Author Archives: hgreely

Book Note: My Lobotomy, by Howard Dully and Charles Fleming

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The lobotomy continues to fascinate and to haunt.  How could the 1949 Nobel Prize for Medicine or Physiology go to Egas Moniz for the invention of a procedure that, within two decades, was rejected, with horror, as barbaric?  As a matter of inside Nobel politics, there has long been some thought that Moniz really won the prize for inventing angiography, but the Prize is given for an invention or discovery, not for a body of work, and the citation is for the “frontal leucotomy.”  The terms frontal lobotomy or prefrontal lobotomy were popularized by the procedure’s American exponent – Walter Freeman, the neurologist who invented the surgical procedure that allowed out-patient use of the procedure, the “ice pick” (literally in the first cases) through the orbit behind the eye.

This same Walter Freeman ended his career with an office in the wealthy Silicon Valley (then in its silicon infancy) suburb of Los Altos.  And, in 1960, he “gave” (the verb seems wrong) a prefrontal lobotomy to a 12 year-old boy named Howard Dully. My Lobotomy is Dully’s story, told by the now 60 year-old Dully himself, with the aid of writer Charles Fleming.

The book began as a result of a National Public Radio program on lobotomies, which, in effect, became a program on Dully.  Dully had been a difficult boy, but not, at least as he tells the story, a particularly abnormal one.  He speculates, plausibly, that today he might have been diagnosed with ADD or ADHD.  He believes his stepmother hated him, irrationally, and was willing to do anything to make him disappear, before and after his “successful” lobotomy.  Freeman, he thinks, was gripped by an overriding urge to keep experimenting with his procedure, extending it still further to children, including Howard, whom he diagnosed as having had juvenile schizophrenia since age 4.

After the procedure Dully did not become a zombie or an idiot. It sounds, from his description (the main one we have) that he became more detached and vague, at least for a while. (Freeman, however, thought his improvement was remarkable.)   His stepmother still would not take him back into the home so he drifted back and forth from the juvenile hall to Agnews, a state hospital for the insane, to a special school for the disabled.  As an adult he lived mainly on social security disability payments and a few women in his life, engaging in too many drugs, too much alcohol, and occasional petty crime, until, at about age 45, he decided to straighten out his life.  He seems to have done well; he has supported himself and his wife through driving a school bus and training other bus drivers for most of the last fifteen years.

The book is mainly Howard’s story, of his family and his early life.  His misbehavior in school, his childhood trips to the mountains, or his complex and painful relationship with his stepmother may or may not interest you, depending on your tastes.  The discussion of Freeman, and the contents of the notes Freeman took on Howard, are more interesting from the perspective of neuroethics. I would have liked more scientific discussion of the lobotomy generally and of Howard’s case in particular.  But this is Howard’s memoir, not a scientific report on him.

The latter may be coming.  According to the afterward of the paperback edition of the book, Dully has now been scanned in an MRI.  The researchers found major brain damage that they would expect to render a person completely incompetent.  They can only attribute his normal or close to normal life to the remarkable brain plasticity of the young.  I understand that they hope to have a manuscript submitted around the end of 2009.  That paper should be well worth reading and will make this already interesting memoir even more useful in neuroethics.

Hank Greely

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fMRI and Lying – An Interesting, Different Approach

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The number of published, peer-reviewed articles exploring the use of fMRI as a lie detector is now around 20 and at least two companies continue to sell fMRI-based lie detection services in the United States (in my much-repeated view, very prematurely).  A new article, though, uses fMRI in a different and interesting way to explore lying.

Josh Greene and Joseph Paxton have just published a paper in the Proceedings of the National Academy of Sciences looking cleverly at some of the processes involved in one kind of lying.  Greene and Paxton, Patterns of Neural Activity Associated with Honest and Dishonest Moral Decisions, PNAS 106:12506-12511 (July 28, 2009).

http://www.pnas.org/content/106/30/12506.full?sid=5e3b601b-662c-424d-aa90-1696fc469431

Greene and Paxton enrolled subjects in what they thought was a study of paranormal abilities to predict the future.  They were asked, while in a scanner, to predict the outcome of computer-generated, random coin flips.  Some of the time the subjects had to record their prediction in advance (the “no opportunity” condition), other times they just reported whether their prediction was correct after they were told the “true” result (the “opportunity” condition).   Each trial was a gamble of $3, 4, 5, 6, or 7 – a correct guess won that amount, an incorrect guess lost that amount.

They got useful data from 35 subjects, each of whom had 70 repetitions under the “opportunity” condition.  Fourteen of them were classed by the investigators as “honest” in the opportunity condition because they were right about 50% of the time.  Fourteen were classified as “dishonest” –  they were “right” 69 percent of the time or more, which should have happened fewer than one time in a thousand.  (The investigators do not accept their own cover story about paranormal ability!) Seven, who were right “too much” but not enormously too much, were classified as ambiguous.

The investigators talk about two models for honesty – “will” and “grace” (thus, perhaps, betraying that at least one of them watched television during the 1998-2006 run of Will and Grace).  The “will” model assumed one’s brain has to work harder to overcome the temptation to cheat.  The “grace” model assumes that some people never even considered cheating and that the cheaters’ brains would have to work harder.

The investigators looked at reaction time and found that the honest group had no significant response time differences in the opportunity and no opportunity conditions or between their wins and losses.   The dishonest group took longer in its opportunity condition “losses” than in its “wins” – took longer to decide to be honest.  It also took longer in its opportunity condition losses than the honest group did.

The fMRI data showed that the dishonest group had greater activation in the dorsolateral prefrontal cortex when it had opportunity “wins” (when it could have cheated to win) than with no opportunity wins.  It also showed more activation in the control network (anterior cingulate cortex, dorsolateral prefrontal cortex, and ventrolateral prefrontal cortex) when it had opportunity “losses” (decided not to cheat) than when it had no opportunity losses.  The honest group showed no differences.

So – at least in this kind of trial, honesty might be a matter of not thinking about cheating, not of controlling an impulse to cheat:  grace, not will.  The article has a much richer discussion of its findings than this poor summary, including a good summary of the limitations of the experiment and I recommend it.  It is particularly noteworthy among the fMRI-based lie detection tests in one way – it is based on “real” lies, situations where the research participant, on his or her own, decides to lie without being instructed to do so (and, in fact, has been at least implicitly instructed to tell the truth).  As such, it may tell us more about at least some kinds of lying than the usual experimental approaches.

Eulogy for John Barton

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I was asked by John’s family to speak at his memorial service on August 16.  Because of his important role in, among many other things, law and the biosciences, especially with regard to intellectual property issues, I thought it might be worthwhile to post here my comments on him.  They focus primarily on his role at Stanford Law School, but do (I hope) give some idea of the breadth and importance of his work and of the fundamental goodness of the man.  He is missed.

* * *

John H. Barton and Stanford Law School

One of the worst things about growing older is the ever increasing number of memorial services.  Sometimes, they do serve as celebrations of lives that had come, through old age or a long struggle with disease, to a natural completeness.  This death, though, was different.  It was tragically premature.  John was in great physical and mental shape and his inquiring spirit was always young.  His family and friends, his colleagues, and all the people around the world who have benefited from his work have been cheated of many more good years of John Barton.

But as John would have been the first to note, life is always uncertain and he had a good run.  It wouldn’t have been like him to complain – a little wistful disappointment, perhaps, but no complaints.  And so, we too should focus on our gratitude for having had so much of John, for so long, to celebrate.

This is particularly true for Stanford Law School.  John arrived at the law school as a first year student in September 1965, almost 44 years ago.  I want to spend the next few minutes telling those of you not from the law school a little bit about what he has meant to us.

John was not our typical law student, a hot shot just out of an elite undergraduate school.  In 1958 he graduated magnum cum laude from Marquette University with joint degrees in physics and in philosophy, an early sign of the breadth of his interests.  The next year, while serving in the Navy, he married Julie and they started their family.  After three years in the Navy, he went to work for a top-secret defense electronics firm.  (I doubt that discrete John ever told anyone what he did there).  As a result, he did not start law school until he was nearing 30, with a wife and four children.  (The fifth made his appearance during Christmas break, John’s second year.)

In 1965 Stanford Law School was in the middle of its steep ascent, from a good regional school, to a very good national school, to one of the world’s top law schools.  In spite of his family obligations and thirty hours a week of paying work throughout law school, John was a spectacular law student.  Our colleague John Merryman remembers John Barton as his student in first year Property. It was, John Merryman says, “the first time I realized the school was getting so good that some of the students were smarter than the faculty.”  He even had first year student John Barton teach one of his class sessions.

After graduating in 1968 (in a rare lapse, only second in his class), John spent one year working for a leading Washington D.C. law firm, Wilmer Cutler and Pickering.  (Those were the days when the largest law firm near Palo Alto had fewer than 20 lawyers.)  But after only a year we pulled him back to the law school. He started teaching in the fall of 1969 and won our teaching award, voted by the students, his very first year.  He was part of  our faculty for the next 40 years.

It’s not quite clear how old the Stanford Law School is – it depends on when you start counting, which may in turn depend on when the Development Office thinks it useful to declare an anniversary – but I estimate that John was at the law school with about half of the students the school has ever had and with about 80 percent of our living alumni.  He taught several thousand Stanford law students, helping them with everything from first year contract law to courses he helped to create, like international business transactions, law in radically different cultures, intellectual property as a business asset, and biotechnology law and policy.  Our colleague, Buzz Thompson was his student in the mid-1970s.  He remembers that John “was the epitome of the absent minded professor.  In those days of chalk, by the end of class, John would be covered by chalk dust — on the front of his shirt and jacket, on his side, on the seat of his pants.  But his lectures were consistently brilliant — packed with interesting and valuable insights.”

John was a particularly important teacher for our foreign graduate students.  The law school has long offered masters and doctoral degrees to lawyers from other countries.  These students, particularly in the doctoral program, can be difficult to teach.  Although they are all very intelligent, they come from many diverse cultures and bring with them vastly different levels of knowledge of the American legal system or American legal thinking – and of scholarly written English.  Even in his retirement, John always took foreign students.  He worked, hard, with them to improve their analysis and insights – and their written English.  He was truly tireless in that role and was greatly appreciated, and loved, for it – and, as a result, he helped populate and improve law faculties around the world.  We’ve gotten several emails from his former international students.  Here’s a sample, from Professor Yahong Li at the University of Hong Kong:

“I have been strongly influenced by his broad knowledge of law, technologies and society, his intellectual curiosity, his work ethic, his kindness, and his love for mankind.  I feel so fortunate to have had the opportunity to be his student, and he will live in my heart as a great mentor forever.”

John retired from the Law School in 2002, which meant that he stopped teaching – except, of course, for all the times when he was brought back to teach courses we needed, to supervise international students who otherwise would have fallen through the cracks, or to deliver guest lectures for colleagues, like me, bent on exploiting him.  In spite of these continuing teaching obligations, retirement increased, not diminished, his research and policy work.

Although I haven’t mentioned it yet, John was always first and foremost a scholar – not an ivory tower scholar but one who wanted to help make policy, with the dirty hands and the occasional scar to prove it.  John’s work covered a very broad range but three aspects of it are especially noteworthy. First, he was interested in how science and law intersected, including but not limited to intellectual property.  Second, he was interested in the whole world, not just the United States.  And third, he was interested in concrete problems, where solutions would make the world a better place.  In the first two, he was a decade or two ahead of his time – forty years ago he picked out fields that had not yet begun their enormous growth in importance to law schools.  In the third, he was timeless.

John’s first topic as an academic was nuclear weapons control.  He then became interested in agriculture – the Green Revolution and its possible successors.  And eventually he came to focus on human health, particularly but not solely through vaccines.  To all of these he brought an engagement with the science along with a deep knowledge and interest in the legal tools that shaped these problems and their possible solutions – public international law, trade law, environmental law, antitrust law, and, increasingly, intellectual property law.  He mastered these legal fields not just because they were fascinating but, primarily, because they were important for people’s lives, including the lives of billions of people who did not know they existed – and whose existence these areas of law often slighted

And so he fought for more food, better drugs, better vaccines, but he did it by working with all sides:  governments, non-governmental organizations, and multi-national corporations.  He idealized none of them, he demonized none of them – he recognized that all were crucial pieces of solutions.  I think John may have been happiest, in recent years, about his role several years ago as chair of the Commission on Intellectual Property Rights and Developing Countries.  It was extraordinary that the British government, which created this commission, should reach out to an American scholar to chair it, but then John was an extraordinary American scholar.

John’s bibliography shows nearly a hundred books, chapters, articles, and other writings.  Very few appear in law reviews, the standard home for our trade’s work.  He wrote and worked with hundreds of collaborators.  Few were law professors or even lawyers.   John was thoroughly interdisciplinary before interdisciplinary was cool – when it was unconventional and even a bit odd.  If that ever bothered him, or worried him, he never showed it.  He did work he thought was important, in the ways that it could best be done, whether or not that fit into the traditional mold of a law school, or law professor.  That mold ultimately changed, in part because John helped break it.

I’ve talked about what John did – what he taught and wrote, but a large part of John’s importance to the law school came from how he was.

Our dean, Larry Kramer, said this about John:

“To me, the most remarkable thing about John was his selflessness and good will.  He never pushed or sought anything for himself and he was always willing to extend himself for others.  He pitched in and just did what needed to be done—without complaint, without needing or seeking recognition.  Even in retirement, he was as active and engaged a colleague as anyone.  And always modest, soft-spoken, and gentle.”

Paul Goldstein calls him “that rarest of beings in the legal academy: a truly humble man.”

And Miguel Mendez recalls “the warm and respectful manner in which he treated everyone: faculty, staff, and students.”

Miguel’s words remind me of a scene from Pygmalion (and My Fair Lady).  Eliza accuses Higgens – Professor Higgins, note – of rudeness.  She holds up Colonel Pickering, who treats a flower girl like a duchess.  Higgins defends himself by saying he treats everyone the same; he treats a duchess like a flower girl.  John treated everyone equally well – with attention, concern, and respect – from the eccentric questioner at a talk to the newest and most clueless student, staff member . . . or colleague.

Pat Adan, who served as John’s assistant in recent years, told me the staff’s general feeling about John:  “Always a gentlemen, never a complaint, always courteous if something needed fixing, he was grateful for anything you did for him.”

Respect, courtesy, and gentleness were certainly important parts of John’s character.  But of his many virtues, the one that strikes me most powerfully was his integrity.  John did what he thought was right, whether or not it was popular or good for his career.  He never even seemed to think about doing anything else – he never seemed to be tempted, because doing anything other than the right thing never seemed to occur to him as an option.

There is a saying so old that it is in Latin:  De mortuis nil nisi bonum dicendum est – speak nothing but good of the dead.  As I realized what a long list of John’s virtues I would have, it occurred to me, as an academic matter, to try to find some failings.  There must have been some – I’m sure humble John would have treated us to a long list – but the best I could come up with was that he wasn’t great at telling jokes . . . although he was very good at laughing at them.

I want to end with a personal word.  To me, John was more than a colleague.  He was a friend, a mentor, a support, and a model of what one could do with an academic life.  I miss him, and I owe him.

And so does all of Stanford Law School – its faculty, alumni, students, and staff for the last 40 years.  We are, individually and collectively, in his debt.  It is comforting, though, to think that John will live on as part of the continuing fabric of the Law School, influencing, as an indelible part of the institution, the lives of countless more students, staff, and colleagues.

We are all worse for his too early death; we are all better for the life he lived so well.  We will miss him.

Professor John Barton is dead

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Stanford Law Professor John H. Barton died on August 3, 2009, nearly three weeks after a bicycle accident had put him into a coma.  John was 72 years old and had retired from Stanford Law School in 2002, but he remained an active presence at the School.  He was still excitedly working on new and continuing projects, mainly aimed at improving health in the developing world.

John graduated with from Marquette University in 1958 with degrees in philosophy and in physics. After three years of service in the US Navy, he worked for several years as an engineer.  In 1965 – married, with children – he became a 1L at Stanford Law School and had a brilliant student career.  After law school he worked as an associate for one year with the firm then known as Wilmer, Cutler, and Pickering before joining the Stanford Law School faculty in 1969.  Until last week, he never left.

From the beginning of his career John was fascinated by the intersections of science, law, and society.  He worked on nuclear weapons control, environmental problems, and human health, almost always with an international field of vision.  From his earliest faculty days through his death, he did not care whether he was doing traditional law professor work – he worked with scientists, lawyers, policy-makers, and anyone else in his effort to make the world a better place.

John was a man of integrity so great that I’m not sure he ever noticed it – I believe it never occurred him not to do the right thing.  He combined curiosity, intellectual rigor, and compassion better than anyone I have known.  He was a great mentor, a great friend, and a very good man. His friends, Stanford Law School, and the world are all diminished by his too early death, but we are all better as a result of his life.

Hank Greely

Book Note: In Pursuit of the Gene by James Schwartz

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This fascinating science history is subtitled “From Darwin to DNA” and, although the main action ends in the 1930s with only a 14 page epilogue moving from Oswald Avery to the Hap Map, the book does cover a lot of historical territory – and a lot of intriguing personalities.  The book follows the concept of the gene from Darwin’s notion of “pangenesis” through Hermann Muller’s prescient speculations about the physical nature of the gene.  It focuses largely on particular scientists and their work, hitting Francis Galton, W.F.R. Weldon, William Bateson, Hugo de Vries, Gregor Mendel, and Walter Sutton, among others, before reaching Morgan and his fly group, and particularly Hermann Muller.

It is not new to suggest that scientists have personalities, quirks, and feuds, but Schwartz provides at least two nice examples of battles within science, following at length the conflicts between Weldon and Bateson in the early 20th century and the travails of Muller with Morgan and his disciples. Schwartz, for good reason, is so fascinated by Muller that I wonder if there might be a Muller biography in his future, to supplement Elof Carlson’s 1981 book.  (What’s not to be fascinated about with Communist/eugenicist scientist from New York City who worked in both Hitler’s Germany and Stalin’s USSR before working on the Republican side of the Spanish Civil War?)  He clearly focuses much more attention on Muller than on Morgan, Sturdevant, Bridges, and the other members of the original Fly Room and its successors (perhaps as a complement to the way Kohler’s history of the fly room arguably under-discussed Muller).

One of the strongest points of the book, to me, was that Schwartz was willing to go into some detail about the experiments that led scientists to their conclusions.  The discussion of the fly crosses, for example, were clear enough that I really felt I understood what had been done and grasped the excitement caused by the results.

I’ve done a fair amount of unmethodical and unfocused (but interested) reading about the history of genetics and molecular biology.  I have greatly enjoyed some of the biographies, such as Evelyn Keller’s biography of Barbara McClintock or Paul Berg’s study of George Beadle.  And Jim Watson’s The Double Helix is, of course, in a category by itself (although into exactly what category this wonderful book fits remains unclear).  Of the broader histories, Schwartz’s seems to me to belong with Judson’s Eighth Day of Creation and Kohler’s The Lords of the Fly – even though it lacks a clever title.   I recommend it.

– Hank Greely

Sharon Begley article on Evolutionary Psychology

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Sharon Begley, one of my favorite American science journalists (at least on bioscience topics), just published a 4300 word article in Newsweek on Evolutionary Psychology.  To call it a devastating attack would be about right, I think.  It is a very powerful summary of the scientific  evidence against strong EvoPsych positions.  I have been skeptical about Evolutionary Psychology ever since I first heard of it and found David Buller’s critical book about the field, Adapting Minds, largely persuasive.  This Begley article, though, seems to me the best short critical assessment I have seen.  I strongly recommend it.

http://www.newsweek.com/id/202789

— Hank Greely

Non-Prescription Usage of ADHD Meds at One University

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I recently was sent a fascinating article on “enhancement” uses of Adderall, Ritalin, and Dexedrine on the campus of one college. The article is

Alan D. DeSantis, Elizabeth A. Webb, and Seth M. Noar, Illicit Use of Prescription ADHD Medications on a College Campus: A Multimethodological Approach, Journal of American College Health 57:315-323 (Nov.-Dec. 2008).

I have not, yet, found a free version of the article that I can link to, but I highly recommend it.

The article discusses a two-pronged look at the use at a large university of ADHD medications by students who did not have a prescription for the medications. The study used two approaches. First, it surveyed 1800 students; then it conducted follow-up interviews with 175 students.

34 percent of the surveyed students reported using an ADHD medication without their own prescription. (Four percent of the surveyed students reported that they had prescriptions for such medications and were excluded from the survey.) The rate of use increased from 18% in the freshman year to 55% by the senior year. 39% of the male subjects used the drugs compared with 30% of the female subjects. 48% of the “Greek” students (fraternity or sorority members) used the drugs compared with 23% of non-Greek students.

Of those who had used the drugs without a prescription, 72% said they did so to stay awake to study, 66% said they did to concentrate on their work, 36% said they used them to help memorize things, 22% said it was to stay awake and have fun, and 12% said it was to make work more interesting. Seven percent said it was for the high and 5 percent for appetite suppression. (People could give more than one reason, so the percentages total far more than 100%.)

There have been other surveys of college student use of these medications, with a range of results. (This survey’s results are at the upper end for usage.) What made this article particularly interesting to me were the quotations from the interviews, as students talked about their motives for using the drugs, their acquisition of the drugs, and their perception of the results. Students found it very easy to get access to the drugs, particularly in libraries or in fraternity or sorority houses. Over ninety percent said they got the drugs from friends or significant others. Fifteen percent got the drugs for free; those who paid spent from $3 to $10 per pill, but people reported that those selling the pills did not do it for the money but as a service to their friends. The sellers were students with ADHD drug prescriptions whose prescriptions were based on daily use but who used the drug much less frequently. As one student reported, “It is easier than beer to get.”

Although there is little, if any, good evidence about the effects of these drugs on the performance of people who do not have ADHD, the students reported strong belief in their efficacy. And they reported a general lack of guilt, in part because it was being used for studying rather than getting high.

I have helped write an article about the use of drugs for cognitive enhancement. (Henry Greely, Barbara Sahakian, John Harris, Ronald Kessler, Michael Gazzaniga, Philip Campbell, Martha Farah; Towards Responsible Use of Cognitive-Enhancing Drugs by the Healthy, Nature 456:702-05 (Dec. 11, 2008)) Adderall, Ritalin, and Dexedrine are not harmless drugs and their widespread use, without prescription, has worrisome health implications. But the DeSantis article does help make the point that such uses are common. “The first thing that became evident during the course of our interviews was how prevalent the use and casual discussion of stimulants were on the college campus.” What, if anything, to do about illegal use of cognitive-enhancing drugs is a complex question, but that use is certainly both real and substantial.

– Hank Greely