The Importance of Global Co-operation: A Statement on COVID-19 from Neuroethics Canada

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Faculty and members of the Advisory Board of Neuroethics Canada, a group of distinguished neuroscientists, ethicists, and community leaders, stand together in this time of COVID-19 to emphasize the importance of global cooperation.

While the closure of physical borders is a necessary means to curtail the spread of the coronavirus, intellectual borders must remain open to international collaboration among scientists and society to reverse the fragmentation caused by the pandemic.

It is through worldwide cooperation that stigma and discrimination will be suppressed, cures discovered, and preventive measures to new threats implemented for a safer future for all people.

NeuroethicsCanada COVID19 Statement nws

Lessons from the pandemic about our brain, climate change, and collective responsibility

Millie Huang
Neuroethics Canada Blog


A central set of behavioural principles governs the inability of humanity to consider complex, compound, and collective threats like climate change—and now, COVID-19—as moral problems.

Here, I will briefly comment on the moral analogy between the two crises using four psychological factors to explain climate inertia: cognitive complexity, uncertainty-generated optimism, tribalism and scapegoating, and temporospatial separation. By establishing how both global crises intersect in remarkably similar ways in terms of moral behaviour, I will discuss how research on COVID-19 public health adherence can promote future collective action on the climate issue.

Psychological factors

Cognitive complexity: As stated in a 2012 article by Markowitz and Shariff (1), people struggle to form strong moral intuitions in response to complex problems requiring cognitively-effortful processes to understand.

Climate change is a quintessential example: it non-linear, consisting of non-proportional inputs and outputs, abrupt changes and tipping points, and feedback loops. These components interlock in complex ways that are not fully understood, leading to significant misconceptions among the general public. Exponential growth bias (Fig. 1.), the cognitive tendency to linearize trends, leads to gross underestimations of the threat posed by exponential progression and leads to hazardous policy delays. Moreover, climate change lacks a simplifying moral framework—one that involves intentionally caused harms to which brain regions responsible for moral judgment are most sensitive (2). Instead, climate change is commonly attributed to natural causes, with some people denying any degree of human involvement.

Fig. 1. A visualization of exponential growth bias. Source: M. Huang 2021©

COVID-19 demonstrates the same nonlinearity. An infectious disease is a textbook example of exponential growth (Fig. 2): within a period of one month, COVID-19 infection rates rose from 58 to more than 150,000 in the USA alone (3). Given the natural origins of the virus, COVID-19 lacks clear human perpetrators. People may be ignorant of their role in disease transmission especially if they are asymptomatic. This is only one complicating factor in COVID-19’s complex transmission including long incubation periods and multiple risk factors. The misinformation epidemic further impedes health guidelines and fosters public mistrust in scientific and public authorities. Overall, underestimation of the viral spread at early stages led to dangerous delays in policy action: a mistake estimated to cost approximately 36,000 lives in the USA (4).

Fig. 2. COVID-19 deaths per million in the early pandemic, as of April 23, 2020.
Source: European CDC; Our World in Data. (5)


Uncertainty-generated optimism: Uncertainty is another defining feature of the climate crisis. Due to the complex dynamics that underlie environmental change, our best predictions for the impacts of climate chance inevitably fluctuate (Fig. 3). Well-intentioned use of probabilistic phrases such as “likely” and “very likely” in mainstream climate reports to encompass these predictions however can mediate poor risk perception and encourage the overestimation of positive future outcomes (6).

Fig. 3. 90% confidence intervals representing statistical uncertainty in global temperature predictions, color-coded by relative contribution to total uncertainty. Source: Ed Hawkins. (7)

The COVID-19 crisis is also highly uncertain, especially at its outbreak due to limited and rapidly-changing information. This increased uncertainty and scepticism, compounded by viral misinformation (8) on social media and the internet. For the COVID-19 pandemic, the lack of past experiences to anchor predictions hindered accurate risk appraisal. This is evident in the disparity in preparedness between countries that had residual awareness from the 2003 SARS epidemic compared to countries facing the pandemic anew (9). Novel research suggests that risk perception is directly correlated with engagement in protective health behaviours during COVID-19 (10). Thus, modelling effective climate risk communications to amplify scientific clarity remains crucial.


Tribalism and scapegoating: When faced with blame, individuals tend to invoke cognitive biases that downplay their own culpability and scapegoat others (11).

As the tragedy of the commons unfolds around environmental issues, some countries refuse to make economically-limiting emissions cuts unless major competitors do the same (12). The concept is tied to moral tribalism: personal, political, and national identity that contribute to discordant perspectives and in-group favouritism. As individuals strain to understand beliefs that conflict with their own, political polarization of climate change threatens beliefs about scientific validity, threat-level, and personal responsibility.

Similar biases are relevant to the COVID-19 pandemic. Public health officials, immigrants, and Asian communities are frequent targets of scapegoating (13, 14, 15). Support for mitigation measures is divided among ideological camps in polarized countries like the USA, reflected in polls (15) and public media. This isolating rhetoric amplifies social divisions and withholds focus from collective responsibility.


Temporospatial separation: A major problem in framing the climate issue is that it is distant, with the most severe impacts befalling not present polluters, but the global poor, future generations, and non-human species. Prosocial moral judgment, still adapted to ancient life in small tribes, favours in-groups rather than psychologically-distant out-groups (16). Certain areas in the social brain activate to a greater extent for proximal individuals, boosting emotional association, empathy, and altruistic motivation. The suffering of distant individuals, including oneself in the future, fails to activate these regions and blunts empathic responses (17). Consequently, many people may believe there is mutual exclusivity between present-day benefits such as socioeconomic development and future-oriented climate change mitigation measures.

This concept drives the largest wedge between the analogy, as COVID-19 is clearly a more short-term phenomenon with visible present-day consequences. However, if the timeline of the pandemic is made relative so that we look at its early stages, it is clear that both crises still present similar challenges. A virus originally localized in East Asia did not elicit countermeasures in countries that had yet to report their first case. One of the main counterarguments against stringent COVID-19 regulations is economic losses, including high unemployment rates. The virus is also sharply unequal in impact. It may be deadly for vulnerable populations, while others may experience little to no symptoms. Systemic inequities exacerbate health inequalities, making certain groups more susceptible to the pandemic, including immigrants, racial minorities, and those of low-socioeconomic status. However, adherence to public health recommendations during the pandemic is partly predicted by pro-sociality towards these aforementioned at-risk populations—highlighting the importance of individual awareness of the collective (18).

The tale of two crises

To avoid the most severe effects of climate change, humanity must reach net carbon neutrality by 2050 (19, 20), requiring rapid, drastic, and systematic changes across societal levels. However, we display an overall apathy towards the economic and lifestyle sacrifices necessary to do so (21).

COVID-19 is a largely different story: lifestyle and economic interests have taken a back-seat to public health. The large part of society is proving itself capable of prioritizing and rapidly adapting to public health measures, sacrificing normal activity like work, school, and social gatherings. There exists a clear priority, one that has led to significant beneficial health outcomes—a study published in Nature (22) estimates that anti-contagion measures averted approximately 495 million infections in China, South Korea, Italy, Iran, France and the United States. Why then, has the world effectively adapted to an infectious disease, but remains unsuccessful in making similar sacrifices for the climate? Perhaps, it is because of the immediate impact of COVID-19 compared to climate change, or the perception that the pandemic is time-limited whereas climate change requires long-term mitigation efforts. While inherent differences make it difficult to distinguish underlying factors, moral judgment may play a central role.

Scientists are addressing these questions in the form of novel research regarding the socio-behavioural motivators of public health adherence. This includes data on prosocial emotions, trust in scientific and governmental institutions, and risk perception (23). By identifying the behavioural factors behind successful public health campaigns, corresponding insights may be drawn for climate mitigation. Altogether, the findings may be consolidated into public communication strategies that translate diffuse challenges into clear mental models that support individual commitment to collective action.

Conclusion

The United Nations Economic Commission for Africa has stated that “COVID-19 lessons offer hope for global efforts to address climate change impacts” (24). Indeed, climate change researchers and communicators alike are recognizing the potential that the COVID-19 pandemic has for providing a template for climate response. This does not entail reframing pandemic response as a precursor for climate change mitigation efforts, but rather clarifying the behavioural motivators underlying successful public health interventions, and connecting these motivators to public communication strategies.

An interdisciplinary approach that combines the knowledge of behavioural scientists, environmental scientists, and communications experts is essential for any effective response to the climate crisis. Policymakers should support behavioural measures, remove structural obstacles to adherence, and promote individual liberties and justice within public ethics strategies.

To echo environmental ethicist Dale Jamieson, the climate problem cannot be solved with only scientific or technological advances. Instead, the solution concerns our values:

It is about how we ought to live, and how humans should relate to each other and to the rest of nature. These are problems of ethics and politics as well as problems of science. (25)

The rapid reaction to the COVID-19 crisis shows that we are more than capable of overcoming psychological roadblocks in order to confront shared challenges. The why behind this outcome is a research gap that we have an ethical obligation to fulfill—for our own sake and that of future generations.

After all, although climate change is much more prolonged a crisis than the current pandemic, it is no less urgent.


Millie Huang is a Research Assistant at Neuroethics Canada.
She is a 3rd year student at the University of Pennsylvania, studying Neuroscience and Classics.

Hacking the mind: How technology is changing the way we view our brain and ourselves

Dr. Nir Lipsman (Assistant Professor, Division of Neurosurgery, Department of Surgery, University of Toronto) presented “Hacking the mind: How technology is changing the way we view our brain and ourselves” at the 2021 Brain Awareness Week – Annual Distinguished Neuroethics Lecture, held on March 16, 2021.

Overview:
As it advances, our relationship with brain technology will change. In this lecture, Dr. Nir Lipsman will discuss how our knowledge of brain circuitry, and how it can go wrong, has informed our understanding of human behaviour. We will then discuss the implications of more sophisticated, precise and less intrusive brain technology, on that relationship, and what it could all mean for the next generation of brain therapy and beyond…

Bio:
Nir Lipsman MD, PhD, FRCSC, is a neurosurgeon and scientist at Sunnybrook Health Sciences Centre and an Assistant Professor of Surgery at the University of Toronto. He completed his undergraduate degree at the University of Toronto followed by a medical degree at Queen’s University, and a neurosurgical residency at the University of Toronto. During his residency, Dr. Lipsman completed his PhD investigating novel neuromodulation strategies in patients with treatment-resistant psychiatric and neurologic conditions. He is currently the Director of Sunnybrook’s Harquail Center for Neuromodulation, and the Clinical Director of Sunnybrook’s Focused Ultrasound Centre of Excellence.

Dr. Lipsman has helped develop several clinical trials of MR-guided focused ultrasound (FUS) in novel indications, including among the world’s first experience of FUS in essential tremor, obsessive-compulsive disorder, major depression and chronic pain, as well as the first randomized control trial of FUS in tremor. He has led the world’s first application of FUS-mediated blood brain barrier (BBB) opening in Alzheimer’s Disease, and helped develop the first applications in primary and secondary brain tumors and ALS. He has published over 100 peer-reviewed papers and book chapters, including in The Lancet, Lancet Neurology, Lancet Psychiatry, New England Journal of Medicine, and Neuron.

Dr. Lipsman also has a strong interest in the broader clinical and ethical implications of neuromodulation, and has been closely involved in the development of international guidelines for the use of surgery in psychiatric disease. In collaboration with Drs. Judy Illes and Pat McDonald at UBC, he helped found the Pan Canadian Neurotechnology Ethics Consortium (PCNEC), bringing together experts in neuromodulation and ethics, to identify and tackle the most pressing ethical questions in the field.

Why neurosurgeons should care about ethics and why ethicists should care about neurosurgery

At the most recent Neuroethics Canada Seminar Series, Dr. Nir Lipsman discussed why neurosurgeons should care about ethics and why ethicists should care about neurosurgery.

Bio:
Nir Lipsman, MD, PhD, FRCSC is a neurosurgeon and scientist at Sunnybrook Health Sciences Centre and an Assistant Professor of Surgery at the University of Toronto. He completed his undergraduate degree at the University of Toronto followed by a medical degree at Queen’s University, and a neurosurgical residency at the University of Toronto. During his residency, Dr. Lipsman completed his PhD investigating novel neuromodulation strategies in patients with treatment-resistant psychiatric and neurologic conditions. He is currently the Director of Sunnybrook’s Harquail Center for Neuromodulation, and the Clinical Director of Sunnybrook’s Focused Ultrasound Centre of Excellence.

Rights and meanings: Advanced technologies for disorders of the brain

This blog post follows on a three minute presentation at the 2020 International Neuroethics Society Meeting that won the Springer Book Prize for “Best Overall Contribution: Clinical Neuroethics”.

I acknowledge that Neuroethics Canada is situated on the traditional, ancestral, unceded territory of the Musqueam people, and express my thanks as a settler to live, work and study on this territory.

Introduction

What are the meanings, values, priorities, and responsibilities surrounding equitable and meaningful access to advanced neurotechnologies for diverse populations?

Advanced neurotechnologies are applied in functional neurosurgery: an important class of brain surgery that aims to ameliorate severe neurologic and mental health conditions that do not respond to pharmacological and other therapies. The interventions are broadly classified as neuromodulation, ablation, and resection, and one well known example is deep brain stimulation (see this blog post by Hrincu et al. for applications in pediatric epilepsy). However, alongside rapid advancements in the field of advanced neurotechnologies, there have been reports of disparate access in both Canada and the USA. Five studies have reported racial disparities for African-American populations in the USA (1,2,3,4,5). Reduced access has also been reported for certain provinces and regions in Canada (6,7,8).

Map
Map of the major functional neurosurgery centres in Canada as of January 2021, demonstrating the unique challenge of serving geographically dispersed populations. Image created by the author.

Despite the diversity of populations living in both countries and the global availability of these interventions, there has been limited exploration of how various cultural groups may differentially conceptualize and relate to the use of functional neurosurgical interventions.

Consultations

We consulted with 29 key informants with diverse expertise in Indigenous health and Western medicine about neurotechnologies for diverse geographic and cultural communities (Harding et al., manuscript in preparation). Our analysis of the interviews is revealing that differences in the meanings and perspectives held by patients and physicians about interventions to the brain are significant barriers to receptivity and access. Innovations in telehealth, education, and low maintenance neurotechnologies are significant facilitators to access. Results from a survey we administered at the end of the interviews with medical professionals show a striking contrast between ratings of the imperative of access for people living in rural and remote areas and the realities of such access to neuromodulatory and ablative neurotechnologies across different medical conditions. Median ratings for imperative of access to neuromodulation, for example, were highest for movement disorders (95% rating high imperative), epilepsy (63%) and pain (57%). Higher imperative ratings were strongly associated with ratings of higher likelihood of access.

Scoping Review

We also conducted a scoping review of the academic literature about global Indigenous groups’ perspectives about the brain and mind (Harding, Marra, et al., manuscript in preparation). We have found that this body of literature has a significant focus on perspectives about neurological and mental health conditions, with a smaller body of work reporting philosophical conceptualizations of the mind and brain. Holism is a common theme: many studies report perspectives of illnesses as caused by a combination of spiritual, psychological and biological factors.

flow
Simplified flow diagram of the articles screened and subsequently included in the scoping review. Image created by the author.

Working Groups

For our next step, we will bring together expertise in Indigenous health and neuroethics for a series of sequential workshops to explore meanings and values for brain wellness. While the idea of hosting these working sessions by videoconference would have been previously inconceivable, in this era of COVID-19 Indigenous communities have developed innovative approaches to uphold cultural protocols in virtual spaces (Harding et al., 2020). Applying a transformative framework, we will collaborate with Indigenous scholars, knowledge holders, and healthcare providers through consensus-seeking and collaborative writings to co-create and deliver strategic recommendations for community-based and systems-based prioritization of neurotechnology for brain health, education, and consultation.

Conclusion

Through the efforts of this ongoing, spiral, community-engaged research project, we will provide recommendations and strategic partnerships for the inclusion of ethical, practical, and cultural domains in the development and delivery of advanced neurotechnologies to mitigate disparities and realize the goal of improving brain wellness.

The work discussed in this article is being conducted at Neuroethics Canada under the leadership of Dr. Judy Illes. I thank collaborators Dr. Christopher R. Honey, Dr. Patrick J. McDonald, Dr. Malcolm King, Caterina Marra, Jacob McFarlane and Vyshu Manohara, as well as other members of the Neuroethics Canada team. This work is supported by the National Institutes of Health (J. Iles; Grant number [RF1#MH117805 01]), the North Growth Foundation (J. Iles), and the Canadian Brain Research Strategy (J. Iles).

Louise Harding is a MSc student in Population and Public Health at the University of British Columbia and a Research Assistant at Neuroethics Canada. She holds a BSc in Psychology with a minor in First Nations and Indigenous Studies from UBC.

Biopic

2021 Brain Awareness Week Annual Distinguished Neuroethics Lecture

Hacking the Mind: How Technology Is Changing The Way We View Our Brain and Ourselves
Nir Lipsman, MD, PhD, FRCSC, Assistant Professor, Division of Neurosurgery, Department of Surgery, University of Toronto

Tuesday, March 16, 2021
4:00 PM – 5:00 PM PDT
For the Zoom details, please RSVP here: https://baw2021.eventbrite.ca

Overview:
As it advances, our relationship with brain technology will change. In this lecture, Dr. Nir Lipsman will discuss how our knowledge of brain circuitry, and how it can go wrong, has informed our understanding of human behaviour. We will then discuss the implications of more sophisticated, precise and less intrusive brain technology, on that relationship, and what it could all mean for the next generation of brain therapy and beyond…

Nir Lipsman MD, PhD, FRCSC
Dr. Nir Lipsman is a neurosurgeon and scientist at Sunnybrook Health Sciences Centre and an Assistant Professor of Surgery at the University of Toronto. He completed his undergraduate degree at the University of Toronto followed by a medical degree at Queen’s University, and a neurosurgical residency at the University of Toronto. During his residency, Dr. Lipsman completed his PhD investigating novel neuromodulation strategies in patients with treatment-resistant psychiatric and neurologic conditions. He is currently the Director of Sunnybrook’s Harquail Center for Neuromodulation, and the Clinical Director of Sunnybrook’s Focused Ultrasound Centre of Excellence.

Dr. Lipsman has helped develop several clinical trials of MR-guided focused ultrasound (FUS) in novel indications, including among the world’s first experience of FUS in essential tremor, obsessive-compulsive disorder, major depression and chronic pain, as well as the first randomized control trial of FUS in tremor. He has led the world’s first application of FUS-mediated blood brain barrier (BBB) opening in Alzheimer’s Disease, and helped develop the first applications in primary and secondary brain tumors and ALS. He has published over 100 peer-reviewed papers and book chapters, including in The Lancet, Lancet Neurology, Lancet Psychiatry, New England Journal of Medicine, and Neuron.

Dr. Lipsman also has a strong interest in the broader clinical and ethical implications of neuromodulation, and has been closely involved in the development of international guidelines for the use of surgery in psychiatric disease. In collaboration with Drs. Judy Illes and Pat McDonald at UBC, he helped found the Pan Canadian Neurotechnology Ethics Consortium (PCNEC), bringing together experts in neuromodulation and ethics, to identify and tackle the most pressing ethical questions in the field.

Wicked Health Challenge Dialogues: COVID19 Edition – What lies ahead?

The Morris J. Wosk Centre for Dialogue and Neuroethics Canada are pleased to invite you to

WICKED HEALTH CHALLENGE DIALOGUES
COVID19 Edition: What lies ahead?

Tuesday, June 2, 2020
1:00 PM – 2:30 PM
Register here: https://bit.ly/2X4wm1y

Are you wondering what response and recovery looks like for a pandemic? How complex are the problems that lie ahead, and why does that matter?

Join us over Zoom as we discuss what response and recovery of our collective health and wellness looks like for COVID-19. We hope to deepen our collective understanding of the complexity of this challenge and consider what that means for collective action.

FEATURING:
Dr. Judy Illes
Professor and Director, Neuroethics Canada
University of British Columbia

Dr. Bruce Y. Lee
Professor, Health Policy & Management
City University of New York

Mr. Donald MacPherson
Director, Canadian Drug Policy Coalition
Simon Fraser University

Dr. Farah N. Mawani
Post-doctoral Fellow, MAP Centre for Urban Health Solutions
St. Michael’s Hospital, Toronto

MODERATED BY:
Dr. Diane T. Finegood
Professor and Fellow, Morris J. Wosk Centre for Dialogue
Simon Fraser University

“Modulating the Mind” – Dr. Judy Illes at TEDx Abbotsford

Neuroethics Canada’s Dr. Judy Illes was invited to speak at the TEDx Abbotsford in November 2019.

We are pleased to share that you may now watch her presentation!

In her TEDx talk, Dr. Illes discussed how how people think about brain surgery for neurologic and psychiatric conditions, including ethical concerns about hope versus hype, rights, justice, agency, and personal privacy.

 

2020 Brain Awareness Week Annual Distinguished Neuroethics Lecture: Hacking the Mind

The 2020 Brain Awareness Week Annual Distinguished Neuroethics Lecture “Hacking the Mind: How Technology Is Changing The Way We View Our Brain and Ourselves” has been postponed due to the continuing threat of the coronavirus.

Please stay tuned here for news of a new date.

Hacking the Mind: How Technology Is Changing The Way We View Our Brain and Ourselves
Nir Lipsman, MD, PhD, FRCSC, Assistant Professor, Division of Neurosurgery, Department of Surgery, University of Toronto

Monday, March 16, 2020
5:30 PM – 7:00 PM
C300 Theatre, UBC Robson Square
800 Robson Street, Vancouver, BC, V6Z 3B7
(map)

Overview:
As it advances, our relationship with brain technology will change. In this lecture, Dr. Nir Lipsman will discuss how our knowledge of brain circuitry, and how it can go wrong, has informed our understanding of human behaviour. We will then discuss the implications of more sophisticated, precise and less intrusive brain technology, on that relationship, and what it could all mean for the next generation of brain therapy and beyond…

Nir Lipsman, MD, PhD, FRCSC
Nir Lipsman, MD, PhD, FRCSC is a neurosurgeon and scientist at Sunnybrook Health Sciences Centre and an Assistant Professor of Surgery at the University of Toronto. He completed his undergraduate degree at the University of Toronto followed by a medical degree at Queen’s University, and a neurosurgical residency at the University of Toronto. During his residency, Dr. Lipsman completed his PhD investigating novel neuromodulation strategies in patients with treatment-resistant psychiatric and neurologic conditions. He is currently the Director of Sunnybrook’s Harquail Center for Neuromodulation, and the Clinical Director of Sunnybrook’s Focused Ultrasound Centre of Excellence.

 

Gene Editing: A silver bullet or a tool for eugenics?

Neuroethics Canada and the Morris J. Wosk Centre for Dialogue are pleased to invite you to

WICKED HEALTH CHALLENGE DIALOGUES
Gene Editing: A silver bullet or a tool for eugenics?

Thursday, January 23, 2020
4:30 PM – 6:30 PM
Jack P. Blaney Asia Pacific Hall, Morris J. Wosk Centre for Dialogue
580 W. Hastings St, Vancouver, BC V6B 5K3
(map)

Come join us for an interesting and exciting dialogue to deepen our understanding of the complexity of this challenge and to surface ideas for action!

FEATURING:
Tania Bubela, JD, PhD
Dean and Professor
Faculty of Health Sciences, Simon Fraser University

Andre Picard
Health Reporter and Columnist
Globe and Mail

Alice Virani, PhD
Clinical Assistant Professor
Faculty of Medicine, University of British Columbia

Wyeth Wasserman, PhD
Vice-President Research
BC Children’s Hospital, Provincial Health Services Authority

MODERATED BY:
Diane T. Finegood, PhD
Professor and Fellow
Morris J. Wosk Centre for Dialogue, Simon Fraser University

Judy Illes, CM, PhD
Professor and Director
Neuroethics Canada, University of British Columbia

Neuroethics Canada Morris J Wosk Centre for Dialogue

 

Gene Editing (11x17) WEB

Click here to view the event’s graphic recording in a higher-resolution.