NeuroEthicsWomen Leaders

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.

When brain imaging sort of came along in the end of the 80s and early 90s, it was basically made for me, because it’s neuropsychology with computers, working out things in the brain – putting people in the scanners and activating their brains. So as postdoc I came to Canada to the Montreal neurology institute and trained for three years.

I spent most of the next 10 years doing what most people refer to as brain mapping, trying to understand how the frontal lobes allow us to perform executive tasks like planning, working memory, these sorts of things. I was fortunate enough to run into Kate Bainbridge, who was admitted to the hospital. She had flu-like symptoms and elapsed into a coma; within a few weeks she was declared to be in a vegetative state. I had just returned to the UK to Cambridge from Montreal, and one of my colleagues said, “Can’t you do something with her with the scanner?” And it was just a complete chance really that we put her in a scanner. We showed her pictures of her friends and family and I think the result of that study completely changed my career and completely mapped the next 15 years. She activated exactly like a healthy volunteer.

A big change happened in 2006, when we published the paper where we asked one of these patients to imagine playing tennis and that has really changed everything because by then I still had no grant money to fund. That was tremendously exciting, because by then I was totally convinced that there were some of these patients who are actually in some sort of locked-in situation rather than being in a vegetative state. We sort of had to work after that point to really convince ourselves that one of these patients was conscious, to get them to generate a command, to actually respond. And the way to do this seems to be through mental imagery.

And to me it just seems like there must be quite a few of these patients. It can’t be that the only person in the world would happen to be in Cambridge, being referred to us. It was first really big, lots of media attention about it and I spent most of the following years, telling people – telling journalists that we have to remember that this could be the only patient in the world. And I think that I was so extremely conservative for a whole year that everybody started saying “does this mean that all vegetative patients are conscious?” Basically I kept saying that “no, she’s just one person, we tried this in one person, she could be the only person in the world.” But they didn’t actually believe that because the chances of that occurring are just miniscule.

If you fast-forward six years, it’s quite interesting that when I moved to London, Ontario, beginning of 2011, started a brand new series of patients. The first patient that was scanned here is our superstar patient. I am very lucky but I think it’s more to do with the frequency of this occurring. It’s rare in the sense that a person in a vegetative state is rare but this situation is not something where we need two or three people because I wouldn’t have found two of them.

So people from all over must have loved to chat with you about your high impact and press coverage of consciousness. What are some really interesting definitions of consciousness that you’ve heard?

I think I can’t answer that question very easily. I get a lot of weird questions to do with consciousness so I think a lot of people perhaps over interpret what I do. So a lot of people think that I am trying to solve consciousness, to understand what consciousness is. I don’t feel that that’s what I’m doing at all. I definitely get pulled in to those types of discussions when I go to conferences in those sorts of areas. But my goal is not to understand consciousness; my goal is to detect consciousness in patients who cannot otherwise show that they are conscious. I think those are really quite different things.

This is quite important because it comes up in lots of questions after my talk. People often say to me, “What is consciousness?” I don’t think for what we do, you have to know what consciousness is. All I’m trying to do with patients is to work out whether they are actually like you or me. It simply requires us to relate their cognition to ours.

This comes up quite often in the study of dead salmon that came up a couple of years ago. The idea is that if you put a dead salmon in an fMRI scanner, you will see some activity. But that has to do with the statistical treatment of the fMRI data. It doesn’t mean that even dead salmon has brain activity – which is the message that some people take away. To me that’s a problem, because people often say, “That’s fine, you’re seeing activity in a vegetative patient but a dead salmon activates, so why is a vegetative patient any different than a dead salmon?” And there is really a fundamental difference; if I put a dead salmon in a scanner, there is no possibility that I could say that part of the salmon is going to activate when I say a particular word. Whereas in our patients, that is exactly what we do. We say the premotor cortex is going to activate when I say, “Start imagining now” – and it does. And that’s really the difference that you’re making with the patient, we are making a prediction about what that person is going to do if they are conscious.

What are some of the popular questions that you seem to always get asked by the public when you give talks or when you meet people?

I always get asked, “Have you asked a patient whether they want to die or not?” That comes up in almost every talk I give. And I think that it is indicative of public fascination and people always presume that these patients would want to die and we somehow apprehend the avenue of that happening. There are many different answers that I give depending on the audience of the talk. The answer is generally always, “No I never asked whether they actually want to die nor do I think that it is appropriate to do so,” mainly because we don’t know what we would do with the client when we ask that question and the patient says yes. We don’t have a legal ethical framework of acting on that information. So why would we then ask the question? I do think it’s mainly to fulfill our curiosity. But until we have sorted out what to do with that information I don’t think that it is the right time. Technically, it is obviously possible to do, when you ask the patient whether they are {in pain} and he answered no twice now.

Another question that was asked quite a lot and it came up last week is: “Why don’t you just ask the patient whether they are conscious?” It was quite interesting, because the girl who asked me the question was utterly convinced that this really would solve the problem. Just asking the patient whether they are conscious, and they answer yes, everything would be fine. But what if the person says no? How are you supposed to know: “No, I am not conscious.” What does it mean? So we never ask the patient that question.

How do you feel about the recent statement that talked about the validity of your EEG results that was published recently in The Lancet?

It did generate a dialogue back and forth about exactly the right way to analyze an EEG. But the thing that really disappointed me about it is that some people took away from it that we were actually wrong and really what happens is that there is a difference amongst people about the best way to analyze the data. This happens all the time. It’s certainly not the first time that this has happened to me. What’s interesting about it is that for us, it forced us to go back and re-run our data using a different type of statistics. We published another paper before it came out on PLOS One journal, using exactly the same technique that they suggested and still showing that one of our patients is conscious. It doesn’t actually matter.

Also, one of the criticism they had about our technique is that it only detects consciousness 70% of the time. I understand why people would find that a concern and if you can’t detect consciousness in a healthy person more than 70% of the time, there must be something wrong. They turned to the method they were suggesting we use, which actually does worse than that. It detects consciousness 40% of the time. In fact, their technique is demonstrably less sensitive than ours. The 70% isn’t a bad thing; it’s just that it isn’t well understood in the brain community interface literature. There are some people, for reasons that we don’t really understand, who are not very good at generating patterns of activity in the brain but can be detected in order to drive, say, brain community. Some people just can’t do it. If you look at the literature of brain community interface, only 70% of the people are able to operate one of the EEG devices.

Our data is pretty much in line with what you see out there in the literature. I would say that EEG analysis is really complicated, there are many different views of how you would do it. But this particular thing is really rather a statistical point – doesn’t really make any difference to the overall data. This is something that people have an appetite for. Hardly a week goes by without something about vegetative state appearing in the newspaper. That can be tremendously useful in raising funds but it can also be damaging if people grab on to an idea. And presented as a bigger story than what it actually is.

Did you ever picture your career moving in this direction?

No, I’ve never really planned anything actually. What motivates me is that I get to meet all sorts of interesting people that share my interest in consciousness and vegetative state. With lawyers, I get to talk about life or death decisions. I get to talk to the ethicists about the ethics involved in this type of situation. Engineers, about how to design brain-computer interfaces and that’s really interesting – makes my life more interesting.

I knew I wanted to be a scientist. When I looked at some of the things I did as a kid, some of them are suggestive – fiddling with stuff, setting things on fire, and mixing chemicals together, that sort of thing. My older brother is a scientist and I basically follow in my brother’s footsteps. He has a physics background and I knew that I didn’t want to go into hard science like his (math and chemistry), so I went into neuropsychology because it seems interesting because of its concern for people. Then computers came along and it presented a perfect combination to me: brain and computers. Then I did get a bit bored, just putting healthy people in scanners and seeing the brain. So I sort of made a conscious effort  to find an application and I went on a mini sabbatical to Australia to try and work out what I wanted to do. And I really didn’t manage to come up with anything, other than to find applications for fMRI.

There is this Western mentality that you need to have a goal – how to get ahead in science and how to get a career in science –  and the first time I gave that talk I was terrified because I actually don’t have an idea of how to build a career in science. So I basically just told people what I had done, rather than what you should do. I mainly focused on what I was good at and just kept pushing. I definitely pursued what I was interested in and various points in my career I made decisions to do the things I was interested in. I came to Canada, I wanted to do more imaging. I definitely did things that I enjoy, and focused less time on things that I did not enjoy.

I didn’t think you can design your life really. I just sort of bumbled my way through my life, my career. With the benefit of hindsight, I think that is probably the best way to do things. If you were to say 10 years from now I will be an oncologist specialist, chances are it’s not going to happen – because the roots of that involve doing the things that you really want to do, but it you’re just really interested in cancer and how cancer affects the body – then pursue that.

What are your sources of inspiration when you think that the goings get tough?

I know exactly what that is. Because I tend to just go back to the problems that we try to solve; work out the next big thing. As an example, when the 2006 paper was published, I understand that that was very controversial. I received hundreds and hundreds of emails from all sorts of people.

Yes. You can see tennis frequently, yes! But spatial navigation, no! And there are a few people who thought I was a neuro-villain that said, “How could it possibly be true?” One group of people says that no amount of brain activity could possibly convince me that somebody is conscious. My answer at the time was that statistically the chances that she was not conscious were very miniscule. Another objection raised at the time was, “If this patient had been in my clinic, I would never have diagnosed them as vegetative.” They took it in a different style – as in, you made a mistake: its not that you did something amazing with the fMRI, its just that you couldn’t work out that she was conscious.

The third type was the dead salmon people. Just because there is some activity, doesn’t mean they’re conscious. There are actually letters published in Science the following year stating that it is well known that areas of the brain will activate spontaneously to words, so couldn’t it be saying, “Please imagine playing tennis” is the same [as actually playing tennis]? All that did is sort of made me go back to the drawing board and work out how this experiment would completely address all of those issues.

If you look at what happened next, two things happen: one, we went for communication. The reason why that was important is that I could understand why it was hard for people to believe. So my team and I get a patient to answer questions. We ask the questions like, “Was the last place you went before the accident Austria or the USA?” How could we possibly know that unless my guy is communicating? He was giving us information that we have to go check later with the family. And we did that whole experiment in an extremely blinded way. We sent back the answers to the questions before we even knew what the questions were. We actually have a behavior of the patient communicating. This really drove me to address the question “I would have diagnosed the patient this way.” My aim is to get a neurologist to see a patient, tell us they’re in vegetative state, ask us to scan them not in that vegetative state, and get that person back again and get them to really assess the patient. Often when we find a patient isn’t what he appears to be, people go back and re-examine and find other evidence. And our patients would often get re-classified as minimally conscious. Once you know another piece of information, it’s kinda hard to ignore that.

When you look back at your accomplishments, how do you define success? Would you say that you are successful now and if so why, and if not then what’s missing?

I can only do this retrospectively – I really enjoy what I do. I’m extremely interested in the scientific question that my team is addressing. And I get a great amount of pleasure from talking about that work and from traveling around the world and going on television and talking about it. That combination of things is sort of a happy place of things. I don’t think I could have ever designed it that way. I don’t think I could have ever sat down 15 years ago and said I’m going to find a really interesting area to work on and the media will find it interesting and will keep me interested. Because I could have never guessed.  I think just by continually doing what kept me interested and what makes me happy, I’m lucky enough that it flourished in my life. I mean it would be pretty awful to have this amount of interest and exposure and not be something I don’t enjoy doing. It’d be a disaster because I live and breathe this stuff and this sort of occupies a large chunk in my life – this whole story of imaging and consciousness.

I think if you end up doing something you feel satisfied with and you enjoy what you’re doing, then I think you’ve been successful. I don’t think you can derive happiness from success. I’ve been doing this for 15 years and I still enjoy it.

Is there anything that you would like to add?

I always add on the end that these conversations are never to give the impression that these vegetative patients are a general group. All this stuff still happens in a minority of patients. I see 10 patients and one of them will activate really well while the other will not activate well. Ten to 20 percent of the patients will give us good results.  Sometimes we only see two in a week. I do actually think that the general public is well aware of this but I know that this is something that my colleagues worry about – that I somehow give the impression that vegetative patients are conscious, or this is somehow a therapy. It’s in no way a therapy. Right now, there is nothing that we can do with these patients other than try to make them as comfortable as we can and try to improve the communication with the outside world. It’s a minority of patients, finding a subset of patients who do not appear to be conscious and it is not the case for most patients. This is just a little disclaimer that I always say.