Neuroethics

, Volume 6, Issue 2, pp 419–427 | Cite as

Towards a Smart Population: A Public Health Framework for Cognitive Enhancement

Review Paper

Abstract

This paper presents a novel view of the concept of cognitive enhancement by taking a population health perspective. We propose four main modifiable healthy lifestyle factors for optimal cognitive functioning across the population for which there is evidence of safety and efficacy. These include i) promoting adequate sleep, ii) increasing physical activity, iii) encouraging a healthy diet, including minimising consumption of stimulants, alcohol and other drugs including nicotine, iv) and promoting good mental health. We argue that it is not ethical to promote or sanction the use of pharmaceutical drugs as putative cognitive enhancers without acknowledging the adverse effects on population cognitive health of failing to encourage the pursuit of healthy behaviours. We conclude with recommendations to increase the public health relevance of bioethical analyses of the cognitive enhancement debate.

Keywords

Cognitive enhancement Public health Sleep Physical activity Diet Mental health 

Notes

Acknowledgments

This research was funded by the Australian National Health and Medical Research Council. The authors would like to thank Professor Wayne Hall for comments on an earlier draft of this paper.

References

  1. 1.
    DeSantis, A., E.M. Webb, and S.M. Noar. 2008. Illicit use of prescription ADHD medications on a college campus: A multimethodological approach. Journal of American College Health 57(3): 315–324.CrossRefGoogle Scholar
  2. 2.
    Teter, C.J., S.E. McCabe, K. LaGrange, J.A. Cranford, and C.J. Boyd. 2006. Illicit use of specific prescription stimulants among college students: Prevalence, motives, and routes of administration. Pharmacotherapy 26(10): 1501–1510.CrossRefGoogle Scholar
  3. 3.
    Sahakian, B., and S. Morein-Zamir. 2007. Professor’s little helper. Nature 450(7173): 1157–1159.CrossRefGoogle Scholar
  4. 4.
    Outram, S.M., and E. Racine. 2011. Examining reports and policies on cognitive enhancement: Approaches, rationale, and recommendations. Accountability in Research 18(5): 323–341. doi:10.1080/08989621.2011.606734.Google Scholar
  5. 5.
    Greely, H., B. Sahakian, J. Harris, R.C. Kessler, M. Gazzaniga, P. Campbell, and M.J. Farah. 2008. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456(7223): 702–705.CrossRefGoogle Scholar
  6. 6.
    Harris, John, and Anjan Chatterjee. 2009. Is it acceptable for people to take methylphenidate to enhance performance? British Medical Journal 338: 1532–1533.Google Scholar
  7. 7.
    Forlini, C., and E. Racine. 2009. Autonomy and coercion in academic “cognitive enhancement” using methylphenidate: perspectives of key stakeholders. Neuroethics 2(3): 163–177. doi:10.1007/s12152-009-9043-y.CrossRefGoogle Scholar
  8. 8.
    British Medical Association. 2007. Boosting your brainpower: Ethical aspects of cognitive enhancement. London: British Medical Association.Google Scholar
  9. 9.
    Commission de l’Ethique de la Science et de la Technologie. 2009. Psychiatric Drugs and Expanded Uses: An Ethical Perspective.Google Scholar
  10. 10.
    Lucke, J.C., S. Bell, B. Partridge, and W.D. Hall. 2011. Deflating the neuroenhancement bubble. AJOB Neuroscience 2(4): 38–43.CrossRefGoogle Scholar
  11. 11.
    Partridge, B.J., S.K. Bell, J.C. Lucke, S. Yeates, and W.D. Hall. 2011. Smart drugs “As Common As Coffee”: Media hype about neuroenhancement. PLoS One 6(11): e28416. doi:10.1371/journal.pone.0028416.CrossRefGoogle Scholar
  12. 12.
    de Jongh, R., I. Bolt, M. Schermer, and B. Olivier. 2008. Botox for the brain: Enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neuroscience Biobehavioural Reviews 32(4): 760–776.CrossRefGoogle Scholar
  13. 13.
    Kumar, Raminder. 2008. Approved and investigational uses of modafinil: An evidence-based review. Drugs 68(13): 1803–1839.CrossRefGoogle Scholar
  14. 14.
    Minzenberg, M.J., and C.S. Carter. 2008. Modafinil: A review of neurochemical actions and effects on cognition. Neuropsychopharmacology 33(7): 1477–1502.CrossRefGoogle Scholar
  15. 15.
    Repantis, D., O. Laisney, and I. Heuser. 2010. Acetylcholinesterase inhibitors and memantine for neuroenhancement in healthy individuals: A systematic review. Pharmacological Research 61(6): 473–481. doi:10.1016/j.phrs.2010.02.009.CrossRefGoogle Scholar
  16. 16.
    Repantis, D., P. Schlattmann, O. Laisney, and I. Heuser. 2009. Antidepressants for neuroenhancement in healthy individuals: A systematic review. Poiesis und Praxis 6(3–4): 139–174. doi:10.1007/s10202-008-0060-4.CrossRefGoogle Scholar
  17. 17.
    Smith, M.E., and M.J. Farah. 2011. Are prescription stimulants “smart pills”? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychological Bulletin 137(5): 717–741. doi:10.1037/a0023825.CrossRefGoogle Scholar
  18. 18.
    Academy of Medical Sciences. 2008. Brain science, addiction and drugs. United Kingdom. ISBN No: 1-903401-18-6Google Scholar
  19. 19.
    Lanni, C., S.C. Lenzken, A. Pascale, I. Del Vecchio, M. Racchi, F. Pistoia, and S. Govoni. 2008. Cognition enhancers between treating and doping the mind. Pharmacological Research 57(3): 196–213.CrossRefGoogle Scholar
  20. 20.
    Outram, S.M. 2010. The use of methylphenidate among students: The future of enhancement? Journal of Medical Ethics 36(4): 198–202.CrossRefGoogle Scholar
  21. 21.
    Repantis, Dimitris, Peter Schlattmann, Oona Laisney, and Isabella Heuser. 2010. Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review. Pharmacological Research 62(3): 187–206.CrossRefGoogle Scholar
  22. 22.
    Belenky, G., L.J. Wu, and M.L. Jackson. 2011. Occupational sleep medicine: Practice and promise. Progress in Brain Research 190: 189–203. doi:10.1016/B978-0-444-53817-8.00012-8.CrossRefGoogle Scholar
  23. 23.
    Gruber, R., S.T. Wiebe, S.A. Wells, J. Cassoff, and E. Monson. 2010. Sleep and academic success: Mechanisms, empirical evidence, and interventional strategies. Adolescent Medicine: State of the Art Reviews 21(3): 522–541.Google Scholar
  24. 24.
    Killgore, W.D. 2010. Effects of sleep deprivation on cognition. Progress in Brain Research 185: 105–129. doi:10.1016/B978-0-444-53702-7.00007-5.CrossRefGoogle Scholar
  25. 25.
    Morin, C.M., and R. Benca. 2012. Chronic insomnia. Lancet 379(9821): 1129–1141. doi:10.1016/S0140-6736(11)60750-2.CrossRefGoogle Scholar
  26. 26.
    Lund, H.G., B.D. Reider, A.B. Whiting, and J.R. Prichard. 2010. Sleep patterns and predictors of disturbed sleep in a large population of college students. The Journal of Adolescent Health 46(2): 124–132. doi:10.1016/j.jadohealth.2009.06.016.CrossRefGoogle Scholar
  27. 27.
    Skaer, T.L., and D.A. Sclar. 2010. Economic implications of sleep disorders. PharmacoEconomics 28(11): 1015–1023. doi:10.2165/11537390-000000000-00000.CrossRefGoogle Scholar
  28. 28.
    Marks, Bonita L., Laurence M. Katz, and J. Keith Smith. 2009. Exercise and the aging mind: Buffing the baby boomer’s body and brain. The Physician and Sportsmedicine 37(1): 119–125.CrossRefGoogle Scholar
  29. 29.
    Esch, Tobias, and George B. Stefano. 2010. The neurobiology of stress management. Neuro Endocrinology Letters 31(1): 19–39.Google Scholar
  30. 30.
    Etnier, J. 2009. Physical activity programming to promote cognitive function: Are we ready for prescription? In Enhancing cognitive functioning and brain plasticity, ed. W. Chodzko-Zajko, A.F. Kramer, and L.W. Poon, 159–175. Champaign: Human Kinetics.Google Scholar
  31. 31.
    Khan, K.M., A.M. Thompson, S.N. Blair, J.F. Sallis, K.E. Powell, F.C. Bull, and A.E. Bauman. 2012. Sport and exercise as contributors to the health of nations. Lancet 380(9836): 59–64. doi:10.1016/S0140-6736(12)60865-4.CrossRefGoogle Scholar
  32. 32.
    Sallis, R.E. 2009. Exercise is medicine and physicians need to prescribe it! British Journal of Sports Medicine 43(1): 3–4. doi:10.1136/bjsm.2008.054825.CrossRefGoogle Scholar
  33. 33.
    Tomporowski, P.D., K. Lambourne, and M.S. Okumura. 2011. Physical activity interventions and children’s mental function: An introduction and overview. Preventive Medicine 52(Suppl 1): S3–9. doi:10.1016/j.ypmed.2011.01.028.CrossRefGoogle Scholar
  34. 34.
    Macniven, R., A. Bauman, and M. Abouzeid. 2012. A review of population-based prevalence studies of physical activity in adults in the Asia-Pacific region. BMC Public Health 12: 41. doi:10.1186/1471-2458-12-41.CrossRefGoogle Scholar
  35. 35.
    Bauman, A., F. Bull, T. Chey, C.L. Craig, B.E. Ainsworth, J.F. Sallis, H.R. Bowles, et al. 2009. The International Prevalence Study on Physical Activity: Results from 20 countries. International Journal of Behavioral Nutrition and Physical Activity 6(1): 21. doi:10.1186/1479-5868-6-21.CrossRefGoogle Scholar
  36. 36.
    le Coutre, J., and J.A. Schmitt. 2008. Food ingredients and cognitive performance. Current Opinion in Clinical Nutrition and Metabolic Care 11(6): 706–710. doi:10.1097/MCO.0b013e32831394a5.CrossRefGoogle Scholar
  37. 37.
    Benton, D., P. Winichagoon, T.P. Ng, E.S. Tee, and M. Isabelle. 2012. Symposium on nutrition and cognition: Towards research and application for different life stages. Asia Pacific Journal of Clinical Nutrition 21(1): 104–124.Google Scholar
  38. 38.
    Snel, J., and M.M. Lorist. 2011. Effects of caffeine on sleep and cognition. Progress in Brain Research 190: 105–117. doi:10.1016/B978-0-444-53817-8.00006-2.CrossRefGoogle Scholar
  39. 39.
    Heatherley, S.V. 2011. Caffeine withdrawal, sleepiness, and driving performance: What does the research really tell us? Nutritional Neuroscience 14(3): 89–95. doi:10.1179/147683011X13019262348785.CrossRefGoogle Scholar
  40. 40.
    Fernandez-Serrano, M.J., M. Perez-Garcia, and A. Verdejo-Garcia. 2011. What are the specific vs. generalized effects of drugs of abuse on neuropsychological performance? Neuroscience and Biobehavioral Reviews 35(3): 377–406. doi:10.1016/j.neubiorev.2010.04.008.CrossRefGoogle Scholar
  41. 41.
    van Holst, R.J., and T. Schilt. 2011. Drug-related decrease in neuropsychological functions of abstinent drug users. Current Drug Abuse Reviews 4(1): 42–56.CrossRefGoogle Scholar
  42. 42.
    Luksys, G., and C. Sandi. 2011. Neural mechanisms and computations underlying stress effects on learning and memory. Current Opinion in Neurobiology 21(3): 502–508. doi:10.1016/j.conb.2011.03.003.CrossRefGoogle Scholar
  43. 43.
    Millan, M.J., Y. Agid, M. Brune, E.T. Bullmore, C.S. Carter, N.S. Clayton, R. Connor, et al. 2012. Cognitive dysfunction in psychiatric disorders: Characteristics, causes and the quest for improved therapy. Nature Reviews. Drug Discovery 11(2): 141–168. doi:10.1038/nrd3628.CrossRefGoogle Scholar
  44. 44.
    Wallace, T.L., T.M. Ballard, B. Pouzet, W.J. Riedel, and J.G. Wettstein. 2011. Drug targets for cognitive enhancement in neuropsychiatric disorders. Pharmacology Biochemistry and Behavior 99(2): 130–145. doi:10.1016/j.pbb.2011.03.022.CrossRefGoogle Scholar
  45. 45.
    Walsh, R. 2011. Lifestyle and mental health. American Psychologist 66(7): 579–592. doi:10.1037/a0021769.CrossRefGoogle Scholar
  46. 46.
    Carek, P.J., S.E. Laibstain, and S.M. Carek. 2011. Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine 41(1): 15–28.CrossRefGoogle Scholar
  47. 47.
    Pack, A.I., and G.W. Pien. 2011. Update on sleep and its disorders. Annual Review of Medicine 62: 447–460. doi:10.1146/annurev-med-050409-104056.CrossRefGoogle Scholar
  48. 48.
    Bostrom, N., and A. Sandberg. 2009. Cognitive enhancement: Methods, ethics, regulatory challenges. Science and Engineering Ethics 15(3): 311–341. doi:10.1007/s11948-009-9142-5.CrossRefGoogle Scholar
  49. 49.
    Avitzur, O. 2010. Will a pill boost your brain power? Consumer Reports 75(3): 12.Google Scholar
  50. 50.
    Farah, M.J., J. Illes, R. Cook-Deegan, H. Gardner, E. Kandel, P. King, E. Parens, B. Sahakian, and P.R. Wolpe. 2004. Neurocognitive enhancement: What can we do and what should we do? Nature Reviews Neuroscience 5(5): 421–425.CrossRefGoogle Scholar
  51. 51.
    Sahakian, B.J., and S. Morein-Zamir. 2010. Neuroethical issues in cognitive enhancement. Journal of Psychopharmacology. doi:10.1177/0269881109106926.

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  1. 1.The University of Queensland, UQ Centre for Clinical ResearchHerstonAustralia

Personalised recommendations