NeuroEthicsOutline.htm

d. Sententia W. Neuroethical considerations: cognitive liberty and converging technologies for improving human cognition. Ann N Y Acad Sci. 2004 May;1013:221-8.

Discussing the biology of mental and neurological disorders is quite an undertaking. In fact, an entire semester of university credit is devoted to it in Vanderbilt’s psychology course entitled the Biological Basis of Mental Disorders. Thus said, there is obviously no way to do the subject justice in one class period. What we did attempt to undertake, however, is a brief description of the biology behind depression. We used this as a springboard for a larger discussion on the ethics of mental disorders and the ethics of medications that treat depression, such as Prozac. Is depression overdiagnosed? Can a person without depression take Prozac and become happier? Can a pill become the panacea for eliminating any feelings of pain or suffering? These are some of the questions pondered in relation to the topic. Many of the questions that come to mind were not addressed in class, but will help the observer to think about this subject in a critical manner.

The most recent hypothesis for the biological basis of depression that has been supported by the most evidence is the theory which implicates the hyperactivity of the HPA axis as the cause of depression. The prefrontal cortex sends messages regarding its perceptions to the amygdala and the hypothalamus, some of the emotional processing centers of the brain. In this schematic, the amygdala serves as a “revving up” of the hypothalamus and the resulting stress response while the hippocampus serves as a “calming down” of the hypothalamus and the stress response. The stress response involves the release of corticotropin-releasing hormones, which prompts the release of adrenocorticpotropin hormone. This travels through the blood as a hormone to the adrenal gland of the kidney and prompts the release of corticosteroids. Normally, these corticosteroids that are released as a result of the stress response would travel through the body, attach to glucocorticoid receptors on the hippocampus, and activate the downregulation of the stress response. Various theories exist as to why this does not happen, but somehow the binding on the hippocampus does not occur and the HPA axis is continually upregulated without being brought back down to resting state by the hippocampus. The theory suggests that depression is a mood disorder regulated by stress and inherently tied to anxiety.

We discussed whether or not we believed that depression is indeed a subset of an anxiety disorder or whether it is something completely different. We discussed this question from a scientific standpoint and from the observational standpoint of how different a depressed person looks from an anxious person. I noted that there are different types of depression and often times a depressed person is also suffering from an anxiety disorder.

Some useful links to explore the HPA axis and the basis of anxiety disorders and depression:

i. Self-fulfilling, e.g., ADHD
ADHD, or Attention Deficit Hyperactivity Disorder, causes extreme hyperactivity and inattentiveness, and can lead to severe problems for students and employees who must spend large amounts of time sitting still and paying attention. Medicines such as Ritalin and Adderall can greatly help school aged children and adults increase their work capabilities and potential. For those who do suffer from ADHD these medicines have enabled them to compete on an average level with their age group; however, average educational standards have been on the rise with each new generation and ADHD diagnoses similarly soaring. Is this due to a more accurate prognosis of the disease or more emphasis being put upon lengthy attention spans and better grades? Teachers are often among those to recommend children for ADHD testing and treatment, yet clearly teachers would benefit from a more focused and quiet classroom. Not to mention, that ADHD medication has become one of the most widely abused drugs, especially among college students. At what point should society draw the line… what does constitute a normal attention span? Children and adults alike are being forced to withstand longer and longer amounts of time behind a desk. Is ADHD medication our answer to this unnatural inactivity or should we take the more natural approach and realize that “kids will be kids”.
Here is a website for more information on the actual symptoms and treatment of ADHD: http://www.nimh.nih.gov/publicat/adhd.cfm#symptoms

Some useful links to explore the HPA axis and the basis of anxiety disorders and depression:

http://www.answers.com/topic/hypothalamic-pituitary-adrenal-axis

http://www.biopsychiatry.com/anxdep.htm

http://www.defeatdepression.org/pdf/cortisolstressdepression.pdf

http://joe.endocrinology-journals.org/cgi/content/short/160/1/1

http://www.dr-bob.org/babble/20000420/msgs/31619.html

i. Farah MJ, Illes J, Cook-Deegan R, Gardner H, Kandel E, King P, Parens E, Sahakian B, Wolpe PR. Neurocognitive enhancement: what can we do and what should we do? Nat Rev Neurosci. 2004 May;5(5):421-5.

ii. Dees RH. Slippery slopes, wonder drugs, and cosmetic neurology: the neuroethics of enhancement. Neurology. 2004 Sep 28;63(6):951-2

                         Drug addiction is different from physical dependence, although they often exist together. The development of tolerance to a drug (having to take more of it to get the original result) also does not necessarily indicated drug addiction. Further, the scientific definition of drug addiction is not influenced by the social acceptability of either the drug or addiction to it. Addiction occurs when behavior to use or obtain a drug overrides normal motivations.
    Two common theories are the Individual and Unitary approaches. The former states that there are different mechanisms for different drugs, while the latter advocates a broad mechanism that exists across all drug types.

(See http://www.mayoclinic.com/invoke.cfm?objectid=23246C2F-131D-4391-BB2A6B3E819A126F&dsection=3 for a review of different categories with an individual theory approach.)

    Discussion on the topic was broad. It included the question of how much responsibility one holds while on drugs (To what extent should people be guilty if they commit crimes while on drugs? To what extent is there scientific evidence supporting the fact that drug addiction might prohibit normal function, since we know there is a significant motivational change during addiction?)
    Most of the time, however, was spent discussing drug use and addiction on Vanderbilt’s campus. An article in the Vanderbilt Hustler focusing on cocaine use on campus (http://www.vanderbilthustler.com/vnews/display.v/ART/2004/04/13/407b6f33ea24e?in_archive=1) was published last year (2004), and alcohol and tobacco use is high on Vanderbilt’s campus (not to say that any other schools are without them).
    Most of the discussion focused on “kids will be kids” vs. “the law is the law” discussion. A student in the class reported that the ResEd policy on drug use is actually illegal: the police are not to be called, and the area director is to confiscate the drug (therefore being illegally in possession) and take it to be destroyed. Such protective policies contribute to irresponsible drug and alcohol use among Vanderbilt students, but many parents (and teachers, who occasionally offer students alcohol at off-campus gatherings) seem to disregard Vanderbilt’s policy of no underage drinking.

Helpful links:
http://www.mayoclinic.com/invoke.cfm?objectid=23246C2F-131D-4391-BB2A6B3E819A126F&dsection=1
http://wings.buffalo.edu/aru/ARUreport04.html
http://www.drugabuse.gov/PODAT/PODATindex.html
http://www.drugabuse.gov/Infofacts/HSYouthtrends.html

(1) Glimcher PW, Rustichini A. Neuroeconomics: the consilience of brain and decision. Science. 2004 Oct 15;306(5695):447-52.

(2) Zak PJ. Neuroeconomics. Philos Trans R Soc Lond B Biol Sci. 2004 Nov 29;359(1451):1737-48.

(1) Gary Lynch, Professor of Psychiatry at the University of California in Irvine, cofounder of Cortex Pharmaceuticals, Inc. (http://www.cortexpharm.com/)

(3) Erik Kandel, Columbia University & Nobel Laureate cofounder of Memory Pharmaceuticals Corp. (http://www.memorypharma.com/)

(1) Supporting its use

Farwell, Brain Fingerprinting Laboratories
"Brain Fingerprinting Laboratories, Inc. has developed and patented EEG/P300 based testing systems that determine with extremely high accuracy whether or not specific information is stored in a person’s memory. The test measures individual brain-wave responses to relevant words, pictures or sounds presented by a computer. The measurements are recorded in fractions of a second after the stimulus is presented, before the subject is able to formulate or control a response. In a major milestone for the company, the results of this patented testing methodology have been ruled admissible in court as scientific evidence. The technology has many exciting applications in several very large markets: national security, medical diagnostics, advertising, insurance fraud and in the criminal justice system."

Center for Cognitive Liberty
"The CCLE is opposed to compulsory Brain Fingerprinting because it threatens cognitive liberty and violates the sanctity of the mind. Compelled Brain Fingerprinting intrudes on the individual's right to mental privacy, it should not be mandated by courts, governments, corporations, or any other institution."