A commentary today in Nature, by Sahakian and Morein-Zamir, poses the question: if you could take a pill which enhanced attention and cognition with few or no side effects, would you?
But I ask, why wouldn’t you?
Interest in potions and drugs which increase awareness and “brain power” has been around for thousands of years. Many natural compounds from ginseng to coffee to cocaine have been touted as a dubious panacea for a muddled mind. However in the pharmaceutical age, we are now in possession of agents which actually do enhance cognition through changes in neurotransmitter release. For example, modafinil, prescribed under the name Provigil, was initially developed to treat narcolepsy however its popularity grew when it was found to increase focus and attention in healthy, normal people. The same has held true for ADD/ADHD drugs on college campuses. Quite a few stressed-out college kids use Ritalin while studying, writing papers, or taking important tests in hopes of improving performance. These are examples of prescription drug abuse on the one hand, but if they can be shown to be safe in normal people, what’s the real issue then?
Students face incredible competition to get into schools (and even more when it comes to medical, or ivy league schools). These kids, and their parents, often have all kinds of weapons in their arsenal for “getting ahead of the game” like tutors, specialized courses for tests (GRE, MCAT), books on how to get into college, sample essays. And I’m not even mentioning the “strings” which are often pulled by friends, favors called in, and money donated to get their kids the best opportunity available. Cognitive enhancers are just the next rational step in the ongoing quest to come out on top by whatever means necessary (short of sabotage or unethical behavior). As long as students are placed in extremely competitive situations, options like these will appear attractive.
However, it needs to be considered whether drugs which enhance cognition are a) harmful in the long term; and b) implicitly more unethical than all the other get-ahead measures I listed above. The issue with ‘a’ is that these drugs are mostly only tested in people who have the disorder it is being targeted to–ie, not perfectly healthy people. What happens when you increase steady-state levels of neurotransmitters from a normal level? What happens when you do this chronically? These are questions that remain unanswered, despite college kids being unwittingly involved in a huge, self-selected but unofficial study which will examine just that in years to come.
The issue with ‘b’ is that people have been engaging in ‘cognitive doping’ for ages. Today the legal drug of choice for cognitive enhancement is caffeine, although nicotine may also have the effect of focusing people. Both of these drugs have side effects which are dose- and delivery-dependent and are quite addictive, however their demand and daily use is staggering. There is a booming industry in herbal enhancers like St John Wort or Ginseng which have evidence to back up *some* of their claims, although side effects and drug interactions are still an issue. And it is difficult to argue that taking a cognitive enhancer is cheating in the academic sense, since a pill will never inform you as to the correct answer on a multiple choice test or give you the answer to any essay question. It will only improve the focus and grasp on information which you already know.
But, I’m interested in the views of others. Would taking Ritalin or some other pharmaceutical enhancer be cheating? Would you do it, if side effects were minimal (on the level, of say, caffeine?)
Janet Stemwedel at Adventures in Ethics and Science weighs in.