I forgot (a note on memory and humanity)

I know that you may not be able to tell, but I'm trying to make my blog posts shorter. So, I left some quotes out of this morning's post on memory. However, this quote from the Time Magazine article, "The Ethics of Erasing a Bad Memory" by Dr. Scott Haig, on human-ness needs to be repeated:

Much of what we read about brain science in the media today would have us believe that we're nothing more, really, than very fancy machines. And surely what we're learning about the physical brain is exciting and powerful — but thinking honestly, it remains so limited. We can trace the brain pathway of a drug "high," we can call it pleasure, but that tells us nothing about what so many people choose instead — deeper things that somehow beat out mere pleasure as the reasons for doing what we do. Those comforts — of ultimate meaning, virtue, peace and joy — have little to do with molecules.

Drugs, Sleep, Memory and Ethics

New information on the science of memory may one day finally tell me why I have a hard time remembering names and even faces, but I'll store a patient's potassium level without even trying. As with all science research, we'll have to decide whether and why the information we discover matters and how to use it.

Last night's post was on the bioethics questions in a television show dealing with a patient who asked for help forgetting a trauma - actually, the emotional memories, not the facts. A wide range of articles on memory research is the subject of yesterday's post at Bioethics.net. There are posts to articles and blog entries on old and new information on drugs that affect memory, and disorders of memory.

That post contains a link to this New York Times article (free registration required) on the significance of sleep and memories. (I love the title, "An Active, Purposeful Machine That Comes Out at Night to Play.") The same session at the American Society of Bioethics and Humanities conference that dealt with blunting the emotional memory of trauma also touched on the ethics of new medications that enable people to sleep less. The question asked was whether avoiding the need for sleep would allow time for more worthy pursuits - the question and answer period focused on what to consider a "worthy" activity. According to the NYT article, the question should be what is lost.

As is too often the case, science gives us some of the answers to our questions (those "power naps" are probably good for dealing with facts and later sleep appears to be useful for detecting patterns) and technology or means (propranolol, propofol, Provigil, etc.) to manipulate ourselves and our behavior, before we come to a consensus on the ethics - or even the ethical principles that apply - of using our knowledge.

The old saying "let's sleep on it" may have some measurable truth - and a lot of wisdom, after all.

Television Ethics: "Private Practice"

The TV show, "Private Practice," hasn't impressed me with its medical, social or psychiatric integrity. But, I found myself watching it tonight, October 24th, and was more impressed than usual. Tonight's show touches on a cutting-edge bioethics topic that was also mentioned at last week's American Society of Bioethics and Humanities.

Major Multiple Spoiler Alert!!! Don't read more if you've recorded the show to watch later.


(Let's forget the thread on the women who come in for their pelvic exam by the kid midwife - where the only exam the women are evidently getting is the actual *pelvic* exam. No eyes, ears, throat, lungs, breast or abdominal exam. My Family Physician, head-to-toe, cradle-to-grave soul can't bear it.)

(And we won't even ask the Mama in me how I feel about 13 year olds having sex. You might be surprised that I don't freak or judge, though, and pretty much treat the girls the same way that the lead doc does. The difference is that I go out of my way to explain to families when they first come to the office that I consider their child my patient in his or her own right and ask permission to treat without notifying - and, of course, without billing - them if the teen requests that I keep silent. I've always been able to convince the young person to turn to their parents for help, but manage to keep privileged information privileged as long as possible. As far as I know, I've only had one family leave my practice after I explained my policy.)

Okay, back to the cutting edge bioethics topic.

One of the guest characters asked the internal medicine doc for a medicine that helps patients forget.

Actually, the medicine, propanolol, will not help her forget. However, it can help some patients stop feeling the panic and other horrifying emotions that come after a near-death or traumatic event like a rape that causes "Post Traumatic Stress Disorder."

MSNBC had a review, here, about the treatment last year.


The technique can be used to blunt the emotional memory -- not the actual memory or physical damage -- of the traumatic event. Adrenaline or epinephrine is the "fight or flight" hormone or drug that is released when there is stress. It's what causes what I call "the near-car-wreck" feeling that we feel, well, when we nearly have a car wreck.

Epinephrine gives you a boost of energy, pumping sugar, cortisone and other hormones into the body, to allow that fight or flight response. Do you need to take off and escape or stand and battle with whatever it is that is threatening you? Epinephrine is also involved in stimulating the bone marrow to make blood and other organs to heal faster, too.

Unfortunately, sometimes the body makes epinephrine inappropriately, when there's no real danger or when the danger is not severe enough. When that happens, we call it a panic attack or an anxiety attack as people experience the physical and emotional symptoms that are associated with real danger. Their bodies are telling them that they are in danger, but there's no actual threat to confront. When it gets in the way of your life, it's a disorder. Long term panic and anxiety that can be related to a past trauma, and that sometimes causing a person to feel as though he's reliving the trauma, is called Post Traumatic Stress Disorder.

Propanolol is a "beta blocker" that blocks epinephrine and which we often use to treat hypertension and even panic attacks. If used during the time after a traumatic event in which the long-term memories are set in the brain and/or in conjunction with behavioral therapy, it appears that the memory is disconnected, "disassociated," from the emotions that the patient experienced during the trauma and during the flashbacks when the memory makes the patient feel as though he's reliving the event, later. The treatment of PTSD that seems to work best is behavioral therapy, teaching the patient to control his own body's reaction.

Some ethicists are concerned that we may blunt a necessary healing function of epinephrine and the other body and mind effects of the stress reaction. However, I think of the treatment of stress disorders in the same way that I think of treatment of pain. Pain may help us prevent injury and warn us of a threat to our health. But we treat pain that is out of proportion or that is not useful to protect us.

Liberal/conservative neuro-experiments?

Nature Neuroscience has reported on an experiment that is being touted as proving that "liberals" are smarter than "conservatives." Or, as the LATimes' Denise Gallene states, "that liberals tolerate ambiguity and conflict better than conservatives because of how their brains work."

I wonder whether these findings mean that all those visual field tests we've been doing could be affected? Which group would be more likely to have a skewed "blind spot"? For that matter, did the researchers have one of their own?

From a review in the LA Times:

Participants were college students whose politics ranged from "very liberal" to "very conservative." They were instructed to tap a keyboard when an M appeared on a computer monitor and to refrain from tapping when they saw a W.

M appeared four times more frequently than W, conditioning participants to press a key in knee-jerk fashion whenever they saw a letter.

Each participant was wired to an electroencephalograph that recorded activity in the anterior cingulate cortex, the part of the brain that detects conflicts between a habitual tendency (pressing a key) and a more appropriate response (not pressing the key). Liberals had more brain activity and made fewer mistakes than conservatives when they saw a W, researchers said. Liberals and conservatives were equally accurate in recognizing M.

Researchers got the same results when they repeated the experiment in reverse, asking another set of participants to tap when a W appeared.

Frank J. Sulloway, a researcher at UC Berkeley's Institute of Personality and Social Research who was not connected to the study, said the results "provided an elegant demonstration that individual differences on a conservative-liberal dimension are strongly related to brain activity."

Analyzing the data, Sulloway said liberals were 4.9 times as likely as conservatives to show activity in the brain circuits that deal with conflicts, and 2.2 times as likely to score in the top half of the distribution for accuracy.

Sulloway said the results could explain why President Bush demonstrated a single-minded commitment to the Iraq war and why some people perceived Sen. John F. Kerry, the liberal Massachusetts Democrat who opposed Bush in the 2004 presidential race, as a "flip-flopper" for changing his mind about the conflict.

Based on the results, he said, liberals could be expected to more readily accept new social, scientific or religious ideas.

The article is "currently unavailable online," but the website instructs us to contact subscriptions at subscriptions@nature.com. Hopefully this is some sort of elaborate practical joke. The potential weaknesses at the least include drawing conclusions from hand to eye coordination to poorly defined political affiliations among the self-described college students. I wonder about the "n" of the college students who call themselves "conservative." How many could there be? Would libertarians call themselves liberal or conservative?


In the meantime, here's the abstract:

Neurocognitive correlates of liberalism and conservatism

David M Amodio (1), John T Jost (1), Sarah L Master (2) & Cindy M Yee (2)
1.Department of Psychology, New York University, 6 Washington Place, New York, New York 10003, USA. 2. Department of Psychology, 1285 Franz Hall, University of California, Los Angeles, Los Angeles, California 90095, USA.

Political scientists and psychologists have noted that, on average, conservatives show more structured and persistent cognitive styles, whereas liberals are more responsive to informational complexity, ambiguity and novelty. We tested the hypothesis that these profiles relate to differences in general neurocognitive functioning using event-related potentials, and found that greater liberalism was associated with stronger conflict-related anterior cingulate activity, suggesting greater neurocognitive sensitivity to cues for altering a habitual response pattern.

Hat Tip to BioEdge, an email newsletter.

Nanofiber Scaffolds for Neural Stem Cells (and some truth)

Johns Hopkins researchers report that they have developed "nanofibers" impregnated with special proteins which allow them to grow neural stem cells from embryonic stem cells without "requiring high concentrations of growth factors."

One of the researchers, Neuroscientist Hongjun Song, comments on the immediate results of the research, which will not include actual patient therapy:

“Eventually, stem cells will be very important for treating disease using cell replacement therapy, but more immediately stem cells offer the opportunity to model human disease and find ways to screen for therapeutic drugs to treat the disease.”

Song is a member of the body which oversees stem cell research at Johns Hopkins, the "Stem Cell Policy and Ethics Program." This means that even though he has a vested interest in maintaining his own lab and promoting his research, he is among those at Johns Hopkins who determine how to follow the institution's mission:

• Facilitate the ability of the public to benefit from advances in cell engineering in morally responsible ways;
  
  
• Anticipate moral and policy challenges in stem cell science and cell engineering; and


• Provide opportunity for careful and interdisciplinary analysis of these challenges that will be of assistance to both policymakers and the public.

The inclusion of Song in justifying and lobbying for his own work under the guise of "ethics" is a serious conflict of interest and can not be called "morally responsible."

The good news is that some people see an end to the use of embryo destruction. From the article posted earlier today on trading eggs for in vitro fertilization fees:

In any case, the need for eggs may only be temporary.

They are, in fact, only a tool to reprogram the inserted DNA so that it will drive the development of an early embryo. Scientists hope to learn enough about that reprogramming process to let them take an ordinary cell from a person and use it to produce other kinds of cells, perhaps without going through an embryo stage. That might happen in 10 years, Murdoch estimated.

And then they wouldn't need eggs any more.

Brain wave biometric key

New Scientist Tech reports on news of a possible personal identification device in the works:

This novel biometric system should be difficult to forge, making it suitable for high-security applications, claim the researchers behind it. The system was developed by Dimitrios Tzovaras and colleagues at the Centre for Research and Technology Hellas, in Greece. It uses an established method for measuring activity in the brain, called electroencephalography (EEG).

EEG measurements identify the location and intensity of millisecond-long fluctuations in electrical activity in the brain via electrodes positioned around a person's scalp.

First tests are planned in Germany this year. Polish scientists working on the technology in another lab have found the identification to be 88% accurate.

However, John Daugman, a biometrics researcher at the University of Cambridge, UK, questions the practicality of the approach. He says an EEG cap could prove too cumbersome and invasive. "Wearing a wired helmet with sensors on one's scalp might change the ambiance of the workplace somewhat," he says.

Similarly, neuroimaging expert Olaf Hauk, also at the University of Cambridge, believes using the system in a wide variety of situations, particularly stressful ones, could complicate the results significantly. "EEG varies greatly depending on a person's alertness, or mental operations," Hauk told New Scientist. "You might not want to be taken for someone else at the airport just because you had a bad night before."

The authors of spy thrillers and milliners should be especially interested. Here's one hat designer who must be prescient with the motto, "The hat on your head is remarkably representative of what's going on inside your head.™"

HT to Kristina Kirby at Emerging Technology