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Daniels F, Torres E, Lawrenz F, Wolf SM, Shen FX. Scientists' perspectives on ethical issues in research with emerging portable neuroimaging technology: The need for guidance on ethical, legal, and societal implications (ELSI). NMR IN BIOMEDICINE 2024:e5243. [PMID: 39245924 DOI: 10.1002/nbm.5243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/23/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024]
Abstract
Deployment of new, more portable, and less costly neuroimaging technologies such as portable magnetoencephalography, electroencephalography, positron emission tomography, functional near-infrared spectroscopy, high-density diffuse optical tomography, and magnetic resonance imaging is advancing rapidly. Given this trajectory toward increasing use of neuroimaging outside the hospital, we sought to identify ethical, legal, and societal implications (ELSI) of these new technologies by understanding the perspectives of those scientists and engineers developing and implementing portable neuroimaging technologies in the United States, Europe, and Asia. Based on a literature review, we identified and contacted 19 potential interviewees and then conducted 11 semi-structured interviews in English by Zoom. Analysis of the interviews revealed key themes and ELSI issues. Developers reported that without proper ELSI guidance, portable and accessible neuroimaging technology could be misused, fail to comply with applicable regulation and policy, and ultimately fall short in its mission to provide neuroimaging for the world. Our interviews suggested that ELSI guidance should address differences between imaging modalities because they vary in capability, limitations, and likelihood of generating incidental findings.
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Affiliation(s)
- Frances Daniels
- Faegre Drinker Biddle & Reath LLP, Minneapolis, Minnesota, USA
| | | | | | - Susan M Wolf
- Law School, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Francis X Shen
- University of Minnesota, Minneapolis, Minnesota, USA
- MGH Center for Law, Brain & Behavior, Boston, Massachusetts, USA
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2
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White AJ, Kelly-Hedrick M, Miranda SP, Abdelbarr MM, Lázaro-Muñoz G, Pouratian N, Shen F, Nahed BV, Williamson T. Bioethics and Neurosurgery: An Overview of Existing and Emerging Topics for the Practicing Neurosurgeon. World Neurosurg 2024; 190:181-186. [PMID: 39004179 DOI: 10.1016/j.wneu.2024.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
Neurosurgery is a field with complex ethical issues. In this article, we aim to provide an overview of key and emerging ethical issues in neurosurgery with a focus on issues relevant to practicing neurosurgeons. These issues include those of informed consent, capacity, clinical trials, emerging neurotechnology, innovation, equity and justice, and emerging bioethics areas including community engagement and organizational ethics. We argue that bioethics can help neurosurgeons think about and address these issues, and, in turn, the field of bioethics can benefit from engagement by neurosurgeons. Several ideas for increasing engagement in bioethics are proposed.
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Affiliation(s)
- Alexandra J White
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Margot Kelly-Hedrick
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
| | - Stephen P Miranda
- Department of Neurosurgery, University of Pennsylvania, Pennsylvania, Pennsylvania, USA
| | | | | | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Francis Shen
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA; Harvard Law School, Cambridge, Massachusetts, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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3
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Hahn A, Lazar AA, Cernera S, Little S, Wang SS, Starr PA, Racine CA. Neuropsychological and social predictors of participation in a deep brain stimulation study of Parkinson's disease and dystonia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.29.24308133. [PMID: 38854092 PMCID: PMC11160823 DOI: 10.1101/2024.05.29.24308133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Objectives Participation is essential to DBS research, yet circumstances that affect diverse participation remain unclear. Here we evaluate factors impacting participation in an adaptive DBS study of Parkinson's disease (PD) and dystonia. Methods Twenty participants were implanted with a sensing-enabled DBS device (Medtronic Summit RC+S) that allows neural data streaming in naturalistic settings and encouraged to stream as much as possible for the first five months after surgery. Using standardized baseline data obtained through neuropsychological evaluation, we compared neuropsychological and social variables to streaming hours. Results Marital status and irritability significantly impacted streaming hours (estimate=136.7, bootstrapped ( b ) CI b =45.0 to 249.0, p b =0.016, and estimate=-95.1, CI b =-159.9 to -49.2, p b =0.027, respectively). These variables remained significant after multivariable analysis. Composite scores on verbal memory evaluations predicted the number of hours of data streamed (R 2 =0.284, estimate=67.7, CI b =20.1 to 119.9, p b =0.019). Discussion Verbal memory impairment, irritability, and lack of a caregiver may be associated with decreased participation. Further study of factors that impact research participation is critical to the sustained inclusion of diverse participants.
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Affiliation(s)
- Amelia Hahn
- University of California, San Francisco, Department of Neurological Surgery
| | - Ann A. Lazar
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Stephanie Cernera
- University of California, San Francisco, Department of Neurological Surgery
| | - Simon Little
- University of California, San Francisco, Department of Neurology
| | - Sarah S. Wang
- University of California, San Francisco, Department of Neurology
| | - Philip A. Starr
- University of California, San Francisco, Department of Neurological Surgery
| | - Caroline A. Racine
- University of California, San Francisco, Department of Neurological Surgery
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Higgins N, Gardner J, Wexler A, Kellmeyer P, O'Brien K, Carter A. Post-trial access to implantable neural devices: an exploratory international survey. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000262. [PMID: 38646454 PMCID: PMC11029395 DOI: 10.1136/bmjsit-2024-000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives Clinical trials of innovative neural implants are rapidly increasing and diversifying, but little is known about participants' post-trial access to the device and ongoing clinical care. This exploratory study examines common practices in the planning and coordination of post-trial access to neurosurgical devices. We also explore the perspectives of trial investigators on the barriers to post-trial access and ongoing care, as well as ethical questions related to the responsibilities of key stakeholder groups. Design setting and participants Trial investigators (n=66) completed a survey on post-trial access in the most recent investigational trial of a surgically implanted neural device they had conducted. Survey respondents predominantly specialized in neurosurgery, neurology and psychiatry, with a mean of 14.8 years of experience working with implantable neural devices. Main outcome measures Outcomes of interest included rates of device explantation during or at the conclusion of the trial (pre-follow-up) and whether plans for post-trial access were described in the study protocol. Outcomes also included investigators' greatest 'barrier' and 'facilitator' to providing research participants with post-trial access to functional implants and perspectives on current arrangements for the sharing of post-trial responsibilities among key stakeholders. Results Trial investigators reported either 'all' (64%) or 'most' (33%) trial participants had remained implanted after the end of the trial, with 'infection' and 'non-response' the most common reasons for explantation. When asked to describe the main barriers to facilitating post-trial access, investigators described limited funding, scarcity of expertise and specialist clinical infrastructure and difficulties maintaining stakeholder relationships. Notwithstanding these barriers, investigators overwhelmingly (95%) agreed there is an ethical obligation to provide post-trial access when participants individually benefit during the trial. Conclusions On occasions when devices were explanted during or at the end of the trial, this was done out of concern for the safety and well-being of participants. Further research into common practices in the post-trial phase is needed and essential to ethical and pragmatic discussions regarding stakeholder responsibilities.
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Affiliation(s)
- Nathan Higgins
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - John Gardner
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
| | - Anna Wexler
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Philipp Kellmeyer
- University of Mannheim School of Business Informatics and Mathematics, Mannheim, Baden-Württemberg, Germany
- Medical Center—University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Kerry O'Brien
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
| | - Adrian Carter
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
- School of Philosophical, Historical, and International Studies, Monash University, Clayton, Victoria, Australia
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Zhang KK, Matin R, Gorodetsky C, Ibrahim GM, Gouveia FV. Systematic review of rodent studies of deep brain stimulation for the treatment of neurological, developmental and neuropsychiatric disorders. Transl Psychiatry 2024; 14:186. [PMID: 38605027 PMCID: PMC11009311 DOI: 10.1038/s41398-023-02727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) modulates local and widespread connectivity in dysfunctional networks. Positive results are observed in several patient populations; however, the precise mechanisms underlying treatment remain unknown. Translational DBS studies aim to answer these questions and provide knowledge for advancing the field. Here, we systematically review the literature on DBS studies involving models of neurological, developmental and neuropsychiatric disorders to provide a synthesis of the current scientific landscape surrounding this topic. A systematic analysis of the literature was performed following PRISMA guidelines. 407 original articles were included. Data extraction focused on study characteristics, including stimulation protocol, behavioural outcomes, and mechanisms of action. The number of articles published increased over the years, including 16 rat models and 13 mouse models of transgenic or healthy animals exposed to external factors to induce symptoms. Most studies targeted telencephalic structures with varying stimulation settings. Positive behavioural outcomes were reported in 85.8% of the included studies. In models of psychiatric and neurodevelopmental disorders, DBS-induced effects were associated with changes in monoamines and neuronal activity along the mesocorticolimbic circuit. For movement disorders, DBS improves symptoms via modulation of the striatal dopaminergic system. In dementia and epilepsy models, changes to cellular and molecular aspects of the hippocampus were shown to underlie symptom improvement. Despite limitations in translating findings from preclinical to clinical settings, rodent studies have contributed substantially to our current knowledge of the pathophysiology of disease and DBS mechanisms. Direct inhibition/excitation of neural activity, whereby DBS modulates pathological oscillatory activity within brain networks, is among the major theories of its mechanism. However, there remain fundamental questions on mechanisms, optimal targets and parameters that need to be better understood to improve this therapy and provide more individualized treatment according to the patient's predominant symptoms.
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Affiliation(s)
- Kristina K Zhang
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafi Matin
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - George M Ibrahim
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
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Gouveia FV, Warsi NM, Suresh H, Matin R, Ibrahim GM. Neurostimulation treatments for epilepsy: Deep brain stimulation, responsive neurostimulation and vagus nerve stimulation. Neurotherapeutics 2024; 21:e00308. [PMID: 38177025 PMCID: PMC11103217 DOI: 10.1016/j.neurot.2023.e00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Epilepsy is a common and debilitating neurological disorder, and approximately one-third of affected individuals have ongoing seizures despite appropriate trials of two anti-seizure medications. This population with drug-resistant epilepsy (DRE) may benefit from neurostimulation approaches, such as vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). In some patient populations, these techniques are FDA-approved for treating DRE. VNS is used as adjuvant therapy for children and adults. Acting via the vagus afferent network, VNS modulates thalamocortical circuits, reducing seizures in approximately 50 % of patients. RNS uses an adaptive (closed-loop) system that records intracranial EEG patterns to activate the stimulation at the appropriate time, being particularly well-suited to treat seizures arising within eloquent cortex. For DBS, the most promising therapeutic targets are the anterior and centromedian nuclei of the thalamus, with anterior nucleus DBS being used for treating focal and secondarily generalized forms of DRE and centromedian nucleus DBS being applied for treating generalized epilepsies such as Lennox-Gastaut syndrome. Here, we discuss the indications, advantages and limitations of VNS, DBS and RNS in treating DRE and summarize the spatial distribution of neuroimaging observations related to epilepsy and stimulation using NeuroQuery and NeuroSynth.
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Affiliation(s)
| | - Nebras M Warsi
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hrishikesh Suresh
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafi Matin
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George M Ibrahim
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Hurley ME, Sonig A, Herrington J, Storch EA, Lázaro-Muñoz G, Blumenthal-Barby J, Kostick-Quenet K. Ethical considerations for integrating multimodal computer perception and neurotechnology. Front Hum Neurosci 2024; 18:1332451. [PMID: 38435745 PMCID: PMC10904467 DOI: 10.3389/fnhum.2024.1332451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Background Artificial intelligence (AI)-based computer perception technologies (e.g., digital phenotyping and affective computing) promise to transform clinical approaches to personalized care in psychiatry and beyond by offering more objective measures of emotional states and behavior, enabling precision treatment, diagnosis, and symptom monitoring. At the same time, passive and continuous nature by which they often collect data from patients in non-clinical settings raises ethical issues related to privacy and self-determination. Little is known about how such concerns may be exacerbated by the integration of neural data, as parallel advances in computer perception, AI, and neurotechnology enable new insights into subjective states. Here, we present findings from a multi-site NCATS-funded study of ethical considerations for translating computer perception into clinical care and contextualize them within the neuroethics and neurorights literatures. Methods We conducted qualitative interviews with patients (n = 20), caregivers (n = 20), clinicians (n = 12), developers (n = 12), and clinician developers (n = 2) regarding their perspective toward using PC in clinical care. Transcripts were analyzed in MAXQDA using Thematic Content Analysis. Results Stakeholder groups voiced concerns related to (1) perceived invasiveness of passive and continuous data collection in private settings; (2) data protection and security and the potential for negative downstream/future impacts on patients of unintended disclosure; and (3) ethical issues related to patients' limited versus hyper awareness of passive and continuous data collection and monitoring. Clinicians and developers highlighted that these concerns may be exacerbated by the integration of neural data with other computer perception data. Discussion Our findings suggest that the integration of neurotechnologies with existing computer perception technologies raises novel concerns around dignity-related and other harms (e.g., stigma, discrimination) that stem from data security threats and the growing potential for reidentification of sensitive data. Further, our findings suggest that patients' awareness and preoccupation with feeling monitored via computer sensors ranges from hypo- to hyper-awareness, with either extreme accompanied by ethical concerns (consent vs. anxiety and preoccupation). These results highlight the need for systematic research into how best to implement these technologies into clinical care in ways that reduce disruption, maximize patient benefits, and mitigate long-term risks associated with the passive collection of sensitive emotional, behavioral and neural data.
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Affiliation(s)
- Meghan E. Hurley
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Anika Sonig
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - John Herrington
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry and Behavioral Sciences, Massachusetts General Hospital, Boston, MA, United States
| | | | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
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Milford SR, Shaw D, Starke G. Playing Brains: The Ethical Challenges Posed by Silicon Sentience and Hybrid Intelligence in DishBrain. SCIENCE AND ENGINEERING ETHICS 2023; 29:38. [PMID: 37882881 PMCID: PMC10602981 DOI: 10.1007/s11948-023-00457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
The convergence of human and artificial intelligence is currently receiving considerable scholarly attention. Much debate about the resulting Hybrid Minds focuses on the integration of artificial intelligence into the human brain through intelligent brain-computer interfaces as they enter clinical use. In this contribution we discuss a complementary development: the integration of a functional in vitro network of human neurons into an in silico computing environment.To do so, we draw on a recent experiment reporting the creation of silico-biological intelligence as a case study (Kagan et al., 2022b). In this experiment, multielectrode arrays were plated with stem cell-derived human neurons, creating a system which the authors call DishBrain. By embedding the system into a virtual game-world, neural clusters were able to receive electrical input signals from the game-world and to respond appropriately with output signals from pre-assigned motor regions. Using this design, the authors demonstrate how the DishBrain self-organises and successfully learns to play the computer game 'Pong', exhibiting 'sentient' and intelligent behaviour in its virtual environment.The creation of such hybrid, silico-biological intelligence raises numerous ethical challenges. Following the neuroscientific framework embraced by the authors themselves, we discuss the arising ethical challenges in the context of Karl Friston's Free Energy Principle, focusing on the risk of creating synthetic phenomenology. Following the DishBrain's creator's neuroscientific assumptions, we highlight how DishBrain's design may risk bringing about artificial suffering and argue for a congruently cautious approach to such synthetic biological intelligence.
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Affiliation(s)
- Stephen R Milford
- Department of Theology, North-West University, Potchefstroom, South Africa.
- Institute for Biomedical Ethics, Basel University, Basel, Switzerland.
| | - David Shaw
- Institute for Biomedical Ethics, Basel University, Basel, Switzerland
- Maastricht University, Maastricht, Netherlands
| | - Georg Starke
- College of Humanities, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
- Munich School of Philosophy, Munich, Germany
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Sabé M, Sulstarova A, Chen C, Hyde J, Poulet E, Aleman A, Downar J, Brandt V, Mallet L, Sentissi O, Nitsche MA, Bikson M, Brunoni AR, Cortese S, Solmi M. A century of research on neuromodulation interventions: A scientometric analysis of trends and knowledge maps. Neurosci Biobehav Rev 2023; 152:105300. [PMID: 37392815 DOI: 10.1016/j.neubiorev.2023.105300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Interest in neurostimulation interventions has significantly grown in recent decades, yet a scientometric analysis objectively mapping scientific knowledge and recent trends remains unpublished. Using relevant keywords, we conducted a search in the Web of Science Core Collection on September 23, 2022, retrieving a total of 47,681 documents with 987,979 references. We identified two prominent research trends: 'noninvasive brain stimulation' and 'invasive brain stimulation.' These methods have interconnected over time, forming a cluster focused on evidence synthesis. Noteworthy emerging research trends encompassed 'transcutaneous auricular vagus nerve stimulation,' 'DBS/epilepsy in the pediatric population,' 'spinal cord stimulation,' and 'brain-machine interface.' While progress has been made for various neurostimulation interventions, their approval as adjuvant treatments remains limited, and optimal stimulation parameters lack consensus. Enhancing communication between experts of both neurostimulation types and encouraging novel translational research could foster further development. These findings offer valuable insights for funding agencies and research groups, guiding future directions in the field.
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Affiliation(s)
- Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
| | - Adi Sulstarova
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, USA
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Emmanuel Poulet
- Centre Hospitalier Le Vinatier, Bron, France; INSERM, U1028, CNRS, UMR5292, France; University Lyon 1, F-69000 Villeurbanne, France; Lyon Neuroscience Research Center, PSYR2 Team, F-69000 Lyon, France; Université Jean Monnet Saint Etienne, F-42000, France; Psychiatric Emergency Service, Hospices Civils de Lyon, F-69005 Lyon, France
| | - André Aleman
- University of Groningen, Department of Biomedical Sciences of Cells & Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Jonathan Downar
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Luc Mallet
- Univ Paris-Est Créteil, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France; Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Paris, France; Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Michael A Nitsche
- Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - André Russowsky Brunoni
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Zuk P, Sanchez CE, Kostick-Quenet K, Muñoz KA, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Outram S, Koenig BA, McGuire AL, Lázaro-Muñoz G. Researcher Views on Changes in Personality, Mood, and Behavior in Next-Generation Deep Brain Stimulation. AJOB Neurosci 2023; 14:287-299. [PMID: 35435795 PMCID: PMC9639000 DOI: 10.1080/21507740.2022.2048724] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself.
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11
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Bluhm R, Sipahi ED, Achtyes ED, McCright AM, Cabrera LY. Stakeholders' Ethical Concerns Regarding Psychiatric Electroceutical Interventions: Results from a US Nationwide Survey. AJOB Empir Bioeth 2023; 15:11-21. [PMID: 37343219 PMCID: PMC10733552 DOI: 10.1080/23294515.2023.2224592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders' perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI). METHODS We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs. RESULTS Participants' ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies. CONCLUSIONS To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs.
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Affiliation(s)
- R Bluhm
- Philosophy and Lyman Briggs College, Michigan State University, East Lansing, MI, USA
| | - E D Sipahi
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - E D Achtyes
- School of Human Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - A M McCright
- Sociology, Michigan State University, East Lansing, MI, USA
| | - L Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
- Rock Ethics Institute, The Pennsylvania State University, University Park, PA, USA
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Asher R, Hyun I, Head M, Cosgrove GR, Silbersweig D. Neuroethical implications of focused ultrasound for neuropsychiatric illness. Brain Stimul 2023; 16:806-814. [PMID: 37150289 DOI: 10.1016/j.brs.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND MR-guided focused ultrasound is a promising intervention for treatment-resistant mental illness, and merits contextualized ethical exploration in relation to more extensive ethical literature regarding other psychosurgical and neuromodulation treatment options for this patient population. To our knowledge, this topic has not yet been explored in the published literature. OBJECTIVE The purpose of this paper is to review and discuss in detail the neuroethical implications of MR-guided focused ultrasound for neuropsychiatric illness as an emerging treatment modality. METHODS Due to the lack of published literature on the topic, the approach involved a detailed survey and review of technical and medical literature relevant to focused ultrasound and established ethical issues related to alternative treatment options for patients with treatment-resistant, severe and persistent mental illness. The manuscript is structured according to thematic and topical findings. RESULTS This technology has potential benefits for patients suffering with severe mental illness, compared with established alternatives. The balance of technical, neuroscientific and clinical considerations should inform ethical deliberations. The nascent literature base, nuances in legal classification and permissibility depending upon jurisdiction, influences of past ethical issues associated with alternative treatments, tone and framing in media articles, and complexity of clinical trials all influence ethical assessment and evaluations of multiple stakeholders. Recommendations for future research are provided based on these factors. CONCLUSION Salient ethical inquiry should be further explored by researchers, clinicians, and ethicists in a nuanced manner methodologically, one which is informed by past and present ethical issues related to alternative treatment options, broader psychiatric treatment frameworks, pragmatic implementation challenges, intercultural considerations, and patients' ethical concerns.
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Affiliation(s)
- Rachel Asher
- Brigham and Women's Hospital/Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA.
| | - Insoo Hyun
- Center for Bioethics at Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
| | - Mitchell Head
- Te Kotahi Research Institute/University of Waikato, Gate 4C, 194H Hillcrest Rd, Hillcrest, Hamilton, 3216, Aotearoa, New Zealand.
| | - G Rees Cosgrove
- Brigham and Women's Hospital/Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA.
| | - David Silbersweig
- Brigham and Women's Hospital/Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA.
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13
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Smith AP, Taiclet L, Ebadi H, Levy L, Weber M, Caruso EM, Pouratian N, Feinsinger A. "They were already inside my head to begin with": Trust, Translational Misconception, and Intraoperative Brain Research. AJOB Empir Bioeth 2023; 14:111-124. [PMID: 36137012 PMCID: PMC10030379 DOI: 10.1080/23294515.2022.2123869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Patients undergoing invasive neurosurgical procedures offer researchers unique opportunities to study the brain. Deep brain stimulation patients, for example, may participate in research during the surgical implantation of the stimulator device. Although this research raises many ethical concerns, little attention has been paid to basic studies, which offer no therapeutic benefits, and the value of patient-participant perspectives.Methods: Semi-structured interviews were conducted with fourteen individuals across two studies who participated in basic intraoperative research during their deep brain stimulator surgery. Interviews explored interpretations of risks and benefits, enrollment motivations, and experiences of participating in awake brain research. Reflexive thematic analysis was conducted.Results: Seven themes were identified from participant narratives, including robust attitudes of trust, high valuations of basic science research, impacts of the surgical context, and mixed experiences of participation.Conclusion: We argue that these narratives raise the potential for a translational misconception and motivate intraoperative re-consent procedures.
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Affiliation(s)
- Ally Peabody Smith
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Lauren Taiclet
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Hamasa Ebadi
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, United States
| | - Liliana Levy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Megan Weber
- Anderson School of Management, University of California, Los Angeles, United States
| | - Eugene M. Caruso
- Anderson School of Management, University of California, Los Angeles, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, United States
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
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14
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Artificial Intelligence in Deep Brain Stimulation: A Brief Review. Neuromodulation 2023. [DOI: 10.5812/ipmn-134133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
: Deep brain stimulation (DBS) is a surgically-based treatment for advanced Parkinson’s disease (PD) that has undergone technological developments. Artificial intelligence (AI) has been used successfully in many healthcare problems, including DBS. Indeed, DBS method is expected to change with the increasing growth of artificial intelligence, especially machine learning methods. So here we explore how AI can improve the results of DBS treatment.
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Sankary LR, Zelinsky M, Machado A, Rush T, White A, Ford PJ. Exit from Brain Device Research: A Modified Grounded Theory Study of Researcher Obligations and Participant Experiences. AJOB Neurosci 2022; 13:215-226. [PMID: 34255614 PMCID: PMC10570922 DOI: 10.1080/21507740.2021.1938293] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices.
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16
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Lázaro-Muñoz G, Pham MT, Muñoz KA, Kostick-Quenet K, Sanchez CE, Torgerson L, Robinson J, Pereira S, Outram S, Koenig BA, Starr PA, Gunduz A, Foote KD, Okun MS, Goodman W, McGuire AL, Zuk P. Post-trial access in implanted neural device research: Device maintenance, abandonment, and cost. Brain Stimul 2022; 15:1029-1036. [PMID: 35926784 PMCID: PMC9588741 DOI: 10.1016/j.brs.2022.07.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Clinical trial participants who benefit from experimental neural devices for the treatment of debilitating and otherwise treatment-resistant conditions are generally not ensured continued access to effective therapy or maintenance of devices at the conclusion of trials. OBJECTIVE/HYPOTHESIS Post-trial obligations have been extensively examined in the context of drug trials, but there has been little empirical examination of stakeholder perspectives regarding these obligations in the rapidly growing field of neural device research. METHODS This study examined the perspectives of 44 stakeholders (i.e., 23 researchers and 21 patient-participants) involved in implantable neural device trials. RESULTS Researchers were concerned about current post-trial management, identified barriers like cost, and suggested ways to improve the system. Many patient-participants were unaware of whether they would have post-trial access, but most thought they should keep devices if beneficial, and agreed with researchers that more should be done to help them keep and maintain these neural devices. CONCLUSION To our knowledge, this is the first in-depth examination of researcher perspectives regarding continued access to experimental neural devices and only the second such examination of patient-participant perspectives. These data can help inform future ethical and policy decisions about post-trial access to implantable neurotechnology.
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Affiliation(s)
- Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States.
| | - Michelle T Pham
- Center for Bioethcis and Social Justice, College of Human Medicine, Michigan State University, East Fee Hall 965 Wilson Road Rm A-126, East Lansing, MI, 48824, United States
| | - Katrina A Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Clarissa E Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Jill Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Simon Outram
- Program in Bioethics, University of California, 490 Illinois Street, San Francisco, CA, 94143, United States
| | - Barbara A Koenig
- Program in Bioethics, University of California, 490 Illinois Street, San Francisco, CA, 94143, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States; Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Biomedical Science Building, JG56, Gainesville, FL, 32611, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States
| | - Wayne Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd Suite E4.100, Houston, TX, 77030, United States
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Peter Zuk
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States
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Kostick-Quenet K, Kalwani L, Koenig B, Torgerson L, Sanchez C, Munoz K, Hsu RL, Sierra-Mercado D, Robinson JO, Outram S, Pereira S, McGuire A, Zuk P, Lazaro-Munoz G. Researchers' Ethical Concerns About Using Adaptive Deep Brain Stimulation for Enhancement. Front Hum Neurosci 2022; 16:813922. [PMID: 35496073 PMCID: PMC9050172 DOI: 10.3389/fnhum.2022.813922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
The capacity of next-generation closed-loop or adaptive deep brain stimulation devices (aDBS) to read (measure neural activity) and write (stimulate brain regions or circuits) shows great potential to effectively manage movement, seizure, and psychiatric disorders, and also raises the possibility of using aDBS to electively (non-therapeutically) modulate mood, cognition, and prosociality. What separates aDBS from most neurotechnologies (e.g. transcranial stimulation) currently used for enhancement is that aDBS remains an invasive, surgically-implanted technology with a risk-benefit ratio significantly different when applied to diseased versus non-diseased individuals. Despite a large discourse about the ethics of enhancement, no empirical studies yet examine perspectives on enhancement from within the aDBS research community. We interviewed 23 aDBS researchers about their attitudes toward expanding aDBS use for enhancement. A thematic content analysis revealed that researchers share ethical concerns related to (1) safety and security; (2) enhancement as unnecessary, unnatural or aberrant; and (3) fairness, equality, and distributive justice. Most (70%) researchers felt that enhancement applications for DBS will eventually be technically feasible and that attempts to develop such applications for DBS are already happening (particularly for military purposes). However, researchers unanimously (100%) felt that DBS ideally should not be considered for enhancement until researchers better understand brain target localization and functioning. While many researchers acknowledged controversies highlighted by scholars and ethicists, such as potential impacts on personhood, authenticity, autonomy and privacy, their ethical concerns reflect considerations of both gravity and perceived near-term likelihood.
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Affiliation(s)
- Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Lavina Kalwani
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Rice University, Houston, TX, United States
| | - Barbara Koenig
- Anthropology & Bioethics Department of Social & Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, United States
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Clarissa Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Katrina Munoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Rebecca L. Hsu
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Demetrio Sierra-Mercado
- Department of Anatomy & Neurobiology School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Jill Oliver Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Simon Outram
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Amy McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Peter Zuk
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
| | - Gabriel Lazaro-Munoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Kostick-Quenet KM, Lang B, Dorfman N, Blumenthal-Barby JS. A Call for Behavioral Science in Embedded Bioethics. PERSPECTIVES IN BIOLOGY AND MEDICINE 2022; 65:672-679. [PMID: 36468396 PMCID: PMC10203975 DOI: 10.1353/pbm.2022.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Bioethicists today are taking a greater role in the design and implementation of emerging technologies by "embedding" within the development teams and providing their direct guidance and recommendations. Ideally, these collaborations allow ethical considerations to be addressed in an active, iterative, and ongoing process through regular exchanges between ethicists and members of the technological development team. This article discusses a challenge to this embedded ethics approach-namely, that bioethical guidance, even if embraced by the development team in theory, is not easily actionable in situ. Many of the ethical problems at issue in emerging technologies are associated with preexisting structural, socioeconomic, and political factors, making compliance with ethical recommendations sometimes less a matter of choice and more a matter of feasibility. Moreover, incentive structures within these systemic factors maintain them against reform efforts. The authors recommend that embedded bioethicists utilize principles from behavioral science (such as behavioral economics) to better understand and account for these incentive structures so as to encourage the ethically responsible uptake of technological innovations.
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Pham MT, Lázaro-Muñoz G. Trust in Neuroethics. AJOB Neurosci 2022; 13:33-35. [PMID: 34931948 PMCID: PMC9930138 DOI: 10.1080/21507740.2021.2001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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21
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Kostick K, Zuk P, Lázaro-Muñoz G. Operationalizing Agency in Brain Computer Interface (BCI) Research. AJOB Neurosci 2021; 12:203-205. [PMID: 33960895 DOI: 10.1080/21507740.2021.1904052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Zuk P, Sanchez CE, Kostick K, Torgerson L, Muñoz KA, Hsu R, Kalwani L, Sierra-Mercado D, Robinson JO, Outram S, Koenig BA, Pereira S, McGuire AL, Lázaro-Muñoz G. Researcher Perspectives on Data Sharing in Deep Brain Stimulation. Front Hum Neurosci 2021; 14:578687. [PMID: 33424563 PMCID: PMC7793701 DOI: 10.3389/fnhum.2020.578687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/16/2020] [Indexed: 01/21/2023] Open
Abstract
The expansion of research on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises important neuroethics and policy questions related to data sharing. However, there has been little empirical research on the perspectives of experts developing these technologies. We conducted semi-structured, open-ended interviews with aDBS researchers regarding their data sharing practices and their perspectives on ethical and policy issues related to sharing. Researchers expressed support for and a commitment to sharing, with most saying that they were either sharing their data or would share in the future and that doing so was important for advancing the field. However, those who are sharing reported a variety of sharing partners, suggesting heterogeneity in sharing practices and lack of the broad sharing that would reflect principles of open science. Researchers described several concerns and barriers related to sharing, including privacy and confidentiality, the usability of shared data by others, ownership and control of data (including potential commercialization), and limited resources for sharing. They also suggested potential solutions to these challenges, including additional safeguards to address privacy issues, standardization and transparency in analysis to address issues of data usability, professional norms and heightened cooperation to address issues of ownership and control, and streamlining of data transmission to address resource limitations. Researchers also offered a range of views on the sensitivity of neural activity data (NAD) and data related to mental health in the context of sharing. These findings are an important input to deliberations by researchers, policymakers, neuroethicists, and other stakeholders as they navigate ethics and policy questions related to aDBS research.
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Affiliation(s)
- Peter Zuk
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Clarissa E Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Kristin Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Katrina A Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Rebecca Hsu
- Evans School of Public Policy and Governance, University of Washington, Seattle, WA, United States
| | - Lavina Kalwani
- Department of Biosciences, Rice University, Houston, TX, United States
| | - Demetrio Sierra-Mercado
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States.,Department of Anatomy and Neurobiology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Simon Outram
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, United States
| | - Barbara A Koenig
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
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