Sunday, August 11, 2013

Should we be permitted to use prescription drugs to upgrade our brain capacity?

My latest OpEd in our local paper, the Kingston Whig-Standard.

Let’s face it - most of us spend a lot of time competing against each other. It might not be a terribly nice thing to do, but what choice do we really have in a world that has decided to shoot for progress through competition?
We try to look better, usually not just for ourselves, but also to look better than whomever we have chosen as our favourite competitor. If we have the financial means we send our kids to take extra lessons so they compete more successfully at school. It seems many professional athletes resort to doping in order to compete more successfully.
When I look at the other middle-aged blokes at the gym, it is clear to me that they do it not just to push death away by a year or two, but also to stay fit in the daily competition at their workplace. Anyone who has ever wondered why so many law and medical school students manage to pull 24- to 48-hour stints in the library close to exam time should be disabused of the idea that it was just coffee or the occasional energy drink that kept many of them going.
In the United States, drugs approved to assist children with Attention Deficit Hyperactivity Disorder, or ADHD, are prescribed by doctors to many children, as well as adults, who don’t actually suffer from that condition. Why? Well, despite the absence of conclusive clinical evidence, parents - as well as many students in high-pressure, high-stakes fields of study - have long voted with their feet and decided to move heaven and earth to upgrade their kids, or themselves, respectively, by means accessing these same ADHD drugs.
They believe these drugs increase our attention span as well as our knowledge retention capacity for significant periods of time. Studies suggest that about 5-10% of high school students and up to 35% of college students use these drugs for non-medically approved purposes.
A large number of society’s best-educated take a gamble on such drugs actually working. Clearly, after they try them once, many students continue to use them, because in their best judgment they do the trick.
Many doctors are opposed to the prescription of drugs for what they describe as non-medical purposes. Being able to focus better in college and to retain your knowledge for longer periods of time are such non-medical purposes. But what is a medical and what is a non-medical use of a particular medication?
This, of course, isn’t purely a clinical question. It’s inextricably linked to this question: what should the purpose of medicine be?
In my view, medicine should aim to achieve the twin objectives of keeping us alive as long as possible at as high a quality of life as is feasible. You can, of course, try to achieve that by fending off disease. Disease certainly impacts negatively on our lives, and all too often it cuts them short.
However, if there were drugs out there that could improve how our brains function, we would undoubtedly be able to improve the quality of the lives of many of those who choose to use them. Assuming that such drugs work – and it doesn’t matter whether the current drugs actually work for this purpose, because a future drug, inevitably, eventually will – our enhanced brain capacity would also mean that we would be more productive and more creative.
Yes, we could do more with our lives for a longer period of time. And this is one of the reasons why doctors who limit their professional activities to fighting disease as opposed to working toward the maximization of our biological and psychological well-being have a wrong understanding of what their job should be all about.
Today you can’t blame them, because the regulatory frameworks we have in place limit their professional activities, in quite conservative ways, to disease-fighting. A few attempts are made to prevent the occurrence of disease - for instance, by way of vaccinating us. The idea, though, that our health and well-being could also be improved from a status quo currently considered healthy is not something seriously considered by the medical profession. That is a profound mistake.
Worse, because of this conservative understanding of the nature of what it means to be a health care professional, no serious research is currently under way with a view toward upgrading our minds. Any such knowledge would be an accidental byproduct, likely of ADHD- or Alzheimer’s-related research.
There are obvious problem with the kind of change that I am proposing. For starters, we should be concerned that access to brain-capacity enhancers isn’t limited to those already well-off, because otherwise we would continue to increase the gap between society’s haves and the have-nots, with a nasty and harmful societal fallout eventually coming our way.
We should also be worried about fairness in the societal marketplace with regard to those who choose not to upgrade their mental capacities. They might do so because they could be, in principle, opposed to 21st-century medicine, or they might be worried about the long-term side-effects of the medication, or for any number of other reasons.
Given that we do compete on a global scale, these choices could well have ramifications for our national ability to compete against other nations. It will be a difficult regulatory balancing act, but I suspect that it is one we will eventually have to confront.
There is something of more immediate concern, and that is the current use of such drugs by students for non-medically approved purposes. Arguably, the playing field between students with access to such drugs and those who do not have access is not level any longer. It is a matter of fairness that we ensure that students with access do not gain a competitive advantage over those students who do not have access. I do think administrators of higher-education institutions should look carefully into the question of whether it is possible to test students for the use of such drugs in order to ensure that the playing field is level again.
No doubt privacy advocates will be up in arms against this proposal. I actually sympathize, but we do need to find a way to ensure that no competitive advantage is gained by those who access memory-enhancing drugs for not currently clinically approved purposes.
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. Follow him on Twitter @schuklenk

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