First up for me this morning: Hank Greely's talk entitled The Neuroscience Revolution and Society. For those of you not familiar with Hank Greely, he is a law professor at Stanford University who is (to quote his faculty website), a "leading expert on the legal, ethical, and social issues surrounding health law and the biosciences" who specializes in the"implications of new biomedical technologies, especially those related to neuroscience, genetics, and stem cell research." I have heard Greely speak 2 times previously, discussing the implications of neuroscience (in particular fMRI technology) for society and the law. Last month, Greely chaired a discussion panel on neuroscience evidence in the courtroom - my blog coverage of the event can be read at the link.
He will talk about the ethical challenges that neuroscience raises, and what we, as scientists can do about it. Greely takes us back to 1969, what he calls the peaking of the first modern neuroscience ethics panic, during which the public came together in concern over many neuroscience themes, including neuroscience’s ability to control minds. He notes that concern over mind control led to many regulations being put in to place, based purely on speculative science. Greely fast forwards to today, where he sees the same trend towards public concern, whereas now the panic is caused by science that is actually available, as opposed to the more speculative nature of the science that was causing concern in 1969.
Greely discusses the problem with public policy being established based upon science that isn’t very good – for example eugenics programs based on our knowledge of genetics. He notes that in the case of genetics, fair and responsible public polities are well established, and the maturity of this process is about 10 years ahead of neuroscience.
What are the issues raised by neuroscience? Greely notes we are in a golden age of neuroscience, we are learning a phenomenon amount about neuroscience, and we care a great deal, both at the individual and the social level, about neuroscience given the close association between our brains and our minds. As we learn more about the brain, we will learn more about human thought and motivations. The ethical issues being raised fall into several categories. The first one of these is research ethics – as we learn more about the neuroscience, we will begin to consider questions regarding the ethics of doing research. For instance, what are the ethics regarding incidental information gathered during experiments – for instance tumors discovered during fMRI studies. Alternatively, ethical issues generated by storing brain images of participants in a database – can those images be used to advance information in ways the participants disagree with?
Greely turns to the question of how neuroscience will change our society, including changing education, medical care, and the law. Greely will talk about 6 different ways that neuroscience will impact the society – prediction, mind-reading, responsibility, consciousness, treatment and enhancement.
Prediction: neuroscience is helping us predict better things about people’s behavior. Sometimes, this involves predicting future disease states – neuroimaging or genetic predictions of who will develop Alzheimer’s. Now, this seems like a good thing, but what are the implications. If our ability to predict Alzheimer’s was coupled with a treatment, this would be fantastic. But as in the case of many genetic predictions, we often are able to predict despite being unable to prevent the occurrence of the disease. Greely notes that we are protected under federal law from discrimination based on genetic predispositions, but not predictions based upon brain scans. Predictive information is not just information - it has consequences, both good and bad. Greely poses the question of who will be responsible for producing the predictions (doctors, companies), and who will be able to have access to the information, beyond the patient. He wonders what we would do with information that predicted with 100% accuracy which 8/1000 children will develop schizophrenia, or make accurate predictions on future criminal/violent behavior. He states that if we can ask the question (what do we do with the information), someone will want to answer it.
Mind-Reading: Greely repeats a line I have heard from him before, that humans are all mind-readers. It is important for us to figure out what those around us are thinking, generally using facial cues, body language, etc… He comment that we all try to do it, but we just aren’t very good at it, and the world would look a lot different if we were better at it. And with neuroscience, we are getting better at it. There are many examples of imaging research where scientists look at activity and make suppositions about what the subjects are subjectively thinking. Now, much of that research involves figuring out whether, for example, a person is thinking of a place or a face – this is not of immediate applicability in the courtroom. But what is applicable is research that is attempting to figure out what people believe or think: e.g. lie detection, figuring out whether people are actually feeling chronic pain, whether people are biased. He introduces the current two commercial companies that offer lie detection, and the two recent court cases that asked whether they would allow fMRI-based lie detection as evidence (they both said no). Greely notes that there is currently no regulation of this field but people are still applying the technology.
Responsibility: Greely discusses recent court cases where the defendants use neuroscience brain scans to claim insanity. A more common argument in these court cases is that its not the defendants fault, it is the fault of their brain and how it works. What will juries do when told that a defendant is a psychopath, and their brain makes them a murder?
Consciousness: Greely brings up the recent paper where two groups showed that of a group of 54 patients diagnosed as being in a vegetative or minimally-conscious state, fMRI scans showed that in 5 patients, being told to plan a motor task resulted in activity in the motor planning area. In addition, 4 patients showed activity in brain regions responsible for navigation when told to imagine walking through their homes. Finally, they took one patient, who had been diagnosed in a vegetative state for 5 years, and showed that he was able to answer personal questions by selectively activating either the motor planning or navigation area. What will we do with that information? Greely comments that doctors at Stanford have already started having families of patients diagnosed as being in a vegetative state ask that the patient be put into an fMRI scanner.
Treatment: Greely wonders what happens when we learn how to “cure” things that are not diseases, such as “deviant sexual behaviors”? What happens when a neuroscience attempts to cure addition with brain lesions, as happened recently in China, where doctors made electrolytic lesions of the nucleus accumbens of soldiers addicted to opium. They reported that after the lesion, soldiers did not crave opium, but Greely notes that the peer-reviewed paper did not report what else the soldiers did not crave. Another example are laws requiring that people convicted of a long list of sexual offenses are required to undergo chemical castration, despite the fact that we don’t have much information regarding the efficacy or safety of the chemicals used for the castration. In addition, even if we know that treatments for addition, psychological diseases, etc… are efficacious and safe, when do we mandate their use?
Enhancement: Many (most) scientists use mind-altering drugs – caffeine and chocolate both alter brain chemistry. But there are greater numbers of students who are now using Ritalin without a prescription to enhance their cognitive abilities. Of course, Ritalin and other drugs like it are not that good at enhancing cognition. But what about memory-enhancing drugs developed to treat diseases such as dementia and Alzheimer’s? What do we do if these drugs work on 20-year olds? What should universities or medical schools do about the availability of these drugs? Greely states emphatically that the single greatest cognitive enhancer is primary education, the ability to read and write. What did we do about it? We made it mandatory. How will be respond to a new host of drugs.
And lastly, Greely turns to the question of how society will respond to neuroscience research regarding the human condition. How will we assimilate information regarding the differences (or lack thereof) between the brains of humans and other animals? What about consciousness – when we can identify it, how will this alter how we treat patients, or fetuses? What about free will – how society react once we can identify the exact mechanisms that lead to our decisions, when we can show that circuits in our brains have made a decision long before we consciously acknowledge that decision. How will religion be affected? Greely imagines that it won’t affect society too much – the general public will continue to believe in free will not matter what evidence neuroscience throws at them.
Having talked about these issues, Greely turns to how neuroscience should start to handle them. The first step is to conduct research to show conclusively whether the techniques mentioned over the past hour are effective and safe. Going further, are questions about how we use these techniques if they are effective and safe? Neuroscientists have perhaps a smaller role, but an important one in making sure the public is aware of the complexities of the science and the techniques. And lastly, the deeper existential questions – and here Greely states that neuroscientists and non-neuroscientists all are on an equal footing, each with something to contribute.
So what can we, as neuroscientists, do? Greely calls us to consider the ethical issues of our own work, and to talk about these ethical issues, whether they come out of our own work or the work of others. He encourages neuroscientists to get involved, to join the Society for Neuroethics, to communicate with the public on these issues, to bring our sophisticated understanding of the strengths, weaknesses and limitations of neuroscience to discussions in the public domain. Greely tells us that he must believe that the more we discuss these ethical issues, the less likely we are to mess up the big decisions. In conclusion, he hopes he made us think about the short and long term implications for neuroscience on society, and that he had convinced us of the critical need for educated neuroscientists go get involved in the introduction of our knowledge into society.
Note: Greely suggests that those interested in asking him questions should email him at firstname.lastname@example.org.