Italian pharmacy online: cialis senza ricetta medica in farmacia.
Attitudes about memory dampening drugs depend on context and country
Applied Cognitive Psychology, Appl. Cognit. Psychol. (2010)Published online (www.interscience.wiley.com) DOI: 10.1002/acp.1740
Attitudes about Memory Dampening Drugs Depend on Context and Country
ERYN J. NEWMAN1, SHARI R. BERKOWITZ2, KALLY J. NELSON2, MARYANNE GARRY1and ELIZABETH F. LOFTUS2*1Victoria University of Wellington, New Zealand2University of California, Irvine, USA
Summary: When people take drugs such as propranolol in response to trauma, it may dampen their bad memories – temperingrecall of a traumatic event. We examined people’s attitudes toward these drugs. Americans and New Zealanders read about ahypothetical assault inserting themselves into a scenario as a victim attacked while serving on a peace keeping mission (soldierrole) or while walking home from a job as a restaurant manager (civilian role). Then they told us whether they should receive amemory dampening drug, and whether they would want to take a memory dampening drug. Subjects were negatively disposedtowards a memory dampening drug, but Americans who adopted the soldier role were more in favor of having access to the drugthan those who adopted the civilian role. We discuss the implications of these ﬁndings in relation to an increasing trend in‘cosmetic neurology’, medicating with the goal of enhancement, rather than therapy. Copyright # 2010 John Wiley & Sons, Ltd.
Distressing memories do not simply feel terrible in the
for a review). Propranolol blocks epinephrine receptors,
moment; they are associated with an array of psychological
and in doing so prevents memory enhancement (Cahill,
consequences, such as dysphoria, depression and low self-
Prins, Weber, & McGaugh, 1994; McGaugh, 2004). In
esteem (Berntsen & Rubin, 2006, 2007; Ross & Wilson,
a well-known study, Cahill et al. (1994) found that
2002). Profoundly distressing memories are a hallmark of
giving people propranolol destroyed the typical memory
posttraumatic stress disorder (PTSD; APA, 1994). PTSD
enhancement of emotional experiences, impairing both
produces mental anguish, and signiﬁcant costs to sufferers,
recall and recognition of emotional memories relative
their families, and society (Kessler, 2000; McNally,
to people who did not take propranolol (see also Cahill,
2003a,b). In some cases, people with PTSD come to feel
Pham, & Setlow, 2000; Reist, Duffy, Fujimoto, & Cahill,
as though they are haunted by those memories, which can
2001; Roozendaal, Quirarte, & McGaugh, 1997). Taken
intrude on their everyday thinking, surface in ﬂashbacks or
together, this research suggests that propranolol can
nightmares, or set off exaggerated physiological responses.
dampen memory for emotional material and raises
One Holocaust survivor said his awful memory is ‘in front of
me. I can’t get rid of it’ (Langer, 1993: p. 96; see also Kuch &
Cox, 1992; Wagenaar & Groeneweg, 1990). Similarly,
In fact, recent studies suggest that if people take
Berntsen and Rubin (2008) found that Danish tourists who
propranolol after a traumatic experience, they suffer fewer
survived the 2004 Indonesian tsunami experienced intrusive
psychological after-effects. In one study, emergency room
patients took propranolol or a placebo shortly after a
These studies and others suggest that distressing memories
traumatic experience; 1 month later, propranolol patients had
keep us stumbling on unhappiness (with apologies to Gilbert,
fewer PTSD symptoms than placebo patients (Pitman et al.,
2006). One interesting question that arises from this research
2002). In another study, PTSD patients described their
is whether people would be interested in taking a drug that
trauma in writing, and then took propranolol or a placebo.
could dampen – that is, lessen the emotion associated with
One week later, patients listened to a recording of their
and diminish content of – a traumatic event? In what context
descriptions while instruments gathered data on their
should people have access to such a drug? These are the
physiological stress responses. Propranolol patients showed
questions we address in the experiment described here.
lower stress responses than placebo patients (Brunet, Orr,
Given the myriad bad consequences associated with
Tremblay, Robertson, Nader, & Pitman, 2008). Although
horrible memories, it is little wonder that scientists have
neither study measured changes in memory, we might
investigated drugs that might blunt them. Memory dampen-
speculate that one mechanism responsible for the reduction
ing drugs, such as the beta-blocker propranolol, may offer
in PTSD symptoms is what Cahill et al. (1994) found:
some relief by disrupting the biological processes that
propranolol makes people remember less, and makes their
make emotional memories so intensely remembered in the
emotional memories more like mundane memories.
ﬁrst place. Emotionally arousing experiences – positive or
As advances in neuroscience make access to memory
negative – cause the release of adrenal stress hormones
dampening drugs more likely, some have raised both legal
that enhance some aspects of memory (see McGaugh, 2000,
and ethical concerns about who should have access to themand in what circumstances (Kolber, 2008; President’sCouncil on Bioethics 2003). Moreover, for all the good
*Correspondence to: Elizabeth F. Loftus, Psychology & Social Behavior,
memory dampening drugs might do to relieve suffering, we
Criminology, Law & Society, Cognitive Sciences, School of Law, University
still do not know if people actually want to take these drugs,
of California, Irvine, 2393 Social Ecology II, Irvine, CA 92697-7080 USA.
or even want the choice to take them.
Copyright # 2010 John Wiley & Sons, Ltd.
But there are good reasons to expect that people would
sense of invincibility. In other words, it could lead people to
indeed want – at the very least – the choice to take a memory
be more concerned that they might develop PTSD and be
dampening drug. For one thing, we know that people often
more positively disposed towards a memory dampening drug
like to have choices. Simply being able to exercise a choice –
(see Menon, Raghubir, & Agrawal, 2008). On the other hand,
rather than being constrained – can result in many positive
some research suggests that base rates often do not affect
psychological outcomes, including boosting feelings of
people’s attitudes – instead, people overlook base rate
control and motivation (Iyengar & Lepper, 1999; Szrek &
information, focusing on idiosyncratic aspects of an event
Baron, 2007; cf. Iyengar & Lepper, 2000). Second, people
(Bar-Hillel, 1980; Tversky & Kahneman, 1974; cf. Ginosar
tend to overestimate how badly they would feel after a
& Trope, 1987; Koehler, 1996). Therefore, it is possible that
hypothetical negative event, which may lead them to
feeding people base rate information might have no inﬂuence
overestimate their need for a memory dampening drug.
on their disposition towards a memory dampening drug.
What leads people to overestimate? Research suggests that
In the study below, we asked a sample of people in the
people do not always consider other factors in their lives that
United States (US) and New Zealand (NZ) to read the assault
contribute to happiness – instead, they overemphasize the
scenarios and then tell us if they wanted the choice to receive
importance of the target event (Gilbert & Wilson, 2007). In
a memory dampening drug, and (assuming they had a choice)
one study, people who imagined suffering from kidney
if they would actually want to take it. We expected that
disease predicted they would feel quite negative – even
people’s responses might vary by country, reﬂecting the fact
though people who actually suffered from kidney disease
that Americans are more comfortable with the idea of taking
reported feeling positive (Riis, Loewenstein, Baron, Jepson,
medication. For instance, people in the US medicate
Fagerlin, & Ubel, 2005). Taken together, these studies
themselves more than people in any other Organization
suggest that people would want to take the drug, or at least
for Economic Cooperation and Development (OECD)
nation, spending $121 per person annually on over-the-
On the other hand, there are also good reasons to expect
counter drugs – more than three times as much as people in
that people would want to avoid a memory dampening drug.
NZ, who spend $40 (OECD Health Data, 2009). When it
For instance, people tend to imagine glowing, positive
comes to prescription drugs, the US again comes out on top,
futures (Szpunar, 2010; cf. Wilson & Ross, 2003). In one
spending $878 USD per person per year (OECD Health Data,
study, when people generated personally meaningful future
2009). By contrast, people in NZ rank 23/24, spending $241
events they were slower at generating negative events than
USD per person per year. The comparison is especially
positive events, and thought the negative events less likely
noteworthy, given that the US and NZ are the only OECD
(Newby-Clark & Ross, 2003). Put another way, positive
countries permitting direct to consumer prescription drug
future events might come to mind more easily – more
ﬂuently – and therefore feel truer, and more likely (see Alter& Oppenheimer, 2009 for a review; Sherman, Cialdini,Schwartzman, & Reynolds, 1985). Considered together, this
research suggests that people may imagine a relativelypositive posttrauma future, and decide they would not need
To address these issues, we asked people to read a
We used a 2 (context: restaurant or military) Â 3 (base rate:
scenario about a vicious assault. We manipulated the
4%, 40% or no information) Â 2 (country: US or NZ)
circumstances of the assault so that people read about
between-subjects design. The ﬁrst factor was context. In the
themselves experiencing one of two similar attacks occurr-
restaurant condition, people read a version of the assault
ing in two very different contexts. In the ﬁrst version, people
scenario that described a restaurant manager returning from
read that they were a restaurant manager attacked while
work late at night. In the military condition, people read a
returning from work late at night; in the second version, they
version of the assault scenario describing the same attack
read about the same attack but as a soldier returning to base
happening to a soldier returning to base late at night.
The second factor was base rate. People read either that
We also manipulated the base rate of PTSD, telling some
4%, or 40% of people go on to develop PTSD; in the ‘no
of our subjects that only 4% of people go on to develop PTSD
information’ version of the scenario, there was no mention of
after a traumatic experience, telling others that the ﬁgure was
40%, and telling still others nothing about the base rate ofPTSD. Because the relevant literature is mixed, we had nospeciﬁc prediction about the effects of this manipulation. On
the one hand, research leads us to speculate that base rate
A total of 997 people from the community completed the
information may inﬂuence people’s attitudes to memory
survey; there were 518 women (52%), 463 men (46%) (16
dampening drugs. Typically, people believe that others are
people did not report gender); they ranged in age from 18 to
more at risk for developing certain medical conditions than
80 (M ¼ 28.2, SD ¼ 13.7). Of the 997 subjects, there were
they themselves are (Hansen, Raynor, & Wolkenstein, 1991;
Perloff & Fetzer, 1986; Weinstein, 1984, 1987, seeWeinstein, 1989 for a review). Therefore, it is possible that
1Note that although cell sizes were uneven, for all effects we report, the Fmax
feeding people base rate information could counteract their
test showed acceptable ratios of cell variances (Tabachnik & Fidell, 2007).
Copyright # 2010 John Wiley & Sons, Ltd.
extent to which they would want access to a memorydampening drug, and in Question 2 [Q2], they reported how
We distributed the survey in various parts of southern
likely they would be to actually take the drug if it were made
California, and Wellington, NZ. People who agreed to take
available. They made their responses on a 5-point Likert type
part completed the survey immediately, and returned it to one
scale, with anchors 1 ¼ deﬁnitely no to 5 ¼ deﬁnitely yes.
of the experimenters. Each scenario was approximately 100
We also asked people for demographic information such as
words long, and varied only in line with the manipulations
sex, age and whether or not they had ever witnessed or
described above. For example, people in the restaurant
You are a restaurant manager who has just ﬁnished work
late at night, and you put the night’s takings in yourbackpack so you can deposit them into the restaurant’s
Our primary interest in this study was to examine whether
bank account in the morning. Your journey home takes
people wanted access to memory dampening drugs and
you through a poorly lit park. While in the park, a man
whether they would actually want to take these drugs. We
appears in front of you, and stabs you in the stomach. As
were also interested in whether the context of trauma
you fall to the ground, he kicks you hard in the ribs, steals
(whether people read about themselves being attacked as a
the money and runs off. Although you are badly shaken by
restaurant manager or a soldier), country of residence and
the viciousness of the assault, you are able to get to the
perceived prevalence of PTSD would affect people’s
attitudes to the drug. Below we focus on two key ﬁndings:the extent to which people wanted the choice to take the drug,
and if they themselves would take the drug. Because we
You are a soldier on a peacekeeping mission in Afghani-
found that base rate information had no effect on our
stan who has just ﬁnished patrolling late at night, and you
ﬁndings, we omitted this factor from the analyses below.
put the night’s supplies in your pack. Your journey to thebase takes you through dark terrain. While on your way to
Who should have access to the memory dampening
the base, a man appears in front of you, and stabs you in
the stomach. As you fall to the ground, he kicks you hardin the ribs, steals the supplies and your gun and runs off.
To examine people’s attitudes about who should have access
Although you are badly shaken by the viciousness of the
to the memory dampening drug, we took their responses to
assault, you are able to get to the nearest base, where there
Q1 and classiﬁed them ﬁrst according to whether they were
from the US or NZ and then by the context in which theassault occurred. We display those results in Figure 1.
Before reading each scenario, people read a paragraph
Figure 1 shows three important ﬁndings. First, regardless
describing a drug used to diminish the possible after-effects
of where people lived or the hypothetical context in which
of trauma. Although we did not mention propranolol by
they read they were attacked, they showed only modest
name, we based our description of the drug and its effects on
desire to have access to the drug. Second, depending on what
subsequent recall from the scientiﬁc literature (Brunet et al.,
country they lived in, the context in which people were
2008; Cahill et al., 1994; Pitman et al., 2002). The
attacked mattered: Americans showed more support for their
paragraphs changed only in respect to the base rate condition.
right to access the drug if they were the soldier than if they
were the restaurant manager; by contrast, New Zealanders
Scientiﬁc studies have shown that on average, 4% of
showed similar support for their right to access the drug when
people who experience a traumatic event will develop
they were either the restaurant manager or the soldier. Third,
PTSD. Some of the debilitating symptoms of PTSD
when they adopted the soldier’s point of view, Americans
include recurrent and intrusive distressing recollections
showed greater support for their right to access the drug than
of the event, irritability or outbursts of anger and an
exaggerated startle response. Recently, research has
Statistical support for these ﬁndings can be seen in a 2
shown that if a person who has had a traumatic experience
(context: restaurant or military) Â 2 (country: US or NZ) analysis
is given a certain drug within a few hours of that experi-
of variance (ANOVA) which showed a Context Â Country
ence, the drug can ‘dampen’ the memory of that event and
interaction, F(1,996) ¼ 4.23, p ¼ .04, f ¼ .06. Follow-up t-tests
minimize the effects of PTSD. In other words, the drug
showed that for Americans, the context mattered: the ‘military’
will lessen the emotion associated with the event, and
subjects agreed more strongly that they should have the choice to
diminish factual content for the event, without causing the
take the drug than did the ‘restaurant’ subjects, t(993) ¼ 2.78,
p ¼ .01, Cohen’s d ¼ .18. For New Zealanders, context did notmatter, t(993) ¼ .52, p ¼ .62. When we focused on just the
The 40% version replaced 4% with 40%, and people who
military subjects, we found that Americans agreed more strongly
read the version with no information read a modiﬁed opening
that they should have access to the drug than did New
sentence: scientiﬁc studies have shown that people who
Zealanders, t(993) ¼ 2.43, p ¼ .02, d ¼ .15.
experience a traumatic event can develop PTSD.
We also examined whether people who had experienced a
Our primary dependent measures were people’s responses
traumatic event would be more inclined to want access to the
to two questions: in Question 1 [Q1], people reported the
memory dampening drug. Would these people have similar
Copyright # 2010 John Wiley & Sons, Ltd.
Figure 1. American and New Zealand responses about access to memory dampening drugs
attitudes about who should have access to the drug? To assess
about taking the memory dampening drug, the more they
this, we analyzed the Q1 responses of the 334 people who
agreed that they would exercise that choice. Put another way,
said they had experienced a traumatic event. When we reran
there was a positive correlation between people’s responses
the ANOVA adding traumatic experience (yes, no) as a
about having the choice of the drug and their responses about
factor, we found the same pattern of results. That is, there
whether they would take the drug, r(994) ¼ .42, p < .01.
was no effect for trauma, F < 1, but there was a
Again we wondered if people who had experienced a
Context Â Country interaction, F(1,971) ¼ 4.21, p ¼ .04,
traumatic event would have different attitudes towards taking
f ¼ .06. Although our conclusions should be taken as
the memory dampening drug. One possibility is that people
speculative because of the violation of random assignment,
who had experienced a traumatic event would have greater
they suggest that experiencing a traumatic event did not
awareness of its distressing after-effects and be more
affect people’s attitudes about having access to the drug.
inclined to want the drug. To address this possibility, wereran the ANOVA adding traumatic experience as a factor,and found that in fact, people who had experienced trauma
Who would want to take the memory dampening
were less inclined to take the drug (M ¼ 2.10, SD ¼ 1.29)
than people who had not experienced trauma (M ¼ 2.29,
Did the effects we found for who should have access to the
SD ¼ 1.25). The remaining pattern of results was the same.
drug translate into similar effects when people were asked
In other words, a 2 (context: restaurant or military) Â 2
whether they themselves would want to take the drug? The
(country: US or NZ) Â 2 (trauma: yes, no) ANOVA showed
answer is no. As Figure 2 shows, we found no effects for
no effect for context, F < 1, no effect for country, F(1,
where people lived or the context in which they were attacked.
970) ¼ 1.03, p ¼ .31, but an effect for trauma, F(1,
Instead, we found that across these factors, people tended to
970) ¼ 5.03, p ¼ .02, f ¼ .07. This pattern of results held
reject the drug when given the choice to take it. In other words,
only for those people who had experienced a traumatic
there was no effect for country, F < 1, no effect for context,
event. People who had witnessed a traumatic event showed a
F(1,995) ¼ 1.27, p ¼ .26 and no interaction, F < 1. Unsurpris-
similar – although not signiﬁcant – pattern of responding,
ingly, the more people agreed that they should have the choice
Figure 2. American and New Zealand responses about taking memory dampening drugs
Copyright # 2010 John Wiley & Sons, Ltd.
Finally, we analyzed the data to determine if age or gender
response model of PTSD. Of course, people’s notions of the
were related to people’s opinions about wanting access to the
relative impact of comparatively minor and major trauma
memory dampening drug or exercising that choice. There
are misplaced, as the evidence arguing against a dose–
was no relationship between age and choice, r(974) ¼ .05,
response model of trauma reactions suggests (see McNally,
p ¼ .14; or age and taking the drug, r(973) ¼ .02, p ¼ .50.
(M ¼ 3.34, SD ¼ 1.50) and women (M ¼ 3.50,
In many ways, people’s widespread rejection of the drug
SD ¼ 1.41) had similar views on access to the drug
was surprising for several reasons. First, we live in an era
t(979) ¼ 1.72, p ¼ .09, d ¼ .11, but men (M ¼ 2.11,
where pharmaceutical advancements produce drugs that
SD ¼ 1.28) were less inclined than women (M ¼ 2.32,
would have been viewed as miracles only decades ago, such
SD ¼ 1.25) to exercise their choice to take the drug
as nanoparticles that act like small biochemical weapons,
selectively destroying cancer cells (Murphy et al., 2008). At
The primary purpose of this research was to examine
the same time, people are increasingly willing to seek out
people’s attitudes about memory dampening drugs. Taken
cosmetic treatments that selectively destroy eyebrow
together, these data suggest that people generally rejected the
furrows. In this context, Chatterjee’s (Chatterjee, 2004,
memory dampening drug. In fact, only 54% of people said
2006) idea of cosmetic neurology reﬂects a public’s
they agreed with having the choice to take the drug (rating
willingness to selectively destroy or minimize even minor
four or ﬁve on the scale), and an even smaller percentage of
ﬂaws. On the face of it, then, it is interesting that people were
people agreed that they would exercise that choice (18%).
not more favorable about a memory dampening drug. But as
This less than enthusiastic support for the memory
Riis, Simmons, and Goodwin (2008) showed, although
dampening drug ﬁts with the research suggesting that
people said they were willing to take drugs that improved
people readily generate rosy futures in their minds, more
their attention and concentration, they were less willing to
ﬂuently imagining positive events and outcomes than
take drugs that changed more social attributes – such as
negative ones (Newby-Clark & Ross, 2003).
anxiety and motivation – that people saw as fundamental to
Nonetheless, it is possible that people did indeed think
they would experience signiﬁcantly bad consequences after
We also found that when Americans adopted the point of
the assault, including severe PTSD (Gilbert & Wilson, 2007;
view of a soldier on a peacekeeping mission, they were more
Riis et al., 2005) – yet they rejected the dampening drug
in favor of having access to the drug than when they adopted
the point of view of a restaurant manager suffering a similar
One possibility is that such a pattern of results might well
attack on the way home. By contrast, New Zealanders
reﬂect general discomfort about tinkering with our mem-
showed no such effects. In addition, people tended to reject
ories, as depicted in movies such as ‘Eternal Sunshine of
the notion that they would take the drug themselves,
the Spotless Mind’.2 In other words, memory dampening
regardless of the context in which the traumatic experience
drugs may threaten people’s sense of their identities. If
memories comprise who we are, then does tinkering with
The fact that Americans who adopted the soldier’s point of
our memories change who we are (James 1890/1950;
view were more supportive of their right to have access to a
Neisser, 1988; Wilson & Ross, 2003)? Perhaps our subjects
memory dampening drug may reﬂect factors such as the
difference in how Americans and New Zealanders view
In addition, we asked people to make a decision about
the military. New Zealanders place little emphasis on the
the drug without knowing if they would ever develop the
military, as revealed by the small percentage of gross
negative psychological consequences that would have
domestic product (GDP) spent on it (1%) – a value smaller
warranted their taking the drug; that is, we asked them if
than its close neighbour Australia (2.4%) and signiﬁcantly
they would take the drug as a preventative measure. Of
smaller than the US (4.06%) (Central Intelligence Agency
course, it is not as though the notion of preventative drugs is
(CIA World Fact Book, 2010); see also Elvy, 2008). In fact, a
novel – people around the world receive immunizations to
recent survey showed that half of New Zealanders were
ward off common and rare diseases. Still, perhaps people
unwilling to increase spending on defense even though 84%
would respond differently to a scenario where therapeutic
of people agreed the military was ill-equipped to deal with an
intervention occurred once people had already developed
PTSD, an approach that is gaining increasing empirical
The attitudes of Americans adopting the soldier’s point of
support (e.g. Brunet et al., 2008; Schiller, Monﬁls, Raio,
view do not square with the ethical concerns raised by
Johnson, LeDoux, & Phelps, 2010). It is also possible that
scholars and pundits: for example, although the President’s
when people considered the memory dampening drug, they
Council on Bioethics (2003) raised the idea that civilians
decided it would be wiser to pursue conventional treatments
who act in defensive public safety roles – police offers,
for PTSD symptoms ﬁrst before turning to something new
ﬁreﬁghters and other ‘ﬁrst responders’ – could have access to
a memory dampening drug, they expressed reservations
Another possibility is that people did not judge the assault
about extending the same options to soldiers – who, by
scenario we asked them to read to be a sufﬁciently signiﬁcant
deﬁnition, have both offensive and defensive roles (see also
trauma; that is, perhaps they would reserve the notion of
Henry, Fishman, & Youngman, 2007; Kolber, 2006).
‘trauma’ for rape, ﬁres and mass murder – a kind of dose–
Whereas public safety personnel defend against the causesof trauma, soldiers also create trauma; a drug that dampens
2We thank an anonymous reviewer for this notion.
their emotional response to waging war might act to produce
Copyright # 2010 John Wiley & Sons, Ltd.
a ‘killing machine’. There is no evidence that American
subjects shared this concern. Of course, we did not ask themto take on board speciﬁc ethical concerns in making their
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Trastuzumab emtansina (T-DM1), de Roche, alargó significativamente la supervivencia de mujeres con un tipo agresivo de cáncer de mama R o che (SIX: RO, ROG; OTCQX: RHHBY) ha comunicado hoy los resultados actualizados de la supervivencia en el estudio de fase III EMILIA, los cuales muestran que mujeres con cáncer de mama HER2-positivo metastásico vivieron significativamente más (s
For our patients: Please note that our virtual colonoscopy procedure involves insertion of a small enema tip into the rectum so the colon can be inflated with carbon dioxide to allow visualization. This commonly causes a brief period of discomfort, cramping or the sensation that an “accident” may occur during the inflation sequences. Our CT technologist will guide you all the way. The i