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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Anonymous
I don’t buy my drugs from the man.
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If neurobiology, and indeed all of biology, is right, then we are the sum of the capacities of our chemical constitution arranged as cells in a coherent organism. What brains can do is in large part dependent upon what chemical signals are passed between cells, in order for those cells to do well what they do.
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I’m convinced: where do I find the stuff?
The point is not that these (or any other) drugs should be prohibited: it is that people taking it should bear full responsibility for the consequences.
This means that adverts should clearly state the possible ‘side effects’ or unwanted reactions, so people can make an informed choice. This is what I would call adult responsible behavior.But where do they sell them?
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It’s easy to agree with the authors’ call for more data and evidence-based policies, less so with brave-new-worldish visions of pupils, soldiers and employees required to cognitively enhanced, or else… The enlarged quote “Many kinds of employee may benefit from enhancement”, slyly points to the many kinds of employer (NPG?) who’d benefit even more.
The parallel with plastic surgery, a private choice, seems to me more apt than with doping in sports where common rules apply.
Drugs won’t go away, prohibition never worked – “on some campuses 25% of students have used them in the past year”. Where does the variation come from?
Careful regulation, i.e. no ham-fisted ban, plus lurid health warnings, education campaigns might. They might even breed a generation of contrarians, proud of their “100% natural” mind.
Tks for the provocative Commentary.sylvie c.
I second Monica Zoppe’: Where do they sell them?
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It’s easy to agree with the authors’ call for more data and evidence-based policies, less so with brave-new-worldish visions of pupils, soldiers and employees having to cognitively enhance, or else… The enlarged quote “Many kinds of employee may benefit from enhancement”, points to the many kinds of employer (NPG?) who’d benefit even more.
Drugs won’t go away, prohibition never worked – “on some campuses 25% of students have used them in the past year”. Careful regulation, i.e. no ham-fisted ban, plus lurid health warnings, education campaigns might. They might even breed a generation of contrarians, proud of their “100% natural” mind.
Tks for the provocative Commentary.sylvie c.
I second Monica Zoppe’: Where do they sell them?
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There are a bunch of issues that are all tangled up here.
1) The practical question of whether such substances “work” in a predictable and advisable way.
2) The public and professional understanding of how they work, so as to assure their appropriate use.
3) The wider cultural impact of acknowledging such substances as appropriate and desirable to use.
4) The legal issue of whether a distinction should be made between such substances, and anythig else one might take/use for the general purpose of self-improvement.
There are probably other issues, too, but these 4 come to mind imediately.
When I used to teach as a junior faculty member, I would often find myself with 6 hours of lecturing to do on a given day, with a few hours in between classes. The thought of a 10hr workday that required me to be able to think on my feet and respond to student questions many hours after starting the day was daunting. At the time, I was aware that much research had been conducted into ways to supplement cholinergic systems of those in early stages of Alzheimer’s, and one of the strategies attempted was dietary lecithin supplements, so I decided to try popping a few grams on days when more “cognitive stamina” was called for and I was concerned about running out of “brain juice” as I like to call transmitter depletion. (I think it may have even been Suzanne Corkin or Richard Wurtman who mentioned to me in the hallway at a Society for Neurosciences meeting about what form of supplement was most likely to result in higher levels of available circulating choline.) My experience was that it did nothing in particular to my thinking, but son of a gun, on those days when I would normally have started to cognitively wane around 3:30 in the afternoon, I was still sharp at 5:30. That’s why I describe it as “cogitive stamina”. Of course, if I was an idiot that day, for whatever reason, nothing helped; I was an idiot ALL day.
Now, that sort of substance is fairly innocuous compared to what’s out there these days, and is not all that much different from recommending bananas or warm milk for those eager to leverage their sleeping with L-Tryptophan supplements. But the application is a very nuanced one, and one that I think a great many just don’t grasp fully. The substance doesn’t DO anything. It lets ME “do” something.
So when we start to talk about the free and legal access to something, we need to ask questions about how it might be used. This provokes questions about whether people understand how it ought to be used, which in turn provokes questions about whether it actually does what people think it does, and what it is that it actually DOES do.
It is my contention that perhaps the greater challenge is not the development of substances, nor the legal aspects, but rather the conceptualization of how a substance might impact on cogition in a positive direction when the individual has no particular impairment to start with. We KNOW that we can screw up normal cognition with drugs (and there are millions of people in prison, and families of deceased, who can vouch for that). We have SOME evidence that people whose cognition is lacking due to disease-related processes can SOMETIMES be improved upon by taking pharmacological steps to reverse some known neurochemical deficit or dysfunction. But when it comes to regular folks who have no known problems, the manner in which a substance could conceivably render cognition “better” or “improved”, and the classification of current and future substances into some nosology of types of action or cognitive enhancement, truly escapes us.
So, until we have a better grasp and model of what such agents “do”, I think it premature to ponder releasing them for public consumption. Call me Mr. Nanny State, but people need protection, and sometimes simply protection from false hopes, confusion, and bad advice. Lord knows they have enough of each already.
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Monica Zoppè wrote “The point is…that people taking it should bear full responsibility for the consequences….This is what I would call adult responsible behavior.”
The problem with this libertarian position is that our actions impact not just us alone but other people too. Just as in sports where non-dopers would suddenly have to compete with those willing to dope, so to tenure decisions, competitive funding decisions, highly competitive conference publication, all will now be done between those willing to dope and those not wanting to dope. As another suggested earlier, will my tenure committee now suggest, at my annual review, that I am lagging and should think about “enhancing” myself?
Adult responsible behavior means proactively considering what impact on others our actions will have, not just reactively taking full responsibility for the consequences.
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As an academic I recognise the pallor in some of the discussion in this thread. No wonder our critics acuse us of not living in the real world. Also being a clinician I take a different view.
Some talk as though our imperfect world operates with many perfect systems. It doesn’t. Everything won’t just turn out fine if we make poor choices.
Some laws are effective enough, some are not so useful for many reasons and some are justifiably considered unhelpful or even foolish or destructive. Regulations follow the same pattern. Indeed this basic pattern can be observed in parmacological development, drug marketing, clinical practice and the list goes on ad infinitum. Where then is the room for presumption of efficacy or safety. These are difficult enough to achieve on a case by case basis and demonstrably impossible to achieve at any greater scale (just look at MEDWATCH for example).
Every single pharmacological agent is unsafe and if used without due care, and in some cases severe restriction, will cause harm. Agents as common as oxygen and as popular as ethanol will cause neurological damage. The psychotropic therapeutic chemicals are especially toxic. The misuse and abuse of these chemicals is already a problem for many individuals and for society at large.
The Commentary essentially takes the position that since there are already substances and processes that we know are dangerous, what’s the big deal about a few more? (As I have implied earlier, their grasp of ethics leaves much to be desired.) A more appropriate question would be, how can we responsibly and effectively ensure there are less?
Messing around with brain chemistry is a very risky proposition. Even highly skilled clinicians acknowledge that prescribing psychotropics is akin to adjusting a fine Swiss watch movement with a sledge hammer.
Does this support the need for further research? Certainly. Research targeted at solving real problems, not pandering to the lazy and the elitist or those who imagine that widespread use of ‘enhancing’ agents would so improve the world that the inescapable associated harms would be justified.
Remember, when you dope people, what you get is dopes.
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Many lured to taking these drugs will be young students in secondary school, college or university hoping to boost their academic performance. They will be under the influence of these drugs while neural networks in their brains are still taking shape. They may feel the need to continuously take these drugs for years to maintain their performance.
Persistent use of such drugs may influence our perception of who we are and what we are capable of. The practice will profoundly change our identity. In addition to the unknown mental woes associated with the use of psychoactive pharmaceuticals in adolescence, the detoxification and clearance of these drugs over decades may overburden liver and kidneys, resulting in irreversible organ damage.
We are ill-advised to expose the healthy public to such risks for marginal gains.
Dr. Richard Friedman has written an insightful editorial published in The New York Times on April 15, 2008, warning of the risks of using such drugs in adolescent patients with mental disorders. With great concern, he alerts us to the fact that we do not understand how early drug therapy may impact the development of our normal selves. I have posted more on the subject on my blog.
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Be responsible for your own behavior, and do what you think is best — or not. In the end, it’s your life to make beautiful or screw up. There’s always a price to pay for screwing up, so make good choices.
If people choose to take drugs, well, that’s a choice. If others turn to herbs for brain oxygenation and psychoactive stimulation or healing, then that’s another choice.
Medical science strongly indicates that organically grown herbs are much less damaging to the planet and to the human body, are less expensive and are already an ancient component of the global culture, and our existing biochemical circuitry.
The authors’ opinion has potential value in that it could serve to obviate a black market in Cannabis, once objective comparisons and studies have been done, and free will is allowed to operate.
My ‘litmus test’ for whether use of a particular substance should be socially discouraged or stigmatized is the effect it is has on our drinking water. Drugs need to be clearly identified as environmentally benign, or not, after passing through the human body, so people can make responsible, individual choices about which drugs they consume.
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