David Baxter PhD
Late Founder
Experts urge wider use of brain-boosting drugs
Bernadette Tansey, San Francisco Chronicle
Monday, December 8, 2008
Three job candidates sit in a quiet room, straining over a tough exam. But one of them has taken a memory-enhancing drug the other two couldn't afford. Is the test fair?
In another futuristic scenario, a drug can help airline pilots keep focused during a long flight, though it causes some side effects. May an airline require pilots to take the drug?
Get ready to confront such questions in daily life, a group of scientists and policy experts urge in a thought-provoking commentary published online Sunday by the journal Nature.
Brain research is accelerating, and a new era of "cognitive enhancement" - the use of brain-stimulating drugs and devices by healthy people - is approaching, the authors said.
While thorny ethical and medical questions must be addressed, pharmaceutical enhancement of inborn mental gifts is a trend to be welcomed, the seven co-authors from Harvard, Stanford and other prestigious institutions said.
"We call for a presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs," said the writers, who include Stanford law Professor Henry Greely and neuropsychology Professor Barbara Sahakian at the University of Cambridge in the United Kingdom. "From assembly line workers to surgeons, many different kinds of employee may benefit from enhancement and want access to it, yet they may also need protection from the pressure to enhance."
Sahakian and another co-author, Ronald Kessler of Harvard Medical School, are consultants for pharmaceutical companies. Nature noted no conflicts of interest for the other five authors, who include the publication's editor in chief, Philip Campbell.
Dr. Russell Reiff, a developmental and behavioral pediatrician at Kaiser Permanente in San Francisco, said he fears the paper will "fuel the fire of what we call prescribing pressure." Reiff said he always looks for alternatives before prescribing attention deficit disorder drugs such as Ritalin and Adderall, which contain amphetamines.
Side effects
Even now, some college students are trying to boost their academic performance by obtaining such drugs, researchers say. While studies indicate that some academics obtain stimulants through legal off-label prescriptions from doctors, others order them via the Internet or buy a few pills from friends - both of which are illegal.
"These medications can have very significant side effects," Reiff said. Healthy college students, rather than "pathologizing" their weariness over a grueling class schedule, could build in some time to shoot hoops between lectures, Reiff said.
Greely, who has been tracking policy issues in neuroscience for six years, said the article is not a clarion call for widespread use of brain-boosting drugs, free of legal controls. Instead, the authors wanted to debunk arguments that drug enhancement is immoral per se, compared to other means of strengthening mental performance, such as a double espresso or an expensive tutor. "Society shouldn't reject them just because they're pharmaceutical enhancements," he said in an interview.
The Nature paper could escalate a debate set off in December 2007 when Sahakian and a colleague, in another Nature piece, said that some scientific colleagues were using sleep disorder drugs to enhance their productivity and that student use of stimulants seemed to be on the rise. Nature followed up with more articles and a survey. That raised a renewed flurry of blog posts, news stories and sensational monikers for the phenomenon, such as "brain doping" and "brain steroids."
Effects on healthy people
Greely said the moral repugnance that is often focused on steroid use in sports should not be grafted onto cognitive enhancement drugs. "Better-working brains produce things of more lasting value than longer home runs," he said.
However, Greely and his co-authors acknowledged that drug safety is a paramount concern. Too little is known about the benefits and risks for healthy people taking medicines approved to treat mental impairments, they said. The authors called for more research so that doctors and patients can balance the gains and the harms. Risks that would be tolerated to treat a severe illness might be unacceptable for a healthy young person, the authors noted.
No new wave of high-efficacy cognitive enhancement drugs has yet emerged for healthy individuals, Greely said. But society needs to prepare itself for the intricate ethical issues that would accompany such advances, he said. Doctors, educators, labor experts, employers and legislators should be thinking about it, he and his co-authors said.
Could the competitive advantages already enjoyed by rich students be unfairly amplified by purchases of expensive new brain enhancers that are out of reach to their less wealthy peers? Such objections need not lead to a ban, the Nature authors said. Instead, they suggested, schools could give every exam taker free access to the drugs.
Fears of coercion
That solution, they acknowledged, could pressure students or workers to take drugs unwillingly to maintain their competitive edge. They called for policies to protect individuals from such indirect coercion, and from direct coercion by superiors.
But even direct coercion may be justified in cases where society would benefit from increased safety, the authors said. For example, Greely said, some societies might decide that the personal freedoms of soldiers would be outweighed by military requirements.
George Annas, who heads the health law and bioethics program at Boston University, said the authors present an idyllic view of brain-modulating drugs that emphasizes the potential upside. "You could ask, what were they smoking when they wrote this article?" he said with a chuckle.
Annas doesn't quibble with the argument that cognitive enhancement drugs are no more immoral, in theory, than other ways of heightening mental performance, such as coffee or sleep. But the crucial ethical difference turns on the safety of each drug, he said. Annas said he doubts drug manufacturers, once their therapeutic products are adopted widely as brain boosters off-label, will spend money on clinical trials that might raise questions about their safety in healthy people.
"The NIH (National Institutes of Health) is not going to fund this research," he said. "If the drug companies don't fund it, it's not going to get done."
Annas also doubts that research will produce new drugs that make the brain function much better with few side effects. "How likely is that?" he asked. "Very little in the body is isolated from everything else."
Bernadette Tansey, San Francisco Chronicle
Monday, December 8, 2008
Three job candidates sit in a quiet room, straining over a tough exam. But one of them has taken a memory-enhancing drug the other two couldn't afford. Is the test fair?
In another futuristic scenario, a drug can help airline pilots keep focused during a long flight, though it causes some side effects. May an airline require pilots to take the drug?
Get ready to confront such questions in daily life, a group of scientists and policy experts urge in a thought-provoking commentary published online Sunday by the journal Nature.
Brain research is accelerating, and a new era of "cognitive enhancement" - the use of brain-stimulating drugs and devices by healthy people - is approaching, the authors said.
While thorny ethical and medical questions must be addressed, pharmaceutical enhancement of inborn mental gifts is a trend to be welcomed, the seven co-authors from Harvard, Stanford and other prestigious institutions said.
"We call for a presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs," said the writers, who include Stanford law Professor Henry Greely and neuropsychology Professor Barbara Sahakian at the University of Cambridge in the United Kingdom. "From assembly line workers to surgeons, many different kinds of employee may benefit from enhancement and want access to it, yet they may also need protection from the pressure to enhance."
Sahakian and another co-author, Ronald Kessler of Harvard Medical School, are consultants for pharmaceutical companies. Nature noted no conflicts of interest for the other five authors, who include the publication's editor in chief, Philip Campbell.
Dr. Russell Reiff, a developmental and behavioral pediatrician at Kaiser Permanente in San Francisco, said he fears the paper will "fuel the fire of what we call prescribing pressure." Reiff said he always looks for alternatives before prescribing attention deficit disorder drugs such as Ritalin and Adderall, which contain amphetamines.
Side effects
Even now, some college students are trying to boost their academic performance by obtaining such drugs, researchers say. While studies indicate that some academics obtain stimulants through legal off-label prescriptions from doctors, others order them via the Internet or buy a few pills from friends - both of which are illegal.
"These medications can have very significant side effects," Reiff said. Healthy college students, rather than "pathologizing" their weariness over a grueling class schedule, could build in some time to shoot hoops between lectures, Reiff said.
Greely, who has been tracking policy issues in neuroscience for six years, said the article is not a clarion call for widespread use of brain-boosting drugs, free of legal controls. Instead, the authors wanted to debunk arguments that drug enhancement is immoral per se, compared to other means of strengthening mental performance, such as a double espresso or an expensive tutor. "Society shouldn't reject them just because they're pharmaceutical enhancements," he said in an interview.
The Nature paper could escalate a debate set off in December 2007 when Sahakian and a colleague, in another Nature piece, said that some scientific colleagues were using sleep disorder drugs to enhance their productivity and that student use of stimulants seemed to be on the rise. Nature followed up with more articles and a survey. That raised a renewed flurry of blog posts, news stories and sensational monikers for the phenomenon, such as "brain doping" and "brain steroids."
Effects on healthy people
Greely said the moral repugnance that is often focused on steroid use in sports should not be grafted onto cognitive enhancement drugs. "Better-working brains produce things of more lasting value than longer home runs," he said.
However, Greely and his co-authors acknowledged that drug safety is a paramount concern. Too little is known about the benefits and risks for healthy people taking medicines approved to treat mental impairments, they said. The authors called for more research so that doctors and patients can balance the gains and the harms. Risks that would be tolerated to treat a severe illness might be unacceptable for a healthy young person, the authors noted.
No new wave of high-efficacy cognitive enhancement drugs has yet emerged for healthy individuals, Greely said. But society needs to prepare itself for the intricate ethical issues that would accompany such advances, he said. Doctors, educators, labor experts, employers and legislators should be thinking about it, he and his co-authors said.
Could the competitive advantages already enjoyed by rich students be unfairly amplified by purchases of expensive new brain enhancers that are out of reach to their less wealthy peers? Such objections need not lead to a ban, the Nature authors said. Instead, they suggested, schools could give every exam taker free access to the drugs.
Fears of coercion
That solution, they acknowledged, could pressure students or workers to take drugs unwillingly to maintain their competitive edge. They called for policies to protect individuals from such indirect coercion, and from direct coercion by superiors.
But even direct coercion may be justified in cases where society would benefit from increased safety, the authors said. For example, Greely said, some societies might decide that the personal freedoms of soldiers would be outweighed by military requirements.
George Annas, who heads the health law and bioethics program at Boston University, said the authors present an idyllic view of brain-modulating drugs that emphasizes the potential upside. "You could ask, what were they smoking when they wrote this article?" he said with a chuckle.
Annas doesn't quibble with the argument that cognitive enhancement drugs are no more immoral, in theory, than other ways of heightening mental performance, such as coffee or sleep. But the crucial ethical difference turns on the safety of each drug, he said. Annas said he doubts drug manufacturers, once their therapeutic products are adopted widely as brain boosters off-label, will spend money on clinical trials that might raise questions about their safety in healthy people.
"The NIH (National Institutes of Health) is not going to fund this research," he said. "If the drug companies don't fund it, it's not going to get done."
Annas also doubts that research will produce new drugs that make the brain function much better with few side effects. "How likely is that?" he asked. "Very little in the body is isolated from everything else."
