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
-
Replies
Jump to resultsResults
-
Oops, that should read “NOT evidence based” rather than “now evidence based”.
-
In George Orwell’s “1984” he described the future when everyone ingested a drug called “Soma.” It acted as a form of authoritarian mass control. It had the properties of great efficacy in making people comfortable and happy with their lives, perhaps a benighn form similar to Freud’s description of religion as “the opiate of the masses.”
Suppose it were true that a drug existed without harmful side effects, assuming that it was taken in the recommended dosages (not an assumption likely in reality to be true for many); and assuming that it did enhance cognition, alertness, and focused energy; indeed, assuming that it even enhanced judgment and impulse control. Suppose also that there was good evidence based upon long-term followup studies that there was no harm or unintended consequences that were harmful. Would it not be something for everyone?
The answer here has to be a firm “NO!” The reason in my opinion is that this is not an empirical question at all, but a moral one. I have often puzzled why some parents firmly resist the use of stimulant drugs for their ADHD child, despite good empirical evidence of both efficacy and safety, at least in the near and medium term, with most followup studies indicating continued benefit without harm, and indeed with many now showing the prophylactic benefits of early treatment against drug abuse and later conduct disorders and antisocial behavior. Even the life-saving benefits now evident from driving studies in teenagers fails to persuade many to use the drugs.
There is something deep-seated in the psyche of many parents against the use of these drugs despite the evidence of their efficacy and safety. I have come to conclude that this resistance relates more to their moral values than to the data. It is not a rational choice to be made but a belief that to use the drugs in the service of desired changes for behaviors that can be changed by effort or practice of parenting skills is simply “wrong.”
I can feel sorry for the poor parent who must endure the out-of-control behavior of their child, which could often be reversed immediately with Aderall or Ritalin, but I cannot deny that they have made a moral choice according to their own value system.
The arguments against the drugs on the basis of drug diversion, unintended side effects, elite advantages in the educational, economic, or athletic competitions of life notwithstanding, there remains the moral aversion ingrained by our culture to the use of chemical aids in those competitive arenas.
-
Keith Conners makes a good point about moral aversion in this culture towards using pharmacological agents of proven efficacy and safety. Unfortunately, evidences of such kind of uninformed/misinformed, irrational, faith- and/or ideology based choices exist in quite a widespread manner even in other areas, too; think, for example, of the situation with vaccines. I sometimes shudder to think of the immeasurable harm some parents do to their children – perhaps with the best of intentions, or perhaps, more often than not, in order to satisfy their own egos or to follow some mindless, faith-based diktat.
But that is not the point. The main objection towards using drugs to enhance cognitive performance – at this point – should really be what Galves and others have cautioned about: The physiology and chemistry of brain is simply not elucidated yet to a point where the effects of a psychoactive agent designed to manipulate higher neural functions can be comprehended in totality, particularly with respect to safety, side-effects and unintended consequences.
A pharamcological agent takes about 12-15 years to reach the market from the bench. There are established guidelines for the steps they must take, preclinical testing for efficacy, safety and toxicity, clinical trials in 3 phases, and continued monitoring in phase 4. Even then sometimes things go wrong, particularly if the science behind any particular step is unsound, or choices made are venally motivated, disregarding scientific evidence or lack thereof.
Therefore, for psychoactive agents directed to higher neural functions, it is even more important to evaluate critically and rationally, without any bias, the research and the evidence gathered therefrom – before recommendations are made for their use. Unlike Mr. Galves, I did not see that article as irresponsible. I rather thought it an indication of a growing interest in an exciting new, hitherto unexplored, area. Safe and effective cognitive enhancers would certainly benefit the individual and society, but that safety and effectiveness must be rigorously and unequivocally established first.
But it is sad, indeed, to see that some people are using this discussion platform to push their preference for psychotropic agents (“drugs”) that are harmful because they are addictive, for which the harmful personal, social and economic consequences are well-documented.
-
Maxine Clarke: your admonition (which now seems to have been removed from the blog) of Jules Mopper and David Colhoun “….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” is inappropriate. There are now so many examples of doctors receiving large sums of money from pharmaceutical companies in exchange for favourable comments on their drugs that the professional opinions of these doctors are of little or no value. Psychiatrists seem to be particularly prone to this unsavoury association (see for example Christopher Lane’s “Shyness”: how normal behaviour became a sickness”). The medical profession has been extremely slow to set its house in order with respect to the distorting influence of the pharmaceutical companies on medical practice. Fortunately there are now a few signs that it is becoming recognized that something needs to be done to break the financial links between individual doctors and companies (“No free Lunch” and the bans on medical staff accepting gifts from pharmaceutical companies by Deans of Medicine at Stanford and Harvard, for example).
BS and RKC may claim to be blameless in this respect, but the evidence that so many of their colleagues behave inappropriately is now considerable. I therefore see no reason why their views should be “rationally and carefully considered” particularly not in respect of a matter from which drug companies will undoubtedly try to make their next fortunes, if they are able to lobby successfully (which they frequently are) to get cognitive-enhancing drugs made available for general use.
The authors comment in their article: “Although regulations governing medicinal drugs ensure that they are safe and effective for their therapeutic indications,…” This is what drug companies would have us believe and recent events (some reported in Nature) have shown that they are willing to suppress inconvenient deleterious findings on their products in order to sustain this belief. All drugs have side effects. No amount of research will produce a cognitive-enhancing (or any other) drug that is free of side effects. If such drugs were to be legalised then the incidence of untoward effects would be in proportion to the number of people taking these drugs, as is the case for all drugs. There is no justifiable cost benefit analysis that can be applied to the general use of cognitive-enhancing drugs, as the situation is completely different from a patient with a diagnosable real illness (not one invented by a drug company).
The authors suggest putting the onus on physicians to provide advice on the ethics of appropriate prescribing of cognitive enhancers. However, the authors are naïve in suggesting that unlike other groups that they recommend should also be consulted, because physicians do not have direct conflicts of interest. Many do and should therefore be excluded from involvement formulating a “physicians response” to this troubling problem.
When I first saw the article I thought it was a pre-Christmas wind-up in rather poor taste. Unfortunately it is clearly much more serious, -
Note: my earlier comment has not been removed. One or two comments have been removed from this thread, one at the request of the person who wrote it, and the others because they were spam.
-
The Drug War is unlawful. Unfortunately, a Legal System has gradually supplanted the Law of the Land. The Brotherhood of Juris Doctors now rules supreme making contemporary America a nation of men rather than laws.
No Power that is repugnant to the Principles underpinning the July 4, 1776 Action of the Second Continental Congress has Lawful Authority.
Unfortunately, since the law of the Land has been supplanted by a legal system that is rotten to the marrow, many unlawful powers are now legal.
Lawful and legal are not synonyms. There is an ethical element in lawful that is absent in legal. Human beings are morally obliged to defy bad laws or at least refrain from interfering with those who do.
There is no lawful way to punish individuals for what they do for or to themselves.
We hold these Truths…
tgsam
-
Readers might also be interested in Martha Farah’s Nature Network entry here. It is about a previous Nature publication on the topic, but of interest in the context of this online conversation here, I think. (Martha Farah is one of the authors of the Commentary being discussed in this thread).
Readers might also like to watch out for tomorrow’s issue of Nature, in which we publish a selection of responses to this Commentary. That is, the issue dated Thursday 29 January 2009, Correspondence pages. The journal is live online at around 1900 hours GMT tonight (Wednesday 28 January).
-
Here is the link to the first of those Correspondence letters. The rest can be accessed from the links at the bottom of this contribution.
-
In their December 7, 2008 article, Henry Greely and colleagues compare cognitive enhancement drugs to:
using a calculator,
using a computer,
receiving an education,
drinking coffee,
sleeping,
taking vitamins,
using written language,
using printing,
using the Internet.However, we know that drinking coffee is not the same as using a calculator. The association of cognitive enhancement drugs with such different ordinary “enhancements” appears to be an attempt to make the public comfortable with the use of such drugs.
A challenge to the authors: Rather than simply stating that cognitive enhancements are like sleeping or using a computer, define the exact relationship between cognitive enhancement drugs and all of the above tools and natural remedies. Are cognitive enhancement drugs still so ordinary after all?
-
The basic lesson from all the history of psychotropic drugs is that brain is a delicate clockwork and it tends to go back to equilibrium if pushed just a bit, and goes BANG when pushed too hard. Even caffeine, which many give as an example of a safe cognitive enhancer, when used regularly only produces mild addiction with little cognitive or attention benefit. Of course acute use is clearly beneficial to people who need to have heightened attention here and now, but it is very easy to slip into the habit, which only causes problems.On the other hand, one might argue that our brain was not evolved to sustain such high load of cognitive tasks as it is forced to perform nowadays, so maybe a little pharmacological help would be welcome. Healthy people already chronically use drugs, such as birth control pills, which arguably enhance the quality of life with very few dangerous side effects.
My basic point is, do we really know that these drugs enhance cognition in the long run in healthy individuals? No. Do we know that they are devoid of serious long term effects? No. How do we find out? By studying these effects, but for goodness’ sake, don’t leave it to the Big Pharma, which is not exactly known for its high ethical standards. Let’s not forget that this is potentially a multibillion dollar industry.
We will probably soon learn much more about the benefits as well as the drawbacks of using the so-called cognitive enhancers. The costs, I bet, will be non-trivial both for the individual and for the society at large. At the end of the day we will have to make the calculation: is it better to have one super-surgeon on dope who will work him- or herself into disability at the age of 60 or maybe should we hire two instead and have them work half the hours and live successful and happy lives without cognitive enhancement. How do we factor human suffering into such an equation?
Feel free to visit my blog to discuss this and other issues in biomedical research.
Results
-
