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27 Nov

What if a medical treatment could prevent criminal behavior?

Handcuffs-500x313When I was a pre-adolescent in the mid-1960s, there was a popular line of pulp novels featuring Doc Savage, a bronze-haired, impossibly muscular scientist-turned-adventurer who had all sorts of amazing futuristic gadgets--from night-vision goggles to a B-2 style flying wing aircraft--that since have become actual realities. But one Doc Savage invention that hasn't yet come to pass is perhaps the most fascinating. Doc was unique among fictional heroes in that he not only defeated criminals, but actually turned them into law-abiding citizens. Of course, Doc's method was a bit extreme. Prisoners would be conveyed to his special clinic in upstate New York, where he would perform corrective brain surgery on them. Once they were turned into blank slates, they could start anew, and hopefully stay on the straight and narrow.

The Doc's solution to crime was an extreme one, but to those who actually saw the evil that men do, it had a certain undeniable appeal, In the book In Cold Blood, Truman Capote's classic study of a real-life grisly, senseless multiple murder in smalltown Kansas, a distraught clergyman actually wishes that killers Dick Hickock and Perry Smith had been subjected to such a procedure:

Doc Savage operated on their brains. He removed the part that holds wicked thoughts. And when they recovered they were all decent citizens. They couldn't commit crimes, because that part of their brain was out. Now, it strikes me that surgery of this nature might really be the answer..."

I bring this up because a just-published New England Journal of Medicine article raises anew the possibility of using medical treatment to prevent criminals from committing new crimes. The article describes how Swedish researchers studied more than 25,000 patients who've been diagnosed with attention deficit hyperactivity disorder (ADHD), an ailment that contributes to impulsive behavior. While only a fraction of the millions of people with ADHD are lawbreakers, an inordinately high number of convicts in prisons--as many as 30 to 70 percent--have the disorder. But the Swedes found that found that the ADHD patients in their country committed crimes at a startlingly lower rate--32 percent for men, 41 percent for women--during periods when they were receiving medication for their disorder. Lead researcher Paul Lichtenstein of Stockholm's Karolinska Institutet said that the pattern held true, no matter what sort of crime. As NYC psychiatry professor Howard Abikoff explained to WebMD

‘”There is some evidence to suggest that while on medication, a person with ADHD is less likely to get involved in criminal behavior,” he says. “They may be less impulsive, or perhaps they are better organized in their life.” Some may have poor judgment when they are not taking medicine to control their symptoms.

In some ways, this finding shouldn't come as a shock, since over the years, neuroscientists have amassed considerable evidence of links between how the brain works and an antisocial activity. A 2000 study by University of Wisconsin-Madison psychologist Richard Davidson, for example, found that imaging of the brains of violent people often showed a breakdown in areas of the prefrontal cortex that regulate the reaction to negative emotions. A 2006 study, published in Proceedings of the National Academy of Sciences, suggests that such inability to control violent urges may be linked to variation in the MAOA gene, though it seems to take an additionally environmental trigger, such as brutal mistreatment by a parent, to bring out that disturbing tendency.

If violent behavior is at least partly neurological in origin, that raises the question of whether some sort of medical treatment might be able to mitigate or even eliminate that contributing factor, and thus prevent the person from committing future crimes. We already know, for example, that gene therapy may offer a cure for certain neurological diseases such as multiple sclerosis, as this February 2012 ScienceDaily acticle details. What if we could find a method of altering the MAOA gene, say, by infecting a patient with a genetically altered virus that would tinker with his or her neurons? 

If we did have such a therapy, of course, there would be another tricky question: Would it be ethical, or even legal, to compel people with a violent history, or even a predisposition to violence, to have the treatment? Court decisions have found that prisoners have at least a partial right to refuse medical treatment, if they are competent to make such a decision. And even in case where a prisoner is psychotic and out of touch with reality, as this 2011 Arizona Republic article  details, prison psychiatrists already must tiptoe through a legal and ethical minefield when it comes to the question of compelling them to take psychiatric medication. On the other hand, crime victims--or potential victims--have rights as well, don't they? But if we decide that the benefit of tinkering with convicted people's brains is acceptable, who gets to make the decision about making what might be permanent alterations in a criminal's brain? And what should the criteria be?

I'm interested in your thoughts on this, so please express your opinion below.

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