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Cognitive Enhancement

ritalin_imageMany neuropsychiatric illnesses occur on a spectrum that includes normal levels of functioning. This raises the question: if medications can improve cognition in people with cognitive impairment, what can they do for normal healthy people?

Two main cognitive systems have been targeted for pharmacological enhancement: attention and memory. Stimulant drugs such as methyphenidate (Ritalin) and amphetamine (Adderall) improve the attention of people with attention deficit hyperactivity disorder (ADHD) and can also enhance attention in healthy people. Although these medications are ostensibly prescribed mainly for the treatment of ADD, sales figures suggest that they are not uncommonly used for enhancement. Campus surveys agree with this inference. Prescription stimulants are currently widely used by college students, many of whom obtain it from friends or campus dealers as a recreational drug and study aid.

A huge research effort is now being directed to the development of memory-boosting drugs. The candidate drugs target various stages in the molecular cascade that underlies memory formation, including the initial induction of long-term potentiation and the later stages of memory consolidation. Although this research is aimed at finding treatments for dementia, there is reason to believe that some of the products under development would enhance normal memory as well, particularly in middle and old age when a degree of increased forgetfulness is normal.

The weaking of unwanted memories is another type of memory treatment, under development for Post-Traumatic Stress Disorder that may cross over to enhancement of healthy individuals. It could conceivably be used psychologically say, for example, soldiers going into battle or rescue workers in a disaster situation.

The ethical issues surrounding cognitive enhancement can be grouped into 3 general categories. The first is safety. Side effects and unintended consequences are a concern with all medications and procedures, but in comparison to other comparably elective treatments such as cosmetic surgery, neuroscience-based enhancement involves intervening in a far more complex system. We are therefore at greater risk of unanticipated problems when we tinker. In addition, drug safety testing does not routinely address long-term use, and relatively little evidence is available on long-term use by healthy subjects.

The second category of ethical issue is social: how will the lives of all individuals, including those who chose not to enhance, be influenced by living in a society with widespread enhancement? In competitive situations such as SAT testing, we may end up needing the equivalent of the regulations surrounding performance enhancing drugs at sports events. Even in everyday work and school contexts, enhancement is likely to touch all of us. The freedom not to enhance may be difficult to maintain in a society where one's competition is using enhancement to improve attention, memory, or the ability to withstand unsettling experiences. Conversely, barriers such as cost will prevent some people who would like to enhance from doing so. This could exacerbate the disadvantages already faced by people of low socioeconomic status in education and employment.

The third category of ethical issue could be called philosophical, in that it concerns our values and our sense of self. We generally view self-improvement as a laudable goal. At the same time, improving our natural endowments for traits such as attention span runs the risk of commodifying those traits. We generally encourage innovations that save time and effort, because they enable us to be more productive and to direct our efforts toward potentially more worthy goals. However, when we improve our productivity by taking a pill, there is the concern that we may be undermining the value and dignity of hard work, medicalizing human effort, and pathologizing a normal attention span.

Martha J. Farah

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