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White T, Blok E, Calhoun VD. Data sharing and privacy issues in neuroimaging research: Opportunities, obstacles, challenges, and monsters under the bed. Hum Brain Mapp 2022; 43:278-291. [PMID: 32621651 PMCID: PMC8675413 DOI: 10.1002/hbm.25120] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/12/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022] Open
Abstract
Collaborative networks and data sharing initiatives are broadening the opportunities for the advancement of science. These initiatives offer greater transparency in science, with the opportunity for external research groups to reproduce, replicate, and extend research findings. Further, larger datasets offer the opportunity to identify homogeneous patterns within subgroups of individuals, where these patterns may be obscured by the heterogeneity of the neurobiological measure in smaller samples. However, data sharing and data pooling initiatives are not without their challenges, especially with new laws that may at first glance appear quite restrictive for open science initiatives. Interestingly, what is key to some of these new laws (i.e, the European Union's general data protection regulation) is that they provide greater control of data to those who "give" their data for research purposes. Thus, the most important element in data sharing is allowing the participants to make informed decisions about how they want their data to be used, and, within the law of the specific country, to follow the participants' wishes. This framework encompasses obtaining thorough informed consent and allowing the participant to determine the extent that they want their data shared, many of the ethical and legal obstacles are reduced to just monsters under the bed. In this manuscript we discuss the many options and obstacles for data sharing, from fully open, to federated learning, to fully closed. Importantly, we highlight the intersection of data sharing, privacy, and data ownership and highlight specific examples that we believe are informative to the neuroimaging community.
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Affiliation(s)
- Tonya White
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of RadiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Elisabet Blok
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Vince D. Calhoun
- Tri‐institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS)Georgia State University, Georgia Institute of Technology, Emory UniversityAtlantaGeorgiaUSA
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2
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Shen FX, Wolf SM, Bhavnani S, Deoni S, Elison JT, Fair D, Garwood M, Gee MS, Geethanath S, Kay K, Lim KO, Lockwood Estrin G, Luciana M, Peloquin D, Rommelfanger K, Schiess N, Siddiqui K, Torres E, Vaughan JT. Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings. Neuroimage 2021; 238:118210. [PMID: 34062266 PMCID: PMC8382487 DOI: 10.1016/j.neuroimage.2021.118210] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
Smaller, more affordable, and more portable MRI brain scanners offer exciting opportunities to address unmet research needs and long-standing health inequities in remote and resource-limited international settings. Field-based neuroimaging research in low- and middle-income countries (LMICs) can improve local capacity to conduct both structural and functional neuroscience studies, expand knowledge of brain injury and neuropsychiatric and neurodevelopmental disorders, and ultimately improve the timeliness and quality of clinical diagnosis and treatment around the globe. Facilitating MRI research in remote settings can also diversify reference databases in neuroscience, improve understanding of brain development and degeneration across the lifespan in diverse populations, and help to create reliable measurements of infant and child development. These deeper understandings can lead to new strategies for collaborating with communities to mitigate and hopefully overcome challenges that negatively impact brain development and quality of life. Despite the potential importance of research using highly portable MRI in remote and resource-limited settings, there is little analysis of the attendant ethical, legal, and social issues (ELSI). To begin addressing this gap, this paper presents findings from the first phase of an envisioned multi-staged and iterative approach for creating ethical and legal guidance in a complex global landscape. Section 1 provides a brief introduction to the emerging technology for field-based MRI research. Section 2 presents our methodology for generating plausible use cases for MRI research in remote and resource-limited settings and identifying associated ELSI issues. Section 3 analyzes core ELSI issues in designing and conducting field-based MRI research in remote, resource-limited settings and offers recommendations. We argue that a guiding principle for field-based MRI research in these contexts should be including local communities and research participants throughout the research process in order to create sustained local value. Section 4 presents a recommended path for the next phase of work that could further adapt these use cases, address ethical and legal issues, and co-develop guidance in partnership with local communities.
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Affiliation(s)
- Francis X Shen
- Professor of Law and Faculty Member, Graduate Program in Neuroscience, University of Minnesota; Instructor in Psychology, Harvard Medical School; Executive Director, MGH Center for Law, Brain & Behavior USA.
| | - Susan M Wolf
- McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; Professor of Medicine; Chair, Consortium on Law and Values in Health, Environment & the Life Sciences, University of Minnesota USA
| | - Supriya Bhavnani
- Co-Principal Investigator, Child Development Group, Sangath, New Delhi, India
| | - Sean Deoni
- Associate Professor of Pediatrics (Research), Associate Professor of Diagnostic Imaging (Research), Brown University; Senior Program Officer, Maternal, Newborn & Child Health Discovery & Tools, Discovery & Translational Sciences, Bill & Melinda Gates Foundation USA
| | - Jed T Elison
- Associate Professor, Institute of Child Development, Department of Pediatrics, University of Minnesota USA
| | - Damien Fair
- Redleaf Endowed Director, Masonic Institute for the Developing Brain; Professor, Institute of Child Development, College of Education and Human Development; Professor, Department of Pediatrics, Medical School, University of Minnesota USA
| | - Michael Garwood
- Malcolm B. Hanson Professor of Radiology, Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota USA
| | - Michael S Gee
- Vice-Chair of Clinical Operations, Chief of Pediatric Radiology, Pediatric Imaging Research Center Director, Massachusetts General Hospital; Co-Director, Mass General Imaging Global Health Educational Programs USA
| | - Sairam Geethanath
- Associate Research Scientist, Columbia Magnetic Resonance Research Center, Columbia University USA
| | - Kendrick Kay
- Assistant Professor, Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota USA
| | - Kelvin O Lim
- Professor, Vice-Chair of Research, Drs. T. J. and Ella M. Arneson Land-Grant Chair in Human Behavior, Department of Psychiatry and Behavioral Sciences, University of Minnesota USA
| | - Georgia Lockwood Estrin
- Sir Henry Wellcome Postdoctoral Research Fellow, Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London UK
| | - Monica Luciana
- Professor, Department of Psychology; Adjunct Faculty Member, Institute of Child Development; Core Faculty Member, Center for Neurobehavioral Development, University of Minnesota USA
| | | | - Karen Rommelfanger
- Director, Neuroethics Program, Center for Ethics; Associate Professor, Departments of Neurology and Psychiatry and Behavioral Sciences, School of Medicine, Emory University USA
| | - Nicoline Schiess
- Technical Officer, Brain Health Unit, World Health Organization Switzerland
| | - Khan Siddiqui
- Chief Medical Officer and Chief Strategy Officer, Hyperfine USA
| | - Efraín Torres
- PhD Candidate in the Department of Biomedical Engineering, NSF GRFP Fellow, University of Minnesota; Garwood Lab member USA
| | - J Thomas Vaughan
- Professor in the Departments of Biomedical Engineering and Radiology, Director of the Columbia Magnetic Resonance Research Center; Principal and Investigator and MR Platform Director of the Zuckerman Institute, Columbia University; Director of the High Field Imaging Lab, Nathan Kline Institute USA
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Wilkenfeld DA, Orbell SL, Lingler JH. Ethical Considerations in Communicating Alzheimer's Disease Neuroimaging Biomarker Test Results to Symptomatic Individuals. Neurotherapeutics 2021; 18:673-685. [PMID: 33860462 PMCID: PMC8423956 DOI: 10.1007/s13311-021-01047-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
This article examines ethical issues associated with the return of AD neuroimaging results to cognitively symptomatic individuals. Following a review of research on patient and study partner reactions to learning the results of biomarker testing for AD, we examine ethical issues that will be of increasing significance as the field transitions to an era wherein disease-modifying treatments for AD become available. We first review the ethical justification for returning AD biomarker results to individuals who desire them. We then address a more novel question: whether, and to what extent, clinicians or clinical researchers should influence the decisions of individuals who are potentially reluctant to learn their AD imaging results. We argue that in many cases, it is ethically correct to explore, and sometimes alter, factors that may be inhibiting one's desire to know these test results. Our argument is grounded in the premise that having more complete information about changes that may be happening in one's brain will generally yield more informed participation in decisions about one's own care, thereby promoting autonomy. Finally, on the assumption that we have established that it is frequently ethically correct to try to communicate testing information, we examine considerations regarding (not whether but) how this is best accomplished, discussing the concept of responsible transparency. We suggest that both (1) explorations of why one may or may not want to learn results of AD biomarker imaging and (2) the responsible return of such test results is best accomplished using a transactional model of communication.
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Affiliation(s)
- Daniel A Wilkenfeld
- Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, USA
| | - Staci L Orbell
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer H Lingler
- Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
- Alzheimer's Disease Research Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Abstract
This article provides an ethical analysis of the U.S. practice guideline update on disorders of consciousness. Our analysis focuses on the guideline's recommendations regarding the use of investigational neuroimaging methods to assess brain-injured patients. Complex and multifaceted ethical issues have emerged because these methods alter the clinical understanding of consciousness. We address issues of false hope, patient suffering, and cost. We argue that, in spite of these concerns, there is significant benefit to using neuroimaging to assess brain-injured patients in most cases.
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Affiliation(s)
- Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public PolicyGeorge Mason UniversityFairfaxVirginia
| | - Adrian M. Owen
- Departments of Psychology and Neuroscience, Brain and Mind InstituteUniversity of Western OntarioLondonCanada
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
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David SP, Naudet F, Laude J, Radua J, Fusar-Poli P, Chu I, Stefanick ML, Ioannidis JPA. Potential Reporting Bias in Neuroimaging Studies of Sex Differences. Sci Rep 2018; 8:6082. [PMID: 29666377 PMCID: PMC5904173 DOI: 10.1038/s41598-018-23976-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
Numerous functional magnetic resonance imaging (fMRI) studies have reported sex differences. To empirically evaluate for evidence of excessive significance bias in this literature, we searched for published fMRI studies of human brain to evaluate sex differences, regardless of the topic investigated, in Medline and Scopus over 10 years. We analyzed the prevalence of conclusions in favor of sex differences and the correlation between study sample sizes and number of significant foci identified. In the absence of bias, larger studies (better powered) should identify a larger number of significant foci. Across 179 papers, median sample size was n = 32 (interquartile range 23-47.5). A median of 5 foci related to sex differences were reported (interquartile range, 2-9.5). Few articles (n = 2) had titles focused on no differences or on similarities (n = 3) between sexes. Overall, 158 papers (88%) reached "positive" conclusions in their abstract and presented some foci related to sex differences. There was no statistically significant relationship between sample size and the number of foci (-0.048% increase for every 10 participants, p = 0.63). The extremely high prevalence of "positive" results and the lack of the expected relationship between sample size and the number of discovered foci reflect probable reporting bias and excess significance bias in this literature.
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Affiliation(s)
- Sean P David
- Department of Medicine, Stanford University School of Medicine, Stanford, USA.
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA.
| | - Florian Naudet
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
| | - Jennifer Laude
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Department of Psychology and Neuroscience, Stanford University School of Medicine, Stanford, USA
| | - Joaquim Radua
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
- FIDMAG Germanes Hospitalaries, CIBERSAM, Saint Boi de Llobregat, Barcelona, Spain
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
- OASIS team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Isabella Chu
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Departments of Health Research and Policy, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, USA
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6
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Cote DJ, Laws ER. The Ethics of "Choosing Wisely": The Use of Neuroimaging for Uncomplicated Headache. Neurosurgery 2018; 80:816-819. [PMID: 28327977 DOI: 10.1093/neuros/nyw180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 12/22/2016] [Indexed: 11/14/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) for evaluation of headache remains excessive among physicians across many specialties according to both the American Headache Society and the American College of Radiology, despite recent attempts at limiting overuse of imaging and procedures. As part of the Choosing Wisely campaign, both of these organizations have explicitly recommended against imaging in patients with uncomplicated or typical migraine headaches. Yet, the practice nevertheless remains prevalent, with estimates ranging from 12.4% to 15.9% of patients with uncomplicated headache receiving MRI in outpatient practices. The low prevalence of serious pathological findings on imaging in patients who present without other indicative symptoms and the high cost of such exams necessitates a thorough evaluation of appropriate use of MRI for headache. Here, we debate the problematic use of MRI for uncomplicated headache and put forth a discussion of possible interventions that could promote more efficient use of imaging. Overuse of imaging has the potential to open a box that cannot readily be closed, and physicians upstream of surgical decision making must remain aware of the downstream effects of their clinical choices.
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7
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Schmidt MH, Hadskis MR, Downie J, Marshall J. Incidental Findings and the Minimal Risk Standard in Pediatric Neuroimaging Research. IRB 2015; 37:11-19. [PMID: 26523322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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8
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Abstract
For over a century, scientists have sought to see through the protective shield of the human skull and into the living brain. Today, an array of technologies allows researchers and clinicians to create astonishingly detailed images of our brain's structure as well as colorful depictions of the electrical and physiological changes that occur within it when we see, hear, think and feel. These technologies-and the images they generate-are an increasingly important tool in medicine and science. Given the role that neuroimaging technologies now play in biomedical research, both neuroscientists and nonexperts should aim to be as clear as possible about how neuroimages are made and what they can-and cannot-tell us. Add to this that neuroimages have begun to be used in courtrooms at both the determination of guilt and sentencing stages, that they are being employed by marketers to refine advertisements and develop new products, that they are being sold to consumers for the diagnosis of mental disorders and for the detection of lies, and that they are being employed in arguments about the nature (or absence) of powerful concepts like free will and personhood, and the need for citizens to have a basic understanding of how this technology works and what it can and cannot tell us becomes even more pressing.
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9
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Wasserman D, Johnston J. Seeing responsibility: can neuroimaging teach us anything about moral and legal responsibility? Hastings Cent Rep 2014; Spec No:S37-49. [PMID: 24634084 DOI: 10.1002/hast.297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As imaging technologies help us understand the structure and function of the brain, providing insight into human capabilities as basic as vision and as complex as memory, and human conditions as impairing as depression and as fraught as psychopathy, some have asked whether they can also help us understand human agency. Specifically, could neuroimaging lead us to reassess the socially significant practice of assigning and taking responsibility? While responsibility itself is not a psychological process open to investigation through neuroimaging, decision-making is. Over the past decade, different researchers and scholars have sought to use neuroimaging (or the results of neuroimaging studies) to investigate what is going on in the brain when we make decisions. The results of this research raise the question whether neuroscience-especially now that it includes neuroimaging-can and should alter our understandings of responsibility and our related practice of holding people responsible. It is this question that we investigate here.
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Weijer C, Peterson A, Webster F, Graham M, Cruse D, Fernández-Espejo D, Gofton T, Gonzalez-Lara LE, Lazosky A, Naci L, Norton L, Speechley K, Young B, Owen AM. Ethics of neuroimaging after serious brain injury. BMC Med Ethics 2014; 15:41. [PMID: 24885720 PMCID: PMC4031564 DOI: 10.1186/1472-6939-15-41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/29/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to "yes" or "no" answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. METHODS/DESIGN Our research program encompasses four projects and uses a mixed methods approach. Project 1 asks whether decision making capacity can be assessed in behaviorally nonresponsive patients. We will specify cognitive functions required for capacity and detail their assessment. Further, we will develop and pilot a series of scenarios and questions suitable for assessing capacity. Project 2 examines the ethics of welfare as a guide for neuroimaging. It grounds an obligation to explore patients' interests, and we explore conceptual issues in the development of a quality of life instrument adapted for neuroimaging. Project 3 will use grounded theory interviews to document families' understanding of the patient's condition, expectations of neuroimaging, and the impact of the results of neuroimaging. Project 4 will provide an ethical analysis of neuroimaging to investigate residual cognitive function in comatose patients within days of serious brain injury.
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Affiliation(s)
- Charles Weijer
- Rotman Institute of Philosophy, Western University, London, ON, N6A 5B8, Canada
- Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada
- Department of Medicine, London Health Sciences Centre–University Hospital, London, ON, N6A 5A5, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, N6A 5C1, Canada
| | - Andrew Peterson
- Rotman Institute of Philosophy, Western University, London, ON, N6A 5B8, Canada
- Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada
| | - Fiona Webster
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada
| | - Mackenzie Graham
- Rotman Institute of Philosophy, Western University, London, ON, N6A 5B8, Canada
| | - Damian Cruse
- Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada
| | | | - Teneille Gofton
- Department of Clinical Neurological Sciences, London Health Sciences Centre–University Hospital, London, ON, N6A 5A5, Canada
| | | | - Andrea Lazosky
- Department of Psychiatry, London Health Sciences Centre–Victoria Hospital, London, ON, N6A 5W9, Canada
| | - Lorina Naci
- Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada
| | - Loretta Norton
- Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada
| | - Kathy Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, N6A 5C1, Canada
- Department of Pediatrics, Children’s Hospital of Western Ontario, London, ON, N6C 2V5, Canada
| | - Bryan Young
- Department of Clinical Neurological Sciences, London Health Sciences Centre–University Hospital, London, ON, N6A 5A5, Canada
| | - Adrian M Owen
- Rotman Institute of Philosophy, Western University, London, ON, N6A 5B8, Canada
- Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada
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Affiliation(s)
- Fabrice Jotterand
- Department of Health Care Ethics, Rueckert-Hatman College of Health Professions, Regis University, 3333 Regis Boulevard, G-5, Denver, CO, 80221, USA,
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Giordano J, Kulkarni A, Farwell J. Deliver us from evil? The temptation, realities, and neuroethico-legal issues of employing assessment neurotechnologies in public safety initiatives. Theor Med Bioeth 2014; 35:73-89. [PMID: 24442931 DOI: 10.1007/s11017-014-9278-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In light of the recent events of terrorism and publicized cases of mass slayings and serial killings, there have been calls from the public and policy-makers alike for neuroscience and neurotechnology (neuroS/T) to be employed to intervene in ways that define and assess, if not prevent, such wanton acts of aggression and violence. Ongoing advancements in assessment neuroS/T have enabled heretofore unparalleled capabilities to evaluate the structure and function of the brain, yet each and all are constrained by certain technical and practical limitations. In this paper, we present an overview of the capabilities and constraints of current assessment neuroS/T, address neuro-ethical and legal issues fostered by the use and potential misuse of these approaches, and discuss how neuroethics may inform science and the law to guide right and sound applications of neuroS/T to "deliver us from evil" while not being led into temptations of ampliative claims and inapt use.
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Affiliation(s)
- James Giordano
- Neuroethics Studies Program, Edmund D. Pellegrino Center for Clinical Bioethics and Division of Integrative Physiology, Georgetown University, Washington, DC, USA,
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Drazin D, Spitler K, Cekic M, Patel A, Hanna G, Shirzadi A, Chu R. Incidental finding of tumor while investigating subarachnoid hemorrhage: ethical considerations and practical strategies. Sci Eng Ethics 2013; 19:1107-1120. [PMID: 23065539 DOI: 10.1007/s11948-012-9403-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 10/05/2012] [Indexed: 06/01/2023]
Abstract
High-resolution neuroimaging modalities are used often in studies involving healthy volunteers. Subsequently, a significant increase in the incidental discovery of asymptomatic intracranial abnormalities raised the important ethical issues of when follow-up and treatment may be necessary. We examined the literature to establish a practical set of criteria for approaching incidental findings. Our objective is to develop an algorithm for when follow-up may be important and to provide recommendations that would increase the likelihood of follow-up. A systematic literature search was performed using the PubMed and MEDLINE databases to identify articles describing brain tumors and intracranial aneurysms. The treatment algorithm we present suggests that incidental intracranial masses suspicious for glioma should be biopsied or resected, while other masses are to be followed with serial imaging based on the expected growth pattern. Lack of follow-up can result in adverse outcomes that can be mitigated by using technology to facilitate communication and improve follow-up care. The importance of training physicians to be good communicators is also stressed. New technology including automated telephone systems, texting and email will improve access to patients and hopefully encourage compliance and follow-up.
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Affiliation(s)
- Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Abstract
The identifying or sensitive anatomical features in MR and CT images used in research raise patient privacy concerns when such data are shared. In order to protect human subject privacy, we developed a method of anatomical surface modification and investigated the effects of such modification on image statistics and common neuroimaging processing tools. Common approaches to obscuring facial features typically remove large portions of the voxels. The approach described here focuses on blurring the anatomical surface instead, to avoid impinging on areas of interest and hard edges that can confuse processing tools. The algorithm proceeds by extracting a thin boundary layer containing surface anatomy from a region of interest. This layer is then "stretched" and "flattened" to fit into a thin "box" volume. After smoothing along a plane roughly parallel to anatomy surface, this volume is transformed back onto the boundary layer of the original data. The above method, named normalized anterior filtering, was coded in MATLAB and applied on a number of high resolution MR and CT scans. To test its effect on automated tools, we compared the output of selected common skull stripping and MR gain field correction methods used on unmodified and obscured data. With this paper, we hope to improve the understanding of the effect of surface deformation approaches on the quality of de-identified data and to provide a useful de-identification tool for MR and CT acquisitions.
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Affiliation(s)
- Mikhail Milchenko
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri 63110, USA.
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15
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d'Abrera JC, Holland AJ, Landt J, Stocks-Gee G, Zaman SH. A neuroimaging proof of principle study of Down's syndrome and dementia: ethical and methodological challenges in intrusive research. J Intellect Disabil Res 2013; 57:105-118. [PMID: 22044507 DOI: 10.1111/j.1365-2788.2011.01495.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Research into specific illnesses and the development of new treatments may only become possible as new technologies become available. When used for research, such technologies may best be described as 'intrusive', in that they require a considerable willingness and commitment on the part of the participants. This has increasingly been the case for brain disorders and illnesses where novel neuroimaging techniques, often combined with clinical and psychological assessments, have the potential to result in new understanding. People with intellectual disabilities (ID) have a history of under-representation as participants in research using such technologies and are therefore at risk of not receiving equal access to state-of-the-art treatments. We propose that 'intrusive' biomedical research is both possible and ethical in ID, and explore some of the methodological challenges by reference to a recent proof of principle study that used a relatively new ligand-based brain scanning technique in a group of volunteers with Down's syndrome. METHODS Five overlapping stages of the study methodology were identified and evaluated for their acceptability to volunteers with mild to moderate ID through discussion, reflection, and analysis of structured feedback in the context of key policy documents, ethical guidelines and relevant legislation. RESULTS Identification of key ethical and methodological challenges from reflective practice and participant feedback facilitated the emergence of strategies that permitted continual refinement of the study design. Important areas considered included (1) being clear about the purpose and scientific justification for the study; (2) reconciling the potential risks and benefits with relevant ethical guidelines and legislation; (3) identifying and implementing effective recruitment strategies; (4) optimising and assessing capacity to consent; and (5) making the 'intrusive' procedures as acceptable as possible to people with ID. CONCLUSION We were able to demonstrate that a proof of principle study incorporating a novel brain scanning technique in a group of volunteers with ID was feasible, safe and well tolerated, despite the vulnerabilities of the study cohort and the intrusive nature of the research. We consider the study within an ethical and historical discourse about the principles that define current 'best practice' in ID research and propose a number of key recommendations for making intrusive research acceptable in people with ID.
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Affiliation(s)
- J C d'Abrera
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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ANDERSON JAMESA, EIJKHOLT MARLEEN, ILLES JUDY. Neuroethical issues in clinical neuroscience research. Handb Clin Neurol 2013; 118:335-43. [PMID: 24182390 PMCID: PMC10460147 DOI: 10.1016/b978-0-444-53501-6.00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
In this chapter, we use the special features of neuroimaging to illustrate research ethics issues for the clinical neurologic sciences, and focus on one particularly compelling case: studies involving first-episode schizophrenic treatment-naïve individuals (FESTNIs) (Eijkholt et al., 2012). FESTNIs are scanned prior to the administration of medication in order to control for the confounding effects of treatment. By concentrating on this program of research, we capture the distinctive ethical challenges associated with neuroimaging research overall, and foreground the issues particular to neuroimaging research involving FESTNIs that have yet to receive sufficient attention in the literature. We highlight assessment of risks and burdens, including risks associated with treatment delays and incidental findings; assessment of benefit, including direct benefit, social value, and scientific quality; subject selection; justice questions related to responsiveness and poststudy access; and, finally, issues related to consent and capacity.
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Affiliation(s)
| | - MARLEEN EIJKHOLT
- National Core for Neuroethics, Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - JUDY ILLES
- National Core for Neuroethics, Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Moosa E. Translating neuroethics: reflections from Muslim ethics: commentary on "Ethical concepts and future challenges of neuroimaging: an islamic perspective". Sci Eng Ethics 2012; 18:519-528. [PMID: 23054670 DOI: 10.1007/s11948-012-9392-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/31/2012] [Indexed: 06/01/2023]
Abstract
Muslim ethics is cautiously engaging developments in neuroscience. In their encounters with developments in neuroscience such as brain death and functional magnetic resonance imaging procedures, Muslim ethicists might be on the cusp of spirited debates. Science and religion perform different kinds of work and ought not to be conflated. Cultural translation is central to negotiating the complex life worlds of religious communities, Muslims included. Cultural translation involves lived encounters with modernity and its byproduct, modern science. Serious ethical debate requires more than just a mere instrumental encounter with science. A robust Muslim approach to neuroethics might require an emulsion of religion and neuroscience, thought and body, and body and soul. Yet one must anticipate that Muslim debates in neuroethics will be inflected with Muslim values, symbols and the discrete faith perspectives of this tradition with meanings that are specific to people who share this worldview and their concerns.
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Affiliation(s)
- Ebrahim Moosa
- Department of Religion, Duke University, Durham, NC, USA.
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Al-Delaimy WK. Ethical concepts and future challenges of neuroimaging: an Islamic perspective. Sci Eng Ethics 2012; 18:509-518. [PMID: 22865482 DOI: 10.1007/s11948-012-9386-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/05/2012] [Indexed: 06/01/2023]
Abstract
Neuroscience is advancing at a rapid pace, with new technologies and approaches that are creating ethical challenges not easily addressed by current ethical frameworks and guidelines. One fascinating technology is neuroimaging, especially functional Magnetic Resonance Imaging (fMRI). Although still in its infancy, fMRI is breaking new ground in neuroscience, potentially offering increased understanding of brain function. Different populations and faith traditions will likely have different reactions to these new technologies and the ethical challenges they bring with them. Muslims are approximately one-fifth of world population and they have a specific and highly regulated ethical and moral code, which helps them deal with scientific advances and decision making processes in an Islamically ethical manner. From this ethical perspective, in light of the relevant tenets of Islam, neuroimaging poses various challenges. The privacy of spirituality and the thought process, the requirement to put community interest before individual interest, and emphasis on conscious confession in legal situations are Islamic concepts that can pose a challenge for the use of something intrusive such as an fMRI. Muslim moral concepts such as There shall be no harm inflicted or reciprocated in Islam and Necessities overrule prohibitions are some of the criteria that might appropriately be used to guide advancing neuroscience. Neuroscientists should be particularly prudent and well prepared in implementing neuroscience advances that are breaking new scientific and ethical ground. Neuroscientists should also be prepared to assist in setting the ethical frameworks in place in advance of what might be perceived as runaway applications of technology.
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Affiliation(s)
- Wael K Al-Delaimy
- Department of Family and Preventive Medicine, University of California, La Jolla, San Diego, CA 92093-0628, USA.
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Eijkholt M, Anderson JA, Illes J. Picturing neuroscience research through a human rights lens: imaging first-episode schizophrenic treatment-naive individuals. Int J Law Psychiatry 2012; 35:146-52. [PMID: 22304987 PMCID: PMC3329217 DOI: 10.1016/j.ijlp.2011.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this paper we examine imaging research involving first-episode schizophrenic treatment-naive individuals (FESTNIs) through a legal human rights lens; in particular, the lens of the Additional Protocol to the Convention on Human Rights and Biomedicine Concerning Biomedical Research. We identify a number of ethical and legal hot spots highlighted by the Protocol, and offer a series of recommendations designed to ensure the human rights compatibility of this research. Subsequently, we argue that the lack of reporting on design elements related to ethical concerns frustrates commitments at the heart of the human rights approach, namely, transparency and openness to international scrutiny. To redress this problem, we introduce two norms for the first time: ethical transparency, and ethical reproducibility. When concluding, we offer a set of reporting guidelines designed to operationalize these norms in the context of imaging research involving FESTNIs. Though we will not make this case here, we believe that parallel reporting guidelines should be incorporated into other areas of research involving human subjects.
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Affiliation(s)
- Marleen Eijkholt
- National Core for Neuroethics, Division of Neurology, the University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC V6T 2B5, Canada.
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Abstract
Neuroimaging research covers a wide range of intriguing issues from revealing brain structures to investigating what happens in our brain when we lie. The field appears to be thriving, but skepticism and alertness to the various ethical, scientific, policy and philosophical challenges associated with it also appear to be on the rise. One particularly complex issue concerns what to do with incidental findings that emerge during the course of neuroimaging research. Research ethics boards (REBs) play a central role in research oversight. In this paper, we will consider some of the potential issues associated with REB liability in negligence in the context of incidental findings in neuroimaging research.
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Affiliation(s)
- Amy Zarzeczny
- Health Law and Science Policy Group (HeaLS), University of Alberta, Edmonton, AB, Canada T6G 2H5
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Gjoneska B. Neuroimaging and neuroethics: imaging the ethics in neuroscience. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2012; 33:419-424. [PMID: 23037187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED This paper outlines the topics that are on the intersection of neuroethics and neuroimaging domain. MATERIALS AND METHODS An extensive search through Medline bibliographic database was performed for a period of 12 years (1997-2009), using a combination of 3 keywords ("ethics", "neuroethics", "neuroimaging"). The search returned 119 indexed articles, of which 102 were found relevant. The articles were classified in two main categories tackling ethical challenges in basic research (55 papers) and applied clinical research and practice (39 papers). RESULTS AND CONCLUSIONS For each of the categories, the majority of articles came under one of the following topics--the neural basis of emotion, reasoning and personality (30 papers) and ethics of neuroimaging in disorders of consciousness (15 papers). The appointed topics stand at the very intersection of the neuroethics and neuroimaging domain, evidencing their strong interdependent relationship. Furthermore, the number of topics and corresponding articles has been steadily increasing over the years (minimal in 1997, maximal in 2009). These data are in good acconcordance with other scientific findings. Also, they correspond to the period of progress in the investigated disciplines, giving rise to the fact that future advances in neuroethics are in strong correlation to the advances of neuroimaging technologies.
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Affiliation(s)
- B Gjoneska
- Neuroinformatics Division, Department of Bioinformatics, Macedonian Academy of Sciences and Arts, Skopje, R. Macedonia
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Pizzetti FG. In quest of constitutional principles of "neurolaw". Med Secoli 2011; 23:963-990. [PMID: 23057208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The growing use of brain imaging technology and the developing of cognitive neuroscience pose unaccustomed challenges to legal systems. Until now, the fields of Law much affected are the civil and criminal law and procedure, but the constitutional dimension of "neurolaw" cannot be easily underestimated. As the capacity to investigate and to trace brain mechanisms and functional neural activities increases, it becomes urgent the recognition and definition of the unalienable rights and fundamental values in respect of this new techno-scientific power, that must be protected and safeguard at "constitutional level" of norms such as: human dignity, personal identity, authenticity and the pursuit of individual "happiness". As the same as for the law regulating research and experimentation on human genome adopted in the past years, one may also argue if the above mentioned fundamental principles of "neurolaw" must be fixed and disciplined also at European and International level.
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