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The Evaluation of Psychopharmacological Enhancers Beyond a Normative “Natural”–“Artificial” Dichotomy

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Medicine Studies

Abstract

The extra-therapeutic use of psychotropic drugs to improve cognition and to enhance mood has been the subject of controversial discussion in bioethics, in medicine but also in public for many years. Concerns over a liberal dealing with pharmacological enhancers are raised not only from a biomedical–pharmacological perspective, but particularly from an ethical one. Within these ethical concerns, there is one objection about the normative differentiation between “natural” and “artificial” enhancers, which is theoretically indeed widely discredited in bioethics, which has, however, entrenched itself in such a persistent way in everyday moral consciousness that it keeps a crucial influence on the assessment of pharmacological enhancers made by the public and medical professionals. This paper tries to first show why a normative differentiation between “natural” and “artificial” enhancers is highly problematic. In a second step, the resulting implications for our current dealing with pharmacological enhancers shall be examined. In a specific comparison of synthetic pharmaceuticals (modafinil, SSRIs) with phytopharmaceuticals (ginkgo biloba, St. John’s wort) and other already established enhancers (alcohol, caffeine), argumentative inconsistencies are pointed out which, at least partly, result from a rationally untenable preference for the “natural” over the “artificial”. Therefore, it is conclusively argued the case for an unprejudiced assessment of pharmacological enhancers beyond a “natural”–“artificial” dichotomy, which equally takes into account biomedical and ethical aspects. The goal is to reach a coherent dealing with pharmacological enhancement in the long run.

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Notes

  1. Klaus Lieb refers to coffee as the oldest substance for a natural enhancement of vigilance, attention and concentration and explicitly recommends it as a cognitive enhancer (Lieb 2010, p. 142).

  2. I will not go into detail about gingko biloba in the following, since procognitive effects could neither be proven with healthy people nor with people with cognitive impairment despite the promises of the manufacturers (Solomon et al. 2002; Birks and Grimley 2009).

  3. See also below for the motives for the consumption of the respective substances. There are, however, psychotropic substances that as a rule are not subsumed under pharmacological neuroenhancement. These are especially the so-called illegal drugs (e.g. cocaine, LSD or certain amphetamine derivatives). For one thing, this is due to the fact that their consumption in most cases is associated with such high health risks that they are out of the question for being enhancers under rational aspects. For another thing, their consumption differs with regard to the underlying motives, as the so-called illegal drugs are mostly taken because of their euphoriant effects and in order to escape from reality (Lieb 2010). Certainly, overlaps with enhancement remain and also the so-called illegal drugs should always be taken into account in the societal debate about the handling of psychotropic substances.

  4. The emergence of the different “neuropharmaceuticals” is explained from a historical perspective in Stork 2007. With regard to the psychostimulant caffeine, he states for example that “The known stimulants of this time were coffee and tea. They reached Europe around 1600 […]. First they were affordable only in courtly circles or for medical purposes. During the eighteenth century, they gradually became a commodity for the new class of urban bourgeois […] in spite of ongoing efforts by most administrations to curb such an unbalanced import trade” (Stork 2007, p. 210).

  5. For this purpose also compare Neil Levy’s reference: “No doubt some of the opposition to psychopharmacology that remains is simply irrational. In part, it seems to be an expression of a deep-seated prejudice against technologies regarded as “unnatural.” When we investigate the roots of this kind of objection, we frequently find that by “unnatural” people tend to mean no more than “unfamiliar” […]” (Levy 2007, p. 72).

  6. These side effects differ substantially and interindividually in frequency and intensity, which can most likely be explained through the respective genetically determined type of cytochrome P450 enzymes (Lieb 2010, pp. 144–145).

  7. This is especially remarkable since one of the main arguments presented against the intake of synthetic pharmaceuticals as neuroenhancers from a biomedical point of view is the uncertainty about long-term effects. Firstly, however, such an argument ignores the fact that with every new technology, a moment of uncertainty exists and that one can never know all the consequences in advance (Gesang 2007, p. 62). Secondly, even the existence of certain risks or uncertainties does not suffice for the prohibition of reversible interventions like psychopharmacological enhancement in liberal societies (Glannon 2008).

  8. Of course, there have always been debates in (addiction) medicine as well as in the different social sciences which demand stronger restrictions in the distribution of alcoholic beverages against the background of the aforementioned risks of alcohol consumption. Also the German State promotes many institutions that especially educate young people about the health risks of alcohol consumption. However, this usually does not change the commonly shared belief that everyone has to bear the responsibility for negative consequences of alcohol consumption themselves in a liberal society (Gesang 2006).

  9. For the ethical debate also cf. the volumes which are mentioned in the introduction.

  10. In this context also cf. Huber and Kutschenko (2009).

  11. Also cf. articles about the “anti-aging culture” in Katz and Peters (2008), Vincent (2008) and Kampf and Botelho (2009).

  12. The question of applicability and desirability of psychopharmacological enhancement in an aging society is discussed in detail in Gather in preparation.

References

  • Ach, J.S., and A. Pollmann, eds. 2006. No body is perfect. Baumaßnahmen am menschlichen Körper; bioethische und ästhetische Aufrisse. Bielefeld: transcript.

  • Bayertz, K. 2003. Human nature: How normative might it be? Journal of Medicine and Philosophy 28(2): 131–150.

    Article  Google Scholar 

  • Beddington, J., et al. 2008. The mental wealth of nations. Nature 455: 1057–1060.

    Article  Google Scholar 

  • Benkert, O., and H. Hippius, eds. 2011. Kompendium der Psychiatrischen Pharmakotherapie. Berlin: Springer Medizin Verlag.

    Google Scholar 

  • Berger, M. et al. 2009. Stellungnahme der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) zum Gebrauch von Neuroenhancern. http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/stellungnahmen/2009/stn2009-11-24-neuroenhancer.pdf. Accessed 3 December 2010.

  • Birks, J., and E.J. Grimley. 2009. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews 1: Art. No.: CD003120.

  • Birnbacher, D. 2006a. “Natur” als Maßstab menschlichen Handelns. In Bioethik zwischen Natur und Interesse, ed. D. Birnbacher, 145–165. Frankfurt am Main: Suhrkamp.

    Google Scholar 

  • Birnbacher, D. 2006b. Natürlichkeit. Berlin: de Gruyter.

    Book  Google Scholar 

  • Bogle, K.E., and B.H. Smith. 2009. Illicit methylphenidate use: A review of prevalence, availability, pharmacology, and consequences. Current drug abuse reviews 2(2): 157–176.

    Article  Google Scholar 

  • British Medical Association. 2007. Boosting your brainpower: Ethical aspects of cognitive enhancements. A discussion paper from the British Medical Association. http://www.bma.org.uk/images/Boosting_brainpower_tcm41-147266.pdf. Accessed 3 Dec 2010.

  • Charlton, B.G. 2003. Palliative psychopharmacology: A putative speciality to optimize the subjective quality of life. QJM: Monthly Journal of the Association of Physicians 96: 375–378.

    Article  Google Scholar 

  • Charlton, B.G. 2001. The potential for pharmacological treatment of unpleasant psychological symptoms to increase personal fulfillment in old age. QJM: Monthly Journal of the Association of Physicians 94(6): 333–336.

    Article  Google Scholar 

  • Chatterjee, A. 2004. Cosmetic neurology: The controversy over enhancing movement, mentation, and mood. Neurology 63(6): 968–974.

    Google Scholar 

  • Clayton, A.H., and A.L. Montejo. 2006. Major depressive disorder, antidepressants, and sexual dysfunction. The Journal of clinical psychiatry 67(Suppl. 6): 33–37.

    Google Scholar 

  • Craik, F.I.M., and T.A. Salthouse, eds. 2008. The handbook of aging and cognition. New York: Psychology Press.

    Google Scholar 

  • Dees, R.H. 2008. Better brains, better selves? The ethics of neuroenhancements. Kennedy Institute of Ethics Journal 17(4): 371–395.

    Article  Google Scholar 

  • Dees, R.H. 2004. Slippery slopes, wonder drugs, and cosmetic neurology: The neuroethics of enhancement. Neurology 63(6): 951–952.

    Google Scholar 

  • Degrazia, D. 2000. Prozac, enhancement, and self-creation. The Hastings Center report 30(2): 34–40.

    Article  Google Scholar 

  • de Jongh, R., et al. 2008. Botox for the brain: Enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neuroscience and Biobehavioral Reviews 32(4): 760–776.

    Article  Google Scholar 

  • Dekant, W. 2005. Alkohole. In Allgemeine und spezielle Pharmakologie und Toxikologie, ed. K. Aktories, et al., 1041–1049. München: Elsevier Urban & Fischer.

    Google Scholar 

  • Farah, M.J. 2002. Emerging ethical issues in neuroscience. Nature Neuroscience 5: 1123–1129.

    Article  Google Scholar 

  • Farah, M.J., et al. 2004. Neurocognitive enhancement: What can we do and what should we do? Nature Reviews Neuroscience 5(5): 421–425.

    Article  Google Scholar 

  • Ferré, S. 2008. An update on the mechanisms of the psychostimulant effects of caffeine. Journal of Neurochemistry 105: 1067–1079.

    Article  Google Scholar 

  • Filipp, S.-H., and A.-K. Mayer. 2005. Zur Bedeutung von Altersstereotypen. Aus Politik und Zeitgeschichte 49(50): 25–31.

    Google Scholar 

  • Fink, H., and R. Rosenzweig, eds. 2010. Künstliche Sinne, gedoptes Gehirn. Neurotechnik und Neuroethik. Paderborn: Mentis.

    Google Scholar 

  • Förstl, H. 2009. Neuro-Enhancement. Gehirndoping. Der Nervenarzt 80(7): 840–846.

    Article  Google Scholar 

  • Franke, A.G., and K. Lieb. 2009. Missbrauch von Psychopharmaka zum “cognitive enhancement”. Mit Hirndoping zu intellektuellen Spitzenleistungen? INFO Neurologie & Psychiatrie 11(7–8): 42–50.

    Google Scholar 

  • Galert, T., et al. 2009. Das optimierte Gehirn. Gehirn & Geist 11: 40–48.

    Google Scholar 

  • Gather, J. (in preparation). Glück für die alternde Gesellschaft!? Zur Anwendbarkeit und sozialen Wünschbarkeit psychopharmakologischen Enhancements im demographischen Wandel.

  • Gesang, B. 2007. Perfektionierung des Menschen. Berlin: de Gruyter.

    Google Scholar 

  • Gesang, B. 2006. “Enhancement” zwischen Selbstbetrug und Selbstverwirklichung. Ethik in der Medizin 18: 10–26.

    Article  Google Scholar 

  • Glannon, W. 2008. Psychopharmacological enhancement. Neuroethics 1: 45–54.

    Article  Google Scholar 

  • Glannon, W., ed. 2007a. Bioethics and the brain. Oxford: Oxford University Press.

    Google Scholar 

  • Glannon, W., ed. 2007b. Defining right and wrong in brain science. Essential readings in neuroethics. New York: Dana Press.

    Google Scholar 

  • Greely, H., et al. 2008. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456: 702–705.

    Article  Google Scholar 

  • Groß, D. 2009. Blessing or Curse? Neurocognitive enhancement by “brain engineering”. Medicine Studies 1: 379–391.

    Article  Google Scholar 

  • Higdon, J.V., and B. Frei. 2006. Coffee and health: A review of recent human research. Critical Reviews in Food Science and Nutrition 46: 101–123.

    Article  Google Scholar 

  • Hofer, S.M., and D.F. Alwin, eds. 2008. Handbook of cognitive aging. Interdisciplinary perspectives. Los Angeles: Sage.

    Google Scholar 

  • Huber, L., and L.K. Kutschenko. 2009. Medicine in a neurocentric world: About the explanatory power of neuroscientific models in medical research and practice. Medicine Studies 1: 307–313.

    Article  Google Scholar 

  • Juliano, L.M., and R.R. Griffiths. 2004. A critical review of caffeine withdrawal: Empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology 176: 1–29.

    Article  Google Scholar 

  • Kampf, A., and L.A. Botelho. 2009. Anti-aging and biomedicine: Critical studies on the pursuit of maintaining, revitalizing and enhancing aging bodies. Medicine Studies 1: 187–195.

    Article  Google Scholar 

  • Katz, S., and K.R. Peters. 2008. Enhancing the mind? Memory medicine, dementia, and the aging brain. Journal of Aging Studies 22: 348–355.

    Article  Google Scholar 

  • Killgore, W.D., et al. 2009. Sustaining executive functions during sleep deprivation: A comparison of caffeine, dextroamphetamine, and modafinil. Sleep 32(2): 205–216.

    Google Scholar 

  • Klinkhammer, G. 2009. Auf dem Weg zum optimierten Gehirn. Deutsches Ärzteblatt 106(44): A2179.

    Google Scholar 

  • Kocka, J. 2008. Chancen und Herausforderungen einer alternden Gesellschaft. In Was ist Alter(n)? Neue Antworten auf eine scheinbar einfache Frage, eds. U.M. Staudinger, and H. Häfner, 217–236. Berlin: Springer.

    Google Scholar 

  • Kramer, P. 1997. Listening to prozac. New York: Penguin Books.

    Google Scholar 

  • Kruse, A., and H.-W. Wahl, eds. 2010. Zukunft Altern. Individuelle und gesellschaftliche Weichenstellungen. Heidelberg: Spektrum Akad.-Verlag.

    Google Scholar 

  • Lehr, U. 2007. Psychologie des Alterns. Wiebelsheim: Quelle & Meyer.

    Google Scholar 

  • Levy, N. 2007. Neuroethics. Challenges for the 21st century. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Lieb, K. 2010. Hirndoping. Warum wir nicht alles schlucken sollten. Mannheim: Artemis & Winkler.

    Google Scholar 

  • Linde, K. et al. 2008. St John′s wort for major depression. Cochrane Database of Systematic Reviews 4: Art. No.: CD000448.

  • Maher, B. 2008. Poll results: Look who′s doping. Nature 452: 674–675.

    Article  Google Scholar 

  • McCabe, S.E., et al. 2005. Non-medical use of prescription stimulants among US college students: Prevalence and correlates from a national survey. Addiction 100(1): 96–106.

    Article  Google Scholar 

  • Merkel, R. et al., ed. 2007. Intervening in the brain. Changing psyche and society. Berlin: Springer.

  • Metzinger, T. 2009. Der Ego-Tunnel. Eine neue Philosophie des Selbst: Von der Hirnforschung zur Bewusstseinsethik. Berlin: Berlin-Verlag.

    Google Scholar 

  • Minzenberg, M.J., and C.S. Carter. 2008. Modafinil: A review of neurochemical actions and effects on cognition. Neuropsychopharmacology 33: 1477–1502.

    Article  Google Scholar 

  • Müller, W.E. 2003. Current St. John′s wort research from mode of action to clinical efficacy. Pharmacological Research 47: 101–109.

    Article  Google Scholar 

  • Normann, C., and M. Berger. 2008. Neuroenhancement: Status quo and perspectives. European Archives of Psychiatry and Clinical Neuroscience 258(Suppl. 5): 110–114.

    Article  Google Scholar 

  • Parens, E., ed. 1998. Enhancing human traits. Ethical and social implications. Washington, DC: Georgetown University Press.

    Google Scholar 

  • President’s Council on Bioethics (PCB), ed. 2003. Beyond Therapy: Biotechnology and the Pursuit of Happiness. A report of The President’s Council on Bioethics. Washington, DC: US Government Printing Office. http://biotech.law.lsu.edu/research/pbc/reports/beyondtherapy/beyond_therapy_final_report_pcbe.pdf . Accessed 3 Dec 2010.

  • Repantis, D., et al. 2009. Antidepressants for neuroenhancement in healthy individuals: A systematic review. Poiesis & Praxis 6: 139–174.

    Article  Google Scholar 

  • Rose, S. 2006. The future of the brain. The promise and perils of tomorrow’s neuroscience. Oxford: Oxford University Press.

    Google Scholar 

  • Roughley, N. 2005. Was heißt “menschliche Natur”? Begriffliche Differenzierungen und normative Ansatzpunkte. In Die menschliche Natur. Welchen und wieviel Wert hat sie?, ed. K. Bayertz, 133–156. Paderborn: Mentis.

    Google Scholar 

  • Sahakian, B., and S. Morein-Zamir. 2007. Professor′s little helper. Nature 450: 1157–1159.

    Article  Google Scholar 

  • Savulescu, J., and N. Bostrom, eds. 2009. Human enhancement. Oxford: Oxford University Press.

    Google Scholar 

  • Schäfer, G., and D. Groß. 2008. Eingriff in die personale Identität. Die Argumente für psychopharmakologisches Enhancement greifen zu kurz. Deutsches Ärzteblatt 105(5): A210–A212.

    Google Scholar 

  • Schermer, M. 2008. On the argument that enhancement is “cheating”. Journal of Medical Ethics 34: 85–88.

    Article  Google Scholar 

  • Schmidt, L.G. 2005. Begriffsbestimmungen. In Alkohol und Alkoholfolgekrankheiten. Grundlagen—Diagnostik—Therapie, eds. M.V. Singer and S. Teyssen, 29–34. Berlin: Springer Medizin Verlag.

    Chapter  Google Scholar 

  • Schöne-Seifert, B. et al., ed. 2009. Neuro-Enhancement. Ethik vor neuen Herausforderungen. Paderborn: Mentis.

  • Schöne-Seifert, B., and D. Talbot, eds. 2009. Enhancement. Die ethische Debatte. Paderborn: Mentis.

    Google Scholar 

  • Solomon, P., et al. 2002. Ginkgo for Memory Enhancement. A Randomized Controlled Trial. JAMA 288: 835–840.

    Article  Google Scholar 

  • Starke, K. 2005. Methylxanthine. In Allgemeine und spezielle Pharmakologie und Toxikologie, ed. K. Aktories, et al., 187–191. München: Elsevier Urban & Fischer.

    Google Scholar 

  • Stork, S.W. 2007. Neuropharmaceuticals: A historical perspective. In Sind die Gedanken frei? Die Neurowissenschaften in Geschichte und Gegenwart, eds. D. Groß and S. Müller, 208–225. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft.

    Google Scholar 

  • Szentpetery, V. July 2008. Die gedopte Elite. Technology Review: 34–39.

  • Vincent, J.A. 2008. The cultural construction old age as a biological phenomenon: Science and anti-ageing technologies. Journal of Aging Studies 22: 331–339.

    Article  Google Scholar 

  • Wesensten, N.J., et al. 2005. Performance and alterness effects of caffeine, dextroamphetamine, and modafinil during sleep deprivation. Journal of Sleep Research 14: 255–266.

    Article  Google Scholar 

  • Zhou, S., et al. 2004. Pharmakokinetic interactions of drugs with St John’s wort. Journal of Psychopharmacology 18(2): 262–276.

    Article  Google Scholar 

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  1. Institute for History, Philosophy and Ethics of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany

    Jakov Gather

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Gather, J. The Evaluation of Psychopharmacological Enhancers Beyond a Normative “Natural”–“Artificial” Dichotomy. Medicine Studies 3, 19–27 (2011). https://doi.org/10.1007/s12376-011-0060-x

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