Should we use drugs to enhance cognitive performance?
Maxine Clarke
Monday, 01 December 2008 17:40 UTC
There is a growing trend to take prescription stimulants (Adderall and Ritalin for example) in order to enhance cognitive performance – perhaps in attempt to obtain better grades or increase learning capacity. Nature has been reporting on developments in this controversial area and providing a forum for discussion. In a Commentary article published online today (_Nature doi:10.1038/456702a; 7 December 2008) Henry Greely and co-authors, who include Philip Campbell, Editor in Chief of Nature, say that society must respond to this demand. The authors call for:
- a presumption that adults should be able to use drugs for this purpose
- an evidence-based approach to evaluate the risks and benefits
- legal and ethical policies to ensure fair and equitable use
- a research programme
- broadly available information about risks and benefits
Do you agree with the authors that new methods of improving our brain function should be welcomed, to improve quality of life and extend lifespans? Will safe and effective cognitive enhancers benefit the individual and society? Or should these drugs remain illegal for these purposes?
The Nature Commentary is published online tonight (7 December) and will be in the 11 December 2008 print edition of the journal.
Previous Nature Network discussion responding to the question ‘would you boost your brain power?’
Updated 08 December 2008 08:27 UTC
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The Commentary article is free online until 18 December, I’m told – but you have to be logged in to see it (i.e. register with nature.com).
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Thanks Maxine, I thought I was automatically already – but I wasn’t…but I am now! Darned technology – I am never going to get used to it!
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Anonymous
I was a teacher for years. I had many students labeled ADHD who took these drugs. These teens tended to be extremely thin (these drugs suppress appetite), and they had learning problems even with the drug. I think we should educate people in a more natural way, with OJT and apprenticeships, instead of chaining them to desks and drugging them so they can memorize tons of useless material they will forget after the exam. Most of the people calling for “cognitive enhancement” are not calling for it so they can THINK more clearly; they want to pass exams for medical school or the bar. How much will they remember long term, especially since they will probably not be fueling their bodies properly? Do you want a surgeon on amphetamines? I do not. I do not want to see the use of these drugs becoming widespread. The kids I knew who took these drugs tended to have other issues. Just because something is happening does not make it right. Drugging healthy people makes profits, but not sense.
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Anonymous
The people that sponsored this paper have no idea how dangerous this could be. They have never had to deal with someone whose doctor gives them a prescription for the generic equivalent of Adderall (amphetamine salts) and that never ever follows the prescribed dosage. I have personally witnessed someone who has not followed the recommended dosage for this medication and have seen them become manic many times when taking much more than the prescribed dosage. When they become manic they are likely to go “ballistic” over anything they perceive as upsetting and become physically dangerous to themselves and others around them. The really sad thing about this is the person who receives the medication refuses to stopping taking more than the recommended dosage because they apparently enjoy the “high” caused by the higher dosage of the medication and will stay up for days at a time. This person has the prescribing psychiatrist totally fooled because by the time the psychiatrist sees the person, the prescribed supply has long since been used up so the psychiatrist never sees how the patient behaves when under the influence of the medication. When this person is not taking the medication they are as normal as ever. I wish I knew how to stop this person from abusing this medication, but reporting the problem to anyone would only make it worse.
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Anonymous
Shame on the authors of this commentary.
Shame on them for arguing for a “full steam ahead” approach (a “presumption” to allow use) even while acknowledging they have no idea yet of the potential consequences (i.e., no “evidence-based evaluation” yet).
Shame on them for suggesting that their philosophical approach is all that is applicable, and that others already “have been persuasively rejected”. If that were true our universities wouldn’t have philosophy departments anymore. This is just the hubris of science.
Shame on them for implying that a strict utilitarian calculus is all that matters, that we should do whatever benefits society most, regardless of the impact on the individual (as long as it is “minimized”), that individuals are just cogs in the societal machine, and we can require them to take drugs if it benefits society.
This last point, especially, is “scientism” at its worst, rejecting all other domains of human understanding, especially philosophical and religious, that place value on the individual. The authors should go back and watch Star Trek II and III again, to see the difference between being Vulcan (supposedly logical scientism) and being Human.
Replace “cognitive enhancment drugs” in this commentary with “genetic and reproductive manipulation” and we end up with an argument for eugenics. Shameful.
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Timothy Leary advocated the same – LSD can be a great cognitive enhancer. Freud thought cocaine was the greatest gift to mankind ever as it was such a fantastic cognitive enhancer. Slave owners found cocaine a great boon in increasing the production from their slaves. Marijuana is great to help those in mundane lives accept their lives and just trudge through without complaining too much – is that ‘cognitive enhancement’? It increases their productivity and lowers their costs. As previously stated, nicotine is a proven cognitive enhancer, if you don’t mind cancer, and other cognitive deficits, and loss of control of your own behavior. Military pilots already take stimulants for long flights – and are carefully monitored for abuse. Airline pilot’s already have one of the highest alcohol abuse rates – is it good giving them these “cognitive enhancers”?
But what exact ‘cognition’ are you enhancing? Most of the cognitive enhancers have shown great results in cases where a simple response is required, but they tend to inhibit the ability to acquire flexible representations. These compounds have been great at enhancing learning in one specific case – and addiction to the substance, and an inability to now think flexibly and alter their addictive behavior and drug seeking behavior.
It is also said that it is a fine line between genius and lunatic, particularly in the arts. If people learn specific associations even better without the distractions of random and odd association, how important do we really consider thinking outside the box? If say da Vinci increased his focus through these drugs, how productive would that actually have made him? he may have become one of the greatest physicians of his time, at the loss of his art and inventiveness. College students use many of these to ‘enhance’ their cognitive ability – on tests that overwhelmingly test rote memory – not creative thinking and application of knowledge. If the tests were changed to more reflect application of knowledge in life, would the drugs still be popular? So we need to not only define what we mean by cognitive enhancement, and not limit it to the over used and abused IQ measures, and also what we define as productive. SO then do we take ritalin to increase our focus, and then also take LSD to increase our insight and creativity?
As the authors mention – many ‘natural’ things increase cognition, but in an across the board fashion. So should we be popping pills, or pumping iron? How many people will simply take the pill instead of getting on a bicycle for 20 minutes, or a good swim, or brisk walk? Focus and production are great, for a robot or computer, or assembly line, but do we really want to say emulating those is the greatest endeavor or goal of humanity?
But then a pill is always easier than doing it yourself in our busy world. You can pop a pill and get an extra 3 hours of work, or get out and walk an hour. See new things, increase natural levels of neurotransmitters balanced by the brain controlling it itself, not by what concoction a pharmacist thinks will be best for the ‘average’ person. Or is that the point? everyone should be the same and average to make our world run smoother and easier? How about instigating a national exercise program? Fight obesity and increase cognitive abilities all at the same time.
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I’d like to know what drugs Henry Greely and his co-authors take — how totally irresponsible to suggest that we healthy people now need to take drugs to compete! Which of the pharmaceutical companies are they trying to appease to obtain a grant for their study? I find it appalling that the human race is coming to this. Can automatons be far away?
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Indeed, nicotine is a cognitive drug. But as with amphetamines and alcohol, there is a struggle over laws. Any substance can be helpful or evil.
I actually have an agenda involving use of Levy numbers instead of random numbers. In the case of pharmaceuticals, this may suggest an explanation for effectiveness of homeopathic treatment. It is also important that we realize that cognitive chemicals may be environmentally persistent. What if all the fish outsmart our nets?
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Surely you jest. Where is your evidence? Where are your randomized controlled trials? Where are your benefit/risk analyses? Where is your conscience? Do any of you remember “First, do no harm?” How did any of you ever qualify for a medical license?
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There is a fundamental misunderstanding about the nature of cognitive enhancers. I started studying these things in the early 80’s, and while I’m not in the area anymore, nothing much has changed drastically in the intervening quarter century besides the synthesis of compounds that produce fewer side effects than their predecessors.
The fundamental fact is that unlike mood enhancing/altering drugs, cognitive enhancers require your unswerving cooperation to “work” (and I define “work” as producing some reliable measurable outcome that is discernibly better than your cognitive performance in the absence of the drug). In this respect, as a “drug”, they are less like an antibiotic (which works without you having to do anything strategic other than take them as prescribed), and more like anabolic steroids (which requires you to actually DO something specific in order to produce the intended outcome).
What they need from you in order to work, is a strategic mind, or more specifically, a cognitive strategy and set of habits that the neurochemical system being affected by the drug supports. No drug has ever, or WILL ever substitute for a strategy. So if you aren’t deploying the required strategy at the moment, the drug does bupkes. This is why in study after study after study, when some cognitive enhancer is given to subjects in any of a variety of species, SOME of them show benefit, some show no effect at all, and some show negative effect. Because all subjects are thinking something different and possess a different default repertoire of strategies. No study will ever permit you to predict a priori who will experience/demonstrate what. This is a lesson that has been lost upon neurochemists and brain scientists who seem to know more about the molecules, than about the mental processes underlying cognition.
Sadly, while cognitive impairment can be easily produced with specific disruptors, quite independent of the volition of the subject, cognitive enhancement (again, performance above normal expectations) requires significant volition on their part. If you park your car at a mega-mall and don’t bother to take a few moments to commit to memory where it is parked, no amount or type of drug in the world will make recall any more likely BECAUSE THAT’S HOW MEMORY WORKS. It is asymmetrical in that needs for you to DO something to produce a better outcome, even though a drug or deficit can produce a worse outcome in spite of your best efforts. It is not a passive machine that can be easily provoked into optimum function by mere molecules.
So, to sum up, faith in such a Brave New World is sorely misplaced. Moreover, a great many people tend to overestimate the cognitive difficulties they may be having relative to others. In that respect, it is a bit like the entire “penis enlargement” industry that makes profits on the backs of sexual insecurity as opposed to real need. Who DOESN’T wonder if they are smart or attentive enough?
You can start backing up the snake oil tanker trucks now.
Get thineself a good night’s sleep, and a decent education, and you’ll be in better shape than anything such substances might conceivably be able to do.
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