Opting-out: The Real Reason Behind the Lack of Organ Donors

If you were asked to predict whether or not someone was a registered organ donor, what factors would you consider first? Perhaps religion? Cultural influences? Their family’s values? What if someone told you that these factors were all irrelevant, and that the main deciding factor was really whether or not someone had to check a box? For such a significant decision, this explanation is not very satisfying, but it may very well be true.

In a 2003 study, Eric Johnson and Daniel Goldstein studied rates of organ donation in European countries. The rate in Austria was close to 100% and in Sweden it was almost 86%, but in Germany and Denmark the rates were 12% and 4% respectively.  Despite the cultural and physical proximity, there were huge gaps between the rates. The main difference between these countries was that the ones with high percentages of organ donors had an “opt-out” system, whereas the countries with low percentages had “opt-in” systems. Essentially, people did not become organ donors in the “opt-in” countries because of the extra effort required to check a box. As Daniel Kahneman succinctly stated in Thinking, Fast and Slow, “The best single predictor of whether or not people will donate their organs is the designation of the default option that will be adopted without having to check a box.”

Kahneman defines this phenomenon as the “framing effect.” He views it as a threat to the economically rational view of human decision-making since people can clearly be manipulated into making (or not making) important decisions based on how a situation is presented.

The United States has an opt-in system with about 45% people registered as organ donors. While 45% is a better figure than some of the other opt-in countries, it is still not enough to prevent the number of deaths that occur due to a lack of organ donations. The logical next step is for Congress to pass a bill changing America’s opt-in system to an opt-out system. Unfortunately, passing a bill through Congress requires even more effort than checking a box.

Escaping Our Own Minds: The Cure May (Really) Shock You

            Affecting hundreds of millions of people worldwide, depression remains the most widespread mental illness across the globe. Chances are, you know at least one person affected by depression’s debilitating effects – as 1 in 10 Americans are affected by its symptoms, and that number is even growing. Personally, depression really fascinates me because it affects such a widespread number of people, yet so little is known about how to effectively treat it. Maybe because it is caused by such a complex combination of social, biological, and psychological factors, treatments aren't always effective in helping eliminate symptoms. But recently, new experiments are providing insight into a specific type of treatment that, surprisingly, has shown such positive effects – electric shock therapy. As harsh and intimidating as this sounds, it’s actually showing to be effective in even the most severe of patients. Now we want to know, most importantly – why.

            The man behind electric shock treatment is Dr. Ian Reid, a psychiatrist at the Royal Cornhill Hospital located in Aberdeen, Scotland. He’s been treating severely depressed patients for 25 years, and witnesses that the disease is an extremely horrible illness. Typically patients who come to Reid’s hospital having major depression first receive a combined treatment of psychotherapy and antidepressants. Usually, less than half respond to their first medication, and 10-20% respond to no medication at all. In these cases, Reid turns to his third and final option, in which he is an expert – officially called electroconvulsive therapy, or ECT, commonly known as shock therapy.

            Dr. Reid is an expert on ECT, and has received an incredible amount of criticism and hateful comments for his use of it on patients. People are shocked (no pun intended) by its use as a medical practice to treat depression, mostly because of the stigma of cruelty and torture associated with the practice. Although the movies typically depict shock therapy as a gruesome process, the actual therapy is not this way – patients are given anesthesia and muscle relaxants, and most importantly, they see results. It seems a little bizarre and twisted, but the numbers line up: in Scotland out of a population of about 5 million, 400 people receive ECT treatment each year for depression and around 75% of them are relieved of symptoms. For some reason, shock therapy outperforms the traditional psychotherapy and antidepressant treatment, but just why is a mystery. It sounds a bit convoluted that making someone have a seizure and giving them an electric shock will somehow make something as intensely complex as depression better.

            Electroconvulsive therapy was first used in 1938 to treat schizophrenic patients in Italy, where it then spread to uses for other diseases in other countries. Although it was clearly effective, it could be a frightening process as patients blacked out after seizures, sometimes breaking bones too. In the 1960’s, doctors added anesthesia and muscle relaxants to the treatment in order to prevent this from happening, but memory loss was still a prevalent problem. In the 1980’s, the treatment was further developed to now become a series of short compulsive shocks instead.

            Reid has now made it his mission to find out how ECT works on patients. According to previous studies, it was known that depression reduces the size of certain brain regions, including the hippocampus and gray matter (both involved in expression of emotion). So in 2009, he set out with colleagues to use fMRI (functional magnetic resonance imaging) to scan the brains of patients pre-ECT treatment, followed them through the therapy process, then followed up with post-treatment scans. The scans showed that after ECT, the hippocampus was often increased in size, but the gray matter was not.

            Reid and his colleagues also investigated another more significant change: how ECT transforms the brain’s communication with itself. Every region of the brain specializes in specific mental tasks, and each of these regions communicates with the regions around it – like a network of parts working closely in tandem. In some brain disorders like Alzheimer’s and schizophrenia, it has been found that these diseases alter the connectivity of certain networks and inhibit regions from communicating with one another. So, in an attempt to discover if this was the case in depression, Reid teamed up with Dr. Christian Schwarzbauer to test this on ECT treatment.

Reid and Schwarzbauer set out to analyze brain scans in depressive ECT patients for changes in connectivity. Typically when neuroscientists want to measure connectivity in the brain, they select a few large regions to measure blood flow between – Schwarzbauer however divided the brain into 25,000 separate chunks and measured connectivity between all of them, looking for important changes before and after ECT. Talk about dedication. This fine-tuned approach revealed a significant discovery: ECT weakened the same connective network in all 9 patients.

This region, surrounding a single hub located above the left eye, is in a brain region called the left dorsolateral prefrontal cortex. As Reid and Schwarzbauer investigated this area in search of a cause, they found previous research indicating that in case studies of depressed people, this network of the brain was “hyperconnected.” So, they speculate that perhaps in depressed individuals, the hyperconnected network excessively bounces thoughts back and forth around the brain, causing an internal information overload. So as shock therapy weakens the connections in this region, it’s possible that ECT allows depressed people to “get out of their own heads” so to speak.

The hypothesis is now currently being tested on patients, and if Reid and Schwarzbauer are correct, hopefully a big breakthrough will lead to a better understanding of depression as a mental illness. Although the study doesn’t clarify the question of how a jolt of electricity to the brain gets rid of hyperconnections, researchers are hopeful that future research will soon make it clear. Hopefully, in time, this could lead to a better long-term treatment that would give the same effect.

For the 1 in 10 Americans, the hundreds of millions around the world, and for family members and loved ones affected by this debilitating illness – this is incredibly good news. As shocking as it may be, a jolt of electricity to the mind may actually be the key to happiness? Scientists aren’t out of their minds – but it will definitely get you out of yours. 

-Madeline Kleypas

Discover Magazine. "The Brain: An Electric Cure for the Mind." http://discovermagazine.com/2012/nov/04-electric-cure-for-the-mind#.UlQwZhb3C8o

Dude-Dame Dimorphism: Are Men's Brains Just Bigger?

Over the past thirty years, a hot topic emerging in popular neuroscience has been the study and anatomical comparison of the male and female brain. From teachers to researchers, writers and bloggers, everyone's interested in it - what anatomical differences in the male and female brain cause the differences between male and female behavior? The answer lies in the brain. Maybe because it simply prods our interest and fuels curiosity, this topic has fascinated people for years. A particular area of interest between gender and the brain is the structure called the corpus callosum, the white matter bridge connecting the brain's left and right hemispheres.

One proposed male-female discrepancy in neuro anatomy is the size of this component, as an early study in 1982 showed that females, overall, had a larger and more bulbous callosal structure. At the time, this newfound discovery sparked tons of popular interest and speculation over its role in male-female behavioral differences. People began to hypothesize and propose that this meant females had more “interconnected” brains, and were better at things requiring multi-tasking or complex functioning:

“The corpus callosum is 30 percent more highly developed in the female brain… allowing information to flow more easily from one side of the brain to the other, which allows a woman to focus on more than one thing at a time.”

Cool, right? As interesting as this sounds, very recently it’s all been proven to be completely untrue - they didn’t get it quite right. In all actuality, a recent study shows that rather than women having a larger corpus callosum, men may just overall have larger brains. The breakthrough in this study has shown that the corpus callosum is relatively smaller in larger brains, appearing larger in smaller-sized brains. Although the original observation in 1982 may have shown the female’s callosum to be larger, it truly just appeared that way because the brain was a smaller size. So, sorry ladies – the actual anatomical difference in gender, and perhaps the only one, is that males have larger brains overall.

The Study:

Eileen Luders, et al.

Luders confirmed this theory with a clever technique. In order to truly investigate the differences between the male and female corpus callosum, the ideal study was planned to extract measurements of the corpus callosum in male and female brains of the same size. To our knowledge today, no other study has compared callosal size in male and females with equal brain mass – so these results are brand new for further exploration. The lack of info on this topic is probably due to the difficulty in finding males and females with similar brain sizes, as cranial capacity differs greatly between sexes. Fortunately, recent databases encompassing thousands of brain images have been established, allowing a unique opportunity to select from a vast pool of subjects. Using the International Consortium for Brain Mapping (ICBM) database, Luders and colleagues selected 24 male brains and 24 female brains from the database, perfectly matched for size. They also complemented this sample with another subset of 24 extra-large male brains and 24 extra-small female brains to account for wide degree of variation in brain size. Total intracranial volume was calculated using imaging technology, and then a special process called “surface-based mesh-modelling” was used to overlay brain images and measure equidistant spatial points in the corpus callosum, male versus female. What Luders found was interesting and completely controversial to prior popular belief. When comparing the brain images divided by sex and accounting for size, Luders’ data pointed to the opposite - that the corpus callosum was actually always thicker in men than in women. However, this gender difference was clearly driven by brain size, thus the following conclusion was formed: simply put, males have larger brains, leading to comparatively thicker corpus callosum than females.

Altogether, findings suggest that individual differences in brain size account for the apparent sex differences in the corpus callosum. Studies like Luders’ will continue to provide important clues about cerebral differences between men and women, especially if appropriate strategies are used to account for variations in brain size. Nevertheless, it is also possible that future studies will use this line of thought to expand on adolescent brain size between boys and girls, examining brain-imaging technology for gender differences in how they develop.

Given the freshness and excitement of these popular findings, and their possible relevance for understanding sex differences in cognition, emotion, and behavior, the sexual dimorphism of the human corpus callosum has been and will be a continued object of exploration. So, as fueled by our neuro-curiosity, the battle of the sexes (the brain battle, that is...) continues on.

-Madeline Kleypas

Eileen Luders, Arthur W. Toga, & Paul M. Thompson (2013). Why Size Matters: Differences in Brain Volume Account for Apparent Sex Differences in Callosal Anatomy Neuroimage DOI:10.1016/j.neuroimage.2013.09.040

The Internal Battle between Past and Present

Do you care more about your experiences in the present or the memories you will have in the future?

In Thinking, Fast and Slow, Daniel Kahneman, winner of the 2002 Nobel Prize in Economics, explores this question. He clearly distinguishes between the “remembering self” and the “experiencing self.” The former is characterized by all the memories one has accumulated over a lifetime, while the latter deals solely with the present moment. One may expect (or at least hope) that these two selves remain consistent with one another, but Kahneman shows that there are many instances in which they are in conflict.

One famous study by Kahneman, Fredrickson, Schreiber, and Redelmeier had participants put one of their hands in painfully cold water (14°C) while placing their other hand on a keyboard to rate the amount of pain they were experiencing. In the short trial, participants put their hand in the cold water for 60 seconds. In the long trial, participants put their hand in the cold water for 90 seconds. The first 60 seconds of the long trial was the same as the short trial, but the last 30 seconds differed in that the temperature rose by 1°C. Objectively, the 2^nd trial was more painful because it included the same initial 60 seconds of pain with an additional 30 seconds.

The subjects were then asked which trial they wanted to repeat. While the shorter trial was less painful, “80% of the participants who reported that their pain diminished during the final phase of the longer episode opted to repeat it, thereby declaring themselves willing to suffer 30 seconds of needless pain in the anticipated third trial,” (Kahneman 383).

Kahneman explained this result using two hypotheses that he had been trying to prove:

• The peak-end hypothesis essentially stated that people would remember a painful event based on the average of the worst part and the end.
• The duration neglect hypothesis stated that people would ignore the length of the trial when rating total pain.

This elegant study is one of many that show that human beings are often not as rational as they are frequently portrayed. It particularly brings up many questions that will impact the medical field. Should a doctor add time to a painful procedure in order to end at a more pleasant point, thereby improving the patient’s stored memory, even if that means intentionally inflicting more pain?

The duration neglect hypothesis does not only apply to painful memories, but also has serious implications for positive ones. For example, if planning a beach vacation and deciding between 1 week and 2 weeks, you might have a better overall memory of the trip if you plan a fun-filled 1 week vacation that finishes on a high note as opposed to a 2 week long vacation that seems to drag on at the end.

While the practical implications do pose many ethical dilemmas that have not yet been resolved, Kahneman and Tversky clearly show that we may not know ourselves as well as we think we do.

What do you think? Which matters more: the elusive experiencing self or the persistent remembering self?

For further reading: 

The book: Thinking, Fast and Slow by Daniel Kahneman

The original research paper: http://brainimaging.waisman.wisc.edu/~perlman/0903-EmoPaper/KahnemanFredricksonSchreiberRedelmeier_1993_WhenMorePainIsPreferredToLess.pdf