Cognitive enhancing drugs - just because we can, should we?

In a discussion forum last month, leading bioethicists expressed support for the use of cognitive enhancing drugs. Researchers have claimed that drugs used to treat ADHD (Ritalin, Adderall) and narcolepsy (Provigil) are widely used in the healthy to improve focus and memory. Bennett Foddy, deputy director of the Institute for Science and Ethics at the University of Oxford, foresees many benefits of making cognitive enhancers acceptable in society. “So far as we can tell, cognitive enhancing drugs have a higher effect on people with lower intelligence,” said Foddy. “So it’s actually an equalizing force. Far from giving some people an unfair advantage, it’s a way of minimizing the unfair advantage which comes about because of differences in people’s genetic endowment” (qtd. in Chinthapalli). Another speaker claimed that there seems to be no moral problem with enhancing ourselves, since it is difficult to judge the boundary between therapy and enhancement in medicine. In regard to the issue of addiction, it was argued that the same problem comes up with many drugs—including alcohol—and that the “benefits outweigh the risks.” The speakers agreed that more studies on the effects of these drugs in healthy people should be performed (Chinthapalli).

But in this case, are the opinions of bioethicists reliable? First of all, the claim that cognitive enhancement is widespread may not be valid. The only evidence of common nonprescription use of Ritalin and Adderall by college students is surveys, which rarely ask specifically about the use of the drugs as enhancers. For instance, the 2009 National Survey of Drug Use and Health asked about the use of a stimulant “without a prescription of the individual's own or simply for the experience or feeling the drugs caused” (qtd. in Lucke et al.). However, students who report nonmedical use of these drugs could be using them to “get high” or to stay alert during late night parties. The same holds true for reported nonmedical use of stimulants in adults. While some adults may be using the drugs to enhance cognitive function at work, others could actually be using them to self-treat symptoms of ADHD (Lucke et al.). If cognitive enhancers aren’t as common as researchers believe, then attempts to facilitate the use of these drugs would be met with more hostility than anticipated. Secondly, the risk of addiction is of far greater importance than these researchers realize. A person taking Ritalin in acceptable doses and with medical supervision may not be likely to become addicted. But in large doses, stimulant drugs cause dependence and have a high potential for abuse.

If cognitive enhancing drugs miraculously improved brain function in healthy people, perhaps we could be willing to dismiss other concerns as secondary. After all, the prospect of reducing disparities in intelligence may seem attractive. But the extent to which enhancers improve cognitive functioning in people with neurological diseases and intellectual disorders is unclear (Lucke et al.). Moreover, recent scientific reviews draw attention to the limited evidence that stimulant drugs improve cognitive performance in healthy individuals. For instance, a recent study on the effects of Ritalin in healthy young men found increased activity in the region of the brain affecting attention. However, these findings did not correspond to “improved accuracy in working memory or visual attention tasks” (Lucke et al.). In addition, research showing the positive influence of cognitive enhancing drugs has important limitations. All evidence for the enhancing effect of Provigil, for example, is based on short-term trials in the laboratory (Lucke et al.). However, such results do not reflect on the practical benefits of long-term use of the drugs. No evidence exists to show that cognitive enhancers work over extended periods of time or in real-world situations. 

Everyone acknowledges that more research is needed to assess the benefits and harms of cognitive enhancing drugs in healthy people. But it is worth questioning whether these types of studies are even worth the investment. Contrary to media opinion, it seems unlikely that cognitive enhancers offer any true advantage for individuals and for society. The positive effects of these drugs over a long period of time in practical situations, if any, are probably minimal. Making stimulant drugs more accessible to healthy people would increase rates of substance abuse, offsetting any small advantage we might gain from enhancement. Bioethics researchers will have difficulty defending cognitive enhancers to a society that has also seen the effects of cocaine and the amphetamines. Not everything that is ethical is always acceptable. 

http://www.bmj.com/content/346/bmj.f1743

http://www.tandfonline.com/doi/full/10.1080/21507740.2011.611122#tabModule