50s. People with two copies of the APOe4 allele, about one to two percent of the population, have a very high risk (at least 50 percent, perhaps as high as 80 percent) of being diagnosed with AD in their sixties or seventies. People with one APOe4 allele and one APOe2 or APOe3 allele – that’s about 20 percent of the population – have two or three times the AD risk of people without an APOe4 allele. Other alleles of other genes have also been found to confer higher risk of AD, and some single nucleotide polymorphisms have been associated with higher risk of the disease.



Other researchers have identified biomarkers that are associated with risk of AD, both in the cerebral spinal fluid (CSF) and in the blood serum. Thus far, the CSF methods have looked for levels of the protein beta amyloid (42), which forms plaques on dead and dying neurons of those with AD, and the protein named “tau,” which forms tangles in the bodies of those neurons. Some of the blood work has looked at those biomarkers; others have looked at a range of different proteins in the blood. None of these methods is ready for clinical use; some of the published research has claimed nearly 90 percent accuracy in predicting relatively near-term AD diagnosis.



Recently, the FDA approved a radio ligand that attaches to the amyloid plaque in the brain and allows the existence of amyloid plaque to be seen by positron emission tomography (PET). The approved labeling is for use in diagnosing AD, not in predicting it, but the off-label use doctrine allows doctors to prescribe it for any purpose. Other researchers are trying to find ways to image tau tangles, though currently the only method for detecting them is through a brain biopsy (not an easy technique!). It is also known that magnetic resonance imaging (MRI) scans of brains can see changes in grey matter density in certain parts of the brains of people with AD; efforts are under way to use that method to predict AD diagnoses.



These various methods need not be used in isolation. They could be used together, in an effort to provide greater accuracy than any one test would do on its own. We are only at the beginning of efforts to assess those possibilities.



The FDA has not approved any of these methods (yet) for clinical use in predicting AD and professional groups have recommended against such use. It remains unclear how good any of these methods are alone or in combination, or at what age or ages they are useful. (A genetic cause may be strongly predictive even before birth; amyloid plaque levels may – or may not – be relevant only for people over 60.) Their accuracy might also vary between completely cognitively normal and those showing some minor signs of cognitive problems (which, for many people, would not progress to AD).



Importantly, these methods were not discovered in order to use them for clinical prediction. They are the results of basic research, of efforts to understand the natural history of the disease, in hopes of ultimately finding preventions or treatments. Their first use in humans has been in AD research, stratifying research subjects into high and low risk groups in the hope of making clinical trials faster and cheaper. But nothing prevents a physician from ordering the tests for a worried patient (with money to pay for tests that insurance will not reimburse).

Via Next Avenue 

Effects



Let’s assume that people did begin to get fairly accurate tests for their AD risks. What would follow?



If we had good interventions to prevent or treat the disease, much good might come from such testing, but we don’t (beyond “chicken soup” kinds of recommendations like “exercise”.) So how and why will people use these predictions and what non-medical consequences can we expect?



Some people will use the information for financial planning. A friend of mine is an “elder lawyer,” who spends a good amount of his time in financial planning for the elderly. He says that if we had a test that was 90% accurate, he would urge all of his clients to get such a test so they can plan how to use (and preserve) their assets for their struggle with AD.



On the other hand, some will worry about the effects of getting tested. Being at high risk for AD might lead to all the usual discrimination suspects – employment, health, life, and disability, plus one special one, long term care insurance. The relatively old ages at which AD strikes (except for the roughly 1% of cases that are early onset) mitigate, but do not eliminate, the number of people who would risk employment and health insurance discrimination. Most people will not be employed when they are diagnosed with AD. And, at time of diagnosis (and hence of increased health care costs), most of those affected will be over 65, and thus will have Medicare for health coverage (whatever may happen to Obamacare). Ironically, though, whether GINA, the Genetic Information Non-discrimination Act, protects them will depend on whether their risks were predicted using genetic methods or other methods. (The consequences of the use of mixed methods are not clear.)



A few special cases of possible “employment” discrimination might be noted. Every four years Americans “employ” someone as President. Would the public want to know the AD risks of the candidates? Not too long ago, President Ronald Reagan was diagnosed with AD only a few years after the end of his second term. The public, acting largely through the press, might want AD risk information from future candidates. (Teneille Brown has explored these issues in more depth¹.)



Similarly, sitting presidents may well want that kind of information about candidates for appointment to jobs with life tenure – federal judges, and particularly Supreme Court justices. In 2009, Judge Karen Williams, Chief Judge of the United States Court of Appeals for the Fourth Circuit, retired from the bench at the age of 57 because of early onset AD. All things being equal, presidents want the judges they appoint to sit, and influence the law, for decades after the president’s term is over.



It is not clear that life insurers would care much about AD risk; the disease process is so long that the age at death, though somewhat reduced, may not be change significantly. But private disability insurers should care, as AD patients who are employed at the time of diagnosis may end up claiming on such policies.



And long-term care insurers, should care, a lot. AD patients will often need years of long-term care. The private long-term care market is relatively new and small. It is a policy initiative to try to deal with the upcoming huge cost of long term care for Baby Boomers, care that is not significantly covered by Medicare or private health insurance. If people were able to test for their AD risk and then, if they test positive, buy long-term care insurance on the same terms, the resulting “adverse selection” will cause insurers either to lose money or to raise their rates. Either outcome, in this young and relatively fragile market, could end long-term care insurance. On the other hand, if insurers can take AD risks into account (at least when the customer knows those risks), people at high risk will often find long term care insurance unaffordable, even though – and especially because – they will need it.



But other, less tangible, consequences may follow. Consider the effects on family dynamics. Will the children take away Dad’s car keys sooner if he has been predicted to be at high risk for AD? Will they take away his checkbook, and control over his finances? How will the relationships within the family change when spouses, partners, and children expect an AD diagnosis?



And, of course, what will be the effects on people predicted to be at high risk? They may face depression or other psychological consequences. They might even make plans for suicide.



These issues, of course, are not new – they occur already with an AD diagnosis. But an AD prediction may move the opening point of these concerns forward several years, years that otherwise might not have been clouded by the knowledge, or fear, of AD.



Should We Care?



In a different sense, none of these issues is new. They already exist with fatal diseases that can be confidently predicted, like Huntington disease, as well as fatal diseases once they are diagnosed. But AD is, in some ways, distinctive. Instead of striking one person in 20,000, like Huntington disease, it will strike an estimated 10% to 15% of the population. And its memory, and ultimately personality, destroying characteristics lead to special challenges, as well as, for some people, to special horror. What, if anything, should we do about it? For now, I will make only two suggestions: assurance of the accuracy of the predictions and a requirement for counseling.



The accuracy of the tests, alone and in combination, needs to be assessed carefully, and for people of different sexes, ethnicities, and other possibly relevant possibilities. I believe some kind of public assessment of accuracy, akin to (and possibly including) FDA approval, should be required before the testing is allowed.



Then, both before the test is taken as well as after any positive results are returned, we should require skilled counseling. The first session will help make sure that the individual understands the advantages and risks of taking the test. The second will help high risk people deal with the shock of the prediction – and with its longer-term consequences.



Conclusion



Pinero’s “life predictor” never existed and never will. That would have been good for the fictional Pinero: in the short story thugs paid by life insurance companies murdered him, on the very date his machine had predicted



Widespread, accurate (or even inaccurate) AD prediction is not yet here. It will be soon. As a common, expensive, and severe disease, its predictability will bring some foreseeable challenges, as well, no doubt, as some unforeseeable ones. We need to work to understand, and cope with, those challenges. And we need to start yesterday.





Reference



1) Teneille Brown, Double Helix Double Standards: Private Matters and Public People, J. Hlth Care L. & Pol. 11:295-376 (2008).

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Greely, H. (2014). Predicting Alzheimer Disease: Potential Ethical, Legal, and Social Consequences. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/06/predicting-alzheimer-disease-potential.html

June 9th and 10th: President's Commission for the Study of Bioethical Issues at Emory University

The Presidential Commission for the Study of Bioethical Issues is an advisory panel that counsels the President on bioethical issues in light of scientific and medical advances. Most recently, the panel published Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society as a part of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. This document touched on relevant ethical issues related to neuroscience and made recommendations for integrating ethics into various facets of neuroscience research, education, and policy making.



On June 9–10, 2014, a public meeting of the President’s Commission for the Study of Bioethical Issues will be taking place at Emory University in the Rollins School of Public Health Building. The complete agenda is listed here, but the Commission will discuss the BRAIN Initiative and current work taking place in the field of neuroscience. Watch the live webcast and follow AJOB Neuroscience on Twitter if you are unable to attend!

http://bioethics.gov/meetings

Brain Imaging and Neurofeedback: Has Fiction Become Reality?

By Carolyn C. Meltzer, MD



Dr. Carolyn C. Meltzer is a professor at the Emory University School of Medicine Departments of Radiology and Imaging Sciences, Psychiatry and Behavioral Sciences, and Neurology. She is also a member of the AJOB Neuroscience Editorial Board.



“Power is in tearing human minds to pieces and putting them together again in new shapes of your own choosing.”

―George Orwell, 1984





In the iconic geopolitical thriller “The Manchurian Candidate,” advanced mind control techniques are used on a Korean War prisoner to turn him into an assassin. As we move into an era in which functional neuroimaging may be applied in ways akin to “mind reading,” such as applied to lie detection and economic choices, this fictional work more closely mimics reality.



Functional neuroimaging tools have helped us to tease out neuronal networks and to better understand how we think and act in health and disease. With the exception of few specific instances of validated clinical use (such as mapping of exquisite cerebral cortex prior to resecting a nearby tumor), most behavioral functional imaging studies require group, rather than individual data.



New research has focused on exploiting brain-computer interfaces that address therapeutic approaches to neurological and psychiatric conditions in individualized care settings. Recording brain activity and using it to modulate behavior or motor activity - or to seek a specific therapeutic outcome - has spawned the field of neurofeedback. Initial applications have used invasive approaches, such as deep brain stimulation in movement disorders and medically intractable depression. More recently, emphasis has turned to non-invasive approaches. Florin and colleagues (2014) demonstrate how real-time magnetoencephalography (MEG) source imaging may modulate the activity of targeted specific brain regions reinforced by visual subject feedback.



There are many ethical issues to explore in the therapeutic setting of neurofeedback, including whether informed consent (autonomy) may be biased by patient desperation and/or unrealistic expectations (Hamani and Moro, 2012). An unanticipated alteration in mood or behavior (and potential alteration of identity) post-treatment may further alter the patient’s decision-making capabilities.



The ethical concerns further escalate as one contemplates current and potential future uses of neurofeedback in which the patient may not consciously consent or even be aware of its use. In a fascinating study by Monti and colleagues (2010), five of 54 brain injury patients in presumed vegetative states were shown to modulate their brain activity (using fMRI) in response to mental imagery tasks. Neurofeedback techniques using imaging signal modulation have already been attempted in conditions with law enforcement implications, such as pedophilia (Renaud et al. 2011) and drug addiction (Carter et al. 2011). Stopczynski, et al present a vision of a world in which a Smartphone Brain Scanner could track (and eventually modulate) a consumer’s emotional responses to product presentation.

Demonstration of a Smartphone Brain Scanner (Stopczynski et al 2014) 

Another avenue of use for neurofeedback is in national security and warfare. The Defense Advanced Research Projects Agency (DARPA) and the Department of Defense have funded neuroscience projects with relevance to deception detection, and enhanced endurance and attention capabilities of soldiers (Tennison and Moreno, 2012).



While most neurofeedback is performed for treatment of a condition, the potential exists for its use to target enhancement of mental function (2007 ethics). While some might argue that this is no different from many accepted therapies such as a cochlear implant or contact lenses, cognitive enhancement may introduce additional concerns of informed consent and the potential for undue social or economic motivators.



The BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies), launched by President Obama on April 1, 2013 and developed by the National Institutes of Health, is a multi-decade effort to “revolutionize our understanding of the human brain.” Given the promise of further acceleration of innovation in neurofeedback tools, scientists, physicians, and policy makers need to be ready to ensure their ethical use.





References



Florin E, Bock E, Bailet S. Targeted reinforcement of neural oscillatory activity with real-time neuroimaging feedback. Neuroimage 2014;88:54-60.



Hamani C, Moro E. Emerging Horizons in Neuromodulation: New Frontiers in Brain and Spine Stimulation. International Review of Neurobiology. Academic Press 2012.



Monti M, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S. Willful Modulation of Brain Activity in Disorders of Consciousness. N Engl J Med 2010; 362:579-589.



Renaud P, Joyal C, Stoleru S, Goyette M, Weiskopf N, Birbaumer N. Real-time functional magnetic imaging-brain-computer interface and virtual reality promising tools for the treatment of pedophilia. Progress in Brain Research 2011; 192:263-272.



Ethical and Legal Aspects of Neuromodulation: on the Road to Guidelines. Neuromodulation: Technology at the Neural Interface, 2007;10: 177–186.



Tennison M, Moreno JD. Neuroscience, Ethics, and National Security: The State of the Art. PLoS Biol. Mar 2012;10(3): e1001289.



Carter A, Bell E, Racine E, Hall W. Ethical Issues Raised by Proposals to Treat Addiction Using Deep Brain Stimulation. Neuroethics 2011;4:129-142.



Stopczynski A, Stahlhut C, Petersen MK, Larsen JE, Jensen CF, Ivanova MG, Andersen TS, Hansen LK. Smartphones as pocketable labs: Visions for mobile brain imaging and neurofeedback. International Journal of Psychophysiology 2014;91:54-66.





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Meltzer, C. (2014). Brain Imaging and Neurofeedback: Has Fiction Become Reality? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/brain-imaging-and-neurofeedback-has.html

A review of The Future of the Mind: The Scientific Quest to Understand Enhance, and Empower the Mind

The Future of the Mind, authored by physicist Dr. Michio Kaku, explores how neuroscience might inform questions that philosophers have been debating for centuries: Do we have a soul? What happens after we die? Do we even have to die? And what would it take to produce a robot with human consciousness or emotions? To explore these questions, Dr. Kaku interviewed hundreds of scientists who are actively conducting ground breaking work in labs around the world, and from these conversations he made predictions on how these scientific findings would shape our future. The work that Dr. Kaku discusses, such as the latest advances in brain-computer-interfaces (BCI) for the disabled,¹ recording dream images with MRI machines,² or implanting memories in mice,^3,4 makes for a fascinating and engrossing read from start to finish. The Future of the Mind is at its best when taking readers through these areas of research and explaining the long-term significance, however many of the neurophilosophical questions posed are largely left to the readers’ imaginations for resolution.



The Future of the Mind is divided into three parts or books, and each book delves more and more into the technology of the future and the type of society that will exist decades and centuries from now. Book I sets the stage for how important physics is for neuroscience; the revolutionary technologies such as MRI, PET, and DBS have used basic physics knowledge, as Dr. Kaku notes, to promote the explosion of advances in the field of neuroscience. The state of these technologies in current research is introduced, along with how to conceptualize consciousness, and in Book II, he discusses how these technologies will enable us to conduct acts similar to telepathy and telekinesis, manipulate thoughts and memories, and enhance intelligence. Book III revisits the idea of consciousness and explores the possibilities related to mind-altering technologies, and suggests we reframe our understanding of consciousness beyond a single type of consciousness (i.e., dreaming, drug-induced states, and mental illnesses). He also suggests that the future understandings of consciousness may move beyond humans to include robots and aliens. Book III also explores ideas straight out of science fiction such as that one day our physical bodies will be too cumbersome for travel to other galaxies through deep space, so we’ll simply leave them behind.

Dr. Kaku excels at taking complex, difficult scientific research and explaining the work in such a way that is easily accessible to the public. His predictions are based on the most recent advances in science, and the criteria for his predictions are that 1) they must obey the laws of physics and 2) a working prototype must exist. For these reasons, even the most far-fetched ideas seem reasonable when presented in his easy to read, pop-culture referenced style. He describes proof-of-concept experiments that take place in mice or primates today and then tries to relate this to what could happen by the end of the century in humans. The Future of the Mind mostly takes place in the science of today and the science of decades and centuries from now, however it does not critically describe the science of tomorrow or even the immediate future.  For example, although we are probably quite far away from directly transferring complex memories to other people, recent work has shown that devices like transcranial magnetic stimulation (TMS) can enhance memory. This could potentially be used to change how the law operates by enhancing eyewitness memories,⁵ although the current implications of TMS are hardly mentioned. Despite focusing more heavily on the technologies that seem almost like science fiction in nature, Dr. Kaku makes current research clear, accessible, and informative to general audiences. The conversations within the book and Dr. Kaku’s effective communication style are perhaps particularly relevant now. With the announcement of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative by President Obama and the Human Brain Project by the European Union, the general public will increasingly need to find resources to enhance their awareness of what neuroscientific advances could potentially be forthcoming



The Future of the Mind is the most engaging when it presents a well-organized breakdown of future technologies; however, a large portion of the books is dedicated to theory of consciousness and altered states of consciousness. Even though Dr. Kaku is well-versed in these subjects and acknowledges the help of over 200 individuals in researching material, he overly simplifies what it means for humans to be conscious and then applies his overly simplistic definition to complex areas of study such as altered consciousness, the consciousness of the future, and alternative beings that may be conscious. Dr. Kaku refers to his theory of consciousness as the “space-time theory of consciousness” and is defined as “the process of creating a model of the world using multiple feedback loops in various parameters in order to accomplish a goal.” In physics, space-time is any formula or model where space and time are placed onto one continuum, and Dr. Kaku, a theoretical physicist who also studies string theory, defines consciousness within these two parameters. In this theory, there are four levels of consciousness, 0 – III, and every organism is assigned a second numerical value associated with how many feedback loops, or parameters of space, he is able to interact with. For example, plants are placed in the lowest level, level 0, but if a plant is able to regulate itself based on 3 parameters (temperature, sunlight, and moisture) it would have a value of 0:3, where 0 represents the level of consciousness on his space-time theory continuum and 3 is the number of feedback loops that the plant is able to use for regulation. Humans are distinct from other organisms in that humans are able to model a situation not only in respect to space, but also time; we can plan ahead not only for tomorrow, but also for times beyond our lifetime. We are capable of “mediating and evaluating many feedback loops in order to accomplish a goal.” A numerical value can also be assigned to humans based on how many realistic outcomes, or parameters of time, a person can model for a specific outcome (e.g., III:100). Human consciousness is understandably a huge task and an enormous area of evolving research, but Dr. Kaku aims to dissolve the difficulties with his theory in explaining this concept and providing a definition in terms that are well applied in the physics field. However, it is unconvincing that consciousness can be reduced to a two value numeric though, especially when discussing disorders of consciousness. Dr. Kaku applies his theory to a few mental disorders including schizophrenia and OCD, stating that problems arise when feedback loops are in conflict. For example, paranoia is an imbalance between the amygdala that recognizes fear and the prefrontal cortex that evaluates this fear. Dr. Kaku does state that this is only a “preliminary sketch,” and future research will unveil the complexities of mental illness that are not discussed in The Future of the Mind.

Photo from: psychpulse.com

While the description of human consciousness is shaky at best throughout the entire book, one of the most engrossing chapters describes the ideas behind silicon consciousness, or how machine intelligence could evolve so that robots are able to feel emotionally and conduct sophisticated thought processes, including those that involve ethical choices. The space-time theory of consciousness is applied to robots that have been developed today and the future state of robotics. While this model is overly simplified in terms of the complexity that is human consciousness, this model actually works quite well when describing robots because robots are still mostly confined to laboratory settings. Today, robots are really simple machines that belong in level I in Dr. Kaku’s space-time theory (one step above plants) because they do have the ability to use physical space as a parameter and they may have a few different sensors that act as feedback loops.  In his model of consciousness, robots would have to be able to interact with others and use this interaction as a feedback loop to enter level II to have any sense of emotional value. To be on par with humans on level III where the threat of take-over is near, robots must be able to use time as a parameter in which they make decisions. Placing robots on the same level as a worm puts the idea of the singularity, the point when artificial intelligence surpasses human intelligence, into perspective. Although the space-time theory works to describe the state of robotics today, this theory will eventually fall short as technology become more sophisticated.



In speaking of the future that is decades and centuries away Dr. Kaku heavily references the transhumanist Dr. Ray Kurzweil’s ideas that we will have the potential to upload our consciousness onto computers, clone humans, or have nanobots that will keep us healthy, although Dr. Kaku is a bit more conservative in acknowledging many of the obstacles for each of these causes. Similarly to Dr. Kurzweil though, Dr. Kaku does believe that silicon consciousness and advances from the BRAIN project will carry us into the future and trusts that “the real impact of this technology…will be to liberate the mind, not enslave it.” This is a powerful statement and idea that is continually conveyed, and ultimately what makes a reader want to live to experience a day in the not so near future if it is anything like what The Future of the Mind predicts. In making these bold predictions Dr. Kaku delivers a book that laudably describes the science taking place today and potentially in the future. These scenarios raise numerous ethical questions such as how using such consciousness scales will impact our healthcare practices or the legal status of nonhuman animals and silicon “minds,” or even how cognitive privacy will be protected in a society where mind-reading is possible.  If the society that The Future of the Mind poses is realized, the socioethical implications of such technological advances will need to be addressed beyond just the readers’ imagination, but by scientists and policy makers alike.





References



(1) Homer, M. L.; Nurmikko, A. V.; Donoghue, J. P.; Hochberg, L. R. Sensors and Decoding for Intracortical Brain Computer Interfaces. Annu. Rev. Biomed. Eng. 2013, 15, 383–405.



(2) Horikawa, T.; Tamaki, M.; Miyawaki, Y.; Kamitani, Y. Neural Decoding of Visual Imagery During Sleep. Science 2013, 340, 639–642.



(3) Liu, X.; Ramirez, S.; Pang, P. T.; Puryear, C. B.; Govindarajan, A.; Deisseroth, K.; Tonegawa, S. Optogenetic Stimulation of a Hippocampal Engram Activates Fear Memory Recall. Nature 2012, 484, 381–385.



(4) Ramirez, S.; Liu, X.; Lin, P.-A.; Suh, J.; Pignatelli, M.; Redondo, R. L.; Ryan, T. J.; Tonegawa, S. Creating a False Memory in the Hippocampus. Science 2013, 341, 387–391.



(5) Vedder, A.; Klaming, L. Human Enhancement for the Common Good—Using Neurotechnologies to Improve Eyewitness Memory. AJOB Neurosci. 2010, 1, 22–33.







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Strong, K. (2014). A review of The Future of the Mind: The Scientific Quest to Understand Enhance, and Empower the Mind. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/a-review-of-future-of-mind-scientific.html

Translating Preclinical Test Results into “Real World” Consequences

By Jalayne J. Arias, JD, MA



Jalayne J. Arias is the Associate Director of the NeuroEthics Program and Assistant Professional Staff in the Department of Bioethics at the Cleveland Clinic. Ms. Arias’ work incorporates empirical and conceptual projects addressing critical legal and ethical issues inherent in diagnosing, treating, and researching Alzheimer’s disease and other neurodegenerative conditions. Most recently, she served as the principal investigator for the study Stakeholders’ Perspectives on Preclinical Alzheimer’s Diagnosis: Patients, Families and Care Givers. Her recent publication, Confidentiality in preclinical Alzheimer disease studies (Neurology), addresses confidentiality concerns relevant to biomarker testing in Alzheimer’s.



In 2007, Dr. Dubois and co-authors introduced the concept of prodromal Alzheimer’s disease in their Lancet article revising diagnostic criteria. In 2011, the National Institutes of Aging and the Alzheimer’s Association supported a series of papers introducing a new paradigm for diagnostic criteria, including Mild Cognitive Impairment and preclinical Alzheimer’s disease. Both papers and new definitions of Alzheimer’s disease incorporate the discovery of Amyloid beta, a biomarker that purports to indicate disease pathology. The concept of using biomarkers, which are detectible years before a patient begins experiencing symptoms, offers the potential for offering preclinical testing in the clinical context. Yet, as researchers continue to validate biomarkers, little is known about how preclinical test results may affect patients and their families.



The Reveal Studies have examined the potential consequences of disclosing genetic disposition to Alzheimer’s to patients. Results indicated that individuals who learned they were APOE positive were more likely to purchase long-term care insurance. Additionally, an assessment of psychological outcomes resulted in data supporting that there were no long-term psychological consequences for individuals who learned they were APOE positive. Important differences between genetic markers for Alzheimer’s and biomarkers, including amyloid beta, should be acknowledged. First, a genetic disposition indicates a risk factor. Comparatively, a biomarker is purported to indicate active disease process. Whether this distinction will have psychological impacts is not yet know. However, another key difference must be highlighted. Unlike genetic information, biomarkers are not protected under the Genetic Information Non-Discrimination Act. This raises questions about individuals who have or will have biomarker status documented in their medical records. Are there legal mechanisms that protect again discrimination based on biomarker status? Could, or even should, insurers or employers use biomarker status to make decisions regarding employment and insurance eligibility?



While these questions seem premature, given the fact that biomarkers are not currently being used in clinical settings to detect Alzheimer’s at the preclinical state, they are being used in other contexts. A recent task force of the Society of Nuclear Medicine and Molecular Imaging and the Alzheimer’s Association evaluated the appropriate use for Amyloid PET. Their conclusions indicate that Amyloid PET imaging may be appropriate in a sub-population of patients. Additionally, biomarker testing is done in the research context. In some studies, researchers are using biomarker status as an inclusion criterion. Given this, by definition, those enrolled in such studies are biomarker positive, which effectively discloses biomarker status. An initial evaluation of the potential legal protections showed that there are minimal and potentially no federal protections for individuals who are enrolled in these studies. As a result, if biomarker status becomes a part of a research participant’s medical record, which is then disclosed to employers or insurers, there may be adverse consequences for participants without viable recourse.

Arias JJ and Karlawish J (2014)

Additional research is needed in this area, including gaining a better understanding of the legal consequences and protections for individuals who are amyloid positive or positive for other biomarkers that indicate disease pathology. This research should also examine if and how insurers and employers would use this information. Another research question is whether biomarker status should be a factor in determining whether an individual may pose a public safety risk in the future should they continue to remain employed and develop cognitive impairment. For example, should an employer be able to use biomarker status when considering employment decisions for a bus driver or an accountant? While researchers continue to work towards validating biomarkers that purport to indicate active disease pathology, parallel research on the consequences for individuals with positive biomarker status will be imperative.





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Arias, J. (2014). Translating Preclinical Test Results into “Real World” Consequences. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/translating-preclinical-test-results.html

When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics

By Brian Earp, MSc

Photo by Rob Judges

Brian Earp is a Research Fellow at the Uehiro Centre for Practical Ethics at the University of Oxford. He is an interdisciplinary researcher with training in cognitive science, experimental (social) psychology, philosophy, and ethics. With Professor Julian Savulescu, Brian is writing a book on the neuroenhancement of love and marriage, to be completed this year.

There is a big debate going on about “enhancement.” For many years now, people have realized that new technologies, along with discoveries in neuroscience and pharmacology, could be used in ways that seem to go beyond mere “medicine” – the treating of deformity or disease. Instead, to use a phrase popularized by Carl Elliot, they could make us “better than well.” Faster, stronger, smarter, happier. Quicker to learn, slower to forget. It has even been suggested that we could use these new technologies to “enhance” our love and relationships, or make ourselves more moral. 



These kinds of prospects are exciting to some. To others, they are frightening, or at least a cause for concern. As a result, there has been a stream of academic papers—alongside more popular discussions—trying to get a handle on some of the ethics. Is it permissible to take “medicine” even if we aren't “sick”? Should we be worried about “Playing God”? Do some people have an obligation to enhance themselves? And so on.



At least one major problem has been lurking in the background. And that is that, quite simply, “enhancement” could mean almost anything. Definitions are often vague, if they’re attempted at all. Some authors resort to simply listing out various interventions, with the hope that the reader will somehow “intuit” how they all hang together. But there are some common themes. In a recent paper with my colleagues Anders Sandberg, Guy Kahane, and Julian Savulescu, I called attention to at least two major “approaches” to understanding the term enhancement that seem to crop up in the academic literature.



The first is the Functional-Augmentative Approach to Enhancement. According to this type of approach, “interventions are considered enhancements insofar as they improve some capacity or function (such as cognition, vision, hearing, alertness) by increasing the ability of the function to do what it normally does.” The debate then usually turns on whether it’s OK to “enhance” someone (in this sense) who doesn’t have a “medical” problem, at least not on that particular dimension. This then leads to a second way of understanding enhancement, which we called:



The Not-Medicine Approach to Enhancement. According to this type of approach, to quote the bioethicist Eric Juengst, “the term ‘enhancement’ [characterizes] interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health.” This is the sense of “better than well” that many people (seem to) have in mind when they are engaging in these kinds of debates.



Both of these definitions have flaws. For one thing, they focus almost exclusively on the “augmentation” of capacities or functions—on “going beyond” the ordinary limits of medicine, or even human nature. But what about interventions that work in the opposite direction? One common example of “enhancement”—found throughout the neuroethics literature—is the use of drugs or other technologies to “blunt” painful memories (for example, after a breakup). Although such an intervention is clearly relevant to these discussions, it seems a little bit more like a “diminishment” than an “enhancement.” How should we consider cases like this?



Here are some other examples. What about the use of “anti-love biotechnology” to help a victim of domestic abuse break ties with her abuser? Or voluntary “chemical castration” for pedophiles seeking to change? To pick something less disturbing, how about appetite suppressants to help someone with her dieting goals? Enhancements? Diminishments? Both?



There’s a simple solution to this puzzle. All of these interventions are “enhancements” in the sense that they are geared toward improving well-being. “That is, once we shift our focus from the particular capacity or function being modified, to the overall normative goal of the modification itself” we stumble upon a third approach to understanding enhancement, which we call:



The Welfarist Approach to Enhancement. On this approach, “enhancement” is defined as “any change in the biology of psychology of a person which increases the chances of leading a good life in a given set of circumstances.” As we explore in our paper—see below for the reference and a link—we think that this approach resolves a number of conceptual ambiguities in the bioethics literature, and offers a useful framework for thinking through the use of new technologies in terms of how they can promote human flourishing. We look forward to hearing what you think!







This post can also be viewed on the Psychiatric Ethics Blog. 



Highlighted paper [open access]



Earp, B. D., Sandberg, A., Kahane, G., and Savulescu, J. (2014). When is diminishment a form of enhancement? Rethinking the enhancement debate in biomedical ethics. Frontiers in Systems Neuroscience, Vol. 8, Article 12, 1-8.



Related reading [open access]



Earp, B. D., Sandberg, A., & Savulescu, J. (2014). Brave new love: The threat of high-tech “conversion” therapy and the bio-oppression of sexual minorities. American Journal of Bioethics: Neuroscience, Vol. 5, No. 1, 4-12.



Earp, B. D., Wudarczyk, O. A., Sandberg, A., & Savulescu. J. (2013). If I could just stop loving you: Anti-love biotechnology and the ethics of a chemical breakup. American Journal of Bioethics, Vol. 13, No. 11, 3–17.



Earp, B. D., Sandberg, A., & Savulescu, J. (2012). Natural selection, childrearing, and the ethics of marriage (and divorce): Building a case for the neuroenhancement of human relationships. Philosophy & Technology, Vol. 25, No. 4, 561-587.



Wudarczyk, O. A., Earp, B. D. , Guastella, A., & Savulescu, J. (2013): Could intranasal oxytocin be used to enhance relationships? Research imperatives, clinical policy, and ethical considerations. Current Opinion in Psychiatry, Vol. 26, No. 5, 474-484.





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Earp, B. (2014). When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/when-is-diminishment-form-of.html