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STANFORD - Researchers have developed ever more sensitive ways of peering into the brain to seek out explanations for brain disease. In most cases these technologies are good news for patients, bringing new ways of understanding health and treatment options. However, standards defining ethical ways of moving forward with the new technology are needed in order to prevent abuse.
Judy Illes, PhD, senior research scholar at the Center for Biomedical Ethics at the Stanford University School of Medicine, will discuss the clinical implications of new imaging technologies Feb. 18 during the "Neuroethics: Neuroscience and its ethical, legal and social implications" panel discussion at the annual meeting for the American Association for the Advancement of Science in Washington, D.C.
Among the areas where brain imaging could start being used is in treating and diagnosing depression. Illes recently surveyed doctors to find out how they think this type of analysis will alter clinical care. These unpublished results could help guide doctors considering the use of such technology in the future.
Brain imaging is also making inroads in diagnosing fetal abnormalities. Women who have an unusual ultrasound can now receive follow-up MRI screening to confirm the finding. The question is whether this expensive screening alters the woman's care and is therefore something that should be covered by insurance.
Radiologists say that in many cases the MRI screening adds valuable information and may alter a woman's medical care for the rest of her pregnancy. "If that's true, it's a major change," Illes said. Woman report that the scan gives them a feeling of reassurance that their pregnancy is normal. Studying when follow-up MRIs are most beneficial will help narrow down which women should be offered the scans.
Illes will also discuss her ongoing work examining how research studies handle those healthy subjects whose brains show sign of abnormalities, called incidental findings. These features could be harmless such as a benign cyst but could also be life-threatening malignant tumors or abnormalities in the blood vessels.
Each type of brain-imaging study poses its own quandaries. For example, should all brain studies have MDs on the research team? The volume and cost of having a physician read each and every scan would be staggering. "When a subject goes into the study, does he or she know it might not be a medical professional who looks at the brain images?" Illes said.
Another issue that research subjects may not realize is that if a benign tumor is found during a scan and listed on their medical records, it could alter health insurance rates. Illes recently co-chaired a meeting at the National Institutes of Health intended to establish standards for how research groups handle these types of incidental findings.
An important way in which imaging is now reaching patients is through direct-to-consumer whole-body scans, which are advertised as a way for patients to feel confident of their health. But these advertisements paint a rosy picture of what the scans can detect without hinting at the technology's limitations and risks.
" People are capable of being very savvy consumers of medical technology, but the information has to be available to them to allow them to be savvy," Illes said. She has advocated developing guidelines that require ads to accurately depict the technology.
Source: Stanford University Medical Center. March 2005.
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