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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I just read a comment by David Colquhoun where he posts conflict of interest info on two of the authors:
Declaration: B.S. consults for a number of pharmaceutical companies and Cambridge Cognition, and holds shares in CeNeS. R.C.K. consults for and has received grants from a number of pharmaceutical companies.
Obvioulsy, I was wrong in calling these people “educated fools.” They seem to know what they’re doing. However, they also prove my point. Sad.
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Jules and David: I quote from one of the earlier comments in this conversation thread:
These authors may have some stated conflict of interest, which thankfully Nature requires authors to confess. However, that possible conflict of interest does not alleviate you, the reader, from your obligation to rationally and carefully consider their argument. They are not wrong just because they consult for pharma.
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Overall the Commentary titled “Towards responsible use of cognitive-enhancing drugs by the healthy” is so poorly informed and argued I am unsure if the cited authors are simply ignorant, significantly unskilled, deliberately mischievous or the hapless victims of editorial manipulation for what appears to be largely marketing purposes. Perhaps it is a combination of all these possibilities. It would be sad for the authors if by adding this publication to their CVs they hoped to enhance their career prospects. It would be sadder still, for all of us, if it did.
The writing is not what it purports to be. It is not worthy to be considered scientific and being so deliberately persuasive and inciting it has no academic merit either. It is manipulative and should be largely dismissed as merely part of the modern marketing enterprise. As marketing it is indeed an interesting piece. Consider for a moment the likely audience, comprised of reasonably educated people who are, shall we say, at least sympathetic towards the ways of modern science. Yet, typical of such purposeful marketing, it fails to respect consumers’ intelligence.
Consider the regular use of misdirection. This surely is not simply poor reasoning, it is misdirection worthy of master marketers. For example:
The commentary begins with the grandiose claim that “Society must respond to the growing demand for cognitive enhancement.” Why? This is a mischaracterisation of what would broadly be understood as a drug problem. The supporting discussion simply provides data describing part of the widespread drug abuse on college campuses. The authors claim “That response must start by rejecting the idea that ‘enhancement’ is a dirty word”. Indeed, they appear to be making an argument where none is required: enhancement is certainly not a dirty word, it is an objective targeted by educators every day. This is simply the first misdirection, employed to distract from appropriate “dirty words” like illegal drug use, drug abuse, drug related crime, and so on, masking them as understandable attempts at “cognitive enhancement”, a more acceptable topic for discourse among such a learned audience.
In the section headed “Paths to enhancement” we find the following. “It is too early to know whether any of these new drugs will be proven safe and effective, but if one is it will surely be sought by healthy middle-aged and elderly people contending with normal age-related memory decline, as well as by people of all ages preparing for academic or licensure examinations.” This is nothing more than a marketing statement. It adds nothing substantive to commentary or debate. Note too, that the ‘paths to enhancement’ include the misuse or abuse of prescription drugs but entirely different language is used.The suggestion that use of psychotropic drugs, when targeted at cognitive enhancement, “should be viewed in the same general category as education, good health habits, and information technology” is disturbing. That the authors, self-described as mainly comprising educators, fail to see the significant differences between such things as teaching and good health habits on the one hand and the consumption of experimental chemicals (and I would argue that even approved prescription drugs are still only experimental) on the other is bad enough to call their credibility into question. That they deem it appropriate to maintain this position as a moral conviction, by use of “should”, the moral imperative, blows their credibility completely.
Indeed their whole grasp of ethics is questionable and even their technical points are rather wooly. They claim that whereas education requires effort, sleep does not. This is a gross overstatement. The fact is that very many people have considerable difficulty obtaining sufficient quality sleep and many people invest a great deal of effort in attempts to do so. (Of course if people take the drugs they advocate there will be more people experiencing sleep deprivation and stimulus to yet another drug market.) One wonders in what sense “changing what we ingest” is “invasive”? And what is one to make of the sentence: “Cognitive-enhancing drugs require relatively little effort, are invasive and for the time being are not equitably distributed, but none of these provides reasonable grounds for prohibition.”? Who suggested that prohibition would be based on relative ease of acquisition? No one. This confused rambling seems to be part of the fundamental structure of the discussion presented in this Commentary.
Another example of both incompetent ethics and poor quality reasoning is so classic it may be studied by thinking students for years to come. The authors claim as follows. “Recent research has identified beneficial neural changes engendered by exercise10, nutrition11 and sleep12, as well as instruction13 and reading14. In short, cognitive-enhancing drugs seem morally equivalent to other, more familiar, enhancements.” Where is the reasoning that links beneficial neural changes in a collection of disparate areas to the use of psychoactive drugs? How does this even relate to the morality of those areas studied and how is a link established between those and the use of these chemicals? Even if we ignore the profound confusion here, at best the authors would be attempting to derive an ought from an is – something any student of ethics can tell you cannot be done (see Hume).
These confused ramblings seem simply to be a smoke screen that permits the placement of selected marketing messages. This deliberate use of cognitively-based marketing techniques, a poor NLP if you will, serves to implant statements into people’s minds while bypassing filtering. A confused mind is easy to manipulate. Note the placement of classic marketing material such as the pull-quote in the Johnson box that says “We should welcome new methods of improving our brain function.” At last, something sensible that a confused mind can latch onto, and what a useful marketing line, preparing people for the next phase in the campaign. Note that normally pull-quotes are at or near the text that they are taken from. This statement does not appear near this Johnson box at all. In fact, it only appears in the conclusion. When reading it in the conclusion many people will assume that it is supported by argument above, in the text of the commentary. While their minds may vaguely register seeing something about this earlier, few will be astute enough to recognise that this was never established by discussion, it was merely asserted in an aside! This is dishonesty, or manipulative trickery, but out of kindness we can simply call it marketing.
Readers do well to give due regard to the links between some of the authors and pharmaceutical companies. It is plainly absurd to advocate the widespread use of psychoactive drugs about which almost nothing is known. The real beneficiaries would be the drug companies and those related to them. Nothing in this commentary lends support for further efforts by drug companies to create a market where none exists.
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Maxine: 3 observations
1. Re 8 Dec editor’s comments on the post by Henry Gee. I consider the remarks to be highly inappropriate. They could be offensive to Henry and others who read them. They do not support a culture that invites open participation. They do not reflect well on the exercise of the editorial role.
2. Re your 9 Dec observation that some particpants appear not to have read the Commentary or your introductory post. Your point is quite valid and this represents effective thread moderation, serving to keep people on topic. I would note though, that those contributors to whom you refer may well be responding quite legitimately to the perceived thrust of the Commentary. While each of those statements you identify may indeed be found in the Commentary, the authors cannot hide behind them and pretend that their discussion is anything other than advocacy for the wider use of these psychoactive drugs.
3. Re your 9 Dec comment to Carol. The statement that “it is very common for those who support homeopathic or other alternative approaches to describe one-off “miracle” anecdotes” is a revealing comment. Your subsequent request that Carol stays on topic seems quite fair, but you clearly chose not to do so yourself, instead taking an opportunity to demonstrate your bias. Referring to “those who support…” as you do, is akin to the language of prejudice against women, the aged, and various minorities, that is best avoided for reasons that I hope are obvious. The reference to the gold standard of orthodoxy, the controlled trial, in relation to research into homoeopathic treatment invites further brief comment. Two recently published scientific papers (one in the journal Homeopathy and the other in the Journal of Clinical Epidemiology) that investigated a previous Lancet review that was anti-homoeopathy conclude that the Lancet got it wrong. Indeed, that an analysis of all high quality trials of homeopathy show positive outcomes. And if you want to refer people to books illuminating bad science (bad morally and technically) why not include Silent Spring by Rachel Carson? It conveys a message that is quite appropriate to the Commentary being discussed in this thread.
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Now could Peter Tyllee ND. PhD. possibly be the same Peter Tyllee whose web site offers
“Your Sluggish Colon is Warning You of Problems!
Discover How To Master Safe, Natural And Effective Home-Based Colon Cleansing With Inner Cleanse Recipes And Easy Step-By-Step Guides”.I presume that ND stands for Doctor of Naturopathy, naturopathy being of course one of those preposterous made-up subjects that Maxine Clarke so properly warned us against.
To get back to the subject, after Tyllee’s diversion to defend homeopaths, there us perhaps some analogy between advocating performance enhancers and much alternative medicine. Both offer pills of dubious efficacy and unknown safety to solve problems that are essentially of social origin, often to the great profit of the salesmen
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Comment by Peter Tylee: Re 8 Dec editor’s comments on the post by Henry Gee. I consider the remarks to be highly inappropriate. They could be offensive to Henry and others who read them. They do not support a culture that invites open participation. They do not reflect well on the exercise of the editorial role.
I’m not sure what the point of this comment is, or why my comments were ‘inappropriate’ or ‘offensive’. I should state that whereas I am an editor of Nature I had nothing to do with the Commentary, and indeed disagree with much of it, as should be clear from the tone of my comments, such disagreement being my right to express as a citizen with some experience of drugs that alter one’s mental state, and the consequences that inappropriate self-administration of these drugs might have.
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Homeopathy is not relevant to this forum. I do happen to believe that homeopathy has no scientific basis and is hokum.
Let’s please stay on track and limit the discussion to the article in question. I would request that people don’t comment here unless they have read the Commentary, which is summarized in my post at the top of this thread, and which is free to access online at Nature (via the link in my post) until 18 December. Thank you very much.
Some stimulating and thoughtful points have been made in this discussion, and I thank the people who have taken the trouble to make them. Please do continue! (But not about homeopathy.)
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Anonymous
There is a wider issue of perceived responsibility here. The traditional role of physician as healer does not sit with the category of enhancement. Plastic surgery serves a good analogy here, with views remaining varied on the ultimate responsibility. But with planned, novel, pharmacological intervention the physician must surely be party to the cause and thus a broadening of their role would be necessary.
Ultimately the call for risk/benefit research and a fuller understanding of mechanisms are therefore welcome, but the real beneficiaries, at least in the short-term, are likely to be dominated by the genuinely needy – neurological and psychiatric patients. These groups have had their needs for cognitive enhancement unmet for far too long.
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Henry: To clarify, my concern was not with the content of your post but with the added editorial comments.
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I felt that I was reading a sci-fi when reading this commentary. It is good that the authors take such a possible drug usage into account, but it is far TOOOOOO early to introduce such drugs into daily life of healthy people.
Safety is the biggest problem, which seemed to be understated by the authors (only three paragraphs in such a long article). If we do not read this commentary careful enough, we would get an impression that the drugs are ready for use now. Just do a simple search on the internet, you will discover that the drugs mentioned in the commentary are far from safe. Side effects, chronic usage, withdrawal symptoms (for example, sudden stop of methylphenidate usage will cause withdrawal symptoms) are not mentioned in the commentary at all. The risk and gain of using such drugs for healthy people are highly unbalanced. The safety risk alone already outweighed gain, so “maximum benefit, minimum harm” is totally impossible.
What is the possible gain? I agree with Terry Kremin’s opinion in the post on Dec 8. I don’t think having focused attention would make a person being defined as a “smart” guy. What about reasoning (modafinil can impair clarity of thinking)? Can these higher brain functions modified by simply disturbing one or two kinds of neurotransmitters in the brain, on whole-brain scale, without much selectivity? Isn’t this extreme reductionism? These drugs are not panaceas to treat “stupidity”, and stupidity is not a disease, and therefore could not be cured by drugs.
The commentary based it’s argument on this logic: the cognition-enhancing drugs are good, so we healthy people should use them. The drugs available now are not good enough, so we are not ready for such drugs now. We should understand our brain clearer (at least we should understand what makes a genius), and produce cognitive-enhancing drugs as safe as coffee and tea, then can we consider put them into daily use.
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