Neuroethics & Law Blog

Thank you! (Tovino)

A warm thank you to Adam for inviting me to guest blog this month.  I'm signing off to prepare for our upcoming balmy weather, but please stop by and say hello to the wonderful folks in our Health Law Institute the next time you're up here in the North Pole.  Looking forward to seeing everyone in 2007 at the Brain Imaging and the Law Symposium Conference and then at the Health Law Professors Conference, if not before.  ~ST

NeuroMarketing (Tovino)

The November 29 San Francisco Chronicle has a fun editorial ("Your Branded Brain: The Bigger the Brand, the Bigger the Brain Wave") about a German neuromarketing study the results of which were presented on Tuesday in Chicago at the annual conference of the Radiological Society of North America.  According to the Chronicle: 

The researchers selected 20 adult men and women with a median age of 28 and high levels of education.  One at a time, they went into MRI machines that had been rigged with a small video screen, and stared at logos for well- and lesser-known brands.  The well-known logos provoked strong activity in brain regions associated with positive emotion, self-identification and reward.  As for the pitiful, unbranded competition?  Brain activity came on strong in regions associated with negative emotion and memory -- signs of a frustrated consumer, trying to remember how to think. 

The good news for marketing types is that even unsexy products can provoke a strong brain response.  The good news for the rest of us?  Well, so far, no one's figured out how to use brain activity to force a purchase.

Drugs and the Brain (Tovino)

The effect of drugs on the brain continues to be a hot topic.  During this week's annual meeting of the Radiological Society of North America, Dr. Maartje de Win of the University of Amsterdam presented research findings showing that even low doses of the drug ecstasy harm the brain on first use.  The study, which was carried out as part of a larger Netherlands XTC Toxicity (NeXT) investigation, used fMRI to show that low-dose, first-time users of ecstasy experienced subtle changes in brain cell architecture and decreased blood flow in some brain regions.  In a November 28 report in The Guardian, Dr. Maartje de Win was quoted as stating, "'We do not know if these effects are transient or permanent.  Therefore, we cannot conclude that ecstasy, even in small doses, is safe for the brain, and people should be informed of this risk.'"

"A Pill to Forget" on 60 Minutes

60 Minutes recently did a segment on the possible use of the drug propranolol as a treatment for PTSD.  There's also some neat footage showing memory-enhancement in a mouse injected with adrenaline.  Here's a link to some of the video and here's the full transcript (which may point to some difficulties in demonstrating that propranolol is more effective than a placebo).  (Hat tip: my USD colleague Larry Hinman).

My article on the legal and ethical implications of memory dampening is now complete and has been sent to the publisher.  Here's the link on SSRN.

Linking Head Size and Intelligence, and more ... (Tovino)

A lot of interesting brain news today.  Today's London Times contains a fun report of a recent study in Pediatrics that concluded that, "The brain volume a child achieves by the age of 1 year helps determine later intelligence.  Growth in brain volume after infancy may not compensate for poorer earlier growth."  According to the Times:

British scientists have just confirmed a link between head size and intelligence.  Their findings reverse decades of fierce scientific arguments.  And, what's more, it has provoked me to set forward a new theory in which natural selection is superseded by man -- more specifically by the modern Caesarean section -- to create an unprecedented breed of big-headed humans.  Listen pinheads, I know this is hard for you, but stay with me.  Back to the burdens of bigheads.  I am not just talking about my own similarity to the browbeaten Charlie Brown, although a hairdresser did once advise me in all kindness to grow a fringe to cover my domed forehead, saying: "If I could grow my hair long enough to cover my big bottom, I would."  Until recently the fashionable scientific thinking is that we are numbskulls, that all the extra we carry up top is just excess baggage.  This was as a result of the failure to prove a link between quantity and quality of mind.  The Victorian fad for phrenology and their more distasteful obsession with calibrating criminal or racial traits through head measurements came to nothing.  Jonathan Swift had one of the biggest brains ever measured, while Anatole France, the 19th-century French author, had one of the tiniest brains on record, half the size of Swift's.  Einstein had a small brain.  All three were brilliant, only Swift had trouble buying hats. . . .  Controversy over the link between head size and IQ raged over the 20th century but was, for the most part, dismissed as simplistic as a child's drawing.  Until now . . .

Today's L.A. Times has a nice article on phantom limb pain.  After summarizing the phenomenon's treatment history, the article (accessible with free registration) concludes:

Doctors have been testing an arsenal of treatments for phantom limb pain since Mitchell's day, including surgery, painkillers, and electrically stimulating the brain -- all of which can offer temporary relief, at best.  Part of the problem is that competing theories abound as to the causes.  Researchers have implicated abnormal nerve growth; nodules forming at the end of severed nerves; the brain's confusion over the loss of sensory information it once received; and the faulty rewiring of nerves sending signals from the lost limb.  But most researchers now agree that the sensations have physical origins, not psychological ones.  Yet many patients are told today what they would have been told in Pare's time -- that the feeling is all in their heads. 

Today's Guardian contains an interesting discussion of Louann Brizendine's The Female Brain (Morgan Road Books, 2006):

In her book, Brizendine claims that men and women are different because their brains function differently, and one of the most interesting examples she comes up with is that women talk more -- 20,000 words a day compared with 7,000 for the average man -- and they talk twice as fast. . . .  Brizendine's thesis is attractive.  It fits in with our perception that women are more emotionally literate than men and happier to talk about their feelings; that men are more bottled up emotionally.  We know it to be true.  Brizendine has done us a service by explaining the neuroscience that underpins all this.  Or has she? . . .   

In a study published in Nature on November 23 ("Synaesthesia: The Taste of Words on the Tip of the Tongue," available to subscribers here), a group of British scientists summarize how they designed a study to test the series of neural events that take place when a person tastes words.  According to today's Newsday (accessible with free registration):

Julia Simner of the University of Edinburgh and Jamie Ward of University College London identified 10 people who can taste words -- a sensory experience that is as real to that person as Bolognese sauce over spaghetti sprinkled with hot pepper.  Only there is no food.  And the word has nothing whatsoever to do with Italy.  Researchers had to travel 9,000 miles around the world to find 10 people who have the rare neurologic anomaly that causes it.  However rare, unraveling the mystery could yield some very important clues about how the brain regulates sensory information, Simner said.  In a study published in the journal Nature last week, the researchers recount how they designed a study to test the series of neural events that take place when a person with this syndrome, called synesthesia, see a word.  To accomplish this, they found unusual objects that people would immediately know but not so easily identify -- a platypus, for instance, or castanets.  They wanted to elicit a tip-of-the-tongue response so they could figure out whether the tastes are triggered by the sound of the word or its meaning.  Almost 100 unusual words were presented to the subjects, who were then asked about the "taste" that was evoked by the word.  They discovered that tastes are linked to the part of the brain that stores the meaning of the word -- and not the sound itself.  The taste actually came to the person before the sound, during the search for the word.  Words can taste like Caesar salad with too much garlic or hot chocolate.  Simner said that all of the people had specific tastes for specific words -- and they didn't change over time.  (They were re-tested a year later.)  What's happening is that the sensory cross talk -- the misfiring of information from one brain region to the next -- is leaving the person with the experience of tasting a certain food when he or she hears the word.  "It's like an open connection," said Simner, who admitted that it is very frustrating to study synesthesia without being able to experience it herself . . . . 

Finally, today's L.A. Times has another nice article on neurofeedback, in which patients use a computer to view and modify the activity in their minds: 

In neurofeedback, people with mental or psychological conditions learn to regulate and reduce their symptoms . . . by monitoring their brain waives on a computer.  The treatment is an increasingly popular cousin to biofeedback, in which people control physical stress by monitoring their heart rate or muscle tension. . . .  Neurofeedback has been used for decades in private clinics, but few well-controlled research studies have been done -- giving it an unscientific reputation.  That's beginning to change.  Researchers are now studying and refining the therapy -- with promising results.  Neurofeedback is being used to treat a growing number of conditions, including chronic pain, attention-deficit hyperactivity disorder, asthma, migraines, post-traumatic stress disorder, substance abuse, autism, and a variant of autism called Asperger's syndrome.  "We've done some definitive studies finally that show it works in important ways," says Eran Zaidel, a professor of behavioral neuroscience and cognition at UCLA's Brain Research Institute . . .

Brain Death and Monkey Research (Tovino)

Policies and procedures permitting the removal of life support from brain dead patients are commonplace in U.S. hospitals.  But in a rare move for a Japanese hospital, the Red Cross Akita Hospital has established guidelines that permit physicians to remove respiratory support from certain brain dead patients.  According to Takashi Minakawa, chair of neurosurgery at the Akita hospital, the guidelines allow removal of respiratory support in situations in which "it is proved medically that recovery is impossible after the pronouncement of brain death."  According to a November 26 Japan Economic Newswire report ("Guidelines Produced on Removing Life Support for Terminal Patients") available through LexisNexis:   

The guidelines concern those patients judged to be in a terminal stage because of acute conditions such as brain hemorrhage and external injuries to the brain where recovery is seen as unlikely even with appropriate treatment.  If respiratory support is to be removed, the patient must be pronounced brain dead in accordance with regulations required for organ transplants from brain-dead patients, the guidelines say.  The family must state their wish in writing beforehand against life-support measures, and the family must also file a signed petition to call for termination of care, according to the guidelines.  After they are submitted to the director of the hospital, the director must issue a notice that authorizes the removal of respiratory support.  For near brain-death situations where a firm judgment cannot be made on brain death, removal of respiratory support will not be allowed but other steps may be allowed, the guidelines say.  These steps include termination of intravenous feed and reducing oxygen concentration in the respirator.  According to the hospital, there has been a case in which doctors considered acting in line with the guidelines but no action was taken because the family had not confirmed the patient's wishes.

Today's Mail has an interesting report describing some secret monkey brain research being conducted at Oxford University.  BBC Two also will feature the research, which has been designed to investigate treatments for Parkinson’s Disease and Multiple Sclerosis but has raised the ire of the animal-rights lobby, in an 80-minute segment beginning tomorrow at 9 p.m.

Neuroethics podcast (Levy)

Australia's Radio National recently interviewed me on the topic of neuroethics. Audio, including a downloadable mp3, can be found here. A transcript will be posted at the same site within a day or two.

Genes, not Brains (Tovino)

A little off topic, but some new findings suggest that one person's DNA code can be as much as 10% different as another's.  The findings, which are published in the November 23 online issues of Nature ("Global Variation in Copy Number in the Human Genome") and Genome Research ("Accurate and Reliable High-Throughput Detection of Copy Number Variation in the Human Genome") and the November 22 online issue of Nature Genetics ("Genome Assembly Comparison Identifies Structural Variants in the Human Genome"), challenge the assumption that the DNA of any two humans is 99.9% similar in content and identity.  Some nice summaries of the findings are available here, here, and here.

The Brain Hospital (Tovino)

BBC One's answer to CBS' 3 Lbs is The Brain Hospital, comprised of three one-hour documentaries, each of which follows patients and staff at London's National Hospital for Neurology and Neurosurgery.  The first episode, which aired last night, featured a patient who had electrodes implanted in his brain to ease his Parkinson's.  The second episode, scheduled to air November 29, will feature former EastEnders star Ross Davidson, who is offered an experimental light treatment for his brain tumor.  We will have to wait until December 6 to see the third episode.  According to a November 23 report in The Guardian, the neurosurgeons at NHNN don't have god complexes.

And, today's L.A. Times contains a narrative by Joel Havemann (accessible with free registration) about Havemann's experience with Parkinson's Disease, including his operation "misleadingly called deep brain stimulation."

Turkey on the Brain (Tovino)

If you are wondering how tomorrow's turkey and stuffing will affect your brain function, the answer probably is somewhere in here or here.  Happy Thanksgiving!

Incidental Findings (Tovino)

In the context of neuroimaging research, incidental findings have been described as observations of potential clinical significance unexpectedly discovered in healthy subjects or in patients recruited to brain imaging research studies if such observations are unrelated to the purpose or variables of the study.  Incidental neuroimaging findings have been the focus of a number of recent studies, listed here.  Did you catch the incidental blood clot finding in Episode 2 of 3 Lbs?  (This finding was discovered in the context of treatment, not research, but the issues are similar.)  What about the attempted use of this finding by the patient's lawyer in the patient's criminal proceeding?  And the lawyer's comment about the legal system keeping pace with science?  Notwithstanding the pheromone subplot, 3 Lbs is hitting a lot of key neuroethics issues!

Judge Orders "Lazarus Pill" for PVS Patient (Tovino)

High Court Judge Sir Mark Potter has ordered physicians to administer zolpidem (trade name Ambien) to a woman reportedly in a persistent vegetative state.  Potter issued his ruling notwithstanding earlier requests by the woman's family to withdraw nutrition and hydration, as well as testimony by Professor Keith Andrews of the Royal Hospital for Neurodisability that the drug probably will not bring the woman out of her PVS.  According to a November 21 report in the Daily Mail, a final decision on the woman's fate will be made in a few weeks, when Potter decides whether the drug is working.  British company ReGen reportedly will begin zolpidem clinical trials with a group of South African PVS patients on Monday, November 27.

To Life, To Life, Resveratrol...

If you're a mouse with access to good health care, you've got a lot to be excited about.  A couple of recent studies have shown that mice given very large doses of resveratrol (a component of grape skins and other foods) were able to (1) live longer on a high-fat diet and (2) have greater endurance than mice who did not consume resveratrol.  The results have been astounding.  It's too early to say whether resveratrol (or experimental drugs based on it that are believed to be "sirtuin activators") will have the same effects on humans and whether side effects will be tolerable.  I was puzzled, though, by this claim in the New York Times:

For the Food and Drug Administration, if for no one else, aging is not a disease and death is not an end-point. The F.D.A. will approve only drugs that treat diseases in measurable ways, so Dr. Westphal hopes to show that his sirtuin activators will improve the indicators of specific diseases, starting with diabetes.

I don't know the basis for this claim about the FDA.  Does it mean that substances designed merely to extend life without treating "disease" (as commonly understood) cannot be regulated by the FDA?  Would we not simply think of such a drug as treating a wide range of diseases that shorten life? I don't know whether its better for the FDA to regulate or not regulate such substances, but it would be unfortunate if pharmaceutical companies think that they must treat specific, identifiable diseases rather than simply promoting the quality and quantity of life in general. (X-posted.)

Language and the Brain, etc. (Tovino)

Do you ever wonder why you are able to block out conversations in a language in which you are not proficient, but you cannot tune out conversations conducted in your own language, even when you are trying to work?  An interesting article in the November 17 issue of The Daily Yomiuri explains that, "Our neural mechanisms are beautifully tuned to catch the sounds of our native languages, but that very tuning has the effect of tuning out new languages."  Patterns of neural connections apparently develop to produce sounds and sound sequences, and to hear them.  The standard sounds for each language establish themselves as "perceptual magnets," or "attractors," so that we automatically interpret any language sound as one of the sounds we know.  These attractors for known sounds preempt new sounds, making it difficult to add new language sound attractors.

Peter Ocko, Executive Producer of the new neurosurgery TV drama 3 Lbs, told Newsday today that we can expect to see episodes involving deep brain stimulation for depression, phantom limb pain, and other topics "on the leading edge of neuroscience."

We also can expect to understand how the brain generates consciousness by the year 2056, according to today's Mirror.  Only 50 more years ...

"Smart Mice, Not So Smart People"

I was recently sent an advance copy of Arthur Caplan's most recent book Smart Mice, Not So Smart People.  The book covers a wide-range of bioethical issues in easily digested, bite-size installments, and is written by a superstar in the world of bioethics.  Speaking of digestion, Caplan accuses Yum Brands Inc. (owner of KFC restaurants and others) of hypocrisy for announcing that 1,200 KFC restaurants will ban smoking while, at the same time, the company was dressing up their "greasy, cholesterol-infused offerings" (p.11) by taking the word "fried" out of the brand name and eliminating the Colonel Sanders brand image ("He seemed to remind people that what they were eating might not be the most nutritious foodstuffs to be found on our fruited plain") (p.11).

Interpret this as you will, but Colonel Sanders is back in a big way.  A very big way:

(Cross-posted at Prawfsblawg.)