Ethically Sound: Gray Matters

Host:

Have you heard that listening to Mozart can make you smarter? It’s a myth. One that sprouted when findings from a brain study were misinterpreted. As neuroscience research ramps up, and scientists unlock more and more of the brain’s secrets, how can we be sure these insights are sought and used in responsible ways?

Welcome to Ethically Sound: A podcast of the Presidential Commission for the Study of Bioethical Issues. I’m Hillary Wicai Viers.

Today, we’re talking with Dr. Stephen Hauser, Chair of the Department of Neurology at the University of California in San Francisco and a member of the Bioethics Commission. But, we’ll start with a story from University of Pennsylvania law professor Stephen Morse.

Dr. Morse:

On January 7th, 1991, Spider Cystkopf, a 64-year-old retired advertising executive was having a heated argument with his wife, Brunhilda, in their 12^th story Manhattan, New York apartment. In frustration, Brunhilda had started scratching at Spider, at which point he grabbed her by the throat, strangled her to death, and threw her out their 12^th story window in an apparent attempt to make it look like a suicide. Cystkopf was arrested, charged with second-degree murder. He was worked up and it was discovered that he had a very, very large cyst growing on the underside of the middle lining that surrounds his brain, that was massively displacing his left frontal lobe. Cystkopf and his lawyers decided to use that cyst and its alleged effect on his behavior as part of the basis for an insanity defense.

In the event, Cystkopf pleaded guilty the night before trial to manslaughter, a lesser included offense in New York, for which he received a sentence of seven years in prison. The prosecution took the position, it was a waste of the people’s time and money to go to an expensive trial when seven years was sufficient for public safety. The defense took the position that the prosecution was afraid of the expert evidence having to do with the brain tumor. In my view, actions speak louder than images, this is a man who had absolutely no prior behavioral history, and this was just a case of sometimes good people do bad things.

Host:

That was law professor Dr. Stephen Morse who is Associate Director for the Center for Neuroscience & Society at the University of Pennsylvania Law School.

The story Stephen shared is not uncommon. Neuroscience is being used more often in the legal system, not just to help us determine if people are guilty of crimes, but to help us understand how the brain develops, why some people commit violent acts, and how prison can change the brain for the worse. But it’s unclear whether the scientific tests and concepts being introduced in the courtroom are really ready for primetime.

The use of neuroscience in law was just one of three topics the Bioethics Commission dug into as it considered the ethical issues that neuroscience raises.

The Bioethics Commission also explored the use of cognitive enhancers. You may have heard of the “Adderall epidemic” on college campuses—students using prescription drugs like Adderall and Ritalin to help them study. But there really isn’t solid evidence about the benefits or potential risks of using drugs and devices to enhance our cognitive abilities. And the Bioethics Commission examined the tough question of how to include people with brain disorders or injuries in research. As scientists try to unlock information about the structure and function of our brains, and use that insight to develop new treatments and cures for devastating illnesses such as Alzheimer’s and Parkinson’s disease, depression, and traumatic brain injury, they will need to include people who have these conditions to enroll in studies. Yet, people with Alzheimer’s or brain injury might not be able to fully comprehend what participating in these studies entails. They might not be able to give their informed consent. So what kinds of protections need to be in place to ensure this type of research is done responsibly?

The Bioethics Commission undertook this review of ethical issues in neuroscience at the request of President Obama, when he announced the ambitious research program called the BRAIN Initiative, which stands for Brain Research through Advancing Innovative Neurotechnologies.

To lay the groundwork for responsible neuroscience research, the Bioethics Commission issued a set of recommendations for integrating ethics throughout neuroscience research—from training young future scientists to spot and understand ethical issues, to including ethics expertise on review panels.

It then released a second series of recommendations that tackled the issues of neuroscience and the legal system, cognitive enhancement and informed consent.

You can download the Bioethics Commission’s two reports Gray Matters, Volumes 1 and 2 at bioethics.gov.

Here today to talk about the Gray Matters reports is Bioethics Commission Member and Robert A. Fishman Distinguished Professor and Chair of the Department of Neurology at the University of California, San Francisco, Dr. Stephen Hauser.

Dr. Hauser, welcome to Ethically Sound.

Stephen Morse told us about a case where neuroscience and the law intersected, and said that “actions speak louder than images.” What is the risk of using neuroscience concepts and images, such as brain scans, in the courtroom, before the science is well understood?

Dr. Hauser:

Many studies show that judges and jurors may be swayed by beautiful images of the brain, or by impressive genetic findings, or by experts using neuroscientific jargon. An exciting finding in brain imaging or in genetics may give us important clues to understanding behavior, culpability, impulsivity, but may not be applicable to determining guilt in an individual person.

Neuroscience remains poorly understood by many judges, lawyers, jury members, and the general public. And thus, one critically important goal of the Bioethics Commission’s report on Gray Matters is to promote general education in science, and specifically, neuroscience.

Host:

Why did the Bioethics Commission look at interventions designed to improve cognition and maintain brain health? What is the ethical dimension of so-called “cognitive enhancement” efforts?

Dr. Hauser: 

Neuroscience, indeed, does have the potential to not only remediate brain problems, protect and prevent against future illnesses, but also potentially to enhance normal human capabilities. Now altering the brain and nervous system through neural modification, including cognitive enhancement is not inherently unethical, and this was a very important conclusion of the Commission’s deliberation. But, whether or not any particular neural modification intervention is ethical depends on a number of factors and needs to be determined on a case-by-case basis, with close attention to equitable access for any intervention that could be developed, and public deliberation on the costs and consequences of deployment of a neural enhancer. And then, finally, safety is another critically important consideration particularly in children, where any efforts in cognitive enhancement need to be applied with the utmost careful attention to safety, not only over a short period of time, but over many, many decades when we are dealing with youngsters.

Host:

The Bioethics Commission also looked at the challenges of conducting neuroscience research ethically when those participating in the research may be neurologically impaired. How did you address this complex issue?

Dr. Hauser:

It is likely that all of us will be affected by, or have a loved one affected by, a neurologic disorder or psychiatric condition that impair consent capacity. Neurologic disorders such as dementia are on the rise as our population ages. Sports injuries and motor vehicle accidents leave us vulnerable to brain trauma. Scientific progress to prevent, diagnose, treat, and repair these disorders requires human participation and research. Test tube models of human disease, animal models of human disease, are very important, but the rubber meets the road when the ideas developed in the laboratory are tested in people with real life neurologic problems.

A challenging tension exists between the need for rigorous research on these diseases and the need to protect individuals who might be vulnerable because of impaired consent. With adequate protections in place, these individuals should be responsibly included in research, so that they might share in its benefits, and this was a very important conclusion of the Commission.

Host:

The first volume of the Gray Matters report focuses on the need for early integration of ethics and science. Why is that so important?

Dr. Hauser:

Well designed, ethical neuroscience research will pave the way for the progress that has the potential to benefit so many. And too often in our nation’s past, ethical lapses in research have had tragic consequences and derailed scientific progress. Most important, these ethical lapses injured people and compromised the public’s confidence in the research mission. Thus, a critical component of neuroscience research must be to bring ethicists and scientists to the table with the public at the earliest stages of planning.

Host:

Dr. Hauser, how have the Bioethics Commission’s recommendations informed or shaped the President’s ambitious BRAIN Initiative?

Dr. Hauser:

In direct response to our recommendations, the National Institutes of Health, one of the agencies that received funding for the BRAIN initiative, created the Neuroethics Workgroup [the NIH Neuroethics Workgroup of the BRAIN Multi-Council Working Group]. The workgroup is chaired by our very own Christine Grady, and also includes our own Nita Farahany as a member. The charge to the group is, in part, to examine specific projects proposed under the brain initiative and to alert researchers to potential ethical concerns, and to even provide specific ethics consultation when appropriate or needed.

In addition, one of our recommendations in our second report has influenced changes to federal human subjects research regulations. We recommended that there be a clearer process in place for researchers and institutional review boards to identify legally authorized representatives to help enroll participants in research who have impaired consent capacity. In response, the new notice of proposed rulemaking, the potential change to the common rule governing human subjects research, cited our report and recommendation and proposed a new process for identifying legally authorized representatives, a process that would make it easier for participants with impaired consent capacity to be enrolled in studies while still being protected.

Host:

Thanks for being with us, Dr. Hauser. It was a pleasure speaking with you.

Dr. Hauser:

It was a great pleasure.

Host:

You’ve been listening to Ethically Sound: A podcast of the Presidential Commission for the Study of Bioethical Issues. Thanks for joining us. You can check out our full series online at bioethics.gov.