The ethics of cognitive-enhancement

The British Medical Association's ethics committee recently published a "discussion paper on the ethics of cognitive-enhancement," centering in part around the use of Ritalin and modafinil to improve memory and learning. The question at hand: the use of these substances for competitive advantage is increasing among so-called healthy adults, but is that particularly a bad thing? A great summary article in the Guardian offers a range of anecdotes to illustrate the ethical complexity involved when a subset of those competing in a field of study, for instance, or in a career path, are enhancing their performance with Ritalin - which is prescribed often enough to kids that people believe it's a basic tool in the kit - and modafinil, which continues to demonstrate its utility at improving short term memory. For instance:

Sahakian and a team of researchers at Cambridge tested modafinil on healthy male undergraduates in 2003. Those who took a single 200mg dose were found to use information more efficiently within two hours of taking it. They were better at mental planning tests, completed puzzles more accurately, could remember longer strings of digits and recognise pictures more quickly. Long-term memory was not enhanced, but the increased ability to concentrate for longer periods of time would, the researchers say, allow them to learn more.

A logical question would be, assuming longer term studies demonstrate that modafinil is not harmful, what would the issues be with allowing widespread access to it? But that's not really what the BMA is bringing up in its discussion paper, since it seems quite likely that significant use is already emerging, regardless of waiting around for long term study results. So the questions are more practical:

The idea of competing with pharmaceutically enhanced peers at work or university will strike many as deeply unfair. "It may not be a fair thing that I took modafinil," Mark says, "but so many students have Ritalin and other drugs, some who have been prescribed it for more or less spurious reasons, or others who can just get hold of it one way or another. Loads of students I knew were using it to stay up and write essays. And at that particular time, this particular drug seemed quite helpful to me, so I didn't feel too bad about taking it."

The seeming ready availability of Ritalin and even modafinil by prescription does indeed seem to leave others out in the cold, but there will always be those without access to key modern tools of learning - the student who can't afford a laptop, for instance. In the meantime:

Trevor Robbins, professor of neuroscience at Cambridge University, who has carried out extensive research on drugs for cognitive enhancement and on drug abuse, is surprisingly sanguine about the use of these drugs by healthy adults. "We already enhance our performance in all sorts of ways," he says. "Some of us wear contact lenses, some of us drink coffee. Some may be horrified that normal people would take drugs to improve their performance, but if you called it a food or a drink, they wouldn't bat an eyelid - people take fish oil because it may make their brains work better, but drugs have a stigma to them.

"I don't really see any argument against self-improvement in itself, except in a competitive situation - in exams, for example. Then it's analogous with doping in competitive sport. But what can you do? Even if you do drug tests in the exam hall, people might have used modafinil to improve their learning on a course in November, for instance, then taken the exam in July. How are you going to test it by then?"

And of course, the panoply of choices for this type of enhancement seems only likely to increase as time marches on:

And right now there are more mind-sharpening medicines in development, and those who want to enhance their mental performance may soon be able to choose, legally or illegally, from a wider range of drugs, each operating on different parts of the brain. The Alzheimer's drug Donepezil, for example, has been shown to delay loss of mental ability in patients, and improve memory in those without dementia. Early clinical trials, meanwhile, suggest that a new and so far unlicensed class of drugs, ampakines, may enhance learning capacity and memory in healthy users, as well as increasing attention span and alertness.

While the Guardian article I first came across on this topic is focused almost exclusively on Ritalin and modafinil, the discussion paper itself seems to have a much broader scope, moving beyond pharmaceuticals and nutrition to topics like "the possibilities and limitations of genetic manipulation and selection as a means of enhancing future people." I haven't had a chance to dig into the actual paper itself; I'll be reading it as I get a chance this week and if anything seems particularly provocative, I'll put a follow-up post together for discussion.

In the meanwhile, how many of you folks have experience, pro or con, with using drugs like these specifically to improve cognitive performance (as opposed to their prescribed uses)?