May 21,
2002
The Neuroethics of New Drugs and Technology
By
Lisa M. Krieger,
(c) Mercury News, May
21, 2002
RESEARCH OFFERS NEW WAYS TO STUDY, ALTER BRAIN FUNCTION BUT BENEFITS COME
WITH SOCIAL POLICY QUESTIONS
It's another sleepless night at Stanford
University.
But unlike the legions of students dozing over textbooks, volunteers at
the Stanford Sleep Disorders Lab have pharmaceutical help: a controversial
new drug called Provigil.
The medication, whose name is an abbreviation of the words "promotes
vigilance,'' keeps the mind fully awake and attentive without the euphoric
"buzz'' or jittery nerves of amphetamines and caffeine. It could
prevent deadly mistakes by sleep-deprived truck drivers, doctors and other
nighttime workers -- but also poses the risk of misuse in a culture fueled
by a 24/7 ethos.
Provigil is but one of many provocative new tools to come out of the
growing field of brain research. As scientists probe deeper into the
brain's chemistry, they are learning more about what makes people feel
alert, energetic, depressed, angry or serene.
The tools and technologies -- from drugs like Provigil to implantable
brain chips, neuro-imaging techniques and brain-scan lie detectors --
offer new ways to alter and explore human cognition. But what's safe?
What's ethical?
Those were the questions pondered last week at a first-ever conference
sponsored by Stanford and the University of California-San Francisco.
Scientists at the conference
on "neuro-ethics'' debated the ethical and policy challenges
posed by a growing knowledge in brain research.
"In the future, basic research in neuroscience may transform our
understanding of human nature,'' said Barbara A. Koenig, executive
director of the Stanford University Center for Biomedical Ethics.
"Studying the brain offers a seductive promise: the ability to make
assessments about people, their motivations, desires and
characteristics.''
The conference, held in San Francisco, brought together ethicists,
neuroscientists and those concerned with social policy to begin a dialogue
that they hope will spread. Experts at the conference predicted that
advances in brain science will influence a range of domains -- and change
many aspects of our lives.
Mapping Criminal Minds
Can we determine who is likely to commit a violent crime? Should those
with brain injuries or other anomalies be considered culpable for their
crimes?
A technique of ``brain mapping'' scans the brain of criminal suspects to
see if they recognize incriminating images. It is under study at Brain
Fingerprinting Laboratories of Fairfield, Iowa, where scientists
interrogate suspects by checking their EEGs for P300 waves. These waves
are
produced when the brain encounters words or images that it recognizes.
A new high-tech version of the lie detector -- an elaborate brain-imaging
machine -- could usher in genuine thought police. Dr. Daniel Langleben of
the University of Pennsylvania, a psychiatrist, has found that when people
lie, brain scans reveal increased activity in several regions of the
brain.
While the idea of monitoring brain waves isn't new, the technique has
become more precise. Someday, say proponents, it will be possible to
recognize brain waves emanated by guilty thoughts. They predict that the
day will come when it will be possible to scan the skulls of everyone
going through airports to search for potential hijackers.
Brain imaging could also contribute to the study of people in prison with
a traumatic brain injury -- which may be a factor in some types of violent
behavior.
"It may be possible in the future to determine whether a specific
brain disease or injury impairs a person's ability to control impulses and
behavior,'' said William J. Winslade, professor of law at the University
of Texas Medical Branch. ``It's very relevant to the question: Can you
control your conduct -- in other words, do you have legal
responsibility?''
But the risk of error troubled many scientists at the San Francisco
conference.
``It raises the question of whether such evidence should be used in legal
settings,'' said Daniel L. Schacter, professor and chairman of the
department of psychology at Harvard University.
Medication effects
``The impact of neuroscience -- through psychopharmaceuticals -- is
already apparent in educational settings,'' said Stanford's Koenig.
High percentages of children, particularly boys, are prescribed medicines
such as Ritalin for conditions that may not be clear-cut brain diseases,
she said.
Equally controversial is the effort to speed up and deepen attention
through pharmaceuticals such as Provigil. If Provigil works for all-night
truck drivers, won't it also help students cramming for exams? Or a
working parent who has been up all night with a sick child?
The volunteers in the Stanford trial arrive on campus during an evening
when they're off work. They're given two capsules of Provigil or an
inactive placebo, then are put to work on a battery of physical and mental
tests.
``Most people report feeling naturally awake and refreshed. They don't
feel like they're on anything; they're not feeling stimulated or euphoric.
They're not jittery or anxious. They just feel awake,'' said Paul Stowers,
a clinical research coordinator at the Stanford Sleep Disorders Clinic,
who has seen the medication's effectiveness in combating symptoms of
narcolepsy, a sleep disorder for which use of the drug is legally
approved.
The drug works by increasing neuronal activity in the hypothalmic-arousal
region of the brain, an area responsible for normal wakefulness.
As its reputation grows, doctors soon may find themselves faced with a
difficult question: When is sleepiness a sickness? And should you
prescribe medication for a student or worker who is intentionally
sleep-deprived?
``There could be misuse, where someone does not have a medical condition
but wants to stay awake,'' Stowers said. ``But we believe the actual abuse
potential is quite low. People with a history of substance abuse don't
like it because there's no `rush.' It doesn't really do anything.''
In the future, other medications may enhance the mind by boosting memory.
Scientists predict that compounds developed to treat Alzheimer's will lead
to substances that boost intelligence.
One such compound, NGD97-1, alters brain chemistry to increase the ability
to form memories. NGD97-1 targets a brain neurotransmitter whose job it is
to reduce the ability to form a memory. By blocking this chemical's
effect, the drug boosts memory. It is being tested for its effectiveness
in
reversing memory loss that afflicts those with degenerative brain
conditions.
At the San Francisco conference, Erik Parens of the bioethical think tank
the Hastings Center of Garrison, N.Y., warned that if the drugs were
available only to wealthy students willing to pay to sharpen their minds,
it could create an unfair advantage -- and, over time, increase the gap
between the haves and have-nots.
"If there is a disease that causes an impairment in the ability to
function, then memory-enhancing drugs are OK,'' said Schacter, of Harvard.
``The question becomes different when you look at trying to depart from
the baseline level of function -- then, stickier questions arise.''
Arthur Caplan, professor of molecular and cellular engineering and chief
of the division of bioethics at the University of Pennsylvania in
Philadelphia, disputed the concerns.
"The notion of enhancement is deeply ingrained in our culture,''
Caplan said. "The only debate about the Kaplan SAT prep test is how
many weeks to attend. What about spending $25,000 a year to send your kid
to private school? Nobody says, 'You should be ashamed, you're giving your
child an
advantage.' ''
Mechanical Manipulations
It's not just brain scans or pills that could change us, scientists said.
Implanting fresh cells, or even computer chips, in an ailing brain could
make the question "Who am I?'' an even more complex one.
Earlier this month, a group of scientists produced the ultimate lab rat --
an animal that can be guided by remote control over fences, up trees and
across rubble. Researchers from the State University of New York and
Drexel University implanted electrical probes in critical centers of the
brain that affect what an animal senses and how it behaves. They then
trained rats to respond to impulses sent through implants.
Once trained, the animals could be controlled by an operator with a laptop
computer transmitting to a small receiver worn by each rat.
In related research using electrodes, a monkey at Brown University wore a
fingernail-size brain implant allowing him to move a cursor on a computer
screen just by thinking.
The drive behind such research is a humanitarian one -- finding better
ways to help people disabled by injury or stroke communicate. It raises
the hope that paralyzed people might one day be able to control complex
devices with their minds.
"All these things create a shift in who we are and where we're
going,'' said Paul Root Wolpe of the Center of Bioethics at the University
of Pennsylvania. "Where is the beginning, or end, of the `tech' me
and the `non-tech' me?''
Such tools may have dire ramifications in a world where science alters
human nature, said Dr. William Hurburt, professor of biology at Stanford
University.
"We're the products of 4 billion years of evolutionary history. Human
beings are all-purpose organisms -- if you make us stronger one way, we
may be weaker in another,'' Hurburt said.
While emerging tools of neuroscience may be benign, even life-saving, we
must be cautious how we use them, said Parens of the Hastings Center.
"I worry that our increased use of medical technologies will reduce
the range of ways that it's acceptable to be,'' Parens said. "If more
healthy adults use Prozac, for instance, what does it mean to our society
that we're all more assertive, confident, resilient people?
"We need to remember that there are a lot of different ways to be in
this world.''
If You're Interested
Volunteers interested in participating in a clinical trial of the drug
Provigil can call the Stanford Sleep Disorders Clinic at (650) 498-7352.
Receive Top News
Alerts in your E-mail box!
>> Learn
more |
