Sahakian on ‘Smart drugs’ at the Royal Institution

Photo: Murdo Macleod in the Guardian

Barbara Sahakian gave a talk at  the Royal Institution the other day on ‘Smart Drugs’.  You can listen to the talk here.   The talk received quite a bit of media attention, most notably in an article in the Guardian entitled, “A Pandora’s box full of smart drugs“.

Personally, I think that the data that methylphenidate and modafinil are bona fide cognitive enhancers is not as strong as many suggest, but there is little question that the pharmaceutical industry is gearing up to produce drugs that will satisfy this market (I hesitate to say need) in the years to come.  I was reassured that Barbara pointed out to the audience that exercise, both physical and mental, can provide effects that are comparable to what these drugs can offer.  Whether the audience heard that or not remains to be seen.

Someone who attended the lecture reported that, “She is disquietingly relaxed about it all; I wasn’t certain that she realises the power of what she is helping to unleash.”   This reminded me of the comment that David Healy made at the Brain Matters conference in Halifax in September 2009, where he opined that one of the problematic consequences of neuroethicists talking about cognitive enhancement is that it educates the populace that these compounds exist, and thereby might encourage their use.  Indeed, in the comments section of the Guardian article, someone calling themselves the ‘Rabid Racoon’ wrote,

I had no idea these drugs existed, thanks for informing me so I can go buy some.

p.s. slightly disapointed that the ‘ads by google’ which are putatibvely (sic) based on the content of the page you are looking at aren’t for online pharmacies

It is indeed the case that people can write whatever they want in anonymous posts such as these, and so a comment such as this hardly represents data. But the question of whether we neuroethicists are acting as cheerleaders for the use of cognitive enhancers when we point out the reasonable concerns that one might have about their widespread introdution is real.

There was one rather perceptive comment from the Guardian article, quite obviously contributed by someone knowledgeable in the field.

The only ethical consideration here involves the potential harm smart drugs may cause to the individual.

If it is the case that they are in any way harmful, the risk / reward balance is still for the individual to make, but there needs to be protection for those who would prefer not to risk their health but nonetheless experience social pressure to do so. I don’t want to live in a society where the best jobs and other opportunities are only open to those who are willing to compromise their health to access them.

On the other hand, it may be the case that smart drugs present insignificant levels of risk to one’s health, much like caffeine or mobile phone use.

In that case, a social expectation of smart drug use, or indeed smart drug use as a social norm is not necessarily unreasonable. As the article mentions, a mental boost can be achieved through moderate regular exercise; should we pity the person who misses out on a job because they don’t excersise as much as the (otherwise similarly capable) successful candidate? Currently we don’t.

We don’t begrudge better opportunities to those who were brought up in more stable, loving households, or who read more books in their childhoods. Yet these do produce measurable advantage in individuals.

Being sharper, more intelligent, less tired – these are all wholly positive qualities. Society and individuals benefit from more clever, healthy people rather than dumber, sicker people.

The challenge for our society is to make the meritocratic principle align with responsibility and effort. Because meritocracy rewards outcomes, not inputs. It rewards people with better genes and penalises people with disabilities. You can try as hard as you like and still not achieve – because effort does not equal ability. And all this is to ignore inequalities rooted in class, race and other such factors.

Adding smart drugs to the mix won’t level the playing field, but it will raise the baseline. That in itself is desirable in any society and economy, but the reality is that anything we call a ‘drug’ has side-effects. This debate would be better served by a discussion of the health risks these substances involve, rather than ‘cheating’.

And then there was this comment, which I include here at the end both for insight and comedic relief.

I’m a student and have taken modafinal a few times. It doesn’t make you less of a moron, alas – you continue being stupid, but faster.

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10 thoughts on “Sahakian on ‘Smart drugs’ at the Royal Institution

  1. I thought that Prof Sahakian’s talk was excellent, giving a balanced view of the benefits and dangers of cognitive enhancere. Yes, I found this article above very interesting too. As a person myself who has written a paper on methylphenidate, one of the named cognitive enhancers, it was interesting for me to ‘catch up’ with this particular area:

    Neuropsychopharmacology. 2006 Mar;31(3):651-8. Methylphenidate (‘Ritalin’) can ameliorate abnormal risk-taking behavior in the frontal variant of frontotemporal dementia. Rahman S, Robbins TW, Hodges JR, Mehta MA, Nestor PJ, Clark L, Sahakian BJ.

    After my doctoral work and postdoctoral work on Parkisnon’s disease, I have been studying at Masters level law and jurisprudence. So I feel that I can appreciate the debate from both legal and medical perspectives. I currently research the published literature on Alzheimer’s disease, so I am very up-to-date with this field. Obviously, ameliorating cognitive problems such as in attention and memory in patients with Alzheimer’s disease is a rather different debate to improving cognitive function in healthy volunteers.

    Concerning cognitive enhancers in healthy volunteers, a lot of studies, including those in Cambridge, have been acute, placebo-controlled experiments, However, the long-term effects of these drugs are extremely poorly understood. This is a very old criticism – and this is a danger admittedly of any drug.

    There are serious issues about whether these drugs give people an unfair advantage, and whether as a society it is particularly ethical to be so keen on cognitive version of airbrushing?

    Who is going to police this and how? As it even worth the money or the effort, because, as such, these volunteers are not committing any criminal offences? Whilst there may be a multitude of people taking these drugs on university campuses, it seems that they are all consenting to taking them. However, if by classing them as legal, will the people who are not taking them feel coerced to take them to “keep up with the Jones”? Autonomy and coercion are a big deal in ethics.

    I therefore think that the societal issues of the use of cognitive enhancers are the problem, and still very poorly understood both in the UK and the US. Whilst we can spend lots of money in funding acute studies of single receptor agonists or antagonists, they may be a limit to the ultimate razzmattazz of their neuroscience, compared to the need for funding the legal and neuroethical issues involved.

    Dr Shibley Rahman, Law and Medicine (obviating the anonymity of comments mentioned above)

  2. cognitive enhancing drugs are routinely compared to palstic surgery or – as above – ‘airbrushing’. But there is a difference.

    A world made of people all made a little bit more symmetrical probably won’t be much of a better world.

    A world of people thinking smarter and faster (if indeed this is what the drugs can do) would be a better and wealthier world. As a civilisation perhaps we could accomplish more.

    this could be a big change..

  3. Dr. Rahman correctly notes that “Autonomy and coercion are a big deal in ethics.”

    Lately, I am very interested in looking at why this is true for some issues and not others. The long comment quoted by Peter captures this concern very nicely – autonomy and coercion are *not* a big deal when it comes to the “ethics” (if we can even speak of such) of coffee, exercise, and book-reading. When we emphasize the autonomy/coercion concerns on the topic of cognitive enhancement, we implicitly assert that modafinil / ritalin / hypothetical-future-smart-drug differ from coffee / exercise / book-reading in some way. Whatever this difference is, it’s a powerful driver of ethics concerns. The commenter seems to suggest that the difference consists in the potential for long-term harm. I like to think this is it, but it remains to be shown conclusively. It could, for instance, be tied to ease of use (but is coffee so hard to brew?) or concerns about selfhood (but surely reading books slowly changes who we are?) …

    The commenter also expresses an apprehension worth considering: “I don’t want to live in a society where the best jobs and other opportunities are only open to those who are willing to compromise their health to access them.” I tend to wonder, though: to what extent is this not the case already? From what I gather about certain lines of work, the ones who get ahead are the ones who work hundred-hour weeks, and the ones who remain alert throughout the hundred-hour weeks are the ones with a generous supply of the nose-candy.

  4. The pill is the easy way out. I feel so much better when I exercise, and take up the phytochemicals from natural food. Thank goodness folks are questioning the long term impact of cognitive enhancers.

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