Archive for May, 2013
The identification of risk for serious mental illnesses: Clinical and ethical challenges
Posted by Karen Rommelfanger in mental health on May 31, 2013
*This post was originally featured on The Neuroethics Blog as part of the AJOB Neuroscience series
By Elaine Walker, Ph.D., Sandy Goulding, MPH, MA., Arthur Ryan, MA., Carrie Holtzman, MA., Allison MacDonald, MA.
Elaine Walker is Samuel Candler Dobbs Professor of Psychology and Neuroscience in the Department of Psychology at Emory University. She leads a research laboratory that is funded by the National Institute of Mental Health to study risk factors for major mental illness. Her research is focused on child and adolescent development and the brain changes that are associated with adolescence.
The identification of risk factors for illness is receiving increased attention in all fields of medicine, especially cardiology, oncology, neurology and psychiatry. There are three potential benefits to identifying risk factors. The first is to reduce morbidity by reducing risk exposure. The second is to enhance opportunities for targeting preventive treatment toward those who are most likely to benefit. Finally, the identification of risk factors can shed light on pathological mechanisms.
There are, of course, costs as well as benefits involved in this endeavor. The benefits, in terms of reducing morbidity and mortality, are noncontroversial. The costs, however, can be very controversial and they have generated discussion among ethicists. Foremost among the costs is the potential discomfort and distress that results from the identification of an individual as being at statistical risk for future illness. There are also significant concerns about whether treatment should be initiated prior to the manifestation of symptoms that reach clinical threshold. These concerns are especially salient in the field of psychiatry. In this post, we discuss current efforts to identify risk factors for serious mental illness and the ethical considerations they raise.
Dr. Grace Lee’s interview with Adrian Owen
Posted by Caitlin McCoyd in consciousness on May 27, 2013
I visited Western University in London, Ontario during the middle of their snowy winter in February 2013. The purpose of my visit was to meet Dr. Adrian Owen, a neuroscientist and Canada Excellence Research Chair in Cognitive Neuroscience and Imaging, laid the groundwork for leading-edge research showing residual brain function in brain-injury patients who are unconscious. My first conversation with Dr. Owen was on the telephone when he was interviewing me as a candidate for my current postdoctoral fellow position. I work in close collaboration with Dr. Owen for my research on neuroimaging and disordered states of conscious at the National Core for Neuroethics in Vancouver. From my diligent background reading on Dr. Owen, I began to appreciate him for his accomplishments as an international (British) scholar and as a celebrity scientist. Needless to say, I went from feeling nervous planning my visit to being star struck at our first handshake. My anxiety dissolved when I saw how approachable and unassuming he was. Here I will share my conversation with Dr. Adrian Owen.
Can you describe the direction of your research from the beginning?
I started my academic life as a neuropsychologist. As an undergraduate, I was very fascinated by the whole idea that you could work out what a particular part of the brain does by examining a patient who has lost that function in that particular part of the brain and working out what they can’t do – and that is the central of neuropsychology. Read the rest of this entry »
Meet a member: Dr. Grace Lee
Posted by Caitlin McCoyd in consciousness on May 22, 2013
I am a clinical neuroscience project director of the National Core for Neuroethics at the University of British Columbia, and entrepreneur in internet marketing. My primary affiliation is with the division of Neurology in the department of Medicine, but I also have an affiliation with the University of Edinburgh where I did the first part of my graduate training. I am the current leader of the Neuroethics Affinity Group for the American Society of Bioethics and Humanities, and I serve on the Communications Board of the International Neuroethics Society. My research examines issues in clinical ethics in the context of medical neuroimaging for patients with traumatic brain injury. My expertise focuses largely on assessing novel applications of brain imaging technology as diagnostic tools or predictors of patient prognosis.
My Journey into Neuroethics from Beyond
I graduated from my PhD last May, and then I started working in neuroethics in my current position last June. So this field is still new to me, as my one-year work anniversary will be this summer!
My prior expertise was in neurodegenerative diseases like ALS and associated movement disorders along the spectrum of motor neuron diseases. I liked working in basic science during my PhD. I spent my doctoral training exploring the causes and molecular mechanisms of motor neuron death in ALS. I also looked at the potential for environmental influences on the onset and progression of ALS. My project used the mSOD1 mouse model of ALS to see if environmental factors can interact with genetic predisposition to the disease, and to delineate the directionality of motor neuron death.
Throughout that time, I developed an insatiable desire to be involved in more than basic science. I grew passionate about pursuing a domain that had direct clinical applications with a high impact on health care. I spent many hours in a dark room with a microscope counting, measuring, and photographing fluorescent cells. All my work was on such a minuscule scale, and as time progressed I was yearning to see the big picture. I started to wonder what I was doing here, how my work could possibly translate to health care, to better the human condition, to put a significant dent in our lack of knowledge.
Then I saw a job posting for a project lead at the National Core for Neuroethics and I jumped at the opportunity. At that time, I had never heard of neuroethics, and as I delved into the literature it grew on me. I quickly appreciated the newness of the field, its moral direction and applicability to improve health care. I also love the fact that there is a component of this work that involves connecting with people: health care professionals, researchers, the mass public, and even patients and their families.
To my delight, I was chosen for this position out of all the other applicants despite my unfamiliarity to clinical ethics. I was enthusiastic to accept the challenge of tackling the steep learning curve that accompanied my re-specialization, and completed a summer certification course in clinical ethics at the University of Washington where I met Al Jonsen and Bill Winslade.
I settled happily into my new role and I’m satisfied at all levels to commit the future of my career to this field.
What do I do?
With support from the Canadian Institutes of Health Research, I investigate the development of functional brain imaging technology, and its applications (current and future) in diagnostics, informed consent, patient’s best wishes, research and treatment decision-making, and end-of-life care. In my role, I oversee the strategic direction of a Canadian-based investigation assessing social, ethical, and legal issues intersecting brain imaging and clinical health care for patients with disorders of consciousness from brain trauma.
My work now is so different from when I was an ‘empirical experimentalist’. I currently work with a fabulous group of people on a team, and there are opportunities and a great need for public outreach. My work environment is clean, warming, and welcoming. I feel there is a stronger sense of collaboration and mentorship. Most importantly, my work is directly applicable to health care for the human condition, and I will see it affect health policies in the near future. There is a rapidly growing public interest in brain imaging and consciousness. I truly enjoy traveling to work in the morning. My days pass quickly because I enjoy what I do, and I am better able to achieve a good work-life balance.
In parallel to my neuroethics side, I write recipes and recommendations for my food blog that currently has a global outreach. I am a co-founder of Krimson Marketing, a consulting firm to help business leverage proven marketing systems for dramatic growth. I launched these initiatives during my PhD as a way of generating a passive stream of income. I’ve always been independent and a compulsive organizer. It comes with my background of having been completely on my own and self-funded at the age of 11.
Words of Wisdom and Unfinished Business
In my self-reflection, I think I’ve always lived by the “play hard, work hard” motto, although not always in that particular order. The serenity during my childhood and adolescence has been peppered with many tragedies and challenges. Throughout these hardships, I found my direction with clarity and focus on my education, allowing myself to dream, and being true to my desires and values. My wide ranging experiences combine to help me relate to people who come from various backgrounds and have taught me to empathize more and judge less.
Fortunately, like all good things, a trail of misfortunes also comes to an end. I eventually found a way to unite my passions with my values in my career, I married into an amazing family, my husband and I live in a lovely new condo in Greater Vancouver Canada, and we sponsor two young orphans in Uganda who refer to us as their parents. And I never stopped dreaming. I have a long list of personal dreams that I can recall at a moment’s notice without the aid of a diary, which I call my unfinished business. I dream of being fluent in Japanese and piano, being licensed to operate a plane and motorcycle, publishing an autobiography and a cookbook, having a kitchen large enough for my hobbies, and, quite literally, traveling the world.
You can find out more about me or connect with me at my professional portfolio, drgracelee.ca.
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