Deep Brain Stimulation Studies

Description

In this fictional case, a young neuroscientist decides whether to take a post-doctoral fellowship in a lab where her assignment would be explore whether deep brain stimulation can be used to modulate soldiers' emotions to make them more effective in high-stress environments.

Body

Shakima Gregory was recently awarded a post-doctoral fellowship to work in one of the most prestigious neuroscience labs in the country after finishing a doctoral thesis on the use of deep brain stimulation (DBS) techniques to treat patients with Parkinson's disease.

Deep brain stimulation is an invasive neurosurgical intervention that involves the implantation of an electrode in the brain. The electrode is connected and stimulated by a device called an implanted pulse generator (IPG), which is inserted in the patient's chest (Bell et al. 2009). DBS was approved by the FDA in 1997 and is now an established therapy for many neurodegenerative disorders. It can be turned off in cases where the patient experiences adverse effects or no effects, and the effects are thought to be reversible. DBS has recently been extended to treat psychiatric disorders, such as major depression and obsessive-compulsive disorder, as well as obesity (Dunn et al. 2011, Halpern et al. 2008).

During her doctoral studies, Shakima became aware of some of the risks and concerns about DBS therapy. As a neurosurgical procedure, DBS carries risks of haemorrhage, infection, and even death (Schermer 2011). It can also have other deleterious side effects, such as cognitive impairment, memory impairment, aggression, and depression (Schermer 2011). However, Shakima was proud to work on research that could contribute to the betterment of the quality of lives of individuals who suffered from Parkinson's disease.

Shakima now has the opportunity to be a post-doc in a lab that uses DBS in an entire new context. The Defense Advanced Research Projects Agency (DARPA) is funding the principal investigator, Dr. Daniels, to examine whether DBS can be used to treat posttraumatic stress disorder in veterans. Dr. Daniels has offered Shakima a position where she would lead a new, related research project in the lab. Her task will be to investigate whether DBS can be used on soldiers to modulate emotions, such as reducing or blocking the sensation of fear, in order to make them more effective in high-stress environments. [1]

Shakima has some hesitation about her research assignment. After discussing her research assignment with a more experienced colleague, Shakima realizes that there are many social and ethical concerns about the use of DBS technology: What if the research is successful and soldiers are forced or coerced into undergoing this kind of invasive neurosurgery? What if DBS interventions develop to the point of creating super soldiers that kill indiscriminately? What if the technology interferes with a soldier's sense of morality? [2] As a pacifist, Shakima is deeply troubled by these possibilities and wonders whether she, as a research scientist, has a social and moral responsibility to raise and/or address these issues.

Discussion Questions:

  • Should Shakima take this post-doctoral fellowship?
  • What are the social and ethical responsibilities of engineers and scientists in conducting defense-related work?
  • Some would argue that defense work often results in "spin-offs" for the civilian economy. Should this factor into Shakima's decision on accepting the offer? [3]

Bibliography

Bell, Emily, Ghislaine Mathieu, and Eric Racine. "Preparing the ethical future of deep brain stimulation." Surgical neurology 72, no. 6 (2009): 577-586. doi: 10.1016/j.surneu.2009.03.029

Dunn, Laura B., Paul E. Holtzheimer, Jinger G. Hoop, Helen S. Mayberg, Laura Weiss Roberts, and Paul S. Appelbaum. "Ethical issues in deep brain stimulation research for treatment-resistant depression: Focus on risk and consent." AJOB Neuroscience 2, no. 1 (2011): 29-36. doi: 10.1080/21507740.2010.533638

Fins, Joseph J., and Nicholas D. Schiff. "Conflicts of interest in deep brain stimulation research and the ethics of transparency." Journal of Clinical Ethics 21, no. 2 (2010): 125-132.

Halpern, Casey H., John A. Wolf, Tracy L. Bale, Albert J. Stunkard, Shabbar F. Danish, Murray Grossman, Jurg L. Jaggi, M. Sean Grady, and Gordon H. Baltuch. "Deep brain stimulation in the treatment of obesity." Journal of Neurosurgery 109, no. 4 (2008): 625-634.

Liao, Matthew. "Can deep-brain stimulation fortify soldiers' minds?" Scientific American. September 4, 2014. Accessed December 9, 2015. http://blogs.scientificamerican.com/mind-guest-blog/could-deep-brain-stimulation-fortify-soldiers-minds/

Rabins, Peter, Brian S. Appleby, Jason Brandt, Mahlon R. DeLong, Laura B. Dunn, Loes Gabriëls, Benjamin D. Greenberg et al. "Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought." Archives of General Psychiatry 66, no. 9 (2009): 931-937. doi: http://dx.doi.org/10.1001%2Farchgenpsychiatry.2009.113

Schermer, Maartje. "Ethical Issues in Deep Brain Stimulation." Frontiers in Integrative Neuroscience 5 (2011): 1-5. doi: http://dx.doi.org/10.3389%2Ffnint.2011.00017

Tennison, Michael N., and Jonathan D. Moreno. "Neuroscience, ethics, and national security: the state of the art." PLoS Biol 10, no. 3 (2012): e1001289. doi: 10.1371/journal.pbio.1001289

Tracey, Irene, and Rod Flower. "The warrior in the machine: neuroscience goes to war." Nature Reviews: Neuroscience 15 (2014): 825-834. doi: 10.1038/nrn3835

Unterrainer, Marcus, and Fuat S. Oduncu. "The ethics of deep brain stimulation (DBS)." Medicine, Health Care and Philosophy 18 (2015): 1-11. doi: 10.1007/s11019-015-9622-0

Widdows, Kayleigh C., and Nick J. Davis. "Ethical considerations in using brain stimulation to treat eating disorders." Frontiers in Behavioral Neuroscience 8 (2014): 1-4. doi: 10.3389/fnbeh.2014.00351

  • [1]This hypothetical scenario is based off Liao (2014).
  • [2]These concerns are also raised by Liao (2014).
  • [3]Thanks to Joe Herkert for these discussion questions.
Notes

The author wishes to acknowledge the contributions of Karin Ellison, OEC - Life and Environmental Sciences Editor, and Joseph Herkert, OEC Engineering co-Editor. They provided valuable input in selecting topics and crafting the resources.

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