Biomedicine on Display

In October, I’m participating in ‘an interdisciplinary workshop for young scholars‘ at the University of Lübeck, organized by the Institute for the History of Medicine and Science Studies at the University of Lübeck, in cooperation with the Institut für Mensch, Ethik und Wissenschaft in Berlin.

The workshop title is “Good life better – anthropological, sociological and philosophical dimensions of enhancement” – which fits nicely with my project on the history of ’successful aging’ and its relation to ideas about human enhancement.

Here’s my abstract for the workshop:

Good old brains — How concerns about the ageing society and ideas about cognitive enhancement interact in neuroscience

Discussions about human cognitive enhancement are in different ways based on assumptions about neuroscientific knowledge production and applicability of neuroscientific results. But what is it in neuroscience that relates to discussions about human enhancement? How has the production of knowledge within the neurosciences anticipated or dismantled the hopes and wishes for cognitive enhancement? Have neuroscientific practices related to such notions as ’successful ageing’ offered new perspectives to the human enhancement debate? Drawing on a historical analysis of the concept of successful ageing in neuroscience publications from the 1980s till today, this paper will discuss how the aims and the production of knowledge within age-related neuroscience are connected to ideas about cognitive enhancement.

Neuroscientific research on ageing is a particularly relevant field for investigating this connection, since the brain is in the focus of both enhancement debates and research (and politics) concerning ageing. In the context of ageing research, the notion of ’successful ageing’ has been influential in emphasising individual lifestyle choices and preventive measures as means to ageing ’successfully’ (Rowe & Kahn, 1987). Instead of viewing ageing as something defined by inevitable physiological and cognitive decline – a growing concern for the ‘ageing’ Western societies from the 1980s onwards – this notion stresses that individuals themselves have the possibility to avoid such decline by maintaining and improving themselves through healthy lifestyles, etc. Concerns about ‘the ageing society’ and the individualised solutions offered by ’successful ageing’ might even be considered an underlying driving force in discussions about cognitive enhancement: Both individuals and societies, it seems, have reason to improve cognitive functions and prevent neuro-degenerative diseases.

At first glance, neuroscientific research seems to corroborate with these concerns and wishes. As an article in Neurobiology of Aging states: “these findings suggest ways in which biological aging can be manipulated to promote good function in aged individuals.” (Collier & Coleman, 1991: 685). Publications such as this one discuss how use of substance intake and certain behaviour (e.g. diet and exercise) might in different ways ‘promote good function’; scientific perspectives that enhancement-proponents have picked up on and turned into notions like ’smart drugs’ and ‘brain training’.

However, neuroscientific ageing-research also offers other perspectives on enhancement. Neuroscience may suggest ”that the aging individual has the potential to enhance or maintain intellectual functioning” (Staudinger, Cornelius & Baltes, 1989: 44). But what most of such suggestions implicate is not that it is possible to improve function beyond the ‘normal’, instead it refers to treating functional decline that has already taken place. On the other hand, preventive measures may work by improving the cognitive function of otherwise ‘normal’ individuals through lifestyle interventions or substance intake. But is this really ‘enhancement’? The notion of enhancement seems to refer to measures that moves us beyond the limits of human bodies (whatever they are), but the plasticity of the human brain complicates such notions as normal or enhanced. In addition, the difficulty of distinguishing ‘normal’ ageing from pathological ageing (what is normal at age 20 or 80?) makes the whole issue even more complicated.

As this is a work in progress, any comments and perspectives will be much appreciated!

As mentioned in a previous blogpost, I’m currently doing a ph.d.-project here at Medical Museion concerning the history of the concept of successful aging in neuroscience and its relation to ideas on cognitive enhancement.

Part of my work, therefore, is going to conferences like this one, held in Copenhagen last week:

The conference was arranged by the Danish research center GNOSIS, and featured both neuroscientists and philosophers – as an attempt to bridge the disciplinary boundaries and maybe produce some kind of synergy.

The first day especially had that feeling. Themed under the headline ‘Brain Plasticity’ and featuring, among others, the English philosophical-minded neuroscientist Steven Rose, German phenomenological philosopher and psychiatrist Thomas Fuchs, and Danish biologist and anthropologist Andreas Roepstorff, there was a real feel of cross-disciplinary science communication. A science communication which was also a communication of the immense complexity of the brain and of the production of knowledge concerning it.

As Steven Rose pointed out, neuroscience is ‘data rich, but theory poor’, needing some theorizing on how best to manage the complexities of the huge amount of collected data. One common perspective to most of the talks at the conference were that the brain’s workings can best be understood viewed as a complex, irreducible and indeterminate, continuously developing process. This was conceptualized from both phenomenology, developmental systems theory (or autopoiesis, as Rose termed it), and biosemiotics – all in one way or the other emphasizing the brain as embodied (or the body as ‘embrained’, as someone smartly put it), and emphasizing the body’s embeddedness in the world (emworlded). Dichotomies and dualisms, determinacy and reductionism were (with maybe one exception) not only forcibly opposed, they were long left behind, it seemed.

But still there was a sense that, despite agreement on the general perspective, this did not solve the concrete methodological challenge of, for instance, going from correlates to causality, inducing from the particular to the common, or explaining the relationship between brain and mind/consciousness/awareness/attention etc. Neuroscience, it seems, brings new attention to a lot of old philosophical problems. The multidisciplinary collaborations within the field of neuroscience, and the demand for new theoretical developments and new conceptualizations, may not find a solution to these problems, but it sure sets the stage for interesting theoretical developments in the years to come.

As for the link to my project on successful aging, this development in neuroscience seems to run almost parallel to the overall development of the field of gerontology and aging research in the last couple of decades from around the time that the concept of successful aging was introduced. Many of the same philosophical problems are also seen in other parts of aging research than the parts including the neurosciences.

Aging research (as well as maybe most other fields in the health sciences?) is becoming a multidisciplinary field where dichotomies and dualisms between brain-mind, body-world, and individual-society are being tested and challenged.

This is the last part of my project description for the Ph.D.-project called “A genealogical study of the concept of ’successful aging’ and its relation to the idea of ‘human enhancement”. See the first two parts here and here.

 ’Successful aging’ in the neurosciences and the link to ‘cognitive enhancement’
In order to narrow the problem field, the project will look closely at how the notion of ‘successful aging’ has been understood and defined in the field of neuroscience in the last decades, and how ‘successful cognitive aging’ has played together with discussions — both in the scientific literature, in science policy documents and in general public discourse — about the possibility for so called ‘cognitive enhancement’ (‘neuro-enhancement’) [12][13][14][17]. Both in the scientific literature and in policy documents on ‘successful aging’ and ‘human enhancement’, the neurosciences are considered as the primary field of research; neuroscience also figures prominently in the corresponding public discourse [7][21][23], cf. [25]. The brain and cognition are ascribed significant cultural value in the emerging ‘knowledge society’; healthy cognitive abilities are considered necessary for a life-long contribution to the labour market and for well-being in everyday life, and not surprisingly some of the exponents for the notion of ‘knowledge society’ are also exponents for ‘converging technologies’ [17][21].

Current developments in the field of aging research also have strong discursive links to cognitive enhancement. As the aforementioned EU parliament study argues: “The growing problem of neurodegenerative diseases in ageing societies has turned research and development in therapeutic cognitive enhancers into a very dynamic field with significant resources” [21:26]. Likewise, in enhancement discussions special attention is being ascribed to cognitive enhancement: “’neuro/ brain enhancement’ as a research field stands at the centre of the CT [converging technologies] debate. It attracts the largest share of attention due to its plans to simulate and manipulate brain processes, which – if realized successfully – could directly affect our concepts of the human self and identity” [17:382], cf. [21][23][25]. Also here there may be a significant aspect of user-driven innovation: medications developed in research into age related diseases like Alzheimer’s disease is already being used by young, healthy individuals to (presumably) enhance their cognitive abilities [14][17][21], and, conversely, one could therefore expect that the market for cognitive enhancement may stimulate research in the prevention and treatment of age-related neurodegenerative diseases.

These interconnected arenas of aging research, enhancement discourse and general ideas about successful aging will be the focus point of this project. The point of departure is that the connection between the discussion about successful aging and the discussion about human enhancement has been overlooked in the scientific literature and that the two discourses are more closely related than usually presumed. Shedding light on the historical relation between the two notions both in the scientific and popular discourses will potentially have significant consequences for future research, for research politics and for the public understanding of successful aging.

References:
7. Kirk, H. (2008). Med hjernen i behold – Kognition, træning og seniorkompetencer. København: Akademisk Forlag.
12. Balling, G. (2002) (ed.). Homo Sapiens 2.0. Når teknologien kryber ind under huden. København: Gads Forlag.
13. Balling, G og Lippert-Rasmussen, K. (2006). Det menneskelige eksperiment. København: Museum Tusculanums Forlag.
14. Greely et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature, 456, 702-705.
17. Beckert, B., Blümel, C and Friedewald, M (2007). Visions and realities in converging technologies. Innovation: The European Journal of Social Science Research, 20(4), 375-395.
21. European Parliament Science and Technology Options Assessment (2009). Human Enhancement Study. Awailable at http://www.europarl.europa.eu/stoa/publications/studies/stoa2007-13_en.pdf (14.08.09)
23. http://www.humanityplus.org/read/2009/07/human-enhancement-what-should-be-permitted-geneva-october-20-21-2009/ (14.08.09)
25. Dumit, Joseph (2004). Picturing Personhood. Brain Scans and Biomedical Identity. Princeton: Princeton University Press

This is the second part of my project description for the Ph.D.-project called ‘A genealogical study of the concept of ’successful aging’ and its relation to the idea of ‘human enhancement’. See the first part here.

The relation between ’successful aging’ and ‘human enhancement’
The project will particularly focus on an analysis of the possible connection between ideas about the prevention and treatment of age-related diseases, on the one hand, and the current merging discourse on ‘human enhancement’, on the other. Like ‘successful aging’, the notion of ‘human enhancement’ — including a large variety of different ideas about the future possibilities for technological improvements of human bodies — became widely spread in the 1980’s and 1990’s [11][12][13][14].

A preliminary survey of the literature indicates that the notions of ‘successful aging’ and ‘human enhancement’ often seem to appear together in the scientific literature and in medical and health policy documents. For example both the European Union (EU) and the National Science Foundation (NSF) have published reports that deal with so called ‘converging technologies’, usually defined as a convergence of nano-, bio-, info-, and cogno-sciences and technologies (NBIC). In such reports, the notion of ‘human enhancement’ is a central concept, around which the discussion of the aging population in the developed countries revolves [15][16][21], cf. also [17][18][19][20]. As a study commissioned by the EU Parliament says, “it is safe to say that a side effect of the fast-growing research and development into pharmaceuticals for age-related neurodegenerative diseases will be a number of new drugs which can be used for the enhancement of performance of young, healthy people.” [21:7]

Similarly, in a large number of websites and blogs published by organisations and individuals that support and promote the notion of ‘human enhancement’, the possibility for using such technologies as life extension devices and for delaying age-related physical and/or cognitive decline constitutes one of the central arguments for developing enhancement technologies [11][22]. Websites that express the opinions of the so called transhumanist (posthumanist) movement is one of the most vociferous exponents of this argument. Both these pro-enhancement advocates and science policy reports (like the EU parliament study and the NSF reports) emphasize the fact that the biomedical sciences, biotechnologies and medicotechnical technologies are increasingly producing new technologies capable of simultaneously enhancing the capacities of healthy people and treating diseases, especially age-related diseases [16][21][23]. Thus the discourse about ‘human enhancement’ and ‘successful aging’ are discursively intimately connected.

In addition, this integration of the ‘human enhancement’ and ‘successful aging’ discourses seem to have a strong element of user involvement. The strong ideological commitment to the integration between the two notions among individuals that view themselves as members of a loose ‘transhumanist’ intellectual movement is probably the best example of user involvement. It is unclear, however, to what extent the scientific community, the ‘transhumanist’ intellectual movement and the public at large differ with respect to an active commitment to integrating the two notions. However, I will suggest that the increasing use of performance-enhancing drugs in the general population (especially among young people) and the increasing dissemination of pro-enhancement policies and visions that challenge traditional views of the use of medicine both work in favour of a similar integration between the two notions.

Furthermore one might expect that the general and widely spread popular attitude to performance-enhancing drugs in Western cultures is an underlying Zeitgeist which supports the current political, scientific (and ethical) discussions about the integration of the two notions in the ‘transhumanist’ movement and among scientists. Finally, one might also expect that such popular attitudes will effect strategic market evaluations in the pharmaceutical industry and thus spill over to strategies for future drug pipelines. In all these respects, the integration of the notions of ‘human enhancement’ and ‘successful ageing’ may well be framed with reference to broader user involvement and user driven innovation (cf. [14][15][16][21][24]). These are preliminary hypotheses only, however, which need further empirical substantiation.

References:
11. Bostrom, N. (2005). A History of Transhumanist Thought. Journal of Evolution and Technology, 14(1).
12. Balling, G. (2002) (ed.). Homo Sapiens 2.0. Når teknologien kryber ind under huden. København: Gads Forlag.
13. Balling, G og Lippert-Rasmussen, K. (2006). Det menneskelige eksperiment. København: Museum Tusculanums Forlag.
14. Greely et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature, 456, 702-705.
15. Roco, M and Bainbridge, W (2002) (eds.). Converging Technologies for Improving Human Performance. NSF/DOC-sponsored report. Awailable at http://www.wtec.org/ConvergingTechnologies/Report/NBIC_report.pdf. (29.05.2009)
16. Innovation: The European Journal of Social Science Research, 20(4) (December 2007). Special Issue: Converging Science and Technologies: Research Trajectories and Institutional Settings.
17. Beckert, B., Blümel, C and Friedewald, M (2007). Visions and realities in converging technologies. Innovation: The European Journal of Social Science Research, 20(4), 375-395.
18. Det Strategiske Forskningsråd (2006). Det aldrende samfund 2030 – Rapport fra Styregruppen for det strategiske fremsyn om det aldrende samfund 2030. Awailable at http://fi.dk/publikationer/2006/det-aldrende-samfund-2030-rapport-fra-styregruppen/det-aldrende-samfund-2030.pdf (29.05.2009)
19. Murphy, T. F.(1986). A cure for aging? The Journal of Medicine and Philosophy, 11(3): 237-255
20. Veatch, R.M. (1979). Life Span: the Hastings Center report on values and life-extending technologies. New York: Harper and Row.
21. European Parliament Science and Technology Options Assessment (2009). Human Enhancement Study. Awailable at http://www.europarl.europa.eu/stoa/publications/studies/stoa2007-13_en.pdf (14.08.09)
22. http://www.humanityplus.org/learn/philosophy/transhumanist-values (14.08.09)
23. http://www.humanityplus.org/read/2009/07/human-enhancement-what-should-be-permitted-geneva-october-20-21-2009/ (14.08.09)
24. Maher, Brendan (2008). Poll results: Look who’s doping. Nature, 452, 674-675

I’ve just begun my ph.d.-project here at Medical Museion. Titled ”A genealogical study of the concept of successful aging and its relation to the idea of human enhancement”, the project is financed by the new Center for Healthy Aging at the Faculty of Health Sciences.

Below is the first part of the project description concerning the notion of successful aging. In two following parts I will first introduce the possible relation between successful aging and human enhancement, and then my attempt to narrow the project to cognitive aspects of ageing and cognitive enhancement. Comments to one or all three parts are much appreciated.

The genealogy of the notion of ’successful aging’
At present there is much focus on the notion of successful aging (healthy aging, optimal aging) in Denmark and other developed countries. The increasing life expectancy of the population in combination with low birth rate and low rate of immigration gives rise to both political and economic concerns about the future maintenance of the living standards for an aging workforce. The increasing number of elderly people gives rise to new demands for developing new knowledge about how individuals can live a healthy life and remain healthy, even in old age.

The notion of ‘successful aging’ is not new. It can in fact be traced back to at least the 1960’s and became ubiquitous in the field of aging research in the 1980′ and 1990’s [1][2][3][4][5]. The dissemination of the notion is connected to a development trend in aging research, whereby scientists gradually changed their understanding of aging as a research object for gerontological/geriatric research. From primarily being concerned with the treatment of diseases in later part of a life course to an increased focus on disease prevention and to a broader public health oriented approach to aging involving several different scientific fields, also beyond the biomedical sciences [4][6], cf. [7].

The aim of this project is to undertake a genealogical study[8][9] of the development of the notion of successful aging from the increased focus on prevention in the middle of the 1980’s until today. The literature on the subject is sparse, consisting of a few short chapters with an overview of the historical development of age research, cf. [6][10]. A more detailed historical study of this development based on the primary literature (scientific articles, textbooks, policy documents, etc.), is supposedly going to produce a deeper and better understanding of the notion of successful aging, which in turn will help qualify the current scientific and public discussions about the prevention and treatment of age-related diseases. The study will thus hopefully also help identify some of the conditions that may influence future understandings of what ‘successful aging’ is and the ways in which the future research in the field might develop.

References:
1. Williams, Richard H., and Wirth, Claudine, G. (1965). Lives through the years: styles of life and successful aging. New York: Prentice-Hall.
2. Rowe, J. W. and Kahn, R. L. (1987). Human Aging: Usual and Successful. Science, 237: 143-149.
3. Rowe, J. W. and Kahn, R. L. (1998). Successful aging. USA: Pantheon Books.
4. Baltes, P. B. and Baltes, M. M. (1990) (eds.). Successful aging: Perspectives from the behavioral sciences. Cambridge, UK: Cambridge University Press.
5. Bond, L. A., S. J. Cutler, and A. Grams (1995). Promoting Successful and Productive Aging. Thousand Oaks, CA: Sage Publications, Inc.
6. Amstrup, K og Poulsen, I. (2007). Geriatri – en tværfaglig udfordring. København: Munksgaard Danmark.
7. Kirk, H. (2008). Med hjernen i behold – Kognition, træning og seniorkompetencer. København: Akademisk Forlag.
8. Villadsen, K. (2006). Genealogi som metode: fornuftens tilblivelseshistorier. Kaspar Villadsen & Ole Bjerg (2005) (eds.). Sociologiske metoder: Fra teori til empiri i kvalitative og kvantitative studier. Frederiksberg: Samfundslitteratur.
9. Foucault, Michel (1992). The archaeology of knowledge. London: Routledge.
10. Bengtson, V.L. and Schaie, K.W (1999) (eds.). Handbook of Theories of Aging. New York: Springer Publishing Company, inc.

Historians of medicine have largely eschewed notions like ‘progress’ and ‘advance’ in medical science and medical practice in favour of more historicist and relativistic understandings. But for medical practitioners and patients alike, the notions of ‘progress’ and ‘advance’ usually make more sense. Some philosophers too think it is time to refocus on the idea of ‘medical progress’.

A forthcoming conference at the University of Bristol (13-15 April 2010) will address the following topics:

To identify progressive trends in current medicine, we need to understand the nature of historical progress more clearly. Has medicine always progressed? If not when did it begin to progress, and why? Historians have long debated these questions. Most recently, David Wootton’s controversial argument that medicine only started to progress in the late 19th century, has renewed interest on the nature of progress in medicine. These questions invite the following further questions.

We need to understand how progress in medicine should be measured. The range and effectiveness of available interventions is an obvious metric, but there has been considerable recent interest in preventive medicine. What are the limits of preventive medicine? Are preventive strategies truly medical, or an admission of the limitations of medicine?

There is a need for greater clarity on the nature of health and disease, if we are to understand progress in promoting the former and treating the latter. Are these concepts biostatistical (as Boorse argues) or partly normative (e.g. Kingma)? What role do social pressures, such as conceptions of acceptable weight, height or sexual characteristics play in shaping the distinction between medically necessary and elective interventions? Is health just the absence of disease, or does modern medicine need to acknowledge a more inclusive notion of well-being?

There is a particular need for greater clarity on these questions as they apply to psychological disorders and the various psychiatric, psycho-therapeutic, and psycho-pharmacological interventions designed to deal with them. The distinction between health and disease is especially unclear in the psychological case, and the history of medicine shows it to be especially fluid.

It is necessary to differentiate the perspectives of medical scientists, clinicians, and patients concerning the nature of progress, and related notions such as a successful treatment outcome. The most dramatic illustration of this need is perhaps the recent controversy on voluntary euthanasia, where Hippocratic principles appear to be at odds with patients’ own desires.

To further medical progress, it is necessary to identify its causes. Is progress driven by advances in basic physiological science? Or by clinical need? By some combination of these—in which case how do they interact?

Insofar as medical knowledge progresses, is there a single, unified methodology for generating that progress, e.g. ‘the scientific method as applied to medicine’? Recent debates concerning Evidence Based Medicine and randomized controlled trials have highlighted the need for clear answers to this question. Is the RCT a “gold standard”, or are there a number of ways of coming to know in medicine? Are these ways incommensurable, or does can a “hierarchy of evidence” (such as that advocated by proponents of EBM) provide a clinically useful basis of comparison and ranking?

The conference will encourage the involvement of methodologically interested medical professionals, philosophers of medicine and historians of medicine. More here.