Friday, June 25, 2010

Turbocharging the Brain - Ethical Dissonance

Arguments about safety, fairness and coercion aside, demand is indeed high for cognitive enhancers that are otherwise prescribed for conditions such as ADHD. Based on government data gathered in 2007, more than 1.6 million people in the U.S. had used prescription stimulants nonmedically during the previous 12 months. Legal medicines in this category include methylphenidate (Ritalin), the amphetamine Adderall, and modafi nil (Provigil). On some campuses, one quarter of students have reported using the drugs. And an informal on line reader survey by Nature last year showed 20 percent of 1,427 respondents from 60 countries polled about their own use said they had used either methylphenidate, modafi nil or beta blockers (the last for stage fright). Overall, a need for improved concentration was the reason cited most frequently. People often manage to ac quire the drugs on the Internet or from doctors, who can prescribe medicines approved for one purpose to treat something else (drugmakers, however, cannot legally promote such “off label” uses).

Ingestion of these chemicals will likely grow along with an aging population and an increasingly globalized economy. “If you’re a 65-yearold living in Boston and your retirement savings have decreased dramatically and you have to stay on the job market and compete with a 23-yearold in Mumbai to stay alert and stay effective, you may feel pressured to turn to these compounds,” says Zack Lynch, executive director of the Neurotechnology Industry Organization.

The recent push for ethical guidelines, of course, presumes that these drugs are better than placebos and do in fact improve some aspect of cognition, be it attention, memory or “executive function” (planning and abstract reasoning, for instance). Given that assumption, many argue, it behooves ethicists to consider the ramifi cations of the popularity of these drugs. Such logic led in 2002 to a new academic discipline, neuroethics, meant in part to address the moral and social questions raised by cognition-enhancing drugs and devices (brain implants and the like).

Taking a highly provocative stand, a group of ethicists and neuroscientists published a commentary in Nature last year raising the prospect of a shift away from the notion of drugs as a treatment primarily for illness. The article suggested the possibility of making psychostimulants widely available to the able-minded to improve performance in the classroom or the boardroom, provided the drugs are judged to be safe and effective enough for healthy people. Citing research demonstrating the benefits of these drugs on memory and various forms of mental processing, the investigators equated pharmaceutical enhancement with “education, good health habits, and information technology— ways that our uniquely innovative species tries to improve itself.”

Six months later one of the article’s authors, John Harris, a bioethicist at the University of Manchester in England, went further in an opinion piece in the British Medical Journal. Harris, editor of the Journal of Medical Ethics and a book called Enhancing Evolution, noted that if methylphenidate is judged safe enough to be used in children, it should be considered sufficiently innocuous for consumption by adults interested in turbocharging their brains. In a later interview, Harris said he foresaw a gradual loosening of restrictions, and if no safety problems arise, the drug (a controlled substance in the U.S.) could ultimately become an over-the-counter purchase, like aspirin.

These musings have not gone unchallenged. Other researchers and ethicists have questioned whether drugs that modulate mental processes will ever have a safety profi le that will justify their being dispensed in the same fashion as a nonprescription painkiller or coffee or tea.

“People say that cognitive enhancement is just like improving vision by wearing glasses,” says James Swanson, a researcher at the University of California, Irvine, who was involved with clinical trials for both Adderall and modafi nil for ADHD. “I don’t think people understand the risks that occur when you have a large number of people accessing these drugs. Some small percentage will likely become addicted, and some people may actually see mental performance decline. That’s the reason I’m opposed to their general use.” Along these lines, the British Home Office, the interior ministry, is awaiting a report from an advisory panel on whether the potential harm from nonmedical use of enhancers requires new regulations.

Other scientists assert that the debate may be moot because improving smarts might not be possible through any means but the tedious exercise of cramming for a calculus exam. Some who have tried to develop drugs to reverse the memory loss of dementia doubt whether enhancement of the healthy is anything but a remote possibility. “I would not worry much about implications of cognitive enhancers in the healthy, because there are no cognitive enhancers to worry about,” says Rusiko Bourtchouladze, author of a popular book about the science of memory and a researcher who contributed to the work that led to a Nobel Prize for Eric R. Kandel in 2000. “To talk about cognitive enhancement, it’s too, too early, and these drugs may not arrive even in our lifetime. There’s too much noise about this.”

In this view, the complex mix of chemical signals, enzymes and proteins that collaborate to form a memory creates a self-regulating balance that resists tinkering unless disrupted by disease. The decline in thought processes and sense of identity that comes with dementia might be addressable by compensating for losses of key chemicals and might merit the risk of untoward side effects from drug intervention. But upsetting the fragile stasis in the healthy could produce unintended consequences: as just one example, any improvement in long-term memory (the place where recollections of childhood and last year’s vacation reside) could be countered by diminished capacity for working memory (the mental scratch pad where your brain stores a telephone number temporarily).

Some critics of those who argue over the ethics of neuroenhancement attribute the current flap to what they call “speculative ethics.” This tendency also besets nanotechnology and other technological endeavors in which ethicists, scientists and policy makers are diverted by discussions of the social implications of technologies yet to be invented, be they smart pills or nanorobots run amok. “A signifi cant part of the debate on human enhancement ... suffers from inflated expectations and technology hype,” notes Maartje Schermer of Erasmus University Rotterdam and her colleagues in the journal Neuroethics.

Source of Information : Scientific American October 2009

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