Communication with vegetative state patients: Dialogue or soliloquy?

By Ania Mizgalewicz and Grace Lee

The world first heard from Canadian Scott Routley this past week. Routley, who has been in a diagnosed vegetative state for the last 12 years, seemed to communicate to scientists via signals measures from blood flowing in his brain that he was not in pain. The finding caught the headline attention of major news sites and spurred vast public commentary. Comments ranged from fearful to hopeful about mind reading, clinical applications of technology, and the ability of this technology to allow patients to communicate their desires to live.

Leading neuroscientist Adrian Owen in London, Ontario, articulates that the technology currently allows patients to respond to yes or no questions, but may one day be used to aide in more interactive communication. Questions would center on daily living preferences, attempting to improve quality of life and health care.

The findings by Owen and his group are truly exciting and provide great hope to the historically neglected population of people with serious brain injuries. Here at the National Core for Neuroethics, we encourage more discussion about the ethical implications of this technology. Questions such as those surrounding decisions about end of life are far in the future. The focus at the present should thus remain on how to validate this technology to one day be used in the clinical setting. If clinical use will be feasible in the future, we would need to address questions about access to the technology and the impact that its availability would have on families of patients.

Great caution and restraint is needed when coupling this still emerging technology with concerns about mind reading, or clinical decision-making about end of life. Hype here unfairly detracts from the true value of this work. With one in five vegetative patients showing signs of consciousness in these studies, the focus should remain on improving their daily surroundings, providing them a means of communication, and supporting their family members. It should also spark a conversation on the effectiveness and validity of current clinical tests used to diagnose these patients at the bedside.

Top image: wellcome images / flickr
Bottom image: Noel A. Tanner / flickr

Neuroscience in the public sphere

Here at Neuroethics at the Core, we have been trumpeting the rise of neuroessentialist thinking in the eyes of the public for some time (here and here and here), and it represents one of the two pillars of my research program in neuroethics. In today’s issue of Neuron, there is a great paper by O’Connor et al. entitled “Neuroscience in the Public Sphere“. The  abstract sums it up rather well:

The media are increasingly fascinated by neuroscience. Here, we consider how neuroscientific discoveries are thematically represented in the popular press and the implications this has for society. In communicating research, neuroscientists should be sensitive to the social consequences neuroscientific information may have once it enters the public sphere.

There are a few points that I would like to highlight. First, as my graduate student Roland Nadler relayed in an email to me last night after we both had a first glance at the paper:

…this is a fantastic article from start to finish. Worth really savoring as an example of how to do the normative stuff well, and its lessons are important for us to avoid producing stuff that could be tarred as neurotrash. Particularly neat that they get the definition of neuroessentialism right. Their discussion of it near the end is trenchant. It makes it clear that some philosophical work needs to be done to save neuroessentialism from the pitfalls of essentialism tout court - as they rightly point out, the latter is some bad juju.

On the topic of neuroessentialism, I particularly liked their final paragraph:

Neuroscience does not take place in a vacuum, and it is important to maintain sensitivity to the social implications, whether positive or negative, it may have as it manifests in real-world social contexts. It appears that the brain has been instantiated as a benchmark in public dialogue, and reference to brain research is now a powerful rhetorical tool. The key questions to be addressed in the coming years revolve around how this tool is employed and the effects this may have on society’s conceptual, behavioral, and institutional repertoires.

Not only do O’Connor et al. provide thoughtful normative comments, they also carried out empirical work, employing content analysis to study the themes that arise most frequently in the popular press. At the top of the list is enhancement of the brain, which represented 28.3% of the articles retrieved from the LexisNexis database. As this just so happens to be the other pillar of my research program, how could I not like this paper?

Excellent stuff.

Use it or lose it

As the technology of memorializing dialogue (in stone, no less) came into vogue, Socrates famously admonished Phaedrus his protegé Plato on its dangers: if people are able to write everything down, their ability to remember what was said will diminish. Plato, being an early version of an early adopter, memorialized the debate, and that is why the apocryphal story is with us today. But even without a grounding in modern neurobiology, Socrates had a valid point: the plasticity of our brains are such that the less we use them for a given function, the more our ability to carry out that function is impaired.

This becomes a tricky issue when thinking about the world in which we live today. In a thoughtful essay over at The Atlantic, Evan Selinger reviews a number of arguments for and against the use of ‘apps’ to make us, as he puts it in his title, a better person. What Evan is particularly concerned with are digital willpower enhancements: the suite of technologies that have been developed to help us do everything from not being distracted by a tweet to refrain from eating more than we would like.

Graphic Warnings on Cigarettes: Nudge or Shove? A Neuro-Perspective

Although the topic of cigarette packaging regulation may not leap immediately to mind when one thinks “neuroethics,” this Bob Greene opinion piece over at CNN nonetheless touched off a stimulating discussion among some of us at the Core recently. The neuroethics connection, in fact, struck us as quite natural: our group has researched (and blogged about) the ethics of “nudging” frequently of late, and, as I worded it when I first emailed the article around, “certainly the images at issue here are a kind of behavioural nudge.” The question that we grappled with was whether the kind of nudge that the graphic warning labels provide is warranted in the case of cigarettes. And, indeed, that discussion called my original characterization into question. Do these labels truly constitute a nudge – a subtle biasing technique that makes a particular option more cognitively accessible than another while preserving the freedom to choose between them – or are they something more akin to a “shove?”

One of the least gruesome of the proposed images for cigarette packs.

As with any highly politicized issue, the question of whether cigarettes ought to be labeled with disturbing imagery is likely to be filleted into oblivion by pundits, bloggers, legal experts, economists, et cetera, et cetera. All I hope to do here, then, is sketch some ways in which the view from neuroethics – informed as it is by philosophy and the cognitive sciences – can shed some interesting and hopefully useful light on the question.

TDCS does not reduce the authenticity objection

In an essay in recent issue of Current Biology, a team of neuroscientists and philosophers examine the neuroethics of transcranial direct current stimulation (TDCS), a relatively inexpensive means of modifying human brain activity that is touted as potentially being at the forefront of a new wave of cognitive enhancement. The article has garnered a great deal of interest in the press (for example here and here and here), and the reasons are unsurprising: the prospect of a device that is cheap (probably), safe (maybe), and effective (time will tell) is something akin to the holy grail of cognitive enhancement. If the initial claims for TDCS hold up, the device may have an impact the practice of enhancement in the relatively near term. As a result, the urgency with which our community must think through the relevant ethical issues intensifies.

A modest proposal: introduce bioethical review into the drug approval process

There has been raucous furor over the decision of Kathleen Sibelius, the Secretary of Health and Human Services in the Obama administration, to overrule the FDA’s approval of the drug known as Plan B One-Step as an over-the-counter drug. It has never previously transpired that the FDA has been overruled on a matter that falls under its jurisdiction such as this, and FDA Commissioner Margaret Hamburg issued a carefully worded response which, given that Sibelius is her boss, was remarkable for its forthrightness:

The High Price of Materialism

The Center for a New American Dream has just posted a great video by Tim Kasser entitled The High Price of Materialism.  In the video, Tim points out the myriad ways in which consumer culture degrades the quality of our lives. Worth noticing are the myriad neuroethical issues that he raises, from the effects of advertising upon our brains to the education that we provide to our children.

For a list of references on the subject, visit here

On the consequences of personhood

Personhood is in the news. Mississippi is considering a ballot initiative to define a fertilized egg as having personhood. This morning, the New York Times published an editorial on the matter, and the arguments were all framed in consequentialist terms:

“Besides outlawing all abortions, with no exceptions for rape or incest or when a woman’s life is in danger, and banning any contraception that may prevent implantation of a fertilized egg, including birth control pills, the amendment carries many implications, some quite serious.”

“It could curtail medical research involving embryos, shutter fertility clinics and put doctors in legal jeopardy for providing needed medical care that might endanger a pregnancy. Pregnant women also could become subject to criminal prosecution. A fertilized egg might be eligible to inherit money or be counted when drawing voting districts by population. Because a multitude of laws use the terms “person” or “people,” there would be no shortage of unintended consequences.”

It is a certainty that there would be consequences to such legislation, but what is interesting is that all of the parties involved in the debate skirt the fundamental issue: what do we mean by personhood anyway?

There they go again

The New York Times had done it again. You would have thought that they had learned their lesson after publishing a rather poorly designed study using fMRI to wax poetic on the various candidates in the 2008 presidential election on the op-ed page; a subsequent letter to the editor signed by 17 experts in brain imaging not only debunked the findings, but added that “the results reported in the article were apparently not peer-reviewed, nor was sufficient detail provided to evaluate the conclusions.” Blog posts galore (here and here and here) and online magazines (here and here) heaped on the scorn, with more than one commentator noting that the op-ed piece seemed more like a thinly veiled advertisement for the private company involved than proper investigation.

But did they learn?  Apparently not.

In today’s New York Times, Martin Lindstrom has a high-profile op-ed piece in which he concludes that the relationship between individuals and their iPhones is more like love than it is like addiction. The conclusion may or may not be true, but the methods he uses to arrive at that conclusion – fMRI experiments with 8 men and 8 women, conducted by a neuromarketing firm – are no more robust or thoughtfully examined than the above-cited Iacobini et al. flim-flam that the New York Times previously published on politics. Mr. Lindstrom, who touts himself as both consumer advocate and branding guru but appears to have no academic credentials to warrant his interpretations of fMRI experiments.

Is nobody home at the New York Times?

Update: Tal Yarkoni has a detailed and thoughtful critique up about the Lindstrom article

Cognitive training as a bona fide therapeutic

The New Scientist reports that Brain Plasticity, Inc. a developer of cognitive training games, has entered into discussions with the FDA to market one of its brain training software packages as a bona fide therapeutic. The issue is of interest on many accounts, and the New Scientist article covers many of the obvious ones that were discussed at the Entertainment Software and Cognitive Neurotherapeutics Society meeting held last week in San Francisco.  Noteworthy among them are the hope that FDA approval will bring validity to a field that has both serious practitioners and charlatans others who cut corners, as well as the concern that FDA approval might slow down progress, as the approval process is likely to be glacial compared to the pace of change in software development.

But if we unpack this a bit, we find that there are deeper levels of significance, and at least one of these are is worthy of further discussion.