Posts filed under 'Science'

Journal of Research Practice looking for papers

The Journal of Research Practice is a relatively new transdisciplinary journal seeking to bring together researchers from diverse fields to explore issues of research practice. JRP is open access, with a truly diverse and international editorial group. [Note: I have been on the Editorial Advisory Board since its first issue.] JRP is actively seeking high quality submissions.

All submissions should be written for a wide audience and should explore new ideas or experiences regarding the practice of research. As a reviewer, I’ve noticed that a major reason papers are rejected is because they are written to assume intimate knowledge of a particular research domain and are not obviously relevant to researchers from other disciplines.

A Call of Submissions can be downloaded here. Please download and post it. And do seriously consider submitting papers.

Add comment May 7th, 2008

Secret clinical trials research puts patients at risk for no benefit

[UPDATED with link to article] An article in the Canadian Press raises serious new questions about the dangers posed to research participants by our corporate-dominated drug development system. Patients were enrolled in clinical trials of a type of blood replacement product despite previous research indicating that these products posed serious risks. The Canadian Press reports that new article in the Journal of the American Medical Association [Available here. Also see accompanying editorial.] pooled data from 13 published studies and three unpublished ones. Their review “showed people who got blood substitutes were 30 per cent more likely to die than those who did not.” These researchers were unable to obtain data from other unpublished studies conducted by companies.

There appear to be several major ethics issue here.

Participants in these studies, who supposedly give informed consent, were not told that prior research suggested these products were harmful. Nor, apparently, were the ethics committees [IRBs] that approved these studies and the informed consent procedures told about the dangers.

The results of several clinical trials were never published, presumably because they produced results indicating the products were harmful. Thus, important information was withheld from the public, putting patients recruited for additional clinical trials at risk.

Lead author Dean Fergusson, a clinical trials expert, said the withholding of the negative results meant ethics boards and trial participants could not accurately weigh the risks and benefits of the research.

“How can patients or their decision makers make truly involved consent without all this information? I think that’s a huge message,” said Fergusson….

The lack of disclosure suggests company stock prices were placed at a higher priority than the safety of people being asked to go into clinical trials, experts suggest.

An additional concern is whether ir is ethical to recruit people for clinical trials, placing the participants at potential risk — which is always the case in drug trials — and then not publish the results. A critical consideration in obtaining approval for research from IRBs is supposed to be a balancing of risks and benefits. Often, the benefits are not to individuals, but to society. If the results are not published, these benefits are not realized. So people are put at risk for no benefit, which is supposedly unethical. It would seem that a commitment to publish the results should be required of any study where there is a serious risk to participants. Otherwise these studies should not be allowed. Note that this argument is different than the argument, with which I also agree, that these studies should be published for the good of the public and that corporate profit should not be allowed to trump public good.

Finally, there is a question of whether these trials should have been undertaken in the first place, given the bad track record of this type of blood replacement products in prior research. The JAMA authors apparently believe the answer is “no”:

The authors were critical of the FDA for not requiring the companies to publish their findings, and for allowing additional trials to be conducted after the risk should have been apparent.

“At some point, somebody should have realized that we’ve tried it in trauma patients, we’ve tried it in surgical patients, we’ve tried it in stroke patients, we’ve tried many different formulations and we keep finding the same result,” said Dr. Charles Natanson, lead author of the meta-analysis, a technique in which data from a number of trials are combined and re-analyzed.

“At some point, and we sort of argue in the paper that may have been the year 2000 . . . it was time to put a halt” to additional trials, Natanson said.

This information raises profound questions about our entire drug development system. The corporate dominance of drug development creates inherent conflicts of interest that put both clinical study participants and the public at risk. Either we need to find ways of overcoming those conflicts of interest or we need to develop a new system for drug development. How many scandals will it take till the health professions, policy-makers, and the public are fed up?

Add comment April 30th, 2008

NPR finds anthropogenic climate change denier “cute”

On Friday, as I drove into work, I heard a ridiculous NPR piece on 15 year old Kristen Byrnes, who has a web site claiming to disprove anthopogenic global warming. While Byrnes seems like an energetic, feisty girl who one roots for in he long run, the piece presented no evidence that she actually knew anything about science or that her views should be taken seriously. When someone makes claims that thousands of scientists, as well as Al Gore are full of crap, surely the media has an obligation to make some effort to evaluate heir arguments before giving them five minutes of exposure to millions of listeners. But NPR increasingly view substance as anathema to the entertainment function of its “news” shows.

In addition to the NPR listeners, Byrnes herself should be upset at being so condescended to by NPR. The fact that a 15 y.o. girl pontificates on climate science is “cute”  was the message. I once was a prodigy (in math) and am aware of how irritating the condescension by the media and other adults can be. I hated it when adults would ask about my work, only to ignore what I said and smile at how “cute” it was that a 14 year old thought he had something interesting to say.

Deltoid links to a number of sites providing commentary on the piece and critique of Byrnes’ claims.

1 comment April 20th, 2008

Pope: Know then thyself

One of the joys of reading Scott Horton’s No Comment blog at Harpers is the exposure to pieces of great literature and wisdom that one might have missed. Today, among other gems, he Alexander Pope’s famous poem Know Then Thyself, the source of that famous phrase The proper study of mankind is Man. So, thanks to Scott, here it is:

Know then thyself

by Alexander Pope

Know then thyself, presume not God to scan,
The proper study of mankind is Man.
Placed on this isthmus of a middle state,
A being darkly wise and rudely great:
With too much knowledge for the Sceptic side,
With too much weakness for the Stoic’s pride,
He hangs between, in doubt to act or rest;
In doubt to deem himself a God or Beast;
In doubt his mind or body to prefer;
Born but to die, and reas’ning but to err;
Alike in ignorance, his reason such,
Whether he thinks too little or too much;
Chaos of thought and passion, all confused;
Still by himself abused or disabused;
Created half to rise, and half to fall:
Great lord of all things, yet a prey to all;
Sole judge of truth, in endless error hurl’d;
The glory, jest, and riddle of the world!

Go, wondrous creature! mount where Science guides;
Go measure earth, weigh air, and state the tides;
Instruct the planets in what orbs to run,
Correct old Time, and regulate the sun;
Go, soar with Plato to th’empyreal sphere,
To the first good, first perfect, and first fair;
Or tread the mazy round his followers trod,
And quitting sense call imitating God;
As eastern priests in giddy circles run,
And turn their heads to imitate the sun.
Go, teach Eternal Wisdom how to rule–
Then drop into thyself, and be a fool!

Superior beings, when of late they saw
A mortal man unfold all Nature’s law,
Admired such wisdom in a earthly shape,
And show’d a NEWTON as we show an ape.
Could he, whose rules the rapid comet bind,
Describe or fix one movement of his mind?
Who saw its fires here rise, and there descend,
Explain his own beginning or his end?
Alas! what wonder! Man’s superior part
Uncheck’d may rise, and climb from art to art;
But when his own great work is but begun,
What Reason weaves, by Passion is undone.

Alexander Pope, Know Then Thyself from An Essay on Man: Epistle II (1711)

Add comment March 29th, 2008

High-tech interrogations may promote abuse

Among certain circles, including the American Psychological Association, we need more research on effective interrogation strategies. Many of us have been suspicious that these calls may cover the design of technologies that will create high-tech tools aiding abusive interrogations. In 2003, the APA sponsored, with the CIA and Rand Corp., a Science of Deception Workshop. CIA contractor torturers James Michell and Bruce Jessen were at this invitation-only conference, which discussed such topics as use of truth serums and the role of sensory overload in interrogations.

According to a press release from the Penn State University, bioethicist Jonathan Marks raises the specter of fMRI technology being used in ways that increase the likelihood of abuse. after all, if a high-tech tool suggests that someone is a “terrorist,” the potential for subjecting them to “harsh techniques” to get information from them is increased.

High-tech interrogations may promote abuse

There is evidence that brain imaging technology is being used to interrogate suspected terrorists despite concerns that it may not be reliable, and that it might inadvertently promote abuse of detainees, according to a Penn State researcher. He says the risk that such technology could license further abuse of detainees remains ever present, given President Bush’s March 8 veto of legislation that would have prohibited the CIA from conducting aggressive interrogations.

The technology - functional magnetic resonance imaging or fMRI - has been around since the 1990s. Neurosurgeons routinely use it to scan for brain tumors, and to diagnose and treat various disorders of the central nervous system.

But in recent times, fMRI has gained support from many in the intelligence community, who feel it could be a reliable tool in identifying terrorists from a group of suspects or detecting lies during an interrogation.

After the 9/11 terrorist attacks, military psychologists attached to intelligence units advised interrogators how to increase interrogation stressors and exploit detainees’ fears to make suspects talk, according to Jonathan Marks, associate professor of bioethics, humanities and law at Penn State.

“The problem is, if you apply pressure, people will say anything they think will make you stop. And that means anything they think you want to hear,” he said.

There are also reports that psychotropic drugs - so-called truth serums - have been administered. The use of brain imaging technologies appears to offer an alternative to such approaches.

The adoption of fMRI is not surprising given the limitations of other lie detection techniques such as a polygraph test, said Marks, whose analysis is published in a recent issue of the American Journal of Law and Medicine.

A polygraph relies on detecting accentuated signs of anxiety such as changes in skin conductance, heart rate, and respiration. But it is useless against sociopaths, and those trained to beat it. Counterintelligence experts also say the device is especially unreliable when questions and answers are translated with the help of an interpreter, as has been the case in Iraq.

Intelligence personnel believe fMRI could circumvent such limitations, and some commentators have argued that fMRI could render torture and interrogation obsolete. But Marks, who has critiqued the use of aggressive interrogation techniques in the war on terror, makes a case that “such claims are unfounded, and that the uncritical acceptance of fMRI as an interrogation tool could be potentially hazardous both to the health of the detainee and to the counterterrorism mission.”

Unlike a polygraph, an fMRI uses powerful magnetic fields to detect tiny changes in blood oxygen levels in the brain. Since active neurons take up more oxygen than inactive ones, these tiny changes are believed to be signatures of cognitive processes.

Some intelligence experts believe that fMRI can be used to detect deception, or to flag when a suspect recognizes (but may not wish to admit that he recognizes) the photograph or name of a suspected terrorist.

Marks, who also heads the Bioethics and Medical Humanities Program at Penn State’s University Park campus, finds the approach problematic. “There can be all sorts of reasons for recognizing a name or a photograph or for responding cognitively to a particular word,” he said. “I spent years living in London, listening to reports of IRA bombings. My brain would light up if you mentioned the word semtex (a plastic explosive).”

Interrogations that employ fMRI may also be making a considerable leap of faith. According to Marks, fMRI-based studies of lie detection have only been conducted on small groups of healthy people to examine changes in blood oxygen levels in the brain when they are lying in highly artificial laboratory settings. These results cannot be generalized, he argued, and should not be applied to terror suspects who have usually been detained in stressful circumstances and may have mental health issues that could clearly be exacerbated by their detention.

“MRI machines are very useful diagnostic tools but using them to claim that certain things are going on inside people’s minds is a major jump,” said Marks, who is also a research fellow and acting director of Penn State’s Rock Ethics Institute. Such a jump is a particularly dangerous one in the interrogation context, he argues.

The short duration of the test is another worry. According to the Penn State researcher, many neuroscientists argue that it could take many hours, even weeks, of testing with the suspect before getting accurate baseline readings.

Marks also argues that fMRI scans are open to broad interpretation, but they can produce seductively persuasive graphic images that provide a false sense of security and help create a narrative that may lead to aggressive interrogation tactics.

“One of the real concerns I have is that you can see how people can begin to say ‘the fMRI picked him out as a terrorist so let us give him a going over in the interrogation room,’ ” Marks explained. “Contrary to the view that fMRI will render torture obsolete, it might become a license for further abuse of detainees because its readings will convince people that they have a terrorist on their hands.”

The Penn State bioethicist says his view, which draws on the previously unpublished statements of an experienced U.S. interrogator, raises fundamental concerns about the use of fMRI either to detect deception or to flag recognition of a stimulus. If a terror suspect does recognize a certain stimulus, that person could be singled out for more aggressive interrogation.

1 comment March 19th, 2008

Olson: From Mirror Neurons to Moral Neuropolitics

Political scientist Gary Olson has been writing on the biological basis of empathy and the potential of this biology creating a foundation for a more communal, noncapitalist society. He has sent me his latest work, which draws upon recent research on mirror neurons, neurons that model perceptions of others and which may provide as basis for empathy.

I find this very interesting. However, I caution that research on mirror neurons is very new and there is still considerable controversy as to how far beyond simple perception of the other’s motion, into affective life, these types of neurons extend.

Another issue that I would give a greater prominence to is the human potential for destructiveness. Progressive visions need, somehow, to come to terms with the potential within each of us to hurt and to destroy. We may have a built-in potential for empathy, but we have many other, darker potentialities as well.

I’m sure readers will have their own thoughts as they engage with Olson’s knowldgeable and stimulating piece.If anyone is moved to write a more extended comment on Olson’s article, I’d be delighted to post it.

From Mirror Neurons to Moral Neuropolitics

Gary Olson

“Empathy is the only human superpower-it can shrink distance, cut through social and power hierarchies, transcend differences, and provoke political and social change.”
-Elizabeth Thomas

“The success of the abolitionist movement lay in its making real for people in Britain and America the slave ship’s pervasive and utterly instrumental terror, which was indeed its defining feature.”
-Marcus Rediker

“The official directives needn’t be explicit to be well understood: Do not let too much empathy move in unauthorized directions.”
-Norman Solomon

In his magisterial study, The Slave Ship, maritime historian Marcus Rediker has documented the role played by emotional and especially visual appeals in ending the trans-Atlantic slave trade. Not unlike the structural violence endemic to global capitalism today, the abolitionist James Field Stanfield argued that the terrible truths of the slave trade “had been withheld from the public eye by every effort that interest, ingenuity, and influence, could devise.” (Rediker, 2007, p. 133) Therefore, “Stanfield appealed to the immediate, visceral experience of the slave ship, over and against abstract knowledge about the slave trade, as decisive to abolition. . . .” (p. 156) The abolitionist’s most potent weapon was the dissemination of drawings of the slave ship Brooks. Rediker asserts that these images were “to be among the most effective propaganda any social movement has ever created.” (p. 308)

Based on recent findings from neuroscience we can plausibly deduce that the mirror neurons of the viewer were engaged by these images of others suffering. The appeal was to the public’s awakened sense of compassion and revulsion toward graphic depictions of the wholesale violence, barbarity, and torture routinely practiced on these Atlantic voyages. Rediker notes that the images would instantaneously “make the viewer identify and sympathize with the ‘injured Africans’ on the lower deck of the ship . . .” while also producing a sense of moral outrage. (p. 315)

In our own day, the nonprofit Edge Foundation recently asked some of the world’s most eminent scientists, “What are you optimistic about? Why?” In response, the prominent neuroscientist Marco Iacoboni cited the proliferating experimental work into the neural mechanisms that reveal how humans are “wired for empathy.” This is the aforementioned discovery of the mirror neuron system or MNS. The work shows that the same affective brain circuits are automatically mobilized upon feeling one’s own pain and the pain of others.

Iacoboni’s optimism is grounded in his belief that with the popularization of scientific insights, these findings in neuroscience will seep into public awareness and ” . . . this explicit level of understanding our empathic nature will at some point dissolve the massive belief systems that dominate our societies and that threaten to destroy us.” (Iacoboni, 2007, p. 14, 2008) In similar fashion, Steven Pinker concludes a recent piece on the science of morality with these challenging but hopeful words from Anton Chekov, “Man will become better when you show him what he is like.” (Pinker, 2008)

In 1996, through single cell recordings in macaque monkeys researchers reported the discovery of a class of brain cells dubbed “mirror neurons” (Gallese, 1996). Located in area F5 of the premotor cortex, these mirror neurons fired not only when the monkey made an action, but also when the monkey was observing somebody else making the same action. The monkey’s neurons were “mirroring” the activity she was observing. Later on, by mapping regions of the human brain using Functional Magnetic Resonance Imaging (fMRI), it was discovered that human areas that presumably had mirror neurons also communicated with the brain’s emotional or limbic system, facilitating connection with another’s feelings, probably by mirroring those feelings. This neural circuitry is presumed to be the basis of empathic behavior, in which actions in response to the distress of others are virtually instantaneous. As Goleman puts it, “That this flow from empathy to action occurs with such automaticity hints at circuitry dedicated to this very sequence.” For example, in the case of hearing a child’s anguished scream, “To feel distress stirs an urge to help” (Goleman, 2006, p. 60).

The existence of empathy, mirror neurons was only inferred by these fMRI studies. But in 2007, Iacoboni, the neurosurgeon Itzhak Fried and their associates at the University of California at Los Angeles (UCLA), studied brain activity in people who had already been wired up by Fried who was attempting to uncover the origins of their epileptic seizures. Through the insertion of electrodes into the frontal lobes, this team of scientists identified several mirror neurons that were activated by both performance and observation of an activity.

Valayanur Ramachandran, director of the Center for Brain and Cognition at the University of California at San Diego (UCSD) observes, “We used to say, metaphorically, that ‘I can feel another’s pain,’ but now we know that my mirror neurons can literally feel your pain.” (Slack, 2007) Ramachandran, who calls them “empathy neurons” or “Dalai Lama neurons,” writes that “In essence the neuron is part of a network that allows you to see the world ‘from the other person’s point of view,’ hence the name ‘mirror neuron.’” (Ramachandran, 2006)

Giacomo Rizzolatti, the Italian neuroscientist who discovered mirror neurons, notes that this hardwired system is what permits us “to grasp the minds of others not through conceptual reasoning but through direct simulation by feeling, not by thinking” (Rizzolatti in Goleman, 2006). As Decety notes, empathy then allows us to “forge connections with people whose lives seem utterly alien from us” (Decety, 2006, p. 2). Where comparable experience is lacking, this “cognitive empathy” builds on the neural basis and allows one to “actively project oneself into the shoes of another person” by trying to imagine the other person’s situation (Preston, in press), Preston and de Waal (2002). Empathy is “other directed” and recognizes the other’s humanity. Little wonder that some scientists believe the discovery of mirror neurons is the most significant neurological finding in decades, perhaps rivaling what the discovery of DNA was for biology. (Ramachandran, 2006)

The neuroscience of empathy parallels investigations being undertaken in cognate fields. Some forty years ago the celebrated primatologist Jane Goodall observed and wrote about chimpanzee emotions, social relationships, and “chimp culture,” but experts remained highly skeptical. A decade ago the famed primate scientist Frans B.M. de Waal (1996) wrote about the antecedents to morality in Good Natured: The Origins of Right and Wrong in Humans and Other Animals, but scientific consensus remained elusive. All that’s changed. As a recent editorial in the journal Nature (2007) put it, it’s now “unassailable fact” that human minds, including aspects of moral thought, are the product of evolution from earlier primates. According to de Waal “You don’t hear any debate now.” In his more recent work, de Waal plausibly argues that human morality-including our capacity to empathize-is a natural outgrowth or inheritance of behavior from our closest evolutionary relatives.

Overwhelming evidence has been marshaled to support E.O. Wilson’s early claim that not only were selfish individuals sanctioned but “Compassion is selective and often ultimately self-serving.” (Wilson, 1978)

Following Darwin, highly sophisticated studies by biologists Robert Boyd and Peter Richerson posit that large-scale cooperation within the human species-including with genetically unrelated individuals within a group-was favored by selection. (Hauser, 2006, p. 416) Evolution selected for the trait of empathy because there were survival benefits in coming to grips with others. In his book People of the Lake (1978), the world-renowned paleoanthropologist Richard Leakey unequivocally declares, “We are human because our ancestors learned to share their food and their skills in an honored network of obligation.”

Studies have shown that empathy is present in very young children, even at eighteen months of age and possibly younger. In the primate world, Warneken and colleagues at the Max Planck Institute at Leipzig, Germany, recently found that chimps extend help to unrelated chimps and unfamiliar humans, even when inconvenienced and regardless of any expectation of reward. This suggests that empathy may lie behind this natural tendency to help and that it was a factor in the social life of the common ancestor to chimpanzees and humans at the split some six million years ago (New Scientist, 2007; Warneken and Tomasello, 2006). It’s now indisputable that we share moral faculties with other species (de Waal, 2006; Trivers, 1971; Katz, 2000; Gintis, 2005; Hauser, 2006; Bekoff, 2007; Pierce, 2007). Pierce notes that there are “countless anecdotal accounts of elephants showing empathy toward sick and dying animals, both kin and non-kin (2007, p. 6). And recent research in Kenya has conclusively documented elephant’s open grieving/empathy for other dead elephants.

Mogil and his team at McGill University recently demonstrated that mice feel distress when they observe other mice experiencing pain. They tentatively concluded that the mice engaged visual cues to bring about this empathic response (Mogil, 2006; Ganguli, 2006). De Waal’s response to this study: “This is a highly significant finding and should open the eyes of people who think empathy is limited to our species.” (Carey, 2006)

Additionally, Grufman and other scientists at the National Institutes of Health have offered persuasive evidence that altruistic acts activate a primitive part of the brain, producing a pleasurable response (2007). And recent research by Koenigs and colleagues (2007) indicates that within the brain’s prefrontal cortex, the ventromedial prefrontal cortex or VMPC is required for emotions and moral judgment. Damage to the VMPC has been linked to psychopathic behavior and individuals with psychopathic tendencies present significant empathic impairment. (Blair, 2005, pp. 53-56)

A study by Miller (2001) and colleagues of the brain disorder frontotemporal dementia (FTD) is also instructive. FTD attacks the frontal lobes and anterior temporal lobes, the site of one’s sense of self. One early system of FTD is the loss of empathy and the brain wave activity of mirror neurons in individuals with autism reveals misfiring.

While there are reasons to remain skeptical (see below) about the progressive political implications flowing from this work, a body of impressive empirical evidence reveals that the roots of prosocial behavior, including moral sentiments like empathy, precede the evolution of culture. This work sustains Noam Chomsky’s visionary writing about a human moral instinct and his assertion that, while the principles of our moral nature have been poorly understood, “we can hardly doubt their existence or their central role in our intellectual and moral lives.” (Chomsky, 1971, n.p., 1988; 2005, p. 263)

In his influential book Mutual Aid (1972, p. 57; 1902), the Russian revolutionary anarchist, geographer, and naturalist Petr Kropotkin, maintained that “. . . under any circumstances sociability is the greatest advantage in the struggle for life. Those species which willingly abandon it are doomed to decay.” Special cooperation provided an evolutionary advantage, a “natural” strategy for survival.

Kropotkin readily acknowledged the role of competition, but he asserted that mutual aid was a “moral instinct” and “natural law.” Based on his extensive studies of the animal world, he believed that this predisposition toward helping one another-human sociality-was of “prehuman origin.” Killen and Cords, in a fittingly titled piece “Prince Kropotkin’s Ghost,” suggest that recent research in developmental psychology and primatology seems to vindicate Kropotkin’s century-old assertions (2002).

So where does this leave us? If morality is rooted in biology, in the raw material or building blocks for the evolution of its expression, we now have a pending fortuitous marriage of hard science and secular morality in the most profound sense. The technical details of the social neuroscientific analysis supporting these assertions lie outside this paper, but suffice it to note that progress is proceeding at an exponential pace, the new discoveries are persuasive (Iacoboni, 2008; Lamm, 2007; Jackson, 2006) and our understanding of empathy has increased dramatically in barely a decade.

That said, one of the most vexing problems that remains to be explained is why so little progress has been made in extending this empathic orientation to distant lives, to those outside certain in-group moral circles. That is, given a world rife with overt and structural violence, one is forced to explain why our deep-seated moral intuition doesn’t produce a more ameliorating effect, a more peaceful world. Iacoboni suggests this disjuncture is explained by massive belief systems, including political and religious ones, operating on the reflective and deliberate level. As de Waal reminds us, evolutionarily, empathy is the original starting point out of which sprang culture and language. But over time, the culture filters and influences how empathy evolves and is expressed. (de Waal, 2007, p. 50) These belief systems tend to override the automatic, pre-reflective, neurobiological traits that should bring people together. Iacoboni hypothesizes the presence of what he labels super mirror neurons in the frontal lobe area of the brain. These more complex, highly developed super mirror neurons may control the so-called lower-level or classic neurons. This research-arguably the apex of the cutting edge of neuroscience work today-is in the preliminary stages but further investigation might suggest how cognitive resistance works to sort, inhibit or otherwise modulate neurophysiological responses.

Hence a few cautionary notes are warranted. The first is that social context and triggering conditions are critical because, where there is conscious and massive elite manipulation, it becomes exceedingly difficult to get in touch with our moral faculties. Ervin Staub, a pioneering investigator in the field, acknowledges that even if empathy is rooted in nature, people will not act on it “. . . unless they have certain kinds of life experiences that shape their orientation toward other human beings and toward themselves (Staub, 2002, p. 222). As Jensen puts it, “The way we are educated and entertained keep us from knowing about or understanding the pain of others” (2002, 2008). Circumstances may preclude and overwhelm our perceptions, rendering us incapable of recognizing and giving expression to moral sentiments (Albert, n.d.; and also, Pinker, 2002). For example, the fear-mongering of artificially created scarcity may attenuate the empathic response.

The limitations placed on exposure to powerful images that might stir deep emotions within the American public is another. The recent destruction of CIA videotapes showing the torture of prisoners is one example. Landstuhle regional medical center in Germany, which routinely receives grotesquely maimed soldiers from Iraq, is off-limits for photos and reporters are closely monitored by military escorts. And we know the Pentagon forbids media photo coverage of the remains of soldiers departing from Ramstein Air Base in Germany or coffins returning to Dover, Delaware. (Tami Silco, who took the now-famous photo of 20 flag-draped coffins leaving Kuwait, lost her job.) Coverage of memorial services for the fallen are also forbidden even if the unit gives its approval.

Conversely, the virtually ubiquitous feedback loop of the towers falling on September 11 tended to create a feeling within the viewer that she was in fact falling, producing both identification with falling victims and a powerful sense of fear of “terrorism.” (Lakoff, 2001)

The second cautionary note is Hauser’s (2006) observation that proximity was undoubtedly a factor in the expression of empathy. In our evolutionary past an attachment to the larger human family was virtually incomprehensible and therefore the emotional connection was lacking. Joshua Greene, a philosopher and neuroscientist, adds that “We evolved in a world where people in trouble right in front of you existed, so our emotions were tuned to them, whereas we didn’t face the other kind of situation.” He suggests that to extend this immediate emotion-linked morality-one based on fundamental brain circuits-to unseen victims requires paying less attention to intuition and more to the cognitive dimension. If this boundary isn’t contrived, it would seem, at a minimum, circumstantial and thus worthy of reassessing morality (Greene, 2007, n.p.). Given some of the positive dimensions of globalization, the potential for identifying with the “stranger” has never been more auspicious.

But not in every case. Carlisle (2007) notes that through the use of technology (including long-range killing and new types of training) the military has attempted to desensitize and circumvent the natural empathic response most soldiers experience toward their opponents. She cautions that “. . . with less opportunity to mirror other human’s suffering that results in empathy, over time our capacity to empathize may disappear altogether.” For a careful study of human’s innate aversion to taking life and how the military has conditioned soldiers to overcome it-and the resulting psychological damage-the best treatment is Lt. Col. David Grossman’s On Killing (1996).

It may be helpful, as Halpern (1993, p. 169) suggests, to think of empathy as a sort of spark of natural curiosity, prompting a need for further understanding and deeper questioning. However, our understanding of how or whether political engagement follows remains in its infancy and considerable work remains to be done. Almost a century ago, Stein (1917) wrote about empathy as “the experience of foreign consciousness in general.” Salles’ film The Motorcycle Diaries addresses empathy, albeit indirectly. The film follows Ernesto Guevara de la Serna and his friend Alberto Granada on an eight-month trek across Argentina, Peru, Colombia, Chile and Venezuela.

When leaving his leafy, upper middle-class suburb (his father is an architect) in Buenos Aires in 1952, Guevara is 23 and one semester from earning his medical degree. The young men embark on an adventure, a last fling before settling down to careers and lives of privilege. They are preoccupied with women, fun and adventure and certainly not seeking or expecting a life-transforming odyssey.

The film’s power is in its depiction of Guevara’s emerging political awareness that occurs as a consequence of unfiltered cumulative experiences. During their 8,000-mile journey, they encounter massive poverty, exploitation, and brutal working conditions, all consequences of an unjust international economic order. By the end Guevara has turned away from being a doctor because medicine is limited to treating the symptoms of poverty. For him, revolution becomes the expression of empathy, the only effective way to address suffering’s root causes. This requires melding the cognitive component of empathy with engagement, with resistance against asymmetrical power, always an inherently political act. Otherwise, empathy has no meaning. [This roughly parallels the political practice of brahma-viharas by engaged Buddhists.] In his own oft-quoted words (not included in the film) Guevara stated that “The true revolutionary is guided by a great feeling of love.”

Paul Farmer, the contemporary medical anthropologist, infectious disease specialist and international public health activist, has adopted different tactics but his diagnosis of the “pathologies of power” is remarkably similar to Guevara. He also writes approvingly of Cuba’s health programs, comparing them with his long work experience in Haiti. Both individuals were motivated early on by the belief that artificial epidemics have their origin in unjust socioeconomic structures, hence the need for social medicine, a “politics as medicine on a grand scale.” Both viewed “politics as medicine on a grand scale” and committed themselves to acting on behalf of the poor. Both exemplify exceptional social outliers of engaged empathy and the interplay of affective, cognitive and moral components. For Farmer’s radical critique of structural violence and the connections between disease and social inequality, see (Farmer, 2003; Kidder, 2003). Again, it remains to be explained why there is such a paucity of real world examples of empathic behavior. Why is U.S. culture characterized by a massive empathy deficit of almost pathological proportions? And what might be reasonably expected from a wider public understanding of the nature of empathy?

Hauser posits a “universal moral grammar,” hardwired into our neural circuits via evolution; this neural machinery precedes conscious decisions in life-and-death situations. However, we observe “nurture entering the picture to set the parameters and guide us toward the acquisition of particular moral systems.” At other points he suggests that environmental factors can push individuals toward defective moral reasoning, and the various outcomes for a given local culture are virtually limitless. (Hauser, 2006) For me, this discussion of cultural variation fails to give sufficient attention to the socioeconomic variables responsible for shaping the culture. As Goldschmidt argues, “It all has to do with the quality of justice and the availability of opportunity” (2006, p. 151) Earlier, Goldschmidt (1999, n.p.) argued that, “Culturally derived motives may replace, supplement or override genetically programmed behavior.”

To reiterate, the neurophysiological data strongly suggests that morality is grounded in biology. As Greene contends, it’s not “handed down” from on high by religious authorities or philosophers but “handed up” as a consequence of the brain’s evolutionary processes. (Greene in Vedantam, 2007). However, as Rizzolatti and Craighero (2006) wisely remind us, “To use the mirror mechanism-a biological mechanism-strictly in a positive way, a further-cultural-addition is necessary.”

Neither a reductive biological explanation nor a culture-inevitably-trumps-nature argument is defensible. Instead, I’m comfortable with what the political theorist William Connolly (2002) describes as “. . . politics through which cultural life mixes into the composition of body/brain process. And vice versa.” (Connolly, to my knowledge the first person to employ the term neuropolitics, doesn’t explore the mirror neurons/politics of empathy link in his erudite inquiry.)

Recent work by Molnar-Szakacs and colleagues suggests that cultural stimuli imprint and influence certain neurobiological responses and subsequent behavior. Further, the culture and ethnicity of those conveying the messages seems to be a critical variable. Using transcranial magnetic stimulation (TMS) they found significant measurable difference in mirror neural activity in their subjects depending on whether the information provider shared the subject’s cultural/ethnic background. Molnar-Szakacs conclude, “Our data shows that both ethnicity and culture interact to influence activity in the brain, specifically within the mirror neuron network involved in social communication and interaction.” (Molnar-Szakacs, 2007; Preston, 2006; and in press). While one hesitates to draw any firm conclusions from this very preliminary research, further investigation of the links between culture and the encoding of mirror neurons is certainly warranted, not the least for its possibly profound political implications.

Here we return to our earlier question regarding the relative absence of widespread empathic responses within society. Cultures are rarely neutral, innocent phenomena but are consciously set up to reward some people and penalize others. As Parenti (2006) forcefully asserts, certain aspects of culture can function as instruments of social power and social domination through ideological indoctrination.

Culture is contested terrain and studying it can reveal how power is exercised and on whose behalf. Lakoff (2005) reminds us that in cognitive linguistics certain values like compassion are termed “contested concepts” because although a core meaning might be assumed, those holding a wildly different ideological commitment can appropriate and direct them toward other ends. The primer here is Gramsci’s (1971) classic analysis of cultural hegemony in which capitalism maintains domination, in part, through subtly but actively creating society’s prevailing cultural norms. This consensual control is achieved through mass media, education, religion and popular culture as subordinate classes assimilate certain ideas as “common sense.”

Cohen and Rogers, in parsing Chomsky’s critique of elites, note that “Once an unjust order exists, those benefitting from it have both an interest in maintaining it and, by virtue of their social advantages, the power to do so.” (Cohen, 1991, p. 17) (For a concise but not uncritical treatment of Chomsky’s social and ethical views, see Cohen, 1991.) Clearly, the vaunted human capacity for verbal communication cuts both ways. In the wrong hands, this capacity is often abused by consciously quelling the empathic response. When de Waal writes, “Animals are no moral philosophers,” I’m left to wonder if he isn’t favoring the former in this comparison. (de Waal, 1996b, n.p.)

One of the methods employed within capitalist democracies is Chomsky and Herman’s “manufacture of consent,” a form of highly sophisticated thought control. Potentially active citizens must be “distracted from their real interests and deliberately confused about the way the world works.” (Cohen, 1991, p. 7; Chomsky, 1988)

For this essay, and following Chomsky, I’m arguing that the human brain is the primary target of this perverse “nurture” or propaganda. In the context of this paper we might rephrase this as the human brain’s mirror neuron network is the target of this manufacturing of ignorance and indifference because exposure to certain new truths about empathy-hard evidence about our innate moral nature-poses a direct threat to elite interests. There’s no ghost in the machine, but the capitalist machine attempts to keep people in line with an ideological ghost, the notion of a self constructed on market values. But “. . . if no one saw himself or herself as capitalism needs them to do, their own self-respect would bar the system from exploiting and manipulating them.” (Kelleher, 2007) That is, given the apparent universality of this biological predisposition toward empathy, we have a potent scientific baseline upon which to launch further critiques of elite manipulation, this cultivation of callousness.

First, the evolutionary and biological origins of empathy contribute robust empirical evidence-not wishful thinking or even logical inference-on behalf of a case for organizing vastly better societies. In that vein, this new research is entirely consistent with work on the nature of authentic love and the concrete expression in that love in the form of care, effort, responsibility, courage and respect. As Eagleton reminds us, if others are also engaging in this behavior “. . . the result is a form of reciprocal service which provides the context for each self to flourish. The traditional name for this reciprocity is love.” Because reciprocity mandates equality and an end to exploitation and oppression, it follows that “a just, compassionate treatment of other people is on the grand scale of things one of the conditions for one’s own thriving.” And as social animals, when we act in this way we are realizing our natures “at their finest.” (2007, pp. 170, 159-150, and 173). (Allot (1992) provides an early account of the evolutionary history of love and its significance for human development and survival.)

Predatory urges, cruelty, barbarism and more are also aspects of our nature and have their evolutionary origins and neural correlates. As Chomsky has written, “If you see somebody beating a child to death, should you say, “Well, you know that’s human nature-which it is in fact: there certainly are conditions under which people will act just like that. To the extent the statement is true, and there is such an extent, it’s just not relevant: human nature also has the capacity to lead to selflessness, and cooperation, and sacrifice, and support, and solidarity, and tremendous courage, and lots of other things too.” (Chomsky, 2002, p. 356) The critical question is how to determine which will prevail, how to realize a form of global environment that enhances the opportunity for the empathic aspect of our nature to flourish.

I’ve noted elsewhere that Fromm’s classic, The Art of Loving, is a blistering indictment of the social and economic forces that deny us life’s most rewarding experience and “the only satisfying answer to the problem of human existence.” For Fromm, grasping how society shapes our human instincts, hence our behavior, is in turn the key to understanding why “love thy neighbor,” the love of the stranger, is so elusive in modern society.

The global capitalist culture with its premium on accumulation and profits not only devalues an empathic disposition but produces a stunted character where everything is transformed into a commodity, not only things, but individuals themselves. The very capacity to practice empathy (love) is subordinated to our state religion of the market in which each person seeks advantage in an alienating and endless commodity-greedy competition.

Over five decades ago, Fromm persuasively argued that “The principles of capitalist society and the principles of love are incompatible.” (Fromm, 1956, p. 110) Any honest person knows that the dominant features of capitalist society tend to produce individuals who are estranged from themselves, crippled personalities robbed of their humanity and in a constant struggle to express empathic love. Little wonder that Fromm believed radical changes in our social structure and economic institutions were needed if empathy/love is to be anything more than a rare individual achievement and a socially marginal phenomenon. He understood that only when the economic system serves women and men, rather than the opposite, will this be possible (Olson, 2006).

The dominant cultural narrative of hyper-individualism is challenged and the insidiously effective scapegoating of human nature that claims we are motivated by greedy, dog-eat-dog “individual self-interest is all” is undermined. From doctrines of original sin and Ayn Rand to mainstream economics and David Brooks (2007), certain interpretations of human nature have invariably functioned to retard class consciousness. These new research findings help to refute the allegation that people are naturally uncooperative, an argument frequently employed to intimidate and convince people that it’s futile to seek a better society for everyone. Stripped of yet another rationalization for empire, predatory behavior on behalf of the capitalist mode of production becomes ever more transparent. And learning about the conscious suppression of this essential core of our nature should beg additional troubling questions about the motives behind other elite-generated ideologies, from neo-liberalism to the “war on terror.”

Second, there are implications for students and teachers. Cultivating empathic engagement through education remains a poorly understood enterprise. College students, for example, may hear the ‘cry of the people’ but the moral sound waves are muted as they pass through a series of powerful cultural baffles. Williams (1986, p. 143) notes that “While they may be models of compassion and generosity to those in their immediate circles, many of our students today have a blind spot for their responsibilities in the socio-political order. In the traditional vocabulary they are strong on charity but weak on justice.”

Nussbaum (1997) defends American liberal education’s record at cultivating an empathic imagination. She claims that understanding the lives of strangers and achieving cosmopolitan global citizenship can be realized through the arts and literary humanities. There is little solid evidence to substantiate this optimism and my own take on empathy-enhancing practices within U.S. colleges and universities is considerably less sanguine. Nussbaum’s episodic examples of stepping into the mental shoes of other people are rarely accompanied by plausible answers as why these people may be lacking shoes-or decent jobs, minimum healthcare, and long-life expectancy. The space within educational settings has been egregiously underutilized, in part, because we don’t know enough about propitious interstices where critical pedagogy could make a difference. Arguably the most serious barrier is the cynical, even despairing doubt about the existence of a moral instinct for empathy. The new research puts this doubt to rest and rightly shifts the emphasis to strategies for cultivating empathy and identifying with “the other.” Joining the affective and cognitive dimensions of empathy may require risky forms of radical pedagogy (Olson, 2006, 2007a; Gallo, 1989). An intriguing implication is that the perceived character of the teacher being “mirrored” may be at least as important as the message being imparted. Evidence produced from a game situation with medical students strongly hints that empathic responses can be significantly enhanced by increased knowledge about the specific needs of others-in this case, the elderly (Varkey, 2006). Presumably, limited prior experiences would affect one’s emotional response. Again, this is a political culture/information acquisition issue that demands further study.

Third, for many people the basic incompatibility between global capitalism and the lived expression of moral sentiments may become obvious for the first time. (Olson, 2006, 2005) For example, the failure to engage this moral sentiment has radical implications, not the least being consequences for the planet. Within the next 100 years, one-half of all species now living will be extinct. Great apes, polar bears, tigers and elephants are all on the road to extinction due to rapacious growth, habitat destruction, and poaching. These human activities, not random extinction, will be the undoing of millions of years of evolution (Purvis, 2000). As Leakey puts it, “Whatever way you look at it, we’re destroying the Earth at a rate comparable with the impact of a giant asteroid slamming into the planet. . . .” And researchers at McGill University have shown that economic inequality is linked to high rates of biodiversity loss. The authors suggest that economic reforms may be the prerequisite to saving the richness of the ecosystem and urge that “. . . if we can learn to share the economic resources more fairly with fellow members of our own species, it may help to share ecological resources with our fellow species.” (Mikkelson, 2007, p. 5)

While one hesitates imputing too much transformative potential to this emotional capacity, there is nothing inconsistent about drawing more attention to inter-species empathy and eco-empathy. The latter may be essential for the protection of biotic communities. Decety and Lamm (2006, p. 4) remind us that “. . . one of the most striking aspects of human empathy is that it can be felt for virtually any target, even targets of a different species.”

This was foreshadowed at least fifty years ago when Paul Mattick, writing about Kropotkin’s notion of mutual aid, noted that “. . . For a long time, however, survival in the animal world has not depended upon the practice of either mutual aid or competition but has been determined by the decisions of men as to which species should live and thrive and which should be exterminated. . . .[W]herever man rules, the “laws of nature” with regard to animal life cease to exist.” This applies no less to humans and Mattick rightly observed that the demands of capital accumulation and capitalist social relations override and preclude mutual aid. As such, neuroscience findings are welcome and necessary but insufficient in themselves. For empathy to flourish requires the elimination of class relations (Mattick, 1956, pp. 2-3).

Fourth, equally alarming for elites, awareness of this reality contains the potential to encourage “destabilizing” but humanity-affirming cosmopolitan attitudes toward the faceless “other,” both here and abroad. In de Waal’s apt words, “Empathy can override every rule about how to treat others.” (de Waal, 2005, p. 9) Amin (2003), for example, proposes that the new Europe be reframed by an ethos of empathy and engagement with the stranger as its core value. The diminution of empathy within the culture reduces pro-social behavior and social cohesiveness. Given the dangerous centrifugal forces of ethno-nationalism and xenophobia, nothing less than this unifying motif will suffice, while providing space for a yet undefined Europe, a people to come.

Finally, as de Waal observes, “If we could manage to see people on other continents as part of us, drawing them into our circle of reciprocity and empathy, we would be building upon rather than going against our nature.” (de Waal, 2005, p. 9) An ethos of empathy is an essential part of what it means to be human and empathically impaired societies, societies that fail to gratify this need should be found wanting. We’ve been systematically denied a deeper and more fulfilling engagement with this moral sentiment. I would argue that the tremendous amount of deception and fraud expended on behalf of overriding empathy is a cause for hope and cautious optimism. Paradoxically, the relative absence of widespread empathic behavior is in fact a searing tribute to its potentially subversive power.

Is it too much to hope that we’re on the verge of discovering a scientifically based, Archimedean moral point from which to lever public discourse toward an appreciation of our true nature, which in turn might release powerful emancipatory forces?

Acknowledgement:A highly abbreviated version of this paper appeared at www.zmag.org (5/20/07) and portions at www.identitytheory.com (10/16/07). I wish to acknowledge helpful comments on earlier drafts by N. Chomsky, D. Dunn, M. Iacoboni, K. Kelly, S. Preston, and J. Wingard. Thanks, as always, to M. Ortiz.

_______________

Gary Olson, Ph.D. chairs the Political Science Department at Moravian College in Bethlehem, PA. He may be reached at olson@moravian.edu.

References

Albert, M. (n.d.) “Universal Grammar and Linguistics,” www.zmag.org/Zmag/articlesAllot, R. (1992) “Evolutionary Aspects of Love and Empathy,” Journal of Social and Evolutionary Systems, 15, 4, 353-370. Amin, A. (2003) “From ethnicity to empathy: a new idea of Europe,” www.opendemocracy.net/debates/articles 24-7-2004.

Barber, N. (2004) Kindness in a Cruel World. New York: Pantheon, pp. 203-231.

Blair, J., Mitchell, D., and Blair, K. (2005) The Psychopath: Emotion and The Brain. Oxford, UK: Blackwell.

Blakeslee, S. (2006) “Cells That Read Minds,” The New York Times, 1/10/06.

Brooks, D. (2007) “Human Nature Redux,” The New York Times, 2/16/2007.

Carey, B. (2006) “Messages from Mouse to Mouse: I feel your pain,” New York Times, July 4.

Carlisle, J. (2007) “Empathy, Mirror-Neurons, Technology and War.” www.associatedcontent.com/article/474799/empathy_mirrorneuronstechnology-and.html.

Chomsky, N. (1971) Human Nature: Justice versus Power, Noam Chomsky debates Michel Foucault. www.chomsky.info/debates

Chomsky, N. (1988) Language and Problems of Knowledge: The Managua Lectures. Cambridge, MA: MIT Press.

Chomsky, N. (2002) Understanding Power: The Indispensable Chomsky. New York: The New Press.

Chomsky, N. (2005a) “What We Know,” Boston Review (Summer)

Chomsky, N. (2005b) “Universals of Human Nature,” Psychotherapy and Psychomatics, 74.

Chomsky, N. and Herman, E. (1988) Manufacturing Consent: The Political Economy of the Mass Media. New York: Pantheon.

Cohen, J. and Rogers, J. (1991) “Knowledge, Morality and Hope: The Social Thought of Noam Chomsky,” New Left Review, 187, pp. 5-27.

Connolly, W. (2002) Neuropolitics. Minneapolis: University of Minnesota Press.

D’Addelfico, G. (n.d.) The Educative Value of Empathy with the Capability Approach, www.capabilityapproach.com/pubs/13dAddelfic.

Decety, J. (2006) “Mirrored Emotion,” Interview, The University of Chicago Magazine, 94, 4, pp. 1-9.

Decety, J. and Lamm, C. (2006) “Human Empathy through the Lense of Social Neuroscience,” The Scientific World Journal, 6, September, 1-25.

de Waal, F.B.M. (1996a) Good Natured: The Origins of Right and Wrong in Primates and Other Animals. Cambridge, MA: Harvard University Press.

de Waal, F.B.M. (1996b) Emory Magazine, Summer: In Brief.

de Waal, F.B.M. (2006) Primates and Philosophers: How Morality Evolved. Princeton, NJ: Princeton University Press.

de Waal, F.B.M. (2005-06) “The Evolution of Empathy,” Greater Good, Fall-Winter, pp. 8-9.

de Waal, F.B.M. (2007) “The ‘Russian Doll’ Model of Empathy and Imitation,” in S. Braten (Ed.) (2007) On Being Moved. Amsterdam: John Benjamins Publishing Company.

Eagleton, T. (2007) The Meaning of Life. New York: Oxford University Press

Editorial (2007) “Evolution and the Brain,” Nature, 447, 7146, 14 June.

Egan, D. (2007) “How Horror Sparks Our Brains,” thetyee.ca/News/2007/03/02MirrorNeurons.

Farmer, P. (2003) Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA: University of California Press.

Fromm, E. (1956) The Art of Loving. New York: Harper & Row.

Gallese, V., Fadiga, L., Fogassi., and Rizzolatti, G. (1996) “Action recognition in the premotor cortex,” Brain, 1192: 593-609.

Gallo, D. (1989) “Educating for Empathy, Reason, and Imagination,” Journal of Creative Behavior, 23, 2, pp. 98-115.

Ganguli, I. (2006) “Mice show evidence of empathy,” The Scientist, June 30, http://www.the-scientist.com/news/display/23764.

Gintis, H., Bowles, S., Boyd, R., and Fehr, E. (2004) “Explaining altruistic behavior in humans,” Evolution and Human Behavior, 24, pp. 153-172.

Gintis, H., Bowles, S., Boyd, R., and Fehr, E. (2005) Moral Sentiments and Material Interests. Cambridge, MA: MIT Press.

Goldschmidt, W. (1999) “Causation to motivation: the margin between biology and culture” www.sscnete.ucla.edu/anthro/bec/papers/Goldschmidt April 12.

Goleman, Daniel. (2006) Social Intelligence. New York: Bantam.

Gouskos, C. (2006) “Empathy and Conditioning Violence,” www.gamespot.com/features/6143438/index.

Grafman, J. (2007) in Vedantam, S., “If It Feels to be Good, It Might Be Only Natural,” www.washingtonpost.com/wp-dyn/content/article/2007/05/27.

Gramsci, A. (1971) Selections from the Prison Notebooks. New York: International Publishers.

Green, J. (2007) in Vedantam, S., “If It Feels to be Good, It Might Be Only Natural,” www.washingtonpost.com/wp-dyn/content/article/2007/05/27.

Grossman, D. (1996) On Killing: The Psychological Cost of Learning to Kill in War and Society. Boston: Little, Brown and Company.

Halpern, J. (1993) “Empathy: Using Resonance Emotions in the Service of Curiosity,” in Howard M. Spiro et al, eds., Empathy and the Practice of Medicine. New Haven: Yale University Press.

Hauser, M. D. (2006a) Moral Minds, New York: Harper Collins.

Hauser, M. D. (2006b) “The Bookshelf Talks with Marc Hauser,” American Scientist, www.americanscientist.org

Iacoboni, M. (2007) “Neuroscience Will Change Society,” EDGE, The World Question Center. http:www.edge.org/q2007pp14-15

Iacoboni, M. (2008, proofs) Mirroring People. New York: Farrar, Strauss and Giroux.

Jackson, P. L., Meltzoff, A. N., and Decety, J. (2004) “How do we perceive the pain of others?” Neuroimage, 125, pp. 5-9.

Jackson, P. L., Rainville, P., and Decety, J. (2006) “To what extent do we share the pain of others?” PAIN, 125, pp. 5-9.

Jensen, R. (3/20/02) “The Politics of Pain and Pleasure.” Counterpunch.

Katz, L. D., ed. (2000) Evolutionary Origins of Morality. Bowling Green, OH: Imprint Academic.

Kelleher, W.J. (2007) “Critique of Steven Pinker’s Blank Slate,” http://www.empathicscience.org/pinker.html

Kidder, T. (2003) Mountains Beyond Mountains. New York: Random.

Killen, M. and Cords, M. (2002) “Prince Kropotkin’s Ghost,” American Scientist, 90, 3, p. 208.

Koenigs, M. et al. (2007) “Damage to the Prefrontal Cortex Increases Utilitarian Moral Judgments,” Nature, Apr 19 446 (7138): 908-11.

Kropotkin, P. (1972) Mutual Aid. Boston: Extending Horizons; originally (1902), London: Heinemann.

Lakoff, G. (2001) “Metaphors of Terror,” www.press.uchicago.edu/News/911lakoff./html

Lakoff, G. (2005) “On Theology and Politics,” www.rockridgeinstitute.org/research/lakoff/TheologyAndPolitics.pdf

Lamm, C., Batson, C., and Decety, J. (2007) “The Neural Substrate of Human Empathy: Effects of Perspective-taking and Cognitive Appraisal,” Journal of Cognitive Neural Science, 19: 1, pp. 42-58.

Leakey, R. and Lewin, R. (1978) People of the Lake. New York: Doubleday.

Mattick, P. (1956) “Kropotkin on Mutual Aid - Review,” Western Socialist, Boston (January-February) in www.marxists.org/archive/mattick-paul/1956/kropotkin.htm

May, T. (2006) “Terms of Empathy,” (Dana Foundation) www.dana.org/news/brainwork/detail.aspx

Mikkelson, G. M., Gonzalez, A., and Peterson, G. D. (2007) “Economic Inequality Predicts Biodiversity Loss,” PLoS ONE 2 (5):e444.doi:10.1371/journal.pone.0000444.

Miller, B., Seeley, P., Mychack P., Rosen, H., Mena, I., and Boone, K. (2001) “Neuroautonomy of the self: Evidence from patients with frontotemporal dementia,” Neurology, 57, 5, pp. 817-821.

Mogil, J.S. (2006) “Social Modulation of Pain as Evidence for Empathy in Mice,” Science, 312, 5782, pp. 1967-1970.

Molnar-Szakacs, I., Wu, A., Robles, F., and Iacaboni, M. (2007) “Do You See What I Mean? Corticospinal Excitability During Observation of Culture Specific Gestures,” PLoS ONE, 2 (7): e626, doi:10.1371/journal.pone.0000626.

New Scientist (2007) “‘Altruistic’ chimps acted for the benefit of others,” NewScientist.com. 25 June.

Nussbaum, M. (1997) Cultivating Humanity. Cambridge: Harvard University Press.

Nussbaum, M. (2001) Upheavals of Thought: The Intelligence of Emotions. Cambridge, UK: Cambridge University Press.

Nussbaum, M. (2006) Frontiers of Justice. Cambridge, MA: The Belknap Press of Harvard University.

Olson, G. (2005) “Scapegoating Human Nature,” ZNet, 11/30/05.

Olson, G. (2006) “Graduates face choice between love or ‘selling out.’” ZNet Commentary.

Olson, G. (2007a, 1987) “Execution Class,” Z Magazine, 20, 3, March, 2007.

Olson, G. (2007b) “Neuroscience and Moral Politics: Chomsky’s Intellectual Progeny,” http://www.identitytheory.com/social/olson neuro.php

Parenti, M. (2006) The Culture Struggle. NY: Seven Stories Press.

Pierce, J. (2007) “Mice in the Sink: On the Expression of Empathy in Animals.” www.environmentalphilosophy.org/ISEEIAEPpapers/2007/Pierce.pdf.

Pinker, S. (2002) The Blank Slate. New York: Viking.

Pinker, S. (2008) “What Makes Us Want to Be Good?” The New York Times, 1/12/08.

Preston, S. and de Waal, F.B.M. (2002) “Empathy: Its ultimate and proximate bases,” Behavior and Brain Sciences, 25, pp. 1-72.

Preston, S. (2006-2007) “Averting the Tragedy of the Commons,” SHIFT, 13, pp. 25-28.

Preston, S., Bechara, A., Damasio, H., Grabowski, T. J., Stansfield, S. M., and Damasio, A. R. (in press) “The Neural Substrates of Cognitive Empathy.” Social Neuroscience.

Purvis, A., Agapow, P-M., Gittleman, J., and Mace, G. (2000) “Non-random extinction and loss of evolutionary history,” Science, 288, 5464, pp. 328-330.

Ramanchandran, V. (2000) “Mirror Neurons and Imitation Learning as the Driving Force Behind ‘the Great Leap Forward’ in Human Evolution,” Edge, 69, June 29, 2000, www.edge.org/3rd­culture/ramachandran/ramachandran­index.html.

Ramachandran, V. (2006) “Mirror Neurons and the Brain in the Vat,” Edge, January 10, 2006, www.edge.org/3rd­culture/ramachandran06/Ramachandran06­index.html+jam.

Rediker, M. (2007) The Slave Ship. New York: Viking.

Rizzolatti, G., Fadiga, L., Gallesa, V., and Fogassi, L. (1996) “Premotor cortex and the recognition of motor actions,” Cognitive Brain Research, 3, pp. 131-141.

Rizzolatti, G. and Craighero, L. (2006) “Mirror neuron: a neurological approach to empathy, www.robotcub.org/misc/review 2/06 Rizzolatti Craighero.pdf

Slack, G. (2007) “I feel your pain,” www.Salon.com 2007/11/05.

Solomon, N. (4/17/03) “Media and the Politics of Empathy,” Media Beat.

Staub, Ervin (2002) In Davidson, R.J. and Harrington, A. (Eds.) Visions of Compassion. New York: Oxford University Press.

Stein, E. (1989) On the problem of empathy. Washington: ICS Publications. (Original work published in 1917) as found in D’Addelfico (n.d.).

Thomas, E. (2006) “Empathetic” www.temple.edu/tyler/empathetic/essay.html

Trivers, R. (1971) “The evolution of reciprocal altruism,” Quarterly Review of Biology, 46, pp. 35-57.

Varkey, P., Chutka, D.S. and Lesnick, T.G. (2006) “The aging game: improving medical students’ attitudes toward caring for the elderly,” J. Am. Med. Directors Assoc. 7, 224-229 in Decety, J. and Lamm, C. (2006).

Warneken, F. and Tomasello, M. (2006) “Altruistic Helping in Human Infants and Young Chimpanzees,” Science, 311, No. 5765, pp. 1301-1303.

Williams, O. (1986) in Johnson, D. (Ed.) Justice and Peace Education. New York: Orbis.

Wilson, A.O. (1978) On Human Nature. Cambridge: Harvard University Press

1 comment March 8th, 2008

Guardian article contrasts IRB protections with APA moral vacuousness on torture

A column in today’s Guardian Comment is Free by Ben Goldacre relates the federal Office for Human Research Protections [OHRP] ridiculous actions interfering with life saving I’d blogged about on New Years Day to the complete lack of any ethical concern by the America Psychological Association for the ethical lapses of psychologists designing Bush’s torture regime. Goldacre points out that OHRP stopped a study in a New York Intensive Care Unit which was using a simple checklist to remind people to follow simple safety protocols. Seems, if it’s research you can’t check the boxes without time-consuming Institutional Review Board [IRB] approval. Of course, if they don’t call it “research,” hospitals can do almost anything they want. The only difference is that in the “research” case, they are actually collecting data to find out if the checklist works. The basic idea, is you can do anything you want without onerous review, as long as you don’t bother to try and find out if it’s helpful.

Goldacre contraststs this silliness, leading potentially to many dead patients, with the ethical blindness that has guided the American Psychological Association [APA] for years when faced with the horrifying roles played by psychologists in the U.S. regime of abusive interrogations. The APAhad its ridiculous silliness as well. They were so concerned about unethical interrogations that they appointed a task force composed mainly of those psychologists most likely involved in unethical interrogations to formulate ethics policy for the association. Makes sese that one would appoint those accused of abuses to formulate your ethics policy, doesn’t it? After all, it wasn’t “research,” so stringent protections weren’t needed.

Here is Goldacre’s article (taken from his Bad Science blog rather than the Guardian because the blog version has many links, including several to this site). Make sure to read the last three paragraphs which discuss the APA madness:

Where’s your ethics committee now, science boy?

by Ben Goldacre

The Guardian,

Saturday February 23 2008

People have done some terrible things, over the years, with science, and with their science skills. I’m talking about Zyklon B, electrocuting gay people straight, torturing people in concentration camps, leaving syphillis untreated in large numbers of black men for an experiment (without telling them, in the US, until the 1970s), and more. Stuff where it’s hard to find any humour.

This is why we have research ethics committees, codes of practise, professional bodies, and regulators like the The US Office for Human Research Protections. Sometimes these organisations can cock up quite badly. Let me tell you about two stories which have been unfolding over the past few months.

In New York, a fiendishly clever trial in ITU departments has looked at one of the simplest interventions imaginable: a ticklist for giving IV lines, a helpful little reminder to wash your hands, wear gloves, and so on. Can something as simple as “using a ticklist”, to check if people are doing the right thing, reduce infections and save lives?

This is the bread and butter of medical academic research, which is usually not about pills, or placeboes, or molecules, but about looking pragmatically at whether one thing works better than another. You will remember that homeopaths and various other quacks are philosophically opposed to this process.

The results were spectacular: in 3 months, the incidence of blood infections from these IV lines fell by two-thirds, and over 18 months, the program saved 1,500 lives and an estimated $200 million. Then someone complained to the OHRP, because this was a research study, and they did not have ethics committee clearance. The project was shut down. This week, the OHRP grandly lifted their ban, explaining that now – since it turns out the research bit is over, and the hospitals are just putting the ticklist into practise – they may tick away unhindered.

This is what we might call the “ethical paradox”. You can do something as part of a treatment program, entirely on a whim, and nobody will interfere, as long as it’s not potty (and even then you’ll probably be alright). But the moment you do the exact same thing as part of a research program, trying to see if it actually works or not, adding to the sum total of human knowledge, and helping to save the lives of people you’ll never meet, suddenly a whole bunch of people want to stuck their beaks in.

Hilary Hearnshaw did an elegant study where she pretended to apply to do a medical research project in the Israel, the UK, and 11 other countries in Europe. She said she wanted to do a trial on a leaflet – contain your excitement - which was designed to help older patients get more engaged with their GP.

Only three countries required the project to go through a process of ethical approval, and in the UK, this was more arduous than in any other country. Getting ethical clearance took ten weeks, required two submissions (because they demanded changes), and five full days of administration, during which the proposal had to be reviewed by full committees, some of which required multiple copies of the application paperwork.

This is just the tip of the iceberg (and I would always welcome more examples by email). For one multicentre clinical trial, each of 125 local research ethics committees required between 1 and 21 copies of a protocol. Ethics approval for another trial, involving 51 centres, required over 25 000 pieces of paper, 62 hours of photocopying, and an average of 3.3 hours of investigator time for each centre. You feel like you’re dying when administrators drag their heels. In the case of medical research, when you delay research findings, and deter researchers from even bothering, people really are dying. This wider harm seems to be a blindspot for the ethics committees, captivated by their own mission creep.

But it’s not the only ethical blindspot. These regulations have their roots in the Nuremburg Code. But while the world of clinicians and academics splits ethical hairs, with our eye off the ball, an elephant has walked into the room.

February has seen another string of prominent psychologists resigning from their membership of the American Psychological Association, in disgust at its failure to take a stand on “abusive interrogation techniques”, cruel, inhuman and degrading treatment, and other activities which you might consider to be torture.

Psychologists are key to these interrogations and other activities, both in designing and enacting what I would rather not call “protocols”, out of compassion for the people on whom they are grimly enacted, in places cameras do not go.

APA members, trained, clinical professionals on their register, who have signed up to their codes of practise, now participate in these activities. The APA’s response has been to specifically bend the codes of conduct to permit their actions, and to obfuscate. Where’s your ethics committee now, science boy?

Bits:

Ken Pope, prominent member of the American Psychological Association (and a former chair of its Ethics Committee), resigned his membership on February 6. He’s the latest of a growing number of professional psychologists who have quit APA in protest of its position on the use of psychologists in government interrogations in the “War on Terror.”

Lots more on the APA and torture at Mindhacks.

Add comment February 24th, 2008

Drug company Pfizer attcks integrity of journal review process

Anyone who’s published in a peer-reviewed scientific journal knows that the peer review process has many flaws. But one of them is not that a drug company can use reviews to undermine research questioning its products. According to an article by the Editor-In-Chief in the new Science, drug company Phizer is attempting a body blow against the integrity of the peer review process by subpoenaing journal reviews to aid its defense in lawsuits. Evidently they hope to use the reviews to discredit certain studies.

Here is the Science article:

Confidential Review–or Not?

by Donald Kennedy

At Science, We editors love our reviewers and know that our editorial colleagues elsewhere do too. After all, the process of scientific publication depends on the volunteer services of thousands of experts all over the world who willingly provide, without compensation, confidential and candid evaluations of the work of others. Because all of us in scientific publishing depend on reviewers, we’d better try to keep them at it, happy, and secure. But the following case, involving a lawsuit, a drug company, and the company’s assault on the confidential files of a journal, is a bad news story.

The drug company Pfizer is being sued in various jurisdictions on product liability grounds. Plaintiffs are claiming that its products Celebrex and Bextra cause cardiovascular and other injuries. Pfizer asserts that in some cases plaintiffs are making use of published papers from the New England Journal of Medicine (NEJM). So it wants to dig though the confidential reviews of those papers in search of something to strengthen its defense. The company served NEJM with a series of subpoenas to which the journal replied, claiming several privileges in support of its refusal to comply.

Now Pfizer’s lawyers have filed a motion to compel NEJMto produce the files, which will be heard by a U.S. District Court in Massachusetts. (Full disclosure: I have filed an affidavit with the court supporting NEJM.) The motion is interesting in terms of its revelations about what Pfizer knows about the process of scientific publication and what it regards as the “public interest.” For example, the motion states: “The public has no interest in protecting the editorial process of a scientific journal …” Say what? Doesn’t the public want access to credible biomedical science? If not, what was the open-access movement all about? Do medical advocacy groups really have no use for knowledge that might help their members?

Does confidentiality count for anything to the scientists who serve the journal? Well, if confidentiality is compromised, Pfizer’s attorneys state with breezy assurance, that won’t be a problem for authors: “It is unreasonable to conclude,” they say in their motion to compel, “that scientists and academics will stop submitting manuscripts to NEJM if it complies with this subpoena.” Perhaps. But what about reviewers, who are explicitly promised confidentiality? And what about other journals? If this motion succeeds, what journal will not then become an attractive target for a similar assault?

Viewed in the larger context, this is really a conflict between competing interests. One is the public’s interest in a fair system of evaluating and publishing scientific work–one that offers high confidence in, though not an absolute guarantee of, the quality of the product. Pfizer dismisses this with a wave of the hand, a strangely inconsistent position given the enthusiasm with which it and other drug companies seek to have their own research validated by the very system of scientific publication that Pfizer’s motion decries and would undermine. On the other side, there is a private interest in gaining information that might protect a corporate defendant against a plaintiff’s attack. Without questioning the legitimacy of the latter, it is surely fair to ask whether fulfilling that need should trump the public interest.

An approach often taken in such cases would examine the prospective weight of what defendant Pfizer hopes to find; in other words, is it worth it? What Pfizer’s motion says on that score is: “Scientific journals such as NEJM may have received manuscripts that contain exonerating data for Celebrex and Bextra which would be relevant for Pfizer’s causation defense.” That’s a pretty frank admission that this is a fishing expedition in which Pfizer hopes it “may” find something to help its defense by exposing a reviewer’s comment. Is that an adequate basis for justifying prospective damage to the public interest? We don’t think so, and we suspect our prospective reviewers won’t think so, either. But if efforts of this kind were to succeed, the sad day might come when Science would have to add a firm caveat emptor to its instructions for peer reviewers.

2 comments February 21st, 2008

Open access now mandated at Harvard

Revere at Effect Measure reports that Harvard is now mandating that all faculty research in the School of Arts & Sciences be made available to the public immediately.

“The Harvard requirement mandates immediate free publication online in a Harvard hosted repository, searchable by Google and other search engines. Thus Harvard authors are not supposed to publish from now on in some extremely high profile journals like Nature and Science who prohibit fee access of papers for a period of time after publication. Whether these journals will publish Harvard papers under these conditions now is a question we don’t know the answer to. It could get very, very interesting.”

This is good news for Open Access, which I support in principle. But there  is a problem. Many of us do much of our research and writing without funding. Open Access generally works by having the authors pay. When there is a funded grant, this is fine. But for some of us in smaller institutions which won’t pay te cost, this is a disincentive. I imagine that scholars in third world countries will also have problems with cost. Some mechanism needs to be developed to distinguish between funded and non-funded research.

2 comments February 16th, 2008

Blast trauma may act at a distance

The new Science contains an important article on current thinking on traumatic brain injury (TBI) from bomb blasts:

Shell Shock Revisited: Solving the Puzzle of Blast Trauma

Even at a distance, explosions may cause lasting damage to the brain. Such findings could have big implications for arming and compensating troops

by Yudhijit Bhattacharjee

Working at the Military Hospital in Belgrade during the brutal Balkan war of the 1990s, neurologist Ibolja Cernak encountered a medical enigma. She saw soldier after soldier with memory deficits, dizziness, speech problems, and difficulties with decision-making–but no obvious injury. Cernak recalls one 19-year-old who went to a grocery store and began to weep after he couldn’t remember how to get back home. When his mother brought him to the hospital a few days later, Cernak learned what later emerged as a common element in all these cases: The soldier had survived an explosion on the battlefield.

The strange thing was that most of these patients had not suffered a direct injury to the head. And yet, in computed tomography and magnetic resonance imaging scans, Cernak saw signs of internal damage. In some cases, the brain’s ventricles–channels that carry cerebrospinal fluid– had become enlarged; and in some, there was evidence of minor bleeding.

But when Cernak dug into the medical literature for an explanation, she came up empty. According to the available research, shock waves from an explosion injure mainly air-filled organs such as the lung and the bowel, not the brain.

With a small band of collaborators in Belgrade, China, and Sweden, Cernak undertook animal studies that eventually confirmed that blast waves can cause neuronal damage. The work drew little attention until 2 years ago when hundreds of U.S. and British soldiers began returning from Iraq with symptoms similar to those of Cernak’s patients. As roadside explosions became more common, military doctors suspected that these symptoms were the likely result of mild traumatic brain injury (TBI) sustained in blasts. Seeing her observations borne out was as if “a myth had become reality,” says Cernak, who is now a researcher at the Applied Physics Laboratory at Johns Hopkins University in Baltimore, Maryland.

How blasts affect the brain has since become an urgent question in military medicine. Last summer, the U.S. Congress gave $150 million to the Department of Defense (DOD) for the first year of research on TBI– both severe injuries that damage the skull and milder ones suspected of causing neurological deficits. The Defense Advanced Research Projects Agency (DARPA) has already launched a $9 million research program aimed specifically at understanding trauma caused by shock waves, heat, and electromagnetic radiation emanating from blasts. Another $14 million a year is going to the Defense and Veterans Brain Injury Center (DVBIC), a DOD-funded agency headquartered in Washington, D.C., for research and outreach on TBI.

This flurry of interest has focused a spotlight on Cernak’s research. There is growing consensus that blasts can produce subtle injuries in the brain as suggested by Cernak several years ago. In fact, the Department of Veterans Affairs (VA) proposed a new rule this month acknowledging blast-related TBI as a special neurological condition whose symptoms may have gone undetected in the past. The proposed rule, published in the Federal Register on 3 January, would allow for greater disability compensation to victims than is granted currently.

But many researchers are skeptical of Cernak’s ideas about how these injuries might occur. Cernak postulates that blast waves ripple through the victim’s torso up into the brain through the major blood vessels, leading to neurological effects that can be slow to appear. Although she has evidence from animal experiments to back up that hypothesis, she admits that more research is needed. If the mechanism is confirmed by future studies, Cernak says, it would mean that helmets do not protect the brain against blast injury.

Besides raising questions about the protection of troops currently in combat, Cernak’s suggestion that simply being exposed to an explosion might lead to long-lasting brain damage has opened a Pandora’s box, particularly for veterans. It implies that some could be suffering from neurological deficits that went undiagnosed or were mistakenly attributed to posttraumatic stress disorder (PTSD). Indeed, since the government began putting out information about blast-related TBI, veterans have been trickling in to seek treatment for mental problems that some have lived with for decades. “It may well be that blast injuries follow the pattern of Agent Orange and Gulf War syndrome,” says former VA psychiatrist David Trudeau, referring to ill-defined health problems that have lingered for years after battle.

Hidden trauma

If Cernak had been a doctor during World War I, she says, she might well have recognized mild TBI among the thousands of soldiers who suffered from what was simply called “shell shock.” But during World War I, many doctors and military commanders viewed shell shock as a transient psychological phenomenon that affected soldiers who, in their opinion, were mentally weak.

Cernak discovered something very different: that soldiers’ mental problems seemed to be driven by enduring physical changes in the brain. To test her hypothesis, she conducted a study of 1300 patients who had suffered penetrating wounds to the lower body but not the head. More than half had suffered injuries in a blast; the rest had been wounded by projectiles. Many of the blast victims complained of symptoms such as insomnia, vertigo, and memory deficits, and more than 36% in this group showed irregular patterns of electrical activity in the brain–as measured by electroencephalograms taken within 3 days of the injury– compared to only 12% in the other group. A year later, 30% of blast- injured patients still showed abnormal brain activity compared to 4% of the rest. Cernak says the findings, published in the Journal of Trauma in 1999, suggested that the mental problems of blast victims had a biological basis.

Her study wasn’t the first to make that point. A year earlier, VA researchers had found that among veterans with PTSD, individuals with a history of blast exposure were much more likely than others to have abnormal brain activity as well as cognitive and behavioral problems.

“Our evidence pointed to the possibility that blast injury was a long- lasting injury in combat veterans,” says Trudeau, who retired in 2000. He says he was disappointed by the lack of follow-up to the study, published in the August 1998 Journal of Neuropsychiatry. “The reception we got was pretty lukewarm,” he says.

For decades, Army researchers had been studying the effects of blast waves but with a different focus. They concentrated on how to protect the lungs and bowel because the pressure from an explosion is most likely to shear at the interface of these tissues, where densities differ. DOD was so confident that advanced body armor was protecting troops against lung and bowel injuries that it closed down this research program in 2003. “We thought, why spend more money on this when we’ve fixed the problem?” says Geoffrey Ling, a neurologist and a program manager at DARPA.

Then the bad news arrived. As blast survivors from Iraq were air-lifted to hospitals, U.S. Army doctors, including Ling, who was deployed in Iraq in late 2004, began to see patients whose brains had swelled markedly within hours of being close to a blast. Some had clear head injuries but many did not. Even in cases involving visible wounds, the extent of swelling was often much greater than expected, leading neurosurgeons to wonder whether blast waves had played a role in addition to penetrating shrapnel. Ling says the patterns of vascular enlargement seen across a range of patients showed a continuum of brain injury, suggesting that there could be milder versions that were less obvious.

That suspicion has grown stronger with hundreds of soldiers returning from the war zone complaining of a common cluster of cognitive and behavioral problems. Army doctors say they have encountered many patients who are unable to perform simple addition and subtraction, read more than one sentence at a stretch, or recall simple things like what they had for lunch. “The majority are individuals who lost consciousness or were dazed after a blast but did not sustain overt head injuries,” says Ronald Riechers, a neurologist at Walter Reed Army Medical Center in Washington, D.C. “Within a short time frame, they develop headaches and notice that their reaction time and concentration are not the same as before.” Based on these evaluations, DVBIC estimates that 10% to 20% of all soldiers on duty in Iraq and Afghanistan have suffered some type of TBI.

Ling says the TBI numbers prompted DOD to restart its research on blast injury, this time with a focus on the brain. DARPA is funding two main projects as part of the first basic science effort on the topic. One will study the mechanical and cellular effects of blast waves in an animal model. Another will look at the consequences of repeated exposures to low-intensity explosions among military breachers, whose job is to blast holes into buildings using shoulder-launched weapons. “Once you know for certain what in a blast is really hurting the brain and how, you can use that to develop therapies and prevention strategies,” says Ling.

A tsunami in the brain

Although it is becoming accepted that blast waves can cause TBI, Cernak’s theory about how the damage occurs is controversial, and it has implications for how best to protect troops. She hypothesizes that when blast waves strike the body, they transfer kinetic energy and cause pressure in the main blood vessels to oscillate rapidly. A pulse travels up through the neck into the brain, damaging axonal fibers and neurons in the hippocampus, brainstem, and other structures close to cerebral vessels. The shock can also injure cells farther out in the cortical regions.

That mechanism is entirely different from the more widely studied effects of acceleration or deceleration in a car crash. Researchers know that a crash impact can shake the brain so violently that axonal fibers are torn. Some say victims of explosions could be experiencing a similar whiplashing, in contrast to Cernak’s view–which would mean that helmets designed to dampen that effect could help. “I am very skeptical that kinetic energy could be transferred through the vascular system,” says J. Clay Goodman, a neuropathologist at Baylor College of Medicine in Houston, Texas. “It is much more reasonable to consider the blast effects directly on the cranial vault and the brain.”

Cernak says her findings show the vascular route to be more plausible. In experiments that exposed rats and rabbits to a simulated blast wave in a shock tube–a cylinder through which an air pulse is transmitted at high velocity–Cernak and her colleagues found that immobilizing the animal’s head with steel plates to prevent whiplash effects did not protect against hippocampal cell damage, as they reported in the Journal of Trauma in 2001. Cernak says the vascular-transmission theory could explain the unique combination of symptoms in blast-induced TBI, as well as why neurological symptoms are seen in soldiers wearing helmets. For example, memory deficits hint at damage to the hippocampus, whereas problems in orientation reflect injuries to the cerebellum. “What’s happening in blast injury is that these inner structures are being affected,” Cernak says, in contrast to TBIs in traffic accidents and contact sports, where the cortex bears most of the brunt.

Cernak presented unpublished results last month at the Blast Injury Conference in Tampa, Florida, showing that exposure to blast waves can trigger neurodegeneration in rat brains, fragmenting the walls of neurons in the hippocampus and other regions. Similar findings have been published by Annette Saljo, a researcher at the University of Goteborg in Sweden and a collaborator of Cernak’s. Saljo and her colleagues reported in the Journal of Neurotrauma in August 2000 that rats exposed to blasts showed a buildup of neurofilament proteins in the cortex and the hippocampus during the week following the injury. This suggests that the damage can worsen over time, like a “slow cooking under the surface,” says Cernak: “One could think of it as a horribly accelerated aging of the brain.”

If blast waves indeed cause injury by vascular transmission, new types of body armor may be needed. “We would need to develop materials that completely absorb or reflect the full range of blast-wave frequencies generated by an explosion,” says Cernak, adding that current body armor only shields against some of a blast’s kinetic energy.

Cernak has done pioneering work, says John Povlishock, a neuroanatomist at Virginia Commonwealth University in Richmond, adding that she may be right that a “rapid rise and fall in venous pressure” is what stamps the blast’s signature on the brain. But more studies are needed to validate her ideas and translate the animal results into humans: “This is a topic with great economic, military, and social implications,” he says, “and as of now, the literature is extremely limited.”

Needed: A gold standard

As blast casualties from Iraq have mounted, the U.S. military has stepped up efforts to detect TBI among troops. In July 2006, the Army Surgeon General asked all unit commanders in Iraq to request TBI screening for soldiers displaying “poor marksmanship, delayed reaction times, decreased ability to concentrate, and inappropriate behavior.”
Troops who have been in a blast are evaluated by field medics using a short questionnaire that asks, among other things, if the person lost consciousness and had trouble remembering things from just before the explosion. Depending on the severity of the symptoms, they are asked to take a day off or see a neuropsychologist.

Some veterans groups believe a more aggressive screening policy is needed, especially because the symptoms of blast injury might not show up until later and because subtle injuries might not show up in standard brain scans. The ideal option, some say, would be to use a biomarker:

“We’d like to be able to do a blood test to determine the injury,” says Colonel Robert Labutta, a neurologist at the health affairs office at DOD. But until the science of blast injury is established, officials say, it does not make sense to bring home every soldier who has been in the vicinity of an explosion.

The costs of treating TBI victims from Iraq and Afghanistan could be astronomical. At last count, nearly 25,000 soldiers had been diagnosed with TBI. One estimate of the financial burden, calculated by Harvard researchers, puts the number at $14 billion over the next 20 years. But officials seem determined not to miss any cases among troops coming
home: In April, VA mandated TBI screening for all Iraq and Afghanistan veterans who come to VA hospitals for any services, even if it’s a dental exam.

The spotlight on mild TBI has drawn the attention of older combat veterans who were exposed to blasts but were never treated for neurological symptoms. Many were diagnosed with PTSD; some of the symptoms–such as depression, irritability, and attention deficit– overlap with those of mild TBI. These cases, some reaching back to the Vietnam War, could have significant legal and financial implications, says Edward Kim, a psychiatrist with Bristol-Myers Squibb in Plainsboro, New Jersey, and author of a recent report from the American Neuropsychiatric Association on the mental health effects of TBI. “I question whether DOD and the VA really want to open this can of worms,”
he says. For example, a veteran with Alzheimer’s disease could make a claim pointing to research showing that TBI increases the risk of developing Alzheimer’s disease.

Cernak says she has been receiving e-mails and phone calls from veterans thanking her for her research and seeking more information. Last month, she got a call from a 47-year-old woman who had served in the first Gulf War. The woman had been a teacher before she went to the combat zone, where she was exposed to repeated blasts. After she returned home, she had to stop teaching because she could not remember any facts. The story reminded Cernak why she had begun studying this obscure field 2 decades ago. “Soldiers anywhere are one of the most vulnerable populations in the world,” she says. “It is a moral obligation to help them.”

2 comments January 25th, 2008

Next Posts Previous Posts


Pages

Calendar

October 2008
M T W T F S S
« Sep    
 12345
6789101112
13141516171819
20212223242526
2728293031  

Posts by Month

Posts by Category