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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
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.
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.
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.
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 .
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.
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 .
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.
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 .
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.
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.
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.
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.
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].
The survey was part of the 7 EU FP project titled “Ethics in Public Policy-Making: The Case of Human Enhancement” .
According to their status in 2011.
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. .
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 .
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.
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 .
Stehr, Nico. 2003. Wissenspolitik. Überwachung des Wissens. Frankfurt am Main: Suhrkamp.
Persson, Ingmar, and Jualian Savulescu. 2012. Unfit for the future: The need for moral enhancement. Oxford: Oxford University Press.
Harris, John. 2007. Enhancing evolution: The ethical case for making better people. Princeton: Princeton University Press.
Bailey, Ronald. 2005. Liberation biology. The scientific and moral case for the biotech revolution. New York: Prometheus Books.
Hughes, James. 2004. Citizen cyborg: Why democratic societies must respond to the redesigned human of the future. Boulder: Westview Press.
Sandel, Michael J. 2007. The case against perfection: Ethics in the age of genetic engineering. Cambridge: Belknap Press of Harvard University Press.
Fukuyama, Francis. 2002. Our posthuman future: Consequences of the biotechnology revolution. New York: Picador.
McKibben, Bill. 2003. Enough: Staying human in an engineered age. New York: Henry Holt and Company.
Habermas, Jürgen. 2001. Die Zukunft der menschlichen Natur. Auf dem Weg zu einer liberalen Eugenik? Frankfurt am Main: Suhrkamp.
Lucke, Jayne C. 2012. Empirical research on attitudes toward cognitive enhancement is essential to inform policy and practice guidelines. AJOB Primary Research 3(1): 58–60.
Nadler, Roland C., and Peter B. Reiner. 2010. A call for data to inform discussion on cognitive enhancement. Biosocieties 5(4): 481–482.
Quednow, Boris B. 2010. Ethics of neuroenhancement: A phantom debate. Biosocieties 5(4): 153–156.
Singh, Ilina, and Nikolas Rose. 2006. Neuro-forum: An introduction. Biosocieties 1(1): 97–102.
Mali, Franc. 2004. Recent dilemmas in the social and legal regulation of biotechnology in the European Union. Vest, Journal for Science and Technology Studies 17(3–4): 39–60.
Slob, Marjan, and Jan Staman. 2012. Policy and the evidence beast. A Dutch study of the expectations and practices in the area of evidence-based policy. Den Haag: Rathenau Institut.
Sauter, Arnold, and Katrin Gerlinger. 2012. Der pharmakologisch verbesserte Mensch. Leistungssteigernde Mittel als gesellschaftliche Herausforderung. Berlin: Sigma Verlag.
Coenen, Christopher, Mirjam Schuijff, Martijntje Smits, Pim Klaassen, Leonhard Hennen, Michael Rader, and Gregor Wolbring. 2009. Human enhancement. Brussels: European Parliament, DG Internal Policies STOA.
Savulescu, Julian, Ruud ter Meulen, and Guy Kahane (ed.). 2011. Enhancing human capacities. Wiley-Blackwell.
Brown, Nik. 2003. Hope against hype–accountability in biopasts, presents and futures. Science and Technology Studies 16(2): 3–21.
Kass, Leon R. 2003. Ageless bodies, happy souls: Biotechnology and the pursuit of happiness. The New Atlantis Spring 2003: 9–28.
Daniels, Norman. 2009. Can anyone really be talking about ethically modifying human nature? In Human enhancement, ed. Julian Savulescu and Nick Bostrom, 25–43. Oxford: Oxford University Press.
President’s Council on Bioethics (ed.). 2008. Human dignity and bioethics: Essays commissioned by the president’s council on bioethics. Washington: US Independent Agencies and Commissions.
Turner, Danielle C., and Barbara J. Sahakian. 2006. Neuroethics of cognitive enhancement. BioSocieties 1(1): 113–123.
Bostrom, Nick, and Anders Sandberg. 2009. Cognitive enhancement: Methods, ethics, regulatory challenges. Science and Engineering Ethics 15(3): 311–341.
Farah, Martha J., Judith Illes, Robert Cook-Deegan, Howard Gardner, Eric Kandel, Patricia King, Eric Parens, Barbara Sahakian, and Paul Root Wolpe. 2004. Neurocognitive enhancement: What can we do and what should we do? Nature Reviews Neuroscience 5: 421–425.
Galert, Thorsen, Christoph Bublitz, Isabella Heuser, Reinhard Merkel, Dimitris Repantis, Bettina Schöne-Seifert, and Davinia Talbot. 2009. Das optimierte Gehirn. Gehirn & Geist 11(2009): 40–48.
Jayne, Lucke, and Brad Partridge. 2012. Towards a smart population: A public health framework for cognitive enhancement. Neuroethics 6(2): 419–427.
Agar, Nicholas. 2010. Enhancing genetic virtue? Politics and the Life Sciences 29(1): 73–75.
Bostrom, Nick, and Rebecca Roache. 2008. Human enhancement: Ethical issues in human enhancement. In New waves in applied ethics, ed. Jesper Ryberg, Thomas S. Petersen, and Clark Wolf, 120–152. Palgrave Macmillan.
Reiner, Peter B. 2010. Distinguishing between restoration and enhancement in neuropharmacology. Virtual Mentor 12(11): 885–888.
Chatterjee, Anjan. 2004. Cosmetic neurology: The controversy over enhancing movement, mentation and mood. Neurology 63(6): 968–974.
Davis, Joseph E. 2010. The Miltown era. Biosocieties 5(1): 149–153.
Bell, Stephanie K., Jayne C. Lucke, and Wayne D. Hall. 2012. Lessons for enhancement from the history of cocaine and amphetamine use. AJOB Neuroscience 3(2): 24–29.
Peterkin, Alexander L., Catherine C. Crone, Michael J. Sheridan, and Thomas N. Wise. 2011. Cognitive performance enhancement: Misuse or self-treatment? Journal of Attention Disorders 15(4): 263–268.
Wolbring, Gregor. 2008. Ableism, enhancement medicine and the techno poor disabled. In Unnatural selection: The challenges of engineering tomorrow’s people, ed. Peter Healey and Steve Rayner, 196–209. London: Earthscan.
Outram, Simon M. 2012. Ethical considerations in the framing of the cognitive enhancement debate. Neuroethics 5(2): 173–184.
Lucke, Jayne C., Stephanie Bell, Brad Partridge, and Wayne D. Hall. 2010. Weak evidence for large claims contribute to the phantom debate. BioSocieties 5(4): 482–483.
Schleim, Stephan. 2010. Second thoughts on the prevalence of enhancement. Biosocieties 5(4): 484–485.
Lieb, Klaus. 2010. Hirndoping. Warum wir nicht alles schlucken sollten. Dusseldorf: Artemis & Winkler.
Fröding, Barbro Elisabeth Esmeralda. 2011. Cognitive enhancement, virtue ethics and the good life. Neuroethics 4(3): 223–234.
Racine, Eric, and Cynthia Forlini. 2010. Cognitive enhancement, lifestyle choice or misuse of prescription drugs? Neuroethics 3(1): 1–4.
Fuller, Steve. 2011. Humanity 2.0. What it means to be human past, present and future. Hampshire: Palgrave Macmillan.
Fuller, Steve. 2012. The emerging political economy of humanity 2.0. Innovation The European Journal of Social Science Research 25(1): 79–92.
Sandberg, Anders, and Julian Savulescu. 2011. The social and economic impacts of cognitive enhancement. In Enhancing human capacities, ed. Jualian Savulescu, Ruud ter Meulen, and Guy Kahane, 92–112. Wiley-Blackwell.
Lynch, Zack. 2005. Neuropolicy (2005–2035): Converging technologies enables neurotechnology, creating new ethical dilemmas. In Managing nano-bio-infocogno innovations: Converging technologies in society, ed. William Sims Bainbridge and Mihail C. Roco, 173–193. Dordrecht: Springer.
Schermer, Maartje, Ineke Bolt, Reinoud de Jongh, and Berend Olivier. 2009. The future of psychopharmacological enhancements: Expectations and policies. Neuroethics 2(2): 75–87.
Greely, Henry, Barbara Sahakian, John Harris, Ronald C. Kessler, Michael Gazzaniga, Philip Campbell, and Martha J. Farah. 2008. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456: 702–705.
Sahakian, Barbara, and Sharon Morein-Zamir. 2007. Professor’s little helper. Nature 450: 1157–1159.
Mehlman, Maxwell J. 2004. Cognition-enhancing drugs. The Milbank Quarterly 82(3): 483–506.
Maher, Brendan. 2008. Poll results: Look who’s doping. Nature 452: 674–675.
Partridge, Bradley J., Stephanie K. Bell, Jayne C. Lucke, Sarah Yeates, and Wayne D. Hall. 2012. Smart drugs “as common as coffee”: Media hype about neuroenhancement. PLoS ONE 6(11): e28416.
Bell, Stephanie, Brad Partridge, Jayne Lucke, and Wayne Hall. 2013. Australian university students’ attitudes towards the acceptability and regulation of pharmaceuticals to improve academic performance. Neuroethics 6(1): 197–205.
Partridge, Brad, Jayne Lucke, and Wayne Hall. 2012. A comparison of attitudes toward cognitive enhancement and legalized doping in sport in a community sample of Australian adults. AJOB Primary Research 3(4): 81–86.
Forlini, Cynthia, and Eric Racine. 2012. Added stakeholders, added value(s) to the cognitive enhancement debate: Are academic discourse and professional policies sidestepping values of stakeholders? AJOB Primary Research 3(1): 33–47.
Castaldi, Silvana, Umberto Gelatti, Grazia Orizio, Uwe Hartung, Ana Maria Moreno-Londono, Marta Nobile, and Peter J. Schulz. 2012. Use of cognitive enhancement medication among northern Italian university students. Journal of Addiction Medicine 6(2): 112–117.
Franke, A.G., C. Bonertz, M. Christmann, M. Huss, A. Fellgiebel, E. Hildt, and K. Lieb. 2011. Non-medical use of prescription stimulants and illicit use of stimulants for cognitive enhancement in pupils and students in Germany. Pharmacopsychiatry 44(2): 60–66.
Bostrom, Nick, and Rebecca Roache. 2011. Smart policy: Cognitive enhancement and the public interest. In Enhancing human capacities, ed. Julian Savulescu, Ruud ter Meulen, and Guy Kahane, 138–149. Wiley-Blackwell.
Butcher, James. 2003. Cognitive enhancement raises ethical concerns. The Lancet 362(9378): 132–133.
Bostrom, Nick. 2003. Human genetic enhancements: A transhumanist perspective. Journal of Value Inquiry 37(4): 493–506.
Kass, Leon R. 2002. Life, liberty, and the defense of dignity. Encounter Books.
Mehlman, Maxwell J. 2003. Wondergenes: Genetic enhancement and the future of society. Bloomington: Indiana University Press.
Savulescu, Julian, and Guy Kahane. 2009. The moral obligation to create children with the best chance of the best life. Bioethics 23(5): 274–290.
Capps, Benjamin. 2011. Libertarianism, legitimation, and the problems of regulating cognition-enhancing drugs. Neuroethics 4(2): 119–128.
Schuijff, Mirjam, Martijntje Smits, Christopher Coenen, Leonhard Hennen, and Michael Rader. 2009. A European approach to human enhancement. Background document for the STOA workshop. Brussels: STOA, European Parliament.
Forlini, Cynthia, and Eric Racine. 2009. Autonomy and coercion in academic ‘cognitive enhancement’ using methylphenidate: Perspectives of key stakeholders. Neuroethics 2(3): 163–177.
Bogner, Alexander. 2010. Let’s disagree! talking ethics in technology controversies. Science, Technology & Innovation Studies 6(2): 183–201.
Fuchs, Michael. 2005. Nationale Ethikräte. Hintergründe, Funktionen und Arbeitsweisen im Vergleich. Berlin: Nationaler Ethikrat.
Mortensen, Arne Thing, Jean-Christophe Galloux, Suzanne de Cheveigné, Agnes Allansdottir, Aigli Chatjouli, and George Sakellaris. 2002. The institutions of bioethics. In Biotechnology–the making of a global controversy, ed. Martin W. Bauer and George Gaskell, 129–149. Cambridge: Cambridge University Press.
EPOCH: Ethics in public policy-making: The case of human enhancement. 2012. http://epochproject.com. Accessed 30 January 2013.
Ahvenharju, Sanna, Mikko Halonen, Susanne Uusitalo, Veikko Launis, and Mari Hjelt. 2006. Comparative analysis of opinions produced by National Ethics Councils. Final report. Helsinki: Gaia Group Ltd.
European Conference of National Ethics Committees. 1998. Comparative study on the functioning of national ethics committees in 18 member states, COMETH 98 (13). Strasbourg. http://www.coe.int/t/dg3/healthbioethic/cometh/COMETH_98_13_fonctionnement_CNEs_bil.pdf. Accessed 23 June 2013.
European Conference of National Ethics Committees. 2012. http://www.coe.int/t/dg3/healthbioethic/cometh/national_ethics_committees/. Accessed June 30 2013.
National Ethics Committee Forum. 2012. http://ec.europa.eu/research/science-society/index.cfm?fuseaction=public.topic&id=1305. Accessed 30 June 2013.
World Health Organization. 2013. The global summit of national bioethics advisory bodies. http://www.who.int/ethics/globalsummit/en/. Accessed 30 June 2013.
Mali, Franc, Toni Pustovrh, Blanka Groboljšek, and Christopher Coenen. 2012. National ethics advisory bodies in the emerging landscape of responsible research and innovation. Nanoethics 6(3): 167–184.
Nuffield Council on Bioethics. 2002. Genetics and human behavior: the ethical context. London. http://www.nuffieldbioethics.org/genetics-and-behaviour. Accessed 10 March 2013.
Health Council of the Netherlands (in cooperation with the Center for Ethics and Health). 2003. Human enhancement. The Hague. http://www.gezondheidsraad.nl/sites/default/files/0308-04E.pdf. Accessed 15 March 2013.
Danish Council of Ethics. 2010. Recommendations concerning cyborg technology. Copenhagen. http://etiskraad.dk/en/Temauniverser/Homo-Artefakt/Anbefalinger. Accessed 17 March 2013.
Bijker, Wiebe E., Roland Bal, and Ruud Hendriks. 2009. The paradox of scientific authority. The role of scientific advice in democracies. Cambridge: The MIT Press.
Larriviere, Dan, Michael A. Williams, Matt Rizzo, and Richard J. Bonnie. 2009. Responding to requests from adult patients for neuroenhancements: Guidance of the ethics, law and humanities committee. Neurology 73(17): 1406–1412.
Dresler, Martin, Anders Sandberg, Kathrin Ohla, Christoph Bublitz, Carlos Trenado, Aleksandra Mroczko-Wasowicz, Simone Kühn, and Dimitris Repantis. 2013. Non-pharmacological cognitive enhancement. Neuropharmacology 64: 529–543.
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.
About this article
Cite this article
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