Neuroethics & Law Blog

An Ivy League perspective on Adderall (Reiner)

This past December, Barbara Sahakian and Sharon Morein-Zamir had a commentary in Nature entitled 'Professor's Little Helper' which discussed some of the ethical issues that arise with the use of cognitive enhancers.  Appended to the article was a request to readers to share their thoughts on cognitive enhancers, and

"We especially want to hear from you if you’re already using these drugs – or if you know people who are. What are your reasons for taking, or not taking, these drugs?"

The ensuing discussion focused more on the ethical issues associated with the introduction cognitive enhancers than autobiography.  In a recent issue of N+1, Molly Young, a senior at an Ivy League university, takes up the challenge in a wonderful piece entitled Kick Start My Heart.  The article has produced a fair bit of dicussion (here, and here, and here, and here), all of it laudatory for the frank way in which Molly discusses the issue. 

Molly shares with us the ambiguity that she felt as she began her adventure with Aderall.

"It is difficult to know whether it is a drug itself or a drug culture that attracts certain people to certain substances. In the case of Adderall, I came for the culture and stayed for the drug. Nothing had ever tempted me before. As an adolescent girl, alcohol was closely allied with promiscuity, and I was a prude. Weed suggested foolishness and snacking, and I was foolish and hungry enough as it was. But then came college, and with it, Adderall—a drug associated with writing, thinking, and joyful, hermetic reading. Adderall Me and Ideal Me were nearly the same person, and I saw no reason not to dabble in my best self."

This comment, perhaps more than any other in the piece, is remarkable insofar as it directly addresses, albeit from a first-person perspective, the notion that cognitive enhancers such as Adderall (if it can indeed be called one) alter our deepest perception of ourselves.  It is not just Molly's insight that suggests this; Molly did some cursory research on how Shire markets Adderall and found essentially the same thing.

"The Shire website offers some vague information about ADHD, the disorder for which Adderall is prescribed, and warns that the consequences of untreated ADHD can include relationship problems, drug abuse, and frequent job changes.  There is a link for people who are already taking Adderall. "Congratulations!" it reads. "By taking ADDERALL XR, you're showing your commitment to reaching your potential in all aspects of your life—and to being the person you were meant to be."

Despite the obvious pressures of an Ivy League education, Molly gives no indication that she felt coerced to take Adderall.  Finding it was easy, and the results were self-reinforcing, but she doesn't describe a culture in which she felt compelled to take the drug just to keep up with her classmates.  Whether this singular experience generalizes across cognitive enhancers will be important to know as more and more of these drugs enter the market.

Happy Blogiversary!

I'm pleased to report that the Neuroethics & Law Blog is three-years-old today.  That makes it almost ancient by blogospheric standards.  My thanks to our guest bloggers, past and present, for all of their contributions.  If you would like to contribute to the blog, I encourage you to contact me.

If you'd like a shortcut to reach the blog, you can use neuroethicsblog.com.

Neurotechnology's Killer App

According to the Associated Press, later this year, a company will sell a "neuroheadset" designed for use in video games for $299:

The headset's sensors are designed to detect conscious thoughts and expressions as well as "non-conscious emotions" by reading electrical signals around the brain, says the company, which demonstrated the wireless gadget at the Game Developers Conference in San Francisco.

The company, which unveiled a prototype last year, says the headset can detect emotions such as anger, excitement and tension, as well as facial expressions and cognitive actions like pushing and pulling objects.

The headset will be sold with a game developed by Emotiv, but it can also be made to work with existing PC games, the company said. Users will also be able to access an online portal to play more games, chat or upload their own content such as music or photos.

It has sometimes been said that the VHS market grew so quickly because it made pornography easily available.  In the Internet age, pornography was again credited with spurring technology for online financial technologies and streaming video.  Who knows whether these "neuroheadsets" can do a good job at what they are purported to do?  BUT, if they become popular in videogames, you can bet that there will be a lot of innovation and cost reduction in technologies like this, along with applications in many different areas.

Tushnet on Trademark and Cognitive Science

Rebecca Tushnet (Law, Georgetown) has posted Gone in 60 Milliseconds: Trademark Law and Cognitive Science (Texas Law Review, Vol. 86, p. 507, 2008) to SSRN. Here is the abstract:

Trademark dilution is a cause of action for interfering with the uniqueness of a trademark. For example, consumers would probably not think that "Kodak soap" was produced by the makers of Kodak cameras, but its presence in the market would diminish the uniqueness of the original Kodak mark. Trademark owners think dilution is harmful but have had difficulty explaining why. Many courts have therefore been reluctant to enforce dilution laws, even while legislatures have enacted more of them over the past half century. Courts and commentators have now begun to use psychological theories, drawing on associationist models of cognition, to explain how a trademark can be harmed by the existence of similar marks even when consumers can readily distinguish the marks from one another and thus are not confused.

Though the cognitive theory of dilution is internally consistent and appeals to the authority of science, it does not rest on sufficient empirical evidence to justify its adoption. Moreover, the harms it identifies do not generally come from commercial competitors but from free speech about trademarked products. As a result, even a limited dilution law should be held unconstitutional under current First Amendment commercial-speech doctrine. In the absence of constitutional invalidation, the cognitive explanation of dilution is likely to change the law for the worse. Rather than working like fingerprint evidence - which ideally produces more evidence about already-defined crimes - psychological explanations of dilution are more like economic theories in antitrust, which changed the definition of actionable restraints of trade. Given the empirical and normative flaws in the cognitive theory, using it to fill dilution's theoretical vacuum would be a mistake.

Spiritualism and Will(s) in the Age of Contract (Buccafusco)

I hope readers won't mind if I post about a couple of current projects I am working on, one historical and one contemporary. The historical project concerns the treatment of Spiritualism by nineteenth-century American law. Here's the abstract, and you can download the complete paper here. Comments are welcome and can be emailed to me at chrstphr@uchicago.edu.

Spiritualism was one of the most salient cultural phenomena of late-nineteenth-century American life. The belief of considerable numbers of respectable citizens that they could communicate with the dead via an entranced medium called into question both popular and scientific conceptions of rationality, volition, and freedom. In turn, these changing ideas about the mind challenged American law's commitment to its belief in free and reasonable legal actors. This Article, the first to consider Spiritualism's implications for American law, examines the legal reaction to the anxieties Spiritualism generated for the age of contract. Principally, it looks at the judicial response to cases of Spiritualists' wills that were challenged on the grounds of insanity and undue influence. In dealing with such cases, I argue, American judges adopted a realist, pragmatic strategy of promoting polyphonic discussion and preserving democratic decision making. Approaching the subject from the perspective of cultural legal history, I suggest that popular culture, science, and the law were mutually constitutive discourses in which nineteenth-century Americans enacted their anxieties about the mind, the will, and the family. Finally, I argue that a contextualized understanding of these nineteenth-century debates can suggest much about current legal debates about rationality, responsibility, and volition engendered by recent discoveries in behavioral economics, the psychology of emotions, and cognitive neuroscience.

Satel reviews The Loss of Sadness (Reiner)

Sally Satel has written an excellent review of Horwitz & Wakefield 's recent book, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder.  The review is published in the Feb 27th edition of the New Republic, but for those without a subscription, Powell's Books has posted it for free on their website.  There is much to recommend in both Satel's extensive review and Horwitz & Wakefield's book; especially relevant for the neuroethics crowd is the book's exhaustive treatment of the route by which psychological variations from the mean become codified into disease in successive editions of DSM.  As Satel points out,

"The Loss of Sadness comes at a fortuitous time for American psychiatry. The APA has just selected the hundreds of clinicians and scientists who will develop the DSM-V. They would be wise to consider the work of Horwitz and Wakefield, and their demand that we avoid pathologizing normal reactions to the vicissitudes of life. Normal reactions to timeless human heartache are not the same as mental disorders. Horwitz and Wakefield call for changes to major depressive disorder that would exempt patients whose depression is triggered by a serious loss, just as bereaved patients are ineligible for the diagnosis. This is certainly worth considering."

The issues that Horwitz & Wakefield raise are hardly confined to the fuzzy line that has been drawn between sadness and depression.  The Loss of Sadness is a clarion call to all who think incisively about what constitutes disease in the context of behavior.

Socioeconomics and Brain Development

This article in the Chronicle of Higher Education discusses the work of Martha Farah et al. on the effect of socioeconomic status on brain development.  From the Chronicle:

For generations, psychologists have noted that children raised in poverty perform poorer on cognitive tests, on average, than do students from wealthier families. Some researchers have taken those results to argue that intelligence is determined for the most part by genetics and that certain races are inherently smarter than others. In 1994, Richard J. Herrnstein and Charles Murray presented that case in their book, The Bell Curve: Intelligence and Class Structure in American Life.

But the new results from neuroscience indicate that experience, especially being raised in poverty, has a strong effect on the way the brain works. "It's not a case of bad genes," said Ms. Farah.

She and her colleagues have investigated the issue by trying to tease out which aspects of poverty alter specific cognitive skills, such as memory, language, and the ability to delay gratification.

. . .

When Ms. Farah's team tested 110 of those children, they found that particular cognitive skills were linked with certain aspects of the environment. Children with better language abilities were more likely to come from intellectually stimulating homes, no matter how nurturing their parents were. Memory skills, however, matched the nurturing levels in the home, reported Ms. Farah, who will publish her results in an upcoming issue of Developmental Science.

To test why, the researchers did MRI scans of the children. They found that students raised in nurturing homes generally had bigger hippocampi, the portion of the brain associated with forming and retrieving memories. The discovery dovetails with previous research in rodents, which showed that rats raised in a stressful environment develop smaller hippocampi.

Daniel Goldberg comments here.  (Thanks to Daniel for bringing the Chronicle article to my attention.)

L.A. Times Highlights Neuroethics & Law Blog

Last week, the L.A. Times ran a story entitled, "Peeking Inside Voters' Minds."  The piece highlights Martha Farah's guest post on this blog that was skeptical of the interpretation of fMRI results presented in a November NYT op-ed:

Several prominent researchers last year criticized the scientific validity of a study by Washington-based neuromarketers FKF Applied Research Inc. that used brain images from an MRI scanner to measure the emotional responses of undecided voters.

Pictures of Clinton activated the anterior cingulate cortex, an area that deals with emotional conflict. UCLA psychiatrist Joshua Freedman, who cofounded FKF, and William Knapp, both Democratic strategists, said the scan revealed an ambivalence about Clinton that could explain why voters snubbed her when she was ahead in Iowa but then rallied behind her in New Hampshire.

But University of Pennsylvania neuroscientist Martha J. Farah says the brain is complex and scans interpreted to indicate anxiety, for example, could have signaled happiness because particular brain areas process many emotions. "The scattered spots of activation in a brain image can be like tea leaves in the bottom of a cup -- ambiguous and accommodating of a large number of possible interpretations," Farah wrote on the Neuroethics and Law Blog, a key website for neuroscientists.

Kudos to Martha Farah (and apparently to this blog--"a key website for neuroscientists").

Neuroethics 1:1 - Levy

My introduction to the first issue of Neuroethics is now available online. In it, I sketch out my conception of what neuroethics is. I suspect that conception is rather broader than that held by others. But that's a good thing: there is plenty of room for diverse views in the journal (including the views of those who want to defend a narrow conception of neuroethics). PDF HTML

Chemophobia

I'm a big fan of the site "Askphilosophers.org", where netizens can pose philosophical questions to a big group of philosopher panelists (more info. here).  It doesn't seem to get as much attention on the Internet as I think it deserves, at least not in the portion of the Internet to which I'm exposed.  Here's a sample Q&A from the site (I picked this one in particular, because I like the description of "chemophobia" at the bottom of the answer):

QUESTION: How logically rigorous is the claim that neurochemical changes in the brain 'cause' mood or emotional disorders? Does a running nose cause a cold? In any case, before prescribing powerful chemicals to emotionally distressed patients shouldn't doctors use some sort of machine to test the chemical levels of their brains?

ANSWER (by Allen Stairs):

You're right: we shouldn't throw the word "causes" around too casually. Let's fix on depression as our example, and let's keep in mind that simply being sad isn't the same as being clinically depressed. On the one hand, neurochemicals probably aren't just symptoms of depression; they probably have something to do with causing the symptoms -- the listlessness or anxiety, or excessive rumination or protacted feelings of sadness. Perhaps it would be more accurate to say that clinical depression is, at bottom, a malfunction in the neurochemical system, though this may be too reductionistic, and it also may turn out not to get the biology right. But perhaps what you're pointing to is that it still makes sense to ask what causes this malfunction in the first place. That's obviously a very good question. My impression is that sometimes life circumstances can trigger depression, but sometimes there's no clear external cause. The right answer here is likely to be very complicated.

At the moment, far as I know, we have no good way of testing the functioning of the neurochemical system itself. Perhaps we will some day; perhaps we'll develop a blood test or scanning technique that will tell us when someone's neurochemical system is out of whack and allow for a biological diagnosis of mental illnesses. Until then, we have to make trade-offs. Some of the chemicals we use to treat psychiatric conditions have serious side effects. Unfortunately, however, untreated mental illness has serious side effects of its own, including death.

Psychiatric medications are tested for safety. We have reasonably good but imperfect information about what percentage of people taking them are likely to develop which side effects. And so we have a basis for making a trade-off: if a patient has serious symptoms, if we have evidence that a certain medication can help alleviate the symptoms, and if the risk of side-effects is not too great, it might well make sense to try the medication even if we aren't sure what's really going on in the brain. All of this should be monitored carefully, of course, and physicians shouldn't be too quick to give out medications when other approaches (cognitive behavioral therapy, for example) might do the job with lower risk of side effects. But I think that what we might call "chemophobia" -- fear of medications -- is potentially just as dangerous as overprescription.