European Neuroscience and Society Network12-13 Nov, 2007, LSE, Regents College Conference Centre.
Launch event
Nik Rose
Aims
Funded by European Science Foundation
‘the new brain sciences’, since 1990s, psyiatric genomics, brain imaging (controversial implications), novel treatments (pharma and brain stimulation)
‘neurotechnologies’
social neuroscience and neuroethics as main areas of discussion
from criminalities to mother love (mother child relationship on brain)
neuroethics is a growing field
implications of some of these developments
neuroethicists have been wary of implications, but neither neuroscience nor neuroethics not been grounded in sound empirical knowledge about what is going on and what would happen if taken outside.
Much of neuroethics has been speculative – slippery slopes, end of free will, working out hypothetical
Aim of ENSN is to find space between social neuroscience and neuroethics – informed debate about realities of neurosciences
Many controversies
‘Today Programme’ this morning – on ADHD and evidence of efficacy of medication
Euro scientists not done much work on empirical aspects of this – mental health
Compare with social implications of new genetics, see how little on neuroscience
Difficult o understand if not scientists
ENSN - 5 year funding - 4 themes o Neuroscience and Society: setting an agenda for Europea (2007-8) o Public Health and the politics of the neurosciences (2009) o Neuroeconomies: markets, hcoice and neurotechnologies (2010) o Sources of the neurochemical self: identity, consciousness, personhood and difference (2011)
ACTIVITIES
Annual Workshops - next, Harvard in May 2008 Network conferences Short visit and exchange Grants Rsidential ‘neuroschools’ Publications and communication
AGENDA FOR ENSN CONTRIBUTION TO EUROPEAN DEBATE
Mapping the field Clarifying key questions for our future work How to create transdiscplinary debate Identifying central areas of agreement and dispute Exploring concepts fo analysis Developing methods
YEAR 1 AND 2
What are key challenges from brain science? For research/fnding Regulation governmenca Debate and elieration - mental health, public halth and social policy, criminal justice system, military, ethics, economies Considerable decision making under uncertainty
PRACTICAL MATTERS
REGULATION – WHERE FROM, WHERE NOW, WHERE NEXT? SIMON GREGOR, MHRA, DIRECTOR OF COMMUNICATIONS
Regulation of medical devices
Where from?
SSRIs – 2004 - timeliness o concern that was new info about medication that was not shared as timely as it could have been - openness o concerned that info had deliberately not been shared - willingness to listen o lack of. - clinical engagement o regulators detached from clinical practice
What people think about regulation is vital
‘If I were you, I would not start from here.’
What’s happened with SSRIs is part of a broader part of communication issues
Outline - what is regulation all about? - Social context - Current issues, current themes - Where next?
5 years past and forward
What is regulation all about?
What is the MHRA? - safety, quality and efficacy - but this is not effective way of communicating outside of medical sphere
safety? - lay terms perceived as absolute; perception that, once on market, then should be safe to use, but all medicine carries risks
quality
efficacy vs effectiveness not clear either
so, if this isn’t way to describe then what?
Revised language: - ‘acceptably safe’ - ‘no product is risk-free’ - ‘keep watch over medicines and devices’ - ‘aim to make as much info as possible publicly available’
taking a different starting point
What is the MHRA?
ALB – Arms Length Body’ Legally, actions of agency are actions of Secretary of State Funding different: - medicines: fees on pharma industry - devices: central government funding from treasury/taxation
‘a trading fund’ responsible for covering own costs
Stakeholders? Public – we take decisions on their behalf Industry – regulate them and assess products Government – delegated responsibilities Academia – conduct trials which we regulate Healthcare professionals – interface between us and patient
What about NICE - imp partner - MHRA decides if a product can be sold - NICE decides if NHS should buy it.
Facts and Figures 2006-7 - issued 80 medical device alerts - inspect over 1300 sites in uk and abroad - received over 800 reports of serious adverse events - employ about 800 staff - central inquiry line 45,000 per year
Social Context
Changing environment - development in research and technology - support innovation without compromising patient safety Changes in patterns of healthcare and society - greater public/patient empowerment and more self-care - appetite for more inf on treatments - openness and accountability Changing institutional and international framework - new partners in uk healthcare arena - increase EU and international cooperation
15 March 2006, Northwick Park Hospital - ‘drugs victim left like the elephant man’ power of headline by chance, market research we did on this happened 2 days after this event broke in news. Worried that this would skew research reslts. Worked with Mori to introduce indicators to account for impact of this story
Lunch
THE NEUROCHEMICAL SELF AND SOCIAL INEQAULITY: A NEW FACE OF NEUROETHICS Alex Mauron
‘Wha makes health a really imp social indicator is that psychosocial risk factors for disease reflect how we think, fel, experience and suffer our lives’ ‘Richard Wilkinson 2005. He impact of inequality: How tO make sick…
‘I shall argue that the brain is a crucial organ in generating the social gradient in health’ ‘Michael Marmot ‘ Status Syndrome’
how it reflects inequalities
There is a social gradient in health, which is largely caused by social inequality.
Universal Ineqaulity
The Whitehall studies
Longevity and several other measures of health are socially stratified One lives longer and healthier lives at the top of t social ladder
Not an ‘us vs them’
- not Marxist social class!!!
More Gradient like
Cuts across all societies
Marmot shows tha differential between social class remains, but those who are in lower class have been catching up
Drever and Whitehad 1997
‘Educational ineqaulites in life expectancy in the German speaking ar of Switzerland between 1990 and 1997: Swiss National Cohort[ - ed achievement good indicator of social stratification
The pecking order - disease and premature death more prevalent in lower part of social ladder - not matter of material circumanstances or acess to medical care - in fact, if healh outcomes in Whitehall are corrected for health behaviours (smoking etc), gradient gets shallower, but remains - relative social status is what counts (in affluent societies), not abslute standards of living - life entails series of more or less stressful transitions and lower you are on social ladder, the harder you are hit at each of thesw
not inevitable
hierarchies are inevitable, but how they translate into inequalities is the question
A steeper social gradient makes things worse for society as a whole
Once counry or region ot of povery, further increase inaverage income no longer good indicator
Wilkinson 2005 – ‘life expectancy in relation to living standards in rich and poor countries’ - in poor countries, small income increase buys a lot, but once passed, things more complex - looks like need to spend more and more money to get marginal benefit - no obvious logic between more affluent variaion in life expectancy
led to investigation of effects of inequality
Ross, Wolso, Dunn ‘Relation between income inequality and mortaliy in Canada and in the United Stats cross sectional assessment using census data and vital statistics’, BMJ
While US is highly unegalitarian, is variation
Trying to explain this variation
Wilkinson 2005: ‘the effects of income inequality (left-hand side) on social and psychologhical well-being 9right-and society) - highlights relative poverty, early childhood, social status (comparing ourselves with others), less trust
more inegalitarian societies tend to have worse health outcomes, due to multiplicity of factors (violence, less social capital, more chronic stress for more people)
Turning biology on its head: social causes, biological effects
I was formerly a molecular biologist
Other factors from Wilkinson include stress, deprerssion, etc
In discussing inequality and biology, must cope with social Darwinism and eugenics. And because of this, have been confined conceptually ie. 1. either biology is there to provide t ‘real’ explanation of social phenomena, or biology is largely irrelevant o social sciences – I think this is rong 2. Either inequality is largely biological and there is nothing one can do bout it or inequality is largely social and social reform is possible –
In either case, third alternative ‘tertium datur’
Is thre a pilot in the plane? - connect mental states with biology
Social Darwinist tradition assumes that bilogy more ‘basic’ than social, so more likely to be causal
But this is wrong
Causation has no a priori direction
Iological and psychosocial equally worth investigating
From social causes to biological effects
Different hypotheses about causation
1. Being in poor health leads to being at bottom of social hierarchies Variant: being poor leads to poor health Variant: poor lifestyles lead to poor health eg. Poorer people smoke more, etc
2. being at bottom leads to poor health and shorter lives
each true in some sense but main message is that, at populaion level, number 2 is more prevalent
suggestive evidence from primatology
Sapolsky: hierarchies in several species of monkies and apes have major effects on longevity
Low status baboons don’t smoke, eat hamburgers, or fail to keep appointments with their doctors; high-status baboons don’t read t health pages of t NYT or elong to fitness clubs’ (Marmot, 2004: 83)
Thus, ‘blame the victim’ mentality – eg. ‘doctor I’ve got brain cancer, what did I think wrong?’ – fails at first sight in non-human primates
Also, if look at biological pointers to hierarchy induced stratification
Stress: one of oldest and most successful links between physiology and behaviour
Hans Selye (1907-1982) - ‘general adaptation syndrome’ - ‘flight or flight’ - hypothalamic pituitary axis
Roger Guillemin (nobel prize 1977) - discovery of brain hormones
hippocampus - memory, stress response, depression, neuronal regeneration
psychology - stress and coping - loss of control ‘learned helplessness’ - social connectedness - self-esteem, social inclusion and exclusion
evolution - why was early human sociality =more egalitarian. Why did agriculture hange that? - How was evolution of cognitive capacity linked to sociality in human evolution? - How are we to understand t evolution of language in relation with sociality (language: a more efficient equivalent of grooming? Robert Dunbar 1996)
Synthesis of Stress - physiopathology - sociology anthropology, econmics - molecular endocrinology - epidemiology - neuroscience, cognitve psych, primate studies, evolutionary psych
biopoliical consequences - worrying about inequality ot of fashion in affluent west - worrying about health is central concern of modern mankind - inequality as public health concern will be heard, where inequality as a matter of social justice may not
but is this merely a tactical issue?
Healh embodies essential ethical values
Neuroscience of healh provide new language in ethics
New face of neuroethics 2 classical faces 1. ethics of neuroscience (ethics of neuroscientific expermentation and progress) 2. neuroscience of ethics
now a third 3. neuroscience of equity: exploring how social structures impinge on health and how this exploration inspires ethical and political reflection on how can redefine them to lead better lives for more people.
THEORIES OF PERSONHOOD: BRAIN, SELF AND BEHAVIOUR IN CHILDREN WITH ADHD Ilina Singh, BIOS LSE
Nurture-neuroethics: a contemporary intellectual and social ethos
Evaluating potential harms of psychtropic drugs against backdrop of assumptions about: - what child is or ought to be - childrens capacities and needs - good/right childrearing practices
often involves a lot of paternalistic practices
highly gendered
can contribute to reified scientific understandings of ‘the child’ - genetic, biological, evolutionary acconts of behaviour, risk, capacities, outcomes
focused on genes and criminality
children don’t have a public voice, since assumption about their needs
FDA now mandated pediatric 6 month extension for new drugs, but unlike mandate for genetic, neuroscience research from NIH does not have an ELSI arm
Bioethical concerns about use of psychotropic drugs with children - threat to personal autonomy and free will - undermine personal responsibility - undermine ‘right to self-creation’ - threaten t ‘character of childhood’ - undermine personal authenticity o sense of self’s uniqueness and desire to be true to this self (Charles Taylor)
a embedded ethics approach (evidence base) - what are children’s experiences of diagnosis and treatment? - are ethical concerns about potential harms t right concerns? - what are t consequences of new biomedical interventions as these are expressed ‘on the ground’? - contributions to: - evidence base for psychsocial and ethical side effects of biomedical intevetions - understanding dynamic associations between neurotech and self etc
Project involving children with ADHD - 2004 UK invu sudy with children taking medication for ADHD (20 boys, 3 girls) - 2007 UK study commissioned by NICE. Focus on boys and girls 9-15yrs. All taking stimulant medication for ADHD, 17 children) - 2006-2011: Wellcome Trust syudy up to 100 children in US and UK o so far, uk children taking med for adhd
poss that results don’t isolate effect of medication
what role does the brain play in behaviour?
Assumption that taking psychotropic drugs will effect how children think about themselves, eg. Authenticity. Is this actually true?
1. Theory of nerves (not the brain)
Some children think it has nothing to do with brain
ME: where does the child get the language for this? How are they explained what happens? What are these children explained about the drugs?
2. War Theory
They draw pictures of chemicals fighting in brain
Children don’t exclusively attribute inability to concentrate on chemicals. They use explanations strategically eg. Using it as an excuse. They also say parents and teachers do too
How important is your brain to who you are? (‘self’)
Story explaind to children where brain replaced by dwarf Not one child has said would accept different brain Reasons: - could be worse off - might not recognize friends and family - memories most salient loss - memories make the person
thus, memories, rather than behaviour define self more
Is taking medication like getting a new brain? (becoming a different person)
Children ambivalent on this. Times when clearly no, just helps behaviour.
But, same children will vary in answer and sometimes say yes: - ‘I hate that it changes me’ - ‘my friends like me better when I’m off the tablets’ - ‘I’m still me, I’m just not as much fun’
Relationship between behaviour to self?
Child shown a picture of a child that looks scruffy
Stable characteristics of the self
Behaviour is sign of core, evil ‘I’ (dimension of self) - more salient in boys - where does idea of core bad self come from? Does it pre-date ADHD diagnosis and medication? - How is belief related to self-esteem and self-perception? - ‘bad boy’ dimension has social status and value
sounds terrible to say ‘I am evil’ but I’m struck by relative lack of concern by this
instability of behaviour
consistent reports of core bad self consistent reports of instability of bad behaviour
majority of older children experiment with their medication eg. Decide whether to take meds or not. This is a way for them to sort out who they are.
Children’s experienced agency over their behaviours could over time unsettle notions of core ‘bad’ dimension of who they are.
But…core, stable dimensions of person are hot topic of research in developmental psychiatric genetics - focus on children with behav disorders, eg. ADHD, CD, ODD
childhood behav disorders, genetics and criminality - continuity - genetic risk strong association - imaging studies show similaries of brain with children with conduct disorder and adult psychopaths - genetic risk factors discovered as well (Viding et al, 2005, 2007)
genes, behaviour and persons - tes of genetic model: DNA database, genetic pellets, shared automated patient medical records systems, mental health screening - prediction of criminality at indiv level is poor - genes small effect
productive nurture-neuroethics - involve children as participants in research - also as agents
Q&A
Q: benefits and harms of psychiatric categories
Nik Rose: ‘interactive human kind’ – notion of self inextricable from self. In Alex’s argument, grounded in animal models, as if stress is a given. But illina’s saying could not be explored in an animal model. So, comments on limits of animal models.
Alex: epistemic of animal models different from what illina was saying. Sort of animal experimentation that comes to mind, brings up preformatted questions. Can there be an animal model for what this pill cures? In my case, thre isn’t prepackaged q about animal model. Interest for primate sties by social epidemiologists much more haphazard. Reason for why they became interested in primatologists, is because were phased by question of causality. Mounting confidence of comparisons, since correspond to physiological and mental functions, where enough affinity between apes and us to believe they are explaining something. Since you are a sociologist, I assume you raise a point about contingency.
Q: memory most salient part of self, rather than behavior, but final part of your presentation, concept of bad self, you presented it as a behavioural thing. But I thin that if memory is more salient, memory of bad self is also important.
Paul Martin, University of Nottingham: ethics – commonalities on issues of political, ethical of disease aetiology. Is there an underlying ethical concern that this meeting is about?
Illina: where are places where children will be made vulnerable and exploited? Trying to ask whether is happening around Ritalin. I’m not sure that it is. My intersection with Alex is in ‘poor children’. Largest proportion of Ritalin are children in foster care, many of which are from ethnic minorities. So, are broader questions related to social justice. A sociology of psychiatry.
Alex: my ethical agenda comes fmor paradox: discourse of economic efficiency that values inequality, sees ego challenge of keeping social status, buying status, all good for economy and other voices that inequality makes us sick.
Simon Williams, Warwick University: as a medical sociologist, broader debate about inequalities in health, psychosocial pathways, neo-material factors, critique of stress-related research, Marmot and Wilkinson criticised for looking at consequences rather than causes of inequality. One debate is neo-liberalism cause of inequality. Recognize that material factors do play a part.
Alex: v important ongoing debate. The left-wing critique to Marmot and Wilkinson. This works function is to provide more sophisticated diagnosis of what happens. Mapping onto history of medicine, this is best of 18th century medicine to make sense. Then a pathological science in 19th century. This is not a critque of work, but xpansion of work programme, upstream into social causes.
Andreas, Aarhus Uni….: inversion of causality. Push argumet, change in biological measurement is index? AleX: yes, you are reformulating my implicit message. Frustration of tradl public healh specialists who, maye 50yrs ago, attacked great public halth problems with missionary spirit and thought that preaching would solve problem. Only so much can do in encouraging people that ar managers of own health. Priest doctor has reached lmit
Q: Alex, programme of activism towards more equality. Relationship between research on neurotech and psychtherapeutic position.
Alex: wrong to imagine a political programme distilled in semi-automatic way in consideration of facts, but some conclsions are quite straightforward. Eg. Stress pathways play major role, they are held by early childhood. So, trying to mitigate against inequalities in childhood, seems a good place to start. Beyond that, more difficult to be precise. Prior step is to identify what makes being in a relatively lowly position in affluent societies, makes one miserable. This precedes policies.
Illina: I certainly have an agenda for clinical work with children who have behavioural disorders. Depends on which regime. In America, must be talking to child, but often child is not involved. In uk, more multimodel diagnosis for behav disorders. Also danger of that disappearing because of lack of understanding.
Break
THE GLOBAL NEUROTECHNOLOGY INDUSTRY 2007 Zack Lynch, Managing Director, Neuroinsights (San Francisco): Executive Director, Neurotechnology Industry Organization (
Neuroinsights – leading market research and advisory company
2 publications
neurotech industry report
“Neurotech Insights”
host annual conference. Investment and partnering conf
what is the neuro industry?
Neuropharma (cogniceutical, emoticeutical, sensoceuitical) Neurodevice (neuroprosthetic, neurostimulation, neurosurgical, XXX|) Neurodiagnostic
2007 - $120.4b, 10% growth
individuals afflicted – 2 billion (largest) sufer from brain related illness - highest is addiction, then anxiety, obesity, sleep disorders, alzheimers, epilepsy, etc etc
brain related more losses than any other category
world economic burden is $2trillion
in 2003, American Cancer society identified burden as $172billion, diabetes $132b
brain is $1billion
NIH neuorscience is similar to cancer, but burden is 6x higher
Human genome projec success has helped
Neuroscience Bioscience (genetic engineered animal models, stem cell) Info Science (Brain processing) Nanoscience
Impact on neurotech clear when looking at pattern trends
Neurotech Innovation Accelerating
From therapy to enhancement
Therapy, enablement, enhancement
Enablement implies lifting up from bottom, implies empowering
Nearly all neurotechs are not enhancements, but enablers
Goals of neuroenablement? - Cognitive (faster learning more rationale decision making, better memory retention, more focus, smarter) o ME: if this is not enhancement, what is? - Emotions (higher/lower arousal threshold, more/less control/) - Sensations
Athletics Cosmetic Surgery (150% increase in 5 years) Competitive Advantage
ME: they looked like enhancements to me.
Future of Business: Neurocompetitive advantage - mental health ultimate competitive resource - neurotechnology increases worker productivity o increase memory retention o decreasing anxiety and stress
cultural concerns over naturalness will influence ethical debate
reality is tht we live in a competitive world
if a few people use it, then will change for rest one of first industries to be affected will be financial model
currently based on assumption that people are rational actors
new ethical and legal challenges - national security vs indiv privacy
how will indivs who consciously shape their neurochem perceive… - each other - family relationships - political rhetoric - economic outlook, consumer confidence - cultural norms
as indivs tone down fear, this can affect which policies become implemented
postindustrial and postinformational neurosociety is imminent
THE BIRTH OF NEUROECONOMY Phillippe Pignarre, Uni of Paris
Not sure of meaning of neuroeconomy We should give meaning to this word Problem is manner of Foucault ‘the XXX function’ Particular commodities, professions, and
Beginning of chronicity
History of psychiatry
1880
bruno latour - should never give general reasons power to explain - proposes shift from socio of durkheim to Gabrielle XX
psychoanalysis suited to needs of community in transition
decline of psychoanalysis
psychpharmaceuticals
Ludwig
Deleuze and guattari – use ‘machine’ in same way – machine is always in interaction with other machines. Eg. Technical machine of factory, interacts with educational machine, marketing machine etc. (from deleuze)
So machine of pharma interacts with machine of industry?
Take proposition of machine seriously not just as metaphor
Produces ‘light biology’ – sum of tes concerneing living organisms. Eg. Dopamine.
Andre Lakoff – ‘The Pharmecutical Industry’ – Cambridge university
Deleuzian machine move away from neuroeceonomic determinism
Ian Hacking – metaphor of ecological niche – transient mental illnesses –
Can have much wider use
Q is what makes some possible and some impossible
Oblige us to find mechanism that explain how something works
Q&A
Answer: modafinil, bringing up to capacity of the highest performers
ME: so, this is raising to the highest range of normal functioning, but including the highest percentile, which is, quite often, a dysfunction.
Philippe: prozac – better than well – not similar to traditional anti-depressants, more like cocaine. 2 risks of proposition is 1) invent cocaine (which already exist) or 2) Lisenco? How to solve political problems with science (solve problem of countryside, agriculture, USSR in 1930s with technological dreams)
Q, Max Plank institute in Berlin: comment – epistemological –
Q: enhancement or enabling applications? Are they afraid of bad publicity, since public is not wlling to accept? Is public opinion likely to change? Or are they going to invent new disorders?
Zach: strong marketing behind this yes. Creating new markets. Slicing and dicing old definitins to sell new things.
Q: nanotechnology – many claims and hopes v similar to ones you’ve mentioned, but difference is that also discussing difference with therapy and enhancement. Didn’t mention enablement. Didn’t really talk about targeting brain specicficaly, but had idea that could target part of body without going through the brain. Is there any convergence from nano with neuro?
Zach: nanotech is fundamental driver of neurotech.
Nik: might be in sitn of ‘either, or’. Either huge burden of mental disease, social economic problem, investment is ethical imperative. Or, find new way of medicalizing marginal conditions, new marketing to generate investment, claims overblown, bubble will burst. If stuck in either or, then don’t advance argument easily. Philippe mentioned ‘Hacking’s notion of marketing for disorder. Just because a niche, doesn’t mean don’t suffer from it. Path dependent theory of truth – investment forcing things into existence. Plea to ask whether way beyond either or. Chart out empirically how things are happening.
Philippe: the drugs that don’t work is mos extraordinary possibility. I
Lindsay: Philip Merton – sociology of expectations – economy of performativity – hype has a market value – do you look at genetics market as cautionary tale – burst bubble of genetic biotech –
Zach: no. venture conferences, analyzing industry. Stock indexes, networking opportunities. If we are lucky enough to have a bubble in some years, tht’s good.