This time had to come: A group that includes some serious neuro-heavyweights, such as neuroscientists Michael Gazzaniga and Ronald Kessler and the highly prominent and influential neuroethicists Hank Greely and Martha Farah, has published in Nature an essay "Towards responsible use of cognitive-enhancing drugs by the healthy."
In this article, we propose actions that will help society accept the benefits of enhancement, given appropriate research and evolved regulation. Prescription drugs are regulated as such not for their enhancing properties but primarily for considerations of safety and potential abuse. Still, cognitive enhancement has much to offer individuals and society, and a proper societal response will involve making enhancements available while managing their risks.
This will make uneasy many who feel our society is already overprescribed, that we have medicalized the normal, and that the drug industry has pushed a lot of this expansion of diagnostic categories and prescribed drug use. Yet Greely et alia here are not proposing we medicalize normality; they're proposing we make it okay to upgrade the normal. This is the difference between treatment and enhancement.
That difference is not as clear as it might be, of course, for it ultimately depends on what we agree to call normal. My own powers of memory and focus, for instance, probably fall within the normal range ; yet they're not as good as those possessed by some of my peers who can therefore perhaps outwork me. Taking some modafinil can close some of that gap -- and, more to the point, help me work at my own best capacity. And it's not hard to rationalize or justify: I already drink (too much) coffee to boost my energy and cognitive performance, and modafinil essentially provides a more complete coffee-achiever boost without producing jittery hands or irritability; in fact, many people find it has a nice antidepressive effect rather than producing the anxiety that too much coffee can.
And virtually no one, of course, suggests it's unfair to drink coffee -- even though I clearly drink it not to cure an ill but to enhance my already existing powers and attentiveness (such as they aren't).
So let's say I switch from coffee to modafinil. Have I done wrong? Greely et alia are saying I have not, and that I should be free to if my doctor and I agree that it's safe to do so. (Modafinial so far has not been shown to have significant ill-effects, either in clinical trials or the more robust test that wide use provides.) This is what the authors mean when they say that "cognitive-enhancing drugs seem morally equivalent to other, more familiar, enhancements."*
This is an important essay, methinks, in which some undeniably influential players make a pretty clear assertion and distinction. And it is, I'm delighted to say, free to read, unlike many things posted at the Nature site.
Update: Here are a few posts and reports on the Nature commentary:
Nature's Great Beyond blog does a bit of a roundup. Technology Review has an interview with co-author Michael Gazzniga. Commentary, meanwhile, includes posts by Nicholas Carr, who explores what I call the crucial coffee question (i.e., as above: Why not use an enhancer if its benefit-cost ratio is better than coffee's?):
I can come up with plenty of thought experiments that shake me up: imagine that the risks are better known, and that they're as much as, say, caffeine (but with more benefits). What then? What if such things turn out, many years in the future, to be necessary to work at any reasonably high level in science, since everyone else will be taking them, too? Is part of my problem with drugs that alter brain function a streak of Puritanism - would I feel better about using such things if I knew that they were guaranteed not to be enjoyable? And so on. . .I have to confess, I found such issues a lot easier to deal with inside the confines of old science fiction stories.
Bernadette Tansey, of the SF Chronicle, ask a good question: Are these drugs fair to those who simply want to live natural? (Hat tip: Knight Science Journalism Tracker) And Maia Szalavitz at HuffPost asks whether this is the beginning of the end of the drug wars.
And Benedict Carey of the Times had a good piece on this back in March.
There will be many more, and I'll try to keep up among other work.
*(I wish someone at Nature had taken some modafinil before reviewing those commas.)
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