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
