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“Drugs and Society: The neuroethics of enhancing or erasing memories”

“Drugs and Society: The neuroethics of enhancing or erasing memories” was a provocative and timely workshop sponsored by the European Dana Alliance for the Brain and the International Neuroethics Society. It was held at the British Neuroscience Association 2013 Festival of Neuroscience in London. Following the presentations, the audience engaged the speakers with stimulating questions about personhood, the over-importance of productivity, drug influence on creativity, and the evolution of education.

Professor Barbara Sahakian set the stage by introducing the chief motivation for developing cognitive enhancers – the personal, social and economic costs of memory and cognitive difficulties in neurological and psychiatric disorders. She emphasized the importance of other common methods to boost brainpower, in particular education and physical exercise, and reviewed common pharmaceutical cognitive enhancers. Studies from Professor Sahakian’s lab have shown that pharmaceuticals can improve performance in cognitive laboratory tasks compared to placebo in individuals with psychiatric disorders (e.g., Scoriels et al., 2012). Importantly, enhancers can also improve performance in healthy individuals and even enhance task enjoyment (Muller et al., 2013). She cited evidence that 90% of modafinil is off label, and concluded by raising some potential cost-benefit considerations for use by healthy individuals.

Professor David Nutt reaffirmed that greater understanding of receptors can afford opportunities to target specific cognitive impairments, such as memory. He focused on the neurotransmitter gamma-Aminobutyric acid (GABA), specifically the alpha-5 subunit, which is preferentially expressed in the hippocampus. Pre-treatment of healthy individuals with a novel alpha-5 inverse agonist reduced alcohol-related forgetting without other functional or subjective impairments, thus protecting individuals from the amnestic effects of alcohol (Nutt et al., 2007). He then discussed ethical implications for normalization treatments, using the example of deafness, where not all patients or their care-givers desire treatment. He also touched on the potential for conflict between care-givers and society and the complexity of informed consent in vulnerable populations. Finally, whilst considering off-label use, Professor Nutt cautioned against extreme societal paternalism, as attempts to criminalize it could lead to greater harm than misuse (Hyman et al., 2012).

Professor Barry Everitt reviewed memory reconsolidation whereby when a memory is retrieved; it enters a labile state where new information can be introduced, before the memory restabilizes, to persist in its updated form. He stressed the aversive and appetitive nature of some memories and focused on disorders where emotionally laden memories contribute to impairment. Professor Everitt discussed preliminary work where administrating propranolol at memory reactivation in PTSD patients reduced physiological responses to subsequent retrieval of traumatic memories. Importantly, he stressed that administration at the wrong time may exacerbate symptoms by preventing extinction rather than reconsolidation. He then showed evidence that enhancing extinction within the reconsolidation window can be achieved behaviorally with a non-pharmacological method (super-extinction). Application in human heroin addicts recently showed diminished subsequent drug memory and cravings, which could assist in abstinence maintenance (Milton & Everitt, 2012).

Professor Judy Illes provided a provocative framework for the application of neuro-enhancers, or neuro-enablers. She classified enhancement into three overlapping dimensions: recreational use enhances societal interaction and allows cognitive and behavioural freedom, performance enhancement provides a competitive edge while clinical enhancement is therapeutic. She then discussed the desired effects, the motivation and strategies for use in each dimension, before providing a neuroethical analysis. Considerations for recreational enhancement included safety and developmental implications, whilst those for performance enhancement encompassed human values (e.g., choosing to forget the holocaust), and coercive use. Among clinical use considerations were the possibility of unwanted repercussions and the legal ramifications – if suffering were extracted from a rape victim’s memories, would the perpetrator be punished less harshly? Professor Illes concluded with reflections on cross-cultural issues and interactions between neuro-enablers. 

By Dr Sharon Morein-Zamir, Department of Psychiatry and the Behavioural and Clinical Neuroscience Institute, University of Cambridge

References

Illes J, Sahakian BJ (2011) Oxford Handbook of Neuroethics. Oxford University Press.

Hyman S, Volkow N, Nutt D (2013) Neuropharm. 64:8-12.

Milton AL, Everitt BJ (2012) Neurosci Biobehav Rev. 36:1119-39.

Muller U, Rowe JB, Rittman T, Lewis C, Robbins TW, Sahakian BJ (2013) Neuropharmacology. 64:490-95.

Nutt DJ, Besson M, Wilson SJ, Dawson GR, Lingford-Hughes AR (2007) Neuropharm. 53:810-20.

Scoriels L, Barnett JH, Soma PK, Sahakian BJ, Jones PB (2012) Psychopharm. 220:249-58.

Posted on 03/05/2013

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