Questions to ponder: neuroethics, drugs, alternative medicine

Neuroethics

  1. To what extent do our brains determine our ethics? To what should they?
  2. “[I[t has been suggested that a large proportion of inmates on death row may have damaged or injured brains. If careful epidemiologic studies establish that this is the case, how should our views about moral and legal responsibility change, if at all, to accommodate this surprising fact?”
  3. Do we have a right to know when someone is lying?
  4. “If someone knows that he or she is at some risk for, for example, a psychotic episode, should he or she be held legally responsible for actions undertaken while delusional in virtue of not having prevented the episode?”
  5. Is there an ethical distinction to be made between “death” and “brain death”? Would you wish to have one without the other?
  6. “Traditional ethical theory has centered on philosophical notions such as free-will, self-control, personal identity, and intention. These notions can be investigated from the perspective of brain function.” Is this a useful perspective to take on these matters? Why?
  7. Imagine, if you will, that you work at a government weapons lab working on a mind-altering technology, such as a long-term neural prosthetic meant to enhance memory encoding. One day, your advisor asks you to begin looking into its converse, the selective elimination of previously encoded memories. What do you do?
  8. What does it mean to change one’s self?
  9. In some sciences there are facts and theories that yield accurate and worthwhile predictions. For example, knowing how diseases spread gives you both population-level anticipatory power and suggests remedies at the person-level. Some forms of ethics provide the same (e.g., the most good for the most people most of the time at least provides a bearing on the moral compass even if it doesn’t put a pin in the moral map). Does neuroethics – either as a field of science or as a field of ethics – provide comparable accurate and worthwhile predictions?
  10. Do we have free will?
  11. Is there a “ghost in the machine”?
  12. Have the shifts in our biological and ethical perspectives throughout history generally been to the benefit or the detriment of the human experiment? 
  13. Is “neuroethics” the right word for what we’re talking about here?
  14. Who are you? And does it matter?

 

Drugs

  1. How do drugs differ from other things?
  2. What does responsible drug use and administration require of the user and the administrator? Should such responsibilities be codified in a nation’s laws?
  3. After Congress mandated that the U.S. Food and Drug Administration (the “FDA”) “validate substantial evidence of safety and effectiveness for new drug products based on adequately controlled clinical trials,” Darrow et al states “the average development time for a new drug predictably rose from 2.5 to 8 years.” Assuming these are the two reasonable bounds, towards which of these time points would a healthier society’s drug approval rate skew?
  4. “Three categories of expanded access now exist” Darrow et al tells us. “The most common request is for individual use, a subset of which involves emergency circumstances leading to treatment even before a formal written request has been submitted to the FDA. The second situation relates to requests by intermediate-size patient populations (tens to hundreds) who are eligible to receive a drug early in its development. The final situation is widespread use under a treatment protocol, such as might occur after a successful trial of an experimental agent has been concluded but before it has received FDA approval.” Should these levels of expanded use be met with different ethical and regulatory standards? If so, how should they differ? If not, why should there be uniform standards?
  5. How much would it cost for you to take a random pill?
  6. Volkow et al. notes, “The regular use of marijuana during adolescence [can be] of particular concern, since use by this age group is associated with an increased likelihood of deleterious consequences”. Such consequences include those from short-term use (e.g., impaired short-term memory, impaired motor coordination, altered judgment, paranoia, and psychosis) and long-term use (addiction1, altered brain development, cognitive impairment, diminished life satisfaction and achievement). With the ever-burgeoning “legalize it” movement pushing for a loosening of federal restrictions on marijuana use, sale, and distribution, what restrictions should remain (particularly with respect to adolescent)? What should accompany them?
  7. Is it better to use more drugs or fewer?
  8. On the subject of using a substance like Adderall to do “better” on an assignment: “Whether the cognitive enhancement is substantially unfair” Greely et al contends, “may depend on its availability, and on the nature of its effects. Does it actually improve learning or does it just temporarily boost exam performance? In the latter case it would prevent a valid measure of the competency of the examinee and would therefore be unfair. But if it were to enhance long-term learning, we may be more willing to accept enhancement. After all, unlike athletic competitions, in many cases cognitive enhancements are not zero-sum games. Cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world.” Do you agree?
  9. What is it that drugs do to us that gets us so curious about them?
  10. “Popular weed killer may be to blame for honey bee deaths, study suggests” a headline from today that were but two words flipped would have made for an excellent discussion.

1. Marijuana addiction occurs in about 9% of users overall, 17% of those who begin use in adolescence, and 25 to 50% of those who are daily users according to Volkow et al.

 

Alternative medicine

  1. What makes medicine “alternative”?
  2. Is “alternative medicine” distinct from “complementary medicine”? Are either or both situated at odds with “traditional”/”Western” medicine?
  3. In their review of 18 trials involving alternative medicines, Bardia et al conclude that “[t]here is paucity of multi-institutional RCTs [randomized controlled trials] evaluating CAM [complementary and alternative medicine] interventions for cancer pain with adequate power, duration, and sham control. Hypnosis, imagery, support groups, acupuncture, and healing touch seem promising, particularly in the short term, but none can be recommended because of a paucity of rigorous trials. Future research should focus on methodologically strong RCTs to determine potential efficacy of these CAM interventions.” To what extent to do you agree with that conclusion given what you know about “alternative” medicines?
  4. I have an aunt who swears by acupuncture. She has had some of the worst pain you can ever imagine in her life, has gone everywhere, consulted every doctor, undergone every treatment, every therapy. She goes to an acupuncturist and the pain is gone and onlywhen she goes to said acupuncturist does this horrible pain get treated to her satisfaction. Should we recommend she keep going?
  5. On placebo. Is it dismissive to attribute a portion of the efficacy of alternative medicine to the placebo effect? Placebo treatments have often proven slightly effective in alleviating certain disorders––to what extent should medical professionals feel comfortable giving them to their patients?
  6. It is estimated that at least one-third of all adults in the United States have used complementary and alternative medicine. It is an industry generating tens to hundreds of billions of dollars in revenue, accounting for likely over one billion trips to “healthcare” providers. This is not the case in other countries. What are we to make of this?
  7. Do you think more or less CAM therapies should be given CPT codes?
  8. If someone told you snake oil really had a curative effective, who would that someone have to be for you to believe them? And why?
  9. Where does something like yoga fall on the Improving Health Spectrum? Do its effects extend beyond those associated with any other form of exercise?
  10. If I gave you a bottle of homeopathic medicine, how many would you feel comfortable taking?
  11. Is there something approaching what we might call the “mind-body-soul” being that medicine should ultimately be treating? We already incorporate quality of life as a factor into most medical decisions, would it really be any different to perhaps take a more “holistic” approach to medical treatment/therapy/devices?
  12. How important is it that we/someone police the boundaries between “medicine” and “not-medicine”? “Science” and “non-science”? Sense and nonsense?