Neuroethics lecture presented with Hollywood twist

Hawkeye Pierce helps to frame question about doctors' obligation to reveal 'incidental findings'

Judy Illes

"MASH's" Hawkeye Pierce might rank among the early bioethicists, though he never claimed the moniker. Take, for instance, the episode in which he inadvertently discovers that a soldier has a life-threatening disease, and then grapples with the same dilemma facing doctors and researchers today: What should he tell the patient?

That question—and that particular episode of the TV show—was among the topics covered in the keynote address given Oct. 16 at the Society for Neuroscience's annual meeting in Atlanta by Judy Illes, PhD, director of the program in neuroethics at Stanford's Center for Biomedical Ethics.

"This lecture is an opportunity to feature the broad landscape of neuroethics," Illes said. "It touches on every aspect of neuroscience."

One point Illes made was that unexpected discoveries like Hawkeye's—called incidental findings—turn up regularly in neuroimaging studies. Until recently, nobody had addressed how to handle such findings, but Illes, as part of a U.S.-Canada neuroethics working group, has helped to develop recommendations for such cases.

As the speaker chosen to deliver the society's David Kopf Memorial Lecture on Neuroethics, Illes discussed the working group's recommended pathway for incorporating incidental findings into reviews by ethics panels, known as IRBs; into researchers and doctors' decisions about when to disclose incidental findings to patients, and how clinical care should be handled once such a problem has been identified.

In the lecture, Illes illustrated her points by drawing on cultural examples from not only "MASH" but also from other TV shows and movies, including "Charly," based on the book "Flowers for Algernon," and "Eternal Sunshine of the Spotless Mind."

In "Charly," the mentally disabled lead character is given an experimental treatment that had turned a mouse into a maze-running genius. However, a decline in the animal's mental abilities predicts Charly's return to his previous mental levels. After struggling with whether to tell Charly, at that point a genius, about his prognosis, the doctors choose to keep the results a secret.

Although neuroscientists can't turn mice or humans into masterminds, they are developing ways of predicting diseases and personality traits, such as addiction or aggression. Like Charly's doctors, researchers must grapple with how much to tell patients in the absence of a treatment, Illes said.

By raising these issues, Illes hopes not to delay research and deployment of new therapies and technologies but to provide answers to the accompanying ethical questions that will arise so neuroscientists move forward more quickly.

"Once procedures are in place it's easy," Illes said.

In other work, she and others have examined the way neuroimaging technology is marketed to the public. In her lecture, she explained that because these technologies have the potential to change how we think about ourselves as people, they need special attention. Right now the way these companies market their technologies and the promises they make are completely unregulated, she said.

One such technology is a neuroimaging technique for detecting a lie. "This is an era in which we hear a great deal about homeland security and where applications of this technology may well find a home," she said. If that's the case, shouldn't there be standards for how the technique is verified and marketed?

In a clip from the movie "Eternal Sunshine of the Spotless Mind," Illes showed one filmmaker's idea of how neurotechology—in this instance, a fictional device to erase memories—might be advertised. With more than 20 companies beginning to market new neurotechnologies, she voiced concerns about whether prospective patients understand the risks and repercussions of such work. She said that she worries about a lack of regulation over how those companies advertise and educate their customers.

With the groundwork Illes and others hope to put in place, Hawkeye would have access to protocols for handling his ethical dilemma. Rather than worrying about the question, he could have been helping other patients.