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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Mark Hammer’s Dec 8th reply details accurately what I perceive to be the crux of the matter – that ’cognitive enhancers require your unswerving cooperation to “work” ’. It appears that for these and similar drugs that the benefits are generally small but real. However, this benefit comes to the prepared and dedicated, and so the drugs are unlikely to turn an idiot into a brilliant scholar.
For steroid use in sports, the athletes are already highly trained, and the benefits of training on steroids provide the improvement necessary to compete when only a few percentage points separates starters from journeymen.
The issues discussed in the Commentary appear to be only relevant to minor changes in cognitive ability. For example, as Hammer wrote, one still has to practice the habit of attention to benefit memory.
What if the drugs had the power to radically change our abilities as Charlie Gordon experienced (albeit by an operation) in Daniel Keyes’ “Flowers for Algernon”? Then the problems would really start, including have and have-nots, freedom to choose and imposed dosing. The disparity in people’s cognitive abilities, in all its flavors, is I think more variable presently than the incremental enhancement by these drugs. But what if the drugs were really much better?
Baseball players have said that they took steroids just to keep their jobs once more and more of their teammates took the drugs. The difference between a 275 and a 300 hitter is only one extra base hit for every ~ 35 at bats over the season – about one extra hit every two weeks.
I doubt the current drugs are going to radically change the way students learn, or researchers work. But it most certainly is the time to start thinking about what happens when, inevitably, the drugs or implanted chips get better to the point were NOT having using them will leave you at a distinct disadvantage.
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This debate will be interesting. On the one hand, if the drugs can improve someone’s prospect in life without side effects then why not? On the other hand, some people will argue that this is cheating (i.e. in exams, tests) much like performance inhancement drugs in sports!
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One of the most perceptive critiques of human enhancement appears in a 2003 report by the President’s Council on Bioethics, Beyond Therapy. “Persuasively rejected,” sniff Campbell and Harris et al. Hmmm. Perhaps they hadn’t taken enough Adderall to grasp Beyond Therapy’s analysis (largely the handiwork of Leon Kass, of the University of Chicago, it seems). Perhaps, more to the point, they know a lot about enhancement, and very little about what it means to be human. After all, they are thorough-going materialists who believe that humanity is just another animal, just a genetic code. He has no free will, no capacity for reason, no ability to transcend matter. Enhancement means tinkering with the circuitry, not growing in wisdom or virtue.
The Beyond Therapy report is far deeper. It points out that enhancement could be incredibly destructive: “Not the agelessness of the body, nor the contentment of the soul, nor even the list of external achievements and accomplishments of life, but the engaged and energetic being-at-work of what nature uniquely gave to us is what we need to treasure and defend. All other ‘perfections’ may turn out to be at best but passing illusions, at worst a Faustian bargain that could cost us our full and flourishing humanity.”
Speaking of Faustian bargains: Remember Timothy Leary, a respected Harvard academic who preached the transformation of humanity through drugs in the 60s and 70s? His favourite was LSD – and it ruined thousands of lives through suicide and mental breakdown.
However shoddy the argument in this article, at least its authors have linked responsibility to the use of drugs. Shouldn’t they also consider responsible use of editorial privilege? To use the world’s most prestigious science journal as a platform for this snake oil will bring science itself into disrepute. The warning bells have already rung. Human embryonic stem cells are a key technology in the transhumanist programme. Is that why scientists around the world were so easily duped by the fraudulent results of Korean stem cell scientist Hwang Woo-suk?
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Anonymous
While I’m uncertain of my acceptance of/agreement with/concurrence with the authors’ sentiments concerning new methods of improving our extension of lifespan, I absolutely agree with the utilization of pharmaceuticals to improve cognitive function. However, I must admit that my position on the question is strongly influenced by my personal experience. Twenty-some years after suffering a mildly displaced compression fracture of C-5, I began to experience temporary sensory and motor losses. My body’s aggressive arthritic response to the fracture had narrowed my spinal canal over time, pressing directly on my spinal cord. The solution I chose was aggressive spinal orthopedic surgery, which required 8.5 hours in the OR. Due to operating surgeon decisions, I did not receive a transfusion, and I emerged from the recovery room with a hematocrit of 29%. The hematocrit is the proportion of blood volume that is occupied by red blood cells. It is normally about 47% for men, which means my brain was getting only 60% of the oxygen it normally receives for a period of several hours. Recovering from this surgery was a challenging and lengthy process. My recovery physically, in terms of returning to my normal level of fitness (45-60 minutes on a rotary trainer), took about a year. Five years post-op, I still had not returned to my normal level of cognitive capability. It was then that I sought the advice of a neurologist. After several neuro-function tests and a spect scan, I received a script for one 200 mg tablet of modafinil, twice a day. While the energizing effect occurs in 20-40 minutes, it took several weeks before I felt that I was beginning to recover command of my full faculties. Now, 9 years after my surgery, I’m actively employed, and no longer am I challenged with understanding that I know the answer to something, but I’m not able to locate the path to where that knowledge is stored. That cognitive deficit was very frustrating; I am very thankful that this pharmaceutical agent is here, and would mourn the day the public might lose that option due to the misguided actions of well-intentioned moralists. Recovery of my full cognitive abilities has taken four years of daily modafinil use, with only a mild deficit remaining (which could very well be due to ageing effects, since I’m almost 59 years old). So, my short response is, “Yes, I agree with the authors.” -
Two things 1) the difference between different enhancers 2) someone needs to throw the first stone.
1) As with all new technologies, I think many people don’t see the difference between enhancers and enhancers. This is probably especially the case in the public, but apparently also in the academic world.
For example, methylphenidate’s and other amfetamine derivates’ neurochemistry is quite different from that of modafinil. So, in an “evidence based approach” there might be good reasons to concider the harms from possible abuse to overweight the benefits in the case of amfetamine derivatives. However, concidering modafinil’s clearly lesser abuse potential the balance is not so clear cut on the safety scale anymore. Sure, it affects cognition in a different way too, but it might be exactly what you need in some situations, so why shouldn’t you be allowed the choice? Possibly because a number of other reasons, but the point is that there are other enhancers than amfetamine derivatives on the market and there will be plenty more in a not-so-distant future, so what shall we do with that next generation pill that we can’t restrict even with extensive trials based on safety arguments alone? That’s where the interesting and inevitable societal discussion begins. And I think it is better to have it now, when we know what is coming and have time to concider it properly, instead of getting caught with our pants down in five or ten years.
2) Secondly, just a brief observation about the commentary. Some of the examples seemed simplistic and downright naive (the invasive food/pill thing for example), but it might have been exactly their intention. After all, that
ishow youstarta discussion, which seems to be their and this forum topics main purpouse. After all, without this discussion, adolescens, college students and calimed other voulnerable groups would have no substantive arguments to say no to enhancements and they would have to relay on authorative “drugs are bad, mmmkay” messages, which we know independant, self-secure, young adults just love.In conclusion, I think “all sides” need to put in a bit extra effort in their arguments and that will only happen if someone writes an “outrageous” commentary in a journal like Nature. So, Good job!
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Anonymous
I fully agree with authors’ thesis.
Moreover, taking in account that happiness, joy and love are more important than work productivity or social recognition,(note that the last is just a mean to reach the former), their thesis should also apply to recreational drugs, such as ecstasy, cocaine, cannabis and others… that directly enhance happiness, joy and love feelings.
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Anonymous
Yes I agree completely with the views in this article.
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This is an extremely irresponsible article. Irresponsible because the authors don’t know enough about the brain to make the kind of recommendations they are making. I know this because I know that nobody knows enough about the brain to make those kinds of of recommendations. What we do know is that the brain will change in reaction to any mind-altering substances that are ingested into it. It will compensate and adjust in ways many of which we don’t know anything about. So when people stop taking the drugs, they will have withdrawal reactions, again many of which we know nothing about.
Very irresponsible indeed.
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Albert Galves has made a good point. Unfortunately some neuroscientists seem to have come to believe much of their own hyperbole. The fact of the matter is that almost nothing at all is understood about higher functions of the brain, For example, at the end of the “decade of the brain” we were hardly any closer to understanding things like memory than at the beginning. We still have no idea of what underlies memory, even in the most qualitative way, A superficial reading of the literature might give a quite different impression,
The need to get grants, and simple self-aggrandisement, serve to disguise the profound extent of our ignorance.
Of course it should not escape our notice that there would be a great deal of money to be made if this sort of drug abuse were to become widespread, Neither should it escape our notice that the evidence that the drugs do the wonderful things that aare claimed for them is really rather thin.
The whole proposal smacks of the promotion of nutritional supplements that don’t work (in most trials)bit which make buckets of money, The difference is that in this case the drugs are likely to be rather more dangerous.
Is this science at all, or is it perhaps ‘alternative science’?
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I agree that we know very little about the brain. But I dont see how that leads to an approval of regulation. Regulation based on what evidence? Most drug prohibition is just fashion or herd mentality, now evidence based. And the urge to regulate is really a side effect of the existing “war on drugs” mentality. A mentality that itself is driven by the police-prison-mafia complex that benefits from drug illegalization, not from some kind of real health concerns. Instead of saying “we dont know enough to allow this”, we should say “we dont know enough to ban this” until we see evidence for harm. That would be the correct scientific attitude.
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