Is football safe for brains?

by Dr. L. Syd M Johnson

Dr. Johnson is Assistant Professor of Philosophy & Bioethics in the Department of Humanities at Michigan Technological University. Her work in neuroethics focuses on disorders of consciousness and sport-related neurotrauma. She has published several articles on concussions in youth football and hockey, as well as on the ethics of return-to-play protocols in youth and professional football.

This post is the first of several that will recap and offer perspectives on the conversations and debates that took place at the recent 2015 International Neuroethics Society meeting.

At the International Neuroethics Society annual meeting in Chicago this month, Nita Farahany and a panel from the Football Players Health Study at Harvard University (FHPS) headlined the public talk “Is professional football safe? Can it be made safer?” The panel declined to provide direct answers to these important questions, but the short answers are “No,” and “Not by much,” respectively.

In recent years, there has been much public concern about the impact of football and other neurotraumatic sports on the brains of athletes. The neuroethics community has been somewhat slow in picking up sport-related concussion and Chronic Traumatic Encephalopathy (CTE) as topics of neuroethical concern. Public and media concern have been fueled by reports stating that the brains of deceased athletes show evidence of the distinctive tauopathy of CTE, attributed by researchers like Bennet Omalu (who described the first case in a retired football player in 2005) and Ann C. McKee (Boston University) to brain trauma sustained while playing sports. To date, there have been approximately 150 documented cases of CTE, and an exceptionally high number of the brains examined by Omalu, McKee, and colleagues have been positive for the characteristic tau depositions.



Of course, there is selection bias in neuropathological case studies, since few retired athletes donate their brains to research after death. Neuroscientist Alvaro Pascual-Leone of the FPHS was openly dismissive of the existing CTE research during his brief discussion of it, criticizing the work as woefully underpowered. The existing science is worth little, Pascal-Leone told the audience, implying that the current alarm about the neurological effects of football-related brain trauma is premature, and probably overblown.

The speakers commented that there are some 15,000 retired, living NFL players—a small, elite group—and the FPHS is attempting to recruit 10,000 of them for its studies. Funded by the National Football League’s Players’ Union, the FPHS proposes to tackle whole lifespan player health through population studies to assess the scope of health problems experienced by retired players, pilot studies to develop interventions, and a law and ethics component that outlines ethical principles important to considerations of player health and is sensitive to the unique conflicts of interest in professional sports. Only some of the work being done by the FPHS addresses brain trauma and its effects on athlete health—that part of their work was, of course, of most interest to the neuroethicists assembled for the meeting, but it received scant attention from the panel. Judging by the questions from the audience, they mostly had brain trauma on their minds as well.

Moderator Nita Farahany and panel members Alvaro Pascual-Leone, I. Glenn Cohen, and Damien Richardson (pictured from left to right).

Concussion and neurotrauma in professional football are the subjects of much neuroscientific activity, but the bigger problem, briefly alluded to by law professor I. Glenn Cohen, is not what happens to adult, professional athletes, but to the large number of junior and amateur players. While there are millions of high school football players in the United States, only several thousands of these players continue to play at the college level, and an even smaller fraction go on to play in the professional ranks. This fall, seven US high football players have already died, most of them due to head trauma-related injuries. The majority of reported concussions in the US occur in high school football players, while the impact of all that head trauma remains largely unknown and understudied. Damien Richardson, a former NFL player, and now a doctor and advisor to the FPHS, discussed his own long path to the pros while sitting on the panel, beginning with Pop Warner football when he was a kid, through high school and college ball. When asked if he thought pro football was safe, he demurred, but explained that knowing what he knows now, he would still play, but would play differently than he did.

Richardson emphasized the need for change in professional football, change that would trickle down to influence the next generation of players coming up through the ranks. That model of top-down change has been endorsed by the NFL as well, but there is already evidence of bottom-up change, with greater attention to and concern about safety leading to fewer kids playing football, and opting for other sports instead. For many young athletes and their parents, there’s no longer any question about the safety of football.

Want to cite this post?



Johnson, LSM. (2015). INS RECAP: Is professional football safe? Can it be made safer? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/10/ins-recap-is-professional-football-safe.html

Technologies of the extended mind: Implications for privacy of thought

by Peter Reiner, PhD

Dr. Reiner is Professor and co-founder of the National Core for Neuroethics, at the University of British Columbia. Dr. Reiner began his academic career studying the cellular and molecular physiology of the brain, and in 1998, Dr. Reiner became President and CEO of Active Pass Pharmaceuticals, a drug discovery company that he founded to tackle the scourge of Alzheimer's disease. Upon returning to academic life in 2004, Dr. Reiner refocused his scholarly work in the area of neuroethics. He is also an AJOB Neuroscience board member.

Louis Brandeis in his law office, 1890.

In 1890, Samuel Warren and his law partner Louis Brandeis 
published what has become one of the most influential essays in the history of US law. Entitled The Right to Privacy [1], the article is notable for outlining the legal principles that protect privacy of thought. But it is not just their suggestions about privacy that are illuminating – it is their insight into the ways that law has changed over historical time scales that makes the paper such a classic. In very early times, they write, “the law gave a remedy only for physical interference with life and property...[and] liberty meant freedom from actual restraint.” Over time, as society began to recognize the value of the inner life of individuals, the right to life came to mean the right to enjoy life; protection of corporeal property expanded to include the products of the mind, such as literature and art, trademarks and copyrights. In a passage that resonates remarkably well with the modern experience, they point out that the time was nigh for the law to respond to changes in technology.

Recent inventions and business methods call attention to the next step which must be taken for the protection of the person, and for securing to the individual …the right “to be let alone”. Instantaneous photographs and newspaper enterprise have invaded the sacred precincts of private and domestic life; and numerous mechanical devices threaten to make good the prediction that "what is whispered in the closet shall be proclaimed from the house-tops."

The notion that privacy is problematic in a world dominated by instant communication is hardly new: as long ago as 1999, Sun Microsystems CEO Scott McNeally famously stated “You have zero privacy anyway. Get over it.”[2] This early sentiment on the invasiveness of technology has been borne out in chilling fashion with revelations that governments and corporations extensively monitor internet and cell phone use. It seems to me that the time is right to consider the proposition that continued changes in technology – in particular with respect to the life of the mind – require that we revisit the contours of the issue known as privacy of thought.

An important starting point is the extended mind hypothesis[3], the idea that cognition extends beyond the brain into the world at large. One example from the original paper - the case of Otto and Inga – illustrates the issue quite nicely. Inga hears about an exhibition at a museum that she recalls is on 53rd Street and sets off to see the artwork. Her neighbor Otto has dementia and so has made a practice of storing important information in a small notebook that he carries with him. When he hears of the exhibition, he consults his notebook, finds that the museum is on 53rd Street and, just like Inga, sets off for the same destination. Thus the cognitive function of storing information is mediated by the brain in one case and pen and paper in the other.

The claims of the extended mind hypothesis are radical: going beyond suggesting that human cognition relies on external structures for scaffolding and support, the extended mind thesis suggests that the physical vehicles that realize (at least some of) our cognitive processes lie outside of the bounds of the skull. Yet the concept resonates with a key feature of modern life: for many, there is a growing sense that computers, smartphones, and increasingly ‘the internet of things’ function as sophisticated extensions of our cognitive toolkit[4]. Conceiving of the mind as a blend between brain and algorithm challenges long-held assertions that there is something exceptional about the brain[5], but one ignores reality at one’s peril. Of late, I have begun to refer to the entire suite of algorithmic agents as "Technologies of the Extended Mind."

If we return to the question of privacy and situate the discussion in the context of a worldview that considers "Technologies of the Extended Mind" as a growing reality, we see that there is some new and interesting terrain to explore. It is well-known that both breaches and oversharing of our digital information has grown from the occasional to an everyday event. But if "Technologies of the Extended Mind" really are extensions of our cognitive toolkits, at some point the ability of others (governments, corporations, employers, friends, hackers, and more) to glimpse this information crosses the line from being a run-of-the-mill invasion of privacy to a more worrisome intrusion upon privacy of thought. Defining this dividing line – even if it turns out to be a fuzzy boundary – is an important challenge for neuroethical discourse.

The fundamental insight of Warren and Brandeis – that changes in technology require us to at least revisit if not update our moral norms – is as relevant today as it was 125 years ago.

REFERENCES

1. Warren, S. D. & Brandeis, L. D. The Right to Privacy. Harvard Law Review 4, 193 (1890).

2. Sprenger, P. Sun on Privacy: “Get Over It." Wired News (1999).

3. Clark, A. & Chalmers, D. The extended mind. Analysis 58, 7–19 (1998).

4. Pew Research Center. Digital Life in 2025. 1–61 (2014) at http://www.pewinternet.org/2014/03/11/digital-life-in-2025/ 

5. Reiner, P. B. The rise of neuroessentialism. in: Oxford Handbook of Neuroethics (eds. Illes, J. & Sahakian, B. J.) 161–175 (Oxford University Press, 2011).

The Neuroethics Blog Reader hot off the presses!

It is my pleasure to present you with our first edition of The Neuroethics Blog reader. This reader includes some of the most popular posts on the site and highlights our junior talent.

While the blog showcases cutting-edge debates in neuroethics, it also serves as a mechanism for mentoring junior scholars and students and providing them with exciting opportunities to have their pieces featured alongside established scholars in the field. In addition, the blog allows for community building, inviting scholars from multiple disciplines to participate. Our contributors have included individuals at various levels of education from fields such as law, neuroscience, engineering, psychology, English, medicine, philosophy, women’s studies, and religion, to name a few. Each blog post is a collaborative process, read and edited numerous times by the editorial leadership in partnership with the author.

We aim to continue to mentor and deliver quality posts that serve to cultivate not only our neuroethics academic community, but also members of the public who may be cultivating their own interests in neuroethics. Whether for direct applications in your profession or simply to understand the world in which we live, we hope the blog will help you navigate the implications of new neurotechnologies and explore what is knowable about the human brain.

At this time, I'd like to thank our amazing editorial team including Lindsey Grubbs (Managing Editor), Carlie Hoffman (Editor of this reader), Ryan Purcell, and Katie Strong. I'd also like to highlight our previous Managing Editors Dr. Julia Haas and Julia Marshall who have since graduated and are continuing their scholarship in neuroethics, as well as Jonah Queen who was there from the very beginning. Stay tuned for more great things from this group along with all of our talented contributors.

Thank you for taking the time to embark on this journey with us and please enjoy this reader!

P.S. If you are lucky enough to find yourself at the International Neuroethics Society conference this Oct 15-16, we will have limited printed copies available. Just look for folks wearing the "Ask Me About AJOB Neuroscience" buttons.

The Neuroethics Blog Reader

Your Brain on Movies: Implications for National Security

by Lindsey Grubbs

An intellectually diverse and opinionated crowd gathered recently for the most recent Neuroethics and Neuroscience in the News journal club at Emory University—“Your brain on movies: Implications for national security.” The discussion was one of the liveliest I've seen in the years I've been attending these events, which is perhaps not surprising: the talk touched on high-profile issues like neuromarketing (which is controversial enough that it has been banned in France since 2011) and military funding for neuroscience.

The seminar was led by Dr. Eric Schumacher, Associate Professor of Psychology at Georgia Tech, director of the Georgia State University/Georgia Tech Center for Advanced Brain Imaging, and principle investigator of CoNTRoL—Cognitive Neuroscience at Tech Research Laboratory. Currently, the lab investigates task-oriented cognition, as well as the relationship between film narratives and “transportation” (colloquially, the sense of “getting lost” in a story), which is a complex cognitive puzzle involving attention, memory, and emotion.

Cary Grant chased by an airplane in North by Northwest,

courtesy of Flickr user Insomnia Cured Here.

Schumacher presented his recent article, “Neural evidence that suspense narrows attentional focus,” published in Neuroscience. Subjects in the study were placed in an MRI scanner and shown film clips of suspenseful films including Alien, Blood Simple, License to Kill, and three Hitchcock films: North by Northwest, Marnie, and The Man Who Knew Too Much (I think I enrolled in the wrong studies to pay for college). The scanner revealed when suspense in the film increased, people's gaze was focused on the film.

Researchers correlated this fMRI data with moments of increased suspense—as when Cary Grant was chased by a plane in North by Northwest. This revealed two key findings: first, during moments of heightened suspense, subjects had increased activity in visual regions processing the film and corresponding decreases in activity to visual regions processing the visual periphery. Second, follow-up questions testing memory initially showed a slight but not significant increase of memory during suspenseful moments for questions like “What color was the truck at the end of the film?” However, when the questions were re-tooled to include plot elements, the memory increase became statistically significant. Thus, memory for plot-relevant information was shown to improve with increasing suspense.

EEG, courtesy of Flickr user Markus Spring

Researchers from this study also collaborated with a group investigating how brain coherence (i.e., the similarity of activity across participants) as monitored on EEG relates to subjective preference. In this experiment, EEG coherence predicted population preference of Super Bowl ads. That is, the more similar the brain signal across participants, the higher rated the Super Bowl ad was. Schumacher identified that some of the same attention and visual processing regions related to suspense are also more active with increasing preference of commercials. According to Schumacher, combining the research into suspense in films and attention in Super Bowl advertisements suggests that when attention is allocated to films and commercials, we can see changes in the brain, especially in visual processing, attention, and memory—and these factors are related more broadly to preference.

These facts alone were enough to spur intense conversation. Participants worried that this kind of neural research into visual engagement might result in more manipulative ads, or in a profusion of dull blockbuster-style action movies designed to trigger neural engagement. Some suggested that there would be nothing wrong with creating films engineered to maximize enjoyment. Others asserted that “enjoyment” is not what art is actually about, and claimed that they want films that make them uncomfortable and push them out of their comfort zone. Still others--including Schumacher--thought that the two are not mutually exclusive, and that art engineered to maximize the enjoyment of the kind of viewer who likes edgy indie films would be even edgier and indie-er, and that everyone could win in the end.

Would Hitchcock use neuro-insights to make more suspenseful films?

 Image courtesy of Wikimedia commons

“Art” seems to be a touchy subject when it comes to neuroscience. The animated discussion highlighted anxiety about science taking on topics we conceive of as belonging to subjective human experience. To many, “art” is intrinsically linked with “humanity,” and hence mechanizing how we think about art seems to make people fear for the mechanization of the individual or society. The fear, apparently, is that films produced using insights from neuroscience would result in a loss of agency or taste that is somehow intrinsic to our being—that films will manipulate or control us. It’s worth noting, though, that science is no more alien to our self-expression than art. Both come from a creative impulse, and science is always shaping our relationship to our humanity, just as our humanity is always shaping the way we engage in science.

The anxiety surrounding neuromarketing or neuro-aesthetic research is compounded in this case by military involvement. A Washington Post article about Schumacher’s research is provocatively titled, “Why DARPA is paying people to watch Alfred Hitchcock Cliffhangers.” The study was funded by “Narrative Networks,” a program of the Defense Advanced Research Projects Agency (DARPA)—the Department of Defense agency heading all kinds of totally wild sci-fi style research.

Narrative Networks specifically is interested in funding research into quantitative methods for studying narratives and their effects, into the neurobiology and endocrinology of responses to narratives, and into simulating and monitoring the impact of narratives and “doctrinal modifications” in the real world. DARPA claims, “Narratives exert a powerful influence on human thoughts and behavior. They consolidate memory, shape emotions, cue heuristics and biases in judgment, influence in-group/out-group distinctions, and may affect the fundamental contents of personal identity. It comes as no surprise that because of these influences stories are important in security contexts: for example, they change the course of insurgencies, frame negotiations, play a role in political radicalization, influence the methods and goals of violent social movements, and likely play a role in clinical conditions important to the military such as post-traumatic stress disorder.”

An article in Wired proclaims, “Darpa wants to Master the Science of Propaganda” and the BBC reported on “Building the Pentagon’s ‘like me’ weapon.” Given their titles, both are actually quite (disappointingly?) measured, and present the project as a defensive, not aggressive, one. The latter quotes neuroscientist Read Montague, who says, “I see a device coming that’s going to make suggestions to you, like, a, this situation is getting tense, and, b, here are things you need to do now, I’ll help you as you start talking.”

The dystopic Ludovico treatment in A Clockwork Orange, 

gif courtesy of Flickr user Gwendal Uguen

Despite this emphasis on defense, the mention of DARPA led our group, again, to spirited debate (also known as rampant conspiracy theorizing by those of us raised on the X-Files). When the research at hand is relatively straightforward and non-threatening, we might ask why military research is such a hot button issue. The most obvious answer is that many object to military activity and are uninterested in advancing science that could be used for violent or nefarious purposes. I will admit that my first glance at DARPA’s innocuous “Narrative Networks” immediately yields the more threatening “propaganda” or “mind control,” but there are at least two ways that this knee-jerk reaction can be elaborated on.

First, understanding narratives can of course yield pacifist as well as violent results. DARPA claims that they hope that understanding the ability of narratives to radicalize, for instance, could lead to more successful methods for de-escalating radicalization. They also point to the possibility of better treatments for PTSD, and to more effective measures for disseminating public health information.

Cold War propaganda, courtesy of Flickr user Dan H.

Second, although the word “propaganda” has an undoubtedly sinister ring to it, it is important to keep in mind that rhetorical appeals meant to influence belief and behavior are omnipresent and not inherently linked to an ethical judgment. We are all trying to convince people of things at all times. Public health campaigns, education, and this blog post itself are all propagandistic in their own ways—but that does not mean that they are necessarily reprehensible or ethically unacceptable. Schumacher hinted at this when he noted that after being quoted saying, “governments use stories,” he wishes he had stated more broadly that “people” use stories. You apparently can’t talk about defense research into narrative without the inevitable Goebbels reference, but rather than reactionary blanket judgments, it will more productive to think about ethical and unethical ways that research can be employed.

So, what are the ethics of military research funding? Although the topic originally calls to mind weapons development, chemical warfare, and the creation of Terminator-esque super soldiers, funders like DARPA provide enormous resources for researchers doing non-nefarious work, for instance, Schumacher’s suspense and transportation study, or Greg Berns’ work on neural connectivity when reading fiction (which I've written about elsewhere on this blog).  For researchers like these, should DARPA be seen as just another (and often extremely generous) source of grant money? Schumacher noted that the money came with no restrictions or conditions on the publication of the data received, and the work doesn’t go directly to some mysterious military database—it is published in major journals in order to advance the field.

Should pacifists have reservations about using DARPA money?

Image courtesy of Flickr user wwwuppertal

But are there other reservations? Can pacifists or conscientious objectors ethically pursue research with military funding? Are there ways that a Quaker graduate student, for example, could refuse to work on a DARPA project for which their PI obtained funding without stigma? Is the source of the funding important when the objective of the study is simply to increase our knowledge of the neural correlates of processes like reading or watching films? Scientific interest in narrative pre-exists this initiative, so in one way DARPA simply funds things we were already curious in. It is worth noting that DARPA is a significant funder for the BRAIN Initiative in the US, and hence is a major partner in advancing study into the brain. But does the military framing change the kinds of questions we ask or research agendas we pursue?

After hearing the skepticism that greeted the idea of military research into narratives, one can almost understand DARPA's enormous investment in controlling narrative and belief. Judging from our conversation, DARPA and the military could really use some work on their PR. But at this point, perhaps many, many years before the successful integration of this research into field tools (if that day ever comes), DARPA’s scientific approach to narrative reminds me less of Obi-Wan Kenobi's “These aren’t the droids you’re looking for” and more of Star Trek’s android Data when he uses his processors to try to act naturally--like when he picks a fight with a girlfriend in order to foster intimacy, explaining to her, “In my study of interpersonal dynamics, I have found that conflict, followed by emotional release, often strengthens the connection between two people.” (The relationship is not a success.)

We should definitely question and discuss the aims guiding research and the ways that the gains of research will be put into action—perhaps especially when the military is involved, but also when it comes to targeted advertising or the creation of appealing art. Perhaps science fiction, dystopia, and conspiracy theorizing provide some protective benefit, as they allow us to imagine possible negative futures that we can then avoid. But (despite the fun of conspiracy theorizing) can we see these conversations as an opportunity to discuss ethical paths forward, not simply unethical nightmares to avoid?

Want to cite this post?

Grubbs, L. (2015). Your brain on movies: Implications for national security. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/10/your-brain-on-movies-implications-for.html

Overexposed: The role of environmental toxicants on your brain

By Carlie Hoffman

It
is often said that we are products of our environment: who we are is
shaped by the things, people, and situations with which we surround
ourselves. However, whatever we may like to think, we are not in
control of every facet of our environment. In fact, we are unknowingly
and involuntarily exposed to dozens of man-made environmental chemicals,
called toxicants,
each day that can negatively alter our bodies and even our very brain
matter. In essence, we are becoming literal products of our environment.

Synthetic
chemicals and toxicants are ubiquitous within our surroundings. While some toxicants come from obvious
sources, like cigarette smoke and car exhaust, other sources of exposure
are more subtle. For instance, electrical equipment (like computers
and cell phones), beauty products (like makeup and shampoo), mattresses,
and furniture all contain flame retardants, chemicals used to reduce flammability [3, 13]. Bisphenol A (BPA) and phthalates,
chemicals used to harden plastics, can also be found in dental
sealants, cigarette filters, soda bottles, and the linings of canned
foods [4, 8, 12]. Additionally, dichlorodiphenyltrichloroethane (DDT),
a pesticide commonly used in the mid-1900s to combat outbreaks of
pests, malaria, and lice, was banned in 1972 in the US and yet is still currently present within both the environment and human tissues [12].

Pesticides not only harm insects, but certain doses can also have harmful effects on the human body.

The presence of chemicals within almost every facet of our society means we are
subjected to varying levels of environmental exposure throughout our lives– from the womb to the grave. A growing desire to
characterize the effects of this lifetime of exposure resulted in the
creation of a new concept: the “exposome.”
Defined in 2005 by Dr. Christopher Wild as “every exposure to which an
individual is subjected from conception to death,” this definition was
expanded by Dr. Gary Miller and Dr. Dean Jones
in 2014 to be “the cumulative measure of environmental influences and
associated biological responses throughout the lifespan, including
exposures from the environment, diet, behavior, and endogenous
processes” [9, 14, 15]. Indeed, some say the exposome profile may
tell a narrative about our individual lives with astounding accuracy–
including where we’ve traveled, what we’ve eaten, and trends in our
overall behavior.

As Dr. Wild stated, our environmental exposures, and our lives, begin in the womb. After this point, the developing fetus is subject to many
of the environmental chemicals and toxicants to which the mother is
(knowingly or unknowingly) exposed. A study described by CNN illustrated this point and found that pregnant mothers were exposed to pesticides and air
pollutants while engaging in everyday activities.  Some of these chemicals were also able to pass through the umbilical cord and enter into the bloodstream of the fetus, resulting in an average of 232 chemicals being found in the cord blood of 10 babies born over the course of the study.  Pregnant mothers were also exposed
to chemicals from unexpected sources, like taking a shower, cleaning the
house, and putting on makeup.  Some of these chemicals also made it into the fetus and were found in the fetal cord blood.  However, it
is important to note that the mere presence of such chemicals within the
blood is not necessarily harmful to human health. Instead, toxicity is
dependent upon the concentration and duration of exposure a person, or
fetus, is subjected to– meaning the presence of exposure does not always lead to the occurrence of detrimental health effects.



That
being said, certain types of environmental exposure can result in
numerous negative consequences for the brain. For instance, exposure to certain
amounts of air pollutants and pesticides during development has been associated with a
reduction in white matter volume in the brain, slower information
processing speed, behavioral problems, attention deficit/hyperactivity
disorder (ADHD) symptoms, and an alteration in mental and psychomotor
development [7, 10]. One study retrospectively examined a group of
adults in Cape Cod, Massachusetts who experienced prenatal and early
childhood exposure to drinking water contaminated with
tetrachloroethylene, a chemical solvent used in dry cleaning, and found
that early exposure was associated with impaired vision, increased
reports of impulsive behavior, and increased risks of developing bipolar
disorder and post-traumatic stress disorder (PTSD) in adulthood [1, 2,
6]. In addition, excessive prenatal exposure to BPA and phthalates has
been found to alter sexually dimorphic development of the brain and can also lead to alterations in anxiety, hyperactivity, and emotional control [4, 8, 12].  Thus, exposure to environmental chemicals can influence how our brains function, affect our mental health, and alter how we interact with the world around us.

Given
these documented detrimental health effects, we should seek to avoid
excessive environmental exposures. However, while we can limit our
interaction with known sources of environmental
chemicals, such as by avoiding areas that have recently been sprayed
with pesticides or not living in areas subjected to large amounts of car
exhaust, how do we protect ourselves from environmental toxicants coming from largely unknown and unavoidable sources?  And why are chemicals are being added to
commonly-used household items in the first place when such substances
have the potential to negatively alter our brains and neurodevelopment?

The
answer to this latter question can be traced to the years surrounding
the Great Depression and World War II. In this era, the fields of human
industry and farming began to employ synthetic chemicals for numerous
beneficial purposes, like controlling pest populations, reducing
flammability, and acting as additives in paints and wood finishes. These
potential useful applications led to the quick introduction of such
compounds to widespread use without thorough examination of their
possible negative impacts on human health. The reason for rapidly adding
these chemicals was described in the 1930s by the president of
the Halowax Corporation: “The problem so far as the chemical
manufacturer is concerned is a question of timing… should we take a
product of which you have developed, say, 5 or 10g and spend $50,000 on
research to determine whether or not it is toxic, or should you wait
until you have determined whether you have a market for it?...You can
see that would run into box car numbers in the way of dollars and cents
until you ever sold any” [12]. Essentially, adequate chemical testing
was not performed because it was not cost-effective, resulting in the
public remaining largely unaware of the adverse health effects that could arise from excessive exposure to these added chemicals.

Unfortunately, this cost-driven lack of investigation still describes how chemical research is performed today.  An article in The New England Journal of Medicine
stated that only 200 of the 80,000 chemicals added to products sold
within the US in 2011 were sufficiently tested for carcinogenicity, not to mention the number of chemicals that were inadequately tested for other, non-cancer-related negative outcomes arising from excessive exposure [5].

EPA

This mass-production of chemicals without adequate toxicity testing continues in part because of the vague chemical testing regulations that govern chemical companies in the United States. According to
the Environmental Protection Agency’s (EPA) chemical testing policy,
chemical companies are responsible for determining whether their
substances “may present an unreasonable risk of injury to health or the
environment.” The nebulous wording of this regulation, the lack of a
precise definition of “unreasonable risk,” and the increased cost
associated with increased research has resulted in many chemical
companies simply testing their chemicals for acute toxicity (which
involves giving experimental animals large doses of a chemical and
checking for a decrease in lifespan or the presence of illness), instead
of performing long-term testing (which involves giving experimental
animals small doses of a chemical over a long period of time). Thus,
the effects of gradual exposure, as would be experienced through daily
contact with a chemical over the course of a lifetime, are not examined
and the effects of such gradual exposure are only determined as people
are exposed to these chemicals for many years.

Thankfully,
this problem of non-consensual daily exposure to toxic chemicals is not
one without a solution– though working toward this solution will not be
easy. One of the first steps toward a less-polluted and more hospitable future is to
continue characterizing the human exposome. Several organizations
within the United States and Europe, including the HERCULES
exposome research center at Emory University, operate under this goal.
These organizations seek to develop a better understanding of the role
of the environment on brain disease onset and progression, to discover
chemicals that cause disease, and to remove or diminish exposures to
such chemicals [11]. More stringent regulations on chemical testing and
increased collaboration between chemical companies and neuroscientists
will also move chemical testing in the right direction, helping to
elucidate the long-term effects of environmental chemicals on the brain
and leading to more detailed chemical toxicity characterization.
Unfortunately, increased chemical testing is often viewed as an
unnecessary hindrance and is perceived as being less cost-effective than
rapidly mass-producing a chemical. However, more thorough testing and
increased chemical regulation will result in an improved quality of
life, better brain development, and an increase in human liberties for
individuals throughout our society and the world– and that is priceless.

Works Cited



1.
Aschengrau, A, Weinberg, JM, Janulewicz, PA, Romano, ME, Gallagher, LG,
Winter, MR, Martin, BR, Vieira, VM, Webster, TF, White, RF, &
Ozonoff, DM (2011) Affinity for risky behaviors following prenatal and
early childhood exposure to tetrachloroethylene (PCE)-contaminated
drinking water: a retrospective cohort study. Environ Health 10: 102.
doi: 10.1186/1476-069x-10-102



2. Aschengrau, A,
Weinberg, JM, Janulewicz, PA, Romano, ME, Gallagher, LG, Winter, MR,
Martin, BR, Vieira, VM, Webster, TF, White, RF, & Ozonoff, DM (2012)
Occurrence of mental illness following prenatal and early childhood
exposure to tetrachloroethylene (PCE)-contaminated drinking water: a
retrospective cohort study. Environ Health 11: 2. doi:
10.1186/1476-069x-11-2



3. Ballesteros-Gomez, A, de
Boer, J, & Leonards, PE (2014) A novel brominated triazine-based
flame retardant (TTBP-TAZ) in plastic consumer products and indoor dust.
Environ Sci Technol 48: 4468-4474. doi: 10.1021/es4057032



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Hoffman, C. (2015). Overexposed: The role of environmental toxicants on your brain. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/09/overexposed-role-of-environmental.html

Unintentional discrimination in clinical research: Why the small decisions matter

by Arthur T. Ryan, M.A. and Elaine F. Walker, Ph.D.



Arthur Ryan is a graduate student in clinical psychology at Emory University. His research focuses on understanding the etiology and neuropathology underlying severe mental illness.



Elaine Walker is a Professor of Psychology and Neuroscience in the Department of Psychology at Emory University and is the Director of the Development and Mental Health Research Program, which is supported by the National Institute of Mental Health. Her research is focused on child and adolescent development and the brain changes that are associated with adolescence. She is also a member of the AJOB Neuroscience editorial board.

Arthur Ryan, M.A.

Over the past several decades, there has been a significant effort to minimize bias against individuals based on ethnicity and other demographic factors through the creation of seemingly impartial and objective criteria across a host of domains. For example, when the United States Federal Sentencing Guidelines were created in the 1980’s, one of their primary goals was to alleviate “...unwarranted disparity among offenders with similar characteristics convicted of similar criminal conduct” [1]. Unfortunately, even well-intentioned efforts such as this one can still have a disparate negative impact upon historically marginalized groups, such as the well-documented disproportionate sentencing of black individuals due to differing rules governing offenses committed with crack vs. powdered cocaine [2]. Concerns about such inadvertent bias are not limited to the legal domain. Agencies that fund clinical investigations are paying greater attention to demographic representativeness and access to participation in health-related research.

Let us consider a hypothetical example, drawn from the authors’ own field of research in a US context, of how seemingly objective research design choices can results in biases in access to research participation. There is increasing evidence that inflammatory factors may play an important role in the etiology of schizophrenia and other psychotic illnesses [3]. One thing researchers do when attempting to understand a complex system like the human brain is to minimize external sources of variance. One readily identifiable correlate of inflammatory markers is body mass index (BMI) [4]. Schizophrenia itself is also correlated with BMI, such that patients tend to have a higher BMI than healthy individuals [5]. So a hypothetical researcher might reasonably say to herself, “Let me compare inflammatory markers in individuals with and without schizophrenia who have a BMI below 25 (BMIs of 25 or greater are considered to be medically overweight). That way, if I find a difference between the groups, I can more strongly conclude that the difference has to do with schizophrenia’s underlying pathology and was not due to individuals with schizophrenia being medically overweight.”

Elaine Walker, Ph.D.

Our hypothetical researcher’s experimental design choice is scientifically defensible and seemingly innocuous, but her decision may have unintended negative consequences. In a study of patients at the Grady Medical Clinic, an Atlanta primary care clinic serving inner city residents, 80% of black American women had a BMI of ≥ 25 [6]. Of particular note, the Grady Health System and its patients regularly participate in mental health research, including our own clinical studies, and the vast majority of those patients— around 85% [7]— are African American. So if our hypothetical researcher had unknowingly gone ahead with her BMI exclusion criterion and was recruiting from a similar population, she would effectively be excluding four out of five black American women from participating in her research, despite the disproportionately high number of black patients served. This would be more than a minor unfairness or lost opportunity for the individual women who could not participate: given the growing research literature showing that various biological and genetic risk markers have differential predictive utility across racial and ethnic groups, this hypothetical study might produce findings that are invalid for minority individuals. Because rates of schizophrenia seem to be similar across various racial groups and nationalities when measured by well-controlled studies, such an omission is not acceptable. If the study yielded results valid largely for one racial group, our hypothetical researcher would also be compromising one of her ethical obligations described under the Belmont Report, which requires that researchers avoid creating unjust patterns in the “...overall distribution of the burdens and benefits of research” [8]. The report explicitly extends this principle to research involving racial minorities and other historically exploited groups.

To reiterate, the preceding example was hypothetical and no such exclusionary criterion was employed in our own work. However, the possibility of research design choices having a discriminatory impact is no hypothetical hazard. In a 2006 review of randomized controlled drug trials, only 24% of participants were women [9], while a 2008 review of trials funded by the National Heart, Lung, and Blood Institute showed a mean female participation rate of 27% [10]. Even non-human females are underrepresented in research, with male-animal-only studies outnumbering female-animal-only studies at a roughly 5 : 1 ratio in neuroscience and pharmacology [11]. Such exclusion is even more notable considering that some conditions may be experienced at higher rates by those left out of such trials. For example, major depression affects women at an approximately 2:1 ratio [12]. So, theoretically, it would be particularly egregious to exclude women from antidepressant medication trials—and any research that sought to create a representative sample should include women at that same 2:1 ratio.

So why do male-only studies still predominate? Because it is cheaper and easier to conduct male-only studies. With less variance among individuals, experimental effects are easier to detect. In addition, male hormones fluctuate less over time and including women in drug trials necessitates extra experimental protections to prevent harm should one of the participants become pregnant. Again, this practice is not simply an unfairness to the individual women who would otherwise want to participate in medical research. FDA studies have shown that drug concentrations in blood and tissue can vary by as much as 40% between men and women, with similar variations in side effect profiles [13]. This shouldn’t be surprising as gene expression may vary between males and females by more than 50% in liver, fat, and muscle tissue [14]. It is clear that such a systematic policy of excluding women from research, even if it lacked any conscious discriminatory intent, could have serious, even life-threatening, consequences for women receiving medical treatment for years to come.

There is no way to completely prevent unintentional discriminatory sequelae of research design choices. And it would be naïve to believe that there will never be genuine tradeoffs that need to be weighed when designing research studies. Sometimes researchers will need to decide between sample representativeness and experimental control. The important point here is that if researchers make their decisions in a reflective and intentional manner, always considering the downstream consequences of their study design choices, they are more likely to identify and mitigate secondary negative consequences of their work. In doing so, they are increasing the scientific value of their work, as well as fulfilling their ethical obligations to promote beneficence and justice with their research.

References



1. United States Sentencing Commission. An Overview of the United States Sentencing Commission.

2. NPR. High Court Rules on Drug Sentencing Disparities.

3. Miller, B. J., Buckley, P., Seabolt, W., Mellor, A. & Kirkpatrick, B. Meta-Analysis of Cytokine Alterations in Schizophrenia: Clinical Status and Antipsychotic Effects. Biol. Psychiatry 70, 663–671 (2011).

4. Festa, A. et al. The relation of body fat mass and distribution to markers of chronic inflammation. Int. J. Obes. 25, 1407–1415 (2001).

5. Homel, P., Casey, D. & Allison, D. B. Changes in body mass index for individuals with and without schizophrenia, 1987–1996. Schizophr. Res. 55, 277–284 (2002).

6. Jacobson, T. A., Morton, F., Jacobson, K. L., Sharma, S. & Garcia, D. C. An assessment of obesity among African-American women in an inner city primary care clinic. J. Natl. Med. Assoc. 94, 1049–1057 (2002).

7. Saunders, S. P. & Campbell, C. L. The Word on the Street: Performing the Scriptures in the Urban Context., (Wipf and Stock Publishers, pp.23, 2006).

8. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research. (1979)

9. Geller, S. E., Adams, M. G. & Carnes, M. Adherence to Federal Guidelines for Reporting of Sex and Race/Ethnicity in Clinical Trials. J. Womens Health 15, 1123–1131 (2006).

10. Kim, E. S. H., Carrigan, T. P. & Menon, V. Enrollment of Women in National Heart, Lung, and Blood Institute-Funded Cardiovascular Randomized Controlled Trials Fails to Meet Current Federal Mandates for Inclusion. J. Am. Coll. Cardiol. 52, 672–673 (2008).

11. Beery, A. K. & Zucker, I. Sex Bias in Neuroscience and Biomedical Research. Neurosci. Biobehav. Rev. 35, 565–572 (2011).

12. Kessler, R. C. Epidemiology of women and depression. J. Affect. Disord. 74, 5–13 (2003).

13. Anderson, G. D. Sex and racial differences in pharmacological response: where is the evidence? Pharmacogenetics, pharmacokinetics, and pharmacodynamics. J. Womens Health 2002 14, 19–29 (2005).

14. Yang, X. et al. Tissue-specific expression and regulation of sexually dimorphic genes in mice. Genome Res. 16, 995–1004 (2006).





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Ryan, A and Walker, E. (2015). Unintentional discrimination in clinical research: Why the small decisions matter. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/09/unintentional-discrimination-in.html.

Ethics and suicide: Are we paying attention to the important issues?

by Victoria Saigle and Eric Racine, Ph.D.

Eric Racine, Ph.D.

Victoria Saigle is a graduate student at the Institut de recherches cliniques de Montréal's Neuroethics Research Unit. She is a completing her MSc in Experimental Medicine at McGill University through the Biomedical Ethics Unit. 

Dr. Eric Racine is the director of the Neuroethics Research Unit at the Institut de recherches cliniques de Montréal and holds academic appointments in the Department of Medicine and the Department of Social and Preventive Medicine at Université de Montréal and in the Department of Neurology and Neurosurgery, the Department of Medicine, and the Biomedical Ethics Unit at McGill University. He is also a member of the AJOB Neuroscience Editorial Board.

Discussing suicide can be difficult in clinical, public, and academic settings because many people have strong intuitions about which, when, and whether voluntary death is appropriate. However, discussions about suicide are largely absent from bioethics scholarship. Considering that suicide is among the ten most common causes of death worldwide and the second leading cause of death for individuals aged 15-29 (World Health Organization, 2014), it is surprising that more attention is not devoted to this topic.

Victoria Saigle

Ethical dilemmas related to suicide intersect with important questions in research ethics, clinical ethics, and public health ethics. However, we discovered in recent work that the majority of ethics scholarship on voluntary death focuses either entirely on physician-assisted dying (PAD – a term we are using here to describe many different acts in which a physician helps to hasten death at a patient’s request) or consists of philosophical arguments about the acceptability or rationality of suicide. Though interesting, these topics do little to address the challenges and lived experiences of suicidal individuals, their families, suicide researchers, or health professionals. Below, we will delineate aspects of suicide that deserve more attention.

From a research ethics standpoint, multiple studies have reported the challenges of conducting research with individuals who are, or who were previously, suicidal. Likewise, recruiting the loved ones of someone who has died by suicide can be difficult

(Mishara & Weisstub, 2005; Moore, Maple, Mitchell, & Cerel, 2013; Omerov, Steineck, Dyregrov, Runeson, & Nyberg, 2014). While it is important to exercise great care and sensitivity when involving these individuals in research, efforts should be made within ethics scholarship to examine what factors contribute to suicide research challenges and to develop solutions when possible. Not doing so risks building barriers to research in an area in need of more evidence. Complications posed by the involvement of suicidal individuals and their families in research should be addressed, rather than ignored.

Similarly, suicidality in clinical settings raises a wide range of ethical issues that deserve attention. For example, health professionals may not have received adequate training to deal with suicidal individuals (Osteen, Jacobson, & Sharpe, 2014) or they may be unsure whether breaking confidentiality is appropriate if their patients disclose suicidal ideations (Barrett, 1997). This can lead to unsettling situations in places like emergency departments, where uncertainty is the norm and time is in short supply. Knowing how to respond to repeated attempts of suicide or to situations where there is evidence that the decision to commit suicide was preplanned may also be challenging for clinicians, whose training teaches them to prevent harm. Protecting the well-being of clinicians who interact with suicidal populations, examining organizational responses to suicide disclosure in clinical settings, and ensuring that the interactions between health care professionals and their suicidal patients are appropriate are all examples of issues that could be addressed within clinical ethics.

Finally, further attention should be paid to the strategies used to detect, address, and prevent suicide at a national level. Many people view suicidality to be a symptom of mental disorders, and it is estimated that roughly 90% of individuals who die by suicide have an underlying mental illness (Turecki, 2014). This presumption that the wish to end one’s life and mental illness are related is not novel. In fact, some have suggested that ethical dilemmas in suicide research are often unaddressed because researchers believe that suicidality is a symptom of mental illness that can be removed by curing the underlying disorder (Stanley, 1986). At the moment, treating the presumed mental illness is the most predominant public health strategy for suicide prevention (Mishara & Chagnon, 2011). However, different ways of conceiving of the linkage between mental illness and suicide can lead to the adoption of different prevention strategies. For example, if it is assumed that mental illness causes suicidality directly, treating the mental illness may be the primary method of suicide prevention. If, on the other hand, suicidality is seen as the result of complications one endures due to a mental illness (e.g. unemployment, social problems), then education and efforts to reduce stigma about mental disorders may become the primary strategy (Mishara & Chagnon, 2011). It is important to consider if more than one prevention method should be used and/or if the emphasis on curing mental illness as the sole form of suicide prevention further stigmatizes the act and makes it harder for those experiencing suicidal ideation to seek help (Mishara & Chagnon, 2011).

In sum, it seems that ethics scholarship about suicide neglects many practical ethical issues that are raised by suicide. Our purpose here is not to pass judgment on whether suicide is always right or wrong, moral or immoral, but to draw attention to the fact that these discussions sometimes eclipse more common issues that deserve more attention than they currently receive.

References

Barrett, N. A. (1997). The medical student and the suicidal patient. Journal of Medical Ethics, 23(5), 277–281.

Mishara, B. L., & Chagnon, F. (2011). Understanding the Relationship between Mental Illness and Suicide and the Implications for Suicide Prevention. In R. C. O'Connor, S. Platt, & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice: John Wiley & Sons, Ltd.

Mishara, B. L., & Weisstub, D. N. (2005). Ethical and legal issues in suicide research. Int J Law Psychiatry., 28(1), 23-41.

Moore, M., Maple, M., Mitchell, A. M., & Cerel, J. (2013). Challenges and opportunities for suicide bereavement research: the experience of ethical board review. Crisis, 34(5), 297-304.

Omerov, P., Steineck, G., Dyregrov, K., Runeson, B., & Nyberg, U. (2014). The ethics of doing nothing. Suicide-bereavement and research: ethical and methodological considerations. Psychological Medicine, 44(16), 3409-3420.

Osteen, P., Jacobson, J. & Sharpe, T. (2014) Suicide Prevention in Social Work Education: How Prepared Are Social Work Students?, Journal of Social Work Education, 50:2, 349-364

Stanley, B. (1986). Ethical considerations in biological research on suicide. Ann N Y Acad Sci., 487, 42-46. 

Carter v. Canada (Attorney General), 2015 SCC 5, (2015). Retrieved from: https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do

Turecki, G. (2014). The molecular bases of the suicidal brain. Nat Rev Neurosci, 15(12), 802-816.

World Health Organization. (2014). Preventing suicide: A global imperative (pp. 1-92). Switzerland: World Health Organization.

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Saigle, V. and Racine, E. (2015). Ethics and suicide: Are we paying attention to the important issues? The Neuroethics Blog. Retrieved on Retrieved on , from http://www.theneuroethicsblog.com/2015/09/ethics-and-suicide-are-we-paying.html