Trouble in Paradise

To coin a phrase by Britain’s pre Second World Prime Minister, Neville Chamberlain, "It is a faraway country of which we know little". Chamberlain was of course referring to Czechoslovakia, and at a time when Hitler’s Germany was preparing to grab the Sudetenland under the pretext that this part of Czechoslovakia was mainly occupied by indigenous Germans. That speech has gone down in the annals of history as one of "appeasement". It also helped reassure Hitler that the British had no stomach to halt his expansionist plans – that was until Winston Churchill replaced Chamberlain.

The Maldives are also a "faraway place of which we know little". Apart from the fact perhaps that for many years it has been a favourite holiday destination for wealthy Westerners, the best resorts barely a skip and a jump from the crowded warrens of the capital Male. Few could have known that these islands in the Indian Ocean were for decades presided over by an authoritarian dictator, President Maumoon Gayoom, whose own luxurious lifestyle marked such a contrast with those of his citizens.  But there were some who should have known better; Western politicians and businessmen who knew full well what Gayoom and his henchmen were up to. I used to remind some of them in the British Labour Party that the islands they were set to holiday in were run by not only by a corrupt elite, the elite were Ba’athists to boot. I particularly reminded them of this when some of these same politicians were supporting the war against Ba’athist Iraq.

So in common with many around the World, I was delighted when my old friend, Mohammed Nasheed, finally beat Gayoom in the Maldives first free Presidential elections in 2008. We briefly attended the same school together in the English West country, and we met again many years later when I was editing Tribune, shortly after ‘Anni’ as he is affectionately known in his home country was first imprisoned for writing an article in a magazine in which he alleged Gayoom had rigged the 1989 elections. This was not to be the last time Gayoom had Anni imprisoned.  In fact he was arrested and incarcerated on a further three occasions, on one of these he was held in solitary confinement and tortured. Anni was made an Amnesty International Prisoner of Conscience in 1991.

His Presidency has been marked by brave attempts to tackle the perennial poverty of his fellow citizens. Anni has eschewed the Presidential Palace and the trappings of power, and instead has put the Maldives firmly on the global radar, famously holding a Cabinet meeting under water in the Indian Ocean, in order to bring the Maldives plight as one of the country’s most at risk to global warming to international attention. He has opened up the media, strengthened the Maldives young democracy and in a poor country has extended educational opportunities. Anni was this year awarded the UN’s "Earth Award", the most prestigious environmental prize that the organisation can give.

Sadly the dark forces that surrounded the former President did not rise to the occasion, but instead set about plotting the downfall of this fledgling democracy. The crisis came to a head at the end of last month when thirteen of Anni’s Cabinet Minister resigned protesting at the antics of some Opposition MPs, and in particular citing allegations of corruption against former Finance Minister and half brother of the defeated President, Abdulla Yameen, and Gasim Ibrahim, leader of the Peoples Association Party. Supporters of Anni claim that efforts have been made to bribe MPs to contrive to block Government legislation and that two prominent Maldivian businessman are involved in the machinations.

The crisis in the Maldives has not abated, and over the next few days there may be more attempts to destabilise that country’s young democracy.

Having failed the Maldives at their time of need during the 1980s and 1990s, the international community cannot afford to turn away now

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
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  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. Think a dialysis machine for the mind. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.