Book Review: Hard Science, Hard Choices


Meeting notes from a neuroethics conference hardly seem like fodder for book club meetings, but Hard Science, Hard Choices by Sandra J. Ackerman (Dana Press, 2006, 174 pages) is likely to produce far more spirited discussion than the latest Oprah selection. Ackerman has rendered a readable summary of the discussion at an unusual meeting of experts in neuroscience, law, public policy, and philosophy; the meeting, held at the Library of Congress, discussed and debated a great variety of issues involving brain science and how progress in that field would soon be creating novel ethical dilemmas.

Fortunately for the lay reader, Hard Science, Hard Choices isn’t a verbatim transcript of these proceedings. Ackerman has neatly summarized the discussions in a very readable text. She manages to preserve the key elements of each topic and present them in a way that is clear and thought provoking. The expanding family of brain-altering drugs is one such topic. What is treatment, and what is enhancement? And when is it acceptable to take a drug purely for enhancement? Currently, some golfers and musicians take beta blockers to quiet the normal tremors in their hands. Another drug, tolcapone, has been found to improve cogitive performance on complex tasks. Stimulants used to treat conditions like ADHD have been shown to improve the performance of “normal” subjects when taking tests. Pharmaceutical companies are working on a host of drugs that alter the way the brain processes dopamine, seratonin, and other natural elements of brain chemistry. Very soon, we will be faced with a plethora of decisions as to what is “normal”, what is a condition that should be treated, and what types of pharmaceutical enhancement may be acceptable.

For those who think the ethics of enhancement drugs are simple, the book offers the interesting example of a not all that hypothetical drug that has been found to reduce tremors in a neurosurgeon’s hands and improve mental focus. Would individuals opposed to drugs used purely for enhancement prefer to be operated on by a neurosurgeon who didn’t use the drug, even if the statistics showed better outcomes for the “enhanced” doctors?

The increasing use of neuroimaging is covered in depth, with one key topic being the determination of consciousness. The contentious Terry Schiavo case, in which different family members for a comatose patient fought over the removal of life support, serves as a backdrop for this discussion. There may be as many as 15,000 patients in the U.S. alone who are in a persistent vegetative state (PVS), and as many in a minimally conscious state (MCS). Neuroscience in general and neuroimaging in particular is being called upon to determine the level of consciousness of these patients, and to assess the chances for a return to a conscious state.

The use of neuroimaging as a perfect lie detector is covered briefly. Some neuroscientists believe that certain areas of the brain are activated when telling the truth, and others when telling a lie. While published research may not fully support this conclusion, the ever-improving resolution of fMRI and other scanning technology, along with increased understanding of how the brain works, may lead to an effective lie detection technique in the future. Should such technology be employed if it can be demonstrated to be accurate? If so, under what circumstances?

Other topics include the use of powerful pharmaceuticals to treat misbehaving children, the use of deep brain stimulation with electrodes to treat medical and psychological conditions, and the use of neuroscreening to predict the future probability of violent behavior. This book is a quick read, but offers plenty of food for thought. If your book club is the least bit interested in medical and political topics, there are guaranteed to be a few issues raised in Hard Science, Hard Choices that will keep the members arguing long after the petit fours are gone.

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