Pharmaceutical Enhancement for All

(Cross-posted from my private practice site at kierstenmarek.com)

Nature Magazine has a new article in which a group of scientists and ethicists lay out a platform for supporting the idea that healthy people can and should seek cognitive enhancement through whatever means necessary — including psychiatric drugs. From the article:

Many people have doubts about the moral status of enhancement drugs for reasons ranging from the pragmatic to the philosophical, including concerns about short-circuiting personal agency and undermining the value of human effort. Kass, for example, has written of the subtle but, in his view, important differences between human enhancement through biotechnology and through more traditional means. Such arguments have been persuasively rejected (for example, ref. 17). Three arguments against the use of cognitive enhancement by the healthy quickly bubble to the surface in most discussions: that it is cheating, that it is unnatural and that it amounts to drug abuse.

In the context of sports, pharmacological performance enhancement is indeed cheating. But, of course, it is cheating because it is against the rules. Any good set of rules would need to distinguish today’s allowed cognitive enhancements, from private tutors to double espressos, from the newer methods, if they are to be banned.


As for an appeal to the ‘natural’, the lives of almost all living humans are deeply unnatural; our homes, our clothes and our food — to say nothing of the medical care we enjoy — bear little relation to our species’ ‘natural’ state. 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?

As for enhancers’ status as drugs, drug abuse is a major social ill, and both medicinal and recreational drugs are regulated because of possible harms to the individual and society. But drugs are regulated on a scale that subjectively judges the potential for harm from the very dangerous (heroin) to the relatively harmless (caffeine). Given such regulation, the mere fact that cognitive enhancers are drugs is no reason to outlaw them.

Based on our considerations, we call for a presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs.

I have written on Kmareka more extensively with concerns about the rapidly increasing use of psychiatric medication on children. While I have seen the benefits of medication use for children at times, I have also seen a full range of side effects including increased tolerance for the medications used, major medical problems, tics, sleep issues, growth issues, and more.

With adults, I think there is more room for accepting the idea that cognitive-enhancing use of medication is appropriate. Adults usually have a stronger sense of their baseline functioning and they are not as subject to developmental changes. But unlike the reasons for objecting to cognitive enhancements cited in the article (it’s cheating, it’s unnatural, and it amounts to drug abuse) my main concern remains that we do not know the long-term side effects of many of the drugs which are becoming more prevalent in their uses.

It comes down to what you consider to be a healthy level of caution when dealing with the unknown. Sometimes it seems like we’re playing with fire, but we humans have been known to enjoy playing with fire.

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8 responses

  1. My daughter was a special ed teacher for nine yers and has a Masters of Education in thet speciality and she was convinced that children were being overmedicated as a convenience without regard for the long term consequences.She is taking her doctoral studies in a more general field of education.It’s one of those situations where I just listen because I don’t have any credentials in an area like education.

  2. When I was in Vietnam they pushed alcohol,because they didn’t want us using the abundant high powered grass and heroin.

  3. These type of drugs need to go hand in hand with the oversight of a counselor. I have had more discussions with Psychiatric doctors that perscribed meds to my X husband without ever ensuring there was a baseline for behaviors. This is a huge problem moreso with adults, because children are typically monitored and in counseling.

    I have also witnessed many highly degreed doctors that generously give out medication such as Kiersten cautions, and that many of them are conflicted because they are taking kick back from Big Pharma and therefore there IS more incentive for them. I have argued with those types that it is for that reason that they don’t mandate to their clientelle to seek counseling in conjunction with the script they write. Shameful, and for health care providers that seemingly want to see their patients get well – these types of pathetic doctors seem to run rampid.

    We just have to remember Doctor’s are not gods. I know this type of information is a great service to opening others eyes and at least “question” the theory.

  4. the ecomonics of the system works against doctors and nurses taking time with patients. it pays to get the patient in and out of the office fast with a drug prescription, and it costs to take time to talk with them and find out what in their lives is contributing to their mood problem. maybe they should talk to an MSW. not to say that meds don’t have a place–sometimes they are necessary and helpful

  5. At the VA you get an appointment with a doctor or other provider that usually is a specified block of time.They don’t rush you out.In one clinic I have to visit routinely they often have to do unscheduled procedures such as minor biopsies and you are there as long as you need to be.You can also wait an hour or more past your scheduled appointment time.There’s a sign on the wall-”good care takes time”-great statement because you know they aren’t glossing over real problems for the sake of expiediency.

  6. that’s good to hear. that’s how it should be.

  7. The VA is one of the best medical systems in the country. It is also the only instance of truly socialized medicine we have here in the USofA.

    The medical “system” we have rewards doctors for providing services. The more patients they see, the more money they make. In the VA, doctors are salaried employees of the gov’t. They have an incentive to make patients better.

    So, yes, Joe, expediency rules. Get ‘em in, dope ‘em up, and see the next one. That ensures a steady stream of customers.

  8. Klaus-my cancer surgeon also has a private practice.I know someone who saw him in that capacity and was very pleased with the care he provided.I get the same level of care from him at the VA.He treats patients like people who might actually have a brain,no talking down at all.He is a straight shooter,not trying to give false optimism,and he really gets into the details,drawing pictures and everything.Last year when I came into the ER with a life-threatening hemorrhage he got out of bed and made it there in about 15 minutes and operated on me while I was awake.I wanted to stay awake-the anesthetist wanted me out-he told her I was entitled to my own decision on that.It wasn’t much fun,but what the heck,we all have bad days.Point being this doctor doesn’t care who’s paying him-you are his patient,period.I’ve had polio,diabetes,coronary artery disease,cancer three times,pneumonia twice and numerous injuries.I have to say most of the medical providers I met were outstanding people.I’m not just talking about doctors either-the whole profession is mostly peopled by good folks.

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