Neuroethical issues in cognitive enhancement and neuroimaging

1
Neuroethical issues in cognitive enhancement and
neuroimaging
Barbara Sahakian FMedSci Professor of Clinical
Neuropsychology Department of Psychiatry, School
of Clinical Medicine and Behavioral and Clinical
Neuroscience Institute (Jointly Funded by the
Medical Research Council and Wellcome Trust) and
Danielle Turner
2
Cognitive Enhancers

• Many drugs have enormous potential to improve the
  quality of life for numerous individuals and to
  benefit society.
• Developments in pharmacogenomics will make it
  possible to target subgroups of individuals with
  safe and effective cognitive enhancers.
• It is important that we are not complacent about
  the harms that many agents can cause,
  particularly with long-term use and in the
  developing brain.
• It is imperative to use experimental psychology
  paradigms to screen drugs to ensure the safest
  possible use of current and future psychotropic
  drugs.

3
Neuroethics

• The study of the ethical, legal and social
  questions that arise when scientific findings
  about the brain are carried into medical
  practice, legal interpretations and health and
  social policy
• The Dana Foundation
• Marcus, 2002

4
Methylphenidate
Increasing prescriptions for Ritalin
Farah 2005 TICS
5
Modafinil
Improvement
Modafinil improves planning in healthy volunteers
6
Modafinil
7
Action of methylphenidate, modafinil, and
atomoxetine
Methylphenidate (Ritalin) increases synaptic
concentration of Dopamine and Noradrenaline by
blocking their reuptake.
Modafinil (Provigil) action is unclear
Possibilities include indirect mediation of ACh
and/or Adrenergic alpha 1 receptor activity.
Appears to effect hypothalamic orexin and
histamine, and has a small effect on dopamine
transporter activity.
Atomoxetine (Strattera) is a relatively selective
noradrenaline reuptake inhibitor (SNRI).
Calm wakefulness
Stimulated vigilance
Stahl SM (2002) J Clin Psychiatry
8
Novel cognitive enhancers

• 40 potential cognitive enhancers are currently
  in clinical development
• - NeuroInvestment

Ampakines improve cognition in healthy aged
volunteers
9
Ampakines enhance the AMPA receptors response to
glutamate
10
The Rights and Wrongs of cognitive
enhancementin healthy people
11
RIGHTS Potential benefits
In addition to scientific and clinical advances

• Increase performance (both pleasurable and
  competitive activities)
• Military

• Shift workers, air traffic control
• School pupils
• Normalisation removal of unfair disparity in
  society (if people can be helped they should be)

12
Military uses of cognitive enhancers
13
WRONGS Potential harms

• There could be long-term side-effects, especially
  in the developing brain
• We run the risk of becoming a homogeneous society
• There could be greater inequality, with access
  dependent on wealth
• Our perception of ourselves could change
  (mechanistic beings) and we will not be able to
  take credit for our achievements
• Virtues such as motivation and working hard could
  become outdated (students will just take a drug)
• You could be over-enhanced e.g. plagued by
  unwanted memories
• People could be coerced into taking cognitive
  enhancers (24/7 society) or even forced

14
(No Transcript)
15
Cognitive enhancementConclusions

• Pharmacological enhancement is one solution to
  improving society. However, we would not want to
  preclude other solutions, for example, extra help
  in the classroom, smaller classes, greater
  consideration for life/work balance etc.
• Currently cognitive enhancers (in particular
  pharmaceuticals like modafinil and
  methylphenidate) have the potential to provide
  important clinical benefits and further
  development in this area is worthy of pursuit
• Pharmacogenomics will make it possible to target
  individuals with safe and effective cognitive
  enhancers
• Scientists need to work together with social
  scientists, philosophers, ethicists, policy
  makers and the general public to actively discuss
  the ethical and moral consequences of cognitive
  enhancement
• This will go some way to ensuring that
  technological advances are put to maximal benefit
  and minimal harm

16
Brain reading Ethics of neuroimaging

• Growing public perception of neuroimaging as
  hard science, complementary to the soft
  science of psychological evaluation
• However this new technology should be applied
  cautiously Neuroimaging is not evidence for
  causation.
• Example criminal psychopaths appear to
  rehabilitate well with behavioural therapy, yet
  have higher rates of reoffending than would be
  predicted by their therapists. This may be
  because they can manipulate or dupe people, but
  could they dupe a brain scan?

News Feature, Nature 2001 vol 410 296-298
17
Examples of possible applications of neuroimaging

• Neuroimaging of emotion in healthy volunteers
• Unconscious biases
• Neural correlates of morality
• Deception and lie detection
• Forensic neuroimaging in violent offenders
• Psychopathy and affective processing
• Self-control imaging inhibition

18
Unconscious racial biases
In White subjects, amygdala activation in
response to Black faces correlates with
unconscious measures of bias (IAT response
latencies) .but not with score on Modern Racism
Scale, measuring how racist they perceive
themselves. (Phelps et al J Cogn Neurosci 2000)
Would it be ethical to screen job applicants,
judges, lawyers, teachers, doctors ... for
discriminatory biases?
19
Neural correlates of morality
Areas shown are those activated by moral versus
non-moral unpleasant visual stimuli.
Differential activation was also seen in moral
vs. neutral conditions. (Moll et al J Neurosci
2002)
How would we interpret someones scan that does
not show this pattern of activation. Are they
immoral? Amoral?
20
Deception and lie detection
Differential patterns of activation observed for
Truth (T), spontaneous-isolated lies (SI) and
memorized scenarios (MS). This may be evidence
for neural correlates of different types of lying.
Ganis et al, Cerebral Cortex 2003
Can we tell when someone is lying? Can we tell
if someone has a false memory?
21
Forensic neuroimaging violent offenders
Criminal psychopaths show different patterns of
emotional-related activity compared to
non-criminal control subjects (Kiehl, Biol
Psychiatry 2001)
Will this change our diagnosis of psychopathy
to a brain scan rather than observed behaviour?
Would we incarcerate brainscan-psychopaths
before they commit a crime?
22
Behaviour prediction imaging inhibition
In noncriminal male subjects, sexual arousal in
response to erotic films produced activation in
limbic and paralimbic regions (compared to
viewing neutral films),
but attempted inhibition of arousal was
restricted to activation of right superior
frontal gyrus and anterior cingulate.
Beauregard et al, J Neurosci 2001
If scanning shows a lack of inhibitory ability,
are you likely to commit a sexual crime? If
ones brain cannot inhibit arousal, is one
responsible for impulsive actions? Should one be
required to register with authorities or accept
treatment?
23
Neuroethical questions

• Should we enhance cognition in healthy people and
  if so, under what conditions (e.g. shift workers,
  military personnel etc)?
• Should we limit access to cognitive enhancing
  drugs? Fairness? Possible harms on the developing
  brain?
• Should we attempt to predict behaviour (e.g. the
  film Minority Report)? What impact will this have
  on our legal system?
• What is the risk/benefit ratio to individuals and
  society of using available neurotechnology? How
  should we address error of measurement?
• Who should have access to this neurotechnology?
• What are the implications of developments in
  pharmacogenomics?

24
Pharmacogenomics
Should people who do not experience harms be
allowed to take illicit drugs? Who should have
access to your gene chip?
Roiser et al. Am J Psychiatry 2005 162(3)609-612

25
Conclusion

• Active discourse is needed between scientists and
  ethicists, policymakers, and the general public
  to address these complicated ethical questions
  raised by new neurotechnology

26
Neuroethics Society
http//www.neuroethicssociety.org/
27
Key references

• Farah MJ, Illes J, Cook-Deegan R, Gardner H,
  Kandel E, King P, Parens E, Sahakian BJ, Wolpe PR
  (2004) Neurocognitive enhancement what can we do
  and what should we do? Nature Reviews
  Neuroscience 5 421-425
• Turner DC, Sahakian BJ (2006) Ethical questions
  in functional neuroimaging and cognitive
  enhancement. Poiesis and Praxis, doi
  10.1007/s10202-005-0020-1
• Turner DC, Sahakian BJ (2006) The neuroethics of
  cognitive enhancement. BioSocieties, 1 113-123
• Turner DC, Sahakian BJ (2006) The
  cognition-enhanced classroom. Better Humans, (Eds
  P. Miller J. Wilsdon), Demos
• Duka T, Turner DC, Sahakian BJ (2005).
  Experimental Psychology and research into brain
  science, addiction and drugs. Foresight Review.
  http//www.foresight.gov.uk/Brain_Science_Addictio
  n_and_Drugs/Reports_and_Publications/ScienceReview
  s/Index.htm
• See also
• Illes, J. (Ed) (2006) Neuroethics Defining the
  issues in the theory, practice and policy, Oxford
  University Press
• Entire issue Brain and Cognition 50, 2002
  particularly Wolpe, Canli and Amin