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Exploring Some Challenges of the Pharmaceutical Cognitive Enhancement Discourse: Users and Policy Recommendations

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Abstract

The article explores some of the issues that have arisen in the discourse on pharmaceutical cognitive enhancement (PCE), that is, the use of stimulant drugs such as methylphenidate, amphetamine and modafinil by healthy individuals of various populations with the aim of improving cognitive performance. Specifically, we explore the presumed sizes of existing PCE user populations and the policy actions that have been proposed regarding the trend of PCE. We begin with an introductory examination of the academic stances and philosophical issues involved in defining PCE. We then focus on an examination of the population sizes of presumed current PCE users that have been listed in the academic literature on PCE, on presuppositions, which have been problematized by some authors as based on anecdotal or misinterpreted survey data. We follow this with an empirical examination of a potential PCE user population in a national context (students at the University of Ljubljana in Slovenia). We then proceed to examine the regulatory options proposed in the academic literature to address PCE, finally comparing them with an empirical overview of the policy recommendations on PCE produced in the multinational context of several national ethics advisory bodies (EABs) in Europe. Our main conclusion is that there is still little debate among the national EABs on what type of public policy responses, if any, are needed to address PCE in European countries, and that the issues they do address are similar to those discussed and proposed in the academic articles on PCE.

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Notes

  1. A number of academics, especially in philosophy and bioethics, have urged for policies and regulations either for [2–5] or against [6–9] various applications of potential HET, in many cases based on technological developments that are only just emerging from cell or animal experiments or that are still at a theoretical or even hypothetical stage.

  2. Another prominent instance is the use of pharmaceutical drugs such as steroids, erythropoietin and stimulants to enhance physical abilities that include endurance, speed and strength in healthy people. The debate concerning physical enhancement is strongly connected with issues of doping, the (ab)use of such substances in professional sporting competitions.

  3. The drug propranolol, a type of beta-blocker developed to treat high blood pressure, is also used to reduce performance anxiety in otherwise healthy individuals.

  4. Notwithstanding, there are some authors who strongly insist on the normative distinction between therapy and enhancement. According to them this distinction is highly relevant for legislative policy makers [6, 7].

  5. Some authors have argued that similar trends were present, for example, during the widening application and mass use of the tranquilizer meprobamate (Miltown) as a “lifestyle drug” [32: 151] in the 1950s and 1960s, and that similar enthusiastic claims of PCE effects were made for cocaine and amphetamines at the time of their introduction, as part of a cycle typical for most psychotropic drugs [33].

  6. The German participants of the Books Forum in the journal Biosocieties also noted a lack of qualitative empirical evidence, arguing that the assessments of the ethical, societal and political consequences of neuroenhancement in Germany shows characteristics of a ‘phantom debate’ [37–39]. According to them, the concerns voiced in Germany about the alarming increase in consumption of neuroenhancers among various population groups are exaggerated. They claim that such exaggerations originate from various types of poor quality empirical evidence, such as the reliance on anecdotal evidence from individual cases, the indiscriminate use of data on the misuse of stimulants by young adults, etc.

  7. In hybrid authoritarian-capitalist countries such as China, the political elites are aware of the importance of the progress of new technologies for strengthening their own political power. The direction of the development and application of new technologies is in such cases primarily shaped by narrow political goals. B. McKibben also reasons that China, due to its one-child policy, introduced in 1978, which officially restricts married, urban couples to one child, while allowing exemptions in several cases, and impacting 36 % of the population, might be especially interested in enhanced children [8].

  8. Here, we will not deal with the issue of social equity. Namely, in modern highly competitive and individualistic societies, there is a constant threat that the use of new technologies will increase social inequality. This is especially likely if PCE technologies are used solely to ensure individual competitive advantages over others.

  9. Some research has been conducted on attitudes towards PCE through interviews with students [52] and on attitudes and use among the general population [53] in Australia, and with focus groups of students and related stakeholders in Canada [54].

  10. One study has also been conducted in Italy among 77 students at an Italian University, which showed that 12 of the 77 have taken drugs for CE, but the definition used allowed for over-the-counter supplements such as caffeine to be included and did not examine what the actual drug used was [55].

  11. The University of Ljubljana as a central academic institution in Slovenia ranks as a large university, with more than 63,000 graduate and postgraduate students.

  12. The prevalence of PCE use might also vary according to which students (faculties) are included in the survey. For example, use might be higher among students of medicine and pharmacy, due to them having easier access both to the required knowledge as well as to the substances themselves, than among students of social sciences or philosophy.

  13. These include those who have answered that they have already used PCE drugs for the non-medical purpose of PCE, and those who have answered that they had used them both for non-medical PCE purposes and for medical purposes, prescribed by a doctor. The 1,42 % (3) who have answered that they had used them for medical purposes only, having been prescribed such drugs for a diagnosed medical condition by a doctor, have not been included in the group of PCE users, but instead assigned to the group of non-users.

  14. As the number of PCE users in or study is fairly small, the following results should be viewed as qualitative rather than quantitative data, providing a limited descriptive illustration of the users’ experiences and opinions, with very limited possibilities for generalizations. PCE use was slightly more widespread among female (6) than among male (5) students. Regarding the PCE drug used, 5 indicated having used AMP, 1 indicated MDF and 1 beta-blockers. No user reported having used MPH, which is presented as the primary PCE drug among US students. We further inquired as to the source from which they received the PCE substance used, and 7 listed third persons, 2 listed a medical prescription (which should be considered off-label in this context) and 2 the internet. Regarding the purposes for using PCE, 7 listed enhancement of wakefulness, 4 improvement of concentration, 2 enhancement of memory, 2 reduction of anxiety and fear, and 1 enhancement of creativity. The two primary reasons listed by PCE users in our survey are similar to those in the US survey referenced by T. Galert et al. [26: 40], although there the first reason was improved concentration and the second enhanced wakefulness. A majority (8) of PCE users stated that they will probably use PCE in the future. Regarding potential future use of PCE substances among the surveyed students who had not used PCE (200), a little over a quarter (27 %) thought that they will probably use such substances in the future.

  15. There are currently strong disincentives for pharmaceutical companies to invest in such research and development, given the existing pharmaceutical drug regulatory system, as gaining approval for purely enhancing drugs is unlikely and thus unprofitable [57: 143].

  16. Previously, several of the authors who had now shifted their attention to PCE were already involved in the discourse on the enhancement uses of novel genetic technologies [59–61].

  17. This group includes authors such as J. Savulescu and G. Kahane [62], J. Harris [3], and R. Bailey [4].

  18. Authors such as M. J. Mehlman [49], C. Forlini and E. Racine [65], B. Sahakian and S. Morein-Zamir [48].

  19. The survey was part of the 7 EU FP project titled “Ethics in Public Policy-Making: The Case of Human Enhancement” [69].

  20. According to their status in 2011.

  21. In another article we examined whether EABs do in fact function as inclusive anticipatory “hybrid forums”, or whether they more resemble “classical” technocratic expert bodies that can often serve merely to legitimize the decisions of policy makers. With this goal in mind, we examined several parameters regarding the functioning of a number of European EABs, such as their transparency, their use of participatory mechanisms, etc. [75].

  22. While the data from our survey pertains to Europe, EABs in the US, such as the former President’s Council on Bioethics under the chairmanship of Leon Kass, have also identified HE and the off-label use of pharmaceuticals for enhancement as a salient topic [22].

  23. One question in our survey among European EABs inquired about the professional backgrounds of members, and 18 out of 21 respondents answered that there are members with a background in philosophy, including ethics, among their members.

  24. The Health Council of the Netherlands (Gezondheidsraad) is quite similar to the US National Academy of Sciences (NAS) in its advisory role to policy decision makers. It is generally considered a successful and highly influential example of a “good practice” EAB [79].

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Acknowledgments

Part of the research presented in this article was conducted with the support of the European Commission FP7 Science in Society funded project, Ethics in Public Policy Making: The Case of Human Enhancement (EPOCH), grant number SIS-CT-2010-266660 (http://epochproject.com). We warmly thank all our partners and collaborators in the EPOCH project for their constructive cooperation.

We would also like to thank Steve Fuller for his insightful comments, as well as the two reviewers, whose suggestions were invaluable in improving an earlier version of this article.

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    Toni Pustovrh & Franc Mali

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Pustovrh, T., Mali, F. Exploring Some Challenges of the Pharmaceutical Cognitive Enhancement Discourse: Users and Policy Recommendations. Neuroethics 7, 137–158 (2014). https://doi.org/10.1007/s12152-013-9192-x

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