A recent (in 2009!) issue of the New Yorker featured a wide-ranging and engagingly written review of the current controversy over the ethics of neuroenhancement, touching upon the scientific findings, social implications, and ethical concerns raised by this increasingly prevalent phenomenon. Neuroenhancement refers to the growing trend of off-label use of psychiatric drugs by men and women of all ages and backgrounds for the purpose of boosting their brain power and ability to get things done. Psychiatrists have been prescribing Ritalin and Adderall to children with ADHD for decades, and teenagers and college students have been abusing these medications for almost as long [link?]. However, it was not until an anonymous survey of scientists and academics appeared in Nature in 2005 [link to online article] that this issue began to receive significant attention in the popular press. Over 1/5 of respondents to that survey reported off-label use of Ritalin, Adderall, or the anti-narcoleptic drug Provigil (known generically as modafinil) to increase their productivity and get by with less sleep. Margaret Talbot’s feature is one of the most comprehensive reports on this trend to appear in a major news publication, and I strongly encourage readers with interest in this subject to read the original article in full. Here, I want to highlight a few points that relate specifically to the ethical implications derived from a comparison of neuroenhancement to the use of steroids and other performance-enhancing drugs (or PEDs) by professional athletes.
A common trope in discussions of neuroenhancement is to compare the use of neuroenhancers by students and scientists to the use of steroids and other PEDs by professional athletes. As with neuroenhancers, steroids have acknowledged medical uses that confer benefits to patients with a wide range of disorders. Likewise, the use of steroids for medical purposes is presumably accepted by most opponents of PED-use in professional athletes, who argue that such use constitutes a breach of fair and sportsmanlike conduct because these athletes do not have a legitimate need for these drugs. By comparison, most (but not all) critics of neuroenhancement accept the therapeutic value of psycho-stimulants (e.g. Adderall, Ritalin, Concerta) for the treatment of ADHD but argue that healthy individuals who use these drugs to boost their focus and concentration or to “cheat sleep” have an unfair advantage over their peers. While I understand the sentiment underlying this point of view, a careful examination of patterns of off-label use of neuroenhancers raises some critical challenges.
The first challenge to the equation of PEDs and neuroenhancers concerns patterns of use, and in this instance it is the similarities between the classes of drugs that serves to weaken the ethical argument against neuroenhancement. Many professional baseball players (and presumably other athletes) initiate steroid use to speed their recovery from injuries [ref/link?]. Although steroids are not typically prescribed for such a purpose, this still raises the question of what constitutes a legitimate medical use. Most of us would probably agree that taking a medication to assist with injury recovery seems like a medical use. On the other hand, steroids are also used by healthy athletes to speed their recovery from ordinary workouts, thus increasing their capacity for intensive workouts which in turn increases their ability to perform on the field. Indeed, the mechanisms by which steroids enhance athletic performance are likely to be more rapid injury recovery and increased exercise ability, which is to say that merely taking a steroid or other PED without making accompanying behavioral changes may have no effect on athletic performance whatsoever. Although this contention is well-supported, the revelation that PEDs are often used for purposes that do not literally enhance athletic performance raises the intriguing prospect that off-label use of neuroenhancers may primarily be used to rectify perceived deficits in academic competence, much as PEDs are used by athletes to rectify physical deficits (i.e. in injury recovery).
Prior to reading Talbot’s article, I was unaware of the possibility that neuroenhancers are most often used to overcome cognitive or motivational deficits, but the more I think about it the more sense it seems to make. Support for this claim can be found in the New Yorker article, which argues that most neuroenhancers in college are underachievers (note, however, that this is based mainly on anecdotal evidence). So it may be true that students who take Adderall in college are gaining an unfair advantage, but this advantage may only be relative to other underachievers, who may receive sub-normal grades while neuroenhancers may be more likely to obtain average grades. Further, recent empirical findings suggest that drugs such as Adderall and Ritalin may benefit less cognitively sharp people to a greater extent than they benefit more intelligent folks.
A second weakness of the PED-neuroenhancer comparison concerns an important difference between the two classes of drugs. One legitimate concern regarding PED use in professional athletes concerns the influence these players have on impressionable young athletes. Indeed, PED abuse by high-school and college athletes has increased in recent years [cit/link?]. The influence that athletes have on young people is particularly problematic when it comes to drug usage, as PEDs such as steroids can be harmful to normal development in childhood and adolescence. Thus, the potential for harm to the developing body creates the possibility that athletes’ highly-publicized use of PEDs may result in serious detriments to teen health. This argument against PED use is persuasive, but its application by analogy to neuroenhancement is highly suspect. For one thing, ADHD medications are disproportionately prescribed to children and adolescents, so if anything, neuroenhancement has spread from children to adults, rather than the other way around. Moreover, the bulk of the evidence suggests that, in contrast to PEDs, neuroenhancers are not harmful to children when taken in normal dosages.
One interviewee in the New Yorker article raises the specter of parents who might force their children to take neuroenhancers so as to increase their competitive advantage in the academic arena and therefore their ability to get into the best colleges. This is a valid and important concern, but it does not logically follow that healthy adults should be forbidden from using neuroenhancement. For one thing, there is a world of difference between parents forcing their children to take neuroenhancers for non-clinical purposes and adults choosing of their own free will to take these drugs. Additionally, such abuses are already possible, as parents may push for psychiatrists to diagnose their children with ADHD so that a prescription for a neuroenhancer may be obtained. This may partially account for the unusually high numbers of children who have been diagnosed with ADHD in recent years.
In her interview with Talbot, the neurologist Martha Farah said that many young people today approach their academic and intellectual responsibilities with the trifecta of “their laptops, their iPhones, and their adderall.” As technology and culture continue to co-evolve in the new millennium, the public debate over the benefits and drawbacks of neuroenhancement will likely become increasingly central to how we view ourselves as individuals and as a society. Neuroenhancement offers the potential for tremendous increases in productivity across occupational and professional domains, but it also raises questions about our core ethical values and what it means to be truly meritocratic. The jury is still out on this question. What do you think?
