Proven or unproven? Panel report on ethics in the translation of neuroscience.

247 Within the field of neuroscience, advances in the basic scientific understanding of neurological disorders has led to some translation into new therapeutic and diagnostic applications. Given the intricacies of the brain, such translations present important medical and ethical challenges. And even if the products of research are successfully translated into new therapeutic or diagnostic applications, the pluralistic nature of contemporary societies means that not everyone will agree on what counts as an “advance”. Perhaps even more fundamental is the difficulty of establishing the criteria by which we first determine how and when promising advances in basic science are tested in clinical research. For example, what are sound criteria for funding and initiating a clinical trial? How should the knowledge-driven interests of science be balanced with the competing practical interests of a patient group?What happens if refusal to initiate clinical trials for an intervention drives medical tourism? Should the justification for initiating clinical trials take into account requests from patients and other social pressures? Such questions have come to the forefront for the Canadian medical and research community in recent months due to the controversy surrounding an experimental intervention for multiple sclerosis based on the hypothesis of chronic cerebrospinal venous insufficiency (CCSVI) (see: http://www.cihrirsc.gc.ca/e/43951.html). In an attempt to better understand the medical and ethical challenges posed by the translation of neuroscience in the Canadian context, we asked an interdisciplinary panel to provide perspectives on the translation of research to patient care. The panel discussion was open to the public, and was held as a preconference event launching an international neuroethics conference. The subsequent conference was designed to elicit expert reflections on the ethical challenges of translations in neuroscience.1 The pre-conference panel discussion entitled “Proven and Unproven Therapies: Issues in the Translation of Neuroscience Research to Patient Care”2 involved four Canadian experts (Shannon MacDonald, patient advocate; Dr. Eugene Bereza, physician and clinical ethicist; Dr. Jonathan Kimmelman, research ethicist; and Dr. Richard Riopelle, neurologist) representing different research, clinical, and health policy Proven or Unproven? Panel Report on Ethics in the Translation of Neuroscience