Dec. 11, 2008 - What's wrong with healthy people taking brain-boosting drugs? Nothing, seven leading scientists and ethicists announced this week.
And there's nothing wrong with that, suggest the authors of a provocative editorial in this week's issue of the science journal Nature.
"We call for a presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs," they write. The editorial also calls for further research into the risks and benefits of using drugs in this way.
It's a prominent list of authors:
- Henry T. Greely, JD, professor of law at Stanford University; co-director of the Stanford program in genomics, ethics, and society; and co-director of the Stanford program in law, science, and technology.
- Barbara Jacquelyn Sahakian, PhD, FMedSci, professor of clinical neuropsychology at the University of Cambridge School of Clinical Medicine, England.
- John Harris, DPhil, FmedSci, research director at the University of Manchester Institute for Science, Ethics and Innovation, and research director at the university's Center for social Ethics and Policy in England.
- Ronald C. Kessler, PhD, professor of health care policy at Harvard Medical School and a member of the U.S. National Academy of Sciences.
- Michael Gazzaniga, PhD, professor of psychology and director for the SAGE Center for the Study of Mind at the University of California Santa Barbara.
- Martha J. Farah, PhD, professor of natural sciences and director of the Center for Cognitive Neuroscience at the University of Pennsylvania.
- Philip Campbell, PhD, editor-in-chief of Nature.
Sahakian and Kessler consult for a number of pharmaceutical companies, but the other authors declare no such ties.
The issue, they say, isn't for drug companies to make money. They suggest that responsible use of drugs for brain enhancement can be good for society as well as for individuals.
Controversial? You bet. Here's WebMD's guide to the issues.
What is brain boosting?
Brain boosting -- or, as scientists like to say, cognitive enhancement -- means making your brain work better.
There are lots of ways to do this without taking drugs: by reading, for example, getting plenty of sleep, or learning something new, such as a new language.
There are also ways to do this with drugs such as caffeine or the prescription stimulants Ritalin, Adderall, and Provigil. Other drugs, such as beta-blockers (Inderal, for example) may also improve mental function.
There is no such thing as a drug benefit without a drug risk. Caffeine has side effects; so do its sister drugs behind the prescription counter.
The FDA has ruled that the benefits of these prescription drugs outweigh their risks for people suffering certain medical problems. For example, people with attention deficit hyperactivity disorder (ADHD) may get help from Ritalin or Adderall. People with daytime sleepiness due to sleep apnea may get help from Provigil.
These drugs also have effects on healthy people. They can increase attention span, boost memory, and focus thinking.
Use of these drugs without a prescription is illegal. In the U.S., unauthorized sale of these drugs is a felony.
Who uses brain-boosting drugs?
In 2007, Sahakian and colleague Sharon Morein-Zamir surveyed their Cambridge colleagues on the use of brain-boosting drugs. They found a surprising degree of acceptance of the practice, at least in principle.
This led Nature to poll its readers. The poll suggested that one in five Nature readers -- mostly scientists -- had used stimulant drugs for nonmedical reasons in order to stimulate their focus, concentration, or memory.
Studies suggest that between 5% and 15% of college students use brain-boosting drugs. Most use Ritalin or Adderall while Provigil use remains uncommon. The Nature poll also found that many people take beta-blockers, such as Inderal.
What are the side effects of brain-boosting drugs?
People who take brain-boosting drugs risk obvious problems if they overdose. Brain-boosting drugs also have important interactions with other drugs or substances a person may be using.
For example, Provigil has not been tested in people who drink alcohol. Patients with Provigil prescriptions are advised to avoid drinking alcohol.
The most common side effects reported in the Nature poll were headaches, jitteriness, anxiety, and sleeplessness. About half of those using these drugs reported these side effects, which were often serious enough to make people stop using the drugs.
But even the proponents of cognitive enhancement admit that too little is known about the long-term use of brain-boosting drugs in healthy people. The Nature editorialists call for more research.
Is it cheating or unnatural to use brain-boosting drugs?
Yes, say critics such as Leon R. Kass, MD, chairman of the President's Council on Bioethics. It is cheating. But even worse, it's unnatural.
"One major trouble with biotechical (especially mental) 'improvers' is that they produce changes in us by disrupting the normal character of human being-at-work-in-the-world ... which, when fine and full, constitutes human flourishing," Kass wrote in 2003. "With biotechnical interventions that skip the realm of intelligible meaning, we cannot really own the transformations nor experience them as genuinely ours."
This loss, Kass argues, subtracts from our humanity.
But in this week's Nature editorial, Greely and colleagues say brain boosting is not cheating. It's not against the rules to drink a double espresso or hire a private tutor, they argue, so why disallow use of brain-boosting drugs?
More importantly, they say, we already live highly unnatural lives.
"Given the many cognitive-enhancing tools we accept already, from writing to laptop computers, why draw the line here and say thus far but no further?"
If other people outperform me because they use brain-boosting drugs, won't I be compelled to use them? Aren't brain-boosting drugs unfair to those who don't use them?
These are tricky questions, Greely and colleagues admit. They say policies should prohibit requiring people to take brain-boosting drugs except where public safety is at stake.
As to fairness, they note that people already have unequal access to brain-enhancing experiences such as private tutoring.
In cases where the drugs are merely used to temporarily boost exam performance, Greely and colleagues suggest that drug use would be unfair. But if the drugs boosted one's long-term learning, they have less of a problem with unfairness.
"Cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world," Greely and colleagues suggest.
How would brain-boosting drugs be regulated?
Greely and colleagues suggest that policies regarding cognitive-enhancing drugs should be based on scientific evidence. They call for:
- Accelerated research into the risks and benefits of cognitive enhancement
- Participation of medical and scientific organizations in formulating guidelines
- Education to increase public understanding of cognitive enhancement
- Legal reforms -- not new laws -- to align existing laws with "emerging social norms and information about safety"