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Posted on March 25, 2015 at 2:36 AM

by Craig Klugman, Ph.D.

For at least a decade, studies have shown that empathy and compassion decline in medical students. The response is often more curricula dedicated to ethics, humanities, communication skills, and patient contact. But what if the answer was simply medicating the students.

An article in Time magazine reported that a study from researchers at the University of California Berkeley and University of California San Francisco have found “that by manipulating a brain chemical, people can become more compassionate and act in prosocial ways to equalize differences.”

Compassion is “a sympathetic consciousness of other’s distress with a desire to alleviate it.” According to the article, the study of 35 subjects found that when taking a drug a person’s desire to alleviate inequity increased. The subjects were randomized into two groups—one received tolcapone, a Parkinson’s drug, and the others did not. In short, the drug tends to increase the amount of dopamine in the brain. A shortage of this chemical causes Parkinson’s disease. However, levels of dopamine were not measured.


A study of compassion?

Subjects were given tokens that were worth a variable amount of money. Tokens given away might be worth more or less than tokens kept for oneself. The drug correlated with people making more egalitarian in distributing tokens. Subjects became averse to inequity whether it is people having too little or too much. The authors concluded that their model provided a potential tool for understanding neuropsychiatric disorders.

Is this the same as compassion? The term compassion never appears in the article. Were the subjects aware (i.e. consciousness) of their choices? The answer is not given in the study because that was not a question under investigation. Was the “other” to whom tokens could be given under distress? No. The “other” simply was an undefined receiver of tokens.

The connection between people being more averse to inequity in an economics game and the term “compassion” comes from the University of California Berkeley News Center, in other words, the public relations office:

“What if there were a pill that made you more compassionate and more likely to give spare change to someone less fortunate?” states the UC Berkeley press release. The word compassion only appears in that grabber statement. I suppose that compassion is much more likely to be picked up in the news media than “inequity aversion” in a small study.

One ethical issue in this case is that of attempts to change words and imply meanings that are not present in the study nor used by the researchers in order to get more coverage. It is important for science to be reported accurately. Researchers must carefully explain their findings in simple terms and to review those stories before release for precision and accuracy.


But, what if there was a pill?

Let’s consider for a moment if there was such a compassion pill. If people have neuropsychiatric disorders that prevents them from feeling empathy or acting compassionately, then this may be a great boon to those who suffer.

Then there are the circumstances where (a) a person desires to change his or her brain chemistry in hopes of changing attitudes and behavior and (b) when such medication is forced upon a person without his or her consent.

The first is a question of autonomy. However, since the new brain chemistry will alter the person, we could ask whether one can ever consent to become a different person, or consent for a person that does not yet exist but who he or she will become?

The second inquiry is where our medical student scenario comes into play. Knowing that students lose their empathy and compassion during medical school, there might be an obligation to require they take such a pill. They would start at a low dose in the first year in order to inoculate them against the coming changes. The does would rise in their latter years to compensate for the known decrease. Taking the pill might start as an option or an experiment but if those students do better on tests of compassion and empathy, then it might be a requirement of enrollment. Perhaps it can be made into a mist and pumped into the lecture halls.

Much has been written about giving healthy people pills to change their thinking, erase unwanted memories, increase cognitive capacity, boost memory, and eliminate depression and mania. The goal in this case, would be to get people to feel the desire to help those in need. Certainly that is a good characteristic of any physician. But absent that feeling naturally or even cultivated, is taking a pill the appropriate solution?

Ethics holds that we have will and can make many of our choices. The notion of pharmaco-neurobiology is that our choices and actions are made by the chemicals in and structure of our brains. We are in a sense, slaves to our biology. By this thinking, the only way to change behavior is to change chemistry, which can easily be accomplished by taking a pill. The answer to whether it is our will or neurotransmitters will only be answered by science. But this study, does not answer it.

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