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Pay-per-reading society: Asda says Harry Potter's Bloombury publisher is "profiteering"

Asda says Potter publisher "profiteering"

Tue Jul 17, 2007 12:02PM BST

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By Mike Collett-White

LONDON (Reuters) - The publisher of the Harry Potter books called in the lawyers after a supermarket chain accused it of "blatant profiteering" for charging 17.99 pounds for the final novel in the series.

The dispute between Bloomsbury and Asda, the British unit of Wal-Mart Stores, erupted on Tuesday, just four days before the launch of "Harry Potter and the Deathly Hallows", widely expected to become the fastest selling book of all time.

Bloomsbury said it cancelled a delivery of 500,000 copies to Asda stores across the country because of unpaid bills.

But Asda believes the real reason is a statement it issued on Sunday in which it criticised Bloomsbury's pricing policy.

"Today, Asda pointed the finger directly at Bloomsbury for attempting to hold children to ransom by raising the recommended retail price on the final Harry Potter instalment," it said, adding that the pricing was "blatant profiteering".

The retail price of 17.99 for "Deathly Hallows" compares with 11.99 pounds for "Harry Potter and the Philosopher's Stone", the first book in the series published 10 years ago.

That book was 223 pages long, compared with 608 pages for the seventh and last instalment.

A spokeswoman for Asda confirmed that the company had received a legal letter from Bloomsbury on Tuesday, and that its own legal team was working out what to do in response. Continued...

"It seems Bloomsbury doesn't like us suggesting the publishers might be profiteering from the sale of the last book in the series," she said.

Asda hopes the issue can be resolved in time for a delivery of the books to its stores ahead of a deadline in the first minute of Saturday morning, when stores around the country will be allowed to begin selling the book.

Bloomsbury said the row started over "invoicing arrears", but escalated after the release of the Asda statement.

"It did start with the invoicing arrears, but you can't escape from the fact that this press release is extremely provocative, and I think potentially libellous," Bloomsbury marketing director Minna Fry said.

"Asda definitely owes us money and this has been going back for years," she told BCC Radio's Today programme.

"When you don't pay your electricity bill you get cut off, they don't just say, 'Oh, we'll wait and see if you perhaps pay up.' They will remain cut off."

She also defended the increase in Potter book prices.

"That was 10 years ago and that was around 200 pages," said Fry, referring to the "Philosopher's Stone".

"This is 608 pages long ... 17.99 is in line with other hardback novels of this length." Continued...

Asda has taken online pre-orders for "Deathly Hallows" for 8.87 pounds, and will reveal its in-store price on Friday.

Asda, rival supermarket chains and online retailers have launched an aggressive price war over the final Potter, likely to sell tens of millions of copies worldwide. Small, independent booksellers have been squeezed out of the market as a result.

Emotions not necessary to make moral judgements. Nature, March 21, 2007

Letter

Nature advance online publication 21 March 2007 | doi:10.1038/nature05631; Received 3 November 2006; Accepted 17 February 2007; Published online 21 March 2007

Damage to the prefrontal cortex increases utilitarian moral judgements

Michael Koenigs^1,5,6, Liane Young^2,6, Ralph Adolphs^1,3, Daniel Tranel¹, Fiery Cushman², Marc Hauser² and Antonio Damasio^1,4

1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
2. Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA
3. Division of Humanities and Social Sciences and Division of Biology, California Institute of Technology, Pasadena, California 91125, USA
4. Brain and Creativity Institute and Dornsife Center for Cognitive Neuroimaging, University of Southern California, Los Angeles, California 90089, USA
5. Present address: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1440, USA.
6. These authors contributed equally to this work.

Correspondence to: Ralph Adolphs^1,3 Correspondence and requests for materials should be addressed to R.A. (Email: radolphs@hss.caltech.edu).

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Abstract

The psychological and neurobiological processes underlying moral judgement have been the focus of many recent empirical studies^{1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11}. Of central interest is whether emotions play a causal role in moral judgement, and, in parallel, how emotion-related areas of the brain contribute to moral judgement. Here we show that six patients with focal bilateral damage to the ventromedial prefrontal cortex (VMPC), a brain region necessary for the normal generation of emotions and, in particular, social emotions^{12, 13, 14}, produce an abnormally 'utilitarian' pattern of judgements on moral dilemmas that pit compelling considerations of aggregate welfare against highly emotionally aversive behaviours (for example, having to sacrifice one person's life to save a number of other lives)^{7, 8}. In contrast, the VMPC patients' judgements were normal in other classes of moral dilemmas. These findings indicate that, for a selective set of moral dilemmas, the VMPC is critical for normal judgements of right and wrong. The findings support a necessary role for emotion in the generation of those judgements.

The basis of our moral judgements has been a long-standing focus of philosophical inquiry and, more recently, active empirical investigation. In a departure from traditional rationalist approaches to moral cognition that emphasize the role of conscious reasoning from explicit principles¹⁵, modern accounts have proposed that emotional processes, conscious or unconscious, may also play an important role^{16, 17}. Emotion-based accounts draw support from multiple lines of empirical work: studies of clinical populations reveal an association between impaired emotional processing and disturbances in moral behaviour^{1, 2, 3, 4}; neuroimaging studies consistently show that tasks involving moral judgement activate brain areas known to process emotions^{5, 6, 7, 8, 9}; and behavioural studies demonstrate that manipulation of affective state can alter moral judgements^{10, 11}. However, neuroimaging studies do not settle whether putatively 'emotional' activations are a cause or consequence of moral judgement; behavioural studies in healthy individuals do not address the neural basis of moral judgement; and no clinical studies have specifically examined the moral judgements (as opposed to moral reasoning or moral behaviour) of patients with focal brain lesions. In brief, none of the existing studies establishes that brain areas integral to emotional processes are necessary for the generation of normal moral judgements. As a result, there remains a critical gap in the evidence relating moral judgement, emotion and the brain.

Investigating moral judgements in individuals with focal damage to the ventromedial prefrontal cortex (VMPC) provides a key test. The VMPC projects to basal forebrain and brainstem regions that execute bodily components of emotional responses¹⁸, and neurons within the VMPC encode the emotional value of sensory stimuli¹⁹. Patients with VMPC lesions exhibit generally diminished emotional responsivity and markedly reduced social emotions (for example, compassion, shame and guilt) that are closely associated with moral values^{1, 2, 12, 13, 14, 16}, and also exhibit poorly regulated anger and frustration tolerance in certain circumstances^{20, 21}. Despite these patent defects both in emotional response and emotion regulation, the capacities for general intelligence, logical reasoning, and declarative knowledge of social and moral norms are preserved^{20, 21, 22, 23}. We selected a sample of six patients with adult-onset, focal bilateral VMPC lesions (Fig. 1) as well as both neurologically normal (NC) and brain-damaged comparison (BDC) subjects. Importantly, each of the VMPC patients had striking defects in social emotion but generally intact intellect and normal baseline mood (Tables 1 and 2, see also Supplementary Table 1). In particular, all six VMPC patients had impaired autonomic activity in response to emotionally charged pictures (Table 2), as well as severely diminished empathy, embarrassment and guilt (Table 2). All comparison subjects (NC and BDC) had intact emotional processing.

Figure 1: Lesion overlap of VMPC patients.

Lesions of the six VMPC patients displayed in mesial views and coronal slices. The colour bar indicates the number of overlapping lesions at each voxel.

High resolution image and legend (364K)

Table 1: VMPC patient neuropsychological data

Full table

Table 2: VMPC patient social emotion data

Full table

Subjects evaluated moral dilemmas designed to pit two competing considerations against one another. A paradigmatic dilemma of this type presents subjects with the choice of whether or not to sacrifice one person's life to save the lives of others. One consideration is a utilitarian calculation of how to maximize aggregate welfare, whereas the other is a strong emotional aversion to the proposed action. One model holds that endorsement of the proposed action (the utilitarian response) requires the subject to overcome an emotional response against inflicting direct harm to another person (a 'personal' harm^{7, 8}). If emotional responses mediated by VMPC are indeed a critical influence on moral judgement, individuals with VMPC lesions should exhibit an abnormally high rate of utilitarian judgements on the emotionally salient, or 'personal', moral scenarios (for example, pushing one person off a bridge to stop a runaway boxcar from hitting five people), but a normal pattern of judgements on the less emotional, or 'impersonal', moral scenarios (for example, turning a runaway boxcar away from five people but towards one person). If, alternatively, emotion does not play a causal role in the generation of moral judgements but instead follows from the judgements^{24, 25}, then individuals with emotion defects due to VMPC lesions should show a normal pattern of judgements on all scenarios.

To test for between-group differences in the probability of utilitarian responses given for each scenario type (non-moral, impersonal moral, personal moral), we used a logistic regression fitted with the generalized estimating equations method (Fig. 2). There were no significant differences between groups on the non-moral or impersonal moral scenarios (all P values >0.29, corrected for multiple comparisons). In contrast, for personal moral scenarios, the VMPC group was more likely to endorse the proposed action than either the NC group (odds ratio = 2.81; P = 0.04, corrected) or BDC group (odds ratio = 3.30; P = 0.006, corrected). There was no difference between the NC and BDC groups (odds ratio = 0.85; P = 0.68, uncorrected). These data indicate that the VMPC group's responses differed only for personal moral scenarios, suggesting that VMPC-mediated processes affect only those moral judgements involving emotionally salient actions.

Figure 2: Moral judgements for each scenario type.

Proportions of 'yes' judgements are shown for each subject group. Error bars indicate 95% confidence intervals. We used three classes of stimuli: non-moral scenarios (n = 18), impersonal moral scenarios (n = 11), and personal moral scenarios (n = 21). On personal moral scenarios, the frequency of endorsing 'yes' responses was significantly greater in the VMPC group than in either comparison group (P values <>High resolution image and legend (59K)

In a more fine-grained analysis, we examined response patterns within the personal moral scenarios. For seven out of the 21 personal moral scenarios, both comparison groups were at 100% agreement in their judgements. An additional eighth scenario elicited 100% agreement from the BDC group, and near-perfect agreement from the NC group (with only one participant deviating from the shared response). These eight scenarios were therefore classified as 'low-conflict' (for example, abandoning one's baby to avoid the burden of caring for it). The remaining 13 scenarios (none of which elicited 100% agreement from either comparison group) were classified as 'high-conflict' (for example, smothering one's baby to save a number of people). Reaction-time data support this distinction: response latencies in the NC group on high-conflict scenarios were significantly longer than on low-conflict scenarios (t-test with 19 degrees of freedom, t(19) = -3.63; P = 0.002).

Like the patients in the comparison groups, the VMPC patients uniformly rejected the proposed action in every one of the low-conflict scenarios (Fig. 3). In contrast, significant differences emerged for the high-conflict scenarios: the VMPC group was more likely to endorse the proposed action than either the NC (odds ratio = 4.70; P = 0.05, corrected) or BDC group (odds ratio = 5.38; P = 0.02, corrected), with no difference between the NC and BDC participants (odds ratio = 0.87; P = 0.77, uncorrected). Every high-conflict personal scenario elicited the same pattern: a greater proportion of the VMPC group endorsed the action than either comparison group.

Figure 3: Moral judgements on individual personal moral scenarios.

Proportions of 'yes' judgements given by each subject group for each of the 21 personal moral scenarios. Individual scenarios (numbered 1–21 on the x axis) are ordered by increasing proportion of 'yes' responses given by the normal comparison group. Responses did not differ between subject groups for the low-conflict scenarios (left of the vertical line). The VMPC group made a greater proportion of 'yes' judgements than either comparison group for every one of the high-conflict scenarios (right of the vertical line).

High resolution image and legend (59K)

To recapitulate, VMPC patients' judgements differed from comparison subjects' only for the high-conflict personal moral dilemmas, all of which featured competing considerations of aggregate welfare on the one hand, and, on the other hand, harm to others that would normally evoke a strong social emotion. Low-conflict personal moral scenarios lacked this degree of competition. This difference probably accounts for the greater consensus and faster reaction times on low-conflict personal dilemmas in the comparison groups, and it can also account for the VMPC patients' pattern of judgements. Evidence suggests that knowledge of explicit social and moral norms is intact in individuals with VMPC damage^{21, 22}. In the absence of an emotional reaction to harm of others in personal moral dilemmas, VMPC patients may rely on explicit norms endorsing the maximization of aggregate welfare and prohibiting the harming of others. This strategy would lead VMPC patients to a normal pattern of judgements on low-conflict personal dilemmas but an abnormal pattern of judgements on high-conflict personal dilemmas, precisely as was observed. The specificity of this result argues against a general deficit in the capacity for moral judgement following VMPC damage. Rather, VMPC seems to be critical only for moral dilemmas in which social emotions play a pivotal role in resolving moral conflict^{4, 8, 16, 17}.

It is important to note that the effects of VMPC damage on emotion processing depend on context. In this study, the VMPC patients' abnormally high rate of utilitarian judgements is attributed to diminished social emotion, whereas in a recent study of the Ultimatum Game, theVMPC patients' abnormally high rate of rejection of unfair monetary offers was attributed to poorly controlled frustration, manifested as exaggerated anger²⁰. These seemingly contradictory findings highlight two distinct aspects of emotion impairment that are due to VMPC damage. In most circumstances, VMPC patients exhibit generally blunted affect and a specific defect of social emotions, but in response to direct personal frustration or provocation, VMPC patients may exhibit short-temper, irritability, and anger. In the moral judgement task we report here, participants respond to hypothetical actions and outcomes that elicit social emotions related to concern for others. In the Ultimatum Game, in contrast, participants respond to unfair take-it-or-leave-it offers that trigger frustration. In brief, the tasks in the two studies are different in that the Ultimatum Game involves self-interest in a real behavioural setting, whereas the task in the present study focuses on the interest of others described in a hypothetical scenario.

To conclude, the present findings are consistent with a model in which a combination of intuitive/affective and conscious/rational mechanisms operate to produce moral judgements^{8, 22, 24, 25, 26, 27}. Though the precise characterization of these potential systems awaits further work, the current results suggest that the VMPC is a critical neural substrate for the intuitive/affective but not for the conscious/rational system.

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Methods

Subjects

Six patients with bilateral, adult-onset damage to the VMPC and twelve brain-damaged comparison patients who had lesions that excluded structures thought to be important for emotions (VMPC, amygdala, insula, right somatosensory cortices) were recruited from the Patient Registry of the Division of Cognitive Neuroscience at the University of Iowa. Twelve healthy comparison subjects with no brain damage were recruited from the Iowa community. Groups were age-, gender- and ethnicity-matched. All participants gave written informed consent.

Neuroanatomical analysis

The neuroanatomical analysis of VMPC patients (Fig. 1) was based on magnetic resonance data for two subjects (those with lesions due to the surgical resection of orbital meningiomas) and on computerized tomography data for the other four subjects (with lesions due to rupture of an anterior communicating artery aneurysm). All neuroimaging data were obtained in the chronic epoch. Each patient's lesion was reconstructed in three dimensions using Brainvox²⁸. Using the MAP-3 technique, the lesion contour for each patient was manually warped into a normal template brain. The overlap of lesions in this volume, calculated by the sum of n lesions overlapping on any single voxel, is colour-coded in Fig. 1.

Stimuli and task

Participants made judgements on a series of 50 hypothetical scenarios, which were adapted from a previously published set⁸. See the Supplementary Information for the full text of the actual scenarios used. Each scenario was presented as text through a series of three screens. The first two described the scenario and the third posed a question about a hypothetical action related to the scenario ("Would you...in order to...?"). Participants read and responded at their own pace, pressing an 'up' arrow key to advance from one screen to the next, and a 'yes' or 'no' button to indicate an answer to the question. 'Yes' responses always indicated commission of the proposed action. There was no time limit for reading the scenario description (screens 1 and 2). Participants had a maximum of 25 s to read the final question screen and respond.

We used three classes of stimuli: non-moral scenarios (n = 18), and two classes of moral scenarios subdivided according to the emotional reaction elicited by the proposed action: 'personal' (n = 21) or 'impersonal' (n = 11), as described previously^{7, 8}. To validate this subdivision, an independent group of ten neurologically normal subjects rated the emotional salience of the actions proposed in the moral scenarios. The actions described in personal scenarios were rated as significantly more emotionally salient than the actions described in impersonal scenarios (means were 5.9 and 3.0 on a scale from 1 to 7, respectively; t(31) = -8.90, P <>

We further subdivided the personal moral scenarios into 'low-conflict' and 'high-conflict' on the basis of the reaction times and consensus produced on them by normal subjects. Reaction times on high-conflict scenarios were significantly longer than on low-conflict scenarios (t(19) = -3.63, P = 0.002). Importantly, low-conflict and high-conflict scenarios did not differ in their rated emotional salience (t(19) = -0.85, P = 0.41).

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References

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11. Valdesolo, P. & DeSteno, D. Manipulations of emotional context shape moral judgment. Psychol. Sci. 17, 476–477 (2006)
12. Damasio, A. R., Tranel, D. & Damasio, H. Individuals with sociopathic behavior caused by frontal damage fail to respond autonomically to social stimuli. Behav. Brain Res. 41, 81–94 (1990) | Article | PubMed | ISI | ChemPort |
13. Damasio, A. R. Looking for Spinoza: Joy, Sorrow, and the Feeling Brain (Harcourt, New York, 2003)
14. Beer, J. S., Heerey, E. H., Keltner, D., Scabini, D. & Knight, R. T. The regulatory function of self-conscious emotion: Insights from patients with orbitofrontal damage. J. Pers. Soc. Psychol. 85, 594–604 (2003) | Article | PubMed | ISI |
15. Kohlberg, L. Essays on Moral Development Vol. 1 The Philosophy of Moral Development (Harper Row, New York, 1981)
16. Damasio, A. R. Descartes' Error: Emotion, Reason, and the Human Brain (Penguin, New York, 1994)
17. Haidt, J. The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychol. Rev. 108, 814–834 (2001) | Article | PubMed | ISI | ChemPort |
18. Ongur, D. & Price, J. L. The organization of networks within the orbital and medial prefrontal cortex of rats, monkeys and humans. Cereb. Cortex 10, 206–219 (2000) | Article | PubMed | ISI | ChemPort |
19. Rolls, E. The orbitofrontal cortex and reward. Cereb. Cortex 3, 284–294 (2000)
20. Koenigs, M. & Tranel, D. Irrational economic decision-making after ventromedial prefrontal damage: evidence from the ultimatum game. J. Neurosci. 27, 951–956 (2007)
21. Anderson, S. W., Barrash, J., Bechara, A. & Tranel, D. Impairments of emotion and real-world complex behavior following childhood- or adult-onset damage to ventromedial prefrontal cortex. J. Int. Neuropsychol. Soc. 12, 224–235 (2006)
22. Saver, J. L. & Damasio, A. R. Preserved access and processing of social knowledge in a patient with acquired sociopathy due to ventromedial frontal damage. Neuropsychologia 29, 1241–1249 (1991) | Article | PubMed | ISI | ChemPort |
23. Burgess, P. W. et al. The case for the development and use of "ecologically valid" measures of executive functions in experimental and clinical neuropsychology. J. Int. Neuropsychol. Soc. 12, 194–209 (2006)
24. Hauser, M. D. Moral Minds: How Nature Designed our Universal Sense of Right and Wrong (Ecco/Harper Collins, New York, 2006)
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29. Barrash, J. & Anderson, S. W. The Iowa Rating Scales of Personality Change (Department of Neurology, Univ. Iowa, Iowa, 1993)

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Supplementary Information

Supplementary information accompanies this paper.

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Acknowledgements

We thank H. Damasio for making available neuroanatomical analyses of lesion patients and for preparing Fig. 1. We thank all participants for their participation in the experiments and R. Saxe for comments on the manuscript. This work was supported by grants from the National Institutes of Health, the National Science Foundation, the Gordon and Betty Moore Foundation, and the Guggenheim Foundation.

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Impaired emotional processing affects moral judgements

• 13:07 22 March 2007
• NewScientist.com news service
• Roxanne Khamsi

Mr Spock, the fictional Vulcan famously logical and lacking in emotion, sacrificed himself for his comrades in the movie Star Trek II: The Wrath of Khan with the following words to Captain Kirk: "The needs of the many outweigh the needs of the few, or the one…"

Now, revealing new research shows that people with damage to a key emotion-processing region of the brain also make moral decisions based on the greater good of the community, unclouded by concerns over harming an individual.

It is the first study to demonstrate how emotion impacts moral judgement and sheds light on why people often act out of respect for an individual rather than choosing to act in a more logical, utilitarian way. The findings could cause a rethink in how society determines a "moral good", and challenge the 18^th-century philosophies of Immanuel Kant and David Hume.

Antonio Damasio at the University of Southern California in Los Angeles, US, and colleagues recruited 30 people for their experiment. Six of the subjects had suffered damage to a region in the front of the brain known as the ventromedial prefrontal cortex (VMPC), which regulates emotions. The participants had this brain injury as a result of an aneurism or tumour growth in the VMPC region.

Twelve participants in the study had damage to other parts of the brain but not the VMPC. And the remaining 12 subjects had no brain injury whatsoever.

"Utilitarian" action

The researchers presented participants with various scenarios (scroll to the bottom for several examples) and asked them to make decisions based on the information provided. Some of the situations involved moral decision-making. For example, subjects had to say whether they would throw a person in front of a train if doing so would stop the train from barrelling into five workmen, killing all five.

In such a situation, most people would find it morally unacceptable to push someone to his or her death – even if doing so would save the lives of others. And this was the reaction of the healthy participants or those that had injury to brain regions excluding the VMPC. But people with damage to the VMPC showed a willingness to take this type of "utilitarian" action.

"You have one group that is ready to endorse what we would regard as an overly utilitarian judgment and the other far less" willing to do so, explains Damasio. He notes that the patients with VMPC damage generally made the same decisions as their control counterparts when it came to non-moral scenarios.

Subtle scenarios

Notably, people with VMPC damage were just as likely as their counterparts to endorse "impersonal" moral decisions that involved indirectly putting strangers at risk for the greater good. These impersonal moral scenarios involved, for example, encouraging the use of a vaccine that would protect the public but cause an adverse reaction in a few individuals.

These results suggest that emotions play a crucial role in moral decisions involving personal contact – but not in moral judgments involving distant, indirect impacts on other people. "What's beautiful to me is how subtly different the situations are," says Marc Hauser at Harvard University in Cambridge, Massachusetts, US, one of the researchers involved.

The finding that some moral judgments involve emotions while others do not supports the supposedly diametrically opposed thinking of philosophers Immanuel Kant and David Hume.

"It means both Kant and Hume are right. Philosophers will have a fit because they like to choose sides," says Frans de Waal at Emory University in Atlanta, Georgia, US. Hume believed that people could be motivated to make proper moral decisions based on their sympathy for others. Kant, meanwhile, warned that moral judgments might be corrupted by emotions.

Personal dignity

Philip Kitcher, who teaches philosophy at Columbia University in New York, US, notes that the study of brain damaged individuals presents a unique challenge to Kant's philosophy. While Kant cautioned against the corruptive influence of emotions, he also argued that individuals have personal dignity, which must be respected.

Yet in the new study, subjects who had impaired emotion processing due to VPMC damage showed the least concern for individual dignity in the personal moral dilemmas that involved directly harming another person to save others. This provides strong biological evidence that emotions enable us to respect individual dignity, says Kitcher.

"Emotions are an anchor for our moral systems. If you remove that anchor you can end up anywhere," says de Waal.

Examples of scenarios used in the experiment:

Non-Moral Scenario: Investment Offer

You are at home one day when the mail arrives. You receive a letter from a reputable corporation that provides financial services. They have invited you to invest in a mutual fund, beginning with an initial investment of one thousand dollars.

As it happens, you are familiar with this particular mutual fund. It has not performed very well over the past few years, and, based on what you know, there is no reason to think that it will perform any better in the future.

Would you invest a thousand dollars in this mutual fund in order to make money?

Impersonal Moral Scenario: Standard Trolley

You are at the wheel of a runaway trolley quickly approaching a fork in the tracks. On the tracks extending to the left is a group of five railway workmen. On the tracks extending to the right is a single railway workman.

If you do nothing the trolley will proceed to the left, causing the deaths of the five workmen. The only way to avoid the deaths of these workmen is to hit a switch on your dashboard that will cause the trolley to proceed to the right, causing the death of the single workman.

Would you hit the switch in order to avoid the deaths of the five workmen?

Personal Moral Scenario: Submarine

You are the captain of a military submarine travelling underneath a large iceberg. An onboard explosion has caused you to lose most of your oxygen supply and has injured one of your crew who is quickly losing blood. The injured crew member is going to die from his wounds no matter what happens.

The remaining oxygen is not sufficient for the entire crew to make it to the surface. The only way to save the other crew members is to shoot dead the injured crew member so that there will be just enough oxygen for the rest of the crew to survive.

Would you kill the fatally injured crew member in order to save the lives of the remaining crew members?

Personal Moral Scenario: Infection

Someone you know has AIDS and plans to infect others, some of whom will die. Your only options are to let it happen or to kill the person.

Do you pull the trigger?

Journal reference: Nature (DOI: 10.1038/nature05631)

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Lisboa

Quinta, 22 de Março de 2007 Edição Papel Decisões morais falham se não houver emoção Filomena Naves É um cenário teórico extremo: alguém com uma doença infecciosa e mortal decide infectar propositadamente outras pessoas, muitas das quais morrerão, e a única hipótese de evitar que isso aconteça é matar essa pessoa. Confrontada com um dilema desta natureza, a maioria das pessoas hesita, ou diz que não o faria, mesmo pensando que em teoria devia fazê-lo. No entanto, doentes com uma lesão muito localizada no cérebro são um caso à parte. E a sua escolha num cenário deste tipo é apenas a escolha lógica, sem as emoções a desencadear hesitações. Conclusão: as emoções desempenham um papel causal importante nas nossas decisões morais. Este é o resultado da mais recente investigação sobre as emoções e o cérebro realizada por uma equipa de neurologistas norte-americanos co--liderada pelo neurocientista português António Damásio. Publicado hoje na Nature, este estudo é também o primeiro a demonstrar esta função das emoções. Sem elas, algumas decisões morais mantêm a lógica, mas resultam frias e inumanas. A lesão cerebral em causa localiza-se no cortex pré-frontal, numa zona chamada VMPC (ventromedial prefrontal cortex, em inglês), e para avaliar o seu papel nas decisões morais a equipa montou uma experiência em que participaram 30 pessoas, dividas em três grupos. Um com este tipo de lesão cerebral, outro com lesões noutras regiões do cérebro e outro ainda sem qualquer lesão cerebral. Todos os participantes foram sujeitos a um questionário com uma série de cenários que envolviam escolhas como a já referida. "A maioria das pessoas sem esta lesão específica fica dividida. Mas estes indivíduos [com lesão na VMPC] parecem não sentir o conflito", explicou António Damásio, que dirige o Brain and Creativity Institute na University of Southern California, em Los Angeles, nos EUA. "É incrível como esta lesão é selectiva", notou Marc Hauser, professor de psicologia em Harvard e co-autor do estudo, sublinhando que ela "interfere com a capacidade de decisão moral quando uma acção negativa entra em conflito com o resultado utilitário". Um sentimento de aversão impede os seres humanos de fazer mal uns aos outros. Com esta lesão cerebral, esse mecanismo deixa de existir.

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Petition for guaranteed public access to publicly-funded research results

You may sign this petition to register your support for free and open access to European research and for the recommendations proposed in the EU's 'Study on the Economic and Technical Evolution of the Scientific Publication Markets of Europe'.

Dear Commissioner,

Our mission of disseminating knowledge is only half complete if the information is not made widely and readily available to society.
Berlin Declaration, October 2003

In January 2006 the European Commission published the Study on the Economic and Technical Evolution of the Scientific Publication Markets of Europe. The Study resulted from a detailed analysis of the current scholarly journal publication market, together with extensive consultation with all the major stakeholders within the scholarly communication process (researchers, funders, publishers, librarians, research policymakers, etc.). The Study noted that 'dissemination and access to research results is a pillar in the development of the European Research Area' and it made a number of balanced and reasonable recommendations to improve the visibility and usefulness of European research outputs.

Now, a year after publication of the Study, we urge the EC to endorse the recommendations in full. In particular, we encourage you to adopt the first recommendation as a matter of urgency:

RECOMMENDATION A1. GUARANTEE PUBLIC ACCESS TO PUBLICLY-FUNDED RESEARCH RESULTS SHORTLY AFTER PUBLICATION

Research funding agencies have a central role in determining researchers' publishing practices. Following the lead of the NIH and other institutions, they should promote and support the archiving of publications in open repositories, after a (possibly domain-specific) time period to be discussed with publishers. This archiving could become a condition for funding.

The following actions could be taken at the European level: (i) Establish a European policy mandating published articles arising from EC-funded research to be available after a given time period in open access archives, and (ii) Explore with Member States and with European research and academic associations whether and how such policies and open repositories could be implemented.

We would recommend that, in accordance with the recent recommendations from the European Research Advisory Board and the statement of the European Research Council on Open Access, any potential 'embargo' on free access should be set at no more than six months following publication.

Research must be widely disseminated and read to be useful. Adopting Recommendation A1 will immediately ensure the widest possible readership for EC-funded research, increasing the potential benefits resulting from the research, and promoting European scholarship both within Europe and beyond. Evidence is accumulating to indicate that research that is openly accessible is read more and used more and that open access to research findings would bring economic advantage across the European Research Area. The Commission has a unique opportunity to place Europe at the forefront of the dissemination of research outputs and we encourage you to adopt the Study recommendations for the benefit of European research.

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Posted by Ciencia, Filosofia, Democracia y Sociedad at 2:48 PM 0 comments Links to this post

Discovery vs tobacco addiction: Scientific report: "Damage to the insula disrupts addiction to cigarette smoking" journal Science, 26 Jan 07, Vol. 315

Damage to the Insula Disrupts Addiction to Cigarette Smoking
Nasir H. Naqvi, David Rudrauf, Hanna Damasio, Antoine Bechara
Science 26 January 2007:
Vol. 315. no. 5811, pp. 531 - 534
DOI: 10.1126/science.1135926
http://www.sciencemag.org/cgi/content/full/315/5811/531/DC1
http://www.usc.edu/uscnews/stories/13312.html

Smokers Quit After Brain Region Damage

University of Southern California
01/25/07

Nicotine addiction depends on a healthy insula, a region linked to emotion and feelings, say researchers from the Brain and Creativity Institute at USC.

By Carl Marziali

Study senior author Antoine Bechara, left, with Antonio Damasio, director of the Brain and Creativity Institute at USC College

Photo/Philip Channing

Smokers with a damaged insula – a region in the brain linked to emotion and feelings – quit smoking easily and immediately, according to a study in the Jan. 26 issue of the journal Science.

The study provides direct evidence of smoking’s grip on the brain.

It also raises the possibility that other addictive behaviors may have an equally strong hold on neural circuits for pleasure.

The senior authors of the study are Antoine Bechara and Hanna Damasio, both faculty in the year-old Brain and Creativity Institute at USC College, in collaboration with graduate students Nasir Naqvi, who was first author on the study, and David Rudrauf, both from the University of Iowa.

“This is the first study of its kind to use brain lesions to study a drug addiction in humans,” Naqvi said.

In the 1990s, Antonio Damasio proposed the insula, a small island enclosed by the cerebral cortex, as a “platform for feelings and emotion.” The Science study shows that the pleasure of smoking appears to rest on this platform.

“It’s really intriguing to think that disrupting this region breaks the pleasure feelings associated with smoking,” said Damasio, director of the institute and holder of the David Dornsife Chair in Neuroscience at USC.

“It is immediate. It’s not that they smoke less. They don’t smoke, period.”

The finding raises the question of whether damage to the insula also could cause a person to quit other addictive behaviors. Can a brain lesion cure someone of their bad habits?

The answer is not yet known, Bechara said, but he suggested the phenomenon could be “generalizable” regarding alcohol abuse, overeating and other addictions.

The discovery of the insula’s role in addiction opens new directions for therapies, Bechara said, including possible drugs targeted to a region that “no one paid attention to.”

“There is a lot of potential for pharmacological developments,” Bechara said.

Any treatment would need to preserve the beneficial functions of the insula. But Bechara noted that the region appears to be involved specifically in “learned behaviors” rather than the fundamental drives necessary for survival. As a result, it might be possible to target one without disrupting the other.

Hanna Damasio, co-director of the institute and holder of the Dana Dornsife Chair in Neuroscience, also stressed the difference between habitual and instinctive behaviors.

“Because the insula is now recognized as a key structure in processes of emotion and feeling, the fact that insular damage breaks down a learned habit such as smoking, demonstrates a powerful link between habit and emotion or feeling,” she said.

The finding that one small region could be the Achilles’ heel of smoking addiction is especially surprising, given the brain-wide effects of nicotine on the nervous system.

The study considered smokers with damage that did not include the insula, but the likelihood of disrupting the smoking addiction was many times greater when the insula was involved.

Funding for the research came from the National Institute on Drug Abuse and the National Institute of Neurological Disorders and Stroke. The University of Iowa provided access to its extensive database of patients with brain lesions.

The mission of the Brain and Creativity Institute is to study the neurological roots of human emotions, memory and communication and to apply the findings to the solution of problems in the biomedical and sociocultural arenas.

The institute brings together technology and the social sciences in a novel interdisciplinary setting. For more information, go to http://www.usc.edu/schools/college/bci/index.html
________________________________________________
Read full text article here:

Nasir H. Naqvi, et al.
Damage to the Insula Disrupts Addiction to Cigarette Smoking
Science Vol. 315, 531, (2007)
DOI: 10.1126/science.1135926
www.sciencemag.org/cgi/content/full/315/5811/531/DC1


Damage to the Insula Disrupts Addiction to Cigarette Smoking
Nasir H. Naqvi,1 David Rudrauf,1,2 Hanna Damasio,3,4 Antoine Bechara1,3,4*


A number of brain systems have been implicated in addictive behavior, but none have yet been shown to be necessary for maintaining the addiction to cigarette smoking. We found that smokers with brain damage involving the insula, a region implicated in conscious urges, were more likely than smokers with brain damage not involving the insula to undergo a disruption of smoking addiction, characterized by the ability to quit smoking easily, immediately, without relapse, and without persistence of the urge to smoke. This result suggests that the insula is a critical neural substrate in the addiction to smoking.

Cigarette smoking, the most common preventable cause of morbidity and mortality
in the developed world (1), is an addictive behavior. Despite being aware of negative
consequences, many smokers have difficulty quitting, and even those who quit experience urges to smoke and tend to relapse (2, 3). These phenomena appear to arise from long-term adaptations within specific neural systems. Subcortical
regions, such as the amygdala, the nucleus accumbens, and the mesotelencephalic dopamine system, have been shown in animal models to promote the self-administration of drugs of abuse (4, 5). Functional imaging studies have shown
that exposure to drug-associated cues activates cortical regions such as the anterior cingulate cortex, the orbitofrontal cortex, and the insula (6–13). Among these regions, the insula is of particular interest because of its potential role in
conscious urges. The insula has been proposed to function in conscious emotional feelings through its role in the representation of bodily (interoceptive)
states (14–16). Activity within the insula on both sides of the brain has been shown to correlate with subjective cue-induced drug urges (7, 8, 11). It has also been shown that a high amount of activity in the right insula during a simple decision-making task is associated with relapse to drug use (17). Given its potential role in cognitive and emotional processes that promote drug use, the question arises as to whether
the insula is necessary for maintaining addiction to smoking. We hypothesized that the insula is a critical neural substrate in the addiction to smoking. We predicted, therefore, that damage to the insula would disrupt addiction to smoking.

We identified 19 cigarette smokers who had acquired brain damage that included the insula (18). Six of these patients had right insula damage, and 13 had left insula damage.We also

1Division of Cognitive Neuroscience, Department of Neurology,
University of Iowa Carver College of Medicine, 200
Hawkins Drive, Iowa City, IA 52242, USA. 2Laboratory of
Computational Neuroimaging, Department of Neurology,
University of Iowa Carver College of Medicine, 200 Hawkins
Drive, Iowa City, IA 52242, USA. 3Dornsife Cognitive Neuroscience
Imaging Center, SGM 501, University of Southern
California, Los Angeles, CA 90089, USA. 4Brain and Creativity
Institute, HNB B26, University of Southern California, Los
Angeles, CA 90089, USA.
*To whom correspondence should be addressed. E-mail:
bechara@usc.edu

www.sciencemag.org SCIENCE VOL 315 26 JANUARY 2007 531

Fig. 1. Number (N) of
patientswith lesion in each
of the regions identified in
this study, mapped onto a
reference brain. Boundaries
of anatomically defined
regions are drawn
on the brain surface. Regions
names are provided
in the Materials and Methods.
Regions not assigned
a color contained no lesions.
(Top) All patients.
The horizontal line marks
the transverse section of
the brain shown in the top
row. The vertical line
marks the coronal section
shown in the bottom row.
(Middle) Patients with
lesions that involved the
insula. (Bottom) Patients
with lesions that did not
involve the insula.

Fig. 2. Patients who
quit smoking after lesion
onset and patients who
underwent a disruption
of smoking addiction after
lesion onset. (A) Tree
diagram showing the behavioral
classification of
patients. (B) Pie charts
illustrating the proportion
of patients in each anatomical
group who fell
into each of the behavioral
categories. The colors
correspond to the behavioral
group depicted
in (A). These actual proportions
are shown in the
Materials and Methods.
The proportion of patients
with a disruption of smoking addiction was higher among both left insula–lesioned patients and right insula–
lesioned patients compared with among noninsula-lesioned patients.

identified a group of 50 cigarette smokers who had acquired damage that did not include the insula. All of these patients had been smoking more than five cigarettes per day for more than 2 years at the time of lesion onset. The groups were matched with respect to several characteristics, including the number of cigarettes they were smoking at lesion onset, the total number of years they had been smoking at lesion onset, and the etiology of their brain damage (Fig. 1 and table S1). First, we performed a logistic regression analysis in which the dependent variable was whether or not patients quit smoking some time after lesion onset (i.e., whether or not they were smoking at the time of the study). The independent variable of interest was the extent of damage in the insula on a given side. An estimate of the total extent of the lesion was entered as a nuisance covariable (Materials and Methods). We found that the likelihood of quitting smoking after a lesion in either the right or the left insula was not significantly higher than the likelihood of quitting after a noninsula lesion
(odds ratio = 2.94, c2 = 2.74, and P = 0.10). When we examined the right and left insulae separately, we found that the likelihood of quitting smoking was not significantly higher after a right insula lesion than after a noninsula lesion (odds ratio = 2.53, c2 = 2.98, and P = 0.08), nor was it significantly higher after a left insula lesion compared with after a noninsula lesion (odds ratio = 1.44, c2=1.12, and P=0.29) (Fig. 2 and table S3). One explanation of this null finding is that, whereas the insula-lesioned patients may have quit smoking due to a disruption of
smoking addiction, the noninsula-lesioned patients may have quit smoking at a similar rate because they were concerned about the negative consequences of smoking. Simply determining whether the patients were smoking at the time of
the study did not address this distinction.

To more specifically assess a disruption of smoking addiction, we asked all of the patients who quit smoking after lesion onset a set of questions aimed at their recollection of the experience of quitting. Patients were classified as having had a disruption of smoking addiction if they fulfilled all four of the following criteria:
(i) reporting quitting smoking less than 1 day after lesion onset, (ii) reporting that they did not start smoking again after they quit, (iii) rating the difficulty of quitting as less than three on a scale of one to seven, and (iv) reporting feeling no urges to smoke since quitting. According to these criteria, 16 of the patients who quit smoking after lesion onset were classified as having a disruption of smoking addiction. The 16 quitters who failed to meet all four of these criteria, along with all 37 nonquitters, were considered to have no disruption of smoking addiction (Fig. 2). We performed a logistic regression in which the dependent variable was whether or not patients
underwent a disruption of smoking addiction after lesion onset as defined by the above


26 JANUARY 2007 VOL 315 SCIENCE www.sciencemag.org 532

criteria. As before, the independent variable of interest was the extent of damage to the insula on a given side, whereas the estimate of the total extent of the lesion was entered as a nuisance covariable. We found that the likelihood of having a disruption of smoking addiction after a lesion in either the right or the left insula was
significantly higher than the likelihood of having a disruption of smoking addiction after a noninsula lesion (odds ratio = 22.05, c2 = 16.64, and P = 0.0005). When we examined the right and left insulae separately, we found that the likelihood
of having a disruption of smoking addiction was significantly higher after a right
insula lesion than after a noninsula lesion (odds ratio = 10.87, c2 = 12.90, and P = 0.0003) and was also significantly higher after a left insula lesion compared with after a noninsula lesion (odds ratio = 3.61, c2 = 10.33, and P = 0.001)
(Fig. 2 and table S3). Although it appears that effects may be somewhat larger with right insula lesions compared with left insula lesions, the sample sizes were too small to confirm this statistically. We then conducted a similar logistic regression
that included only the patients in our sample who quit smoking after lesion onset (thus, we were not required to assume that patients who continued to smoke after lesion onset had an intact smoking addiction).We found that five of five of the patients who quit smoking after a right insula lesion and seven of eight of the
patients who quit smoking after a left insula lesion met the criteria for having a disruption of smoking addiction, compared to 4 of 19 of the patients who quit smoking after a noninsula lesion (right insula–lesioned patients versus
noninsula-lesioned patients: odds ratio = 6.55, c2 = 7.76, and P = 0.005; left insula–lesioned patients versus noninsula-lesioned patients: odds ratio = 7.19, c2 = 10.06, and P = 0.002). Putting the right and left sides together, 12 of 13 patients
who quit smoking after a lesion in the insula did so with a disruption of smoking addiction. Relative to noninsula-lesioned patients, this translates
into an odds ratio of 136.49 as estimated by the logistic regression (c2 = 15.48 and P = 0.00008) (Fig. 2 and table S3). In our sample, the patients with insula lesions
tended also to have damage in adjacent areas (Fig. 1). This raises the question of whether the observed effects were necessarily due to insula damage or whether they required damage in one or more areas adjacent to the insula. To address
this issue, we performed a region-by-region logistic regression analysis that estimated, for each region of the brain that we sampled, the likelihood of having a disruption of smoking addiction after a lesion that included the region
compared to a lesion that did not include the region. This analysis included all of the patients in the sample. We found that the only regions in which lesions were significantly associated with an increased likelihood of having a disruption of
smoking addiction were the right and left insulae (Fig. 3). On the left side, there were nearsignificant effects in regions adjacent to the insula, such as the putamen. We cannot rule out the possibility that some of these regions independently
or cumulatively play a role in smoking addiction. For example, evidence from
animal studies suggests that the dorsal striatum, which includes the putamen, is involved in learning and expression of drug-use habits (4).

However, for most of these regions the patients with lesions who had a disruption of smoking


Fig. 3. Whole-brain region-by-region logistic regression analysis. The color of each region corresponds to a c2 statistic given the sign of regression coefficient obtained from the logistic regression analysis. The only regions that were assigned a color were those for which the number of patients was sufficient to detect a statistically significant effect (Materials and Methods). Regions for which there was a statistically significant association between a lesion and a disruption of smoking addiction (P <>

addiction also had damage in the insula (table S4), suggesting that apparent effects of lesions in these regions were due to a bystander effect.We did find four patients who had a disruption of smoking addiction after suffering from brain damage that did not involve the insula. When we examined their lesions, we found that each of
them had damage in a unique set of regions (table S5). This raises the possibility that certain patients may undergo a disruption of smoking addiction as a general effect of suffering from a brain injury. The results indicate that smokers who acquire
insula damage are very likely to quit smoking easily and immediately and to remain
abstinent. In addition, smokers with insula damage are very likely to no longer experience conscious urges to smoke after quitting. These findings are consistent with previous functional imaging evidence showing that activity in the insula is correlated with subjective drug urges (7, 8, 11). Additionally, the results provide
evidence that subjective urges are an important factor in maintaining smoking addiction. However, urges may not be the only factor that promotes smoking. Recent theories of addiction propose that usual drug use in addicted individuals is driven primarily by automatic or implicit motivational processes, such as habits (4) and
incentive salience wanting (19). Conscious urges come into play when there is an impediment to drug use, such as an attempt to quit or to resist relapse (20). The present results are consistent with this view. However, it remains to be
seen whether insula damage spares the automatic tendency to smoke. It also remains to be seen whether patients with insula damage still obtain pleasure from smoking, because pleasure and urge may be dissociable facets of smoking
reward (19). Our sample included a number of patients with damage to the orbitofrontal cortex (Fig. 1), a region that, like the insula, has been implicated
by functional imaging studies to play a role in conscious drug urges (6, 8, 9, 11–13).We found no association between lesions in the orbitofrontal
cortex and a disruption of smoking addiction (Fig. 3 and table S4). One explanation of this result is that smokers who acquire orbitofrontal damage experience a reduction in conscious urges but continue to smoke because their
automatic tendency to smoke is still intact. At the same time, these patients may have a low likelihood of attempting to quit smoking after suffering from a brain injury, because the orbitofrontal region is critical for decisions that override the automatic tendency to obtain immediate rewards in order to avoid future negative
consequences (21, 22). Insula-lesioned patients, in contrast, may not have such severe decisionmaking deficits and thus may be likely to attempt
to quit smoking after suffering from a brain injury. The results of this study suggest that the insula is a critical neural substrate for the urge to

www.sciencemag.org SCIENCE VOL 315 26 JANUARY 2007 533

smoke, although they do not in themselves indicate
why the insula, a region known to play a
role in the representation of the bodily states
(16), would play such an important role in urge.
A clue may be provided by the account of one
patient in our sample who quit smoking immediately
after he suffered a stroke that damaged
his left insula. He stated that he quit
because his “body forgot the urge to smoke”
(23). His experience suggests that the insula
plays a role in the feeling that smoking is a
bodily need. Indeed, much of the pleasure and
satiety that is obtained from smoking is derived
from its bodily effects, in particular its impact on
the airway (24, 25). In addition, nicotine withdrawal
is associated with changes in autonomic
and endocrine function (26, 27), which may
contribute to its unpleasantness. Current evidence
suggests that the insula plays a role in
conscious feelings by anticipating the bodily
effects of emotional events (14, 15). The insula
may therefore function in the conscious urge to
smoke by anticipating pleasure from the airway
effects of smoking and/or relief from the aversive
autonomic effects of nicotine withdrawal.
Thus, damage to the insula could lead a smoker
to feel that his or her body has “forgotten” the
urge to smoke.
An important question pertains to whether
insula lesions cause a disruption of motivated
behaviors other than smoking. In a follow-up
survey, we found that none of the patients with
insula damage who had a disruption of smoking
addiction admitted to any reductions in their
pleasure from eating, their desire to eat, or their
intake of food. This does not preclude the possibility
that these patients had some impairment
of taste perception (28, 29) or had deficits in
othermotivated behaviors thatwe did not assess.
One possibility is that motivated behaviors that
are fundamental to survival, such as eating, are
supported by redundant neural mechanisms that
are difficult to disrupt with a lesion in a single
brain region. A related possibility is that the insula
is critical for behaviors whose bodily effects
become pleasurable through learning; although
the bodily effects of eating are inherently pleasurable,
the bodily effects of smoking are initially
aversive and become pleasurable as
addiction develops (25). It would be interesting
to see how insula damage affects other learned
pleasures.
Our findings suggest that therapies that modulate
the function of the insula will be useful in
helping smokers quit. For example, sensory
replacements for smoking, such as denicotinized
cigarettes and irritant inhalers, are highly effective

effective
in reducing urges and promoting abstinence
(30, 31). Such therapies may work by engaging
sensory representations of the airway within the
insula, thereby satisfying the “bodily need” to
smoke. Future pharmacologic therapies may
target neurotransmitter receptors that are expressed
within the insula. In addition, the efficacy
of various smoking cessation therapies may be
monitored by measuring activity within the
insula with functional brain imaging. Lastly, the
findings of this study demonstrate that conscious
feelings, such as urges, are an important component
of addiction.
References and Notes
1. R. Peto, A. D. Lopez, J. Boreham, M. Thun, C. Heath Jr.,
Lancet 339, 1268 (1992).
2. American Psychiatric Association (A.P.A.), Diagnostic and
Statistical Manual of Mental Disorders Text Revision:
DSM-IV-TR (A.P.A., Washington, DC, ed. 4, 2000),
pp. 191–296.
3. U.S. Department of Health and Human Services, 1988
Surgeon General’s Report: The Health Consequences of
Smoking: Nicotine Addiction (U.S. Government Printing
Office, Rockville, MD, 1988) chap. 6, pp. 377–458.
4. B. J. Everitt, T. W. Robbins, Nat. Neurosci. 8, 1481
(2005).
5. F. E. Pontieri, G. Tanda, F. Orzi, G. Di Chiara, Nature
382, 255 (1996).
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(1996).
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(2002).
8. A. L. Brody et al., Arch. Gen. Psychiatry 59, 1162
(2002).
9. R. Z. Goldstein, N. D. Volkow, Am. J. Psychiatry 159,
1642 (2002).
10. H. Garavan et al., Am. J. Psychiatry 157, 1789 (2000).
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(2000).
13. H. Myrick et al., Neuropsychopharmacology 29, 393
(2004).
14. A. R. Damasio et al., Nat. Neurosci. 3, 1049 (2000).
15. A. R. Damasio, The Feeling of What Happens: Body and
Emotion in the Making of Consciousness (Harcourt,
Chicago, 2000).
16. A. D. Craig, Nat. Rev. Neurosci. 3, 655 (2002).
17. M. P. Paulus, S. F. Tapert, M. A. Schuckit, Arch. Gen.
Psychiatry 62, 761 (2005).
18. All of the patients in this study were selected from the
patient registry of the Division of Behavioral Neurology
and Cognitive Neuroscience, Department of Neurology,
University of Iowa. Selection criteria are detailed in the
Materials and Methods. The insula was defined here as
the region bounded anteriorly by the limen insulae and
posteriorly, inferiorly, and superiorly by the circular
insular sulcus. This included both anterior and posterior
insular cortices and underlying white matter.
19. K. C. Berridge, T. E. Robinson, Trends Neurosci. 26, 507
(2003).
20. S. T. Tiffany, Psychol. Rev. 97, 147 (1990).
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(2000).
23. Patient N. is a right-handed male who was 38 years old
when we interviewed him. N. started smoking at the age

of 14. At the time of his stroke, he was smoking more
than 40 unfiltered cigarettes per day and was enjoying
smoking very much. By his own admission, he was heavily
addicted to smoking. He recalled that he used to
experience frequent urges to smoke, especially upon
waking, after eating, when he drank coffee or alcohol,
and when he was around other people who were
smoking. He often found it difficult to refrain from
smoking in situations where it was inappropriate, e.g.,
at work or when he was sick and bedridden. He was
aware of the health risks of smoking before his stroke but
was not particularly concerned about those risks. Before
his stroke, he had never tried to stop smoking, and he
had had no intention of doing so. N. smoked his last
cigarette on the evening before his stroke. When asked
about his reason for quitting smoking, he stated simply,
“I forgot that I was a smoker.” When asked to elaborate,
he said that he did not forget the fact that he was a
smoker but rather that “my body forgot the urge to
smoke.” He felt no urge to smoke during his hospital
stay, even though he had the opportunity to go outside to
smoke. His wife was surprised by the fact that he did not
want to smoke in the hospital, given the degree of his
prior addiction. N. recalled how his roommate in the
hospital would frequently go outside to smoke and that
he was so disgusted by the smell upon his roommate’s
return that he asked to change rooms. He volunteered
that smoking in his dreams, which used to be pleasurable
before his stroke, was now disgusting. N. stated that,
although he ultimately came to believe that his stroke
was caused in some way by smoking, suffering a stroke
was not the reason why he quit. In fact, he did not recall
ever making any effort to stop smoking. Instead, it
seemed to him that he had spontaneously lost all interest
in smoking. When asked whether his stroke might
have destroyed some part of his brain (fig. S2) that made
him want to smoke, he agreed that this was likely to have
been the case.
24. N. H. Naqvi, A. Bechara, Pharmacol. Biochem. Behav.
81, 821 (2005).
25. J. E. Rose, Psychopharmacol. Ser. (Berlin) 184, 274
(2006).
26. D. Hatsukami, J. R. Hughes, R. Pickens, Natl. Inst. Drug
Abuse Res. Monogr. 53, 56 (1985).
27. W. B. Pickworth, R. V. Fant, Psychoneuroendocrinology
23, 131 (1998).
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32. The authors thank A. Damasio, T. Grabowski, D. Tranel, and
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S. Mehta for expert advice on the logistic regression
analyses. This research was supported by National Institute
on Drug Abuse grants F30 DA016847 (N.H.N.) and R21
DA16708 (A.B.) and National Institute of Neurological
Disorders and Stroke grant P01 NS019632 (A.B. and H.D.).
Supporting Online Material
www.sciencemag.org/cgi/content/full/315/5811/531/DC1
Materials and Methods
Figs. S1 and S2
Tables S1 to S5
References
4 October 2006; accepted 15 December 2006
10.1126/science.1135926


http://www.sciencemag.org/cgi/content/full/315/5811/531/DC1
Materials and Methods
Figs. S1 and S2
Tables S1 to S5
References
4 October 2006; accepted 15 December 2006
10.1126/science.1135926

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