Research on Institutionalized Children: A Scientific Advancement or Ethical Setback?

     Children in the foster care system and orphanages have often been overlooked and cast away to the shadows. Who is keeping their adolescence safe and a priority from the horrors of being institutionalized? Children within the system are more susceptible to a life of emotional, physical, and mental abuse. Society tends to forget about them when they are calling out for the world to help them the most. Researchers have conducted studies and experiments on institutionalized children, but have the ethics of these experiments been truly evaluated? To some that is a question of objectivity. Yes, these children are not being put in harms way and rather helping push the boundaries of scientific research on the effects of children within the system. Though to others, this debate has been deemed to terms of subjectivity in regard to the moral conflict of exploiting these children’s trauma for educational gain in the name of science. 

In the article, “Ethical Considerations in International Research Collaboration: The Bucharest Early Intervention Project”, Zeanah et al. weighed the ethical costs of conducting experiments on institutionalized children. The researchers highlighted the multiple ethical controversies that arose from such a study. The Bucharest Early Intervention Project (BEIP) was a study that evaluated the ethics of experiments noting the physical and psychological effects on children living in orphanages or the foster care system. The researchers conducted this study so that they could bring the government data proving whether foster care or institutional care to be more beneficial for citizens. In their conclusions, the researchers state that foster care was better for child development and had less of a negative impact on the child’s well-being over being institutionalized. Due to these findings, the debate of removing children from these institutions and placing them into the foster care system has become a question of ethical responsibility for the researchers and a moral obligation. If the researchers do not act in the best interest of the children, the research does not prove to have the benefits it claims to be providing. 

    In the article, “Who Speaks for Me?: Addressing Variability in Informed Consent Practices for Minimal Risk Research Involving Foster Youth” Greiner et al. discussed the importance of informed consent from foster youth when conducting empirical studies. The researchers reviewed many pieces of literature on conducted experiments in retrieval of informed consent. The researchers concluded by stating that there is no concrete way to obtain informed consent from foster children to participant in scientific research. Though, they emphasize in high regard that consent should be adequate of the child’s interests and be accompanied by an individual of legal authority when seeking out research involving youth in the foster care system. 

Overall, both articles proved to be very informative when discussing the problems arising from the ethical standpoint of conducting experiments on institutionalized children. The ethical questions that have been raised are very complex and hard to deliver a clear cut answer. To some it maybe easier to quickly condemn the study, but then how would the children’s best interest be kept a top priority? Would they simply be forgotten once again? Any negative environment involving children is not ideal, yet how does one turn the bad into good? Some people might find the data retrieved to be very important for the progression of enhancement of child development in the foster care system and can be deemed beneficial on the long term.

References:

Greiner, M. V., Beal, S. J., Allen, A., Patel, V., Meinzen-Derr, J., & Matheny Antommaria, A. H. ( 2018). Who Speaks for Me? Addressing Variability in Informed Consent Practices for Minimal Risk Research Involving Foster Youth. Journal of Health Disparities Research and Practice, 11, 111-131. doi:https://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1797&context=jhdrp

Zeanah, Charles H., et al. “Ethical Considerations in International Research Collaboration: The Bucharest Early Intervention Project.” Infant Mental Health Journal, vol. 27, no. 6, 2006, pp. 559–576., doi:10.1002/imhj.20107.

Considering Optogenetic Applications in Humans

 What if the solution to a problem could be solved with just the flip of a switch? With novel advancements in optogenetics, it just might be that easy.

Optogenetics is a relatively new technology that utilizes light to stimulate cells or neurons that have specialized light-sensitive ion channels. In the study done by Dr. Stiedl, optogenetic stimulation of the ventral tegmental area (VTA) was used to examine mechanisms of reward. Using optogenetic probe implantation, they were able to precisely stimulate laterodorsal tegmental nucleus cholinergic and gulatmatergic fibers in the VTA (Steidl, 2017).

Since light does not usually penetrate through the skull to the brain, most optogenetic interventions such as Dr. Steidls are highly invasive and require surgery to implant a fiber optic cable that directly inserts onto the brain.

To combat the invasiveness of the technique, researchers Dr. Xin Gong et al. have engineered a novel step-function opsin called SOUL which has ultra-high light sensitivity. This allows neurons in animals with SOUL mutations to be activated just by transcranial optic stimulation and does not require an invasive optic cable to be inserted. Further the step-function aspect of the technology allows ion channels to be open for up to 30 minutes after stimulation, allowing these animals to freely move around while the neurons remain activated. Perhaps most importantly is that SOUL worked with neurons in the lateral hypothalamus, one of the deepest regions in the mouse brain, as well as in the cortex in macaque monkeys (Gong, 2020).

Applying this clinically in humans could present incredible potential as a therapeutic for a variety of neurological and psychiatric disorders and could even serve as an alternative to deep brain stimulation, an invasive yet effective technique that has been used in attenuating some of the symptoms in motor neuron diseases such as Parkinson’s. However, the article by Drs. Adamcyzk  and Zawadzki illustrates the ethical concerns regarding the potential of optogenetic applications in humans due to its specificity and accuracy. For example, one study they found was able to implant a false memory in mice brains by means of contextual fear conditioning using optogenetics and not only succeeded in implanting the false memory but was able to do so without any form of communication. Other studies they cited demonstrated how optogenetics can treat memory loss, enhance memory, or improve memory consolidation. However, specifically in terms of using optogenetics in memory modification technologies, this powerful potential can also present neuroethical concerns, particularly regarding exploitation, authenticity, and exactly who should be qualified to receive these treatments (Adamcyzk and Zawadzki, 2020).

Taken together, optogenetics is an incredible tool in neuroscience and, if applied to human clinical trials, could present a viable treatment for a number of neurological disorders. However, although no human trials have taken place yet, it is never too early to consider the ethics of applying such a technique. Especially in terms of memory modification technologies, where exactly is the line drawn between necessary therapeutic and simply performance enhancement? And who decides? As optogenetics prove to be a more realistic therapeutic in humans, it is important to establish a sound infrastructure for optogenetic neuroethical standards as well.

Works Cited:

Adamcyzk, A.K., and Zawadzki, P. (2018, Oct. 17). The Memory-Modifying Potential of Optogenetics and the Need for Neuroethics. NanoEthics. 14, 207-225. https://link.springer.com/article/10.1007/s11569-020-00377-1.

Gong, X., Mendoza-Halliday, D., Ting, J.T., Bi, G., Desimone, R., Feng, G. (2020, Jul. 8). An Ultra-Sensitive Step-Function Opsin for Minimally Invasive Optogenetic Stimulation in Mice and Macaques. Neuron. 107(1): 38-51. https://www.cell.com/neuron/fulltext/S0896-6273(20)30239-7?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0896627320302397%3Fshowall%3Dtrue#%20.

Steidl, S., Wang, H., Ordonez, M., Zhang, S., Morales, M. (2017, Feb.). Optogenetic excitation in the ventral tegmental area of glutamatergic or cholinergic inputs from the laterodorsal tegmental area drives reward. European Journal of Neuroscience. 45(4): 559-571. https://pubmed.ncbi.nlm.nih.gov/27740714/.

Alzheimer's Beyond Amyloid

Alzheimer’s is a neurodegenerative disease marked by the degeneration of brain neurons in the cerebral cortex, causing severe memory loss and overall impaired cognition. Although most candidate drugs have attempted to attack protein markers of the disease such as tau or beta-amyloid, there has been little success in these endeavors. In fact, since the year 2000, over 200 Alzheimer’s drugs have been tested but none prove to be a “silver bullet” (Park 1). It was not until quite recently that researchers like Dr. Krishna Bhirani have discovered the linkage brain-derived neurotropic factors have to Alzheimers and fueled the creation of a brand-new cocktail drug that is currently in the process of phase 2 trials and data analysis.

In the article “Serum pro-BDNF levels correlate with phospho-tau staining in Alzheimer’s disease”, Dr. Krishna Bharani et al. explore the relationship between brain-derived neurotrophic factors (BDNF) and the development of Alzheimer’s disease (AD). The researchers looked at various postmortem brain and fluid samples of patients with AD and compared them to control samples to examine any possible correlations with BDNF and AD. First, the researchers found lower precursor BDNF levels in the entorhinal and frontal cortices in AD brains as well as lower staining densities of TrkB (a BDNF receptor) in the hippocampus paired with greater Amylo-Glo and pTau staining in this region. Further, they discovered lower total BDNF levels correlated with lower Amylo-Glo training in the hippocampus, suggesting that the lower levels of BDNF levels in the brain may influence amyloid accumulation in the hippocampus (Krishna 1). Together, these results suggest a strong relationship between BDNF and Alzheimer’s, paving the pathway towards a potential treatment in the disease. 

One potential treatment that echoes research findings like Dr. Krishna’s is the drug LM11A-31, which is discussed in the TIME article “Alzheimer’s from a New Angle” by Alice Park. The company PharmatrophiX, led by the chairman of the department of neurology and neurological sciences at Stanford Dr. Frank Longo, has been working on the drug for many years and the company is currently proceeding with data analysis of their phase 2 trial (Longo 1). As previously mentioned, the countless drug candidates for Alzheimers focused on directly attacking amyloid or tau. What makes this approach inefficient is that “about 30% of people over 70 have amyloid in their brains but no signs of dementia. In other words, everyone with Alzheimer’s has amyloid, but not everyone with amyloid has developed Alzheimer’s” (Park 3). Thus, Alzheimer’s drug cannot only focus on amyloid accumulation because it is not a clean-cut indicator of Alzheimer’s. Targeting tau, which comes at later stages of Alzheimer’s, also proves to be a difficult task for drugs focusing only on this protein marker. 

This is where the new candidate drug comes in: instead of directly attacking amyloid or tau, it’s goal is to simply keep the brain cells strong at all possible stages of Alzheimer’s. In order to maintain neuronal strength, this drug is taking into account recent research that emphasizes the importance of growth factors that play roles in preserving and even regenerating connections between nerves by experimenting with various nerve-growth factors, including BDNF. The article cites that “having higher levels of factors like BDNF might give people cognitive reserve–the ability to counteract any damage that’s occurring and minimize its effects” (Park 3). For example, in a study with mice treated with the drug (which includes anti-amyloid, anti-tau as well as nerve-growth factors), beyond treating the markers of Alzheimer’s, the researchers even found some significant reversal of damage caused by the disease, highly crediting the role of nerve-growth factors. Although trials are still being conducted, LM11A-31 is showing some promise in being both a preventative treatment as well as a potential cure for Alzheimer’s.

As shown in Dr. Krishna’s article, BDNF is a key player in the mechanism of Alzheimer’s progression as it has strong relationship with protein markers of the disease such as amyloid and tau accumulation in the hippocampus. Research results like these are crucial in treating Alzheimer’s because they shed a new light on what previous drug candidates have been getting wrong. As seen in the TIME article by Alice Park, the drug LM11A-31 is taking the road less traveled by targeting amyloid and tau as well as implementing various nerve-growth factors such as BDNF in the treatment. Although trials and data analyses are still being run at this very moment, it acts as hope for light at the end of the tunnel.

Works Cited

Bharani, Krishna, et al. “Serum pro-BDNF Levels Correlate with Phospho-Tau Staining in Alzheimer’s Disease.” Neurobiology of Aging, 2020. 

Longo, Frank. Pharmatrophix, Inc., 2020, www.pharmatrophix.com/. 

Park, Alice. “Alzheimer's from a New Angle.” Time, Time, 11 Feb. 2016, time.com/magazine/us/4217023/february-22nd-2016-vol-187-no-6-u-s/. 

The Effects of Covid Bringing Classes Online

 

As a result of the covid pandemic, many institutions had to adapt to using online alternatives. One of the most impacted institutions is the education system. Teachers and students alike are expressing negative emotions concerning online school. The online medium has prevented people from having true interaction with others. This has created a huge emotional strain on everybody involved. Depression and anxiety is at an all time high all around the world currently. These emotional and psychological strains are affecting the learning of our students. However, there is another aspect of online school that may be a reason for a lack of performance of out students taking online classes. It is that our mind learns better through visual cues of the body. Hence, online videos may not cut it. This is explained in a research by Wakefield et al. called “Gesture helps learners learn, but not merely by guiding their visual attention”. In the research, Wakefield and associates use eye tracking technology to track students’ attention during lessons. They found that children performed significantly better after learning with speech and gesture instruction as opposed to speech alone lessons. The eye tracking reveals that gestures bring students attention to the teaching content. The gestures are also able to help synchronize the information with what is heard during the lecture. It combined visual learning with auditory learning.

            According to an article on Economic Policy Institute, it was predicted that students would come into fall of 2020 with about 70% of learning gains in reading and even smaller gains in math at only 50%. When checked with the actual data for grades 3-8, reading values stayed relatively the same; however, math scored in every grade dropped significantly. This could be due to the limited gestures that can be preformed on online classes. Wakefield’s research was specifically focused on gestures on math lessons, and Economic Policy Institute’s article supports Wakefield’s findings. While the long-term affects are still unknown, the evidence is concerning for kids’ education during a time like this.

            A possible alternative is the use of virtual pointers during lessons. This may not be able to completely replicate a gesture with the human body, but it will be able to synchronize visual could with the audio lectures. Some professors have opted to just using a whiteboard on their webcam so they can record their whole body. This may remove the issue of lack of gestures all together. Hopefully, overtime we are able to figure out better ways to adapt to online schooling to prevent these problems.

 

References

Wakefield E, Novack MA, Congdon EL, Franconeri S, Goldin-Meadow S. Gesture helps learners learn, but not merely by guiding their visual attention. Dev Sci. 2018;21(6):e12664. doi:10.1111/desc.12664

Report • By Emma García and Elaine Weiss • September 10. “COVID-19 and Student Performance, Equity, and U.S. Education Policy: Lessons from Pre-Pandemic Research to Inform Relief, Recovery, and Rebuilding.” Economic Policy Institute, www.epi.org/publication/the-consequences-of-the-covid-19-pandemic-for-education-performance-and-equity-in-the-united-states-what-can-we-learn-from-pre-pandemic-research-to-inform-relief-recovery-and-rebuilding/.

Ethical Considerations of the Advancement of Science

 With ever-evolving technology allowing everyone from scientists to rich interested parties to study, adapt, and change aspects of our humanness, the world of ethics has its work cut out for them. To keep everyone involved safe and allow sufficient progress to be made, the mixed field of ethics and learning through the scientific process must grow together, hence the creation of bioethics. This practice can both take place for current ethical considerations, and past experiments. ETHICAL CONSIDERATIONS IN INTERNATIONAL RESEARCH COLLABORATION: THE BUCHAREST EARLY INTERVENTION PROJECT, a paper written by C.H. Zeanah et al., takes a look at a controversial, albeit enlightening project done in collaboration with American investigators and the Romanian government. The  Bucharest Early Intervention Project focused on the development of children in Romanian institutions contrasted with the intervention of being taken to foster homes that address the implicit socio-economic issues that ravage the institutions of Romania. The key question was, how does infant trauma become woven into the fabric of an individual's neurological development and present as behavior. While the Bucharest Early Intervention Project (BEIP) did strictly adhere to the current ethical guidelines, the paper does leave some feeling a slight sense of disgust. The author of the ethical consideration even stated as much. The issue then lies with the guidelines, perhaps they are not strict enough, or take into account the wrong perspective. This will not be the last time a queasiness will follow a study, this is the nature of science. It is supposed to make people uncomfortable, but it is a fine line of wonder and malcontent. And with this ever globalizing world, more care must be taken to avoid harming underserved communities and unfairly privileging the wealthy and better off. The Ethical Implications of Neuroscience, an article written in the World Economic Forum states as much. It goes on to contemplate the possible uses and abuses of new technologies such as mood-altering drugs and forms of deep brain stimulation to change a person. While there is an argument to be made that, if we have the technologies to help in the betterment of a global society, to use such technologies. For example, neuroscientists working in Leiden University in the Netherlands found that nodal excitability-enhancing tDCS of the mPFC reduced prejudice. But rewiring a brian can be skewed into something of a dystopian universe. 

Works Cited

“Bioethics.” ScienceDaily, ScienceDaily, www.sciencedaily.com/terms/bioethics.htm.

Written by
Nathan Emmerich, Visting Research Fellow. “The Ethical Implications of Neuroscience.” World Economic Forum, www.weforum.org/agenda/2015/05/the-ethical-implications-of-neuroscience/.

Zeanah, Charles H., et al. “Ethical Considerations in International Research Collaboration: The Bucharest Early Intervention Project.” Infant Mental Health Journal, vol. 27, no. 6, 2006, pp. 559–576., doi:10.1002/imhj.20107.

To what extent of severity must observations in an experiment be to halt The Bucharest Early Intervention Project?

 

In a 2000 study, Zeanah et al. launched the Bucharest Early Intervention Project. This was an international collaboration by America and Romania to investigate and compare the effects of children in foster care homes and children in child institutions run by the government in Romania. Romania was chosen as the setting for investigation due to its large growth in child institutions and orphans. This increase in child population was caused by the Communist Party’s creation of the “Romanian Workers Army”. All women under the age of 40 were required to birth five children in order to increase the work force. Many families could not support that many kids; as a result, many children were given up to government institutions by the poor families. In contrast to Romania, majority of orphaned children were placed in foster care homes in the United States. With the increasing use of child institutions in Romania, Zeanah and associates took this opportunity to observe the effects of orphaned children in order to find the best method of upbring: child institutions or foster homes. However, this study raises a lot of questions and controversy on the ethics of such an investigation.

Zeanah and associates claim that the researched benefits outweigh the risk. The research will be used in order to help children after its completion. This raises the question whether saving the help for the future instead of the present is really a good alternative. According to a 2015 article posted on the website The World, Vlad Odebescu tells the story of half a million kids who were abused in Romain Orphanages after the end of the Cold War. The living conditions were abysmal and the one’s running the orphanages were corrupt. Children experiences hunger, cold, beatings, and sexual abuse. Would the Bucharest Project need to be halted by law if instances like these are found to be occurring again? Protection of vulnerable participants are determined by a rule of minimal risk. The Bucharest Project states minimal risk as “the probability and magnitude if harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life…” As long as the study does not implement harm on the participants greater than what they already experience, the study is ethical. What if what the children experience in their daily lives is already at considered great harm? What is the standard? There must be a line drawn where statistical research is no longer necessary to deduce the outcomes of such an institution.

The researchers of The Bucharest Early Intervention Project do their best to keep an open mind against their American-influenced bias. However, aside from being researchers, they are also humans. The subjects are humans as well. Sometimes learning the effects of child development is not worth the knowledge.

References

Zeanah, Charles H et al. “The Bucharest Early Intervention Project: case study in the ethics of mental health research.” The Journal of nervous and mental disease vol. 200,3 (2012): 243-7. doi:10.1097/NMD.0b013e318247d275

“Half a Million Kids Survived Romania's 'Slaughterhouses of Souls.' Now They Want Justice.” The World from PRX, www.pri.org/stories/2015-12-28/half-million-kids-survived-romanias-slaughterhouses-souls-now-they-want-justice.

The Ethicality of Foster Care

    Children in foster care has always been a controversial topic, especially in the western world. The ethicality has been debated pertaining to living conditions and the behavioral outcomes of these children that live their lives in foster care. Ethical considerations were brought to light in accordance with a study done in Romania, named the Bucharest Early Intervention Project. The goal of this project was to see if foster care, as an alternative to institutionalized care, would eliminate social deprivation of these children and would eliminate the additional adverse effects of institutionalization. Romania was chosen in the first place due to a large amount of children finding themselves institutionalized and government officials wondering if, by building a family unit through foster care, these children would be better off. There were obvious risks and benefits seen from this study. The benefits seen were that the children were able to receive proper medical care, referral if needed for identified issues, and more careful scrutiny of the children's' legal situations that could result in them being placed in a better home. Another notable benefit was the legacy of this study, which was the formation of the Institute for Child Development that provides training and further research for foster care families and officials. The risks were, of course, any additional harm to these children. This risk was counteracted with specific protocols to ensure no harm was done to these children. The official result of this study was that the benefits outweighed the risks and foster care is a healthy alternative, or at least more healthy compared to institutionalization, for children.

    While in this study children did not experience adverse affects as a result of being placed in a foster home, more often than not they have in other areas of the world other than Romania. A study was done in the United States on the efficacy of different mental health interventions on children in foster care. Approximately 400,000 children every year are in foster care just in the US alone. Due to this, about 50-80% of children raised in foster care meet the criteria for a mental health disorder. The goal of this study was to find mental health interventions that could help foster care children, because, unfortunately, most of the time these children are not able to get help and if they do, it is not effective. One intervention was child-only, three were caregiver-only, and the remaining 6 were child and caregiver. Some of the interventions were tailored to foster care children specifically, and the others were more mainstream interventions that were changed to fit the need of the children's situations. Keeping Foster Parents Trained and Supported was the most effective one in this study.

    The Bucharest Early Intervention Project was successful in deciphering whether or not foster care could benefit children as opposed to having them institutionalized. Regarding the ethics of the study, many people agreed that the benefits outweighed the risks, and others disagree. It is important to look at the context of these two studies, though. One study was held in the eastern world, whereas the efficacy of mental health study was done here, in the United States. Both of these countries have different outlooks on mental health and foster care systems generally. This being said, both of these studies proved to be effective in their respective countries. More work will continue to be done to ensure that wherever children are in foster care systems, they will be taken care of.

References:

Zeanah, C. H. (2006). Ethical considerations in international research collaboration: The Bucharest Early Intervention Project. Retrieved December 09, 2020, from https://onlinelibrary.wiley.com/doi/abs/10.1002/imhj.20107?casa_token=SlVRIU4g9FgAAAAA:1lFnIg1kGh-GOncTJ_hfzy24MnA6cc8VAhHrj9V_Of-dSWFsz8raxdSV2rpNc1T3FkLNtkqQ57QSoA

Hambrick, E., Oppenheim-Weller, S., N'zi, A., & Taussig, H. (2016, September 08). Mental health interventions for children in foster care: A systematic review. Retrieved December 10, 2020, from https://www.sciencedirect.com/science/article/pii/S0190740916302717?casa_token=FRKKU5ZytHwAAAAA%3ApIEGcpwAeHiUXSKVa7lVgOmZcNfddu86mW5XU0DR_GS0pfM3aTg6wdw0JhNuXA7_Tc3T2NApnA