Australasian Science: Australia's authority on science since 1938

No Joy for Addicts

By Michael Cook

Neurosurgeons in China are treating drug addicts by destroying a part of the brain responsible for feeling pleasure.

Chinese neurosurgeons are treating heroin addicts by destroying a region of the brain which feels pleasure. Time magazine reports that this “risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy.”

Even in China, zapping bits of the brain is controversial. The Ministry of Health banned it in 2004 – but left a loophole for researchers. Apparently one surgeon drove a truck through this loophole and by 2007 he had done 1000 of these operations to treat severe depression, epilepsy and schizophrenia.

And it is still happening. Last October, doctors at Tangdu Hospital at the Fourth Military Medical University in the city of Xi’an reported the results of neurosurgery on drug addicts – ablation of the nucleus accumbens – in the major international journal World Neurosurgery.

They found that it was effective in getting addicts off drugs, but only in about 58% of them – compared with a 30–40% non-relapse rate for conventional treatments. There are also side-effects, although the doctors say that these are relatively minor. For such a drastic treatment, then, the odds of success are quite low.

Time cited a number of ethical concerns. First, animal studies suggest that the ablation of the nucleus accumbens did not stop the craving for opioids.

Second, there may be a lack of informed consent. Drug addiction is a capital crime in China, and patients may be clutching at straws to stay out of the courts.

Third, publishing the results of unethical research may itself be unethical.

Fourth, the risks seen to outweigh the benefits. While the operation might be acceptable for long-term addicts, a recent article mentioned that some patients were only 19 and had been addicts for only 3 years. “Addiction research strongly suggests that such patients are likely to recover even without treatment, making the risk–benefit ratio clearly unacceptable.”

From a consequentialist standpoint, the numbers do not add up for ablation of the nucleus accumbens. But imagine for a moment that the Chinese scientists were ethically irreproachable. If that were the case, my guess is that Western neurosurgeons would be quite interested.

In fact, the Portuguese neurosurgeon Egas Moniz won the 1949 Nobel Prize for Medicine for developing the frontal lobotomy portrayed in One Flew Over the Cuckoo’s Nest. This is now regarded with horror as disabling and brutal, but in the 1940s and 1950s it was mainstream medicine. American doctors did about 40,000 of them as “cures” for schizophrenia, depression and other mysterious disorders.

Is there anything bioethically amiss with mutilation, or deliberately inflicting a disability? At its most brutal there is the punishment of amputation – as in hands lopped off for theft under Sharia law. Less obviously disabling is chemical castration as a punishment for incorrigible sex offenders. We recoil from both of these because they make us just a bit less human.

However, a thief who has been maimed is still psychologically normal. Chemical castration affects a paedophile’s psyche by dulling his libido, but the procedure is reversible.

But things are different for the addict whose capacity for pleasure has been destroyed. He has been permanently mutilated both psychologically and physically. He would be unable to appreciate a sunset, Mozart (or Lady Gaga), fine dining, the thrill of winning, the satisfaction of a job well done, the joy of hugging his children, his capacity for sexual intimacy. He would be just a husk of humanity, unrecognisable to his family and friends.

“To lesion this region that is thought to be involved in all types of motivation and pleasure risks crippling a human being,” says Dr Charles O’Brien, head of the Center for Studies of Addiction at the University of Pennsylvania. David Linden, of Johns Hopkins University, calls the surgery “horribly misguided”.

Ablation of the nucleus accumbens is medicine only in the sense that capital punishment is a therapy for boredom. It removes the pain by removing the prisoner.

Doctors are supposed to restore addicts’ capacity to enjoy flourishing lives as human beings. This means helping them to regain self-mastery and set wholesome, realistic goals for themselves. The Chinese solution risks turning the addict from a man into a mouse.

In The Odyssey, the enchantress Circe turned the companions of Odysseus into grunting swine. For Homer 2700 years ago, it seemed the most wretched of fates. It still is.

Michael Cook is editor of the international bioethics newsletter BioEdge.