Climate Change, Alzheimer’s Disease and the Conundrum of Scientific Authority.

There is perhaps no greater source of authority in modern society than science.  As a result, scientific claims are nearly ubiquitous, and often controversial. How do we decide when to trust and when to doubt ostensibly authoritative science?

This question was brought home to me in a couple of exchanges I’ve been part of this year concerning climate change and Alzheimer’s disease. When Peter Whitehouse recently wrote a post on the Myth of Alzheimer’s blog asserting that extreme weather events associated with climate change pose a significant threat to elders, particularly those with cognitive impairment, a climate change denier thanked him for exposing the myth of Alzheimer’s but took him to task for falling for the myth of global warming.

Going in the opposite direction, back in March someone took great offense at a talk I gave questioning the ostensibly authoritative claims of Alzheimer’s researchers and accused me of engaging in the equivalent of climate denial: making specious arguments that are dismissive of the very real problem Alzheimer’s disease presents to individuals and society, and thus reducing the global commitment needed to recognize and respond to it. (This exchange happened to take place as I was preparing for a four day bicycle trip with my 12-year-old daughter from central PA to Washington DC to raise awareness about the need for climate action, so it did get under my skin.)

It’s tempting to dismiss these criticisms as simple ignorance. After all, as I pointed out in reply to the same climate denier’s 30-link torrent  in response to a subsequent post by Whitehouse on climate change, a very strong scientific consensus on anthropogenic climate change is in the realm of objective fact: A survey of nearly 12,000 relevant peer-reviewed scientific articles published from 1991-2011 show that 97% of them support the basic consensus on climate change, and virtually every prestigious scientific society in the United States and around the world has issued or signed on to statements supporting the consensus that climate change is being driven by emissions from the burning of fossil fuels and poses a serious threat to human society. And my criticism of the emphasis over the past thirty years in the Alzheimer’s field on cure and prevention rather than support for creative, stable caregiving hardly amounts to a denial that dementia is real, and causes real suffering and loss to society.

But a legitimate question remains. It seems that on the one hand, I am pleased to accept the claims of a majority of climate scientists as authoritative. On the other, I seem equally pleased to criticize the claims of a majority of scientists and practitioners in the Alzheimer’s field. How can I justify this apparent inconsistency? Perhaps I have enough direct familiarity with the content of the relevant branches of science in both of these broad fields to make an informed judgment? Absurd. I’m very knowledgeable about Alzheimer’s for a non-scientist, and probably better read than the average person on climate science.  But the volume and degree of specialization in modern scientific research makes it a challenge for scientists to keep up with research even in their own narrow fields. Directly assessing the volume of work in broad fields like dementia or climate research is simple impossible. At some point, no matter how broad or thorough your scientific education and competency may be, you will need to trust (or not) the claims of others about science. But how to decide who and what to trust?

Here I think the academic fields that have formed me as a scholar – the history of medicine and STS (Science, Technology and Society) – have much to offer. The implicit idea of these fields is that understanding some of the science itself is necessary but far from sufficient. To understand science deeply enough to reach sound judgments about when to trust and when to question scientific claims, one must learn and think more about science and the way it is actually practiced in the world. One must understand the social and cultural contexts that shape scientific interest and help determine what kind of scientific questions are pursued. One must consider the social, economic and political factors that inevitably influence scientists. One must be able to recognize the way that social and cultural values are embedded in seemingly mundane questions of scientific method and analysis. The point of these sorts of questions is not to dismiss or diminish science, but to understand its real power, and in so doing reach better judgments about how it should be used to better serve human flourishing.

It’s the consideration of these sorts of questions that lead to my different stances toward climate science and Alzheimer’s research. As I mentioned above, in simple numerical terms the consensus on climate change is very strong. But in socio-historical terms, the breadth and resilience of the consensus is even more impressive. As shown by physicist and historian of science Spencer Weart’s comprehensive research, the consensus around the theory of anthropogenic climate change is not supported by evidence generated from the work of a single scientific field, but emerged with the convergence of many lines of research from a broad range of scientific fields ranging from geology, chemistry, atmospheric physics, meteorology, oceanography, computer modeling and many more. Practitioners in these fields use different methods and approaches to what counts as evidence, so that the theory has been challenged and tested from multiple directions. Scientists in different fields also get research funding from different sources within the federal government and the private sector, so the potential funding bias is less than when funding comes from a more narrow range of sources. Moreover, since the theory of anthropogenic climate change implicates the energy industry, it is profoundly threatening to some of the most powerful political interests, who have responded by spending vast sums to discredit it. Historians Naomi Oreskes and Eric Conway have shown that this involve funding the activities of a handful of scientists with an anti-regulatory bent who have attacked not only the climate change consensus, but had also been involved in earlier attacks on scientific research showing the harmful effects of DDT, CFCs, and tobacco. Journalists have also begun to trace the donations of hundreds of millions of dollars from conservative billionaires with fossil fuel industry ties to public relations and lobbying campaigns aimed at attacking the climate change consensus in the media and on Capitol Hill.  That a strong consensus supporting the theory of anthropogenic climate change remains despite decades of well-funded, systematic attack enhances its credibility.

While I in no way intend to dismiss research in the Alzheimer’s field over the past several decades that has produced much important knowledge about some of the likely pathological mechanism that lead to dementia, a consideration of socio-historical factors raises questions that are not often enough asked, especially in media coverage. First, while there is no credible denial that age-associated progressive dementia exists as a significant individual and social problem, there are many different  theories regarding what causes it among respected researchers in the field, and debate within the field about whether it can truly be disentangled from usually more benign processes of systemic brain aging. Second, while researchers from diverse fields certainly conduct Alzheimer’s research, the dominant approach emphasizing the drive to pharmacological treatment and prevention is the product mostly of psychiatrists and neurologists, and this group is largely supported by a narrow funding stream from the pharmaceutical industry. Critics like David HealyCarl ElliottJohn Abramson  and others have documented the distorting effects of pharma money on medical research in general, and several authors in a book on dementia treatment I co-edited show that this happens in the Alzheimer’s field as well. Finally, unlike climate change, the dominant approach to Alzheimer’s disease is in sync with the interests of the pharmaceutical industry, which has accordingly spent vast sums to persuade the public and lawmakers of its importance to society so that there has been relatively little public debate about it. None of this amounts to a reason to dismiss mainstream Alzheimer’s research outright, but it does suggest there is a need to ask some critical questions.

Both climate change and Alzheimer’s disease are complicated problems, and much will no doubt continue to change in the scientific understandings of both of them. But the persistence of such a strong scientific consensus around the fundamental of climate change despite factors that we would normally except to weaken that consensus, especially the strong resistance of powerful economic interests, helps convince me that it is time to take strong steps as a society to lower carbon emissions. While we must also continue to take the challenge of Alzheimer’s disease very seriously, I see a need for a broader debate about whether the emphasis on developing a pharmaceutical solution – which has been promoted by powerful economic interests – has led us to pay too little attention to other ways of effectively responding.

And beyond both of these issues, we need to move beyond ubiquitous claims of scientific authority and superficial controversy to a more thoughtful public discourse about science and its place in society.

Skewering the Emerging “Brain Fitness” Industry

Capture brain fitnessPerhaps I should look into joining The New Yorker as a staff writer now that major articles on dementia seem to have become a regular feature of the magazine. In this week’s issue, humorist Patricia Marx skewers the emerging “brain fitness “ industry.  Her tone is breezy and light compared to the gravity of the two articles I reviewed in my previous post, going for laughs by probing the tension between mid-life anxiety about cognitive decline and the range of improbably diverse claims for the cognitive benefit of various activities:

It’s a pretty regular occurrence for me to leave my reading glasses God knows were or lose my train of thought or have trouble recalling the word `phlogiston’ – and, egads, what happened to all that stuff I used to know about Charlemagne’s in-laws? In my darkest moments, I imagine that my friends are humoring me when they insist that their amnesiac lapses are no less alarming than mine. (“Have you ever squeezed toothpaste onto your contact lenses?” a friend asked triumphantly.) Am I, like so many of my gang, just another one of the `worried well?’(A 2011 survey found that baby boomers were more afraid of losing their memory than of death.) Should I get out a crossword? Learn to play bridge? Chew gum? Take a nap? Drink more coffee? Eat blueberries? Give up tofu? There are studies that tout the benefits that each of these undertakings has on the brain. What to do?”

Readers who themselves are struggling with significant cognitive loss, or caring for people with dementia, may be put off by the tone of the article. But Marx is making an important point about how the purveyors of brain training software and other “neurobic exercise” programs are forging a billion dollar industry on anxiety about dementia and scientific sounding claims about various techniques for re-invigorating the brain.

Marx is not, however, completely dismissive of recent findings about neuroplasticity and the potential for diet, exercise and stress management to prevent cognitive decline. The work of Kenneth Kosik, a neuroscientists at the University of California at Santa Barbara and founder of a non-profit brain fitness center, comes off as reasonable, legitimate, and firmly grounded in real science. Citing the well-known nun study and other recent research, Kosik explains the scientific basis for believing that social, physical and intellectual enrichment that promotes good brain health across the lifespan can increase the resilience of the brain and help prevent dementia. Kosik, who is also involved in more mainstream biomedical research, is careful to keep claims about brain fitness modest, arguing that they should be part of an overall health lifestyle. Of his brain fitness center , Kosik says that “I’m sure some of my colleagues in Boston would look at this as a fringe operation, a storefront with walnuts and incense. On the other hand, we can wait for science to come up with a cure or we can jump in and try to create an atmosphere that is conducive to good brain health.”

Though Kosik is clearly right that this holistic approach to brain health as a factor in dementia is at odds with the reductionist drive in biomedicine to find the key to curing or preventing dementia in specific pathological mechanisms, he is quite wrong about how the brain fitness industry looks. The companies Marx spends most of the article quite justifiably mocking are careful not to look like smoky dens of new age mysticism. Rather, they relentlessly deploy neuroscience lingo and wildly extrapolate from limited research evidence to make absurdly inflated claims for the efficacy of their products.

After a crash course of several weeks Marx concludes:

Judging from the series of questionnaires I’d filled out during the course of my training, my mood brightened, my sleep was more restful and I felt more confident. I may also have become a bigger liar on questionnaires but that was not evaluated. As for the exercises, my scores were higher across the board. In an email summing up my progress, Merzenich [neuroscientist and co-founder of BrainHQ] wrote `Your advances on these exercises comes from brain remodeling. If we had recorded from/imaged your brain before and after training, we could have easily shown that you now have a `better’ (stronger, faster, more reliable, more accurate) brain.’ (Wouldn’t they make dandy wallet photos?) Compared with my poky old brain, my souped-up brain, according to Merzenich, has more synapses, better wiring, stronger connections, and more forceful activity. (Doesn’t that sound like an ad for a five-thousand-dollar stereo?)

I’m not sure I noticed my newfound cognitive abilities in everyday life. It’s hard to be both scientists and lab rat. On the positive side, I am slightly less troubled about the size of my hippocampus. On the negative side, why did I sprinkle NutraSweet on my broiled salmon last night?”

The New Yorker on Dementia: Crisis in Scientific Research and Progress in Caregiving

The peer-reviewed article may be the coin of the realm in academic science, but the high profile magazine article is the bellwether of popular attitudes toward health, medicine and disease. Thus it’s notable that The New Yorker, one of the few remaining popular periodicals aimed at well-educated general readers, recently published two major articles about the search for new approaches to Alzheimer’s and dementia. One focuses on the lack of progress in scientific research, and the other on encouraging developments in nursing home care.

Jerome Groopman’s “Before Night Falls,” which appeared in the June 24 issue, aims to describe the current state of research on Alzheimer’s disease and the search for new directions.  Groopman holds a prestigious medical research chair at Harvard Med, but is more widely known as the author of a number of bestselling books that explore the experience of illness, the often tangled relationship between doctors and physicians, and the inherent difficulties of the diagnostic process.  Groopman’s popularity is well-deserved.  He is an excellent writer, and here he provides a compelling description of the struggle of leading Alzheimer’s researchers to find a viable direction following “three decades of Alzheimer’s research [that] has done little to change the course of the disease.” But Groopman’s qualities as a writer and critical observer of medicine make the limitations of this article all the more disappointing.

Groopman depicts the Alzheimer’s field as essentially split between two camps – the majority of researchers who continue to believe that the key to the disease is the excess accumulation of the protein beta-amyloid that ultimately forms plaques in the brain, and the smaller group of dissenting researchers who call instead for a focus on the tau protein involved in the formation of neurofibrillary tangles or some other putative cause, or who suggest that the disease is simply too complex and scientific understanding too limited to warrant focus on a single target.

The article strikes a fair enough balance between these two camps. It focuses on the work of champions of the amyloid orthodoxy like Dennis Selkoe and Reisa Sperling, and especially on the emerging emphasis on early diagnosis and prevention in the wake of the failure of anti-amyloid drugs to improve the cognitive functioning of people who have been diagnosed with dementia. But it also gives ample space to the views of prominent critics like George Perry and Peter Davies to explain their doubts.

Indeed, the article is far from the sort of naïve expression of fervent belief in the inevitability of medical progress that is all too typical of medical journalism today. It does not gloss over the uncertainties, risks and costs involved in the new emphasis on early diagnosis and treatment targeting amyloid accumulation. Moreover, the personal and societal consequences of Alzheimer’s are depicted as so grave that, as the title suggests, the overall tone of the piece is more gloomy than triumphant. The final section of the article reiterates the apocalyptic demography that characterizes so much Alzheimer’s advocacy: the looming economic burden of the disease, reckoned to be more than a trillion dollars a year by 2050, makes spending billions of dollars on research, whatever the uncertainties, seem like the only rational course of action – even to budget hawks like Republicans Eric Cantor and Newt Gingrich. Groopman gives researcher Reisa Sperling the final, almost desperate word:

I think it’s a war – a war against Alzheimer’s disease, and we are losing, so I’m going to use military terms,” she said. She argues that those who are concerned about an ill-conceived rush to preventive trials lack the appropriate sense of urgency. “The idea of waiting another ten years, just to study the natural history of Alzheimer’s disease, is not tenable,” she said. “These are the dilemmas. How do we make the best possible decision right now, in the absences of all the data we need?” She paused for a long moment, then said, “My biggest fear is that we are just doing too little too late, and that even if we move sooner, we are not lowering amyloid sufficiently. So we will get to the end of the trial and say, `Well, here we are, and we have the same conundrum. We just did not do enough.’”

There are two glaring omissions in Groopman’s article. First, there is virtually no discussion of big pharma’s role in the development and continued dominance of the amyloid approach. Critics like David Healy, Carl Elliott, John Abramson  and others have documented the distorting effects of pharma money on medical research, and several authors in a book on dementia treatment I co-edited show that this happens in the Alzheimer’s field as well. While reasonable people may disagree about the effect of the pharmaceutical industry on medical research, it is inexcusable to simply ignore the issue in a story of this length and prominence. Second, there is absolutely no mention of the many studies suggesting that non-pharma approaches to overall brain health like diet, exercise, and social engagement can effectively lower the risk of dementia, most recently two studies showing that dementia rates in Denmark and the United Kingdom may actually be falling even as the population ages.  Such approaches, which anecdotally at least appear at least as promising as any drug, have the advantage of being safe and cheap – and something we should want to do for other compelling reasons anyway. It is surely worth asking why Alzheimer’s researchers working to establish a new regime of early diagnosis and prevention would not want to rigorously explore how non-pharma approaches could be part of that strategy.

As an antidote to the feeling of gloom and desperation in Groopman’s depiction of the search for an effective medical treatment for Alzheimer’s, one should turn to exciting developments in the field of nursing home care that are promising to dramatically improve the lives of people with dementia and their families today. These developments are described in great depth by Rebecca Mead in an article called “The Sense of an Ending” that appeared in the May 20th issue.

Mead focuses on the work in dementia care at the Beatitudes Campus in Phoenix, AZ, and the NYC chapter of the Alzheimer’s Association that is exploring ways to incorporate its approach in nursing homes there. Beatitudes is part of a culture change movement in nursing home care that encourages moving away from a medical model of care focused on treatment and efficient service delivery, to a more holistic, person centered approach to dementia care that aims to create environments that minimize distress and value the enjoyment and meaning inherent in the non-cognitive human capacity for sensory pleasures and intimacy.  “Without any immediate prospect for a cure,” Mead writes “advocacy groups have begun promoting ways to offer people with dementia a comfortable decline instead of imposing on them a medical model of care, which seeks to defer death”

But the culture change movement is about more than making people with dementia comfortable as they await the release of death. It is based on a profound re-valuing of the person with dementia, focusing not just on the cognition that is lost, but the physical and emotional capacities that remain, capacities that might even be enhanced in dementia. Mead writes that Tena Alonzo, director of education and research at Beatitudes, views people with dementia as “closer to the higher being. This is who they are: real, honest, and sometimes raw. There is no ability to reason, or to cover up who you really are. And so, for much of the time, you see the loveliness of the soul – it is bare  for everyone to acknowledge.”

Seen from this perspective, the aim of caregiver is no longer to change or manage the person with dementia, but to overcome the anxieties and defenses that prevent caregivers from developing real, life-giving relationship with who the person with dementia has become.  Mead acknowledges the difficulty of this, especially for children or partners who cannot help but grieve the abilities that the people with dementia they love have lost. Nonetheless, one can see in her rich description of the world of care at Beatitudes what caregivers can gain from these relationships. Mead describes a woman who spent most of every day walking up and down the corridors. In a typical nursing home, this behavior might be seen as pathological and worrisome, a risky problem behavior to be managed and perhaps suppressed. But the staff learned that she had worked in retail for decades, and determined that she was not going to stop walking just because she was in a dementia unit, so they sought merely to minimize her discomfort by considering additional pain killers when her feet appeared to be painfully tired. Mead describes her feelings when she interacted with her:

I spent some time on day walking along the corridor with this woman, into the sunroom and out of it again. Her face brightened at the company, and she was eager to talk, even when her side of the conversation devolved into singsong nonsense. Sometimes she stopped to shimmy for a moment, and I could imagine what a figure she must have cut at a dance. Being in her company triggered memories of being a child alongside my grandmother, now long dead. I recalled the at-a-loss-for-words feeling that I used to experience with her, even as she made me feel held within a sphere of affection. This woman’s powers of cognition were limited, but her capacity to experience emotion seemed unimpaired, and she demanded engagement the way a small child does: it made no more sense to resist her impulse toward intimacy than it would to withhold a smile from a baby. When she grasped my hands and told me I was perfect, I told her that she was perfect too.”

What will strike many people as most remarkable about Beatitudes is that is cost-effective. Mead notes that despite the innovations that make Beatitudes a much more gracious place to live than the typical nursing home, the average cost of care is roughly the same. Not least among the ways that a person-centered approach to dementia care can save money is by reducing the use of expensive anti-psychotic drugs, which can cost hundreds of dollars per month for every patient on them. Mead quotes Alice Bonner, director of the Center for Medicare and Medicaid Services: “People are starting to realize that, with some creativity and curiosity, we can figure out other ways of taking care of people with dementia.”

Taken together, these two articles suggest a change in emphasis. The future of the dementia field may lie less with developing high-tech medical interventions aimed at curing or preventing dementia, and more at developing and practicing innovative models of care. Perhaps we can learn to see dementia as less of a personal and collective apocalypse than a great human challenge that can bring out the best in us.

Wiring for Dummies: What Neuroscience Can and Can’t Tell Us about Ourselves.

connectome cover

A Review of Sebastian Seung’s The Connectome: How the Brain’s Wiring Makes Us Who We Are. Mariner Books, 2013.

There is no scientific field more exciting than contemporary neuroscience, poised as it is to develop concepts and technologies that will finally penetrate and manipulate fundamental mechanisms of the human mind. There is also no scientific field more arrogantly simplistic, bedazzled as it is by reductionist theory and fantasies of human power and control over complex biological processes. MIT neuoroscientist Sebastian Seung’s brilliant book manages to be both.

Seung is a rising rockstar scientist with drop-dead good looks, bold fashion sense (he typically sports jeans and t-shirt and showed up to a recent high profile debate wearing shiny gold sneakers), and a knack for making complicated ideas and profound problems in neuroscience not only understandable but cool. He gave a popular TED talk laying out the central thesis of his work that “I am my connectome,” that the sum total of synaptic connections within the brain constitute human selfhood in all its rich uniqueness. This book is a fuller elaboration of that idea and its intellectual history, and a fascinating account of the development of the theories and technologies that Sueng believes will make possible what he views as the ultimate goal of neuroscience – a complete map of the human connectome.

Pursuing this goal, according to Seung, will have both philosophical benefits in terms of understanding human nature and practical benefits in terms of getting at the true causes of mental disorders like autism and schizophrenia which he argues may usefully be thought of as “connectopathies”—abnormal patterns of neural connection.  Beyond this, Seung argues that it is theoretically possible (or at least not yet a proven impossibility) that in the future connectomics will advance to the point of being able to fully read off and duplicate the contents of individual human consciousness thus essentially achieving the dream of immortality. Though Seung hedges on whether he really believes projects like cryonics and the uploading of consciousness are plausible or even desirable, he clearly embraces the broader transhumanist dream of developing technological means of human improvement. He concludes the book with grand vision that evokes the technological singularity, when humans will finally transcend the limits of their biology:

Connectomics marks a turning point in human history. As we evolved from apelike ancestors on the African savannah, what distinguished us was our larger brains. We have used our brains to fashion technologies that have given us ever more amazing capabilities. Eventually these technologies will become so powerful that we will use them to know ourselves—and to change ourselves for the better.”

Seung acknowledges that neuroscience is very far from achieving the extraordinarily difficult goal of mapping the connectome. It took scientists more than a decade to map the connectome of the nematode C. elegans, whose simple brain consists of only 300 neurons and 7000 synaptic connections. The human connectome is 100 billion times larger, with a million times more connections than the human genome has letters. But as Seung explains, the development of technologies that automate much of the work are beginning to make this enormous project feasible.

However the real problem is not just size, but complexity. While the nematode connectome is relatively fixed and stable from one individual organism to the next, the connectome of every human being is unique, reflecting the ongoing re-wiring of synaptic connections within the brain as each individual interacts with the environment. Yes, there is an underlying brain structure common to all human brains, but the wiring of the connectome evolves in a way that reflects the unique experience of the world each individual gains through their senses, their thoughts and feelings, and even the ideas they have encountered through participation in human culture. Connectionism itself suggests that human consciousness can never be reducible to a universal brain structure or state; it seems quite plausible that ostensibly identical synaptic connections could be encoded with different mental content.

In recognizing the dialectical relationship between brain and environment, connectionism would seem to avoid the crude reductionism of discredited intellectual ancestors like phrenology that sought to identify specific regions of the brain with complex personality traits and mental functions. Indeed, one of Seung’s clearest messages is that “the connectome is where nature meets nurture.” If that is true, then traditional understandings of the role of culture and society should be seen as equally important in the formation of self, and psycho-social approaches equally important as biotechnology in dealing with mental disorders. But Seung and other neuroscientist are not much interested in the dense matrix of “nurture” constituted by human culture and society. They are really interested only in the wiring.

For example, Sueng makes much of the infamous discovery of the Jennifer Aniston neuron – a specific neuron in themedial temporal lobe (MTL) that fires only when research subjects look at a photograph of her, along with neurons that fire exclusively on perception of other celebrities. He extrapolates from this to theorize about how perception works in general by comparing the brain to an army of paparazzi employed by a magazine that seeks to publish titillating photos of movie stars:

One hounds Jennifer Aniston with his camera, another devotes himself to Halle Berry, and so on. Every week, their activities determine which celebrities appear in the magazine, just as the spiking of MTL neurons determines which celebrities are perceived by the person.”

paparazzi

While this is a fascinating speculative theory about the mechanism of perception in the brain, it actually tells us very little about the mind. Following the actions of this “army of papparazi” might tell us how certain things end up in “the magazine” of the mind, but it really does not tell us why that magazine devotes attention to celebrities at all, who “buys” it, etc. Seung tries to meet this kind of objection by suggesting that the “Jen neuron” is activated by a population of neurons triggered by neurons devoted to components of the perception – neurons that fire for blonde hair, dazzling smiles, blue eyes, and other attributes. But this comes to seem very much like a return to phrenology. It’s as though Seung seeks to explain why you assembled songs into a playlist by examining the circuitry of your iPod. To explain your playlist, we are going to need to know some things about the society and culture you live in.

All of that said, Seung’s book is well worth reading for its clear discussion of what neuroscience is uncovering about the workings of the brain. Neuroscience is indeed opening an exciting frontier, and work toward mapping the brain may tell us some valuable things about human nature and mental illness. But as we think about these possibilities, and how to prioritize our investments in science, we should also acknowledge that there are things it will never be able to tell us.

Around the Web: Omphalos and Hole Ousia

As I sat down to write this, I just realized that it was actually one year ago today that I launched this humble blog. One of the best reasons for blogging and social media is the chance of making contact with people you likely never would have encountered otherwise. This happened with my first post, when Peter Gordon introduced himself in a comment. Peter is a geriatric psychiatrist in Scotland who also has been thoughtfully exploring in video and writing the need to develop a richer approach to dementia informed by the humanities, and the broader problem of the division between science and the humanities in biomedicine.

I was especially flattered that he used extensive quotations from my book in one of his first videos called  The Diseased Other.  Lately, he has been courageously raising vital critical questions about the push for early diagnosis of dementia, which he summarizes in this short film:

Peter makes his videos as Omphalos and shares them on Vimeo. He blogs at Hole Ousia, and  at the Myth of Alzheimer’s blog. Check his work out.

Solidarity Along the Supply Chain: Why We Should Care About Sweatshops

This is the first of a series of occasional posts on issues of solidarity. As a long-term project, I am exploring the idea that every significant public issue raises problems of solidarity – of establishing emotional ties and making common cause with people who seem profoundly separated from us by differences of culture, class, body, space and time. The primary moral challenge of the modern world is forging bonds of solidarity; it is essential to making progress on every issue that matters to the future of humanity.

The defining feature of twenty-first century American culture may be the fantasy that there is something transformative about mass violence, suffering and death.  From the 9-11 attacks on, we have witnessed a numbing litany of mass catastrophes – deaths and suffering from terrorism, war, senseless killing sprees, and the alchemy of social, meteorological and geological circumstances that shape the so-called natural catastrophes of drought, flood, famine and fire. Through the mass media we witness the death and suffering of others in lurid, emotionally shattering detail, but with a frequency and on a scale that defies our powers of recall, let alone our ability to comprehend and care. And yet, every time, even as the broken bodies are being pulled out of the smoldering ruins and the blood is being hosed off of the street, we tell ourselves that this time it will be different. Surely catastrophe on this scale, loss this terrible, cannot be ignored and will finally compel us to take action. Surely we will never forget, we will not allow such horrors to happen again. But soon enough the shock diminishes, and our attention wanes as the restless media eye flits to other things. And nothing ever really changes, does it?

Any number of recent events might be taken as an occasion for such thoughts. But I write this specifically as a reaction to the collapse in April of an eight story building in Bangladesh that killed more than 1,100 people. The story seems particularly compelling because it connects the intimate, everyday appetite for cheap clothing of consumers in affluent nations with the callous exploitation of the global poor. Five garment factories housed in the building – facing pressure to fulfill contracts with European and American retail giants and big name apparel brands – refused to halt production despite warnings that large cracks had been seen in the building the day before, and ordered their workers to return despite the danger.

The magnitude of the tragedy and the intimacy of the news coverage – especially the haunting images captured by Bangladeshi activist and photographer Taslima Akhter – were hard to ignore and cast a harsh light on the corporate supply chains that connect affluent consumers in countries like the United States with impoverished workers in the developing world. One of Akhter’s photos, showing the final embrace of a man and a woman crushed to death in the rubble, went viral and seemed to capture the meaning of the tragedy:

Final embrace

Time Magazine’s photography blog devoted a post to the image, and a quote from a leading Bangladeshi photographer and writer describes its power: “This image, while deeply disturbing, is also hauntingly beautiful. An embrace in death, its tenderness rises above the rubble to touch us where we are most vulnerable. By making it personal, it refuses to let go. This is a photograph that will torment us in our dreams. Quietly it tells us. Never again.” For a media moment at least, it seemed hard to ignore the idea that our clothes are indeed stitched with the blood of the poor.

But while such images clearly provoke a strong emotional reaction among people in the privileged classes, it is far from clear that the usual apocalyptic fantasies will translate into the sense of solidarity, responsibility and resolve necessary to challenge the deeply entrenched global economic inequality that inevitably produces such calamities. As the immediate shock and horror recede, there is a tendency to settle back into established patterns of thought. And the privileged are generally very good at finding ways to live with the emotional and moral stress of knowing that the systems from which they benefit cause grave suffering to distant others. Never underestimate the capacity of the powerful for denial, self-serving rationalization and feigned helplessness – all of which were at work even as the bodies were being removed from the rubble of the building in Bangladesh.

Denial

A Huffington Post/YouGov poll of 1000 American adults conducted two weeks after the building collapse found that 35% had heard nothing about it, and 48% had heard only a little. But this kind of ignorance is hardly justifiable. Ignorance in the internet age, though perhaps a greater problem than ever, is in the West at least typically more a matter of willful denial than scarcity of information. Certainly the tragedy in Bangladesh was prominent enough in every major newsfeed that anyone even minimally wired into the news and infotainment infrastructure had to choose not to know, to click away to something lighter and less troubling. Yes, the giant media corporations encourage us to obsess about entertainment rather than news, vapid celebrity gossip and political hot air rather than critical thought. But you don’t have to passively accept what they push at you like a lamb sucking at a glowing glass teat. Google search will lead you to plenty of good information about the lives of those around the world who work at making our clothes. You can choose to use it instead to wallow in the latest Kardashian outrage, kitty videos, or porn. But that’s a choice to be ignorant, to seek out titillation and distraction to the exclusion of knowledge about our real moral connections in the world. Ignorance is no excuse.

Of course, it is possible to simply not care about the moral implications of your choices as a consumer. An overwhelming majority of respondents to the Huff/You Gov poll say they are much more motivated by the price of clothes than they are about the working conditions of the people who make them. One interpretation of this is that they simply do not care what happens to people around the world. I doubt that is true of many people. Willful ignorance and cruel indifference are the very definition of an asshole. I think most people would like to think better of themselves than that, so they typically try to justify themselves by claims that the system really is for the best, or that in any event nothing can be done to change it.

Rationalization

While even the most hard-hearted market fundamentalist would not want to see tragedies like the building collapse in Bangladesh, within days several commentators rushed to defend sweatshops. The day of the collapse, Matt Yglesias at Slate argued against calls for unified global safety standards, arguing that the poverty of workers in Bangladesh led them to understandably and appropriately accept much greater risks in the workplace than relatively prosperous American workers. Two days later, in response to the outrage his piece generated, Yglesias strongly qualified his argument, distinguishing between appropriate market driven differences in safety standards and what increasingly appeared to be a criminal violation of existing Bangledeshi safety laws. Alex Massie at the Spectator moved from the specific issue of workplace safety to in Bangladesh to a broader defense globalization and the growth of sweatshop manufacturing in poor countries. While he acknowledged that the tragedy perhaps called for some narrow improvements or at least better enforcement of safety standards in Bangladesh, he sharply warned that “western fastidiousness or guilt should not blind us to the fact that grim as they may be these sweatshops – and globalised capital – have been a force for good.”

But at Forbes, neo-liberal economist Benjamin Powell was unapologetic, blithely asking us to look up from the rubble to “the grand scheme of things,” arguing that in an impoverished country like Bangladesh such tragedies are entirely acceptable. Bangladeshi workers freely choose to work in dangerous conditions because they are desperately poor and the benefits to them of factory jobs far outweigh the risks. Safety will improve only after a rise in wages and the overall economic development of the country – which would be slowed or reversed by imposing safety regulations that would either come out of worker’s wages or drive up the cost of labor such that the factories will be closed. “Consumers who truly care about the welfare of Bangladeshi workers,” he concludes, “should encourage companies to source garments from the country, rather than abandon its factories.”

It is true, of course, that the growth of the manufacturing sector in developing countries over the past several decades of globalization has brought economic growth to countries that has been of real benefit to millions of the poorest of the world’s poor – a fact acknowledged by the likes of one of the leading critics of market fundamentalism Paul Krugman and global human rights advocate Nicholas Kristof. But to conclude from this that nothing can or should be done to try to improve conditions for these workers is more a self-serving rationalization of the economic interests of the affluent than a moral argument. Moreover, Powell’s claim that sweatshop reformers naively ignore the benefits of the growth of manufacturing jobs in developing countries is simply wrong. Leading groups working to fight global sweatshops (whom I have followed for decades) like the Worker’s Rights Consortium and the Institute for Global Labour and Human Rights have never advocated simply pulling factories out of countries where sweatshop practices are entrenched, nor for imposing Western wage and safety standards that would drive industry away, but for constructive engagement with corporations and governments to establish contextually fair wages and working conditions.

In fact, a model for how this can work emerged from the international outrage over the Bangladesh tragedy in the form of an agreement signed by dozens of large European retailers to be part of an unprecedented legally binding safety plan that will require publicly reported independent safety inspections with an active role for workers and their unions, and obligate the retailers and brands to underwrite the costs of mandatory repairs and renovations and to terminate business with any factory that refuses to make necessary safety upgrades. Though Powell and other sweatshop apologists have ignored it, the plan got unqualified praise praised from the Worker’s Rights Consortium, which said “This agreement is exactly what is needed to finally bring an end to the epidemic of fire and building disasters that have taken so many lives in the garment industry in Bangladesh.” But most American retailers — most notably, Wal-Mart, which argued that its own efforts would be more effective, and Gap, which argued that the agreement makes them vulnerable to litigation – refused to sign the agreement.

More broadly, Powell’s notion that economic growth alone will lead to fair wages and improvements in safety is a gross simplification of history. Growth is certainly necessary, and may even be the driver of such reforms, but they have always been accompanied by long hard campaigns for justice by workers and their allies among middle class reformers.  And his claim that the preference of the desperately poor for work in sweatshops over the absolute misery of rural poverty represents a free choice makes a mockery of our deep traditions of liberty. Freedom cannot be reduced to market choice, especially in a market where bargaining power is so unevenly distributed. As Wendell Berry said, “rats and roaches live by competition under the laws of supply and demand; it is the privilege of human beings to live under the laws of justice and mercy.”

But even if you are inclined to give this kind of neoliberal market fundamentalism more credence than I am, it does not amount to a brief for consumer disengagement. The corporate supply chains we consume from entangle us with the lives of the poor, and we have an obligation to think matters through, to critically examine the effect our consumption has on their lives as well as ours.  And as Kevin Carson argues, one of the things we should be examining is the constellation of forces that structure the world such that, for Bangladeshi workers, the best available option is a job in a sweatshop.

Despair

But I suspect that for most consumers the biggest barrier to moral engagement on the sweatshop issue is not the specious arguments of market fundamentalists, but uncritical pessimism. Though I have not been able to find any survey data to support this, my impression is that most consumers justify their ignorance and inaction by claiming that nothing they do can possibly make any real difference anyway. Certainly the impossibility of making individual choices or taking collective actions that will change entrenched social structures is a commonplace in popular discourse about a whole range of important social issues. Perhaps most distressingly, I find that this is the prevailing view among the undergraduate students I teach, who quickly grasp the complexity and gravity of social problems, but who are highly resistant to the idea that we can and thus should take individual and collective action to solve them. On the face of it, there is no reason to conclude this (though many educators I know are just as quick to reach this conclusion as their students). Everything we know about the persistent problem of sweatshops suggests that improvement will be difficult and may take a long time. But there is no evidence to conclude that it is impossible.

Here is the question I ask my students, and anyone else in the privileged classes I encounter repeating the mantra that “nothing can be done, nothing can be done:” How did you get to be that way? Objectively speaking, a person who can take a university class, buy new clothes at a shopping mall, or read a blog on the web is almost certainly part of one of the wealthiest, most politically empowered groups of people in the history of humanity. Yes, the significant differences of money and power among the privileged people of the United States and other affluent nations are not without consequence. But still, in the “grand scheme” of human history, anyone who can do these things is fabulously wealthy and privileged. And while our democracy certainly has flaws, we are ostensibly free as citizens to do and say what we like, to gather together as we deem necessary to exercise our rights as the only true sovereign power in our society. With all this,. how in the world have you come to believe that you are powerless? That you lack the ability to change the world for the better? This is not a rhetorical question, but something that requires a real explanation.

One explanation of course is that it is a self-serving dodge. We should be skeptical whenever the most powerful people in a given situation protest that they are powerless. What they may really be saying is that they are simply not willing to make the effort or sacrifice necessary for change. Here we have the cruel ignorance and indifference of the asshole who simply does not care, without the virtue of honesty.

But most people who feel powerless are I think sincere, and when pressed will give some good reasons for their pessimism. Among the best explanations is that the large, powerful corporate entities who benefit the most from the status quo have tight control over what kind of products make it to the marketplace, and what kind of information we can find about what we buy. Worse, they spend vast sums on advertising to stimulate our desire, and they would certainly rather keep us obsessing about our own inadequacies and the way buying their products can make us better than asking critical questions about the social conditions of their production. Under this mental barrage, it is no wonder that people feel disempowered.

What is particularly interesting about this line of argument is that it suggests that affluent consumers are in actual fact controlled and exploited by the same corporate forces that, at the other end of the supply chain, control and exploit poor workers in developing countries like Bangladesh. So to the degree that it is very difficult for us to know and care, let alone do anything about the exploitation of workers around the globe who make our clothes, we find cause for greater solidarity with those workers in that we struggle against some of the same forces. So it ultimately turns out that if we really want to be free and in control of our own lives, we have a strong common interest in the struggle of the world’s poor for freedom and self-determination.

I know how righteous and judgmental this all sounds. I understand that my claim about the historical power and privilege of the middle class in an affluent consumer society is absurdly abstract, and ignores the struggle that life really is for the people I blithely call privileged. Believe me, for all the wealth and privilege I know I enjoy, I feel the pressures and anxieties of trying to hold down an imperiled job in a shrinking market, of trying to pull free of the death spiral of debt, of somehow being present to the needs of my family. But every day that is filled only with our own fears, we die a little bit. I really do believe that the only way we can keep these pressures and anxieties from dominating us is by looking beyond ourselves to see how our problems and challenges are connected to the lives of others. Solidarity is the way out of the madness.

Climate Ride Recap

Climte ride, DC arrivalThis is a  follow-up to my previous post on the bike trip I took with my daughter and four other folks from PA-Interfaith Power and Light from State College to Washington DC to join members of Interfaith Power and Light from all over the country to talk with our congressional representatives  about the need for action on climate change. The trip was a great success, including an appearance in a story by PBS’s Religion and Ethics Newsweekly on religion and the environment. And we reached DC just as the cherry blossoms were peaking.

You can read more about the trip on PA-IPL’s blog. Below is the guest post I wrote. 

climate ride, group shot at Capitol

Day 4 (Guest blogger: Jess) It’s been like riding into springtime, each day a little warmer, a little greener.

We rolled away from our overnight stay at Christ Reformed United Church of Christ in warmth and bright sunshine to an excellent breakfast with some of our new friends in Hagerstown. Rev. Tim Leighton, pastor at another United Church of Christ in Hagerstown and an avid cyclist, rode along with us, pointing out many points of interest along the way. For me, one of the blessings of this trip has been seeing something of the rich uniqueness of places like Hagerstown that I’ve only known as name on a highway sign. There is so much beauty in our country that you’ll never see from the interstate.

After a relatively short ride through the Antietam Battlefield and the town of Sharpsburg, we made a steep descent to the C&O canal towpath for most of the day’s 57 miles of riding. The level terrain along the Potomac was a welcome change from yesterday’s hilly, wind-blasted challenge. We rode along relatively easily through the growing warmth and dappled sunshine, stopping to take in some of the stirring views of the river and some of the beautifully restored aqueducts along the canal.

There aren’t leaves on the trees yet, but wildflowers were in bloom along the trail. The most alarming moment of the day came after stopping in the small town of Brunswick for lunch at a charming local place called Sloppy Tacos. Andy had been having increasing trouble working the gears on his bike for the last two days, and he discovered that his rear gear cassette was actually coming loose – a problem we were not going to be able to solve with the few basic tools we are carrying along even if we could figure out how. We saw that there was a local bike shop – Three Points Cycle – just across the street from the taqueria, and Andy brought his bike over to see if there was anything that could be done. The owner fixed it up in 15 minutes for free.

That was the second time a great local bike shop bailed us out on this trip. In Huntingdon, Jon discovered that his chain had actually chewed through his front derailleur cage. The owner of Rothrock Outfitters in Huntingdon fixed that up in a half hour, charging only $12 for the part. These local bike shops are such a great resource – support them with your business! I’d also like to mention how thankful we are for our own great local shop in State College, Freeze-Thaw Cycles, for its generous support of PA IPL.

We ended the day’s ride by climbing up out of the Potomac valley to Poolesville, MD to the home of Joyce Breiner and Dave Yaney, some friends of PA-IPL that Jon made on last year’s ride (Hannah and I will be staying with Laurie and Brian Hundertmark; Laurie is the daughter of Barb and John Fisher – members of Grace Lutheran in State College). We had wonderful meal out on the back deck, enjoying the warm evening air, the wonderful food, the funny, passionate conversation ranging widely over our experiences and aspirations working for a greener world. Sitting there, it was easy to believe that spring had finally arrived, and that another, more just, more sustainable world is coming.

Of course it is. You can’t hold back the spring.
Jess (and the gang)

Riding and Reading for Climate Action

Over the next four days, my 12-year-old daughter and I will be biking to Washington D.C. with four other riders from Pennsylvania Interfaith Power and Light, an organization engaged in a faith-based response to climate change. The ride is aimed at raising awareness about the need for action on the climate.

bike trip

I’ve asked my friends and social network to consider supporting our effort in two ways. If you have a good understanding of the climate issue and the need for action, consider making a contribution to PA-IPL or to support its excellent work, or sharing your thoughts and prayers about climate change for my daughter to deliver to our congressional representatives. You can find out how to do that at the PA-IPL page dedicated to the ride.

But I’ve also asked friends who are skeptical of climate change or its importance, or who don’t feel they know enough about it, or don’t feel a personal connection to it, to take our ride as a challenge to learn more about the issue. For them and anyone else interested to learn more about the issue, I wanted to briefly note some things to read on climate change.

If you need to start from scratch and want a quick primer on the basic scientific ideas involved in climate change, the group of climate scientists who blog at RealClimate.Org have put together this excellent list of resources that can bring you quickly up to speed.

From my point of view as a scholar working in science and technology studies, beyond having a grasp of the basics, rather than trying to learn a lot more of the science (i.e., pouring over IPPC reports), I wuld encourage people to learn more about the science – how do scientists know what they know? what is the larger historical and social context? In this connection, I can recommend two excellent books.

The first is The Discovery of Global Warming by historian of science and physicist Spencer Weart. It’s a short book, very readable, and gives a compelling account of how scientists from diverse different fields gradually forged the conceptual framework of climate against the larger social context of an emerging ecological consciousness that recognized it was possible for human activity to have an impact on global natural systems. Weart has also put together an incredible website with separate historical essays that go into topics in more depth, and link to the key primary documents in climate science.

For those a bit more ambitious, I would recommend Paul N. Edwards’s A Vast Machine, a fascinating account of computer models, climate data and the politics of global warming. Edwards documents and analyzes in far greater detail than any climate change denier ever has all of the complexities and uncertainties of gathering, storing, and communicating basic data about the climate, but shows how climate scientists have developed computational and conceptual tools for working that data into increasingly consistent and reliable climate models. He concludes with an argument about why climate science has been so politicized, and how such knowledge could and should be used to inform policy.

Crucial to understanding the “controversies” that have surrounded climate science is to understand the world of climate deniers. Merchants of Doubt by historians of science Naomi Oreskes and Erik Conway shows that the same small circle of scientists who, with funding from the fossil fuel industry,  have opposed the consensus of climate science concerning anthropogenic climate change, had earlier, with funding from big tobacco companies, opposed the scientific consensus about the health risks of smoking. The connecting threat was an ideological commitment to free market economics that led them to oppose any scientific research that made some form of regulation seem necessary.

If you’re all good on the science, but aren’t sure why you should care, I’d recommend the work of environmentalist Bill McKibben and his activist organization 350.org. You can find many of McKibben’s essays online, but I’d recommend his essay on “Global Warming’s Terrifying New Math” as a good overview of why we should be concerned. His book Eaarth: Making a Life on a Tough New Planet is a clear sighted and, by the end anyway, a surprisingly optimistic vision for how societies might adapt as the effects of climate change unfold.

Finally, for a religious perspective since we are riding as part of a group motivated by their faith, the website for the national Interfaith Power and Light (of which PA-IPL is a chapter) provides some excellent resources. Virtually all faiths have mounted a response to the moral challenge of climate change. As a Catholic, the Catholic Climate Covenant’s website as pulling together many documents and resources from a Catholic perspective. And on our trip, which will include several stops at churches along the way, I’ll be reading Sacred Acts: How Church’s are Working to Protect Earth’s Climate.

Bless Me Father, for I have Sinned. It has been Six Months since My Last Blog Post….

If it’s self-indulgent to write a blog (and it certainly is), it’s doubly self-indulgent to apologize for failing to keep up with it. But to the extent that returning to the task of regular blogging is going to be worth anything to me or my imagined readers, I feel that I need to begin by explaining the long absence – especially since the point of this blog was to chronicle and thus focus my thoughts on the development of my second scholarly book project on the history of Alzheimer’s disease. Letting the blog drop seems like a bad sign regarding the prospects for that book. And, to be triply self-indulgent, dammit, I intend to write that book and more!

confusion-cr

So, the obvious and unfortunate thing to say is that the blog has not gone dormant because I’ve been all on fire with research and writing. Rather, my time and energy has been absorbed with the usual sorts of things that keep mid-career academics from research and writing – teaching and administrative demands and obligations to family, friends and the wider world. Plus, for me, there has been the additional challenge and anxiety of trying to figure out my job situation in the wake of Penn State’s elimination of the Science, Technology and Society Program in the face of state budget cuts. At this point, my future at Penn State remains unclear, and the academic job market is tough even (or perhaps especially) for a mid-career academic, even one who has published a well-regarded book.

But I am starting to question whether it is helpful to characterize all these things as mere distractions that take me away from my work. At this point, I think the only way I will be able to move forward with this project, my career and my life is to think about how  all these seemingly disparate demands and desires are connected. That’s perhaps obvious. Tracing the connections between individual experience and larger structures and meanings in society unfolding in time has always been the attraction for me of historical inquiry. My first book argued that the experience of dementia and the diagnostic category of Alzheimer’s are not only a personal tragedy and a medical concept, but are connected to a profound historical transformation in the meaning of selfhood and the politics and policy of disease in an aging society. More broadly, understanding the way that my individual struggles and occasional triumphs are connected to the wider world is essential to living a conscious, good life. But it’s no less challenging for being obvious. The tendency to ignore or obscure such connections has become perhaps the defining feature of late capitalist society.

All of which is to say that as I turn my attention back to this blog, I will be moving away from my original intention of keeping it focused strictly on my work on the recent history of dementia and Alzheimer’s. I’ll continue to write plenty about that as I continue to follow the field and hopefully do begin to make some progress in framing and research the book. But I’ll also be blogging about concerns ostensibly far afield from dementia that draw or demand my attention – like climate change, or global poverty, or the political economy of the modern research university, or biking or music – and about how they all might somehow link up on the faith that wherever my work and my life take me from here, it will be the richer for the inquiry.

As the working title of my book, To Conquer Confusion describes both the ostensible goal of finding an effective treatment or prevention for Alzheimer’s and other dementias, and the challenge of creating and maintaining coherent intellectual and institutional frameworks that could connect and coordinate the diverse experiences, interests and efforts of the many different kind of people connected to each other in the dementia field. As the title of my blog, To Conquer Confusion will also describe my own struggles to develop this work while answering the conflicting demands of life.

Book Review: Mind Wars by Jonathan Moreno

For LibraryThing Early Reviewers

Jonathan Moreno, Mind Wars: Brain Science and the Military in the 21st Century. Bellevue Literary Press, 2012. 

In this book, the influential bioethicist Jonathan Moreno sets out to make the case for what he calls an “ethics of neuroscecurity.” By neurosecurity he means 1) the ways that science and technology targeted at the brain and nervous system should be managed for the public good, and 2) a strategy by which democratic states must use advances in neuroscience to protect themselves from their adversaries. Neurosecurity is complicated by the principle of “dual use,” which U.S. security agencies officially adopted in the early 21st century of giving funding priority to projects that promise both a military and civilian payoff, particularly in economic growth. Dual use, Moreno argues, has encouraged neuroscientists to focus on the potential of their work to advance medicine and science while ignoring the potential military applications. Moreno argues that we need university scientists to become more engaged with difficult ethical questions regarding military interest in and potential application of advances in neuroscience.

Most of the book is devoted to a description of the wide variety of actual and potential applications of neuroscience to the military context – ranging from futuristic cyborg super-soldiers and chimeras, through pharmacologically enhancements to make soldiers more alert, less subject to psychic trauma, and more masterful in challenging combat situations, non-lethal weapons that operate on the nervous system to disable hostile forces (or quell popular protests), to low-tech applications of psychology in the interrogation of prisoners or influence of populations. At times, Moreno seems near to a kind of “gee whiz!” enthusiasm for the possibilities, but he is careful to note at several points that researchers are often inclined to hype. And he is always attentive to the often frightening ethical dilemmas that are raised by the militarization of neuroscience.

Given the dangers and dilemmas of what he has described, Moreno acknowledges that some will be understandably inclined to completely separate academic neuroscience from the military. But he argues that this would be a great mistake for two reasons. First, he does think that America does face dangers that make the cautious development of military applications of brain science a necessity. Second, and for him more importantly, if civilian academic scientists withdraw from involvement with the military, the military will pursue the development of these technologies within its own agencies, shielded from any public awareness and oversight. Moreno argues that the best way to avoid the sorts of ethical nightmares he spends much of the book exploring is for neuroscientists in academia to be fully engaged with the U.S. security apparatus, insisting on tht the transparency and openness that are core values of civilian science continue to operate as military applications of neuroscience are explored.

Moreno may be right that the active involvement of civilian scientists in the development of military applications of neuroscience is far less dangerous than allowing these applications to developed completely within the military, but I am far less sanguine than he is that the best norms and practices of science will withstand the pressures of involvement with the military. If the history of ethical catastrophes in science proves anything, it is that the ethical norms of science are fragile and vulnerable, and that under pressure from entanglement with government and corporate interests make academic scientists all too likely to abandon their commitment to transparency, the ethical treatment of research subjects, and other norms and values of the humane practice of science.

Whether you ultimately agree with Moreno’s conclusions, he is surely right about the dangers and dilemmas ahead, and the need for scientists and the public to remain awake and ethically engaged with neurosecurity.

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