Muddled Ethics: Why Death Pathways Are Okay But Cognitive Enhancers Are Bad
    By News Staff | December 24th 2012 07:00 PM | 3 comments | Print | E-mail | Track Comments

    The current raging ethical debate in western health care is not how to save lives but how to end them. The controversial Liverpool Care Pathway in the UK, for example, where health care is nationalized, is really a death pathway. Unfortunately, half of the people on it are never told they are on it.

    Canada has a different ethical problem; a whole bunch of citizens want to be smarter. It's been found that stimulants and neuropharmaceuticals prescribed to treat attention deficit disorder (ADD) really boost the concentration, memory, alertness and mood of people without ADD.

    Such cognitive enhancement is bad, says  Dr. Eric Racine and his research team at the IRCM
    the Canadian Medical Association Journal (CMAJ). They cite uncertain benefits and harms, and limited health care resources, all true when health care is paid for by everyone, just as trying to keep people alive can be costly. 

    How prevalent is cognitive enhancement?  The number is unclear, so they cite a rather broad  1 to 11 percent estimate on university campuses and say the stimulants are associated with risks of dependence, cardiovascular problems, and psychosis, which won't make parents feel better about giving them to children with ADD either.

    "Individuals take prescription stimulants to perform better in school or at work," says Racine, a Montréal neuroethics specialist and Director of the Neuroethics research unit at the IRCM. "However, because these drugs are available in Canada by prescription only, people must request them from their doctors. Physicians are thus important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for such cognitive enhancers."

    "Current evidence has not shown that the desired benefits of enhanced mental performance are achieved with these substances," explains Cynthia Forlini, first author of the study and doctoral student in Dr. Racine's research unit. "With uncertain benefits and clear harms, it is difficult to support the notion that physicians should prescribe a medication to a healthy individual for enhancement purposes. Physicians in Canada provide prescriptions through a publicly-funded health care system with expanding demands for care. Prescribing cognitive enhancers may therefore not be an appropriate use of resources. The concern is that those who need the medication for health reasons but cannot afford it will be at a disadvantage."

     "An international bioethics discussion has surfaced on the ethics of cognitive enhancement and the role of physicians in prescribing stimulants to healthy people," concludes Racine. "We hope that our analysis prompts reflection in the Canadian medical community about these cognitive enhancers."


    Gerhard Adam
    It's been found that stimulants and neuropharmaceuticals prescribed to treat attention deficit disorder (ADD) really boost the concentration, memory, alertness and mood of people without ADD.
    Where's the science to back this up?

    This is hardly an ethical issue at this point, unless and until the science demonstrates that such cognitive improvements are actually possible without more harm than benefit.
    Mundus vult decipi
    One of the most common cognitive enhancers is modafinil (aka provigil) of which I have some first-hand experience. I used it because I was sleepy all the time, a problem eventually traced to sleep apnea, now under control without medication. In the meantime I needed to stay awake: coffee was not enough. My doctor appeared to be totally ignorant of modafinil, confusing it with amphetamine which is the cheaper, addictive, standard medication for sleepiness in the UK and an outright stimulant and euphoriant, unlike modafinil which is none of those things to any serious degree. In fact he also recommended coffee - a pleasant-tasing beverage, certainly, but also addictive and gives you the jitters if you drink enough to wake yourself up. Well, it does for me anyway. I resorted to purchasing modafinil from the much-maligned "overseas pharmacies". This is perfectly legal in the UK, though selling it without a prescription on domestic territory is not. Unlike coffee, modafinil merely promotes wakefulness with negligible side effects as long as you get the dose right. You can even sleep through it on low doses though you may not feel the need. 

    That adds up to a pretty good lifestyle-enhancer if your sleeping is otherwise normal as you can stay up all night - whether out on the town or trying to catch up on your studies. What is more interesting, however, is the side effects at higher doses. Being a little bit adventurous I did try 800mg  - not a vast dose but enough to create a whole new spectrum of effects. In particular focus on boring jobs was hugely intensified, to the extent that it became quite difficult to break free, for instance, from carefully shading a temporay image pixel by pixel just to get it right (OCD in a pill). I also became more sociable - "expansive and confident" they said - which I rapidly learned to mask as not everyone has liberated views on self-medication. As for cognition - well yes, I found myself looking at a lot of physics I did not understand at university and getting stuff clearer in my head. Whether this was actually due to improved understanding or simply better attention etc, I can't be sure.
    I have not used it for a couple of months now and I don't miss it. It seems to have very few long-term adverse effects. I can find other pills on-line to fix the ones it does.

    This article is crap, full of misleading generalizations that show exactly what is wrong with popular science journalism today. Yes, science knows that amphetamine and methylphenidate-derived drugs are addictive and bad for your health. What it doesn't acknowledge is the cognitive benefits of using racetam drugs like Noopept, or eugeroic stimulants like modafinill, which DARPA has researched extensively and is now used by the US Air Force instead of amphetamine because it actually works, and has an excellent safety profile.