A Wired Society

Drugs to make you smarter, helmets to induce creativity, brain scans to convict people and mind findings in military warfare. We discuss how an explosion in neuroscience findings are making their way into education, art, the legal system and the battlefield.

In this episode, how a revolution in technology is bringing an unprecedented flood of information about the brain.  With this, concerns over use, including students buying memory boosting chemicals or smart drugs over the internet, hoping for this...

Barbara -   In a small 10% improvement in memory score could lead to a higher A level grade or degree class.

Hannah -   And how a 100-pound helmet, sending an electric stimulus through your scalp to your brain has been claimed to help with - well, almost anything...

Vince -   Mood, decision making, morality, anxiety, depression, mathematical learning, language, memory, autism, ADHD, Parkinson's disease etc.  Now either this is magic or we're not putting tough enough filters on the messages that we're giving out.

Hannah -   Alongside, brain scans to keep people in or out of jail and the military latching into the mind for warfare.  So, who's responsible for how these neuroscience findings are being employed?  Is it the government or misrepresentation by the press?

Vince -   I'll put it out there, for the first time in my experience, I think we're in an area where the hype is led by scientists.

Hannah -   As we develop new ways to peer into the brain, a flood of data is coming out.  A quick search for the keyword 'brain' on PubMed - the scientific online results library - reveals that there's been an explosion in brain-based publications.  The number of papers is doubling every 20 years.  Currently, a whopping 5,000 new results are out each month on the topic.  The press and marketing teams are leaping at the findings with the breaking headlines suggesting that you could swallow computer code and become a walking encyclopaedia.  So, buying neuro-drinks that help you fall asleep, wake up, or fall in love. 

I spoke with Barbara Sahakian, Professor of Psychiatry and Neuroethics at Cambridge University and Vince Walsh, Professor of Human Brain Research at University College London for their thoughts.

Barbara -   Well, there's not a big a problem than understanding our brains in health and disease.  It's terrific that we have this explosion of these new techniques that we can use in neuroscience, but we have to be aware of their effects on society and the implication - ethical implications of using these.  My own work has to do with cognitive enhancing drugs.  Now, we have an increasing lifestyle use of these drugs by healthy people.  And we have to ask how is that going to change our society and is this is a good thing or is it something we should be really concerned about.  So, it's very important that we actually discuss the way it will change our society and what the implications are for individuals.

Hannah -   And you're mentioning smart drugs or cognitive enhancers.  So, it's something like 1 in 10 students at Cambridge University for example are reporting that they get these drugs over the internet in order to try and help boost their grades.  And we're seeing increasing numbers of students that are even younger.  They may be 14 or 15 that maybe feeling the pressure of exams and are taking these pills to try and make them smarter.  Is there any scientific basis to these drugs.  Are there any possible side effects for these children in the future?

Barbara -   Well, that's the important thing because you don't know what will happen with the long term use of these drugs in healthy people and that's what I'm very concerned about.  I'm very concerned about internet buying because you don't know what you're buying is very dangerous way to get these prescription-only drugs.  But these smart drugs such as modafinil and also methylphenidate which is also known as Ritalin are being quite commonly used as you say.  I've been studying also, why are they being used.  Obviously, they're being used as you mentioned to get the competitive edge against other students where you want to get an improvement in your exam score.  So for instance, the academy of medical sciences in 2008 report pointed out that even a small 10% improvement in a memory score could lead to a higher A level grade or degree class.  They're also using them to counteract jetlag and to stay awake and alert.  But these other interesting reason that we found out recently that they're using them for is because they enhance a motivation.  So, for things that you were putting off and didn't want to do say, studying for your exams or writing a long essay paper, it makes doing that more interesting, more pleasurable.

Hannah -   Well, this all sounds very positive.  I mean, I'm tempted to get some now.  Is there any reason that I shouldn't?

Barbara -   Well, there are other ways we can boost our brain power.  We know that exercise is a very good way to boost our brain power and obviously, it's very good for your physique as well.  So, that will improve your mood and it will improve your cognition and improve your physique.  So, that's a brilliant thing to do and we know that exercise can actually increase neurogenesis - new cells in the hippocampus and a very important area of the brain for memory.  So, that's one thing we could do.  And also, new learning increases neurogenesis.  So, there's many other ways that we can actually boost our cognition and really, we should be working to do this rather than just taking pills.

Vince -   I think we also, going right back to what we're in universities for, getting good exam results isn't what the university or a school education is for.  It's about finding out what you love doing and developing your skills at that.  I'm right with Barbara.  I'm looking at lifestyle, where exercise, is the best way of improving your memory.  And overall health is taking control of your sleep regime, a better way of improving your memory and learning rather than looking for these short, quick fixes which have or may have hither to unknown side effects.  We really just don't know.

Hannah -   As well as the chemical ways that you can tweak your brain and your behaviour and boost your cognition, there's also other ways that you can stimulate yourself which I believe you're concerned about, Vince.

Vince -   Yeah.  There's a similar problem in the brain stimulation world.  I think what we've got is a problem of big data with the (papers) of advances in the neurosciences and the (papers) of the sheer numbers, the volumes of papers means that it's not a question of what we can measure.  It's a question of what we need to pay attention to and most, we measure what matters of what we're measuring.  There's a lot of measuring and a lot of attempts to manipulate the brain which might not really be fundamental.  They're just do'able.  I think that that distance between laboratory science and every day science because everybody can access everything now has really shrunk to a point where we haven't just got a scientific problem anymore.  We've got a data management problem, we've got a philosophical problem and we've got a problem that required scientists to think about how we address the public when we talk about our results. 

So in the brain stimulation field, there are two forms of brain stimulation.  I'm most concerned with transcranial magnetic stimulation which is a much more established area that's come down over the past few years and we're now consolidating on the things that it really can help things like depression.  But in another area of direct current stimulation, there are lots of claims of direct current stimulation helping mood, decision making, morality, anxiety, depression, mathematical learning, language, memory, autism, ADHD, Parkinson's disease, etc.  Now either this is magic or we're not putting tough enough filters on the messages that we're giving out and I think there's a scientific responsibility here that's more than just having to report our data as we see it.  We have to think about how this is going to be perceived by the public.  So, I think we have a philosophical problem as well as a problem with the sheer volume, the volume of stuff that we're putting out which we've never actually had before.  I think if we take a good look at ourselves in the mirror, we have to say that we have been blind sighted by the speed by our own progress, if it's progress.

Hannah -   So, the brain uses electricity in order to communicate and give our perception of the world around us and you can actually tweak people's behaviour using changes in electricity and scientists have been looking at how magnets and changes in the electricity can help particular patient groups.  Now, students are for example buying helmets over the internet for about 100 pounds, putting them on their head and then changing the electrical currents in their brains, thinking that that's going to increase their grades for example or help them in a particular way of thinking or behaving.  Is there any scientific basis to that or any worries that we should be aware of?

Vince -   A big no and a tiny yes.  This is a problem that the signal to know its ratio when there's so much data out there.  If people make claims about what direct current stimulation can do then members of the public will follow up on those claims.  But if we take a really close look at how big those claims are, just two examples both from recent papers that are random size of what's been making me angry in the past few weeks, one was a single case study of direct current stimulation showing that direct current stimulation could relieve anxiety.  Now, that's actually worthless.  It's not in the mould of classic neuropsychological case studies.  It's a pilot study on one subject that should've been followed up with a large group and a control group and control stimulations.  But it's there in the literature for anybody who wants to Google it, is DC stimulation good for anxiety?  It's that kind of irresponsibility that I think we have to watch out for. 

A second example, a study to assess the tolerance of direct current stimulation in children.  I think these were about 10 to 12 years old and the measure of tolerance was whether their parents at home observed that the children tolerated the daily stimulation well enough.  This is, I'm not ashamed to say, we're very nice to each other in science, we're very gentlemanly and we hid behind peer review, but this is unacceptable.  We really don't know what these currents do to the brain. 

I'll give you one example.  If these things might be doing something to the brain and if the very small millisecond effects that we observe in the laboratory can be translated into the real world then we really have to be much more careful than we are being in having parents assess whether children are okay or having single case studies.  But the second case, is it possible that these things are not doing anything to the brain?  I'll give you one example. 

Everything that we know about these techniques is based on how it affects a certain path of the brain called the motor cortex because we can measure how it makes the hand twitch.  Now, I can make your hand twitch and I can change its sensitivity, the part of the brain that controls it for up to 90 minutes and that makes a very nice paper.  I can control brain excitability for 90 minutes.  That's as long as you sit very still throughout my experiment for 90 minutes.  If you shake your hand like you're shaking out a pen for 10 seconds, all those effects of brain stimulation go away.  So, the probability of a 30-millisecond increase in your reaction time under laboratory conditions where you've been caffeine deprived, you've had a good night's sleep, you're only allowed to do it for an hour.  There's probability of that translating to a 17-year-old who's on his 4th kind of Redbull at 4:00 o'clock in the morning and is doing it because he really wants to win has got to be close to zero.  I don't know where to punch the hardest, whether it's to explain that these forms of brain stimulation are really unlikely to be doing anything or if they are doing anything then we really ought to be holding back and being a lot more responsible than we are.

Barbara -   I'd like to go back to an earlier point that Vince made because I do think it's very important.  And that's when we think about cognitive enhancement, we usually think about enhancing called cognitive tasks, the sort of planning, problem solving, the sorts of memory, that sort of thing.  But maybe we should think about it more generally when we're thinking about neuroscience in society and we're thinking about neuroethics.  Don't we want people to be more responsible people and to give back to society so that we do need to also look at some of these studies where we have cognitive enhancing drugs and how they might affect social cognition and behaviour towards each other?  There's very few studies in that area.  There are some, but not very many.  Again, going back to the fact that there are other ways to improve one's self other than through drugs, but it's another point.  So, I think really, we should be thinking more about what's our vision of society for the future and how do we want to obtain that and enhance ourselves in that way.

Hannah -   I suppose also another point is that although we're getting more information about how the brain works and how a behaviour is linked to the brain, we're not quite there, really understanding the fine level of tuning there. 

An example is oxytocin which is kind of the cuddle hormone which is being given internasally as a spray.  I shoved up couple's noses whilst their having a relationship therapy in order to try and make them bond and become closer and to try and help their relationship survive.  But one side effect that's been seen of oxytocin recently is that you will actually be more selfish in your group and actually, almost more racist or you won't want to interact with other groups within society.  So, there are some very worrying side effects and we're using this neuroscience, this very small neuroscience knowledge at the moment in the society. 

So, what's the answer then?  Should we be stricter with peer reviewing?  Should we not talk or engage with the public with some of the findings or the preliminary findings of the neuroscience?  Should we somehow monitor how these findings are being applied in the real world and promoted?  Who's fault is this and how do we solve it?

Vince -   So first of all, those couples deserve each other if they're going to go for this option!  Choosing hormones is a really good example of how a headline message gets out and the same is true for testosterone as well.  It's not a simple story that it makes you more competitive or brutal or any of those things.  There are many new effects about the hormones.  There are many effects of the drugs that we've been talking about and there are many effects of the forms of brain stimulation. 

So, I think we're in a very strange phase where I might be wrong, but I'll put it out there for the first time in my experience.  I think we're in an area where the hype is led by scientists.  That might be because we've been overtaken by the amounts of data that we've got and we don't want to do with it ourselves.  We're just people.  It might be because of the career structure in science now.  I don't know about you, but I certainly wouldn't like to be starting out back where I was 20 years ago.  Now in the current climate, it's just a much tougher world in terms of making a career.  So, the pressures on the scientists are much greater. 

Of course, we've got to communicate science.  I don't think science is completed.  Your work as a scientist is completed until you've actually communicated the science to the people who've paid for it, the tax payer.  But the challenge is how to give a new  message.  It's not just going to be a one-way traffic.  It's going to be a philosophical mindset shift that we need to think about.  Thinking about those questions, what is education for?  Is it just about getting better marks?  Do we just want to do things faster?  Do we just want to do things quicker.  Do we want to engage with things and think of improving in something as part of a personal journey and changing the way that we think about doing things?  There should be no embarrassment about scientists addressing those questions because we're at a stage now especially in cognitive neurosciences where our data is not in a moral vacuum and we have to deal with that.

Hannah -   Barbara...

Barbara -   Pick up both on your point, Hannah and also, Vince's point because I think they're very important and the initial studies with things like oxytocin and drugs like the SSRIs (selective serotonin reuptake inhibitors) like Prozac type drugs.  They got these effects on social behaviour, social interaction.  But I think what happened since then is they're being kind of refined and it now seems that it's very context dependent.  This very simple story that people were telling initially doesn't seem to hold.  And then that sort of brings in some of Vince's comments.  I think really, the answer is replication, replication by your own group and replication by other scientific groups.  And so obviously, these studies have to be of good quality, but also, they have to be replicated and hopefully, will go a bit further.  But I also think it's very exciting times because we do have this explosion of different techniques.  The public are very interested in the brain and they're very interested in proving themselves and enhancing themselves.  I think in general, this is a good thing.  We want to expand ourselves as people and develop in better ways, but maybe not just cognitively, maybe also socially in another regards because we might end up with a better world and less wars and things like that.  And there are these other techniques that we can use besides drugs.

Hannah -   What about the applications of neuroscience in the military for example?

Barbara -   Well of course, the military has been using stimulant drugs for some time - the amphetamines and Ritalin.  There may be certain groups of the population where you would want them to use drugs to keep themselves safe and perhaps their colleagues and the military may be one of these groups.  I also did a study with Lord Ara Darzi at Imperial College where he was looking at doctors who were sleep-deprived because he was concerned about surgeons taking excessive caffeine in the form of coffee to stay awake and alert at night while doing quite lengthy operations.  He was worried about the tremor as a side effect.  And so, he was wondering whether there was a safer, more effective cognitive enhancing drug to keep doctors awake and alert during lengthy operations.  So, we did look at the effects of modafinil and we found that they indeed showed better cognitive flexibilities so that they would be better at problem solving for instance.  And that they also showed less impulsive behaviour.  So, it did seem that in that group, there were these definite improvements.  So, one can think that there may be specific circumstances or specific populations where these drugs could be definitely of beneficial use.

Hannah -   And you said earlier Barbara, obviously, repetition with these studies is key before the NHS starts doling out these cognitive enhancers to all of their doctors to ensure that they don't get the shakes and also have very little attention during a long surgery.

Barbara -   Well also, there are other ways.  I mean now, we're doing a lot with cognitive training as well for our neuropsychiatric patients to boost their cognitive function and that can be very beneficial.  Again, combining that with new technology for instance in the form of games could be a very exciting way to go.  So, it isn't just drugs.  There are other ways that we can enhance cognitive function.

Hannah -   What about the applications of neuroscience first sports enhancement?  You were mentioning earlier Vince, that you can actually stimulate muscles in your hand by stimulating in an area of the brain called the motor cortex by electrically activating it.  So, could athletes just exercise their muscles by just activating particular areas of their brain?

Vince -   I think the long answer to that is no.  I think when people make suggestions of using things like brain stimulation for athletes or for soldiers or anybody with high performance.  And like a musician for example, what they'd be trying is a lack of knowledge about just what it is these people do, what the level of excellence that they do it, and how far away it is from the laboratory that we work in.  There's a deep sense in which brain science is often going to be behind what these people do rather than able to manipulate it because what we're asking our best athletes to do is to do something faster, higher, longer, more skilfully than anybody has ever done it before in history.  They have to go to deep dark places within themselves and trying extraordinarily hard, both body and mind to achieve these things.  I think it's almost disrespectful of people to - even when my friends publish their papers, suggesting those that we might have a role of brain stimulation in enhancing sports performance.  There's one area of sport where brain stimulation might have a role.  It's measuring let's say, cortical integrity in cases of concussion because it's a test that can't be faked for example.  We could look at the speed of cortico motor conduction time in athletes and track that overseas, but as an enhancement tool, philosophically, it's just wrong.  That's not what sports is about, but scientifically, I think it's a non-starter as well.

Hannah -   What about the potential applications for neuroscience in the legal setting?

Vince -   Let me give you an example that I overuse.  If we think about this table that we're sat up now, it's made of wood, but actually, it's mostly empty space because of the spacing of the particles in the matter.  That's true and it's interesting and it's poetic, and it's of absolutely no use whatsoever to a carpenter.  What we're doing in neuroscience is we're giving that atomistic description of the brain and cognition.  But in everyday life, we're in the position of the carpenter.  I think sometimes we get over excited about making that leap between the atomistic structure of things that we've got and the practical applications.  I think law is a good example of that.  So in the US at the moment, evidence from brain scans might be used when people, considering the sentencing of someone found guilty of a crime.  And recently, there has been a case I believe in which that led to contribute to somebody not being given the death sentence.  But that should worry us because that means in principle, the things that we say in neuroscientific journals and the way that we communicate to people and we could be called upon could contribute to somebody being given the death sentence.  So, it's not a game anymore.  There are deep issues.  And even if you're not ever going to be called upon to contribute to that type of debate, I think it's worth thinking that the flavour of the debate that we have with the general public and the way that we present our science has an impact on how that will be seen even by judges and juries.

Barbara -   I think these questions of neuroscience in society is just so important.  I mean, they're now being looked at very carefully by the European Human Brain project.  But also, President Obama has been very interested in how neuroscience is going to affect society.  Recently, within the International Neuroethics Society, we commented on the ethical considerations of neuroscience research and the application of neuroscience research findings for the study of bioethical issues.  So, they are very concerned about how neuroscience will be affecting society and how we'll be using it in the future.

Hannah -   Thanks to you, Barbara Sahakian, Professor of Psychiatry and Neuroethics at Cambridge University and Vince Walsh, Professor of Human Brain research at University College London.