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Emerging Cognitive Neuroscience and Related Technologies 4 Cultural and Ethical Underpinnings of Social Neuroscience INTRODUCTION In this chapter, the committee places the evolution of emerging cognitive neuroscience and related technologies in context by discussing the cultural and ethical issues associated with the science and technology. This discussion shows that advances in science and technology are not isolated in a laboratory and that the ways in which different cultures view the issues surrounding cognitive neuroscience are meaningful. CULTURAL UNDERPINNINGS OF SOCIAL NEUROSCIENCE Introduction This section identifies trends in basic and applied social-science research on culture that can improve the U.S. intelligence community’s (IC’s) understanding of the expected directions of this research in the next 20 years.1 In the context of the present report, this chapter serves as a link between scientific findings in neuroscience in general and current social-science research on culture in particular. The chapter also builds on the recommendation of a recent National Research Council report, Human Behavior in Military Contexts, that the military and the IC support several fields of relevant social-science research (NRC, 2008): 1 For purposes of this report, “culture” is defined as a collective identity whose shared membership has distinct values, attitudes, and beliefs. Behavioral norms, practices, and rituals distinguish one cultural group from another. Distinct cultural groups are defined around regional, political, economic, ethnic, social, generational, or religious values.
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Emerging Cognitive Neuroscience and Related Technologies it addresses how research on culture can advance effective intercultural competence, nonverbal behavior and emotion detection, and human, social, cultural, and behavioral models in national-security and military settings. The problems facing national-security analysts will be discussed first. By definition, culture applies not only to nation-states but to individuals, ethnic groups, and transnational affiliates. Globalization requires national-security analysis to account more than ever for the political, social, economic, and cultural interactions, interests, and identities among states and especially nonstate actors. Contemporary foreign and military policy and intelligence gathering and analysis require understanding of the efforts undertaken by states in their dealings not only with other states but with numerous other external actors. Political realists in international relations have traditionally considered the state to be the most important element of concern. However, this chapter will begin with a discussion that shows that the selection of the unit of cultural analysis for understanding must be based on plural and global paradigms, not on political theory alone. The array of research in political science; cultural anthropology; social, political, and cognitive psychology; and social neuroscience that is exploring implications of culture for cognition, meaning, and behavior will then be discussed. There are valid frameworks for assessing the values, preferences, and norms of cultural groups. The second part will outline the basic research and applied frameworks used to understand the cultural perspectives and mindset of individuals and of particular national cultures. The third area of discussion will address whether research has shown that people can read, influence, or control the minds of others in various cultural and national contexts. Is brain functioning or neural mapping biologically universal, or is it culturally determined? It may not yet be possible to read minds with neuroscientific diagnostics and devices, but have practices in trust-building and management of fear that have relevance for the IC been developed in intercultural communication and conflict resolution? Conclusions will be drawn on how cultural research and frameworks can increase the effectiveness of programs in human behavior and culture models—such as the Human Terrain Project, GlobeSmart Soldier, and CultureSpan—under development by the IC and the military and diplomatic communities. Culture and the Unit of Analysis The study of culture requires a definition of the boundaries such as norms and ethics that identify a particular group. Political realism asserts that geographic and legal definitions of the state have been the bases of political and cultural understanding and interaction. Political realism has traditionally assumed that the state is a unitary actor (sometimes referred to as a black box) that has one policy or perspective at any given time on any particular issue. The state is essentially a legal and rational actor, which pursues foreign-policy and military-
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Emerging Cognitive Neuroscience and Related Technologies policy decision-making processes through consideration of all feasible alternatives and objectives and ultimately selects one that maximizes the security of the state. Political realism also assumes that national security is at the top of the list of issues that dominate world politics. Conflicts between states are maintained and addressed by using force to resolve disputes and prevent territorial violations (Viotti and Kauppi, 1987). Pluralism uses a different set of assumptions. Whereas a nation is strictly defined as a group of people who have a common identity, states are often comprised of more than one nationality. Nonstate actors are critically important in international relations. International organizations and transnational corporations and affiliations, with their own organizational and ethnic cultural perspectives, have increasing influence on foreign and military policy. That challenges the notion that the state is a unitary actor but that it is composed of interest groups, bureaucracies, and individuals that have their own cultural identities and influences on foreign and military policy. The pursuit of individual cultural-value–maximizing strategies at an organizational level can lead to disaster or bias for state military or foreign policy. The pluralist paradigm rejects the notion that primarily military-security issues dominate the agenda of world politics. Economic, social, and cultural issues—not military ones—are often at the forefront of international affairs (Viotti and Kauppi, 1987). The globalist view, which is fundamentally different from the realist and pluralist views, is that the global context within which states and other actors interact is important. Globalists emphasize the overall interdependent structure of international conditions and believe that actors are predisposed to behave in particular ways. States, societies, ethnic groups, and other nonstate actors operate as part of the entire world system. The globalist focus is on patterns of dominance within and among societies with respect to complex, and often conflicting, perspectives on economic, social, cultural, and political factors. In this view, national-security issues are dominated by groups that share transnational identities and interests but are often not bounded by a legal, sovereign-state, or by sanctioned foreign policy (Viotti and Kauppi, 1987). Increasing global interdependence implies that societies and cultures will be brought into greater contact with one another (Friedman, 2005). Efforts to use social and cultural modeling and frameworks to predict behavior and intentions in an intelligence and military context will require a focus on the various patterns of organization of cultural groups. The IC’s understanding of culture will be enhanced by a pluralist and globalist view of how culture groups are organized and how research is conducted and applied in the field of culture studies. Need for Cultural Due Diligence Cultural due diligence has traditionally included attention to communication and language systems, jargon, gestures, and dialects used to distinguish national
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Emerging Cognitive Neuroscience and Related Technologies cultural groups. Understanding of dress and appearance, food and dining habits, attitudes toward time, relationships, protocol, traditions, rituals, and greeting issues has become central in the effectiveness of interactions with national groups other than one’s own (Harris et al., 2004). Lack of cultural attention can lead to embarrassing or even dangerous situations. In Iraq, the United States military misunderstood the system of information transmission in Iraqi society and consequently lost opportunities to influence public opinion (McFate, 2005). Much of intercultural training and profiling has been on the protocol, gestures, greetings, and other observable behaviors that may differ among cultures. However, there has recently been more research on what “lies beneath the surface” of awareness and the internal world at the cognitive and emotional levels. Efforts are being made to understand better how behavior is linked to ideas and emotional values in the subconscious mind (the “bottom of the iceberg”). That is the new frontier of social neuroscience, and it links behavior with brain functioning, cognition, and emotions. Many contributors to the field of intercultural studies have analyzed cultural differences by state, but an increasingly pluralist and globalist view is being taken in the study of culture. National profiling is the easiest and most pragmatic way to differentiate distinct cultures (Dahl, 2000). Within national groups there are often subgroups that have characteristics that distinguish them from others. Age, sex, social class, race, and sects can define the subgroups. The Arab-Muslim world, for example, is a vast, diverse civilization, “encompassing over one billion people and stretching from Morocco to Indonesia and from Nigeria to London. It is very dangerous to generalize about such a complex religious community, made of many different ethnicities and nationalities” (Friedman, 2005). A pluralist view of culture would pay attention to the interrelated levels of culture, which are more practical for understanding human behavior. For the pluralist and globalist, the narrow focus on national culture is too simplistic for the social, political, and organizational complexity of the 21st century. Schmitz (2005), for example, asserts that it is possible to distinguish five interrelated levels of culture: Interpersonal level—the primary building block of culture. This is the level where culture is experienced and created through social interaction. Individuals are the reflections of a societal pattern of values and norms, and they cause cultural changes through active shifts and changes in these social patterns. An example is the interactions of the typical U.S. soldier stationed in Iraq or Afghanistan with Iraqis or Afghanis. Likewise, there are differences between one intelligence analyst who is schooled in the cultures of a foreign country and another who is a second-generation member of that very nationality or subnationality. Group or team level—refers to social, functional, or professional groups. Each group requires a set of values and norms if it is to be cohesive. As interactions shape the group dynamics, individuals directly affect the pattern of group values
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Emerging Cognitive Neuroscience and Related Technologies and norms. Within the federal government, examples of these differences have long existed between the various uniformed services, as well as between the Central Intelligence Agency (CIA) and the Federal Bureau of Investigation (FBI). Functional level—describes the dominant values, norms, and practices that exist within a particular professional function. These are the patterns that characterize and distinguish, for example, human resources, marketing, operations, bureaucratic units, and legislative units. In the IC, examples of these include the differences in the CIA between Directorate of Intelligence analysts and their Directorate of Operations case-officer counterparts in the clandestine service. Organizational level—represents the deep patterns of values and norms that define societal institutions. Examples of these include the differences in the national-security realm between the uniformed services and the civilians, or between the Executive and the Legislative branches. Societal or national level—involves the distinctive set of values, norms, practices, and institutions that defines what it means to be a member of a society. The nation-state has been the most common form of this level of analysis that has primarily been addressed thus far in this chapter. Each distinguishable cultural group is characterized by a distinct set of behavioral norms, practices, and institutions that define what it means to be a member of the group. Within each group, there will often be some variation around the dominant set of values, variation that is necessary if the group is to be able to adapt and change. These cultural groupings can identify the set of behavioral norms, practices, and institutions that guide particular cultures’ members and overcomes the reductionist approach that compares cultures only in terms of their behavioral norms. The use of behavioral norms, practices, and institutions and a comparison model of cultural preferences can lend practical guidance in self-awareness and awareness of others (Walker et al., 2003). Culture is understood to exist at all those interrelated levels and can be defined as the pattern of ideas, emotions, and observable manifestations (including behaviors, practices, institutions, and artifacts) that tends to be expected, reinforced, and rewarded by, and within, a particular group (Walker et al., 2003). Cultural-orientation models (COMs) are now used not only at the national level but as tools to describe, analyze, and facilitate interactions in any interpersonal, social, organizational, economic, or political cultural group. Intercultural competence includes analysis of one’s own cultural preferences, values, attitudes, and beliefs and of how they are reflected in one’s behavior. Much of intercultural development and training builds on awareness of one’s own culture and how that culture can lead to misunderstandings and destructive interactions with those in other cultural groups. Cultural knowledge is understood to be about not only a general knowledge of a cultural group but how life and values have been shaped by history. For example, a cultural analysis involves a focus on
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Emerging Cognitive Neuroscience and Related Technologies how conflicts have been solved, how decisions are made, and how people have been motivated and rewarded. Cultural due diligence also includes assessing and preparing for a multicultural setting. It involves investigating the cultural backgrounds and orientations of members of a group and evaluating the potential and actual cultural differences by using the COM-like frameworks. One example is the GlobeSmart Commander used for training North Atlantic Treaty Organization multinational peacekeeping forces, and another is the GlobeSmart Soldier used in Iraq programs. Those programs involve training and development for U.S. military personnel through self-assessment surveys, gap analysis, briefings on culture and history, and cultural scenario exercises (Aperian Global, 2007). Strategies and skills for minimizing adverse social effects must be developed. The idea is to know how one’s own experiences and those of other cultures affect the perspective, outlook, and outcome to be achieved. One key skill involves style-switching; that is, developing the ability to use a broad and flexible behavioral repertoire to accomplish one’s goals. Another key skill is to develop cultural dialogue abilities to elicit cultural information, to build trust and rapport through conversation, to illuminate cultural underpinnings of behavior and performance, and to close cultural gaps and create cultural synergy (Schmitz, 2005). This synergy builds on similarities and fuses differences, and the results are more effective human activities and systems (Harris et al., 2004). More than observation, conversation is a powerful means to reach new understandings and a new basis on which to think and act. These processes not only can elicit information but can lead to solving problems. Cultural mentoring, or assistance in facilitating cultural understanding and integration into new and different cultural environments, has become a demanding practice (Schmitz, 2005). Other intercultural competences are the ability to communicate with someone in a way that does not offend or break rules, effectiveness when there is high anxiety and uncertainty, adaptation and adjustment in unfamiliar or dangerous surroundings, understanding of nonverbal and other types of face-saving and face-threatening strategies, mindfulness or openness to new information, and awareness of others’ emotional states (Rudd and Lawson, 2007). Culturally competent negotiators, for example, rarely use lie-detection tools, such as polygraphy or other technology, but they do rely on due diligence to achieve a high level of business intelligence, and they use emotional, cultural, and social profiling to verify “signals” in a multicultural negotiation. Cultural intelligence means being skilled and flexible in understanding a culture and learning how to reshape one’s own thinking about interactions with people of other cultures (Thomas and Inksen, 2004). Like other forms of intelligence—such as social intelligence (the capacity to interact with and influence others) and emotional intelligence (the ability to regulate and use one’s emotions)—cultural intelligence has become a subject of social-science research. For example, psychometric tools have been designed to measure the components
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Emerging Cognitive Neuroscience and Related Technologies of a global mind-set, which affects performance, influence, and effective behaviors in multicultural surroundings. They measure intellectual capital (knowledge of global issues, networks, organizations, strategies, and so on), psychological capital (strong psychological attributes, openness, curiosity, cosmopolitanism, and so on), and social capital (ability to work with others and build relationships and networks in multicultural settings) (Javidan et al., 2007). A globalist approach to culture asserts the need for an integrated understanding of not only the facts about cultural groups but the social and psychological capabilities of adapting and adjusting to rapidly changing cultural identities and formations (Huntington, 1997). History provides us with many examples of the battles between cultures. However, the technologies and understandings about social gaps and conflict are more advanced than they use to be in ways that enhance general understanding about social and political behavior. The cultural splits and groupings “animated by religion and politics” will require a more complex “understanding of culture, not new technology or science” (Ikle, 2006). In short, they will require a deeper understanding of the “software of the mind.” Determination of Intent IC and national-security analysts have long been interested in determining intent and motivation with cultural accuracy. There is an increasing need to understand “hearts and minds” at a strategic level because of the effect they can have, for example, in exacerbating an insurgency in Iraq. Cultural ignorance at an operational level can lead to negative public opinion and at a tactical level can endanger both civilians and troops. A lack of continued research and training regarding adversaries’ cultures can have grave consequences strategically, operationally, and tactically (McFate, 2005; Freakley, 2005). Efforts to enhance cultural awareness and to determine the intentions of political adversaries and supporters are not new. Cultural training in the U.S. military began during the Indian Wars of 1865-1885 and resulted in the Bureau of American Ethnology. During World War II, anthropologists served the war effort directly, first conducting intelligence operations in Burma for the Office of Strategic Services and later advising on how to generate political stability in target countries through a process known as schizmogenesis. American anthropologists produced studies, for example, that by ethnographer Ruth Benedict (1946), The Chrysanthemum and the Sword, which concerned the Japanese national character. Understanding one’s friends and enemies requires not only intelligence from a satellite photo of an arms dump but intelligence about a group’s cultural interests, habits, intentions, beliefs, social organizations, and political symbols. New adversaries and operational environments necessitate a sharper focus on cultural knowledge of not only adversaries but also supporters to avoid grave consequences. Understanding the culture of an adversary can make a positive
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Emerging Cognitive Neuroscience and Related Technologies difference strategically, operationally, and tactically (McFate, 2005; Kipp et al., 2006). Although future success in “reading minds and intentions” will depend on cultural knowledge, DOD lacks the programs, systems, models, personnel, and organizations to deal with either an existing threat or the changing cultural environment. At a strategic level, understanding “minds” in Iraq will require a better understanding of the tribal nature of the Iraqi culture and society and of why power struggles have reverted to the tribe. Once Sunnis were humiliated in the conflict and frozen out of their jobs through the disbanding of the Iraqi military or de-Baathification, the tribal network became the backbone of the insurgency as a direct result of U.S. misunderstanding of the Iraqi culture (McFate, 2005). Understanding local culture and mindset can make a favorable difference strategically, operationally, and tactically. More broadly, “reading the Arab mind” requires attention to a regional and collective mindset with respect to values about child-rearing, evaluation of male-female relationships, and boy-girl differences (Patai and De Atkine, 2007). A current initiative addressing “anthropology and a level of knowledge concerning a wide range of culture” is the U.S. Army’s Human Terrain System (HTS). The core building block of the system is a five-person human terrain team (HTT) that will be embedded in each forward-deployed brigade or regimental staff. The HTT will provide a commander with experienced officers, civilians, and social scientists who are trained and skilled in cultural research and analysis. Current intelligence systems and organizations remain traditionally structured and collect battlefield elements of information to support commanders in physical combat. As contemporary conflicts have moved further from combat involving regular formations and heavy maneuvering warfare, it has become apparent that technical battle information has diminished in importance relative to the requirements for ethnographic, economic, and cultural information to stabilize an indigenous government (Kipp et al., 2006; Packer, 2007; Kilcullen, 2007). What is the future of the understanding and evaluation of human intent? What are the implications for national security? To begin with, any theories that advance the ability to determine intent in the context of multicultural interactions will continue to put forth that cultural behaviors and psychological patterns are interrelated. Sociocultural and psychological models will advance a deeper understanding of psychological processes in a cultural context (Asch, 1953; Bruner, 1990; Hastorf and Cantril, 1954). There will be a trend for advances in cross-cultural understanding of intention and meaning to occur in a cross-cultural comparative research. For example, traditional social-science models built primarily on Western assumptions will be challenged. In particular, a bias that is invisible to many psychological and social-science models assumes that Western social-science models regarding what is normal are universal. Therefore, cross-cultural comparative research can be pursued to validate or invalidate many of the European and American psychological
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Emerging Cognitive Neuroscience and Related Technologies models that assume that basic processes of brain function and human behavior are universal. Traditional social-choice research concludes that individualism that prevails in European American models of psychology predicts individuality and preferences for freedom and control (Markus, 2007). That is illustrated in the cultural-orientations assessments and profiles of European Americans who tend to prefer environmental control, equality as a power value, and individualism as a core value (Price, 2007). There is an assumption in Western models of choice that those who choose for themselves are happier, are healthier, and perform better than those who do not get to choose (Brehm, 1956; Deci and Ryan, 1987). However, having more choice or decision options is not necessarily preferred. A disjointed (individualism-independent) or conjointed (collectivism-interdependent) psychological construct of the self in choice-making is determined by whether the cultural patterns are Western or Eastern, respectively (Markus, 2007). That can have implications for the processes of Western ideals of freedom and democracy. Research will continue to determine the effects of culture on the brain. To date, this research has taken two routes: studies of neuroplasticity that provide insight into the effects of social experience on the brain and studies of brain evolution that provide insight into natural selection and the brain. Cultural change and acculturation are evident in studies, for example, of the “reorganization of the brain” (neuroplasticity) in response to adaptation. Future research may also advance undertanding of cross-cultural differences in object-processing regions of the brain (Chen, 2007). Measurement of brain activity of Western and Chinese people has provided neuroimaging evidence that culture shapes how the self is represented in the human brain (Zhu et al., 2007). When judging self-relevant items, both Western and Chinese participants showed activation in the medial prefrontal cortex (MPFC). Further research may lead to better understanding of the neural basis of cultural differences in fundamental processes of cognition, emotion, and motivation. That would be an important future direction, although logistical hurdles would need to be dealt with for this field to thrive (for example, comparing functional magnetic-resonance images between groups presents problems of reliability and requires that studies be done in the same location). Other research on cultural dimensions includes the work done by Aycan et al. (2000) on cultural fatalism, by Gelfand et al. (2006) on the construct of cultural tightness-looseness (strength of social norms), by Bond et al. (2004) on social axioms (cynicism, spirituality, and reward for allocation), and by Shalom Schwartz (1994) on values at the individual and cultural levels. Research will advance understanding of systematic cross-cultural differences in the anatomical structure and function of the brain. Many of the variations in brain functions appear to be rooted in culture-dependent experiences, such as language experience and early learning, as well as by variations in neuronal
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Emerging Cognitive Neuroscience and Related Technologies genes. Future research will probably examine gene-culture interactions as a way to understand historical adaptation by social groups (Chen, 2007). Dan Sperber, a cognitive anthropologist, proposes that research on culture be understood as an epidemiology of mental representations; this would translate to the spread of ideas and practices from person to person.2 The mathematical tools of epidemiology (how diseases spread) and of population biology (how genes and organisms spread) can be used to understand cultural evolution (Pinker, 2002). Research in neurolinguistic programming (NLP) as an interpersonal approach will also advance the subjective study of language, communication, and personal change in a cross-cultural context (Laborde, 1984; Moine and Lloyd, 2007).3 The application of NLP to negotiation, sales, and communication has not been validated in a cross-cultural context. Generally, NLP aims to increase behavioral flexibility (choice) by understanding how a person thinks about a problem or a desired outcome. Rather than just listening to and responding to someone, NLP aims to respond to nonverbal communication, such as tone, gesture, posture, and eye movements. Nonverbal cues reveal information not typically available when one is distracted by preconceptions or expectations. Research on NLP methods and questioning is intended to clarify what has been left out or distorted in verbal communication. These approaches are used to reframe thinking and to become aware of others’ preferences for communication that might not be one’s own. The greatest challenge in current cross-cultural communication research is the difficulty in reading others’ minds when one’s own mind has cultural filters and biases about values and intentions. It is important to note that there is also increased research interest in how meditation, empathy, compassion, and suffering are represented in the brain. William Mobley, of Stanford University, argues that these traditionally are subjects that “neuroscientists avoid … because we don’t understand them” (Baker, 2005). Last, the field of neuroeconomics is another recent research agenda that uses neuroscience methods to understand cooperation, decision making, fairness, among others (Sanfey et al., 2003; Zak, 2004; Loewenstein et al., 2008) This field may also be integrated with cross-cultural theory and methods. Finding and Recommendation Finding 4-1. There is a growing awareness in the U.S. government that effective engagement in a complex world—commercially, militarily, and diplomatically—will increasingly require an unbiased understanding of foreign cultures. Research 2 See Sperber’s biography online at http://en.wikipedia.org/wiki/Dan_Sperber. Last accessed on June 23, 2008. 3 Neurolinguistic programming is defined as the study of the human subjective experience and of how it provides a structure for all behavior. Neurolinguistic programming was created specifically to understand how verbal communication and nonverbal communication affect the human brain and enhance management of otherwise automatic neurological functions.
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Emerging Cognitive Neuroscience and Related Technologies is enhancing understanding of how culture affects human cognition, including brain functioning, and is even suggesting a link between culture and brain development. The U.S. military is placing greater emphasis on cultural-awareness training and education as a critical element in its strategy for engaging in current and future conflicts. Military conflicts will increasingly involve prolonged interaction with civilian populations in which cultural awareness will be a matter of life and death and a major factor in outcomes. Similarly, political leaders, diplomats, intelligence officers, corporate executives, and academicians will need a deeper, more sophisticated understanding of foreign cultures to communicate more effectively with their counterparts in non-Western societies in the era of globalization. Recommendation 4-1. The growing U.S. government interest in cultural training and education is well placed, and its investment in related research and development and in practical training should be substantially increased. Training programs, to be most effective, should be developed and implemented on a multidisciplinary basis. Investment should be made particularly in neuroscience research on the effects of culture on human cognition, with special attention to the relationship between culture and brain development. ETHICAL IMPLICATIONS OF COGNITIVE NEUROSCIENCE AND RELATED TECHNOLOGIES Introduction Modern bioethics is a complex field that emerged in the late 1960s among a small group of philosophers, theologians, and physicians.4 Motivated by such dramatic developments in the life sciences as the decoding of deoxyribonucleic acid (DNA), experiments in organ transplantation, the introduction of renal dialysis, and advances in end-of-life interventions, those thinkers found ethical traditions to be stressed in addressing novel moral questions. The Hippocratic oath emphasized the avoidance of intentionally harming patients, maintaining confidentiality, and respecting fraternal and guild-like professional relationships but was silent about telling patients the truth or obtaining their informed consent. Nor did traditional medical ethics address balancing individual and group interests or society’s role in providing access to health care. External factors also played an important role in stimulating the early development of bioethics. The patients’-rights movement emerged as a variant of other civil-rights movements, especially for psychiatric patients and their advocates. Treatment of stigmatized diseases, such as cancer, began to show signs of 4 The “small group” referred to was in the United States and led to the creation of the first two bioethics research centers, The Hastings Center (1969) and the Kennedy Institute of Ethics at Georgetown University (1971).
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Emerging Cognitive Neuroscience and Related Technologies improvement and to stimulate a demand for more information and control for patients and a greater interest in communication in the doctor-patient relationship. And litigation became a more prevalent method of resolving disputes. Medical schools gradually introduced more systematic ethics education into their curricula and appointed professors of medical ethics. The term bioethics became popular because it suggested consideration of ethical issues in the life sciences generally, not only in clinical medicine. During the middle 1970s, problems of consent to medical treatment of those who could not speak for themselves sparked a national debate, and ethics committees were instituted in hospitals partly to clarify the values at stake in difficult cases and partly to settle disagreements among caregivers and family members without resort to the courts. Two important characteristics of bioethics are the large and continuing role of scandals in the growth of the field and the prominence of public commissions in the development of its canon and in advancing its social legitimacy. A 1966 paper in the New England Journal of Medicine by a distinguished Harvard professor of anesthesiology asserted that ethical problems in human research trials were rampant and cited nearly two dozen published papers in which examples of unethical conduct were claimed to be evident (Beecher, 1966a,b). Social-science studies, such as Stanley Milgram’s “obedience to authority” experiment, also called attention to professional ethics (Milgram, 1973, 1974). No incident so rocked the medical world as the 1972 revelation of the U.S. Public Health Service syphilis study in which 400 black men who had tertiary syphilis were observed for 40 years without consent and without penicillin therapy when it became available (Moreno, 2001). Among the public responses to the syphilis-study scandal was the formation of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-1978).5 The commission proposed specific protections for particular populations that it identified as vulnerable—including children, pregnant women, and prisoners—and informed consent and prior review of experiment proposals by a special committee, the latter conditions to apply to all research subjects. With some modifications, those proposals were codified and continue to be the basis of the U.S. research protection system to this day. All federal agencies that fund or sponsor human-subjects research are supposed to be in compliance with the “common rule,” and several agencies have more specific regulations, depending on their missions. Any institution or organization that receives federal research funds and any entity that volunteers to be in compliance regardless of the funding source are also covered by the common rule. A few states have instituted regulations governing particular forms of research. Current guidelines for ethical recruitment and participation of human volunteers in research generally prohibit participation by prisoners, due to actual or potential coercion risk. There is a 5 The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was established under Title II of Public Law 93-348, Section 201(a).
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Emerging Cognitive Neuroscience and Related Technologies general challenge in conducting research that might actually be aimed at helping the prisoners to regain function or improve certain functions, and whether they are able to give informed consent (IOM, 2006). More recent and related commissions include the President’s Commission on Ethical Problems in Medicine and Biomedical and Behavioral Research (1980-1984), the National Bioethics Advisory Commission (1996-2000), and the President’s Council on Bioethics (2001-present). There are several sanctions for failure to comply with research regulations. The federal Office for Human Research Protections may find that an institution has failed to comply with the relevant regulations and therefore halt current protocols. The Food and Drug Administration (FDA) may find that drug or device development has failed to comply with the regulations and withhold licensure for marketing. Investigators may lose their sponsor’s financial support and be subjected to limitations of their ability to conduct future clinical trials. Editors of professional journals may refuse to publish papers that include “tainted” data or, if the data are sound in spite of demonstrated ethical lapses, publish only with specific attention to those failings. In some instances, litigation may ensue, especially if failure to comply is associated with an injury in the course of research. Recently, investigators’ and sponsors’ financial conflicts of interest have become a matter of general concern. There is evidence that study design and timely release of data have been influenced by proprietary considerations. Conversely, decisions about which promising lines of research are pursued are surely influenced by market concerns, especially as government support of science declines. Those problems, too, have been brought into the ambit of bioethics. On the whole, however, the system of protections for human research subjects is not well designed to capture instances of intentional wrongdoing. Rather, it provides guidance for well-motivated investigators who wish to be in compliance with regulatory requirements and practice standards. In part, that limitation results from the system’s being based on paper reporting rather than in situ audits of professional conduct. Yet the scrutiny associated with the prevailing system does seem to provide some check on individual investigator discretion. In contrast with bioethical principles that are well established, such as the obligation to obtain the informed consent of competent subjects, there are many unresolved questions. For example, under what circumstances is a deceptive research design, as is common in social psychology, ethically acceptable? When is it justifiable to involve persons in research whose decision-making capacity is diminished, such as persons with neurological disorders? Those sorts of problems continue to excite a great deal of debate in science and ethics. Professionals in the life sciences and many laypersons are generally aware of the history and requirements of human-subjects research in the civilian world, but far fewer appreciate the long and complex history of such considerations in the military and in the IC. In fact, human-experiments policies in the national-security world preceded, and to some extent anticipated, policies that were cre-
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Emerging Cognitive Neuroscience and Related Technologies ated only much later in the world of civilian biomedicine. A striking example is the appearance of the first consent form in a medical experiment, which was probably devised by U.S. Army Major Walter Reed in the course of his yellow fever experiments in Cuba in 1900. Reed’s brilliant and arduous efforts and those of his colleagues (one of whom died as the result of exposure to the bite of a carrier mosquito) not only led to the virtual elimination of a fearful scourge but exemplified an advance in the treatment of experiment volunteers—in this case, soldiers and Spanish immigrant laborers (Moreno, 2001). (It must be said, however, that both the circumstances of recruitment of the laborers and the financial inducement offered would probably not be acceptable today.) Nearly 50 years later, 23 Nazi doctors and bureaucrats were tried at Nuremberg for crimes involving horrific experiments on concentration-camp inmates. The experiments listed in the indictment included several that were sponsored by the Luftwaffe, such as studies of explosive decompression and hypothermia. Both were tied to unanswered clinical questions of interest to the medical corps. The defendants appealed to the doctrine of superior orders and to a utilitarian justification that many lives could be saved by jeopardizing the lives of a few people already slated for death. They further noted that the allied governments had themselves engaged in human experiments on captive populations for national-security purposes during the war, such as a malaria study involving 800 federal prisoners. The three American judges finally rejected the defense arguments and sentenced eight of the defendants to death and eight others to long prison terms for complicity in murder, but they were sufficiently impressed by the apparent absence of international experiment standards that they decided to write their own (Moreno, 2001). The third part of the tribunal’s decision is known as the Nuremberg Code. The first sentence is famous and reads, “The voluntary consent of the human subject is absolutely essential.” A number of other principles that were articulated would elicit wide agreement today but were not necessarily well established at the time, such as the right of the volunteer to leave an experiment at any time.6 It is remarkable that the national-security–related interest in human-experiment rules was unfolding in the United States at precisely the same time as the Nuremburg Tribunals, but not in public. Early in 1947, the new Atomic Energy Commission discovered that its predecessor, the Manhattan Engineer District (better known as the Manhattan Project), had sponsored the injection of plutonium into 17 hospitalized patients, apparently as part of an effort to establish the human excretion rate for the sake of young laboratory workers who might be exposed to the newly isolated metal. The commission decided not to release information about those sensitive experiments to the public, but it determined that 6 Nuremberg Military Tribunals. 1949. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law. No. 10, Vol. 2, pp. 181-182.Washington, D.C.: U.S. Government Printing Office. Available from http://ohsr.od.nih.gov/guidelines/nuremberg.html. Last accessed June 18, 2008.
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Emerging Cognitive Neuroscience and Related Technologies its contractors to whom it released radioisotopes for medical studies would have to obtain the subjects’ “informed consent.” That was the first time that phrase appeared, as far as is known. However, the requirement seems to have been at best poorly applied and to have disappeared from institutional memory by the early 1950s (Moreno, 2001). As the early Cold War era unfolded, DOD contemplated the need to engage in human experiments involving atomic, biological, and chemical agents for defensive purposes. In a secret consultation process, several DOD advisory committees were asked to develop recommendations for the conduct of such experiments. Finally, the department’s general counsel proposed that the Nuremberg Code, penned by three American judges only a few years before, apply to the atomic, biological, and chemical “(ABC) warfare” experiments to avoid the U.S. hypocrisy of not following the code. Secretary Charles M. Wilson adopted the proposal shortly after taking office in 1953 but included a written consent requirement. That caused consternation among the advisory committees that seem largely to have opposed the adoption of any such formal policy, considering it an unnecessary departure from prior practices and a dangerous precedent that could undermine military and medical authority (Wilson, 1953). The Wilson policy made little difference in the conduct of national-security-related scientific and technological exercises. Perhaps the most graphic example of the failure of the policy was the deployment of over 200,000 soldiers and marines within a few miles of ground zero at atomic test shots throughout the 1950s. Those deployments were regarded as training exercises rather than as medical experiments. In contrast, the Army lysergic acid diethylamide (LSD) experiments of the 1960s were accompanied by some informed-consent processes, however minimal and inadequate. By 1975, the Army inspector general concluded that the Wilson policy had failed. Interestingly, some of the wording of the original memo has survived in current military regulations on human experimentation, such as Army Regulation 70-25 (Moreno, 2001). Those examples raise the question of policy-makers’ attitudes toward the use of military personnel in medical experiments. On the whole, the attitude of both World War II and Cold War–era authorities seems to have been that, although the risks associated with a medical experiment in military service might pale in comparison with those encountered in combat, it seemed important not to reduce young men and women in uniform to the status of human guinea pigs. Thus, alternative populations were often sought, including in at least some cases hospitalized psychiatric patients. In the last few years, however, new information has emerged concerning the exposure of sailors and soldiers to active nerve agents during the 1960s. Secret military and intelligence-related human experiments seem to have ceased after the Army and CIA scandals of the middle 1970s, and a vastly more sensitive attitude on these matters appears to have prevailed, although some insist that secret experiments should continue, citing the development of the anthrax
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Emerging Cognitive Neuroscience and Related Technologies vaccine as an example. What seems to be unassailable is that military authorities are loath to violate informed-consent standards without justification (in accordance with the Uniform Code of Military Justice) or without authorization by appropriate civilian authorities.7 Thus, DOD sought and received from FDA a waiver of informed consent for the voluntary use of some compounds during the first Gulf War. Although the waiver was controversial, especially after the war, that it was sought is noteworthy. The stated motive for the waiver request was the concern that military personnel could be exposed to agents (such as nerve gas and botulinum toxin) for which there was no approved therapy but substantial evidence in other contexts that the compounds in question could be protective. Under the Uniform Code of Military Justice, members of the armed forces are required to obey all lawful orders, including those involving medical care that may maintain or re-establish their ability to do their job. However, they are under no obligation to participate in a medical experiment. Today, the formal procedures in place for the use of military personnel in medical experiments are at least as stringent—and probably far more stringent—than those common in industry and academe. That implies not that no abuses can occur, nor that convenient alternative frameworks (such as field testing) cannot be used to circumvent the research rules, but only that the official policies and procedures in the military are rigorous. The IC is subject to the same common provisions of informed consent and prior review although it is claimed that no human experiments are performed by intelligence agencies. An interesting and unresolved policy dilemma is whether classified research can ever be ethically sound inasmuch as it lacks transparency, such as in the form of public accountability. For example, if a member of an ethics review board disagrees with a majority decision involving a classified human experiment, that member would be unable to engage in a public protest of that decision. A contemporary problem is the status of detainees at military installations who are suspects in the war on terrorism.8 Presumably, the ethical standards that apply to all human research subjects should apply to them as well. But if they are not protected by the provisions of the Geneva protocols for prisoners of war, the question would be whether as potential research subjects they are nonetheless 7 The Uniform Code of Military Justice is available from http://www4.law.cornell.edu/uscode/10/stApIIch47.html. Last accessed March 27, 2008. 8 Acts of terrorism do not in themselves imply that the perpetrators have a fundamentally different neurological constitution from other human beings. Our own social and political history is rife with examples of behavior that terrorized those who felt themselves to be potential targets—guerilla actions during the Revolution and the Civil War, racist lynchings, labor insurrections, domestic rebel movements, and presidential assassinations. Often, the perpetrators have been called radicals or anarchists rather than terrorists, but the principle is the same. Like today’s foreign terrorists, some may be attracted for many reasons to an extremist ideology, including an exceptionally rigid idealism, youthful immaturity, physical or psychological coercion, psychopathological conditions, or some combination of them. Such conditions are not peculiar to an ethnic, national, racial, or religious group.
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Emerging Cognitive Neuroscience and Related Technologies protected by other international conventions, such as the Universal Declaration of Human Rights (United Nations, 1948). Those technical questions of international law are beyond the scope of this report. One striking conclusion to be drawn from this brief history is that, as far as is known, no U.S. administration has ever declared that the human-experiment rules could be suspended because of a national emergency. That cannot be said of Nazi Germany: the Third Reich ignored an Interior Ministry guidance from 1931 that was still technically in effect. Nor did the imperial Japanese government hesitate to engage in human experiments with biological and chemical weapons in Manchuria that rivaled or even exceeded the Nazi experiments in barbarity. Less is known about America’s traditional allies, which have been far less candid about their research activities on sensitive issues. One interesting recent exception is the sarin gas experiments at Porton Down in the United Kingdom during the 1950s. Revelations associated with the 1953 death of a British soldier in one of those experiments led to a new inquest in 2005 that cast some light on the work and raised grave questions about the consent and safety procedures in place at the time.9 Ethics, Cognitive Neuroscience, and National-Security Research The field of bioethics has spawned several related fields—clinical ethics, research ethics, and public-health ethics—and more recently has given rise to neuroethics.10 Intensive interest in the ethical issues raised by the rapid advances in neuroscience led first to several academic conferences in the early 2000s, then to a spate of literature, and now to the creation of a professional organization and at least two academic journals. Among the topics addressed in neuroethics are the nature of personal identity, human dignity, and autonomy in light of various novel surgical and pharmacological interventions; the relationship between mind and body in light of new information about brain processes; the implications of neural imaging for privacy; neurogenetics and behavior control; and the management of suspicious results of neuroimaging research. Discussions of neuroethics and human experiments for national-security purposes generate concerns that go beyond the already controversial topics of human experiments and national security.11 Because the modern world views the brain as the organ most closely associated with personal identity and modern 9 For additional information on neuroethics and the law, please see http://www.press.uchicago.edu/cgi-bin/hfs.cgi/00/16495.ctl. The American Association for the Advancement of Science has a related program that may be viewed online at http://www.aaas.org/spp/sfrl/projects/neuroscience/. Last accessed on June 19, 2008. 10 Neuroethics is a phenomenon mainly in the English-speaking world, including the United States, Canada, the United Kingdom, and Australia. However, interest in Europe appears to be growing, to judge by personal communications of the committee. 11 The topic of the nature of research necessary to prepare American military forces to withstand various kinds of potential behavior-modifying techniques is not addressed in this report.
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Emerging Cognitive Neuroscience and Related Technologies democratic theory values the individual as a rights-bearer and moral agent, there is sure to be enormous societal interest in any prospective manipulation of neural processes. American society experienced a telling episode along those lines during the 1950s, when “brain-washing” became part of popular culture—and IC experiments—after the treasonous statements of American prisoners of war in captivity in North Korea. Although anxieties about clandestine U.S. government activities are easy to deride, later Army and CIA experiments involving hallucinogens were associated with at least two deaths in 1953 and with multiple exposures of ordinary citizens. Serious contemporary ethical discussion of neuroscience and national-security policy carries an unusual historical burden. The current underlying science and resulting technology are far more sophisticated and, to many, threatening to personal autonomy and human dignity. Proponents of the science may well argue that neuroscience promises to enhance rather than undermine dignity and autonomous choice, but that point of view is not always the prevalent one, especially when national-security goals are viewed with suspicion. Examples of neuroscience experiments that may have implications for national security are numerous. Virtually all involve what has been called “dual use” research applicable to military, intelligence, or policing, as well as health-care, purposes. International Standards and Controls Research with human subjects is guided by several international documents that are discussed in detail in Appendix E; there are also numerous international harmonization initiatives that apply to drug development and regulation and to environmental risk assessment and management. In Europe, research is further governed by the European Medicines Agency (EMEA)12 and the European Forum for Good Clinical Practice (EFGCP).13 As discussed previously in this report, in the United States, FDA and the Department of Health and Human Services Common Rule (45 CFR 46) guide drug and device development and human-subjects research in general (United States Department of Health and Human Services, 2005). Nations other than the United States and the European Union may have their own specific rules and directives, but not much is known about the extent to which they are implemented and complied with. It should be noted that the United States is not necessarily in a position of moral superiority to other countries with regard to practices; as noted above, there are serious questions about the extent to which the research house in the United States is in order. Nonetheless, it can be said at least that the developed world 12 For additional information, see EMEA’s Web site, http://www.emea.europa.eu/. Last accessed on December 20, 2007. 13 For additional information, see EFGCP’s Web site, http:://www.efgcp.org. Last accessed on December 20, 2007.
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Emerging Cognitive Neuroscience and Related Technologies has established fairly well-articulated ethical standards and that there are various avenues for addressing egregious violations. However, several questions remain about the adequacy of the protection of human beings as subjects of biomedical research related to cognitive neuroscience, especially in confidential or military contexts. For example, How great is the impact of international ethical rules and regulations governing human-subjects research, such as the Declaration of Helsinki (DoH) (World Medical Association, 1964)? The DoH is essentially an internationally accepted document, but some countries might not comply with it. How are international rules and standards respected by individual countries? How is compliance enforced? How much overlap is there between national and international requirements for the protection of subjects of research involving human beings? REFERENCES Published Aperian Global. 2007. GLOBESMART COMMANDER and GLOBESMART SOLDIER: Helping Remove the Fog of War. Aperian Press Release. San Francisco, CA, April 9, 2007. Available from http://www.aperianglobal.com/about_aperian_global_news.asp. Last accessed March 26, 2008. Asch, S.E. 1953. Effects of group pressure upon the modification and distortion of judgements. Pp. 151-162 in Group Dynamics: Research and Theory. D. Cartwright, and A. Zander, eds. Evanston, IL: Row Peterson. Aycan, Z., R.N. Kanungo, M. Mendonca, K. Yu, J. Deller, G. Stahl, and A. Kurshid. 2000. Impact of culture on human resource management practices: A 10-country comparison. Applied Psychology: An International Review 49(1):192-220. Baker, Mitzi. 2005. Dalai Lama and neuroscientists build bridge between Buddhism and Western medicine. Press release. Stanford University. Available from http://med.stanford.edu/events/dalailama/full_story.html. Last accessed March 26, 2008. Beecher, Henry K. 1966a. Consent in clinical experimentation: Myth and reality. Journal of the American Medical Association 195:34-35. Beecher, Henry K. 1966b. Ethics and clinical research. New England Journal of Medicine 274:1354-1360. Benedict, Ruth. 1946. The Chrysanthemum and the Sword. Boston, MA: Houghton, Mifflin Company. Bond, M.H., K. Leung, A. Au, K-K Tong, S.R. Carrasquel, F. Murakami, S. Yamaguchi, G. Bierbrauer, T.M. Singelis, M. Broer, F. Boen, S.M. Lambert, M.C. Ferreira, K.A. Noels, J. Bavel, S. Safdar, J. Zhang, L. Chen, I. Solcova, I. Stetovska, T. Niit, K-K. Niit, H. Hurme, M. Böling, V. Franchi, G. Magradze, N. Javakhishvili, K. Boehnke, E. Klinger, X. Huang, M. Fulop, M. Berkics, P. Panagiotopoulou, S. Sriram, N. Chaudhary, A. Ghosh, N. Vohra, D.F. Iqbal, J. Kurman, R.D. Thein, A.L. Comunian, K.A. Son, I. Austers, C. Harb, J.O.T. Odusanya, Z.A. Ahmed, R. Ismail, F. Vijver, C. Ward, A. Mogaji, D.L. Sam, M.J.Z. Khan, W.E. Cabanillas, L. Sycip, F. Neto, R. Cabecinhas, P. Xavier, M. Dinca, N. Lebedeva, A. Viskochil, O. Ponomareva, S.M. Burgess, L. Oceja, S. Campo, K-K. Hwang, J.B. D’souza, B. Ataca, A. Furnham, and I.R. Lewis. 2004. Culture-level dimensions of social axioms and their correlates across 41 cultures. Journal of Cross-Cultural Psychology 35(5):548-570. Brehm, J.W. 1956. Postdecision changes in the desirability of alternatives. Journal of Abnormal and Social Psychology 52(3):384-389.
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