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Hon. Patrick KennedyAmerican Psychiatric Association
May 21, 2007
The Road to Equity: Marching Toward a Just Treatment of Mental Illness and Addiction in America
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Never Discuss Floods With Noah In the Audience
Never Discuss Floods With Noah In the Audience
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Stick to stuff you know something about!
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I’ve become obsessed with the science-society relationship
• Overlays the science base for mental illness and addiction understanding, stigma and treatment– And reimbursement issues
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The Evolving Climatefor Neuroscience & Society
American Psychiatric AssociationMay 21, 2007
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Why do we have science anyway?
To provide natural explanations of the nature and workings of the natural world
Whether we like the answers or not!
To improve the human condition
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Baseline truism:
Science and technology are ever-more imbedded in every aspect of modern life!
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Corollaries:
For people to prosper in modern society, they need fundamental understanding and comfort with S&T
For science to prosper, the science-society relationship must be positive and strong
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We have a problem
The science-society relationship is experiencing significant tension
Is beginning to erode
Neuroscience is not immune
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As Charles Dickens would say…..
We’re living in the best of times
And the worst of times
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On the one hand
We’re living in the best of scientific times
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Advances in science are coming at a fantastic pace
The rate of incremental advance is accelerating
New technologies are enabling quantum jumps in understanding
With great practical significance
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L. Chang, M.D., T. Ernst, Ph.D., O. Speck, Ph.D.Harbor-UCLA Medical CenterGenerating words (left brain dominant)
LeftLeft
RightRight
DorsalDorsal
VentralVentralAnteriorAnterior
posteriorposteriorLL
RR
LL
RR
SMASMA
Broca’s areaBroca’s area
Broca’s areaBroca’s area
Parietal CortexParietal Cortex
Functional MRI of a “normal” subject writing a talk
Chang, et al.
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The Evolving Climate for Neuroscience and SocietyAmerican Psychiatric Association, May 21, 2007
14Gogtay, et al., PNAS, 2004, 101: 8174-
8179
Dynamic mapping of human cortical development during childhood through early adulthood
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Lesser brain activation in adolescents compared to adults in anticipation of monetary reward
Bjork, et al., J. Neurosci. 24:1793-1802 (2004)
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That’s why 12 year-olds and 18 year-olds feel like different species
Their brains are different
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Descartes
Mind and Body are InseparableMind and Body are Inseparable
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Descartes Freud
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Comparison Subject METH Abuser
Dopamine Transporter Loss AfterHeavy Methamphetamine Use
Source: Volkow, N.D. et al., Am J. Psychiatry, 158(3), pp. 377-382, 2001.
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Mental Disorders and Addiction are Brain
Diseases
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So, scientific progress is going great!!
With all its implications for understanding, prevention and treatment
For stigma
For reimbursement
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On the other hand….
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Other issues within science are not going so well…and negatively affect the broader (societal) context for science
Incidents of scientific misconduct
Human subjects concerns
Animal welfare issues
Conflict of interest problems
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These are factors internal to science
There are problematic external factors as well
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People generally still respect science and technology….
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US public’s view of scientific research
National Science Board, Science and Engineering Indicators - 2002
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They have little understanding of what is and is not science
60% of Americans believe in extrasensory perception
41% think astrology is somewhat scientific
47% still do not answer “true” to the statement: “Human beings developed from earlier species of animals”
Science and Engineering Indicators, 2004
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Some Americans have reservations about science
Agree
%
Disagree
%
Science makes our way of life change too fast 38 59
Scientific research has created as many problems for society as it has solutions
52 41
Scientific research these days doesn’t pay enough attention to the moral values of society
56 37
We depend too much on science and not enough on faith
50 45
Science and Engineering Indicators, 2006
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There’s a lesson here!
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People need to know more about science as an enterprise
What makes something scientific?
The limits of scientific investigation
Natural explanations of the natural world
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Much science-society tension results from conflicts between scientific findings and
Political/economic expediency
Core human values
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One political (economic) example…
Is there global warming?
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Source: IPCC, 2007
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36Source: IPCC, 2007
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Science-society tension results from conflicts between scientific findings and
Political/economic expediency
Core human values
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Scientific issues abut against values:
Embryonic stem cell research
Studying “personal” topics
Sex
Genetics of behavior
“Intelligent Design” versus evolution in science classrooms and science museums
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Many neuroscience issues abut against human values
More…..
The ability for anyone to look
into your brain and
watch your mind in action
Darkest secret thoughts
Lie detecting
The nature of the mind
Mind-body-soul concepts
Free will vs. determinism
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Neuroscience issues that abut against human values (cont.)
How to relate to brain disordered individuals
Personal responsibility for your brain diseased behavior
When and how to intervene in brain-mind function
Society’s views on this continue to havean enormous impact on parity issues
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The emergence of neuroethics as a field/enterprise
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Two prominent values-related examples
Embryonic stem cell research
Evolution vs intelligent design
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The embryonic stem cell issue
Whether or not human embryos can be destroyed to produce (and grow) pluripotent stem cells for research directed at potential therapies
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Objections are not based on skepticism about the potential for developing therapies
Most people agree there is significant potential
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Objections have more to do with how the issue intersects with one’s religious/moral beliefs
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Stem cells and religion
Different religious groups have differing ethical perspectives on using embryonic stem cells for research purposes
When does life begin?
Fertilization
During gestation
Birth
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Intelligent design
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Intelligent design claims to believe, like evolution, in gradual change
But a supernatural being guided the process
Claims to be a scientific alternative to evolution
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Advocates want intelligent design taught in science classrooms as an alternative to evolution
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Scientists argue that ID is not science
Science is restricted to the natural world
ID posits a supernatural “designer”
And supernatural is not science
Keep non-science out of science classrooms
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Source: Miller, et. al. Science 313, 765 (2006).
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= “Intelligent design” initiative eruption
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Overlay of values is having serious consequences for the whole science-society relationship
Society wants to influence science
Rather than just the reverse
Creating a divide between science and the rest of society
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What to do?
How to improve the science-society relationship?
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We can’t just “educate” our way out of it
The problem is not just lack of understanding
People do understand much of what we’re saying or want to do
They don’t like it
Conflict with their core values trumps their view of societal benefits
Only scientists must “stick to the science”
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What can we do?
Continue protesting/lamenting the situation
Adopt a more assertive strategy
Engage with the public on the issues
Try to find common ground
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One can’t deal with
Evangelical fundamentalists
Evangelical atheists
Militant agnostics
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One can work with
Undecideds
Rational middle
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Communicating Communicating to the public with the public
We need to change not only the style and content but also the intent of the conversation:
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We need to listen to the public about:
Their concerns about science and technology and their concomitants
Their priorities among research areas
Questions they would like or need us to answer
Help frame the research agenda
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Formal dialogues in the United States:
NIH/NHGRI’s “Ethical, Legal and Social Implications” (ELSI) Program
AAAS’s Dialogue on Science, Ethics and Religion
Johns Hopkins Univ. Genetics and Public Policy Center
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In genetics:
What values and priorities should genetic research and its application seek to uphold?
Where does the public draw the line on an acceptable level of risk?
Kathy Hudson, Research USA, June 30, 2003
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Neuroscience needs to go out to the public in a similar way
Stigma
Personal responsibility for brain diseased behavior
Criminal justice policies related to addicted individuals
Reimbursement for mental disorders and addiction treatment
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AAAS Public Engagement Programs
Science center/museum collaborations
Science Update – radio show
Array of publications
Dialogue on Science, Ethics and Religion (DoSER)
Center for Public Engagement with Science and Technology
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AAAS Center for Public Engagement with Science and Technology Town meetings
Family science days
Topical public workshops
Meet the scientists events
Broadcast opportunities
Partnerships with science museum and centers
Active outreach
Clubs
Residential communities
Religious institutions
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AAAS “Glocal” strategy
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Working with local opinion leaders and resources
Local media and op-eds
Clergy
School officials
Local government leaders/politicians
Science museums and centers
Community groups
Town meetings
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= “Intelligent design” initiative eruption
= AAAS intervention
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The Dover trial local op-ed strategy
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As we move through this difficult era for science and society
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We Need to Restore Equilibrium to the Science-Society Relationship
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Public sentiment is everything. With public sentiment, nothing can fail; without it, nothing can succeed. Abraham Lincoln
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Who’s going to do it?
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We All Need to be a Part of the Effort!